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Resumen: Hasta este momento, la evidencia disponible sugiere que los pacientes con enfermedad inflamatoria intestinal (EII) no tienen un mayor riesgo de desarrollar COVID-19. En pacientes con remisión de la EII: los 5-aminosalicilatos (5-ASA) no incrementan el riesgo de infección y se deben continuar sin necesidad de suspenderlos o disminuir la dosis; los fármacos inmunomoduladores como las tiopurinas y metotrexato deben continuarse sin modificar las dosis (a considerar en el paciente con infección por SARS-CoV-2 positiva); y en relación con cualquier tipo de terapia biológica, no deberá suspenderse a menos que existan datos de COVID-19. En aquellos pacientes con actividad de la EII: se deberá optimizar la dosis de 5-ASA en administración oral y/o tópica en caso de recaída de la enfermedad; considerar el uso de budesonida MMX en casos de actividad leve a moderada con el fin de evitar el uso de esteroides sistémicos; los esteroides sistémicos deben evitarse en la medida de lo posible, ya que dosis mayores de 20 mg al día ejercen un efecto inmunosupresor el cual pudiera aumentar la susceptibilidad a cualquier tipo de infección, incluyendo COVID-19; evitar el uso combinado de tiopurinas con esteroides y/o agentes anti-TNF ya que puede incrementar el riesgo de infecciones, incluyendo COVID-19; y finalmente, el tratamiento biológico con agentes en contra del factor de necrosis tumoral alfa (anti-TNF alfa) o de cualquier otro mecanismo de acción como antiintegrinas o antiinterleucinas deberán suspenderse en caso de documentarse infección por SARS-CoV-2 y podrán reiniciarse en cuanto haya cedido el proceso infeccioso. Abstract: So far, available evidence suggests that patients with inflammatory bowel disease (IBD) are not at greater risk for developing COVID-19 infection. In regard to patients with IBD remission: 5-aminosalycylates (5-ASAs) do not increase the risk for infection and should be continued. There is no need to suspend them or lower the dose. Immunomodulating drugs, such as thiopurines and methotrexate, should be continued, without modifying doses (even in patients with positive SARS-CoV-2 infection). No type of biologic therapy should be suspended, unless there are signs of COVID-19. Regarding patients with IBD activity: the oral and/or topical 5-ASA dose should be optimized in cases of disease relapse. Budesonide MMX should be considered in cases of mild-to-moderate activity, to avoid systemic steroid use. Systemic steroids should be avoided whenever possible because doses above 20 mg per day have an immunosuppressive effect, which could increase susceptibility to any type of infection, including COVID-19. The combined use of thiopurines with steroids and/or tumor necrosis factor (TNF) monoclonal antibodies should also be avoided because those combinations can increase the risk for infections, including COVID-19. Finally, biologic treatment with anti-TNF-alpha agents or any other mechanism of action, such as anti-integrins or anti-interleukins, should be suspended if patients become infected with SARS-CoV-2. The drugs can be restarted once the infectious process is resolved.

Background: There is growing evidence that gut flora plays a role in the development of Irri- table Bowel Syndrome (IBS). Abdominal bloating is a common symptom in these patients and the severity of this symptom could be related to the variations in their fermentative profiles, obtained by measuring the levels of breath hydrogen excretion after lactulose ingestion. Aims: Our objective was to determine the difference in abdominal bloating severity between IBS patients with high vs low levels of breath hydrogen excretion after lactulose administration. Methods: Lactulose breath tests were carried out on IBS patients in our institution between July 2009 and August 2010. Patients were requested to fill out a validated questionnaire to assess the severity of their symptoms. Abdominal bloating severity score was compared among patients with high and low breath hydrogen levels. Results: A total of 234 patients were enrolled. There was a statistically significant difference in the abdominal bloating severity score between groups: 7.0 (5.7-8.0) vs 6.5 (5.0-7.5), p=0.001. The comparison among IBS patients with constipation (IBS-C) in both groups also showed a statistically significant difference: 7.5 (6.0-8.5) vs 5.8 (3.5-7.2), p=0.0051. Conclusions: Those patients with a low level of breath hydrogen excretion after lactulose inges- tion presented with significantly greater abdominal bloating than those with a high level of breath hydrogen excretion. © 2011 Asociacion Mexicana de Gastroenterologia. Published by Masson Doyma Mexico S.A. All rights reserved.

Objetivos: Demostrar el efecto gastroprotector del aceite de Copaifera officinalis usando indometacina y ligadura de píloro en ratas. Diseño: Estudio preclínico. Lugar: Facultades de Medicina, de Farmacia y Bioquímica. Universidad Nacional Mayor de San Marcos, Lima, Perú. Material biológico: Ratas y aceite de copaiba. Intervenciones: Se colectó el aceite de copaiba en Ucayali, Pucallpa. La citoproteccción fue evaluada con indometacina, considerando un grupo control normal, indometacina, grupos de aceite de copaiba y omeprazol. Las lesiones de la mucosa gástrica fueron calificadas como las compatibles con necrosis local (tejido no viable), hiperemia, enrojecimiento presente y hemorragia, empleando la escala de puntaje observacional; y la úlcera, según la escala de Macallister modificado. El ensayo de antisecreción fue realizado por el modelo de ligadura del píloro, en el que 24 ratas albinas fueron divididas al azar en 3 grupos; un control, otro de aceite de copaiba 40mg/kg y un tercero de omeprazol 10 mg/kg. Después de 4 horas de ligazón, fueron sacrificados, extrayéndose los estómagos; con mucho cuidado se midió el volumen y se determinó el pH de la secreción gástrica, por potenciometría. Se realizó evaluación histopatológica según Devi. Principales medidas de resultados: Lesiones ulcerosas. Resultados: Los resultados indicaron 100% de efecto citoprotector con el aceite de copaiba y de 97,8% para el omeprazol (p, Objetives: To determine the gastroprotector effect of Copaifera officinalis oil using indomethacin and pyloric ligature in rats. Design: Preclinical study. Setting: Faculties of Medicine, Pharmacy and Biochemistry, National University of San Marcos, Lima, Peru. Biological material: Rats and copaiba oil. Interventions: Copaiba oil was collected in Ucayali, Pucallpa. Cytoprotection was tested with indomethacin considering a normal control group, and indomethacin, copaiba and omeprazole groups. Using visual analogue scale mucosa gastric injuries were referred as those compatible with local necrosis (unviable tissue), hyperemia, flushing, and hemorrhage, and ulcers according to the modified Macallister’s scale. The anti-secretion trial used the pyloric ligature model. Twenty-four albino rats were randomized in three groups: control, copaiba oil 40 mg/kg and omeprazole 10 mg/kg, respectively. After 4 hours of linkage, they were sacrificed. Stomachs were removed, their volume measured carefully and gastric secretion pH determined by potentiometry. Devis’s histopathological evaluation was used. Main outcome measures: Ulcerous injuries. Results: There was 100% cytoprotection with copaiba oil and 97,8% with omeprazole (p

Objetives: To determine the gastroprotector effect of Copaifera officinalis oil using indomethacin and pyloric ligature in rats. Design: Preclinical study. Setting: Faculties of Medicine, Pharmacy and Biochemistry, National University of San Marcos, Lima, Peru. Biological material: Rats and copaiba oil. Interventions: Copaiba oil was collected in Ucayali, Pucallpa. Cytoprotection was tested with indomethacin considering a normal control group, and indomethacin, copaiba and omeprazole groups. Using visual analogue scale mucosa gastric injuries were referred as those compatible with local necrosis (unviable tissue), hyperemia, flushing, and hemorrhage, and ulcers according to the modified Macallister’s scale. The anti-secretion trial used the pyloric ligature model. Twenty-four albino rats were randomized in three groups: control, copaiba oil 40 mg/kg and omeprazole 10 mg/kg, respectively. After 4 hours of linkage, they were sacrificed. Stomachs were removed, their volume measured carefully and gastric secretion pH determined by potentiometry. Devis’s histopathological evaluation was used. Main outcome measures: Ulcerous injuries. Results: There was 100% cytoprotection with copaiba oil and 97,8% with omeprazole (p