Background and objectives: immune system alteration in irritable bowel syndrome (IBS) patients may be modulated by probiotics. We assessed the efficacy of some probiotic species in alleviating characteristic IBS symptoms.Material and methods: a meta-analysis of all identified randomized controlled trials comparing probiotics with placebo in treating IBS symptoms was performed with continuous data summarized using standardized mean differences (SMDs) with 95% confidence intervals (95% CIs), where appropriate. The random-effects model was employed in cases of heterogeneity; otherwise, fixed-effects models were used.Results: meta-analysis was performed with 10 of 24 studies identified as suitable for inclusion. Probiotics improved pain scores if they contained Bifidobacterium breve (SMD, -0.34; 95% CI, -0.66; -0.02), Bifidobacterium longum (SMD, -0.48; 95% CI, -0.91; -0.06), or Lactobacillus acidophilus (SMD, -0.31; 95% CI, -0.61; -0.01) species. Distension scores were improved by probiotics containing B. breve (SMD, 95% CI, Conclusions: some probiotics are an effective therapeutic option for IBS patients, and the effects on each IBS symptom are likely species-specific. Future studies must focus on the role of probiotics in modulating intestinal microbiota and the immune system while considering individual patient symptom profiles. INTRODUCTIONDefining and treating irritable bowel syndrome (IBS) can be challenging. Among the wide variety of treatment options, probiotics appear to be one of the best options (1). Recently, growing evidence has suggested an alteration in the immune system cell profile of IBS patients and a close relationship between the immune and nervous systems (2,3). Furthermore, several authors have studied the relationship between probiotic intake and blood cytokine levels (4) or changes in fecal microbiota (5,6). Several reviews and meta-analyses that have evaluated the role of probiotics in IBS therapy have concluded that probiotics appear to improve overall IBS symptoms (7-12). However, a meta-analysis that includes any probiotic in the evaluation of symptom relief may not be the best method for assessing the efficacy of specific probiotics (11-13). Therefore, we assessed the efficacy of each specific probiotic species in alleviating characteristic IBS symptoms. Effect of probiotic species on irritable bowel ORIGINAL PAPERSOrtiz-Lucas M, Tobias A, Saz P, Sebastián JJ. Effect of probiotic species on irritable bowel syndrome symptoms: A bring up to date meta-analysis. Rev Esp Enferm

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We report a case of fatal gastrointestinal bleeding due to hepatic artery pseudoaneurysm diagnosed by means of endoscopy in a 66-year-old male who had undergone laparoscopic cholecystectomy the previous month. We think that the image is of remarkable interest and rarity.

Roux-en-Y gastric bypass, biliopancreatic diversion (BPD; Scopinaro's technique), and BPD with distal gastric preservation (BPDGP) are different surgical procedures, currently performed with laparoscopic assistance, successfully used as a treatment for morbid obesity. All of these modalities bear the burden of a difficult access when it comes to explore and work within the biliary tract. We present a case of acute cholangitis due to choledocholithiasis in a patient with BPDGP for morbid obesity successfully managed by laparoscopy-assisted endoscopic retrograde cholangiopancreatography through the gastric remnant.

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