Lactobacillus acidophilus LB: a useful pharmabiotic for the treatment of digestive disorders.

Dysbiosis, a loss of balance between resident bacterial communities and their host, is associated with multiple diseases, including inflammatory bowel diseases (nonspecific chronic ulcerative colitis and Crohn's disease), and digestive functional disorders. Probiotics, prebiotics, synbiotic organisms and, more recently, pharmabiotics, have been shown to modulate the human microbiota. In this review, we provide an overview of the key concepts relating to probiotics, prebiotics, synbiotic organisms, and pharmabiotics, with a focus on available clinical evidence regarding the specific use of a unique pharmabiotic, the strain Lactobacillus acidophilus LB (Lactobacillus boucardii), for the management of gastrointestinal disorders. Since it does not contain living organisms, the administration of L. acidophilus LB is effective and safe as an adjuvant in the treatment of acute diarrhea, chronic diarrhea, and antibiotic-associated diarrhea, even in the presence of immunosuppression.

[Guidelines for diagnosis and treatment of constipation in Mexico. B) Diagnostic approach]. / Guías de diagnóstico y tratamiento del estreñimiento en México. B) Abordaje diagnóstico.

BACKGROUND: Constipation is a heterogeneous symptom so an accurate diagnosis requires an appropriate approach. OBJECTIVE AND METHODS: To establish the clinical guidelines for diagnosis and treatment of chronic constipation in Mexico we have reviewed the diagnostic aspects of constipation according to the availability of resources in our country. In addition, evidence-based recommendations have been provided. RESULTS: The symptoms that best define constipation in our population are infrequent stool, hard stool expulsion, excessive effort and sensation of incomplete evacuation. Digital rectal examination is a useful diagnostic tool to discard organic diseases and pelvic floor dyssynergia. Patients with risk factors such as recent onset of constipation, family history of inflammatory bowel disease or colon cancer and those with alarm signs (unintentional weight loss and significant anemia, blood in stool) should undergo endoscopic diagnostic studies. If they are available, the most useful tests in evaluating patients with functional constipation are colonic transit with radiopaque markers and anorectal manometry with balloon expulsion test. CONCLUSIONS: Patients with symptoms of chronic constipation should undergo advanced colorectal physiological studies to try to establish the cause of constipation.

[Comparison of two forms of nasal and pharyngeal topical anestesia for performing esophageal manometry]. / Comparación de dos formas de anestesia tópica nasal y faríngea para la realización de manometría esofágica.

BACKGROUND: The esophageal manometry (EM) is an invasive procedure that causes nasal pain, pharyngeal pain, and nausea. A topical anesthetic may improve tolerance of the examination. OBJECTIVE: To compare the effectiveness of 10% lidocaine with 20% benzocaine as topical anesthetics in order to reduce discomfort during an EM. MATERIALS AND METHODS: 251 patients who had been prescribed an EM received either lidocaine or benzocaine in the nose and pharynx before inserting the catheter An EM was carried out using the usual pull-trough technique and an observer registered the insertion time of the catheter. Patients assessed the intensity of nasal pain and nausea by means of a visual analog scale. Finally, patients were asked whether, if necessary, they would repeat the study. RESULTS: 127 patients were studied in the lidocaine group and 124 in the benzocaine group. The EM was carried out on all patients without complications. Although benzocaine tended to be the preferred anesthetic, no significant differences were found between the groups in relation to nasal pain, nausea, and insertion time. The percentage of patients with moderate or intense discomfort was significantly less in the benzocaine group (nasal pain 10 vs. 33%, p < 0.001; and nausea 24 vs. 36%, p = 0.05). A similar percentage of patients said they would not agree to having another EM (p = NS). CONCLUSIONS: Both lidocaine and benzocaine are topical anesthetics that can reduce discomfort during an EM. Benzocaine seems to achieve a better effect among more patients submitted to this procedure.

[Detection and treatment of subclinical hypothyroidism in patients with irritable bowel syndrome. Does it modify the use of health resources?]. / La detección y tratamiento del hipotiroidismo subclínico en pacientes con síndrome de intestino irritable. Modifica el uso de recursos de salud?

BACKGROUND: It is still unknown whether the treatment and control of conditions that coexist with irritable bowel syndrome (IBS) change the utilization of healthcare resources for this disease. OBJECTIVES: To determine whether the treatment of subclinical hypothyroidism in patients with IBS decreased the use of healthcare resources and work absenteeism. MATERIAL AND METHODS: Patients with IBS and subclinical hypothyroidism (cases) and patients with IBS and no hypothyroidism (controls) were diagnosed during a three-year period. Other conditions were ruled out by means ofa group of tests. Four years later, a survey on the associated medical events, the use of healthcare resources, and work absenteeism during the previous year was applied. Controls were age- and gender-matched at a 2:1 control: case ratio. RESULTS: Fourteen cases and 28 controls were studied, all of them females, with a mean age of 46 years. The survey was conducted 4 years after the initial diagnosis in both groups. No significant differences were found between both groups in the following: the proportion of the patients who had received medical treatment for IBS (79% of cases vs. 82% of controls), the prescription of psychotropics (36% vs. 36%, respectively), the proportion seen in the emergency room due to gastrointestinal complaints (21% vs. 18%, respectively), job absenteeism (7% vs. 11%, respectively), and the proportion of patients who underwent abdominal surgery (14% vs. 11%, respectively). The mean number of visits to the doctor due to gastrointestinal complaints within the year prior to the interview was similar in both groups (3.1 for cases vs. 3.4 for controls). CONCLUSIONS: The detection and treatment of subclinical hypothyroidism do not modify the utilization of healthcare resources in IBS.

[Usefulness of colonoscopy with biopsy for the study of patients with chronic diarrhea]. / La utilidad de la colonoscopia con toma de biopsias en el estudio de pacientes con diarrea crónica.

BACKGROUND: the endoscopic evaluation of the colonic mucosa complemented with biopsy sampling may be very useful in the study of patients with chronic diarrhea. However its value in daily practice has not been extensively explored. OBJECTIVE: to know the utility of colonoscopy with systematic biopsy sampling in the study of the patients with chronic diarrhea. MATERIAL AND METHODS: patients with chronic diarrhea (loose stools and frequent bowel movements for at least four weeks) were examined with colonoscopy and biopsy sampling for systematic histologic examination; even in patients with a normal-appearing mucosa. Patients with the following were excluded: a diagnosis of HIV infection/AIDS, previous colon surgery, known inflammatory bowel disease, gastrointestinal bleeding, anemia or involuntary weight loss. RESULTS: a total of 109 patients were included (63 females, mean age 52 years). Colonoscopy was normal in 53 cases (49%) and abnormal in 56 (51%). The biopsies showed a specific disease in 31 cases (28%), non-specific changes in 58 (53%) and normal mucosa in 20 (18%). Microscopic colitis (lymphocytic or collagenous colitis) was detected in 12 cases (11%) all of them with a normal colonoscopy. Colonoscopy with systematic biopsy sampling allowed making a specific diagnosis in 31 of patients (28%). CONCLUSIONS: colonoscopy with systematic biopsy sampling is very useful in the study of patients with chronic diarrhea, since it established a specific diagnosis in 28% of the patients and 11% with microscopic colitis, all of them with normal mucosa.

Performance, tolerability, and symptoms related to prolonged pH monitoring using the Bravo system in Mexico.

BACKGROUND: The traditional system for esophageal 24-h pH monitoring requires transnasal introduction of the catheter with pH sensors; this technique produces discomfort, inconvenience, and interference with daily activity. Recently, a catheter-free pH monitoring system (Bravo) has been proposed as an alternative and promising method for 24-h pH. AIM: To evaluate performance, tolerability, and symptoms related to this new technology in our population. METHODS: Consecutive patients with gastroesophageal reflux disease (GERD) with indication for 24-h pH were included. pH Bravo capsule was placed 6 cm above the squamocolumnar junction using endoscopic measurement. Symptoms associated were evaluated daily in a personal diary until 7 days after the capsule attachment. Severity of symptoms was assessed by a 5-point Likert scale. Capsule detachment was assessed by chest X-ray. RESULTS: Eighty-four patients were included. Forty-nine were female (mean age 44 +/- 12 yr). Indications for pH monitoring were: nonresponse to proton pump inhibitor therapy in 38 (45%), preoperative evaluation for anti-reflux surgery in 36 (43%), previous failed transnasal 24-h pH monitoring in 6 (7%), and extra-esophageal manifestations of GERD in 4 (5%). The capsule was successfully attached in 95% of patients. At day 7, capsule detachment occurred spontaneously in all cases. Symptoms related to capsule attachment were: chest pain in 26 (33%), foreign body sensation in 11 (14%), nausea in 5 (6%), and 9 (11%) patients had more than one symptom. Severities of those symptoms were mild, and no patient required removal of the capsule. Women and younger patients had more symptoms related to the procedure (p < 0.05). CONCLUSIONS: Esophageal pH monitoring with Bravo capsule is a safe, reliable, and tolerable method in patients with GERD.

[Prevalence of different groups that comprise endoscopy-negative reflux disease]. / La prevalencia de los diferentes grupos que integran la enfermedad por reflujo con endoscopia negativa.

BACKGROUND DATA: Endoscopic-negative reflux disease (ENRD) is a heterogeneous population. There are few data regarding the prevalenece of each group and subgroups that constitutes ENRD population. OBJECTIVE: To describe the prevalence of the differents groups and subgroups in ENRD. PATIENTS AND METHODS: We studied consecutive patients with frequent heartburn and acid regurgitation with endoscopically normal esophageal mucosa in whom ambulatory 24-h esophageal pH monitoring was performed. According with the pH-testing data and the correlation between symptoms and the acid reflux events, the subjects were classified in two groups: non-erosive gastroesophageal reflux disease (NERD) and functional heartburn. The functional heartburn group was splited in 3 subgroups: asymptomatics during pH-monitoring, hipersensitive esophagus and those with physiologic reflux with negative association between symptoms and acid reflux events. These last subgroup was classified in: minute changes of intra-esophegeal pH (upper than 4, n = 19) and non-acid related stimuli. RESULTS: One hundred and eleven patients with ENRD were classified in NERD (28%, n = 31) and functional heartburn (72%, n = 80). Patients with functional heartburn were classified in asymptomatics during pH-monitoring (11%, n = 12), hipersensitive esophagus (9%, n = 10) and those with physiologic reflux with negative association between symptoms and acid reflux events (52%, n = 58). In these last subgroup 19 (17%) patients were classified as minute changes of intra-esophegeal pH (upper than 4) and 39 (35%) as non-acid related stimuli. CONCLUSIONS: Even most of the patients with ENRD have normal ambulatory pH-test, their symptoms are related with drops of esophageal pH in 26% of the cases. Eleven percent do not have symptoms during ambulatory pH-monitoring.

[Prevalence of use of alternative and complementary medicine in patients with irritable bowel syndrome, functional dyspepsia and gastroesophageal reflux disease]. / La prevalencia del uso de medicina alternativa y complementaria en pacientes con síndrome de intestino irritable, dispepsia funcional y enfermedad por reflujo gastroesofágico.

INTRODUCTION: The prevalence of use of complementary and alternative medicine (CAM) is high in developed countries and is believed to be even higher in developing countries. There are no data on the use of CAM in patients with gastrointestinal tract disorders in Mexico. OBJECTIVE: To determine the prevalence of CAM use in Mexican patients with gastrointestinal disorders. MATERIAL AND METHODS: A survey was applied to all first-time patients presenting at the gastroenterology service between December 2003 and November 2004. Patients with irritable bowel syndrome (IBS, defined by Rome II), functional dyspepsia (FD, defined by Rome II), and gastroesophageal reflux disease (GERD, defined as erosive esophagitis or abnormal pH intraesophageal monitoring) were included. The use of CAM to relieve gastrointestinal symptoms was examined and the demographic data, the disease history and healthcare use 12 months prior to the study were recorded. RESULTS: The survey was answered by 413 patients (61% IBS, 22% FD y 17% GERD). A total of 181 users of CAM were identified (44% of the total group). The use of CAM was most frequent for IBS (51% IBS, 36% FD, 27% GERD). Herbal medicine was the type of CAM most often used by all groups. The factors associated with CAM use were IBS, history of abdominal surgery, emergency room visits, disabilities and prescription of benzodiazepines, and > or = 3 medical visits for gastrointestinal tract disorders within the previous year. CONCLUSIONS: Prevalence of CAM use is high in general and significantly higher for IBS. Herbal medicine is the most frequently used modality.

[Peritoneal coccidioidomycosis]. / Coccidioidomicosis peritoneal.

BACKGROUND: Peritonitis is a very rare condition that has been found on inmunocompromised patients and patients on peritoneal dialysis. OBJECTIVE: To present one case of a patient with chronic abdominal pain that was found to have coccidioidomycosis. CASE PRESENTATION: 50 year old female with 6 months of intermittent abdominal pain referred to right upper quadrant, nausea and vomiting, without fever or jaundice. On physical exam she had pain localized to right upper quadrant. An US was performed and reported a schleroatrophic and litiasic gallbladder. Exploratory laparoscopy was performed, the findings were diffuse lesions in the peritoneal cavity parietal and visceral, some of them were biopsied. A peritoneal coccidioidomycosis was reported and fluconazol treatment was started. Postoperatory evolution was unremarkable at 3 years. CONCLUSION: Coccidioideal peritonitis is a rare disease, most of the patients are asymptomatic and frequently diagnosed while working up other disease.

[Utility of rabeprazole as a diagnostic test in non-erosive gastroesophageal reflux disease]. / Utilidad del rabeprazol como prueba diagnóstica en la enfermedad por reflujo gastroesofágico no erosiva.

BACKGROUND: Proton pump inhibitor test (PPIt) has been shown adequate diagnostic usefulness and cost-effectiveness in the evaluation of patients with gastroesophageal reflux disease (GERD). However, comparative studies of PPIt with 24 hr esophageal pH-metry (24-pH) in non erosive GERD (NERD) are scarce and the utility of rabeprazole as a PPIt has not been evaluated. OBJECTIVE: To investigate the diagnostic utility of rabeprazole test in patients with NERD. MATERIAL AND METHODS: An open label trial was performed, and NERD patients with heartburn at least 3 times per week were included. Symptomatic evaluation before, during and after rabeprazole 20 mg bid for 7 days was performed. All patients underwent 24-pH before treatment with rabeprazole. Patients were classified in three groups: 1) abnormal pH, 2) normal pH and symptom index (SI) positive, and 3) normal pH and SI negative. A positive rabrepazole test was considered when symptoms improvement was higher than 50% at the end of the test. Sensitivity, specificity, negative predictive value, positive predictive value and positive likelihood ratio were calculated considering the 24-pH as gold standard. RESULTS: Sixty four patients, 47 (72%) female were studied. Forty four percent of the patients had normal pH, 29% with SI positive and 71% with SI negative. Sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio were 82%, 47%, 78%, 52% and 1.406 respectively. No adverse events were reported. CONCLUSION: PPI test with rabeprazole 20 mg bid for 7 days is a simple and useful test in the diagnostic approach of patients with NERD.