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Migrant patients share the same diseases as natives, but biological or environmental differences may lead to distinct prevalence and manifestations of certain syndromes. Some common conditions in Primary Care stand out, such as fever, diarrhea, anemia, eosinophilia, and chronic cough, where it is important to have a special consideration. Fever may indicate a serious imported illness, and malaria should always be ruled out. Diarrhea is generally of infectious origin, and in most cases, management is outpatient. Anemia may indicate malnutrition or malabsorption, while eosinophilia may indicate a parasitic infection. Lastly, chronic cough may be a sign of tuberculosis, especially in immigrants from endemic areas. Family medicine holds a privileged position for the comprehensive, culturally sensitive, and person-centered approach to these conditions.

The development of the immune checkpoint inhibitors (ICI) is one of the most remarkable achievements in cancer therapy in recent years. However, their exponential use has led to an increase in immune-related adverse events (irAEs). Gastrointestinal and liver events encompass hepatitis, colitis and upper digestive tract symptoms accounting for the most common irAEs, with incidence rates varying from 2% to 40%, the latter in patients undergoing combined ICIs therapy. Based on the current scientific evidence derived from both randomized clinical trials and real-world studies, this statement document provides recommendations on the diagnosis, treatment and prognosis of the gastrointestinal and hepatic ICI-induced adverse events.

Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self-esteem, and interferes with everyday activities, in turn, favoring social isolation. There are no guidelines or consensus in Mexico on the topic, and so the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, neurogastroenterologists, and surgeons) to carry out the «Mexican consensus on fecal incontinence» and establish useful recommendations for the medical community. The present document presents the formulated recommendations in 35 statements. Fecal incontinence is known to be a frequent entity whose incidence increases as individuals age, but one that is under-recognized. The pathophysiology of incontinence is complex and multifactorial, and in most cases, there is more than one associated risk factor. Even though there is no diagnostic gold standard, the combination of tests that evaluate structure (endoanal ultrasound) and function (anorectal manometry) should be recommended in all cases. Treatment should also be multidisciplinary and general measures and drugs (lidamidine, loperamide) are recommended, as well as non-pharmacologic interventions, such as biofeedback therapy, in selected cases. Likewise, surgical treatment should be offered to selected patients and performed by experts.

OBJECTIVE: No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children.
METHODS: We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances).
RESULTS: The sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P < .01), with no significant differences in the development of adverse events.
CONCLUSIONS: The PEG 3350 + E treatment protocol for constipation in critically ill children was effective and associated with few adverse events, even in children aged less than 2 years.

Primary eosinophilic gastrointestinal diseases (EGID) are chronic inflammatory disorders of the gastrointestinal tract with unknown etiology. Features, utility, and evolution are still unknown in screening for EGID in adult patients with eosinophilic esophagitis (EoE).
To evaluate the prevalence, characteristics, comorbidities, and evolution of EGID in adults diagnosed with EoE and investigate differences between both groups.
Prospective unicenter observational and analytical study. Gastric and duodenal biopsies were obtained during upper baseline endoscopy in all consecutive EoE adult patients evaluated. A colonoscopy with colon biopsies was performed upon persistent diarrhea and normal duodenal biopsies.
212 EoE patients were included. Nine patients (4.3%) also showed significant eosinophilic infiltration in at least one organ within the digestive tract. The most common site affected was the small bowel (78%). Gastrointestinal symptoms (43% vs. 100%, p<0.002) and, more specifically, either abdominal pain or diarrhea (17% vs. 78%, p<0.001), some food sensitizations, and digestive comorbidities (p<0.05) were significantly more common in patients with EGID. Gastrointestinal symptoms were present in 94/212 (44%) patients, of whom 9 (10%) had EGID. Considering only abdominal pain or diarrhea, 20% suffered from it.
EGID rarely coexist with EoE, even when gastrointestinal symptoms are present. These findings advise against routine gastric, duodenal, or colon biopsies in adult EoE patients with gastrointestinal symptoms. Most of the characteristics of EoE do not change due to having EGID except gastrointestinal symptoms, digestive comorbidities, and sensitizations to some foods. The evolution was generally favorable despite intermittent adherence to treatment, especially maintenance.

BACKGROUND: Campylobacter spp. is the leading cause of bacterial enteritis in industrialized countries, but the literature about its recurrence is scarce. The objective of this study is to analyze a case series of recurrent campylobacteriosis in adult and pediatric patients.
METHODS: During a two-year period, the demographic, clinical and microbiological data were collected retrospectively from patients who met the clinical criteria of recurrent Campylobacter spp. gastroenteritis. Enteropathogens were identified by a multiplex-PCR gastrointestinal pathogens panel. When Campylobacter spp. was detected, the stool sample was cultured in specific medium and tested for antibiotic susceptibility.
RESULTS: Twenty-four (2.03%) out of 1180 patients with Campylobacter spp. positive-PCR met the inclusion criteria. Thirteen patients suffered from underlying diseases, and 11 had no known risk factors but they were all pediatric patients. From the 24 patients were documented 70 episodes. One patient had two episodes of bacteremia. Coinfection/co-detection with other enteropathogens was found in 10 patients being Giardia intestinalis the most frequent. Twelve (22.6%) out of 53 isolates were resistant to macrolides. One patient had two isolates of multi-drug resistant C. coli, only susceptible to gentamicin.
CONCLUSIONS: The results suggest the presence of underlying diseases in most adult patients with recurrent Campylobacter spp. infections, particularly primary immunodeficiency. Most of the pediatric patients with recurrent campylobacteriosis lack of known risk factors. Concomitant detection with other enteropathogens was common. The resistance to macrolides was much higher as compared with previous reported rates.

The role of Aeromonas species in gastrointestinal disease is controversial. The aim of this study was to know the epidemiological distribution of Aeromonas spp. isolated from stool in our health area, determine the existence of diarrhea as a significant symptom, identification of existing species in our environment and association as co-pathogen.
It was a retrospective descriptive study of isolates of Aeromonas spp. in feces (2016-2020). The protocol for these isolates included coproculture, identification by MALDI-TOF (Vitek-MS®, BioMerieux) and confirmation by multiplex PCR.
A total of 366 Aeromonas spp. isolates were analyzed being Aeromonas caviae the most prevalent species (289, 78.7%). A total of 58 (15.8%) co-infections were identified, being more frequent in pediatric age (49;84.5%) (p=0.01) and mostly associated with Campylobacter spp.
Aeromonas spp. prove to be a gastrointestinal pathogen more frequently associated with co-infections in pediatric age, evidencing its appearance especially with Campylobacter spp.

Paracoccidioidomycosis is a systemic infection caused by the fungus Paracoccidioides. It may present in two forms: an acute/subacute form, whose most frequent manifestations include weight loss, fever, anemia, and adenopathy, and a chronic condition with mainly respiratory symptoms. Digestive symptoms, although they may occur, are not frequently reported. Paracoccidioidomycosis usually affects adult male agricultural workers; thus, its presentation in children is rare.
We describe the case of a 9-year-old male patient diagnosed with paracoccidioidomycosis, who showed abdominal pain and diarrhea as initial manifestations of the disease.
This case is reported not only because of the age of presentation but also due to the existence of digestive symptoms from the onset of the disease, both infrequently reported in the literature.
La paracoccidioidomicosis es una infección sistémica producida por el hongo Paracoccidioides. Se puede presentar de dos formasuna forma aguda/subaguda, cuyas manifestaciones más frecuentes incluyen pérdida de peso, fiebre, anemia y adenopatías, y una forma crónica con manifestaciones principalmente respiratorias. Las manifestaciones digestivas, aunque pueden presentarse, no se reportan frecuentemente. La paracoccidioidomicosis afecta usualmente a varones adultos que trabajan en labores agrícolas, por lo que su presentación en niños es poco frecuente.
Se describe el caso de un paciente de sexo masculino de 9 años de edad con diagnóstico de paracoccidioidomicosis, con dolor abdominal y diarrea como manifestaciones iniciales de la enfermedad.
Se reporta este caso, no solamente por la edad de presentación, sino también por la existencia de síntomas digestivos desde el inicio de la enfermedad, ambos reportados en forma infrecuente en la literatura.

BACKGROUND: Outbreaks of equine coronavirus (ECoV) infections have been described in different parts of the world including Europe. The aim of this report was to describe clinical signs, diagnostic work-up and outcome of the first documented outbreak of ECoV in Switzerland in order to raise the awareness for the disease and its various clinical presentations. The outbreak occurred on a farm with 26 horses. Of these, seven horses developed clinical disease ranging from mild signs such as fever and anorexia to severe signs of acute colitis. One horse died due to severe endotoxemia and circulatory shock secondary to severe acute necrotizing enteritis and colitis. Out of the 26 horses, five horses tested positive for ECoV, including two ponies without any clinical signs of infection. The low number of positive cases should nevertheless be interpreted with caution as testing was only performed on one occasion, over a month after the onset of clinical signs in the first suspected case. This report highlights the importance of diagnostic testing and early implementation of biosecurity measures on a farm with an ECoV outbreak. It should furthermore raise the awareness for unspecific and mild clinical signs such as fever and anorexia in affected animals that are potentially able to spread the disease.
BACKGROUND: Ausbrüche von Infektionen mit dem Equinen Coronavirus (ECoV) wurden in verschiedenen Teilen der Welt, einschliesslich Europa, beschrieben. Das Ziel dieses Berichts war es, klinische Anzeichen, diagnostische Aufarbeitung und die Ergebnisse des ersten dokumentierten Ausbruchs von ECoV in der Schweiz zu beschreiben, dies um das Bewusstsein für die Krankheit und ihre verschiedenen klinischen Präsentationen zu schärfen. Der Ausbruch ereignete sich auf einem Reitstall mit 26 Pferden. Sieben Pferde entwickelten eine klinische Erkrankung, die von leichten Krankeitsanzeichen wie Fieber und Anorexie bis zu einer schweren, akuten Kolitis reichte. Ein Pferd verstarb an einer schweren Endotoxämie mit Kreislaufschock infolge einer schweren akuten nekrotisierenden Enteritis und Kolitis. Von den 26 Pferden wurden fünf positiv auf ECoV getestet, darunter zwei Ponys ohne klinische Anzeichen. Die geringe Anzahl positiver Fälle sollte jedoch mit Vorsicht interpretiert werden, da die Tests nur einmal, nach mehr als einen Monat nach Auftreten der klinischen Symptome im ersten Verdachtsfall, durchgeführt wurden. Dieser Bericht hebt die Bedeutung diagnostischer Tests und der frühzeitigen Umsetzung von Biosicherheitsmassnahmen in einem Betrieb mit einem ECoV-Ausbruch hervor. Ausserdem soll das Bewusstsein für mögliche Krankheitsüberträger mit unspezifischen und milden klinischen Anzeichen wie Fieber und Anorexie geschärft werden.
BACKGROUND: Des foyers d’infection à coronavirus équin (ECoV) ont été décrits dans différentes parties du monde, y compris en Europe. L’objectif de ce rapport est de décrire les signes cliniques, le diagnostic et les conséquences du premier foyer d’ECoV documenté en Suisse, afin de sensibiliser le public à cette maladie et à ses différents aspects cliniques. L’épidémie s’est produite dans une écurie comptant 26 chevaux. Parmi ceux-ci, sept chevaux ont développé une forme clinique allant de signes légers tels que la fièvre et l’anorexie à des signes sévères de colite aiguë. Un cheval est mort en raison d’une endotoxémie sévère et d›un choc circulatoire secondaire à une entérite nécrosante aiguë sévère et à une colite. Sur les 26 chevaux, cinq ont été testés positifs à l›ECoV, dont deux poneys sans aucun signe clinique d’infection. Le faible nombre de cas positifs doit néanmoins être interprété avec prudence car les tests n’ont été effectués qu’à une seule occasion, plus d’un mois après l’apparition des signes cliniques chez le premier cas suspect. Ce rapport souligne l’importance des tests de diagnostic et de la mise en œuvre rapide de mesures de biosécurité dans une exploitation où un foyer d’ECoV est détecté. Il devrait en outre sensibiliser à la présence de signes cliniques peu spécifiques et bénins tels que la fièvre et l’anorexie chez les animaux atteints qui sont potentiellement capables de propager la maladie.
BACKGROUND: Focolai di infezioni da coronavirus (ECoV) sono stati descritti in varie parti del mondo inclusa l’Europa. Lo scopo di questo studio era di descrivere i segni clinici, il percorso diagnostico e l’esito del primo focolaio documentato di ECoV in Svizzera in modo di poter aumentare la consapevolezza sulla malattia e le sue varie presentazioni cliniche. Il focolaio è comparso in un’azienda con 26 cavalli. Fra questi, sette cavalli hanno sviluppato una malattia clinica che comprendeva sintomi lievi come febbre e l’anoressia e sintomi gravi come la colite acuta. Un cavallo è deceduto a causa di una severa endotossiemia e di uno shock circolatorio secondario a una grave enterite necrotizzante acuta e una colite. Tra i 26 cavalli, cinque sono risultati positivi al ECoV, inclusi due pony senza alcun segno clinico. Tuttavia, il basso numero di casi positivi deve essere interpretato con molta cautela poiché i test sono stati eseguiti una sola volta e a più di un mese dall’insorgere dei primi segni clinici nel primo caso sospetto. Questo rapporto sottolinea l’importanza dei test diagnostici e dell’implementazione tempestiva di misure di biosicurezza negli allevamenti con un focolaio di ECoV. Inoltre, bisognerebbe aumentare la consapevolezza sulla presenza di segni clinici, non specifici e lievi come febbre e anoressia, negli animali affetti, potenzialmente in grado di diffondere la malattia.