Los nuevos criterios de Roma (IV) de los trastornos funcionales digestivos en la práctica clínica

Para un digestólogo, Roma, además de ser la Ciudad Eterna y la capital del Imperio Romano en la antigüedad, es la ciudad donde se han ido reuniendo periódicamente, desde el año 1992, un grupo de expertos en trastornos funcionales digestivos (TFD) —la última vez en el mes de mayo de este año— para discutir y revisar los criterios diagnósticos de los mismos, que son muchos más que los más conocidos por todos, la dispepsia funcional (DF) y el síndrome del intestino irritable (SII). En otro orden de cosas, escribía Baltasar Gracián, mi paisano, en su Oráculo manual, 232: «¿De qué sirve el saber si no es práctico?». Y, yo, añado: «… y se utiliza», a la vez que me pregunto: ¿De qué sirve disponer de los nuevos criterios Roma IV de los TFD, que tanto trabajo y tiempo ha llevado desarrollarlos, si no es para utilizarlos en la práctica clínica del día a día, en las consultas de digestología, medicina interna o medicina familiar y comunitaria? (...

Síndrome del intestino irritable: lo (pen)último sobre lo que se está investigando

Sobre el síndrome del intestino irritable (SII) todos los licenciados o graduados en Medicina, y los propios pacientes, hemos leído, escuchado y comentado algunos aspectos, información más o menos reciente y contrastada, procedente de libros, artículos de revistas, cursos, conferencias, Internet, etc., que no se trata de repetir aquí. Lo que pretende este editorial es repasar y hacer llegar a los lectores de Medicina Clínica los últimos avances científicos, las últimas evidencias que se están publicando sobre este trastorno, tan frecuente como poco (o no demasiado) conocido todavía...

El kéfir: tan desconocido como beneficioso para la salud

El kéfir es una antigua leche fermentada que contiene una compleja microbiota. Los granos de kéfir están compuestos por péptidos bioactivos y polisacáridos dónde está confinada una compleja comunidad simbiótica de bacterias ácido lácticas, levaduras y bacterias ácido acéticas, que cohabitan en un equilibro específico. Su principal polisacárido es el kefirán, que es el compuesto del kéfir al que se atribuyen la mayor parte de las propiedades, entre las que se incluyen la mejora de la digestión y la tolerancia a la lactosa, el efecto antibacteriano, control de la hipercolesterolemia, control de la glucosa en plasma, efecto antihipertensivo, efecto antiinflamatorio, anticancerígeno y antialérgico. En este artículo se revisan los aspectos más destacados de este alimento funcional y agente biológico, tan desconocido como beneficioso para la salud humana

Afectación del aparato digestivo en la COVID-19. Una revisión sobre el tema

La pandemia por el SARS-CoV-2 está conllevando una elevada mortalidad y suponiendo una crisis sanitaria a nivel mundial. La afectación fundamental es respiratoria; sin embargo, el virus también puede afectar a otros órganos, como el tracto gastrointestinal y el hígado. Los síntomas más habituales son anorexia y diarrea. Aproximadamente, en la mitad de los casos se podría detectar RNA viral en heces, lo que constituye otra línea de transmisión y diagnóstico. La COVID19 tiene peor pronóstico en pacientes con comorbilidades, aunque no existe evidencia suficiente en caso de patologías digestivas previas. Las endoscopias digestivas pueden originar aerosoles, que las convierten en técnicas con elevado riesgo de infección. Expertos y organizaciones científicas a nivel mundial han elaborado guías de funcionamiento para adoptar medidas de prevención. Se revisan las evidencias disponibles sobre la afectación gastrointestinal y hepática, la repercusión en pacientes con enfermedades digestivas previas y guías de funcionamiento para Unidades de Endoscopia durante la pandemia. ABSTRACT The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. COVID19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Background: Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90-90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods: A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results: Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions: This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 ± 5.2 mm vs 19.9 ± 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 +/- 20.6% vs 93.6 +/- 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 +/- 5.2 mm vs 19.9 +/- 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment