Estudio de test de ureasa en exámenes endoscópicos con patologías benignas: ¿algún cambio en diez años? / Positivity of urease tests: results of its application in an open-access unity after a decade is there any change?

Epidemiological studies have shown changes in upper digestive diagnosis in recent times. It has been observed especially in developed countries, consisting in a diminution of duodenal peptic ulcers and non cardial gastric cancer and an increase of symptoms and lesions attributable to gastroesophageal reflux. Both circumstances have been considered as a consequence of a reduction in the prevalence, of infection with Helicobacter pylori and its more aggressive strains. There is little information of Possible changes in our country, so we have studied our experience in years 1996 and 2006 observing the results of Helicohacter pylori presence through urease tests and biopsies in a 10 year period. Patients were assessed with endoscopy indicated for upper digestive symptoms in an open access University Endoscopy Center. The accuracy of the test compared with biopsies was similar in both years. We observed after a decade: increase in the number of examinations and urease tests similar percentages of normal endoscopies and those with esophagitis, gastritis, or ulcers. In patients studied for suspected gastroesophageal reflux, there were similar percentages of those with and without esophageal erosions. The Urease Test was positive in similar high percentage in duodenal ulcers, but showed decreased values in patients studied for reflux, both erosive and non erosive esophagitis and also in erosive gastritis. In conclusion, Helicobacter pylori infection is still important in duodenal ulcer, with reductions in other diagnosis, possibly as a consequence of differences in patients social status or the very common medication aiming at the eradication of the infection or control of gastroesophageal symptoms.

Estudios epidemiológicos han mostrado cambios en la incidencia de patologías digestivas consistentes en disminución de úlceras duodenales y cáncer gástrico y aumento de cuadros atribuidos a reflujo gastroesofágico. Ambas tendencias se han asociado a disminución de la tan difundida infección por Helicobacter pylori y sus cepas genéticamente más agresivas. El presente estudio tuvo come objeto revisar retrospectivamente los resultados de endoscopias en 1996 y 2006 para observar eventuales cambios en la patología de esófago y gastroduodenal. Los resultados en la última década indican: aumento del número de exámenes y de tests de ureasa; proporción similar, de: endoscopias normales, esofagitis erosiva, síntomas de reflujo no erosivo, gastritis erosiva, úlcera gástrica, úlcera duodenal; porcentaje similar de esofagitis erosiva y reflujo no erosivo en pacientes estudiados por síntomas sugerentes de reflujo gastroesofágico y disminución de la positividad del TU, significativamente en EE y GE. Pensamos que el Hp continúa siendo factor patogénico en UD y que la disminución de positividad en pacientes con RGE puede atribuirse a cambios en la composición de la población examinada y al uso de medicación que puede modificar su presencia en la mucosa de estómago, siendo similar la reducción en reflujo con y sin esofagitis erosiva.

Seroprevalencia de anticuerpos anti Helicobacter pylori en personal de la sección gastroenterología del hospital clínico de la Universidad de Chile / Seroprevalence of antibodies against Helicbacter pylori in personnel working in the gastroenterology section of the clinical hospital of the University of Chile

Introduction: Helicobacter Pylori (Hp), a bacterium that colonizes gastric mucosa, is considered an important pathogen in some forms of histological gastritis, gastric and duodenal ulcers and a risk factor for gastric adenocarcinoma and lymphoma. Means of transmission are the oro-oral and feco-oral routers. Infection could be acquired by contamination with products as saliva, vomits, aerosols or feces from people colonized by the bacterium. Aim: was to study the seroprevalence of antibodies against Helicobacter Pylori in personnel working in the gastroenterology section of the clinical hospital of the University of Chile. Material and methods: the study included physicians that perform endoscopic procedures, technical assistants for them and laboratory personnel. Anti-Hp antibodies were determined with an ELFA (fluorescent immunoassay) method. Results: the group was formed by 35 persons, being 19 males and 16 females and 26 (74 percent) were anti-Hp positive, among them 14/19 (78 percent) males and 12/16 (75 percent) females, without difference. No difference was found in endoscopy 18/24 (73 percent) or extraendoscopy 8/11 (75 percent) personnel, or professionals (68 percent) and non professional assistants (90 percent). Conclusion: prevalence of antibodies against Hp is high in our section (74 percent) in accordance with what has been found in other studies in our population.

Antecedentes: el Helicobacter pylori (Hp) es una bacteria que coloniza principalmente la mucosa gástrica y desempeña un rol etiopatogénico importante en algunas formas de gastritis, ulceraciones gastro-duodenales y es además un factor de riesgo de padecer adenocarcinoma y linfoma gástrico. Se ha postulado que la vía de contagio principal seria, oral-oral o fecal-oral. Existiría un riesgo de adquirir la infección al estar en contacto con secreciones orales, aerosoles, vómitos o deposiciones de sujetos colonizados con la bacteria. El propósito de la siguiente investigación fue estudiar la seroprevalencia de anticuerpos anti Helicobacter pylori en la sección de gastroenterología del hospital clínico de la Universidad de Chile. Material y métodos: el grupo de estudio estuvo formado por los médicos que realizan endoscopias, el personal técnico de apoyo a este procedimiento y el personal del laboratorio clínico de la sección gastroenterología. Los anticuerpos anti-Helicobacter pylori se analizaron empleando la técnica ELFA, (inmunoensayo de fluorescencia), Resultados: se estudiaron 35 personas, 19 hombres y 16 mujeres. Veintiséis sujetos (74 por ciento) tuvieron anticuerpos anti Hp positivos. No se encontró diferencia según sexo, siendo positivos 14/19 hombres y 12/16 mujeres, 78 y 75 por ciento, respectivamente. Tampoco se encontró diferencia entre los que trabajan en área de endoscopia o extraendoscopia, 18/24 y 8/11, 73 y 75 por ciento, respectivamente, ni entre los profesionales 68 por ciento y ayudantes 90 por ciento. Conclusión: la presencia de anticuerpos anti Hp fue altamente prevalente en nuestra sección (74 por ciento) aunque concordante con las cifras de infección que se manejan a nivel poblacional.

Enfermedad Celíaca del adulto: experiencia clínica / Adult celiac disease: clinical experience

Background: The prevalence of celiac disease (CD) is unknown in Chile. We have recently noted a rise in the number of cases diagnosed among adults. Aim: To describe the clinical characteristics of a group of adult celiac patients. Patients and methods: Clinical data of patients older than 15 years with positive antitransglutaminase or antiendomysial autoantibodies and a duodenal biopsy characteristic of CD were retrospectively reviewed. Age at diagnosis, symptoms and signs and laboratory, endoscopic and histological findings, were analyzed. Results: Thirty seven patients (28 women), were studied. Median age at diagnosis was 41 years (range 15-69). Main symptoms and signs were diarrhea (78%), weight loss (38%) and abdominal pain (38%). Anemia was found in 49%, elevation of ESR in 57%, elevation of alkaline phosphatases in 54%, elevation of aspartate aminotransferase in 38% and a rise in alanine aminotransferase in 27%. Antiendomysial antibodies were positive in 17/22 (77%) and antitransglutaminase in 19/22 (86%) patients. Endoscopic findings were suggestive of CD in 47% of cases and duodenal biopsy showed intestinal villi atrophy in 34 (92%) patients. The three patients with normal histology had positive serology and a good response to gluten free diet. Conclusions: CD should be considered in the differential diagnosis of patients with unespecific digestive symptons, even when they present late in adult life. Serologic markers are a good diagnostic tool. A normal duodenal pathology does not exclude the diagnosis, if other diagnostic features are present.

Octreótido, tratamiento endoscópico o ambos en la hemorragia variceal activa enpacientes cirróticos: estudio multicéntrico / Octreotide administration and/or endoscopic treatment in cirrhotic patients with acute variceal bleeding: a multicentric study

Background: Acute variceal bleeding in cirrhotic patients is an emergency with a high risk of rebleeding and death. Endoscopic procedures such as sclerotherapy or banding, combined or not with drugs such as octreotide could be considered. Aim: To assess the value of octreotide in the control of acute variceal bleeding. Patients and methods: Ninety-two patients were randomized into three groups: endoscopic therapy plus octreotide 50 Ág/h bolus and continuous infusion for 5 days (n= 36); octreotide (same dosage) (n= 13) and endoscopic therapy only (banding and/or sclerotherapy) (n= 43). Results: Haemostasis at 24 hours was achieved in 97 percent of patients with combined treatment, 69 percent of patients receiving octreotide, and 93 percent of patients with endoscopic therapy (p= 0.2). Three patients with combined treatment, four patients receiving octreotide and eight patients with endoscopic therapy, rebled during the first five days (p= 0.15). The mean of blood units transfused was similar in the three groups. No differences were observed in hospital days and side effects. At 42 days of follow up, eight patients with endoscopic therapy, one patients with combined therapy and 2 patients receiving octreotide, died (p=NS). Conclusions: Octreotide is useful in the management of acute variceal bleeding. The absence of important side effects, renders it as a safe adjuvant treatment associated with endoscopic treatment (Rev MÚd Chile 2004; 132: 285-94).

¿Es necesaria la encoscopía de urgencia? estudio comparativo según horario de ingreso en hemorragia digestiva alta aguda / Is early endoscopy necessary? comparative study acute in upper gastrointestinal bleeding

El objetivo de la presente comunicación es evaluar si los pacientes con hemorragia digestiva alta aguda (HDAA), que ingresan en horario hábil de trabajo (grupo A), difirieren en su evolución y pronóstico, con respecto de los que ingresan en horario inhábil, o en días festivos (grupo B), quienes podrían tener algún desmedro en su atención, por la realización de endoscopía digestiva más tardía. Las historias clínicas de 66 sucesivos pacientes ingresados por HDAA cierto y los datos completos para el estudio. Los grupos son similares estadísticamente (A = 12 pts. y B = 29 pts.), de acuerdo a sexo, edad, número de pacientes que recibieron transfusión de sangre, mortalidad, número de días de estada, valores de hematocrito al ingreso, y número de pacientes con cirrocis. LOs pacientes del Grupo A tuvieron más endoscopía dentro de las primeras 24 horas, y más procedimientos de escleroterapia endoscópica, pero sin alcanzar significación estadística. De los pacientes transfundidos, los del Grupo B recibieron estadísticamente más unidades de sangre que los del grupo A (3,43-2,17) p < 0,05). No encontrar otras diferencias significativas, puede deberse al pequeño número de hemorragias activas críticas.