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Introduction: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. Aim: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. Materials and methods: Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement of >70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. Results and conclusions: Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis (UC) and pouchitis, and the treatment of covert and overt hepatic encephalopathy.

Introducción: El uso de los probióticos es común en la práctica clínica. Existe un número significativo de estudios que apoyan la eficacia de los probióticos en algunos trastornos digestivos. Sin embargo, el desconocimiento de la evidencia científica y las diferentes presentaciones y composiciones microbianas de los probióticos disponibles dificultan su prescripción. Objetivo: Proveer al clínico de una revisión consensuada sobre los probióticos y recomendaciones de su uso en gastroenterología. Material y métodos: Se seleccionaron los ensayos clínicos controlados, metaanálisis y revisiones sistemáticas publicados hasta 2015, usando los términos MESH: probiotics, gastrointestinal diseases, humans, adults and children. Se utilizó la metodología Delphi. Diecisiete gastroenterólogos de adultos y 12 de niños elaboraron enunciados los cuales fueron votados hasta obtener acuerdo > 70%. Para cada enunciado se evaluó el nivel de evidencia basado en el sistema GRADE. Resultados y conclusiones: Se generaron 11 enunciados sobre conceptos generales de probióticos y 27 enunciados sobre uso de probióticos en enfermedades gastrointestinales tanto en niños como en adultos. El grupo de consenso recomienda el uso de probióticos en las siguientes condiciones clínicas: prevención de la diarrea asociada a antibióticos, tratamiento de la diarrea aguda infecciosa, prevención de infección por Clostridium difficile y enterocolitis necrosante, para disminuir los eventos adversos de la terapia de erradicación del Helicobacter pylori, el alivio de los síntomas del síndrome de intestino irritable, en el estreñimiento funcional del adulto, para inducir y mantener la remisión en pacientes con colitis ulcerosa crónica idiopática y pouchitis, y en la encefalopatía hepática oculta y manifiesta.

Introduction and Objectives: The hepatitis A virus in our country is an endemic disease with a benign course that presents in early stages of life, generating lasting immunity so that the frequency of presentation decreases in adulthood. Serious cases often occur at the extremes of life. We have observed an increase in cases of Hepatitis A requiring hospitalization with severe liver dysfunction.This study aimed to determine the clinical, biochemical, complications, and mortality characteristics of patients with acute hepatitis A virus admitted to a tertiary-level hospital. Materials and Patients: A descriptive, cross-sectional, retrospective, observational study was carried out in patients with acute hepatitis A virus hospitalized in the Gastroenterology service of the Hospital de Especialidades CMN La Raza from February 2022 to April 2023. Age, gender, clinical presentation, complications, and comorbidities were assessed. The results were analyzed with relative and central frequency measures to obtain percentages, mean, and arithmetic mean. Results: 31 patients were registered, 29 men (94%) and two women (6%). The average age was 35 years (18-56). 11 patients (35%) presented acute liver failure, and 1 case was a prolonged cholestatic atypical hepatitis. The most frequent complications presented during the hospital stay were the following: coagulopathy (INR>1.5) 64%, acute kidney injury 38%, anemia 35%, encephalopathy 35% (Table 1). Mortality was 13% (4 patients) due to acute liver failure and without comorbidities. The average of relevant biochemical alterations: AST 1849 U/L, ALT 2602 U/L, total bilirubin 18.24 mg/dL, creatinine 2.05 mg/dL, INR 2.56. (Table 2). 64% of patients had no comorbidities. The comorbidities found were cirrhosis, polycystic liver disease, essential thrombocytosis, multiple sclerosis, Evans syndrome, arterial hypertension, diabetes, obesity, dyslipidemia and HIV. Conclusions: The presence of acute liver failure and mortality in our population was high in comparison to what has been reported in the international literature. Coagulation disorders, acute kidney injury and anemia were the most frequent complications in our cases of hepatitis A. It was relevant that most of the patients were

Introduction and Objectives: There are physiological changes in the hepatobiliary system during pregnancy. However, there are also pregnancy-related liver diseases, which occur in up to 3% of all pregnancies and can have potentially serious consequences for the mother and fetus. The most frequent are hyperemesis gravidarum, preeclampsia/eclampsia, elevated liver enzymes and low platelet count syndrome (HELLP), intrahepatic cholestasis of pregnancy (ICP) and acute fatty liver of pregnancy (AFLP). The prognosis depends on timely diagnosis and treatment. This study aimed to report the epidemiological characteristics of liver diseases in a Mexican population of pregnant women. Materials and Patients: A retrospective descriptive observational study that included information collected from the electronic file of pregnant patients treated at UMAE HGO No. 3, of CMN La Raza, assessed by the Gastroenterology service of HE CMN “La Raza” in the period March 2021- May 2023. Results: 142 patients were included, the mean age was 30 years, 54% were multiparous women, 8.4% of the patients were in the first trimester, 27% in the second trimester and 64% in the third trimester. In our total sample, alterations in liver biochemistry that met clinical and biochemical criteria for pregnancy-associated liver disease were analyzed, where 49% reported hypertransaminasaemia due to etiologies such as preeclampsia, HELLP syndrome, metabolic dysfunction associated fatty liver disease (MAFLD) and biliary pathology, 41% met criteria for ICP, 6% hyperemesis gravidarum, 1.4% were diagnosed with portal hypertension and liver cirrhosis, only 0.7% were diagnosed with autoimmune hepatitis and AFLP. Conclusions: Based on solicited assessments over a 2-year period of women at any stage of pregnancy, hospitalized due to changes in liver biochemistry, most changes occurred In the third trimester of pregnancy, the most frequent disorder was intrahepatic cholestasis of the pregnancy, the rest of the pathologies were included in the hypertransaminasaemia group, where the most frequent causes were: MAFLD and cholelithiasis, less frequently: preeclampsia, HELLP syndrome or intrahepatic bile duct disorders.

Introduction and Objectives: : Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, there are approximately 71 million infected individuals worldwide, up to 40% of them will have spontaneous resolution and60% will develop chronic infection with risk of developing cirrhosis and hepatocellular carcinoma.In Mexico it is the fourth cause of death and one of the main causes of disability. Current HCV treatment with direct-acting antivirals (ADDs) has a high rate of sustained viral response that ensures the cure of the infection, decreases the progression of liver fibrosis and decompensation rates in patients with cirrhosis. This study aimed to describe the demographic and clinical characteristics of patients with chronic HCV infection, treated at a third-level care hospital in Mexico City. Materials and Patients: A retrospective cohort study in a part of the patients from the HCV clinic of an IMSS third-levelhospital, which included cases with confirmed HCV infection, who received treatment with direct-acting antivirals +/- ribavirin, in the period of 2017-2022. Results: Data from 222 treated patients was collected; a mean age of 53 years was reported, with a male-female ratio of 1:1. Among candidates for treatment with direct-acting antivirals 50.5% had advanced chronic liver disease at the time of diagnosis. Of these patients 76.1% were classified as a compensated chronic liver disease with a stage of Child Pugh A and 86.7% had a MELD-Na score of less than 14 points. The sustained virologic response rate in this population was 99%. Conclusions: It was observed that the collected treated population was on average in the sixth decade of life, with no gender predilection. Half of this population had advanced chronic liver disease at the time of diagnosis and initiation of treatment with direct antivirals. The majority of patients were in a compensated stage by Child Pugh, and showed a low MELD-Na score which was favorable for follow-up and subsequent management.