ABSTRACT
Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.
Subject(s)
Humans , Diabetes Mellitus, Type 2/surgery , Bariatric Surgery/methods , Obesity/surgery , Societies, Medical , Body Mass Index , Chile , Risk Factors , Treatment Outcome , Medical IllustrationABSTRACT
BACKGROUND: The potential progression from intestinal metaplasia to low grade dysplasia, to high grade dysplasia and to adenocarcinoma represents a well recognized sequence in patients with Barrett's esophagus (BE). The time required for this transformation is not well known. AIM: To report the results of a 10 years follow up of patients with BE. MATERIAL AND METHODS: Between 1989 and 2000 we followed 402 patients with BE. RESULTS: Sixty six subjects (16.2 per cent) presented low grade dysplasia at the time of diagnosis and 10 patients (2 women/8 men) developed adenocarcinoma during the follow-up period. Four out of these 10 patients were operated because of gastro-esophageal reflux disease, but after 3-5 years, reflux symptoms recurred. The other 6 patients rejected surgery and were on Omeprazole with good symptomatic results. Two patients had a short BE (< 3 cm), seven cases had a classic BE (3-10 cm) and one patient had an extensive > 10 cm BE. The mean time elapsed from intestinal metaplasia to low grade dysplasia was 9 months, to high grade dysplasia 56 months and to adenocarcinoma 82 months. From low grade dysplasia to early cancer it was 18 months, from high grade dysplasia to early cancer 14 months and from high grade dysplasia to advanced transmural cancer 14 months. All patients were subjected to esophagectomy. Five patients detected as State I are alive without any evidence of recurrence after 36 to 130 months after surgery. Five patients with advanced transmural carcinoma subjected to radical esophagectomy died because of progression of the malignancy between 3 and 24 months after surgery. CONCLUSIONS: Progression to adenocarcinoma may occur even in absence of reflux symptoms while on acid suppression therapy. Detection at early stage intestinal metaplasia in the esophagus offers a high chance of cure after surgical resection.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Adenocarcinoma/pathology , Barrett Esophagus/pathology , Esophageal Neoplasms/pathology , Survival Analysis , Disease Progression , Esophagectomy , Esophagoscopy , Esophagus/pathology , Time Factors , Metaplasia/pathology , Follow-Up StudiesABSTRACT
Se estudiaron 408 pacientes con esofagitis por reflujo en un protocolo prospectivo entre 1976 y 1987. Se analizan las características clínicas endoscópicas, manométricas y cintográficas (reflujo G-E, vaciamiento gástrico y reflujo duodenogástrico). Según el estudio endoscópico se clasificó a los pacientes en esofagitis grado I o leve (presencia de erosiones aisladas), grado II o moderada (erosiones múltiples o confluentes), esofagitis grado III (metaplaisa columnar del esófago distal o síndrome de Barret no complicado) y esofagitis grado IV (presencia de úlcera y/o estenosis esofágica o síndrome de Barret complicado). A los pacientes grado III y IV se les catalogó como esofagitis severa. Hubo 210 pacientes con esofagitis grado I, 52 en grado II, 56 en grado III y 90 en grado IV. No hubo diferencias significativas en la presencia de síntomas, salvo en disfagia y hemorragia digestiva que se presentó en la esofagitis severa. La presión del EGE fue similar en todos los grupos, pero la incidencia de trastornos motores fue significativamente mayor en la esofagitis severa. El reflujo cintilográfico fue severo en la mayoría y nos se detectaron diferencias significativas en la velocidad de vaciamiento gástrico de sólidos y en la positividad del reflujo duodeno gástrico. En conclusión, hay diferencias importantes tanto en análisis subjetivo y objetivo de la magnitud de la esofagitis por reflujo en los diferentes pacientes lo que obliga al médico tratante a emplear diversas estrategias de tratamiento
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Esophagitis, Peptic/physiopathology , Esophagitis, Peptic , Esophagogastric Junction/physiopathology , Gastric Emptying , Manometry , PressureABSTRACT
Se presentan tres casos clinicos de pacientes portadores de fistula gastrocolica por cancer gastrico (dos) y cancer do colon transverso (uno). La presencia de esta complicacion es baja y recientes publicaciones senalan que las causas mas frecuentes son las neoplasias de estomago y colon transverso. Los sintomas predominantes son el dolor epigastrico, baja de peso, diarrea y vomitos fecaloideos. El diagnostico se confirma con estudio radiologico y endoscopico.El exito del tratamiento se basa en mejorar las condiciones nutritivas y en la posibilidad de efectuar cirugia resectiva que mejora las condiciones y expectativas de vida