The Mexican consensus on irritable bowel syndrome. / Consenso mexicano sobre el síndrome de intestino irritable.

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.

[Prevalence of irritable bowel syndrome in Veracruz City, Mexico: a community-based survey]. / Prevalencia del síndrome de intestino irritable en población abierta de la ciudad de Veracruz, México.

BACKGROUND: Irritable bowel syndrome (IBS) is recognized as the most frequent functional digestive disorder around the world. In Latin America and Mexico there are few studies in order to demonstrate its real prevalence in general population. AIMS: To determine the prevalence of IBS in general population from Veracruz City Mexico, using the Rome II criteria. MATERIAL AND METHODS: Using basic information given by bureau for planning urban services from Veracruz country, a 10% random population sample was obtained. Subjects between 16-80 years old were interviewed using a questionnaire based on Rome II criteria and a visual analogous scale in order to estimate the negative effect of IBS symptoms on daily activities. RESULTS: We interviewed 459 subjects with a median age of 31.2 +/- 13.6 years old detecting 78 subjects (16.9%) with IBS symptoms: 25 males and 53 females (gender prevalence of 11.3% and 22.1%, respectively). 28.2% of them had IBS with diarrhea, 50% had IBS with constipation and 21.8% alternating bowel movements, diarrhea and constipation. Negative effect of IBS symptoms on daily activities was significant. CONCLUSIONS: The prevalence of IBS in open population was 16.9% according to Rome II criteria, being higher in those older than 35 years old. Constipation was the predominant pattern. Further studies should evaluate associated factors of these findings.

[Usefulness of gel lidocaine in esophageal manometry]. / Utilidad de la lidocaína en gel en la manometría esofágica.

BACKGROUND: Esophageal manometry (EM) is a functional study performed without sedation. The insertion of a catheter through nasal passages provokes the greatest discomfort as it is being performed. OBJECTIVE: To evaluate the usefulness of lidocaine jelly to diminish discomfort patient during EM and to ease the procedure. MATERIAL AND METHODS: Ninety patients sent to EM were randomly assigned to receive lidocaine jelly at 2% (n = 45) or chlorexidine gluconate (n = 45) as a lubricant for the catheter. A solid-state catheter was employed via the pull-through technique under topic anesthesia of the hypopharynx in all cases. Patients quantified nasal pain and nausea produced by analog visual scale (AVS, 0-10 cm). The physician quantified difficulty of insertion using the same method. An independent observer kept time records from the moment of insertion of the probe through the nasal passages until the location of all sensors in the stomach (time of insertion). RESULTS: No significant differences were found between the two groups in their evaluation of nasal pain (2.8 cm lidocaine group vs. 2.6 cm chlorhexidine group), and there was no difference found in the intensity of nausea (3.3 cm vs. 3.1, respectively). Ease of the procedure was similar (2.2 cm lidocaine group vs. 1.8 cm chlorhexidine group), as well as insertion time (120 vs. 111 sec, respectively). CONCLUSIONS: Lidocaine jelly at 2% neither diminishes the discomfort provoked by the insertion of an EM catheter, nor does it make the procedure any easier.

[Hypertensive inferior esophageal sphincter. Prevalence and clinico-manometric features]. / El esfínter esofágico inferior hipertenso. Prevalencia y características clinicomanométricas.

BACKGROUND: The hypertensive lower esophageal sphincter (HLES) is an unusual primary motor disorder of the esophagus. The lack of a precise definition has made it difficult to establish its prevalence and its clinical and manometric characteristics. OBJECTIVES: 1) To determine the prevalence of HLES using precise diagnostic criteria, 2) To identify the clinical manifestations of this disease, and 2) To compare manometric findings in patients with HLES against normal subjects. METHODS: A total of 705 consecutive esophageal manometries were performed over 52 months. HLES was defined as basal pressure 45 > or = mmHg, normal relaxation in response to swallowing, and normal peristalsis of the esophageal body. Clinical records were reviewed to identify the main symptoms that prompted the manometry. The manometric data of patients with HLES was compared to that of 16 healthy control subjects. RESULTS: Seven HLES patients were identified establishing a prevalence of 1%. Four HLES cases were referred due to dysphagia, two due to symptoms of gastroesophageal reflux disease, and one due to thoracic pain. Upon comparing manometric data of patients with HLES and healthy control subjects the motor function of the esophageal body, the total length of the lower esophageal sphincter, and its position in respect to the diaphragm were similar in both groups. CONCLUSIONS: Prevalence of HLES was 1%. Dysphagia was the main symptom. Total length of the sphincter, as well as length of the thoracic and abdominal segments do not appear to contribute to high basal pressure.