Necrosis esofágica aguda (esófago negro) asociado a neoplasias digestivas / Acute esophageal necrosis (black esophagus) associated with digestive neoplasms

INTRODUCCIÓN. La necrosis esofágica aguda es un síndrome raro que se caracteriza endoscópicamente por una apariencia negra circunferencial irregular o difusa de la mucosa esofágica intratorácica, la afectación es generalmente del esófago distal y la transición abrupta de mucosa normal en la unión gastroesofágica, con extensión proximal variable. CASOS. Se presentan dos casos con diferentes comorbiliades, presentación de signos y síntomas, antecedentes y tratamiento, teniendo en común el diagnóstico a través de endoscopía digestiva alta. RESULTADOS. Caso clínico 1: tratamiento clínico basado en hidratación, suspensión de vía oral, omeprazol intravenoso y sucralfato; mala evolución clínica caracterizada por: disfagia, intolerancia oral y recurrencia del sangrado digestivo alto, se realiza colocación de gastrostomía endoscópica. Caso clínico 2: esófago con mucosa con fibrina y parches de necrosis extensa, se realiza compensación tanto de foco infeccioso pulmonar como hidratación y nutrición, en estudios complementarios se observa masa colónica, con estudio histopatológico confirmatorio de adenocarcinoma de colon en estado avanzado. DISCUSIÓN. La esofagitis necrotizante aguda es una entidad inusual, de baja prevalencia e incidencia, asociada con estados de hipoperfusión sistémica y múltiples comorbilidades que favorezcan un sustrato isquémico. Al revisar los reportes de casos que hay en la literatura médica, los casos que reportamos se correlaciona con las características clínicas, epidemiológicas, endoscópicas y factores de riesgo causales de la enfermedad. La presentación clínica más frecuente es el sangrado digestivo alto, que se debe correlacionar con el hallazgo endoscópico clásico. Nuestro primer caso reportado termina con la colocación de una gastrostomía para poder alimentarse. CONCLUSIÓN. El pronóstico de la necrosis esofágica aguda es malo y se requiere un alto índice de sospecha clínica y conocimiento de esta infrecuente patología para un diagnóstico temprano y un manejo oportuno. Se requiere una evaluación por endoscopia digestiva alta. Es una causa de sangrado gastrointestinal que conlleva tasas altas de mortalidad, principalmente en adultos mayores frágiles. El reconocimiento temprano y la reanimación agresiva son los principios fundamentales para un mejor resultado de la enfermedad.

INTRODUCTION. Acute esophageal necrosis is a rare syndrome that is characterized endoscopically by an irregular or diffuse circumferential black appearance of the intrathoracic esophageal mucosa, the involvement is generally of the distal esophagus and the abrupt transition of normal mucosa at the gastroesophageal junction, with variable proximal extension. CASES. Two cases are presented with different comorbidities, presentation of signs and symptoms, history and treatment, having in common the diagnosis through upper gastrointestinal endoscopy. RESULTS. Clinical case 1: clinical treatment based on hydration, oral suspension, intravenous omeprazole and sucralfate; poor clinical evolution characterized by: dysphagia, oral intolerance and recurrence of upper digestive bleeding, endoscopic gastrostomy placement was performed. Clinical case 2: esophagus with mucosa with fibrin and patches of extensive necrosis, compensation of both the pulmonary infectious focus and hydration and nutrition is performed, in complementary studies a colonic mass is observed, with a confirmatory histopathological study of colon adenocarcinoma in an advanced state. DISCUSSION. Acute necrotizing esophagitis is an unusual entity, with low prevalence and incidence, associated with states of systemic hypoperfusion and multiple comorbidities that favor an ischemic substrate. When reviewing the case reports in the medical literature, the cases we report correlate with the clinical, epidemiological, endoscopic characteristics and causal risk factors of the disease. The most common clinical presentation is upper gastrointestinal bleeding, which must be correlated with the classic endoscopic finding. Our first reported case ends with the placement of a gastrostomy to be able to feed. CONCLUSION. The prognosis of acute esophageal necrosis is poor and a high index of clinical suspicion and knowledge of this rare pathology is required for early diagnosis and timely management. Evaluation by upper gastrointestinal endoscopy is required. It is a cause of gastrointestinal bleeding that carries high mortality rates, mainly in frail older adults. Early recognition and aggressive resuscitation are the fundamental principles for a better outcome of the disease.

Behavioral Risk Factors of HBV Infection and its Association with HBs Ag Positivity among Residents of Kaza Sub- division of District Lahaul & Spiti in Himachal Pradesh

Background: Chronic viral hepatitis is a major global public health problem, an important cause of morbidity and mortality. We conducted this study to evaluate the behavioral risk factors of HBV infection and its association with HBsAg positivity among residents of Kaza sub-division of district Lahaul & Spiti in Himachal Pradesh. Material & Methods: The study was carried out by the Gastroenterology, Community Medicine, and Microbiology Department at Indira Gandhi Medical College Shimla at Kaza, a subdivision of Lahaul & Spiti. The cluster sampling technique was used to get the desired sample size of 4000. Forty clusters were chosen using a probability proportionate to size sampling method, and 100 research participants were added to each cluster using a simple random sampling method. The data was gathered using a pre-tested interview plan. A blood sample of 5ml from each study participant was obtained, and its HBsAg content was examined. Results: In our study, 2.7% of the interviewed respondents’ parents were positive for hepatitis B and 3.7% reported one positive family member. Injectable drug use was reported by 1.6 (68/4231). Among these users 8.8% (6/68) shared needles with other IDUs in last 12 months and 35.3% (24/68) used a common container to draw up drug solution. Sexual intercourse was reported to be experienced by 15.5 (655/4231) and 12.2% either did not disclose or were children. Out of those who ever experienced sexual/penetrative intercourse 38.3% (251/655) had reported it with someone else other than a spouse. Majority of these had two partners other than a spouse (30.3%; 76/251). Around 30% (195/655) reported of using a condom in their last intercourse. Body piercings or a tattoo from someone who doesn’t sterilize his or her equipment, including local treatment from lamas, was prevalent among 16.3% of the population (689/4231). Acupuncture was taken as a remedy for any medical condition by 9% of participants. Regression analysis also revealed that one infected family member emerged as an independent factor associated with HBsAg positive test after adjusting for confounders. Conclusion: Our study provided much important information concerning hepatitis B risk factors in this tribal group. Health education about behavioral risk factors among this tribal population should be the main intervention that might help limit the spread of these blood-borne infections.

Propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología / A proposal of specific professional competences for the training of gastroenterology specialists

Introducción: La formación con calidad del capital humano en el sector salud constituye un reto para la educación médica cubana contemporánea. La formación académica, en particular la especialidad, tiene el cometido de formar un profesional con alta competencia y avanzadas capacidades para el desempeño especializado, solidez de los principios ético-morales y elevada calificación científico-técnica, por lo que el desarrollo de competencias profesionales resulta una prioridad para la formación de los especialistas biomédicos. Objetivo: Elaborar una propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología. Métodos: Se realizó un estudio educacional, de investigación aplicativa, bajo el enfoque general dialéctico-materialista, con fundamento en teorías y enfoques filosóficos, psicológicos y legales de las leyes de la educación, y de la educación médica en particular. Asimismo, se utilizaron métodos teóricos, empíricos y estadístico-matemáticos. Resultados: Se elaboró una definición operativa de competencias profesionales específicas en gastroenterología, a partir del estudio del sistema de competencias y de la sistematización de los documentos rectores en dicha formación. También se identificaron y definieron las competencias profesionales específicas en las áreas asistencial, docente, investigativa y de dirección, que posibilitaron la mejora en el desempeño profesional de los futuros especialistas. Conclusiones: La formación basada en el desarrollo de competencias profesionales específicas constituye una prioridad para la educación médica y la salud pública cubana contemporánea, en aras de elevar la calidad del proceso formativo en la especialidad de gastroenterología y la atención médica que brindan estos galenos en los niveles de atención en salud(AU)

Introduction: The quality training of human capital in the health sector is a challenge for contemporary Cuban medical education. Academic training, particularly the residence, has the task of training a professional with high competence and advanced capabilities for specialized performance, solid ethical-moral principles and high scientific-technical qualification; therefore, the development of professional competences is a priority for the training of biomedical specialists. Objective: To elaborate a proposal of specific professional competences for the training of gastroenterology specialists. Methods: An educational study of applicative research was carried out under the general dialectical-materialistic approach and based on philosophical, psychological and legal theories and approaches of the laws of education and, particularly, of medical education. Theoretical, empirical and statistical-mathematical methods were also used. Results: An operational definition of specific professional competences in gastroenterology was elaborated, based on the study of the system of competences and the systematization of the guiding documents for such training. Specific professional competences were also identified and defined in the care, teaching, research and management areas, which allowed to improve the professional performance of future specialists. Conclusions: Training based on the development of specific professional competences is a priority for contemporary Cuban public health and medical education, in view of raising the quality of the training process in the specialty of gastroenterology and the medical care provided by these physicians at the levels of healthcare(AU)

Hacia un proceso de formación del residente en Gastroenterología con enfoque creativo y tecnológico / Towards a training process for residents in Gastroenterology with a creative and technological approach

Introducción: la formación de los residentes deviene proceso fundamental para garantizar especialistas con una sólida preparación profesional. Objetivo: exponer un conjunto de ideas, posicionamientos teóricos y metodológicos orientados a elevar la calidad de la formación del residente en Gastroenterología desde un enfoque creativo y tecnológico. Métodos: se realizó una revisión bibliográfica sistemática para desarrollar un análisis del contenido de documentos, tesis de doctorado, maestría, artículos originales y de revisión publicados entre 1981 y 2022 en español. Se consultaron 47 artículos y se seleccionaron 28. La búsqueda fue realizada en las bases de datos SciELO y Google académico de julio a septiembre de 2022. Tras la identificación de los estudios preseleccionados, se llevó a cabo la lectura de los títulos, resumen y palabras claves para comprobar su pertinencia con el estudio. Desarrollo: la revisión documental permitió esclarecer una serie de dificultades presentes en el proceso de formación de los especialistas en Gastroenterología y hacer propuestas que pueden contribuir en este sentido desde las nuevas concepciones de la educación como la creatividad, el trabajo colaborativo y la enseñanza problémica, usando las ventajas de las tecnologías de la información y las comunicaciones. Conclusiones: el proceso de formación de los residentes en Gastroenterología necesita adaptarse a las nuevas exigencias de la educación. Potencializar la creatividad desde la perspectiva de la enseñanza problémica y el trabajo colaborativo mediante el uso de las herramientas que brindan las tecnologías de la información y la comunicación, debe ser la directriz, en este propósito.

Introduction: The training of residents becomes a fundamental process to guarantee specialists with a solid professional preparation. Objective: To present a set of ideas, theoretical and methodological positions that guide how to raise the quality of the resident's training in Gastroenterology from a creative and technological approach. Method: A systematic bibliographic review was carried out to develop an analysis of the content of documents, doctoral theses, master's degrees, original and review articles published from 1981 to 2022 in Spanish. We consulted 47 articles and selected 26. The search was carried out in the SciELO and Google scholar databases from July to September 2022, after the identification of the pre-selected studies, the titles, abstract and keywords were read to check their relevance to the study. Development: The documentary review allowed to clarify a series of difficulties in the training process of specialists in gastroenterology and make proposals that can contribute in this sense from the new conceptions of education, such as creativity, collaborative work, problem-solving teaching using the advantages of information and communication technologies. Conclusions: The training process of residents in gastroenterology needs to adapt to the new demands of education. Potentiating creativity from the perspective of probability teaching and collaborative work through the use of the tools provided by information and communication technologies, should be the guideline, in this purpose.

Prognostic factors of liver transplantation for acute-on-chronic liver failure / Fatores prognósticos de transplante hepático em "acute-on-chronic liver failure"

ABSTRACT BACKGROUND: Liver transplantation (LT) is the only treatment that can provide long-term survival for patients with acute-on-chronic liver failure (ACLF). Although several studies identify prognostic factors for patients in ACLF who do not undergo LT, there is scarce literature about prognostic factors after LT in this population. AIM: Evaluate outcomes of ACLF patients undergoing LT, studying prognostic factors related to 1-year and 90 days post-LT. METHODS: Patients with ACLF undergoing LT between January 2005 and April 2021 were included. Variables such as chronic liver failure consortium (CLIF-C) ACLF values and ACLF grades were compared with the outcomes. RESULTS: The ACLF survival of patients (n=25) post-LT at 90 days, 1, 3, 5 and 7 years, was 80, 76, 59.5, 54.1 and 54.1% versus 86.3, 79.4, 72.6, 66.5 and 61.2% for patients undergoing LT for other indications (n=344), (p=0.525). There was no statistical difference for mortality at 01 year and 90 days among patients with the three ACLF grades (ACLF-1 vs. ACLF-2 vs. ACLF-3) undergoing LT, as well as when compared to non-ACLF patients. CLIF-C ACLF score was not related to death outcomes. None of the other studied variables proved to be independent predictors of mortality at 90 days, 1 year, or overall. CONCLUSIONS: LT conferred long-term survival to most transplant patients. None of the studied variables proved to be a prognostic factor associated with post-LT survival outcomes for patients with ACLF. Additional studies are recommended to clarify the prognostic factors of post-LT survival in patients with ACLF.

RESUMO RACIONAL: O transplante hepático (TH) é o único tratamento a proporcionar sobrevida a longo prazo para pacientes com "acute-on-chronic liver failure" (ACLF). Vários estudos identificaram fatores prognósticos para pacientes em ACLF que não realizam TH, porém há poucos dados na literatura sobre fatores prognósticos nessa população transplantada. OBJETIVOS: Avaliar desfechos de pacientes ACLF submetidos a TH, e seus preditores de mortalidade. MÉTODOS: Foram avaliados pacientes em ACLF submetidos a TH entre janeiro de 2005 e abril de 2021. Variáveis como valores CLIF-C ACLF e pontuação no ACLF foram comparadas com os desfechos. RESULTADOS: A sobrevida de ACLF pós TH de pacientes (n=25) em 90 dias, 1, 3, 5 e 7 anos, foi de 80, 76, 59,5, 54,1 e 54,1% versus 86,3, 79,4, 72,6, 66,5 e 61,2% para pacientes submetidos a TH por outras indicações (n=344), (p=0,525). Não houve diferença estatística para mortalidade em 01 ano e 90 dias entre pacientes com os três graus de ACLF (ACLF-1 vs. ACLF-2 vs. ACLF-3), bem como quando comparados a pacientes não ACLF. O escore "chronic liver failure consortium" (CLIF-C) ACLF não se correlacionou com desfechos de óbito. Nenhuma das outras variáveis estudadas mostrou-se preditora independente de mortalidade em 90 dias, após um ano ou global. CONCLUSÕES: TH conferiu sobrevida em longo prazo à maioria dos pacientes transplantados, semelhante aos pacientes submetidos à TH por outras indicações. Nenhuma das variáveis estudadas mostrou-se fator prognóstico associado a desfechos de sobrevida pós-TH para pacientes com ACLF. Estudos adicionais são necessários para estabelecer fatores prognósticos pós-TH em pacientes com ACLF.

Oral findings in children on liver transplantation programming: a scoping review / Achados odontológicos em crianças em programação para o transplante hepático: revisão de escopo

Abstract Objective: To identify oral characteristics found in children with liver disease in programming for liver transplantation. Data source: The methodology was written according to PRISMA-ScR. We adopted the methodological framework and recommendations for this type of review by Arksey and O'Malley and the Joanna Briggs Institute. The protocol was registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). A systematic search (Medline/PubMed, Scopus, Web of Science, and ProQuest) was conducted to identify studies that met the inclusion criteria: systematic reviews; prospective clinical trials (parallel or crossover group designs); observational studies (cohort, case-control, and cross-sectional studies); clinical case series; and case reports evaluating children with liver disease in preparation for transplantation. The last search was conducted in July 2021, and no restrictions were imposed as to language or year of publication. Studies presenting mixed data with post-transplant evaluation, and studies evaluating not only liver transplantation but also other solid organs were excluded. Screening, inclusion, and data extraction were performed by two reviewers independently. A narrative synthesis was conducted to describe the findings of the study. Data synthesis: The bibliographic search identified 830 references. A total of 21 articles were read in their entirety after the inclusion criteria assessment. Finally, after evaluating the exclusion criteria, only 3 studies were considered for the qualitative analysis. Conclusions: Children with liver disease in preparation for transplantation may present enamel defects, tooth pigmentation, caries, gingivitis, and opportunistic infections such as candidiasis.

RESUMO Objetivo: Identificar características bucais em crianças hepatopatas em programação para o transplante hepático. Fontes de dados: A metodologia foi descrita de acordo com o PRISMA-ScR. Adotamos a estrutura metodológica e recomendações para este tipo de revisão por Arksey e O'Malley e o Instituto Joanna Briggs. O protocolo foi registrado no Open Science Framework (https://doi.org/10.17605/OSF.IO/QCU4W). Uma pesquisa sistemática (Medline/PubMed, Scopus, Web of Science e ProQuest) foi conduzida para identificar estudos que preenchessem os critérios de inclusão: revisões sistemáticas; ensaios clínicos prospectivos (desenhos de grupos paralelos ou cruzados); estudos observacionais (coorte, caso-controle e estudos transversais); séries de casos clínicos; e relatos de casos que avaliam crianças com doenças hepáticas em preparação para o transplante. A última busca foi conduzida em julho de 2021, e não foram impostas restrições quanto ao idioma ou ano de publicação. Foram excluídos estudos que apresentavam dados mistos com avaliação pós-transplante e estudos que avaliavam não só o transplante de fígado, mas também de outros órgãos sólidos. O rastreio, inclusão e extração de dados foram realizados por dois revisores independentemente. Foi conduzida uma síntese narrativa para identificar os resultados do estudo. Síntese dos dados: A pesquisa bibliográfica identificou 830 referências. Foram lidos 21 artigos na íntegra após avaliação dos critérios de inclusão. Finalmente, após a avaliação dos critérios de exclusão, apenas três estudos foram considerados para análise. Conclusões Crianças com doença hepática em preparação para o transplante podem apresentar defeitos de esmalte, pigmentação dentária, cárie, gengivite além de infecções oportunistas como a candidíase.

Soft skills of nursing teachers in the department of gastroenterology and their impact on teaching behaviors / 中华医学教育探索杂志

Objective:To investigate the soft skills of nursing teachers in the department of gastroenterology and their impact on teaching behaviors.Methods:A total of 438 nursing teachers from the Department of Gastroenterology of 12 grade A tertiary hospitals in our province were selected as the subjects by cluster sampling. The general information questionnaire, nursing soft skill assessment scale, and clinical nursing mentors' behavior scale were used for a questionnaire survey. The scores for soft skills and teaching behaviors of nursing teachers were evaluated. A Pearson correlation analysis was conducted to discuss the correlation between soft skills and teaching behaviors. The independent sample t test and variance analysis were performed for univariate analysis of teaching behaviors. A multivariate analysis of teaching behaviors was performed by multiple linear regression analysis. Results:The total score of the nursing soft skill assessment scale was (164.75±18.49), and the average score of items was (3.43±0.49). The total score of the clinical nursing mentors' behavior scale was (94.26±8.48), and the average score of items was (4.10±0.46). The total score of nursing soft skills was positively correlated with the total score of teaching behaviors ( r=0.31, P<0.05). The total score of the behavior scale of nursing teachers varied significantly across different education backgrounds, professional titles, nursing ages, and teaching years ( P<0.05). The multiple linear regression analysis found that professional title, teaching years, and nursing soft skills were important factors affecting the teaching behavior level of nursing teachers, which could explain 39.50% of the teaching behavior level. Conclusion:Soft skills of nursing teachers in the Department of Gastroenterology are at a middle level. Professional title, teaching years, and soft skills are important factors affecting teaching behaviors. Improving soft skills of nursing teachers may help improve teaching behaviors.

Application of mind mapping teaching of gastroenterology in the standardized training for general practitioners / 中华医学教育探索杂志

Objective:To explore the effect of mind mapping teaching of gastroenterology in the standardized training for general practitioners, and provide new ideas for general practice education.Methods:A total of 65 physicians who were enrolled in the standardized training of general practice from January to December 2017 were collected as the control group, and the traditional teaching method was adopted; another 58 physicians from January to December 2018 were selected as the experimental group, and the mind mapping was adopted based on the traditional teaching method. The learning effect (theoretical and operational results) and the satisfaction questionnaire of trainees and teachers were used as evaluation indicators. SPSS 21.0 was used for t test and chi-square test. Results:The theory exam and clinical skills examination results of experimental group (80.80±5.30, 82.66±5.90) were significantly higher than those of the control group (71.60±5.20, 75.72±4.57), and the difference was statistically significant ( P<0.05). Compared with the control group, the experimental group had better understanding of knowledge points of this discipline, clinical thinking ability, higher learning interest, teamwork ability, innovation ability and teacher satisfaction, with statistical significance ( P<0.05). Conclusion:The mind mapping has more advantages than traditional teaching methods in the standardized training for general practitioners, which can be further extended.

Competencias profesionales específicas para la formación de los especialistas en Gastroenterología / Specific professional competencies for the training of specialists in gastroenterology

Introducción: La formación académica en Cuba se propone una formación con alta competencia profesional y avanzadas capacidades para el desempeño profesional especializado, por lo que constituye una prioridad para la Educación Médica cubana dar respuesta a dicha exigencia. Resulta esencial un modelo de competencias profesionales para la formación de los especialistas médicos, que permita el mejoramiento del desempeño profesional en respuesta a las exigencias del modelo del egresado. Objetivo: Diseñar un modelo de competencias profesionales específicas para la formación de los especialistas en Gastroenterología. Material y Métodos: Se realizó un estudio educacional, prospectivo, de investigación aplicativa bajo el enfoque general dialéctico-materialista, con fundamento en teorías y enfoques filosóficos, psicológicos, legales, de las leyes de la Educación y la Educación Médica. Se utilizaron métodos teóricos, empíricos y estadístico-matemáticos. Se desarrolla en la Universidad de Ciencias Médicas de Matanzas en el período 2019-2021. Resultados: El modelo de competencias profesionales específicas se estructura en el marco epistemológico, objetivos, contexto social, representación gráfica, forma de implementación, así como se identifican y definen las competencias profesionales específicas en las áreas: asistencial, docente, investigativa y de dirección que posibilitan la mejora en el desempeño profesional de los futuros especialistas. Se corrobora la viabilidad del modelo, a partir de los resultados obtenidos de la triangulación efectuada. Conclusiones: El modelo de competencias profesionales específicas diseñado es pertinente, en correspondencia con el perfil profesional y ocupacional de la especialidad, lo que enriquece las Ciencias de la Educación Médica en lo referido a la formación permanente y continuada(AU)

Introduction: Academic training in Cuba proposes training with high professional competence and advanced skills for specialized professional performance, which is why it is a priority for Cuban medical education to respond to this requirement. A model of professional skills is essential for the training of medical specialists, which allows the improvement of professional performance in response to the demands of the graduate model. Objective: To design a model of specific professional competencies for the training of specialists in Gastroenterology. Material and Methods: An educational, prospective, applicative research study was carried out under the general materialist dialectical approach, based on philosophical, psychological, legal theories and approaches of the laws of Education and Medical Education. Theoretical, empirical and statistical-mathematical methods were used. It is developed at the University of Medical Sciences of Matanzas in the period 2019-2021. Results: The model of specific professional competencies is structured in the epistemological framework, objectives, social context, graphic representation, and form of implementation; additionally, specific professional competencies in the areas of care, teaching, research and management that enable improvement in the professional performance of future specialists are identified and defined. The viability of the model is corroborated, based on the results obtained from the triangulation carried out. Conclusions: The model of specific professional competencies designed is pertinent, in correspondence with the professional and occupational profile of the specialty, which enriches the Sciences of Medical Education in terms of permanent and continuing education(AU)

Revista de Gastroenterología del Perú: Análisis bibliométrico decenio 2010-2019

El objetivo es realizar un análisis bibliométrico de las publicaciones científicas publicadas en la Revista de Gastroenterología del Perú durante el decenio 2010-2019. Se realizó un estudio bibliométrico retrospectivo. La población estuvo constituida por los artículos publicados en la Revista de Gastroenterología del Perú del 2010 al 2019; la muestra fue conformada por los siguientes artículos: artículos originales, artículos de revisión, reportes de casos, artículos especiales y cartas al editor. Se valoraron índices de producción, impacto y colaboración bibliométrica. Se analizaron 514 publicaciones. La producción general se contabilizó entre 46 a 76 publicaciones por año, con una media de 4,89 autores por artículo. Se encontró el factor de impacto "Scimago Journal Rank" entre 0,12 a 0,157 y un índice-h total de 8. El artículo más citado recibió 14 citas. Se diseñó una red de coautoría compuesto de 91 nodos y 11 clústeres, y una red de colaboración institucional de 16 nodos y 5 clústeres. Los indicadores de producción de artículos e impacto se encuentran con una tendencia ascendente frente a valores previos de la revista y de forma comparativa con otras publicaciones de la región, mientras que los indicadores de colaboración son incipientes aún.

The objective was to design a bibliometric analysis of the Revista de Gastroenterologia del Peru's scientific publications. We conduct bibliometric retrospective research. All articles of Revista de Gastroenterologia del Peru since 2010 to 2019 were considered. The sample included: original articles, review articles, case reports, special articles and letters. Production, impact and collaboration bibliometric index were assessed. 514 publications were analyzed. The total production remained in a range between 46 to 76 publications per year, with an average of 4.89 authors per article. The Impact factor Scimago Journal Rankwas between 0.12 to 0.157 and h-index of 8. The most cited article received 14 citations. A co-authorship network composed of 91 nodes and 11 clusters, and an institutional collaboration network of 16 nodes and 5 clusters were designed. The production and impact index show an upward trend compared to previous values of the journal and comparative way with other publications in South America, while the collaboration indicators are incipient, yet.

Implementación del servicio de teleconsulta con énfasis en gastroenterología en la Red de Clínicas San Pablo (Perú) durante la pandemia por COVID-19

Objetivo: Describir las atenciones del servicio de teleconsulta en la Red de Clínicas San Pablo (RCSP) durante la pandemia por COVID-19, con énfasis en la especialidad de gastroenterología. El estudio: Estudio descriptivo. Se revisaron los datos del Sistema de Historias Clínicas Electrónicas y el sistema administrativo de la RCSP. Hallazgos: La RCSP incluye 8 sedes (5 en Lima). Entre abril 2020 y diciembre 2021, se realizaron 1 156 253 atenciones (6,6% de estas por teleconsulta). Las especialidades con más teleconsultas fueron medicina interna y endocrinología. Las especialidades con más consultas presenciales fueron gineco-obstetricia y traumatología. Gastroenterología fue la novena especialidad más frecuente en teleconsulta y la quinta en consulta presencial. Los diagnósticos más frecuentes de esta especialidad, tanto para consulta presencial como teleconsulta, fueron dispepsia y enfermedad del reflujo gastroesofágico Conclusión: Se reporta la implementación del servicio de teleconsulta en la RCSP. Además, se brindan lecciones aprendidas en este proceso.

Objective: To describe the assistance provided by the teleconsultation service in the San Pablo Clinic Network (RCSP) during the COVID-19 pandemic, with an emphasis on the specialty of gastroenterology. The study: Descriptive study. Data from the Electronic Medical Records System and the RCSP administrative system were reviewed. Results: The RCSP includes 8 locations (5 in Lima). Between April 2020 and December 2021, 1,156,253 visits were made (6.6% of these by teleconsultation). The specialties with the most teleconsultations were internal medicine and endocrinology, and the specialties with the most face-to-face consultations were gynecology-obstetrics and traumatology. Gastroenterology was the ninth most frequent specialty in teleconsultation and the fifth in face-to-face consultation. The most frequent diagnoses of this specialty, both for face-to-face consultation and teleconsultation, were dyspepsia and gastroesophageal reflux disease Conclusion: The implementation of the teleconsultation service in the RCSP is reported. In addition, lessons learned in this process are provided.

Relative Risk Analysis of Patient Return Within 72 Hours to Emergency Department.

Introduction: Transparency in patient care in an emergency department can be projected by capturing data from the medical records of patients. Policy makers envision that transparency in this data will allow the patient to choose the right hospital of his choice. Relative risk is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group. It is usually used in the scenario of clinical events. In this study we have used it to analyse one of the key performance indicators used in Emergency Department, as per Emerald standards. The problem statement identified in the study is the returning of patients to the Emergency department of a private, tertiary care hospital within 72 hours after the initial visit. A revisit in this study is assumed as an unplanned visit done by the patient within 72 hours with similar presenting complaints. Methodology: A retrospective cohort study for all emergency visits between January to June 2021. People who returned to EMD within 72 hours were compared to other non-re attending patients based on medical diagnosis, patient demographics, mode of arrival, triage category and qualification of doctors in charge. Multivariate analysis using the generalized linear model was conducted on variables associated with 72-hour ED re-attendance. Result: Among 18,355 patients, 128 (0.69%) were in the 72-hour re-attendees’ group. Multivariate analysis showed female gender as more, above 60 years of age, arrival by ambulance, triaged as yellow. Among the ICD-10 diagnosis for the patients who returned, it was not possible to identify one specific condition. But abdominal pain was one reason for the re-visit of a few patients. There was also a significant difference in the seniority ranking of the doctor-in-charge between both groups. Conclusion: Identification of characteristics of patients lead to improved care by surgeons and gastroenterology.

Desempeño asistencial en la formación del residente de gastroenterología / Heath care performance in the training of the gastroenterology resident

Introducción: El desempeño asistencial del residente de gastroenterología en cuanto al diagnóstico y tratamiento de pacientes con enfermedades digestivas condiciona su pertinencia profesional en la salud pública. Objetivo: Profundizar en el proceso de formación del residente de gastroenterología. Métodos: Se realizaron un análisis epistemológico y un diagnóstico fáctico del proceso de formación del residente de gastroenterología en cuanto a la atención a pacientes con neoplasias digestivas, en el Hospital General Docente Dr. Juan Bruno Zayas de Santiago de Cuba, durante el bienio 2017-2018, a partir de la observación del desempeño asistencial, la aplicación de una encuesta a residentes y de entrevistas a especialistas de esa rama en la provincia. Resultados: Existieron inconsistencias en esta formación como resultado de una visible polarización médico-instrumental de la práctica en la asistencia, orientada hacia la endoscopia digestiva diagnóstica y terapéutica en detrimento de lo preventivo. Conclusiones: Pudo confirmarse que no se había sistematizado lo suficiente la dimensión de asistencia a pacientes con neoplasias digestivas a partir de la integración formativa de la prevención, el diagnóstico y la terapéutica en la praxis endoscópica de ese profesional.

Introduction: The heath care performance of the gastroenterology resident conditions his professional pertinence in the public health as for the diagnosis and treatment of patients with digestive diseases. Objective: To deepen in the training process of the gastroenterology resident. Method: An epistemologic analysis and factic diagnosis of the training process of the gastroenterology resident regarding the care to patients with digestive neoplasm in Juan Bruno Zayas Teaching General Hospital from Santiago de Cuba during the biennium from the observation of the health care performance, the survey to residents and interviews to specialists of this branch in the province. Results: There were inconsistencies in this training as a result of a visible polarization doctor-tools of practice in the care, orientated to the endoscopic and therapeutic digestive endoscopy contrary to the preventive procedure. Conclusion: It could be confirmed that the care dimension had not been sufficiently systematized while giving care to patients with digestive neoplasm taking into account the training integration of prevention, diagnosis and therapeutics in the endoscopic praxis of this professional.

Presencia de ansiedad y depresión en pacientes de consulta externa de gastroenterología en Lima Metropolitana

Los objetivos fueron identificar la presencia de ansiedad y depresión en pacientes que acuden a consultorio externo de gastroenterología en la ciudad de Lima y describir los antecedentes gastroenterológicos y síntomas más relacionados a estos trastornos. La muestra estuvo conformada por 200 pacientes adultos pertenecientes a 32 distritos de Lima Metropolitana, atendidos por la especialidad de Gastroenterología en la modalidad de consultorio externo durante marzo a octubre del 2021, a quienes se les aplicó la Escala de Ansiedad y Depresión Hospitalaria (HADS) adaptada por Vilela. El estudio fue descriptivo-correlacional y la muestra prospectiva. Alrededor de 1 de cada 2 pacientes (49%, n=98) presentó ansiedad, 1 de cada 5 (19%, n=38) depresión y 16,5% (n=33) concomitantemente ambos trastornos. Los antecedentes gastroenterológicos de Dispepsia (v=0,216) y Síndrome de Intestino Irritable (v=0,188) mostraron asociación estadística para ambas variables. Diarrea (v=0,214) y dolor torácico (v=0,215) fueron síntomas asociados a ansiedad, así como dolor torácico, con depresión. Los trastornos de ansiedad y depresión tienen alta prevalencia en la población que acude a consulta externa, sugerimos explorar dichas variables y ofrecer un abordaje multidisciplinario a los pacientes atendidos por esta modalidad.

The objectives were to identify anxiety and depression in patients attending a gastroenterology outpatient clinic in the city of Lima, and to describe the gastroenterological history and symptoms most related to these disorders. 200 adult patients belonging to 32 districts of Metropolitan Lima attended from March to October 2021 were enrolled; the Hospital Anxiety and Depression Scale (HADS) adapted by Vilela was applied. The study was descriptive-correlational and prospective sample. 49% (n=98) reported anxiety, 19% (n=38) depression and 16.5% (n=33) both disorders concomitantly. Dyspepsia (v=0.216) and Irritable Bowel Syndrome (v=0.188) showed a statistical association for both variables. Diarrhea (v=0.214) and chest pain (v=0.215) were symptoms associated with anxiety, as well as chest pain with depression. Anxiety and depression are highly prevalent among patients that come to outpatient office visits, we suggest exploring these variables and offering a multidisciplinary approach to patients treated by this modality.

Custo efetividade do uso da terlipressina no tratamento da síndrome hepatorrenal / Cost effectiveness of using terlipressin to treat hepatorenal syndrome

ABSTRACT Background Hepatorenal syndrome (HRS) is the most severe form of acute kidney injury in patients with advanced cirrhosis, and it is associated with high mortality. It is usually diagnosed according to criteria defined by the International Ascites Club. Currently, the most frequently indicated pharmacological therapy for the treatment of HRS is a combination of splanchnic vasoconstrictors (terlipressin or norepinephrine) in combination with albumin. With the progressive increase in healthcare spending, it is important to conduct a cost-effectiveness analysis of pharmacological treatment in patients who are diagnosed with HRS. Objective: To perform a cost-effectiveness assessment for the use of terlipressin in combination with albumin to treat HRS in patients with cirrhosis. Methods: Economic evaluation of cost-effectiveness based on secondary data from studies showed the efficacy of terlipressin therapy compared with norepinephrine combined with albumin or albumin alone. The cost-effectiveness analysis was calculated using an incremental cost-effectiveness ratio (ICER), and a sensitivity analysis was developed by varying the values of therapies and probabilities. The Brazilian real was the currency used in the analysis, and the results were converted to US dollars. Results: After selection, eligibility, and evaluation of the quality of publications, the results demonstrated that administration of terlipressin or norepinephrine in combination with albumin in patients diagnosed with HRS type 1 was efficacious. The cost of treatment with terlipressin in combination with albumin was USD $1,644.06, administration of albumin alone was USD $912.02, and norepinephrine plus albumin was USD $2,310.78. Considering that the combination therapies demonstrated effectiveness, the incremental cost of terlipressin and norepinephrine in combination with albumin was USD $666.73, and an effectiveness of 0.570 was found for terlipressin in combination with albumin and 0.200 for norepinephrine in combination with albumin. The incremental effectiveness was 0.370, and the ICER was USD $1,801.97. Thus, the parameters of increasing cost per therapy and ICER indicated that the combined therapy of terlipressin plus albumin was cost effective compared to albumin alone or norepinephrine plus albumin in a public single-payer healthcare system. Conclusion: A cost-effectiveness analysis showed that terlipressin in combination with albumin when administered concomitantly to patients who were diagnosed with type 1 HRS is cost-effective compared to norepinephrine in combination with albumin administered in a controlled environment.

RESUMO Contexto: A Síndrome Hepatorrenal (SHR) é a forma mais grave de lesão renal aguda em pacientes com cirrose avançada, estando diretamente associada a alta taxa de mortalidade. Normalmente é diagnosticada seguindo critérios definidos pela International Ascites Club (IAC). Atualmente, as terapias farmacológicas mais indicadas no tratamento da SHR são a combinação de vasoconstritores esplâncnicos (terlipressina ou norepinefrina) associados à albumina. Com o aumento progressivo dos gastos em saúde, torna-se relevante realizar uma análise de custo-efetividade do tratamento farmacológico em pacientes com diagnóstico de SHR. Objetivo: Realizar avaliação de custo-efetividade do uso da terlipressina associada à albumina no tratamento da SHR em pacientes com cirrose. Métodos: Avaliação econômica de custo-efetividade, com base em dados secundários de estudos publicados com resultado da eficácia da terapia com terlipressina, em comparação com norepinefrina combinada com albumina ou apenas albumina. A análise de custo-efetividade foi calculada usando a razão de custo-efetividade incremental (RCEI) e uma análise de sensibilidade foi desenvolvida variando os valores das terapias e probabilidades. O real foi a moeda utilizada na análise. Resultados: Após a seleção, elegibilidade e avaliação da qualidade das publicações, os resultados demonstraram que a administração da associação de terlipressina ou norepinefrina com albumina em pacientes diagnosticados com SHR tipo 1 possui eficácia comprovada. Os custos do tratamento com a terapia combinada de terlipressina com albumina foram de USD $1,644.06, administração de somente albumina USD $912.02 e norepinefrina mais albumina USD $2,310.78. Considerando as terapias combinadas com efetividade terapêutica comprovada, isto é, terlipressina e norepinefrina associada a albumina, o custo incremental foi de USD $666.73 e efetividade de 0,570 para o grupo da terlipressina associada a albumina e de 0,200 para o grupo da norepinefrina associada a albumina. A efetividade incremental foi de 0,370 e o valor da RCEI foi de USD $1,801.97. Assim, os fatores de incremento do custo por terapia e razão de custo-efetividade incremental definem que a terapia combinada de terlipressina mais albumina é custo efetiva quando comparada a administração de somente albumina ou norepinefrina no cenário do sistema único de saúde. Conclusão: O estudo demonstrou por meio de uma análise de custo-efetividade que a terlipressina associada à albumina quando administrada concomitantemente a pacientes com diagnóstico de SHR tipo 1 é custo-efetiva quando comparada à albumina sozinha e com norepinefrina associada à albumina administrada em um ambiente controlado.

Práctica, praxis y desempeño asistencial: su redimensionamiento epistemológico en la formación del residente de Gastroenterología / Practice and assistance performance: its epistemologic resizing in the training of the Gastroenterology resident

Introducción: En la formación del residente de Gastroenterología, la función asistencial emerge como una de las más esenciales porque prepara al futuro especialista para aplicar los principios básicos fundamentales en la práctica de la endoscopia diagnóstico-terapéutica, con vistas a garantizar la calidad de su desempeño médico en la atención a pacientes con neoplasias digestivas. Sin embargo, la relación entre la práctica y la praxis asistencial aún necesita un redimensionamiento epistemológico para favorecer la transformación del quehacer profesional de estos especialistas. Desarrollo: Se realizó un análisis epistemológico de la relación entre práctica, praxis y desempeño asistencial en la formación del residente de Gastroenterología, lo que permite connotarla a partir de un nivel de interpretación más esencial, de manera que trascienda la visión fragmentada e instrumental de su enfoque teórico hacia uno nuevo totalizador que sistematiza su esencia formativa desde una intervención endoscópica holística, que integra la prevención, el diagnóstico y la terapéutica en la atención a pacientes con neoplasias digestivas. Conclusiones: La reinterpretación epistemológica de esta investigación consolidó la dialéctica entre la práctica y la praxis asistencial en un estadio epistemológico superior, lo que permite sustentar un nuevo tratamiento teórico de esta relación a partir del vínculo entre la práctica integral de procedimientos preventivos endoscópicos del aparato digestivo y la praxis interventiva endoscópica preventivo-curativa a fin de perfeccionar la formación de este especialista.

Introduction: In the training of the Gastroenterology resident, the assistance function emerges as one of the most essential because it prepares the future specialist to apply the fundamental basic principles in the practice of the diagnostic-therapeutic endoscopy, aimed at guaranteeing the quality of its medical performance in care of patients with digestive neoplasms. However, the relationship between the practice and the assistance practice still needs an epistemologic resizing to favor the transformation of the professional performance of these specialists. Development: An epistemologic analysis of the relationship between practice, and assistance performance in the training of the Gastroenterology resident was carried out, what allows to connote it starting from a more essential interpretation level, so that transcends the fragmented and instrumental vision of its theoretical approach toward a new totalizer approach that systematizes its training essence from an holistic endoscopic intervention that integrates prevention, diagnosis and therapeutic in the care of patients with digestive neoplasms. Conclusions: The epistemologic reinterpretation of this investigation consolidated the dialectics between the practice and the assistance practice in a superior epistemologic stage, what allows to sustain a new theoretical treatment of this relationship starting from the link between the integral practice of endoscopic-digestive preventive procedures and the preventive-curative endoscopic interventive practice in order to perfect this specialist training.

Application of constructivism teaching theory combined with PBL teaching mode in the training of new nurses in department of gastroenterology / 中华医学教育探索杂志

Objective:To explore the role of constructivism teaching theory combined with problem-based learning (PBL) teaching mode in the training of new nurses in the department of gastroenterology.Methods:A total of 27 newly recruited nurses in the Department of Gastroenterology in West China Hospital of Sichuan University from August 2018 to August 2019 were selected as the control group, and traditional teaching was adopted. In addition, 24 newly recruited nurses from September 2019 to September 2020 were selected as the research group, using constructivism teaching theory combined with PBL teaching mode. After the training, the teaching effect was compared between the two groups through the assessment results and the training method scores. SPSS 19.0 was used for t test. Results:The research group's newly recruited nurses' theoretical evaluation scores [(95.08±5.61) vs. (91.63±5.27)] and practical skills operation evaluation scores [(94.30±7.22) vs. (87.13±6.84)] were both higher than those of the control group, and the difference was statistically significant ( P<0.05). Compared with the control group, the newly recruited nurses of the research group believed that the combination of constructivism teaching theory and PBL teaching could improve clinical thinking ability, analysis and problem-solving ability, and the degree of integration of theory and practice, mobilize the enthusiasm of autonomous learning, enhance autonomous learning ability, and improve communication ability, cultivate teamwork ability, stimulate interest in learning, improve work confidence and training satisfaction, with statistical significance ( P<0.05). Conclusion:The combination of constructivism teaching theory and PBL teaching mode is beneficial to the training of newly recruited nurses in the department of gastroenterology to independently construct a theoretical framework of knowledge, improve comprehensive ability, and make a useful exploration for the training of newly recruited nurses.

The dysphagia investigation: is there still space for the videofluoroscopic method? / Investigação da disfagia: ainda há espaço para o método videofluoroscópico?

ABSTRACT - BACKGROUND: Dysphagia can lead to aspiration pneumonia, impacting the nutritional status and quality of life of the patient. The videofluoroscopy is highlighted for allowing both a real-time evaluation and the recording of the images for later review and analysis. AIM: This study aimed to describe the characteristics of the population referred for videofluoroscopy and its value as an investigation method. METHODS: A descriptive and retrospective study was conducted. Exams were analyzed in lateral and anteroposterior views and reviewed using the frame-by-frame analysis software. The variables analyzed were an indication of the exam, previous diseases, dynamics of the oral and pharyngeal phases, and the degree of penetration/aspiration. RESULTS: A total of 141 exams were analyzed. The study population had a median age of 66.24±17.78 years. For the indication of the exam, the investigation of dysphagia was highlighted (n=87, 61.7%) and for previous conditions, diverticulum (n=13, 9.2%), pharyngeal bar (n=12, 8.51%), and stroke and Parkinson's disease (n=9, 6.4%) were highlighted. In the oral phase, 45 (31.9%) patients had a premature loss, and 108 (76.6%) patients had normal transit time. However, 100 (70.9%) had inadequate ejection. In the pharyngeal phase, 119 (84.4%) had efficient laryngeal displacement and 107 (75.9%) had an adequate opening of the upper esophageal sphincter. The beginning of the pharyngeal phase was classified as inadequate in 131 (92.9%) patients, and 80 (56.74%) had pharyngeal residue. Notably, 100 (70.9%) patients had grade 1 on the penetration/aspiration scale. CONCLUSION: Despite the didactic division of phases, swallowing is complex and has transition stages. Videofluoroscopy is the only method for evaluating all phases of swallowing and its events.

RESUMO - RACIONAL: a disfagia pode levar ao desenvolvimento de pneumonia broncoaspirativa, impactando o estado nutricional e a qualidade de vida do paciente. A videofluoroscopia se destaca por permitir tanto a avaliação em tempo real como o registro das imagens para revisão e análise posterior. OBJETIVO: Descrever as características da população encaminhada para videofluoroscopia e seu valor como método de investigação. MÉTODOS: estudo descritivo e retrospectivo. Exames analisados em visão lateral e ântero-posterior e revisados com software de análise quadro a quadro. Variáveis analisadas: indicação do exame, doença base, dinâmica da fase oral e da fase faríngea e a grau de penetração/aspiração. RESULTADOS: foram analisados 141 exames. A população estudada tinha em média 66,24 ± 17,78 anos. Para indicação do exame, destacou-se: investigação de disfagia (n=87, 61,7%) e para condição prévia: divertículo (n=13, 9,2%), barra faríngea (n=12, 8,51%), acidente vascular e doença de Parkinson (n=9, 6,4%). Na fase oral, 45 pacientes (31,9%) apresentaram escape prematuro. Tempo de trânsito normal foi registrado em 108 (76,6%) pacientes. Porém, 100 pacientes (70,9%) apresentaram ejeção inadequada. Na fase faríngea, 119 (84,4%) apresentaram deslocamento laríngeo eficiente e 107 (75,9%) abertura adequada do esfíncter esofágico superior. O início da fase faríngea foi classificado como inadequado em 131 pacientes (92,9%) e 80 (56.74%) apresentaram resíduo faríngeo. 100 pacientes (70,9%) apresentaram grau 1 na escala de penetração/aspiração CONCLUSÃO: apesar da divisão didática das fases, a deglutição é uma função complexa e possui etapas de transição. A videofluoroscopia é o único método para avaliar todas as fases da deglutição e seus eventos.

Google Trends en Gastroenterología / Google Trends in Gastroenterology

Google Trends (GT) is an online portal that provides data on user search patterns. It is currently widely used in the vast majority of medical specialties. Objective: to analyze publications in gastroenterology that have used GT as an epidemiological tool. Methods: Using PubMed, Lilacs, Google Schoolar Academic and Scopus, we searched for gastroenterology articles that contained GT in their title or abstract between the years 2011 to 2021. Titles/abstracts had to also include at least one out of 49 terms related to digestive diseases from symptoms to treatments. Results: The 30 articles selected addressed topics such as symptoms, different pathologies including infectious, diagnostic methods and diets, among others. Conclusions: GT is a very useful tool to measure what people search for on the Internet and allows us to detect epidemic outbreaks, evaluate the impact of the days dedicated to some pathology as well as the impact of publications on the network of the public and doctors.

Google Trends (GT) es un portal en línea que proporciona datos sobre patrones de búsqueda de los usuarios. Actualmente muy utilizado en la gran mayoría de las especialidades médicas. Objetivo: analizar las publicaciones en gastroenterología que han usado a GT como herramienta epidemiológica. Material y Método: Mediante PubMed, Lilacs, Google Schoolar Academic y Scopus buscamos los artículos de gastroenterología que contenían a GT en su título o en el resumen entre los años 2011 a 2021. Los títulos/resúmenes debían incluir además, al menos uno de 49 términos relacionados a enfermedades digestivas desde síntomas hasta tratamientos. Resultados: Los 30 artículos seleccionados abordan temas como síntomas, distintas patologías incluyendo infecciosas, métodos diagnósticos y dietas, entre otras. Conclusiones: GT es una herramienta de gran utilidad para medir lo que las personas buscan en internet y permite detectar brotes epidémicos, evaluar el impacto de los días dedicados a de alguna patología así como el impacto de publicaciones en la red del público y médicos.

Artículo de revisión: abordaje del síndrome de intestino irritable en APS / Review article: Irritable bowel syndrome approach in PHC

El síndrome de intestino irritable es un trastorno digestivo funcional recientemente reconocido como una alteración en el nivel intestino-cerebral que no se explica por alteraciones morfológicas, metabólicas o neurológicas demostrables por las técnicas diagnósticas habituales, caracterizándose por la presencia de dolor y distensión abdominal recurrente asociado a alteraciones del ritmo deposicional, ya sea en forma de constipación, diarrea o ambas. La prevalencia oscila entre los 6-11% dependiendo de los criterios diagnósticos utilizados y la zona geográfica, en Chile no hay datos actuales. Su fisiopatología es multifactorial, donde ninguno explica por si solo el síndrome. El diagnóstico es positivo basado en los criterios de Roma IV establecidos en el año 2016, a su vez es imperante establecer un subtipo de SII para realizar el manejo adecuado, es así como podemos tener un SII con predominio de constipación, diarrea, mixto o indeterminado. El manejo consta de la educación al paciente, una buena relación médico-paciente, dieta adecuada, actividad física aeróbica y otros tratamientos no farmacológicos, sumado a antiespasmódicos, antidiarreicos y fibra soluble, dependiendo del síntoma predominante.

Irritable bowel syndrome (IBS) is a functional digestive disorder recently recognized as an alteration in the gut-brain axis which can´t be explained by morphological, metabolic or neurological alterations demonstrable by the usual diagnostic techniques, characterized by the presence of recurrent abdominal pain and distention associated with alterations in the stool rhythm, either in the form of constipation, diarrhea or both. The prevalence ranges between 6-11% according to the diagnostic criteria used and the geographical area, in Chile there's no current data. Its pathophysiology is multifactorial, where any of them explains the syndrome itself. The diagnosis is positive based on the Rome IV criteria established in 2016, it is imperative to establish a subtype of IBS to carry out the appropriate management, This is how we can have IBS with a predominance of constipation, diarrhea, mixed or indeterminate Management consists of patient education, a good doctor-patient relationship, adequate diet, aerobic physical activity and other non-pharmacological treatments, added to antispasmodics, antidiarrheals and soluble fiber, depending on the predominant symptom.