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Introducción: el papel del farmacéutico comunitario ha adquirido mayor relevancia en el contexto de las restricciones derivadas por la pandemia de COVID-19. Objetivo del estudio: identificar el resultado de la indicación farmacéutica ante la consulta por diarrea o estreñimiento durante este período. Material y métodos: estudio observacional, transversal, multicéntrico y nacional. Se invitó a participar a los farmacéuticos comunitarios registrados en la base de datos Medynet. Los seleccionados se estratificaron por comunidades autónomas y población rural o urbana. La población de estudio fueron los pacientes que acudieron a las farmacias comunitarias desde enero a junio de 2021 por estreñimiento o diarrea. Resultados: un total de 121 farmacéuticos de un máximo establecido de 120 reclutaron a 849 pacientes (49,7 % consultaron por diarrea y un 50,3 % por estreñimiento). Un 83,5 % de farmacéuticos consideraba haber atendido un mayor número de consultas por síntomas digestivos, pero sin llegar a ser el doble que antes de la pandemia. En los pacientes con diarrea, dieta (76,9 %) y suero oral (64,2 %) fueron las indicaciones más frecuentes, mientras que en los pacientes con estreñimiento destacaron el aumento de la ingesta de agua (86,9 %), la dieta (84,1 %) y la indicación de algún medicamento de prescripción libre (68,1 %). 4 de cada 5 consultas farmacéuticas por diarrea o estreñimiento fueron resueltas en la farmacia comunitaria sin precisar derivación al médico. Conclusión: el presente estudio refuerza el papel destacado del farmacéutico comunitario como profesional de primera línea, realizando indicaciones farmacéuticas personalizadas a pacientes con diarrea o estreñimiento, contribuyendo de forma sustancial a la eficiencia y sostenibilidad del sistema sanitario durante la pandemia de COVID-19.

Background: Irritable bowel syndrome with diarrhoea (IBS-D) is a frequent problem associated with a significant socioeconomic implication. Increased gut permeability is an important pathophysiological mechanism. A medical device containing xyloglucan (XG), pea protein and tannins (PPT) from grape-seed extract, and xylo-oligosaccharides (XOS) has proven restoration of intestinal barrier function. Our objective was to evaluate the efficacy and safety of treatment with the medical device XG + PPT + XOS (XG-PPT-XOS) in adult patients with IBS-D in a clinical setting for 6 months. Material and methods: This was a multicentre, open-label, prospective, observational study conducted to evaluate long-term safety and efficacy of XG-PPT-XOS. IBS-D adult patients (Rome IV criteria) were included and received two tablets twice daily for 6 months. IBS Symptom Severity Score (IBS-SSS) and bowel habit were registered at baseline and monthly, until the end of follow up. Efficacy was evaluated by comparison of mean scores at each time point. Results: 50 patients were included, of which 19 completed the 6 months. IBS-SSS score decreased from 312.2 ± 82.2 to 213.6 ± 109.9 ( p

Granulomatous cheilitis, characterized by persistent inflammation of the lips and a granulomatous histology, is sometimes associated with Crohn’s disease and is a therapeutic challenge. Reported evidence indicates treatment with an anti-TNF agent (mainly infliximab) is the most recommended therapeutic option after failure of conventional treatments. The clinical case reported the effectiveness of ustekinumab, a monoclonal antibody against interleukins 12/23, to induce the remission of severe and recurrent granulomatous cheilitis in a patient with Crohn’s disease.

Background: Linaclotide is approved for the treatment of moderate-to-severe irritable bowel syndrome (IBS) with constipation (IBS-C) in adults. This study aimed to assess factors predictive of a clinical response and improvements in non-IBS symptoms with linaclotide treatment in a Spanish patient population. Methods: In this open-label phase IIIb study, patients with moderate-to-severe IBS-C received linaclotide 290 μg once daily for 12 weeks. The primary endpoint was clinical response at week 12, defined as >30% reduction in IBS symptom severity score (IBS-SSS) or IBS-SSS

Background. Nutritional deficiencies may aggravate the course of chronic hepatitis C (CHC). Our aim has been to perform a comprehensive analysis of body composition and nutritional deficiencies in CHC patients in non-cirrhotic and compensated cirrhotic stages to correlate the detected deficiencies with the fibrosis stage.Material and methods. Body multifrequency bioimpedance analysis (BIA) and a wide and simultaneous analytical profile were prospectively performed in 74 CHC patients (36 male) with known METAVIR fibrosis stage established with liver biopsy or transient elastography. Results were analyzed to identify deviations from the normal range and variations according to the fibrosis stage.Results. Body fat compartment was greater in women. Body composition did not change among the 4 stages of liver fibrosis. Low levels (< 30 μg/L) of vitamin D were detected in 74.3% of patients irrespective of the fibrosis stage. Most analytical results remained into the normal range with the exceptions of thrombocytopenia and vitamin A deficiency, that were limited to the stage 4 of fibrosis, and low Zn and LDL-cholesterol values, that were frequently found in patients with advanced (F3 and F4) fibrosis stage.Conclusion. Body composition and most biochemical parameters, including cyanocobalamin, folic acid and vitamin E, are well preserved in compensated patients with CHC, with the exception of generalized vitamin D insufficiency and of deficiencies of vitamin A and zinc that are restricted to the more advanced, although still compensated, stages of the disease.

Background: The aim of this study was to evaluate reliability of four different assays for measuring infliximab trough levels and antibodies to infliximab (ATI). Methods: In this non-interventional, cross-sectional study including IBD patients, infliximab levels and ATI were measured using four different assays: Lisa-Tracker, Promonitor, Q-Inflixi and Sanquin. Reliability and agreement for infliximab levels was assessed using the intraclass correlation coefficient (ICC) and Bland–Altman plots. Qualitative agreement for infliximab (based on a pre-established target window of trough levels between 3 µg/ml and 7 µg/ml) and for ATI were estimated by Cohen’s kappa. Results: Serum samples of 84 IBD patients were evaluated for infliximab using the four assays. Reliability was ‘substantial’ between Lisa-Tracker versus Promonitor and ‘almost perfect’ between the remaining assay pairs, with ICCs [95% confidence interval (CI)] ranging from 0.93 (0.70–0.97) for Lisa-Tracker versus Promonitor to 0.97 (0.95–0.98) for Q-Inflixi versus Sanquin. Bland–Altman plots showed significant bias between assays except Promonitor versus Q-Inflixi, which had excellent agreement. The greatest differences in mean infliximab were found between Promonitor versus Lisa-Tracker (–0.91 µg/ml) and Lisa-Tracker versus Q-Inflixi (0.69 µg/ml). Qualitative agreement for infliximab was ‘almost perfect’ for Promonitor versus Q-Inflixi (kappa 0.84) and Q-Inflixi versus Sanquin (kappa 0.81), and ‘substantial’ for the remaining pairs. More than 10% of patients who had infliximab levels within the target interval by Lisa-Tracker had suboptimal concentrations (7 µg/ml) by Lisa-Tracker. In the remaining paired comparisons, fewer than 5% of patients were placed in different subgroups. Qualitative agreement for ATI fluctuated between ‘moderate’ and ‘almost perfect’. Conclusions: All four assays seem suitable for therapeutic drug monitoring of infliximab. Promonitor and Q-Inflixi had the best agreement, making those assays fully interchangeable. Systematic biases between Lisa-Tracker with Promonitor and Q-Inflixi suggest that these assays should not be interchanged during the follow up of an individual patient.

Background and purpose of the study: This study assessed the experiences of irritable bowel syndrome patients with the healthcare system. Specifically, this study focused on the barriers that patients found. Methods: Three focus groups were conducted with the participation of 19 patients and 10 healthcare professionals. From this information a script of questions was designed and 33 structured interviews were conducted. Finally, a scale for evaluation of the perception of patients was designed for primary care (14 items) and gastroenterology (13 items). Internal consistency and construct validity were calculated. Results: The difficulties of accessibility, to clarify doubts, concerns regarding uncertainty, reduced information about prognosis and its social and labour effects were the most cited by patients. Low adherence and persistence in the treatment plan were the problems cited most often by professionals. The items of the scale for primary care were grouped into 4 factors (explained variance, 73%), while those for gastroenterology were grouped into 3 factors (explained variance, 67%). The internal consistency was 0.84 and 0.82, respectively. A total of 29 (88%) patients were satisfied with the care provided in gastroenterology, while 24 (73%) declared themselves satisfied with the primary care physician (Chi-square 2.4, p = 0.21). This study was carried out from November 2013 to July 2014. Conclusions: This study describes the most relevant problems in the assistance received by these patients.

Durante la última década las ciudades venezolanas han experimentado un proceso de transformación asociado a la expansión del mercado inmobiliario, los nuevos marcos de redistribución de la renta petrolera y la emergencia de nuevas subjetividades que, articuladas en movimientos sociales y populares, intervienen en la ciudad y lo urbano para transformarlo. En este artículo nos detendremos en dos casos que ejemplifican distintos procesos de producción social del suelo urbano y la ciudad: los Campamentos de Pioneros y la Gran Misión Vivienda Venezuela, para mirar a fondo los modos de reproducción y/o ruptura con el contexto de las desigualdades urbanas y las potencialidades de las prácticas sociales que, articuladas en el territorio, proponen el despliegue de nuevos tejidos urbanos.

Acute liver failure has a high mortality and its most frequent cause in Spain is viral infection. In this article, we present a case of fulminant liver failure. The failure is secondary to an idiosyncratic reaction to ibuprofen, an entity included in the DRESS syndrome. This syndrome plays a key role in the differential diagnosis of acute liver failure, since its unfortunate course often requires liver transplantation as the only useful therapeutic weapon. This case illustrates the need for an efficient coordination between hospitals as a key factor for improving the prognosis.

Background/aims: Nausea and vomiting of pregnancy (NVP) impact in the pregnant woman's quality of life, especially when are persistent or severe. The objective is to estimate the prevalence and factors associated with the persistence of NVP in each trimester of pregnancy. Methods: We studied a cohort of 263 pregnant women with gestational age < 12 weeks. Data were collected using the Gastro-Esophageal Reflux Questionnaire validated for use in the Spanish population. Data were collected through telephone interviews at the end of each trimester of pregnancy. The main variable was the presence of NVP in each trimester and their persistence along the pregnancy. Results: The prevalence of nausea in the each trimester was 63.5 %, 33.8 %, 26.2 %, and vomiting was 29.3 %, 22.1 %, 14.1 %, respectively. Factors associated with nausea in the first trimester were Latin-American origin (OR: 3.60, 95 %IC 1.61-80.5) and primary education (OR: 0.31; 0.13-0.73); vomiting was associated with Latin-American origin (OR: 13.80, 1.82-104.4) and was inversely associated with weight gain (OR: 0.58, 0.35-0.97). Persistence of NVP were only associated with suffering the symptom in the previous trimester (p < 0.01), and did not find other predictor factors. Conclusions: NVP's prevalence declines along pregnancy, is associated with race and inversely with weight gain, and its persistence over time cannot be predicted.

The Helicobacter genus includes Gram negative bacteria which were originally considered to belong to the Campylobacter genus. They have been classified in a separate genus since 1989 because they have different biochemical characteristics, with more than 24 species having been identified and more still being studied. H. pylori is the best known. It has an important etiopathogenic role in peptic ulcer disease and gastric cancer. Enterohepatic Helicobacter s (EHH) other than H. pylori colonize the bowel, biliary tree and liver of animals and human beings with pathogenic potential. The difficulties existing to correctly isolate these microorganisms limit the description of their true prevalence and of the diseases they cause. Many studies have tried to discover the different clinical implications of EHH. Diseases like chronic liver disease, autoimmune hepatitis, hepatocarcinoma, autoimmune hepatobiliary disease, biliary lithiasis, cholangiocarcinoma and gallbladder cancer, Meckel's diverticulum, acute appendicitis and inflammatory bowel disease have been related with different EHH species with different results, although their prevalence is greater than in healthy subjects. However, these data are currently not sufficient to draw definitive conclusions. Finally, the best known role of EHH in bowel disease is production of acute and chronic diarrhea pictures initially referred to as Campylobacter. H. pullorum has been identified in patients with acute gastroenteritis. The correct identification of EHH as producers of infectious gastroenteritis is found in its antibiotic susceptibility. It is generally macrolide-susceptible and quinolone-resistant.

Background: the Irritable Bowel Syndrome Severity Score (IBSSS) is a questionnaire only available in English that classifies IBS patients according to the severity of their symptoms and can be used to guide and monitor the treatment. Aims: to adapt and validate into Spanish the English version of the IBSSS questionnaire. Methods: the Spanish version of the questionnaire was obtained through a process of translation-evaluation of the comprehensibility and back translation. In a later phase we evaluated the applicability (n = 15), reproducibility (n = 31) and sensitivity to change (n = 40) of the Spanish version of the questionnaire. Finally we evaluated an alternative version of the ISBSS using a numerical scoring system instead of the original analog visual scale (n = 40). Results: the Spanish version of the IBSSS showed an excellent reproducibility (r = 0.81 for global score) and an adequate sensitivity to change: a decrease of 45 points or more identified worsening of IBS with a 70.6% sensitivity and 87.5% specificity; an increase of 45 points or more identified improvement of IBS with a 85.7% sensitivity and 87.5% specificity. The severity score was practically the same regardless of the scoring system used (r = 0.96). Conclusions: the Spanish version of the IBSSS is a reproducible tool that is able to identify relevant changes over the course of the disease. The use of a numerical scoring system is a valid alternative to the visual scale that improves the applicability of the questionnaire to situations when the written communication is limited or not possible.Introducción: el "Irritable Bowel Syndrome Severity Score" (IBSSS) es un cuestionario disponible solo en inglés, que permite clasificar a los pacientes con SII en función de su gravedad y sirve como guía para orientar y valorar la respuesta al tratamiento. Objetivos: adaptar y validar para su uso en pacientes españoles la versión inglesa del cuestionario de severidad del SII. Método: la versión española del cuestionario se obtuvo mediante un proceso de traducción-valoración de la comprensibilidad y retrotraducción. En una segunda fase se evaluaron la aplicabilidad (n = 15), reproducibilidad (n = 31) y sensibilidad al cambio (n = 40) de la versión en castellano del cuestionario. Finalmente, se confirmó la validez de una versión alternativa del cuestionario (n = 40) aplicando una escala de respuestas numérica en lugar de la original escala analógica visual. Resultados: el IBSSS mostró una excelente reproducibilidad (r = 0,81 para la puntuación global) y una adecuada sensibilidad al cambio; una disminución de 45 puntos o más mostró una sensibilidad del 70,6% y una especificidad del 87,5% para identificar mejoría, mientras un aumento de 41 puntos o más identificaba empeoramiento con una sensibilidad del 85,7% y una especificidad del 87,5%. La valoración de la gravedad mediante el uso de la escala numérica o visual es virtualmente idéntica (r = 0,96). Conclusiones: la versión española del IBSSS es un instrumento reproducible capaz de identificar cambios clínicamente relevantes. El uso de una escala de respuestas numérica es una alternativa valida a la visual, que mejora la aplicabilidad del cuestionario.

Backgrounds: irritable bowel syndrome (IBS) is a common and complex disorder. Though it is estimated that IBS constitutes an important part of the gastroenterology (GI) practice, the burden of this problem in the GI outpatients clinics in Spain is unclear. Aim: the aim of this study is to obtain a "shot" of the burden and management of this syndrome in the daily GI practice. Methods: 508 general gastroenterologists from all over the country were approached and asked to complete a survey that included questions about their daily practice and the definition, diagnosis and treatment of IBS. Results: 55% of the surveyed physicians estimate that IBS constitute between a quarter and a half of all their consultations; and pointed out that most of these patients were referred from primary care. Overall, the Spanish gastroenterologists show an adequate knowledge of the different diagnostic criteria, though they do not always follow the current guidelines. Up to 55% of the physicians always perform a complementary test to support their diagnosis and 40% order a diagnostic test only in older patients (> 50 years) or in presence of alarm symptoms. Interestingly, 80% of the gastroenterologists start empirical treatment based on the patients' symptoms. Conclusions: though Spanish gastroenterologists seem to have an adequate theoretical knowledge of the disease, they do not systematically follow current guidelines and tend to manage IBS symptoms based on their own criteria.Introducción: el síndrome de intestino irritable (SII) es un trastorno frecuente, aunque la magnitud de este problema y su complejidad en las consultas de digestivo en España no están bien caracterizadas. Objetivo: obtener conocimiento sobre cómo manejan clínicamente el SII los especialistas de aparato digestivo en España. Método: encuesta transversal realizada a 508 especialistas de aparato digestivo de toda España que incluía preguntas generales acerca de su práctica clínica diaria y específicas sobre la definición, el diagnóstico y el tratamiento del SII. Resultados: el 55% de los gastroenterólogos encuestados estima que los pacientes con SII representan entre un 25-50% del volumen de sus consultas; la mayoría referidos desde primaria para diagnóstico. En general los gastroenterólogos españoles refieren conocer los criterios diagnósticos clínicos, aunque la mayoría no basa su diagnóstico en ellos y suele solicitar alguna prueba complementaria para descartar organicidad. Pese a ello, un 80% de especialistas suele comenzar tratamiento enfocado al control de los síntomas sin esperar al resultado de las pruebas. Conclusiones: el SII es uno de los problemas más prevalentes en las consultas de aparato digestivo. Los gastroenterólogos españoles, pese a tener un buen conocimiento teórico de la enfermedad, no siempre se basan en la evidencia científica a la hora de diagnosticar y tratar a estos pacientes.

Background: pregnancy is associated with an increased incidence of heartburn. However, there is no information for other symptoms related to gastro-esophageal reflux (GOR). Aim: to assess the prevalence of atypical symptoms of GOR during pregnancy, and to examine its association with typical GOR symptoms. Methods: we report data for 263 women with a pregnancy of less than 12 weeks. They were interviewed at the end of each trimester of pregnancy and at 1-year post-partum, using the Gastro Esophageal Reflux Questionnaire (GERQ). In the first interview, information about symptoms in the year before pregnancy was also collected with GERQ. Results: women suffered atypical GOR symptoms during pregnancy more frequently than in the year before: non-cardiac chest pain (NCCP) (9.1 vs. 1.9%), dysphagia (12.6 vs. 2.3%), globus (33.1 vs. 4.6%), cough (26.6 vs. 6.8%), belching (66.2 vs. 19.4%) and hiccups (19.0 vs. 8.4%). Atypical GOR symptoms in pregnancy showed an association with suffering the same symptom before pregnancy and NCCP, globus, belching and hiccups with suffering typical GOR symptoms in the first trimester. Conclusions: atypical GOR symptoms are highly prevalent in pregnancy, and are associated with atypical symptoms before pregnancy and with typical symptoms of GOR in the first trimester.

The diffusion of sodium in green olives, variety Arauco/Criolla was quantitatively measured during the debittering process with lye of 1,50; 2,25 y 3,00%, at 20 ºC. With lye of 1,50%, the diffusion is apparently controlled by skin resistance resulting in smaller sodium concentrations and a more uniform debittering. With lye of 3,00%, the diffusion is more affected by flesh resistance, resulting in greater sodium concentrations and less uniform debittering. With lye of 2,25%, the diffusion of sodium is controlled by skin resistance at first and by flesh resistance thereafter. From this study, a final average concentration of 0,20 meq-Na/g-olive could be inferred as an appropriate treatment value. The experimental data were correlated with the equation: C=Ci+A*t-B (t=diffusion time), then A and B were correlated with sodium penetration distances.

BACKGROUND: There are no existing studies that provide data regarding the epidemiology of, and risk factors for, fecal impaction, either in the general population or in any sub-group of people. OBJECTIVE: Estimate the prevalence of and factors associated with fecal impaction on a representative sample of the institutionalized elderly population. DESIGN: Two-phase study. Phase 1: pilot study validating the methodology in which all residents of a single nursing home participated. Phase 2: national multi-center cross-sectional study. SETTING: 34 randomly selected nursing homes. MEASUREMENTS: The presence of fecal impaction and associated factors were evaluated using three different tools: data collected from medical records; a self-completion questionnaire filled out by the subjects or a proxy; and a rectal examination. SUBJECTS: Older subjects living in nursing homes. RESULTS: The prevalence of chronic constipation was 70.7% (95%CI: 67.3-74.1%), of which 95.9% of patients were properly diagnosed and 43.1% were properly controlled. The prevalence of FI according to patient history was 47.3% (43.6-51.0%) and 6.6% (4.7-8.5%) according to rectal examination. Controlled constipation (OR: 9.8 [5.2-18.4]) and uncontrolled constipation (OR: 37.21 [19.7-70.1]), the number of medications (OR: 1.2 [1.1-1.3]), reduced functional capacity (OR: 0.98 [0.97-0.99]) and the occasional use of NSAIDs were independent risk factors for fecal impaction. CONCLUSIONS: Constipation affects more than 70% of people living in nursing homes. Although it is properly diagnosed in more than 95% of cases, the disease is only controlled in less than 50%. Constipation, especially when not controlled, is the most significant risk factor leading to fecal impaction, which is prevalent in almost 50% of this population.

Whipple's disease is a chronic systemic infection produced by the actinomycete Tropheryma whipplei. Endoscopic tests are key in the diagnosis as they allow biopsy and histopathological examination for definitive diagnosis of this entity. We present a case of Whipple's disease where capsule endoscopy, uncommon for the diagnosis of this condition, was essential for it and its performance before and after antibiotic treatment allows to describe the macroscopic evolution of the findings in the small bowel. This case illustrates the usefulness of capsule endoscopy to allow complete examination of the small bowel disease in which up to 30% of patients may present with normal endoscopy.

In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.

Irritable bowel syndrome and functional constipation represent a relevant and common health issue. However, real-world clinical practice includes patients with constipation who may or may not have other abdominal complaints (pain, bloating, abdominal discomfort) with variable frequency. The goal of the present study was to obtain information on the workload entailed by patients with constipation and associated abdominal complaints, predominant clinical behaviors, education needs, and potential daily practice aids both in Primary Care and gastroenterology settings. The clinical behavior of doctors is generally similar at both levels, despite differences in healthcare approach: use of empiric therapies and clinically guided diagnostic tests, with some differences in colonoscopy use (not always directly accessible from Primary Care). Regarding perceptions, general support and osmotic laxatives are most valued by PC doctors, whereas osmotic laxatives, combined laxatives, and linaclotide are most valued by GE specialists. Furthermore, over half of respondents considered differentiating both diagnoses as challenging. Finally, considerable education needs are self-acknowledged at both levels, as is a demand for guidelines and protocols to help in managing this issue in clinical practice. A strength of this study is its providing a joint photograph of the medical approach and the perceptions of constipation with abdominal discomfort from a medical standpoint. Weaknesses include self-declaration (no formal validation) and a response rate potentially biased by professional motivation.