Relevancia y necesidades del síndrome del intestino irritable (SII): comparación con la enfermedad inflamatoria intestinal (EII). (Por favor, si no te interesa el SII, léelo.) / Relevance and needs of irritable bowel syndrome (IBS): Comparison with inflammatory bowel disease (IBD). (Please, if you are not interested in IBS, read it.)

Introducción: En nuestra opinión existe un desequilibrio entre la relevancia del síndrome del intestino irritable (SII) y los medios que se le proporcionan. Objetivo: Revisar los diferentes factores que determinan (o deberían determinar) el interés de los gastroenterólogos por el SII, comparándolo con la enfermedad inflamatoria intestinal (EII). Para ello se han analizado 7 áreas diferentes: 1.Impacto médico; 2.Impacto social; 3.Importancia académica; 4.Relevancia clínica; 5.Relevancia científica; 6.Relevancia pública, y 7.Aspectos personales del médico. Resultados: La prevalencia es 10 veces superior en el SII, suponiendo hasta el 25% de las visitas del gastroenterólogo. Ambas patologías alteran la calidad de vida, en muchos casos de forma semejante. El coste social es muy importante en ambos casos (p.ej., absentismo del 21 y del 18%), así como el económico, aunque muy superior en medicación para la EII. La dedicación académica es más del doble para la EII, tanto en la universidad como en la formación MIR. La relevancia científica es mayor en la EII, con un número de publicaciones cuatro veces superior. La relevancia pública no es muy diferente entre las dos entidades, aunque los pacientes con EII son más asociativos. Los médicos prefieren la EII y tienden a estigmatizar el SII. Conclusión: En nuestra opinión, para disminuir este desequilibrio entre necesidades y recursos, humanos y materiales, en el SII es imprescindible realizar cambios drásticos tanto en los aspectos educativos, de habilidades de comunicación, de priorización de acuerdo con las demandas de los pacientes, y de recompensa (personal y social) de los médicos.(AU)

Introduction: In our opinion there is an imbalance between the relevance of irritable bowel syndrome (IBS), and the resources that are provided. Objective: To review the different factors that determine (or should determine) the interest of gastroenterologists in IBS, comparing it with inflammatory bowel disease (IBD). For this, 7 different areas have been analyzed: (1)Medical impact; (2)Social impact; (3)Academic importance; (4)Clinical relevance; (5)Scientific relevance; (6)Public relevance, and (7)Personal aspects of the doctor. Results: The prevalence is 10 times higher in IBS, which represents up to 25% of gastroenterologist visits. Both pathologies alter the quality of life, in many cases in a similar way. The social cost is very important in both cases (e.g.: absenteeism of 21% and 18%) as well as the economic cost, although much higher in medication for IBD. Academic dedication is more than double for IBD, both in university and in MIR training. Scientific relevance is greater in IBD, with a number of publications four times higher. Public relevance is not very different between the two entities, although IBD patients are more associative. Doctors prefer IBD and tend to stigmatize IBS. Conclusion: In our opinion, to reduce this imbalance between needs and resources, human and material, in IBS it is essential to make drastic changes both in educational aspects, communication skills, prioritization according to the demands of patients, and reward (personal and social) of physicians.(AU)

Relevance and needs of irritable bowel syndrome (IBS): Comparison with inflammatory bowel disease (IBD). (Please, if you are not interested in IBS, read it.). / Relevancia y necesidades del síndrome del intestino irritable (SII): comparación con la enfermedad inflamatoria intestinal (EII). (Por favor, si no te interesa el SII, léelo.).

INTRODUCTION: In our opinion there is an imbalance between the relevance of irritable bowel syndrome (IBS), and the resources that are provided. OBJECTIVE: To review the different factors that determine (or should determine) the interest of gastroenterologists in IBS, comparing it with inflammatory bowel disease (IBD). For this, 7 different areas have been analyzed: (1)Medical impact; (2)Social impact; (3)Academic importance; (4)Clinical relevance; (5)Scientific relevance; (6)Public relevance, and (7)Personal aspects of the doctor. RESULTS: The prevalence is 10 times higher in IBS, which represents up to 25% of gastroenterologist visits. Both pathologies alter the quality of life, in many cases in a similar way. The social cost is very important in both cases (e.g.: absenteeism of 21% and 18%) as well as the economic cost, although much higher in medication for IBD. Academic dedication is more than double for IBD, both in university and in MIR training. Scientific relevance is greater in IBD, with a number of publications four times higher. Public relevance is not very different between the two entities, although IBD patients are more associative. Doctors prefer IBD and tend to stigmatize IBS. CONCLUSION: In our opinion, to reduce this imbalance between needs and resources, human and material, in IBS it is essential to make drastic changes both in educational aspects, communication skills, prioritization according to the demands of patients, and reward (personal and social) of physicians.

Functional and motor gastrointestinal disorders. / Trastornos funcionales y motores digestivos.

This article discusses the most interesting presentations at Digestive Disease Week, held in San Diego, in the field of functional and motor gastrointestinal disorders. One of the most important contributions was undoubtedly the presentation of the new Rome IV diagnostic criteria for functional gastrointestinal disorders. We therefore devote some space in this article to explaining these new criteria in the most common functional disorders. In fact, there has already been discussion of data comparing Rome IV and Rome III criteria in the diagnosis of irritable bowel syndrome, confirming that the new criteria are somewhat more restrictive. From the physiopathological point of view, several studies have shown that the aggregation of physiopathological alterations increases symptom severity in distinct functional disorders. From the therapeutic point of view, more data were presented on the efficacy of acotiamide and its mechanisms of action in functional dyspepsia, the safety and efficacy of domperidone in patients with gastroparesis, and the efficacy of linaclotide both in irritable bowel syndrome and constipation. In irritable bowel syndrome, more data have come to light on the favourable results of a low FODMAP diet, with emphasis on its role in modifying the microbiota. Finally, long-term efficacy data were presented on the distinct treatment options in achalasia.

Diarrea crónica: definición, clasificación y diagnóstico / Chronic diarrhoea: definition, classification and diagnosis

La diarrea crónica es un síntoma de presentación frecuente, tanto en las consultas de medicina de familia como en las de digestivo. Se estima que >5% de la población sufre diarrea crónica y que cerca del 40% de estos sujetos son mayores de 60 años. El clínico se enfrenta con frecuencia a la necesidad de decidir cuál es el mejor enfoque diagnóstico de estos pacientes y elegir entre las múltiples pruebas diagnósticas existentes. En 2014 la Societat Catalana de Digestologia creó un grupo de trabajo con el objetivo principal de crear algoritmos diagnósticos en base a la práctica clínica y evaluar las pruebas diagnósticas disponibles y la evidencia científica para su utilización. Para clasificar la evidencia científica y la fuerza de las recomendaciones se utilizó el sistema GRADE. Se han establecido 28 recomendaciones y 6 algoritmos diagnósticos. Se describen los criterios de derivación desde medicina primaria a digestivo de un paciente con diarrea crónica

Chronic diarrhoea is a common presenting symptom in both primary care medicine and in specialized gastroenterology clinics. It is estimated that >5% of the population has chronic diarrhoea and nearly 40% of these patients are older than 60 years. Clinicians often need to select the best diagnostic approach to these patients and choose between the multiple diagnostic tests available. In 2014 the Catalan Society of Gastroenterology formed a working group with the main objective of creating diagnostic algorithms based on clinical practice and to evaluate diagnostic tests and the scientific evidence available for their use. The GRADE system was used to classify scientific evidence and strength of recommendations. The consensus document contains 28 recommendations and 6 diagnostic algorithms. The document also describes criteria for referral from primary to specialized care

Trastornos funcionales y motores digestivos / Functional and motor gastrointestinal disorders

En este artículo se comentan las comunicaciones más interesantes que se han presentado en el congreso americano, durante la Digestive Disease Week celebrada en San Diego, en el área de las alteraciones motoras y los trastornos funcionales digestivos. Sin ninguna duda, una de las comunicaciones más relevantes fue la presentación de los nuevos criterios diagnósticos de los trastornos funcionales digestivos según el consenso de Roma IV. Por ello se dedica una parte del texto a explicar cómo son estos nuevos criterios en los trastornos funcionales más frecuentes. De hecho, se comentan ya datos que comparan los criterios de Roma IV y Roma III en el diagnóstico del síndrome del intestino irritable, comprobando que los nuevos criterios son algo más restrictivos. Desde el punto de vista fisiopatológico hay varios trabajos que demuestran que la agregación de alteraciones fisiopatológicas comporta una mayor gravedad sintomática en distintos trastornos funcionales. Desde el punto de vista terapéutico se aportan más datos sobre la eficacia y mecanismos de acción de acotiamida en la dispepsia funcional, de eficacia y seguridad de domperidona en pacientes con gastroparesia y de eficacia de linaclotida, tanto en intestino irritable como en estreñimiento. Siguiendo con el síndrome del intestino irritable, vuelven a presentarse más resultados favorables a la dieta baja en FODMAP que hacen énfasis en su papel sobre las modificaciones de la microbiota. Finalmente, también se presentaron datos de eficacia a largo plazo de las distintas opciones de tratamiento de la acalasia

This article discusses the most interesting presentations at Digestive Disease Week, held in San Diego, in the field of functional and motor gastrointestinal disorders. One of the most important contributions was undoubtedly the presentation of the new Rome IV diagnostic criteria for functional gastrointestinal disorders. We therefore devote some space in this article to explaining these new criteria in the most common functional disorders. In fact, there has already been discussion of data comparing Rome IV and Rome III criteria in the diagnosis of irritable bowel syndrome, confirming that the new criteria are somewhat more restrictive. From the physiopathological point of view, several studies have shown that the aggregation of physiopathological alterations increases symptom severity in distinct functional disorders. From the therapeutic point of view, more data were presented on the efficacy of acotiamide and its mechanisms of action in functional dyspepsia, the safety and efficacy of domperidone in patients with gastroparesis, and the efficacy of linaclotide both in irritable bowel syndrome and constipation. In irritable bowel syndrome, more data have come to light on the favourable results of a low FODMAP diet, with emphasis on its role in modifying the microbiota. Finally, long-term efficacy data were presented on the distinct treatment options in achalasia

[Chronic diarrhoea: Definition, classification and diagnosis]. / Diarrea crónica: definición, clasificación y diagnóstico.

Chronic diarrhoea is a common presenting symptom in both primary care medicine and in specialized gastroenterology clinics. It is estimated that >5% of the population has chronic diarrhoea and nearly 40% of these patients are older than 60 years. Clinicians often need to select the best diagnostic approach to these patients and choose between the multiple diagnostic tests available. In 2014 the Catalan Society of Gastroenterology formed a working group with the main objective of creating diagnostic algorithms based on clinical practice and to evaluate diagnostic tests and the scientific evidence available for their use. The GRADE system was used to classify scientific evidence and strength of recommendations. The consensus document contains 28 recommendations and 6 diagnostic algorithms. The document also describes criteria for referral from primary to specialized care.

[Functional and motor gastrointestinal disorders]. / Trastornos funcionales y motores digestivos.

This article discusses the most interesting studies on functional and motor gastrointestinal disorders presented at Digestive Diseases Week (DDW), 2015. Researchers are still seeking biomarkers for irritable bowel syndrome and have presented new data. One study confirmed that the use of low-dose antidepressants has an antinociceptive effect without altering the psychological features of patients with functional dyspepsia. A contribution that could have immediate application is the use of transcutaneous electroacupuncture, which has demonstrated effectiveness in controlling nausea in patients with gastroparesis. New data have come to light on the importance of diet in irritable bowel syndrome, although the effectiveness of a low-FODMAP diet seems to be losing momentum with time. Multiple data were presented on the long-term efficacy of rifaximin therapy in patients with irritable bowel syndrome and diarrhoea. In addition, among other contributions, and more as a curiosity, a study evaluated the effect of histamine in the diet of patients with irritable bowel syndrome.

Trastornos funcionales y motores digestivos / Functional and motor gastrointestinal disorders

En este artículo se comentan los trabajos sobre trastornos funcionales y motores digestivos presentados en el congreso de la American Association of Gastroenterology (Digestive Diseases Week) del año 2015 que nos han parecido de mayor interés. Se siguen buscando biomarcadores para el síndrome del intestino irritable y, en este sentido, se han presentado nuevos datos. Se presentó un estudio que confirma que el uso de los antidepresivos a dosis bajas tiene efecto antinociceptivo y que no modifican los aspectos psicológicos de los pacientes con dispepsia funcional. Una aportación que podría ser de aplicabilidad inmediata es el uso de acupuntura eléctrica transcutánea, que ha demostrado ser eficaz en el control de la náusea en pacientes con gastroparesia. Se siguen aportando datos de la importancia de la dieta en el intestino irritable, aunque parece que la eficacia de la dieta baja en FODMAP está perdiendo fuelle con el tiempo. Se han comunicado múltiples datos de la eficacia a largo plazo del tratamiento con rifaximina en pacientes con intestino irritable con diarrea. Además, entre otras aportaciones, y más como curiosidad, se presentó un estudio que valoraba el efecto de la histamina en la dieta en pacientes con síndrome del intestino irritable

This article discusses the most interesting studies on functional and motor gastrointestinal disorders presented at Digestive Diseases Week (DDW), 2015. Researchers are still seeking biomarkers for irritable bowel syndrome and have presented new data. One study confirmed that the use of low-dose antidepressants has an antinociceptive effect without altering the psychological features of patients with functional dyspepsia. A contribution that could have immediate application is the use of transcutaneous electroacupuncture, which has demonstrated effectiveness in controlling nausea in patients with gastroparesis. New data have come to light on the importance of diet in irritable bowel syndrome, although the effectiveness of a low-FODMAP diet seems to be losing momentum with time. Multiple data were presented on the long-term efficacy of rifaximin therapy in patients with irritable bowel syndrome and diarrhoea. In addition, among other contributions, and more as a curiosity, a study evaluated the effect of histamine in the diet of patients with irritable bowel syndrome

[Motility and functional gastrointestinal disorders]. / Trastornos funcionales y motores digestivos.

This article discusses the studies on functional and motor gastrointestinal disorders presented at the 2014 Digestive Diseases Week conference that are of greatest interest to us. New data have been provided on the clinical importance of functional gastrointestinal disorders, with recent prevalence data for irritable bowel syndrome and fecal incontinence. We know more about the pathophysiological mechanisms of the various functional disorders, especially irritable bowel syndrome, which has had the largest number of studies. Thus, we have gained new data on microinflammation, genetics, microbiota, psychological aspects, etc. Symptoms such as abdominal distension have gained interest in the scientific community, both in terms of patients with irritable bowel syndrome and those with constipation. From the diagnostic point of view, the search continues for a biomarker for functional gastrointestinal disorders, especially for irritable bowel syndrome. In the therapeutic area, the importance of diet for these patients (FODMAP, fructans, etc.) is once again confirmed, and data is provided that backs the efficacy of already marketed drugs such as linaclotide, which rule out the use of other drugs such as mesalazine for patients with irritable bowel syndrome. This year, new forms of drug administration have been presented, including metoclopramide nasal sprays and granisetron transdermal patches for patients with gastroparesis. Lastly, a curiosity that caught our attention was the use of a vibrating capsule to stimulate gastrointestinal transit in patients with constipation.

Trastornos funcionales y motores digestivos / Motility and functional gastrointestinal disorders

En este artículo se comentan los trabajos sobre trastornos funcionales y motores digestivos presentados en el congreso de la Digestive Diseases Week del año 2014 que nos han parecido de mayor interés. Se han aportado nuevos datos sobre la importancia clínica de los trastornos funcionales digestivos con datos recientes de prevalencia, tanto del síndrome del intestino irritable como de la incontinencia fecal. Se conocen mejor los mecanismos fisiopatológicos de los distintos trastornos funcionales, en especial del síndrome del intestino irritable, en el que el número de estudios ha sido mayor. Así, se tienen nuevos datos de microinflamación, de genética, de microbiota, de aspectos psicológicos, etc. Síntomas como la distensión abdominal han cobrado interés por parte de la comunidad científica, tanto en pacientes con síndrome del intestino irritable como en aquellos con estreñimiento. Desde el punto de vista de diagnóstico se sigue buscando un biomarcador para los trastornos funcionales digestivos, en especial en el síndrome del intestino irritable. En el aspecto terapéutico se vuelve a constatar la importancia de la dieta en estos pacientes (FODMAP, fructanos, etc.) y se aportan datos que confirman la eficacia de fármacos ya comercializados como la linaclotida, y que descartan el uso de otros fármacos como la mesalazina en pacientes con síndrome del intestino irritable. Este año, también se presentan formas novedosas de administración de fármacos como el espray nasal de metoclopramida o los parches transdérmicos de granisetrón para los pacientes con gastroparesia. Finalmente, una curiosidad que nos llamó la atención ha sido el uso de una cápsula vibradora para estimular el tránsito en pacientes con estreñimiento

This article discusses the studies on functional and motor gastrointestinal disorders presented at the 2014 Digestive Diseases Week conference that are of greatest interest to us. New data have been provided on the clinical importance of functional gastrointestinal disorders, with recent prevalence data for irritable bowel syndrome and fecal incontinence. We know more about the pathophysiological mechanisms of the various functional disorders, especially irritable bowel syndrome, which has had the largest number of studies. Thus, we have gained new data on microinflammation, genetics, microbiota, psychological aspects, etc. Symptoms such as abdominal distension have gained interest in the scientific community, both in terms of patients with irritable bowel syndrome and those with constipation. From the diagnostic point of view, the search continues for a biomarker for functional gastrointestinal disorders, especially for irritable bowel syndrome. In the therapeutic area, the importance of diet for these patients (FODMAP, fructans, etc.) is once again confirmed, and data is provided that backs the efficacy of already marketed drugs such as linaclotide, which rule out the use of other drugs such as mesalazine for patients with irritable bowel syndrome. This year, new forms of drug administration have been presented, including metoclopramide nasal sprays and granisetron transdermal patches for patients with gastroparesis. Lastly, a curiosity that caught our attention was the use of a vibrating capsule to stimulate gastrointestinal transit in patients with constipation

Importancia de la dieta en el síndrome del intestino irritable / Importance of diet in irritable bowel syndrome

Aproximadamente dos tercios de los pacientes con síndrome del intestino irritable (SII) relacionan sus síntomas con algún alimento. Revisamos aquellos factores dietéticos que pueden influir. La fibra soluble puede mejorar el estreñimiento pero frecuentemente aumenta la distensión y el dolor abdominal. La malabsorción de hidratos de carbono parece más frecuente en los pacientes con SII. Se ha planteado así una dieta exenta de oligosacáridos, disacáridos, monosacáridos y polioles fermentables (FODMAP), obteniéndose una mejoría significativa, lo que la plantea como una opción terapéutica. Se aconseja realizar cribado de la enfermedad celiaca mediante serología en pacientes que no padezcan estreñimiento. También puede existir una sensibilidad al gluten no-celiaca, definida como una forma de intolerancia al gluten cuando se han excluido la enfermedad celiaca y la alergia al trigo. Aunque no existe una dieta específica sí que puede ser beneficioso realizar comidas pequeñas y frecuentes, y evitar alimentos grasos, lácteos, muchos hidratos de carbono, cafeína y alcohol

About two-thirds of irritable bowel syndrome (IBS) patients associate their symptoms with certain foods. We reviewed food-related factors putatively associated with manifestations of IBS. Soluble fiber may improve constipation but frequently increases bloating and abdominal pain. Carbohydrate malabsorption seems to be more frequent in IBS. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet significantly reduces IBS symptoms and has been suggested as a therapeutic option. Serological screening for celiac disease should be done in patients without constipation. Moreover, non-celiac disease gluten sensitivity, defined as gluten intolerance once celiac disease and wheat allergy have been ruled out, should be considered in these patients. There is no specific diet for IBSpatients but small and frequent meals, avoiding greasy foods, dairy products, many carbohydrates, caffeine and alcohol, is recommended

Chronic constipation, irritable bowel syndrome with constipation and constipation with pain/discomfort: similarities and differences.

OBJECTIVES: Some patients with chronic constipation (CC) have abdominal pain and discomfort (painful CC) without fulfilling the criteria for irritable bowel syndrome (IBS). Our aim was to investigate similarities and differences among nonpainful CC, painful CC, and CC in patients with IBS according to prevalence, individual symptoms, associated factors, and impact on health-related quality of life and use of medical resources. METHODS: We conducted a telephone survey of a random sample of the Spanish population (N=1500). Bowel symptoms were recorded using the Rome III questionnaire, health-related quality of life using the short form-12 (SF-12) and quality of live in constipation-20 (CVE-20) questionnaires, and self-reported constipation, lifestyle habits, and consultation behavior using an ad hoc questionnaire. RESULTS: The overall prevalence of CC was 19.2%, with prevalence by subgroups being 13.9% for nonpainful CC, 2.0% for painful CC, and 3.3% for CC in patients with IBS. CC was more prevalent among women at a ratio of 2.7:1. Subjects with painful CC and CC in patients with IBS were younger, reported more constipation, and had more symptoms than subjects with nonpainful CC. Age and physical activity were significantly associated with CC. Symptoms associated with consultation were abdominal pain and digitation. Nonpainful CC patients were more satisfied with laxative use than were the other subgroups. Subjects with CC showed a significant impairment in the physical and mental component of the SF-12 questionnaire. CONCLUSIONS: CC appears to be a spectrum; most patients do not have abdominal pain/discomfort but others (with otherwise quite similar characteristics) are patients with IBS or are out of any established diagnosis.

[Importance of diet in irritable bowel syndrome]. / Importancia de la dieta en el síndrome del intestino irritable.

About two-thirds of irritable bowel syndrome (IBS) patients associate their symptoms with certain foods. We reviewed food-related factors putatively associated with manifestations of IBS. Soluble fiber may improve constipation but frequently increases bloating and abdominal pain. Carbohydrate malabsorption seems to be more frequent in IBS. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet significantly reduces IBS symptoms and has been suggested as a therapeutic option. Serological screening for celiac disease should be done in patients without constipation. Moreover, non-celiac disease gluten sensitivity, defined as gluten intolerance once celiac disease and wheat allergy have been ruled out, should be considered in these patients. There is no specific diet for IBS patients but small and frequent meals, avoiding greasy foods, dairy products, many carbohydrates, caffeine and alcohol, is recommended.

[Functional and motor digestive disorders]. / Trastornos funcionales y motores digestivos.

This article discusses the most interesting studies on functional and motility gastrointestinal disorders presented in Digestive Diseases Week (DDW) in 2013. New data were reported on the clinical importance of functional gastrointestinal disorders (FGID) and on how they can produce numerous disturbances such as inflammatory bowel disease. These disturbances are associated with somatic functional disease and particularly with fatigue. In addition, new data have emerged on the physiopathology of these disorders, with some studies reporting that environmental factors and events in early infancy can favor their development. Data were also presented on how bile acids can increase susceptibility to diarrhea in patients with irritable bowel syndrome (IBS) and on how the type of food intake can favor the development of symptoms. More data are available on the presence of underlying celiac disease in patients with IBS, which should prompt us to investigate this disease in our patients. Likewise, indiscriminate application of a gluten-free diet in patients with IBS has been shown not to produce a clear improvement. Regarding the physiopathology of functional dyspepsia (FD), results have been presented on how psychological factors can modify gastric accommodation and how this is in turn related to visceral hypersensitivity and gastric emptying. Regarding therapy, mirtazapine can improve symptoms and lead to weight gain in patients with severe FD and substantial weight loss. Results were presented on new drugs for IBS such as ibodutant and on old drugs with new applications such as mesalazine and ebastine. The antinociceptive effect of linaclotide is now better understood and a meta-analysis has shown its effectiveness in IBS with constipation as the main symptom. In patients with constipation, pelvic floor dysynergy can be diagnosed by a simple clinical interview and rectal touch. More data are available on the efficacy of prucalopride (which has been shown to accelerate colon transit time) and data were provided on plecanatide, a potential new drug that could be useful in constipation. Finally, results were presented on the use of botulinum toxin injection in patients with spastic motility disorders of the esophagus. Also worthy of mention is a study confirming a higher frequency of esophageal cancer patients with achalasia who receive treatment.

Trastornos funcionales y motores digestivos / Motility and functional gastrointestinal disorders

En este artículo comentamos los trabajos sobre trastornos funcionales y motores digestivos presentados en el Congreso de la Asociación Gastroenterológica Americana (Digestive Diseases Week, DDW) del año 2013 que nos han parecido de mayor interés. Se han aportado nuevos datos sobre la importancia clínica de los trastornos funcionales digestivos (TFD) y cómo pueden producir tantas molestias como la enfermedad inflamatoria intestinal, que se asocian con patología somática funcional y especialmente con fatiga. Además hay más datos sobre fisiopatología, de forma que se ha descrito que los factores ambientales y acontecimientos de la primera infancia pueden favorecer el desarrollo de un TFD. También se han presentado datos de cómo los ácidos biliares pueden favorecer la diarrea en pacientes con síndrome del intestino irritable (SII) y de cómo el tipo de ingesta puede favorecer el desarrollo de síntomas. Tenemos más datos de la presencia de enfermedad celíaca subyacente en pacientes con SII que nos deben motivar a investigarla en nuestros pacientes. Asimismo se ha demostrado que la dieta sin gluten aplicada de forma indiscriminada a los pacientes con SII no supone ninguna mejoría clara en ellos. Respecto a la fisiopatología de la dispepsia funcional (DF), se aportan resultados de cómo los factores psicológicos pueden modificar la acomodación gástrica y cómo esta, a su vez, se relaciona con la hipersensibilidad visceral o el vaciamiento gástrico. Desde el punto de vista terapéutico se ha constatado cómo la mirtazapina puede mejorar los síntomas y el peso en pacientes con DF grave con importante pérdida de peso. Se han presentado resultados de nuevos fármacos para el SII como el ibodutant, o de viejos fármacos con nuevas aplicaciones como la mesalazina o la ebastina. Se conoce mejor porque la linaclotida tiene un efecto antinociceptivo y se ha comunicado un metaanálisis en el que se demuestra su efectividad en el SII con predominio de estreñimiento. Respecto a los pacientes con estreñimiento hemos podido comprobar cómo la simple entrevista clínica y el tacto rectal permiten el diagnóstico de disinergia del suelo pélvico. Tenemos más datos de la eficacia de prucaloprida (que se demuestra que es capaz de acelerar el tiempo de tránsito de colon) y se presentan datos de plecanatida, un potencial nuevo fármaco útil en el estreñimiento. Finalmente se aportan resultados del uso de la inyección con toxina botulínica en pacientes con trastornos motores espásticos del esófago. En este sentido, también es remarcable un estudio en el que se confirma una mayor frecuencia de cáncer de esófago en pacientes tratados de acalasia (AU)

This article discusses the most interesting studies on functional and motility gastrointestinal disorders presented in Digestive Diseases Week (DDW) in 2013. New data were reported on the clinical importance of functional gastrointestinal disorders (FGID) and on how they can produce numerous disturbances such as inflammatory bowel disease. These disturbances are associated with somatic functional disease and particularly with fatigue. In addition, new data have emerged on the physiopathology of these disorders, with some studies reporting that environmental factors and events in early infancy can favor their development. Data were also presented on how bile acids can increase susceptibility to diarrhea in patients with irritable bowel syndrome (IBS) and on how the type of food intake can favor the development of symptoms. More data are available on the presence of underlying celiac disease in patients with IBS, which should prompt us to investigate this disease in our patients. Likewise, indiscriminate application of a gluten-free diet in patients with IBS has been shown not to produce a clear improvement. Regarding the physiopathology of functional dyspepsia (FD), results have been presented on how psychological factors can modify gastric accommodation and how this is in turn related to visceral hypersensitivity and gastric emptying. Regarding therapy, mirtazapine can improve symptoms and lead to weight gain in patients with severe FD and substantial weight loss. Results were presented on new drugs for IBS such as ibodutant and on old drugs with new applications such as mesalazine and ebastine. The antinociceptive effect of linaclotide is now better understood and a meta-analysis has shown its effectiveness in IBS with constipation as the main symptom. In patients with constipation, pelvic floor dysynergy can be diagnosed by a simple clinical interview and rectal touch. More data are available on the efficacy of prucalopride (which has been shown to accelerate colon transit time) and data were provided on plecanatide, a potential new drug that could be useful in constipation. Finally, results were presented on the use of botulinum toxin injection in patients with spastic motility disorders of the esophagus. Also worthy of mention is a study confirming a higher frequency of esophageal cancer patients with achalasia who receive treatment (AU)

[Functional and motility gastrointestinal disorders]. / Trastornos funcionales y motores digestivos.

We summarize and discuss the studies presented at the congress of the American Association of Gastroenterology (Digestive Disease Week) that, in our opinion, are of greatest interest. Both clinically and physiopathologically, functional gastrointestinal (GI) disorders are highly complex. A single cause is unlikely to explain symptoms as heterogeneous as those of functional dyspepsia and irritable bowel syndrome (IBS). Therefore, it is easier (and more useful) to try to understand functional GI disorders using a bio-psycho-social model. Moreover, data supporting the combined importance of genetic, organic and psychological factors in the onset and persistence of functional GI disorders are increasingly convincing. This year, new data have been provided on pharmacogenetics in gastroparesis, on microinflammation or alterations in the modulation of somatic and visceral sensitivity in functional dyspepsia, and on the impact of psychological factors in IBS. From the therapeutic point of view, further information has been provided on the role of probiotics, the antinociceptive effect of linaclotide (demonstrated in several studies presented this year), and on the high efficacy of hypnotherapy in patients with IBS. Finally, data on the clinical management of patients with constipation due to pelvic floor dyssynergia and on the safety and efficacy of prucalopride in patients with severe constipation were also of interest.

Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists.

AIM: To investigate usefulness of adherence to gastro-esophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology. METHODS: Prospective, observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice. Patients (aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms, such as dyspeptic symptoms and/or supraesophageal symptoms. Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists. RESULTS: Endoscopy was indicated in 123 (41%) patients: 50 with alarm symptoms, 32 with age > 50 years without alarm symptom. Seventy-two patients (58.5%) had esophagitis (grade A, 23, grade B, 28, grade C, 18, grade D, 3). In the presence of alarm symptoms, endoscopy was indicated consistently with recommendations in 98% of cases. However, in the absence of alarm symptoms, endoscopy was indicated in 33% of patients > 50 years (not recommended by the guideline). Adherence for proton pump inhibitors (PPIs) therapy was 80%, but doses prescribed were lower (half) in 5% of cases and higher (double) in 15%. Adherence regarding duration of PPI therapy was 69%; duration was shorter than recommended in 1% (4 wk in esophagitis grades C-D) or longer in 30% (8 wk in esophagitis grades A-B or in patients without endoscopy). Treatment response was higher when PPI doses were consistent with guidelines, although differences were not significant (95% vs 85%). CONCLUSION: GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms; PPIs were prescribed at higher doses and longer duration.

Trastornos funcionales y motores digestivos / Functional and motility gastrointestinal disorders

Resumimos y comentamos los trabajos que nos han parecido de mayor interés de los que fueron presentados en el congreso de la Asociación Gastroenterológica Americana (Digestive Diseases Week [DDW]). Los trastornos funcionales digestivos (TFD) son muy complejos, tanto desde el punto de vista clínico como fisiopatológico. Es poco probable que una sola causa pueda explicar síntomas tan heterogéneos como los presentes en la dispepsia funcional (DF) o el síndrome del intestino irritable (SII). Por tanto, es más fácil (y más útil) intentar comprender los TFD de acuerdo a un modelo biopsicosocial. Además, cada vez son más convincentes los datos que refuerzan la importancia conjunta de los factores genéticos, orgánicos y psicológicos en la aparición y permanencia de los TFD. De hecho, este año se aportan nuevos datos sobre farmacogenética en la gastroparesia, sobre microinflamación o alteraciones en la modulación de la sensibilidad somática y visceral en la DF, o sobre el impacto de los factores psicológicos en el SII. Desde el punto de vista terapéutico se aporta más información acerca del papel de los probióticos, sobre el efecto antinociceptivo demostrado en varios trabajos presentados este año de la linaclotida, o sobre la elevada eficacia de la hipnoterapia en pacientes con SII. Finalmente, también son interesantes los datos presentados para el manejo clínico de los pacientes con estreñimiento por disinergia del suelo pélvico, y respecto de la seguridad y la eficacia de prucaloprida en pacientes con estreñimiento grave (AU)

We summarize and discuss the studies presented at the congress of the American Association of Gastroenterology (Digestive Disease Week) that, in our opinion, are of greatest interest. Both clinically and physiopathologically, functional gastrointestinal (GI) disorders are highly complex. A single cause is unlikely to explain symptoms as heterogeneous as those of functional dyspepsia and irritable bowel syndrome (IBS). Therefore, it is easier (and more useful) to try to understand functional GI disorders using a bio-psycho-social model. Moreover, data supporting the combined importance of genetic, organic and psychological factors in the onset and persistence of functional GI disorders are increasingly convincing. This year, new data have been provided on pharmacogenetics in gastroparesis, on microinflammation or alterations in the modulation of somatic and visceral sensitivity in functional dyspepsia, and on the impact of psychological factors in IBS. From the therapeutic point of view, further information has been provided on the role of probiotics, the antinociceptive effect of linaclotide (demonstrated in several studies presented this year), and on the high efficacy of hypnotherapy in patients with IBS. Finally, data on the clinical management of patients with constipation due to pelvic floor dyssynergia and on the safety and efficacy of prucalopride in patients with severe constipation were also of interest (AU)

Frequency and clinical implications of supraesophageal and dyspeptic symptoms in gastroesophageal reflux disease.

OBJECTIVE: We studied the frequency of supraesophageal and dyspeptic symptoms and their impact on the quality of life (QoL) and treatment response in patients with gastroesophageal reflux disease (GERD). METHODS: Multicenter, prospective, observational study of patients who consulted a gastroenterologist because of typical GERD symptoms. Upper digestive symptoms were assessed using direct interviews. The Short Form-12 and the Quality of Life in Reflux and Dyspepsia questionnaires were used to measure QoL. Patients were treated with proton pump inhibitors (PPIs). RESULTS: A total of 301 patients (58% men; mean age, 45 years) were included. Baseline symptoms were heartburn (99% of cases; nocturnal heartburn 78%), regurgitation (86%), both heartburn and regurgitation (85%), dyspeptic symptoms (91%; epigastric pain syndrome 20%, postprandial distress syndrome 4%, both 75%), and supraesophageal symptoms (58%). In 56% of cases of heartburn, 35% of regurgitation, and 34% of nocturnal heartburn, symptoms were severe or very severe. One in six patients had dysphagia. Supraesophageal and/or dyspeptic symptoms were associated with worse scores on the Short Form-12 and Quality of Life in Reflux and Dyspepsia instruments. After treatment, heartburn and regurgitation disappeared in 93 and 87% of the patients, respectively. The percentage of patients responding to PPI treatment was significantly higher (P<0.05) in those with heartburn than those without heartburn (96 vs. 86%) and in those with regurgitation than without regurgitation (95 vs. 83%), whereas no differences were observed in those with and without supraesophageal or dyspeptic symptoms. CONCLUSION: Patients with typical GERD symptoms (heartburn and/or regurgitation) very frequently have dyspeptic and supraesophageal manifestations, which are related to a worse QoL but unrelated to PPI response.