Probiotics, prebiotics, and low FODMAP diet for irritable bowel syndrome - What is the current evidence?

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders worldwide. While the pathogenesis is not clearly understood, current research points to the role of the gut microbiome and alterations in the diversity of the microbiota. Probiotics, prebiotics, and low FODMAP diet are therapeutic means associated with modification of the gut microbiome for the alleviation of IBS symptoms. This narrative review assesses the current evidence on the efficacy of these treatment options based on findings from recent systematic reviews and meta-analyses published from October 2013 to October 2018. There is a general agreement in the 11 included systematic reviews and meta-analyses that probiotic therapy is safe and can be effective in improving overall IBS symptom scores and abdominal pain in the general IBS population. Nonetheless, conflicting findings remain and no recommendation on the specific species/strains or combination can be made. Short-term restriction of FODMAP in the diet can improve IBS symptoms as per the findings of 7 systematic reviews and meta-analyses, even though the quality of the evidence remains questionable. Inappropriate use of the low FODMAP diet can potentially impact health negatively. As such, a low FODMAP diet is only recommended as a second line treatment guided by qualified clinicians with specialized training. Despite preclinical studies of some prebiotics demonstrated the potential use in improving gut microbiome and intestinal inflammatory response, the beneficial effect of prebiotics for IBS remains theoretical. Two systematic reviews found no evidence to support the clinical use of prebiotics for IBS.

Estados inflamatorios pulpares más frecuentes en servicios de urgencia / Inflammatory states must frequent of the pulpin the service of urgency

Se realizó un estudio descriptivo transversal en el servicio de urgencias de la Clínica estomatológica Ramón Guevara Montano, Baracoa, desde enero 2016 - enero de 2017, con el objetivo de determinar el comportamiento de los estados inflamatorios pulpares más frecuentes. El universo estuvo constituido por pacientes que acudieron a consulta con dolor asociado a estructuras dentarias y la muestra por 85 pacientes mayores de 15 años a los que se les diagnosticó un estado inflamatorio pulpar. Se trabajó con las variables; edad, sexo, calidad, intensidad, aparición, localización, tiempo de refracción y evolución del síntoma dolor, hallazgos clínicos asociados y clasificación del estado inflamatorio pulpar diagnosticado. El estado inflamatorio pulpar más frecuente responde a la pulpitis irreversible aguda siendo la caries dental la responsable principal de los estados inflamatorios(AU)

It was carried out a tranverse descriptive study in the service of urgency of the stomatologic clinical Ramón Guevara Montano, in the period of January of 2016 to January of 2017, with the objective of determining the behavior of the states inflammatory more frequent pulpares. The universe was constituted by all those patients that went to consultation with pain associated to structures you would jag and the sample for the 85 patients bigger than 15 years to those that were diagnosed a state inflammatory of the pulp. The patients were included in the sample according to the reception order. Worked variables; age, sex, quality, intensity, appearance, localization, time of refraction and evolution of the symptom pain, associate clinical findings and classification of the diagnosed inflammatory pulpar state. It was concluded that the more frequent inflammatory state of the pulp in the services of urgency were the irreversible acute pulpitis and that in spite of the activities of prevention and cure of the developed dental cavity, this one remains being the main responsible of these inflammatory states(AU)