Dysbiosis, a loss of balance between resident bacterial communities and their host, is associated with multiple diseases, including inflammatory bowel diseases (nonspecific chronic ulcerative colitis and Crohn’s disease), and digestive functional disorders. Probiotics, prebiotics, synbiotic organisms and, more recently, pharmabiotics, have been shown to modulate the human microbiota. In this review, we provide an overview of the key concepts relating to probiotics, prebiotics, synbiotic organisms, and pharmabiotics, with a focus on available clinical evidence regarding the specific use of a unique pharmabiotic, the strain Lactobacillus acidophilus LB ( Lactobacillus boucardii), for the management of gastrointestinal disorders. Since it does not contain living organisms, the administration of L. acidophilus LB is effective and safe as an adjuvant in the treatment of acute diarrhea, chronic diarrhea, and antibiotic-associated diarrhea, even in the presence of immunosuppression.
Since the publication of the 2007 dyspepsia guidelines of the Asociación Mexicana de Gastroenterología, there have been significant advances in the knowledge of this disease. A systematic search of the literature in PubMed (01/2007 to 06/2016) was carried out to review and update the 2007 guidelines and to provide new evidence-based recommendations. All high-quality articles in Spanish and English were included. Statements were formulated and voted upon using the Delphi method. The level of evidence and strength of recommendation of each statement were established according to the GRADE system. Thirty-one statements were formulated, voted upon, and graded. New definition, classification, epidemiology, and pathophysiology data were provided and include the following information: Endoscopy should be carried out in cases of uninvestigated dyspepsia when there are alarm symptoms or no response to treatment. Gastric and duodenal biopsies can confirm Helicobacter pylori infection and rule out celiac disease, respectively. Establishing a strong doctor-patient relationship, as well as dietary and lifestyle changes, are useful initial measures. H2-blockers, proton-pump inhibitors, prokinetics, and antidepressants are effective pharmacologic therapies. H.pylori eradication may be effective in a subgroup of patients. There is no evidence that complementary and alternative therapies are beneficial, with the exception of Iberogast and rikkunshito, nor is there evidence on the usefulness of prebiotics, probiotics, or psychologic therapies. The new consensus statements on dyspepsia provide guidelines based on up-to-date evidence. A discussion, level of evidence, and strength of recommendation are presented for each statement.
La enfermedad por reflujo gastroesofágico (ERGE) es sumamente prevalente en nuestro medio. Sus síntomas son variados y los mecanismos fisiopatológicos son múltiples. Por lo tanto, el diagnóstico de esta entidad suele ser complejo. Han sido descriptos una serie de métodos diagnósticos. No obstante, el patrón de oro continúa siendo el tiempo de exposición ácida, medido durante el monitoreo ambulatorio de reflujo a través de pH-metría. El objetivo de este primer consenso latinoamericano fue evaluar críticamente, sobre la base de las mejores evidencias disponibles a la fecha, los diferentes métodos diagnósticos propuestos para la ERGE y emitir recomendaciones consensuadas luego de la discusión entre un grupo de expertos y una votación. Este consenso fue desarrollado por un grupo de expertos a partir de una búsqueda sistemática de la literatura y utilizando la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para la evaluación de la calidad de la evidencia y la decisión de la fuerza de recomendación. Se emitieron recomendaciones en cuanto a la utilidad de diferentes métodos diagnósticos en relación con la ERGE.
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