Fascioliasis hepática / Hepatic fascioliasis

La fascioliasis hepática es una enfermedad parasitaria infecciosa producida por el trematodo Fasciola hepática. El humano es infectado accidentalmente al ingerir vegetales (principalmente berros) contaminados con las formas enquistadas del parásito (metacercarias). Clínicamente se reconoce una fase hepática (fase aguda) que comprende desde la liberación de la larva en el duodeno hasta su llegada a la vía biliar, y una fase biliar (fase crónica), en donde la Fasciola se localiza en la vía biliar, madura a su forma adulta y produce huevos. El diagnóstico requiere un alto índice de sospecha dado el polimorfismo en la presentación y muchas veces el desconocimiento de antecedentes epidemiológicos. Las manifestaciones clínicas dependen del período en el cual se encuentra la enfermedad, sin embargo, lo más habitual es la presencia de dolor abdominal y eosinofilia. El diagnóstico definitivo requiere la demostración del parásito a través de métodos directos (visualización por medio de colangiografía retrógrada endoscópica o búsqueda de huevos en deposiciones o bilis) o a través de la demostración por métodos serológicos. El tratamiento actualmente disponible con triclabendazol es altamente efectivo.

The hepatic fascioliasis is a parasitic disease caused by infectious trematode fasciola hepática. Man is infected accidentally by ingesting vegetables (mainly watercress) contaminated with the parasite encysted forms (metacercariae). Clinically a hepatic phase (acute phase) is recognized, ranging from the release of the larvae in the duodenum to their arrival to the bile duct and a bile phase (chronic phase), where fasciola is located in the bile duct, and the parasite matures to the adult form and produces eggs. The diagnosis requires a high index of suspicion given the polymorphism in the presentation and the frequent lack of epidemiological history. The clinical manifestations depend on the current period of the disease is, however, the most common is the presence of abdominal pain and eosinophilia. Definitive diagnosis requires demonstration of the parasite through direct methods (visualization by ERCP or search for eggs in stool or bile), or through the demonstration by serological methods. The currently available treatment is highly effective with triclabendazole.

Tuberculosis intestinal / Intestinal tuberculosis

La tuberculosis (TBC) es una enfermedad infecciosa crónica, de tipo granulomatosa, producida por el Mycobacterium tuberculosis. En Chile es endémica, con tasas de 18 casos por 100.000 habitantes. La forma extrapulmonar constituye el 24 por ciento de los casos totales, siendo el compromiso intestinal uno de los más frecuentes, destacando la región ileo-cecal como la más afectada (90 por ciento de los casos). El diagnóstico es complejo ya que las manifestaciones clínicas son inespecíficas y el bacilo difícil de aislar, lo que muchas veces retrasa el inicio del tratamiento aumentando la morbimortalidad. Las manifestaciones clínicas habituales son: dolor abdominal, fiebre, baja de peso y compromiso ileal, siendo frecuente la duda diagnóstica con otras enfermedades que afectan el íleon distal, principalmente la enfermedad de Crohn. El diagnóstico definitivo sólo puede ser realizado a través de la histología o la detección directa del bacilo. La notificación de los casos de TBC es obligatoria en nuestro país; el tratamiento estándar con drogas antituberculosas es altamente efectivo y está garantizado para toda la población chilena.

Tuberculosis (TBC) is a chronic infectious disease of granulomatous type, caused by Mycobacterium tuberculosis. In Chile, the disease is endemic with rates of 18 cases per 100,000 inhabitants. The extrapulmonary form accounts for 24 percent of the total cases. Of these, intestinal tuberculosis is the most frequent, being the ileo-colonic region the most affected (90 percent of cases). Diagnosis is complex because the clinical manifestations are non specific and the bacteria is difficult to isolate, which often delays the onset of treatment thus increasing morbidity and mortality. The most common clinical manifestations are abdominal pain, fever, weight loss and ileal disease, increasing the diagnostic uncertainty in relation to other diseases affecting the distal ileum, mainly Crohn’s disease. A definitive diagnosis can only be made through histology or direct detection of the bacillus. Notification of TBC cases is mandatory in our country; standard treatment with antituberculosis drugs is highly effective and is guaranteed for the entire Chilean population.

Alteraciones del metabolismo del fierro post by pass gástrico / Metabolic iron disorders post gastric by pass

A complication of bariatric surgery and especially gastric bypass are nutritional deficiencies that occur in the long term, being very important iron deficiency and anemia. Several mechanisms influence this, highlighting the exclusion of the duodenum and part of jejunum. Is in these places which have been described the presence of the iron transporter, which is over expressed in situations of iron deficiency. Special adaptation mechanisms may explain the maintenance of iron homeostasis in these patients. Associated with this, they require a specific nutritional management including diet and special supplements, however, despite this there is a proportion of patients who will develop the deficit and in some cases even become a major problem. Today we know several pathways, proteins and transporters involved in iron metabolism, mainly at the level of absorption, but little is known about the changes that occur at this level in people undergoing deficit, such as patients undergoing gastric bypass and the changes that occur here to optimize it metabolism. Here you will see a review of the iron metabolism and then a description of the changes that occur in its physiology following a gastric bypass.

Fasciolasis hepática: enfermedad con múltiples presentaciones / Hepatic fascioliasis: a disease with multiple presentations

Human Fascioliasis is a zoonosis produced by the liver fluke fasciola. Its diagnosisrequires a high index of suspicion because of the polymorphism in its presentation. However, treatment with triclabendazole is highly effective. We report three cases that, in spite off presenting with diverse clinical severity, all had good response to treatment. Patient 1 presented with nonspecific recurrent abdominal pain with a normal CT scan of abdomen. Patient 2 presented with an abdominal CT scan showing multiple hepatic nodules. Patient 3 with an asymptomatic liver tumor requiring a comprehensive and expensive evaluation. All had eosinophilia and all responded to triclabendazole therapy without adverse effects.

La fasciolasis humana es una zoonosis producida por el trematodo fasciola hepática. Su diagnóstico requiere un alto índice de sospecha dado el polimorfismo en su presentación. Pese a esto, el tratamiento con triclabendazol es muy efectivo. Se reportan tres casos clínicos que, pese a presentar muy distinta clínica y gravedad, todos tuvieron buena respuesta al tratamiento con Triclabendazol. El paciente 1 se presentó con dolor abdominal inespecífico y recurrente, sin compromiso del estado general con tomografía de abdomen normal. La paciente 2 presentó dolor abdominal intenso, baja de peso y gran compromiso del estado general que requirió hospitalización, con tomografía de abdomen que mostró lesiones nodulares hepáticas. La paciente 3 se presentó como hallazgo de tumor hepático asintomático que requirió amplio estudio y grandes costos. Todos presentaron eosinofilia y todos respondieron a terapia con triclabendazol sin efectos adversos.

Enfermedad celíaca del adulto / Adult celiac disease

Celiac disease is a chronic enteropathy caused by intolerance to gluten. The true prevalence of this condition is much greater than previously recognized, with more silent cases being diagnosed and a greater proportion of cases diagnosed later in adulthood. It presents with a spectrum of clinical manifestations and histological abnormalities. Duodenal biopsy remains the gold standard for diagnosis of celiac disease, even though there are new serologic tests that are very specific. Correlation of clinical, serologic, and histological features are essential for a definitive diagnosis of celiac disease. The pathogenesis consists in an interaction between genetic, immunologic and environmental factors, which interact with HLA molecules to activate an immunologic response in the small bowel mucosa causing tissue damage. The main treatment is a free gluten diet. Health risks for untreated celiac disease appear to be greater compared with those patients who adhere to this treatment.