Síndrome del intestino irritable / Irritable bowel syndrome

El síndrome del intestino irritable es uno de los trastornos funcionales intestinales más comunes y tiene un impacto sustancial en la vida diaria de los pacientes, así como un enorme impacto económico en la sociedad. Se caracteriza por dolor abdominal, meteorismo con distensión abdominal y alteración en las evacuaciones intestinales, con predominio de diarrea, estreñimiento o alternancia de estos signos, los cuales no pueden ser explicados por una anormalidad estructural o bioquímica. Se desconoce su etiopatogenia y su mecanismo fisiopatológico. La enfermedad afecta a entre el 5 y el 10% de los individuos sanos en un momento dado y, en la mayoría de las personas, tiene un curso de recaídas y remisiones. En este artículo se revisan algunas de las evidencias principales y más actuales acerca de su epidemiología, factores de riesgo, fisiopatología, manifestaciones clínicas, aproximación diagnóstica y opciones terapéuticas, tanto de tipo dietético como farmacológico y psicoterapéutico.

Irritable bowel syndrome. / Síndrome del intestino irritable.

Irritable bowel syndrome is one of the most common functional bowel disorders, and has a substantial impact on patients' daily lives, as well as a big economic impact on society. It is characterised by abdominal pain, bloating and abdominal distention and altered bowel movements, with a predominance of diarrhoea, constipation, or alternation of these signs, which cannot be explained by a structural or biochemical abnormality. Its aetiopathogenesis and pathophysiological mechanism are unknown. The disease affects 5%-10% of healthy individuals at any given time and, in most people, has a relapsing-remitting course. This article reviews some of the main and most current evidence on its epidemiology, risk factors, pathophysiology, clinical manifestations, diagnostic approach, and therapeutic options, both dietary, pharmacological and psychotherapeutic.

Colostomía endoscópica percutánea como tratamiento de un vólvulo de sigma recidivante en paciente casi centenario / No disponible

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Percutaneous endoscopic colostomy to treat recurrent sigmoid volvulus in an almost centenary patient.

We report the case of a 96-year-old institutionalized male, with severe dementia, who was admitted to our hospital with sigmoid volvulus. After successful decompression, the patient developed recurrent sigmoid volvulus twice within 76 hours, which required endoscopic repositioning. However, after a new recurrence and rejecting surgery, we chose percutaneous endoscopic colostomy, using the standard gastrostomy technique, in order to fix the mobile intestine to the abdominal wall to prevent torsion. Although observational studies with more cases and longer follow-up are needed, percutaneous endoscopic colostomy could be a safe and effective alternative in patients in whom conventional surgery is considered unsafe or inappropriate.

Recomendaciones prácticas para una adecuada vigilancia pospolipectomía endoscópica desde atención primaria / No disponible

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Influence of Compliance to Diet and Self-Efficacy Expectation on Quality of Life in Patients with Celiac Disease in Spain.

The purpose of this study is to understand the health-related quality of life (HRQoL) in patients with celiac disease (CD) and analyze its main determinants. A transversal descriptive study of 738 patients with celiac disease was carried out. A series of questionnaires were answered related to their HRQoL, adherence to a gluten-free diet (GFD), and self-efficacy beliefs among other relevant variables. Regression analyses were carried out in order to explore the predictive variables in adherence to the GFD and HRQoL. A total of 61.2% showed a good HRQoL, and the main predictors of HRQoL were specific self-efficacy, adherence to the diet, risk perception, time since diagnosis, and age. While 68.7% of participants showed good or excellent adherence to the GFD, and the main predictors of adherence were specific self-efficacy, perceived adoption of recommended behaviors, HRQoL and gender. The HRQoL of patients with CD, and adherence to the GFD in Spain, are good. It is the self-efficacy expectation, measured specifically and not generally, which is the best predictor of both adherence and HRQoL. It is necessary to develop programs to improve the HRQoL of patients with CD that focus on improving specific self-efficacy.

The effect of self-efficacy expectations in the adherence to a gluten free diet in celiac disease.

Objective: To analyse the effect of general and specific self-efficacy on the adherence to a gluten free diet (GFD) in patients with celiac disease along with the effect of other relevant variables.Design: 271 patients with celiac disease participated in this transversal descriptive study and completed a series of questionnaires regarding adherence (CDAT), general self-efficacy (GSES) and specific self-efficacy (Celiac-SE) and quality of life (CD-Qol), among others.Main Outcome Measures: Dependent variable was adherence to the Gluten Free Diet (GFD). Main independent variables were general self-efficacy, specific self-efficacy and quality of life. Model tests were conducted using regression analysis.Results: 71.9% of patients show an excellent or good adherence to the diet. Higher levels of adherence are positively associated to a high expectancy of specific self-efficacy, to the perceived adoption of recommended behaviours, risk perception and better quality of life (these variables accounted for 36.4% of the variance in the adherence to a GFD, p < .001).Conclusions: Specific self-efficacy rather than general has a predictive value in adherence to a GFD. Therefore, we need to develop and transculturally adapt new instruments to assess specific self-efficacy. Celiac-SE has proved to be a useful scale for this objective.

Síndrome del intestino irritable con predominio de diarrea y giardiasis: ¿es uno u otra? / Irritable Bowel Syndrome with predominant diarrhea and giardiasis: is it one or the other?

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Inhibidores de la bomba de protones y carcinogénesis gástrica / Proton pump inhibitors and gastric carcinogenesis

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Development and Validation of a Specific Self-Efficacy Scale in Adherence to a Gluten-Free Diet.

The aim of this study was to develop a scale to assess the levels of specific self-efficacy in order to enhance adherence to a gluten-free diet and the life quality of celiac patients. Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed people. The only treatment is a strict lifelong gluten-free diet. Within the framework of Social Cognitive Theory, expectation of self-efficacy is understood as the degree in which a person believes himself to be capable of performing a certain task (e.g., adhering to a gluten-free diet), a construct which has been widely studied in its relation with adopting healthy behaviors, but scarcely in relation to celiac disease. A validation study was carried out in various stages: preparation of the protocol; construction of the questionnaire and a pilot run with 20 patients; validation of the scale with 563 patients and statistical analysis. A 25-item scale was developed. Feasibility was excellent (99.82% of participants completed all the questions). Factorial analysis pointed to the existence of five factors that explained 70.98% of the variance with a Cronbach alpha of 0.81 for the scale overall and between 0.64 and 0.90 for each factor. The scale showed a Spearman's Rho coefficient of 0.279 with the General self-efficacy Scale. This easily administered scale provides good psychometric properties for evaluating specific self-efficacy of celiac patients in adhering to treatment. It seeks to be the first scale that provides not only a measurement of specific self-efficacy in celiac disease, but also to determine its levels for each of the areas as a first step toward designing interventions of self-management and empowerment programs to cope with the disease.

Alucinaciones por omeprazol. No tan raras como se cree / Omeprazole-induced hallucinations. Not as rare as you might think

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Sensitive bowel syndrome better than irritable bowel syndrome / Síndrome del intestino sensible mejor que síndrome del intestino irritable

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De la flora intestinal al microbioma / From the intestinal flora to the microbiome

En el presente artículo, se repasa la historia de la microbiota; se definen los conceptos relacionados de microbiota, microbioma, metagenoma, patobionte, disbiosis, holobionte, filotipo y enterotipo; se presentan algunos de los conocimientos más precisos y actualizados sobre la misma y se repasan sus funciones: metabólicas, nutricionales e inmunomoduladoras. Se comentan, de forma sucinta, aquellas patologías digestivas en cuya patogenia se ha implicado a la microbiota intestinal, incluyendo la enfermedad inflamatoria intestinal, el síndrome del intestino irritable y la enfermedad celiaca, entre otras. Finalmente, se refieren algunos datos destacados y prometedores del trasplante de microbiota fecal en determinados procesos digestivos (AU)

In this article, the history of the microbiota is reviewed and the related concepts of the microbiota, microbiome, metagenome, pathobiont, dysbiosis, holobiont, phylotype and enterotype are defined. The most precise and current knowledge about the microbiota is presented and the metabolic, nutritional and immunomodulatory functions are reviewed. Some gastrointestinal diseases whose pathogenesis is associated with the intestinal microbiota, including inflammatory bowel disease, irritable bowel syndrome and celiac disease, among others, are briefly discussed. Finally, some prominent and promising data with regard to the fecal microbiota transplantation in certain digestive illness are discussed (AU)