title: The Mexican consensus on probiotics in gastroenterology.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology.
  
  
  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>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement.
  
  
  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 and pouchitis, and the treatment of covert and overt hepatic encephalopathy.
authors.affiliation: Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México. Electronic address: miguelvaldovinosd@gmail.com.
authors.forename: M A
authors.initials: MA
authors.lastname: Valdovinos
authors.affiliation: Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: E
authors.initials: E
authors.lastname: Montijo
authors.affiliation: Servicio de Gastroendoscopia, Hospital Regional n.(o) 2 con Unidad de Medicina de Atención Ambulatoria, IMSS, Ciudad de México, México.
authors.forename: A T
authors.initials: AT
authors.lastname: Abreu
authors.affiliation: Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México.
authors.forename: S
authors.initials: S
authors.lastname: Heller
authors.affiliation: Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: A
authors.initials: A
authors.lastname: González-Garay
authors.affiliation: Hospital Infantil de las Californias, Tijuana, BC, México.
authors.forename: D
authors.initials: D
authors.lastname: Bacarreza
authors.affiliation: Unidad de Pacientes en Estudio, Universidad Autónoma de Guadalajara, Zapopan, Jalisco, México.
authors.forename: M
authors.initials: M
authors.lastname: Bielsa-Fernández
authors.affiliation: UMAE Hospital de Pediatría, Centro Médico Nacional de Occidente, IMSS, , Guadalajara, Jalisco, México.
authors.forename: M C
authors.initials: MC
authors.lastname: Bojórquez-Ramos
authors.affiliation: Departamento de Medicina Interna, División de Gastroenterología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L., México.
authors.forename: F
authors.initials: F
authors.lastname: Bosques-Padilla
authors.affiliation: Departamento de Epidemiología Genética e Infecciones, CISEI, INSP, Cuernavaca, Mor., México.
authors.forename: A I
authors.initials: AI
authors.lastname: Burguete-García
authors.affiliation: Práctica privada, San Luis Potosí, S.L.P., México.
authors.forename: R
authors.initials: R
authors.lastname: Carmona-Sánchez
authors.affiliation: Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
authors.forename: A
authors.initials: A
authors.lastname: Consuelo-Sánchez
authors.affiliation: Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
authors.forename: E
authors.initials: E
authors.lastname: Coss-Adame
authors.affiliation: Departamento de Gastroenterología Pediátrica, UMAE Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, IMSS, Ciudad de México, México.
authors.forename: J A
authors.initials: JA
authors.lastname: Chávez-Barrera
authors.affiliation: Servicio de Gastroenterología, Hospital Español, Ciudad de México, México.
authors.forename: M
authors.initials: M
authors.lastname: de Ariño
authors.affiliation: Departamento de Gastroenterología y Endoscopia, UMAE Hospital de Pediatría Dr. Silvestre Frenk Freund, Centro Médico Nacional Siglo XXI, Ciudad de México, México.
authors.forename: J
authors.initials: J
authors.lastname: Flores-Calderón
authors.affiliation: Clínica de Gastroenterología, Endoscopia Digestiva y Motilidad Gastrointestinal, Hospital Ángeles Puebla, Puebla, México.
authors.forename: O
authors.initials: O
authors.lastname: Gómez-Escudero
authors.affiliation: Departamento de Gastroenterología, Centro Médico Issemym, Metepec, Estado de México, México.
authors.forename: M S
authors.initials: MS
authors.lastname: González-Huezo
authors.affiliation: Hospital Star Médica, Mérida, Yucatán, México.
authors.forename: M E
authors.initials: ME
authors.lastname: Icaza-Chávez
authors.affiliation: Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México.
authors.forename: A
authors.initials: A
authors.lastname: Larrosa-Haro
authors.affiliation: Práctica privada, Guadalajara, Jalisco, México.
authors.forename: M
authors.initials: M
authors.lastname: Morales-Arámbula
authors.affiliation: Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: C
authors.initials: C
authors.lastname: Murata
authors.affiliation: Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: J A
authors.initials: JA
authors.lastname: Ramírez-Mayans
authors.affiliation: Laboratorio de Motilidad y Fisiología Digestiva, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana (UV), Veracruz, México.
authors.forename: J M
authors.initials: JM
authors.lastname: Remes-Troche
authors.affiliation: Servicio de Gastroenterología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Ciudad de México, México.
authors.forename: T
authors.initials: T
authors.lastname: Rizo-Robles
authors.affiliation: Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
authors.forename: M
authors.initials: M
authors.lastname: Peláez-Luna
authors.affiliation: Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México.
authors.forename: E M
authors.initials: EM
authors.lastname: Toro-Monjaraz
authors.affiliation: Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
authors.forename: A
authors.initials: A
authors.lastname: Torre
authors.affiliation: Servicio de Gastroenterología Pediátrica y Endoscopia, Hospital Regional ISSSTE, Monterrey, N.L., México.
authors.forename: M E
authors.initials: ME
authors.lastname: Urquidi-Rivera
authors.affiliation: Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
authors.forename: R
authors.initials: R
authors.lastname: Vázquez
authors.affiliation: Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
authors.forename: J K
authors.initials: JK
authors.lastname: Yamamoto-Furusho
authors.affiliation: Servicio de Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Guarner
mesh_terms: D000328:Adult; D002648:Child; D003697:Delphi Technique; D005762:Gastroenterology; D017408:Guidelines as Topic; D006801:Humans; D008800:Mexico; D019936:Probiotics / Q000627:therapeutic use*
keywords: Adultos; Adults; Children; Consenso; Consensus; Enfermedades gastrointestinales; Gastrointestinal diseases; Mexico; México; Niños; Probiotics; Probióticos