RESUMO
BACKGROUND: Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociación Mexicana de Gastroenterología (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. AIMS: To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. METHODS: The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. RESULTS: Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. CONCLUSIONS: We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included.
Assuntos
Síndrome do Intestino Irritável/terapia , Consenso , Técnica Delphi , Medicina Baseada em Evidências , Guias como Assunto , Humanos , MéxicoRESUMO
The histopathological study is very useful to establish a correct diagnosis in hepatic diseases, nevertheless conventional percutaneous liver biopsy is contraindicated in patients with abnormal coagulation. For this reason, some other alternatives have been looked for. The purpose of this study was to evaluate the safety and effectivity of gelfoam plugged liver biopsy, like alternative of the conventional biopsy in patients with impaired coagulation. The procedure was done in fourteen patients with prothrombin time longer than twelve seconds over the control and platelet count until 20,000/mm3. Besides that, we used real time ultrasound to guide the biopsy, in order to improve the safety and effectivity of this technique. All were successful, and there were no serious complications. This technique is a good alternative in patients with liver disease and impaired coagulation, in whom the histological diagnosis is essential.
Assuntos
Biópsia por Agulha/métodos , Transtornos da Coagulação Sanguínea/complicações , Hepatopatias/patologia , Fígado/patologia , Feminino , Humanos , Hepatopatias/complicações , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
A 51-year-old man with epilepsy received carbamazepine during three weeks. He developed fever, jaundice, dark urine and pale stools. Laboratory data showed hepatocellular injury and cholestasis; six weeks after withdrawal of the drug these abnormalities returned to normal limits. The liver biopsy showed acute cholangitis, bile duct injury, granulomas and eosinophils in the portal areas.
