Sistema OLGA (Operative Link on Gastritis Assessment) como marcador para cáncer gástrico y displasia en una población colombiana de alto riesgo: estudio multicéntrico

Introducción. En Asia y Europa, el sistema OLGA ha sido útil como marcador de riesgo de cáncer gástrico. Sin embargo, su utilidad en poblaciones de alto riesgo en Colombia aún se desconoce. Objetivo. Establecer si los estadios OLGA se asocian con un mayor riesgo de cáncer y displasia en una población de alto riesgo en Colombia y determinar la capacidad diagnóstica de la escala para evaluar dicho riesgo. Materiales y métodos. Se realizó un estudio multicéntrico con pacientes con cáncer gástrico y displasia (casos), y pacientes con atrofia y metaplasia intestinal (controles), provenientes de tres centros de una zona de alto riesgo de cáncer gástrico en Colombia. Se incluyeron 506 pacientes cuyo estudio endoscópico e histopatológico fue realizado mediante el sistema de Sydney y la estadificación de OLGA propuesta por Rugge. El efecto de cada variable de interés sobre la enfermedad (cáncer gástrico y displasia) se evaluó mediante modelos bivariados y multivariados. Un valor de p menor de 0,05 se consideró estadísticamente significativo. Resultados. Los estadios elevados del sistema OLGA (III-IV) se asociaron con un mayor riesgo de displasia y cáncer gástrico (OR ajustado = 8,71; IC95 % = 5,09-14,9; p=0,001) con una sensibilidad del 54,9 %, especificidad del 89,3 % y una razón de probabilidad positiva de 5,17. Conclusiones. El estadio OLGA es un marcador de riesgo de cáncer gástrico y displasia en la población de estudio. Se recomienda su implementación como estrategia para optimizar el diagnóstico oportuno y el seguimiento de pacientes con mayor riesgo.

Introduction. The OLGA system has been proved to be useful in Asia and Europe as a risk marker of gastric cancer. However, its usefulness in high-risk populations in Colombia is still unknown. Objective. To assess potential associations between the OLGA staging system and an increased risk of gastric cancer and dysplasia in a high-risk Colombian population and to establish diagnostic capacity of the scale to assess the risk. Materials and methods. We carried out a multicenter study including patients with cancer and dysplasia (cases) and patients with atrophy and intestinal metaplasia (controls). A total of 506 patients were recruited from three centers in an area with a high risk population in Colombia. The endoscopic and histopathologic studies were evaluated according to the Sydney system and the OLGA staging system proposed by Rugge. The effect of each variable on the disease (gastric cancer and dysplasia) was evaluated using bivariate and multivariate models. Statistical significance was set considering a p value inferior to 0.05. Results. Advanced stages of the OLGA system (III-IV) were associated with a higher risk of dysplasia and gastric cancer (adjusted OR = 8.71; CI95% = 5.09-14.9; p=0.001), sensitivity=54.9%, specificity=89.3% and positive likelihood ratio=5.17. Conclusions. The OLGA staging system is a risk marker for gastric cancer and dysplasia in the studied population. We recommend its implementation to improve the timely diagnosis and follow-up of patients with the highest cancer risk.

Helicobacter pylori infection and serum pepsinogen concentrations in an elderly population representative of Costa Rica / Infección por helicobacter pylori y concentraciones séricas de pepsinógenos en una población representativa de adultos de Costa Rica

Abstract Introduction: Costa Rica has among the highest mortality rates from gastric cancer in the world, largely due to late detection. It is therefore important that economically and logistically sustainable screening is implemented in order to detect risk of developing cancer. We have previously shown that low pepsinogen (PG) values and infection with Helicobacter pylori-CagA+ are associated with risk of gastric atrophy and cancer in Costa Rican populations. OBJECTIVES: To determine how markers for gastric cancer risk are distributed in an elderly population representative of Costa Rica in order to design a screening strategy. METHODS: The population studied consists of 2,652 participants in a nationally representative survey of ageing. Information concerning epidemiologic, demographic, nutritional and life style factors is available. Serum PG concentrations as well as H. pylori and CagA status were determined by serology. Possible associations were determined by regression analyses. RESULTS: Antibodies to H. pylori were present in 72% of the population and of those, 58% were CagA positive. Infection with H. pylori was associated with higher PGI concentrations (p=0.000) and infection with H. pylori-CagA. with lower PGI concentrations (p=0.025). Both showed association with lower PGI/PGII (p=0.006 and p=0.000). Higher age was associated with lower prevalence of H. pylori infection (OR=0.98; p=0.000) and CagA. (OR=0.98; p=0.000) but not with PG values. Regions with high risk of gastric cancer showed lower PGI (p=0.004) and PGI/PGII values (p=0.021) as well as higher prevalence of H. pylori infection (OR=1.39; p=0.013) but not CagA.. Using cut-off values of PGI<100 µg/L and PGI/PGII<2.0, 2.5 and 3.0, 7-15% of the population would be considered at risk. CONCLUSIONS: H. pylorialone is not a useful marker for risk of gastric cancer. Screening using serum pepsinogen concentrations and infection with H. pylori-CagA. is feasible in the general elderly population of Costa Rica but appropriate cut-off values have to be determined based on more clinical data and follow up capacity.

Resumen Introducción: Costa Rica tiene una de las tasas de mortalidad por cáncer gástrico más altas del mundo, en gran parte debido a la detección tardía. Por lo tanto, es importante que se implemente un tamizaje económico y logísticamente sostenible para detectar el riesgo de desarrollar cáncer. En estudios anteriores demostramos, que valores bajos de pepsinógeno (PG) y la infección por Helicobacter pylori-CagA+ están asociados con el riesgo de atrofia gástrica y cáncer en poblaciones costarricenses. OBJETIVO: Determinar cómo se distribuyen los marcadores de riesgo de cáncer gástrico en una población representativa de adultos de Costa Rica para diseñar una estrategia de tamizaje. MÉTODOS: Se estudió una población representativa a nivel nacional de 2.652 adultos, que formaron parte de un estudio longitudinal sobre envejecimiento. Se dispone de información sobre factores epidemiológicos, demográficos, nutricionales y de estilo de vida. Las concentraciones séricas de PG, así como el estado de H. pylori y CagA se determinaron mediante serología. Las posibles asociaciones se determinaron mediante modelos de regresión (logística y lineal múltiple). RESULTADOS: El 72% de la población presenta anticuerpos contra H. pylori, de ellos, el 58% fueron positivos para CagA. La infección por H. pylori se asoció con altas concentraciones de PGI (p = 0,000) y la infección por H. pylori-CagA+ con bajas concentraciones de PGI (p = 0,025). Ambas pruebas mostraron asociación con una baja razón PGI/PGII (p = 0,006 y p = 0,000). El rango de mayor edad se asoció con una menor prevalencia de la infección por H. pylori (OR = 0,98; p = 0,000) y de CagA+ (OR = 0,98; p = 0,000) pero no se asoció con los valores de PG. Las regiones con alto riesgo de CG mostraron valores bajos de PGI (p = 0,004) y de PGI/PGII (p = 0,021) así como una alta prevalencia de la infección por H. pylori (OR = 1,39; p = 0,013), no así con CagA+. Utilizando valores de corte de PGI<100 µg/L y de PGI/PGII <2,0, 2,5 y 3,0, se consideraría en riesgo de cáncer entre 7-15% de la población. CONCLUSIONES: La infección por H. pylori, por sí sola, no es un marcador de riesgo de CG útil. Es factible realizar el tamizaje de adultos de la población general de Costa Rica, utilizando como marcadores las concentraciones séricas de pepsinógenos y la infección por H. pylori-CagA+, sin embargo, los valores de corte apropiados deben determinarse con base en una mayor cantidad de datos clínicos y la capacidad de seguimiento.

Exploratory multigroup structural equation modeling approach to analyzing H. pylori infection, serological pepsinogen levels, and life style factors in an elderly population in Costa Rica / Enfoque exploratorio del modelo de ecuaciones estructurales multigrupo para el análisis de la infección con H. pylori, niveles de pepsinógenos séricos y factores asociados a estilo de vida en una población de adultos mayores en Costa Rica

Abstract The aim of this work is to describe and analyze the association of PGI/PGII ratio (indicator of gastric atrophy) with H. pylori-CagA and life style factors such as caloric intake, obesity, and harmful habits amongst H. pylori-positive elderly people infected in Costa Rica using an exploratory multigroup structural equations model (SEM). Using a sample of 1748 H. pylori-positive elderly people from CRELES first wave study, a SEM was employed analyze if the relationships between PGI/PGII ratio with levels of H. pylori-CagA, caloric intake, obesity, and harmful habits, differs by sex, age and risk areas subgroups. The proposed SEMs exhibited a good fit in males (RMSEA = 0.039), females (RMSEA = 0.000), low-risk area (RMSEA = 0.038), middle-risk area (RMSEA = 0.042), individuals under 80 years (RMSEA = 0.038) and individuals aged 80 and over (RMSEA = 0.042), while an acceptable fit was observed for the high-risk area (RMSEA = 0.061). Fitted SEMs showed that CagA predicted PG-ratio as expected, with effects increasing with the risk area, but similar between sex and age groups. All indicators measuring obesity (BMI, arms, and waist) showed significant standardized coefficients, with similar effects between sex, age and risk area groups. No other significant effects or differences between groups were identified. We propose a good-fitted SEM model for the possible relationships between CagA and PG ratio and the geographical risk area level for elderly people. No differences were observed on measured parameters between male and female population, or between under 80 years and older individuals.

Resumen El objetivo de este trabajo es describir y analizar la asociación entre PGI/PGII (indicador de atrofia gástrica con H. pylori-CagA y factores asociados a estilo de vida como ingesta calórica, obesidad y hábitos nocivos entre adultos mayores positivos por H. pylori en Costa Rica utilizando modelos de ecuaciones estructurales multigrupo (SEM). Con una muestra de 1748 adultos mayores del estudio CRELES, se utilizó un SEM para analizar las relaciones entre PGI/PGII, CagA, ingesta calórica, obesidad y hábitos nocivos difieren por sexo, edad y áreas de riesgo. Los SEMs propuestos exhibieron un buen ajuste en hombres (RMSEA = 0.039), mujeres (RMSEA = 0.000), área de bajo riesgo (RMSEA = 0.038), áreas de riesgo medio (RMSEA = 0.042), individuos menores de 80 años (RMSEA = 0.038) e individuos de 80 años o más (RMSEA = 0.042), mientras que hubo un ajuste aceptable en áreas de alto riesgo (RMSEA = 0.061). Los SEMs ajustados mostraron que CagA predice la relación PGI/II en la dirección esperada con efectos proporcionales al área de riesgo, pero no por sexo y edad. Todos los indicadores medibles de obesidad (IMC, brazos y cintura) mostraron coeficientes estandarizados significativos con efectos similares entre los grupos por sexo, edad y área de riesgo. No se encontraron otros efectos o diferencias significativas. Proponemos un modelo SEM bien ajustado para las posibles relaciones entre CagA y PGI/II y el nivel de riesgo del área geográfica en adultos mayores. No se encontraron diferencias en las variables analizadas entre hombres y mujeres ni entre los grupos de edad.

Tratamento cirúrgico em fratura de mandíbula atrófica: uma revisão de literatura / Surgical treatment of atrophic jaw fracture: a literature review

Analisar o manejo de fraturas em mandíbula atrófica voltado para a abordagem cirúrgica com ênfase na melhor técnica indicada. A perda óssea alveolar tem sido uma das consequências do edentulismo, que tem o potencial de levar a atrofia óssea. As fraturas de mandíbulas atróficas, normalmente são consideradas um procedimento desafiador, devido ser encontrada em pacientes idosos ou em virtude da perda dentária precoce resultando em um reparo dessas fraturas mais complexo. Os principais fatores etiológicos têm sido os acidentes automobilísticos, seguidos de queda e agressão. Geralmente, as causas das quedas decorrem de desequilíbrio, fraqueza muscular, tontura, e uso crônico de medicamentos como sedativos. As opções terapêuticas objetivam restaurar forma, função e imobilização apropriada desse possível evento. A individualização do tratamento de escolha é de grande importância, pois geralmente o paciente apresenta alterações fisiológicas decorrentes do envelhecimento e ossos mais fragilizados com potencial osteogênico reduzido, que dificultam a abordagem cirúrgica. Entretanto, deve ser considerado para o manejo dessas fraturas, a idade do paciente, as condições e quantidade de tecido ósseo e tecido mole. Porém, vale ressaltar que o envelhecimento não apresenta contraindicação, apenas exige condições especiais que devem ser consideradas. Nesse sentido, quando há oportunidade de dispositivos tecnológicos, como os biomodelos que contribuem significativamente para procedimentos cirúrgicos bucomaxilofaciais, esses fornecem maior previsibilidade de resultados, bem como redução do tempo cirúrgico.

To analyze the management of fractures in atrophic mandible aimed at the surgical approach, emphasizing which technique is best indicated. Alveolar bone loss has been one of the consequences of edentulism, which has the potential to lead to bone atrophy. Atrophic jaw fractures are usually considered a challenging procedure, as they are found in elderly patients or due to early tooth loss, resulting in a more complex repair of these fractures. The main etiological factors have been described as car accidents, followed by falls and aggression. Commonly, the causes of falls stem from imbalance, muscle weakness, dizziness, and chronic use of medications such as sedatives. The therapeutic options aim to restore form, function and appropriate immobilization of this possible event. The individualization of the treatment of choice is of great importance, as the patient usually presents physiological changes resulting from aging and more brittle bones and a reduced osteogenic potential, which makes the surgical approach difficult. However, the patient's age, conditions and amount of bone and soft tissue must be taken into consideration for the management of these fractures. However, it is noteworthy that aging has no contraindication, it only requires special conditions that must be considered. In this sense, when there is an opportunity for technological devices, such as biomodels that significantly contribute to maxillofacial surgical procedures, it provides greater predictability of results, as well as reduced surgical time.

Patrones de detección de Helicobacter pylori y lesiones relacionadas mediante protocolo Sydney en una población de Antioquia, Colombia

Objetivos: Se buscó determinar si las endoscopias que cumplieron el protocolo Sydney en una población de Antioquia tuvieron una detección mayor de H. pylori y sus lesiones asociadas que las endoscopias que sólo tomaron muestras de antro. Materiales y métodos: Realizamos un estudio retrospectivo, trasversal y descriptivo. Se incluyeron pacientes adultos sometidos a endoscopia superior. Se dividieron los pacientes en dos grupos según si se siguió o no el protocolo Sydney y se midió la frecuencia de detección de H. pylori, y lesiones premalignas. Resultados: Se incluyeron 261 participantes, a 88 se les tomó el protocolo de Sydney y a 173 se les tomaron muestras exclusivamente de antro gástrico. La indicación principal de endoscopia fue dispepsia (35,6%). La detección de H. pylori, gastritis atrófica y metaplasia intestinal fue del 36,4%, 19,3% y 20,5% respectivamente en el grupo Sydney, y 30,1%, 11,6% y 9,8% en el grupo control. En el grupo Sydney, la detección de H. pylori fue mayor en antro y cuerpo (26,1%) que en antro (6,8%) o cuerpo (3,4%) por separado. La detección de gastritis atrófica y metaplasia intestinal fue mayor en antro solamente (10,2% y 11,4% respectivamente) que en antro y cuerpo o cuerpo por separado. Conclusiones: La omisión del protocolo Sydney reduce la detección de H. pylori, gastritis atrófica y metaplasia intestinal en un 9,4%, 29,4% y 27,7% respectivamente. Se debe implementar el protocolo sistemáticamente en todo centro de endoscopia digestiva.

Objectives: We sought to determine whether the endoscopies that met the Sydney protocol in a population of Antioquia had a greater detection of H. pylori and their associated lesions than the endoscopies that only took antrum samples. Materials and methods: We carried out a retrospective, cross-sectional and descriptive study. Adult patients undergoing upper endoscopy were included. Patients were divided into two groups depending on Sydney protocol compliance. The detection frequency was measured for H. pylori and premalignant lesions. Results: 261 participants were included, 88 from which biopsies were taken with the Sydney protocol and 173 with biopsies taken exclusively from the gastric antrum. The main endoscopy indication was dyspepsia (35.6%). The detection of H. pylori, atrophic gastritis and intestinal metaplasia was 36.4%, 19.3% and 20.5% respectively in the Sydney group, and 30.1%, 11.6% and 9.8% in the control group. In the Sydney group, the detection of H. pylori was higher in the antrum and body (26.1%) than in antrum (6.8%) or body (3.4%) separately. The detection of atrophic gastritis and intestinal metaplasia was higher in antrum only (10.2% and 11.4% respectively) than in antrum and body or body separately. Conclusions: The omission of the Sydney protocol reduces the detection of H. pylori, atrophic gastritis and intestinal metaplasia by 9.4%, 29.4% and 27.7% respectively. The protocol must be implemented systematically in every gastrointestinal endoscopy center.

Estimación de la frecuencia de infección por Helicobacter pylori en pacientes con lesiones potencialmente malignas gástricas del municipio de Pasto-Nariño, 2016-2019 / Estimation of the frequency of Helicobacter pylori infection in patients with potentially malignant stomach lesions of the city of Pasto- Nariño, 2016-2019

Resumen Objetivo: Estimar la frecuencia de infección por Helicobacter pylori en lesiones potencialmente malignas gástricas de pacientes de la ciudad de Pasto, Nariño. Materiales y métodos: Estudio retrospectivo con análisis secundario de información sociodemográfica e histopatológica obtenida de reportes de patología para biopsias gástricas de pacientes del departamento de Nariño, Colombia del año 2016-2019. Resultados: Los pacientes de la ciudad de Pasto (n=359) presentaron una frecuencia de infección por Helicobacter pylori de 35.6%, siendo significativamente mayor en hombres que en mujeres (p=0.037). La edad promedio de los hombres positivos para Helicobacter pylori fue de 44 años y de las mujeres de 47 años (p<0.001). La edad promedio de los casos de gastritis crónica atrófica en hombres y mujeres fue de 49 y 54 años respectivamente (p<0.001) y de metaplasia intestinal fue de 59 años en hombres y 61 años en mujeres (p<0.001). Conclusiones: En el presente estudio, la detección de Helicobacter pylori fue mayor en el grupo de hombres en comparación al de las mujeres (43.2% vs 31.6% respectivamente). La frecuencia de gastritis crónica atrófica y metaplasia intestinal en hombres fue de 37.9% y 23.1% respectivamente; mientras que en mujeres fue de 35.2% y 15.1% respectivamente.

Abstract Aim: To estimate the frequency of Helicobacter pylori infection in potentially malignant stomach lesions in patients of the city of Pasto- Nariño. Materials and methods: Retrospective study with secondary analysis of sociodemographic and histopathological information derived from pathology reports for gastric biopsies of patients from the department of Nariño, Colombia from year 2016-2019. Results: Patients from the city of Pasto (n=359) presented a percentage of detection for Helicobacter pylori of 35.6% and the infection was significantly higher in men than in women (p=0.037). The average age of men positive for Helicobacter pylori was 44 years and women 47 years (p<0.001). The average age of the cases of chronic atrophic gastritis in men and women was 49 and 54 years respectively (p<0.001) and for intestinal metaplasia cases, the average age was 59 years in men and 61 years in women (p<0.001). Conclusions: In the present study, the detection of Helicobacter pylori was higher in the male group compared to the female group (43.2% vs 31.6% respectively). The frequency of atrophic chronic gastritis and intestinal metaplasia in men was 37.9% and 23.1% respectively; in women was 35.2% and 15.1% respectively.

Asociación de los resultados de dos pruebas diagnósticas de infección por Helicobacter pylori / Association of the results of two diagnostic tests for Helicobacter pylori infection

Helicobacter pylori es un microrganismo que se considera que afecta al 50% de la población. Se realizó un estudio con diseño no experimental, correlacional y transversal, con el objetivo de determinar la asociación de los resultados de pruebas diagnósticas de infección por H. pylori a través de biopsia obtenida por endoscopía superior y prueba de antígeno de la superficie en mues-tras de heces en 100 pacientes atendidos en el Servicio de Gastroenterología del Centro Clínico Quirúrgico Ambulatorio (Hospital del Día) Efrén Jurado López del Instituto Ecuatoriano de Seguridad Social (IESS), en la ciudad de Guayaquil, Ecuador, durante 2019. La media de la edad en la muestra de estudio fue 37,5 años, con un predominio del género femenino (78%). El 65% de las pruebas de antígeno para la detección de H. pylori en heces resultaron negativas. Los repor-tes de las pruebas de antígeno en heces e histopatología permitieron apreciar diferencias entre estos, pero con predominio de las coincidencias en los diagnósticos positivos. Existió una asocia-ción estadísticamente significativa entre las lesiones inflamatorias de la mucosa gástrica producto de la gastritis crónica atrófica y la infección por H. pylori. Los resultados de las dos pruebas diag-nósticas tuvieron una correlación lineal positiva y débil con significación estadística.

Helicobacter pylori is a microorganism that affects 50% of the population worldwide. A study with a non-experimental, correlational, and cross-sectional design was carried out in order to determine the association of the results of diagnostic tests for H. pylori infection through biopsy obtained by upper endoscopy and surface antigen test in samples of feces in 100 patients. These ones were treated at the Gastroenterology Service of the Ambulatory Surgical Clinic Center (Hospital del Día) Efrén Jurado López of the Ecuadorian Institute of Social Security (IESS), in the city of Guayaquil, Ecuador, during 2019. The mean age in the study sample was 37.5 years old, with a predominance of the female gender (78%). 65% of stool antigen tests for H. pyloriwere negative. The reports of the stool antigen test and histopathology allowed to appreciate differences between them, but with a predominance of the coincidences in the positive diagno-ses. There was a statistically significant association between the inflammatory lesions of the gastric mucosa because of chronic atrophic gastritis and the infection by H. pylori. The results of the two diagnostic tests had a positive and weak linear correlation with statistical significance

Gastritis eosinofílica: a propósito de un caso

Introducción: La gastritis eosinofílica es una enfermedad infrecuente caracterizada por la presencia de eosinofilia hística, que afecta las diferentes capas de la pared intestinal. Este tipo de gastritis se caracteriza por una infiltración eosinofílica intensa que puede afectar solo la mucosa gástrica o todas sus capas hasta la serosa. La presentación clínica difiere de la posición y la extensión de la infiltración del eosinófilo, así como también su profundidad a través de la pared del intestino. Objetivo: Presentar el caso de un paciente diagnosticado y tratado como una gastritis eosinofílica. Caso clínico: Paciente masculino, raza blanca, de 47 años de edad, que acudió al Servicio de Gastroenterología del Hospital Universitario Manuel Ascunce Domenech, de la provincia Camagüey; en octubre de 2019. Refirió que durante los dos últimos meses había consultado en atención primaria de forma esporádica por molestias epigástricas, estos episodios cedían con pautas cortas de antiácidos. Los síntomas comenzaron agudizarse y se hicieron más resistentes al tratamiento, apareciendo náuseas, vómitos y pérdida de peso marcada. Se decidió comenzar la realización de estudios analíticos al paciente. Conclusiones: El resultado del estudio histológico fue infiltrado inflamatorio crónico severo con presencia de eosinófilos más del 50 % que se extiende a todas las capas con epitelio glandular reactivo, concluyó como una gastritis eosinofílica.

Introduction: Eosinophilic gastroenteritis is a rare disease characterized by the presence of tissue eosinophilia, which affects the different layers of the intestinal wall.This type of gastritis is characterized by an intense eosinophilic infiltration that can affect only the gastric mucosa or all its layers up to the serosa. The clinical presentation differs on the position and extent of the eosinophil infiltration, as well as its depth through the bowel wall. Objective: To present the case of a patient diagnosed and treated as eosinophilic gastritis. Case report: A 47-year-old white male patient from Camagüey province, who attends the Gastroenterology Service of the Manuel Ascunce Domenech University Hospital, Camagüey province; in October 2019. He reported that during the last two months he had consulted primary care sporadically due to epigastric discomfort, these episodes subsided with short courses of antacids. The symptoms began to worsen and became more resistant to treatment, with nausea, vomiting and marked weight loss appearing. It was decided to start performing analytical studies on the patient. Conclusions: The result of the histological study was a severe chronic inflammatory infiltrate with the presence of eosinophils more than 50% that extends to all layers with reactive glandular epithelium, concluding it as eosinophilic gastritis.

Frecuencia de cambios morfológicos en biopsias gástricas asociadas a infección por Helicobacter Pylori / Frequency of morphological changes in gastric biopsies associated with Helicobacter pylori infection

Resumen Introducción: se han descrito cambios morfológicos asociados a la infección gástrica por H. pylori como: gastritis crónica superficial, gastritis atrófica, gastritis folicular y metaplasia intestinal. Importancia: La atrofia y la metaplasia gástrica pertenecen a la cascada de cambios histológicos que conducen al cáncer gástrico. Metodología: estudio retrospectivo de corte transversal en el que se analizaron pacientes con dispepsia; durante su examen se practicó endoscopia y biopsias gástricas. Se documentó infección o no por H. pylori y los cambios morfológicos presentes. Resultado: total de casos positivos para infección H. pylori en biopsias gástricas 127/166 (76.5%), casos negativos para infección H. pylori en biopsias gástricas 39/166 (23.4%). Edad promedio 45.38 años, sexo femenino 80/127 (63%), gastritis crónica superficial 61/127 (48%), gastritis nodular 43/127 (33.87%), atrofia gástrica 7/127 (5.5%), metaplasia intestinal 7/127 (5.5%). Biopsias negativas para H.pylori con diagnóstico de atrofia 5/39 (12.8%), con hallazgo de metaplasia fueron: 4/39 (10.2%). Conclusiones: los cambios morfológicos encontrados en biopsias gástricas son similares a la literatura universal. La atrofia y especialmente la metaplasia intestinal son cambios morfológicos asociados a la infección por H.pylori y son a su vez factores de riesgo para el desarrollo del cáncer gástrico que fueron documentados en la serie que presentamos. Hay casos negativos para la infección H.pylori, con cambios superficiales de atrofia y metaplasia por lo que es recomendable hacer estudios adicionales para descartar completamente la infección por H. pylori. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1987).

Abstract Introduction: morphological changes associated with gastric H. pylori infection have been reported, such as chronic superficial gastritis, atrophic gastritis, follicular gastritis and intestinal metaplasia. Importance: Gastric atrophy and metaplasia are part of the cascade of histological changes that lead to gastric cancer. Methods: a retrospective cross-sectional study analyzing patients with dyspepsia; gastric endoscopy and biopsies were conducted during their exams. The presence or absence of H. pylori infection was documented along with the morphological changes present. Results: a total of 127/166 cases were positive for H.pylori infection on gastric biopsy (76.5%), and 39/166 cases were negative for H. pylori on gastric biopsy (23.4%). The average age was 45.38 years, 80/127 (63%) were female, 61/127 had superficial chronic gastritis (48%), 43/127 (33.87%) had nodular gastritis, 7/127 (5.5%) had gastric atrophy, and 7/127 (5.5%) had intestinal metaplasia. Of the biopsies which were negative for H. pylori, 5/39 (12.8%) had a diagnosis of atrophy, and 4/39 (10.2%) had a finding of metaplasia. in those with a diagnosis of atrophy Conclusions: the morphological changes found in gastric biopsies are similar to those reported in the international literature. Atrophy, and especially intestinal metaplasia, are morphological changes associated with H.pylori infection, and, in turn, risk factors for developing gastric cancer, which were documented in our study. There are H. pylori-negative cases with superficial atrophic and metaplastic changes; thus, it is advisable to carry out further studies to completely rule out H. pylori infection. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1987).

Tratamiento no hormonal del síndrome genitourinario de la menopausia / Non-hormonal treatment of genitourinary syndrome of menopause

El síndrome genitourinario de la menopausia (SGUM) describe los síntomas y signos vulvo-vaginales y del tracto urinario inferior, de carácter crónico y progresivo, secundario a un estado clínico de hipoestrogenismo que caracteriza a la postmenopausia. La presente revisión tiene como objetivo describir y analizar las diferentes alternativas terapéuticas no hormonales, con sus ventajas y desventajas, a fin de ofrecerle a los lectores una completa variedad de opciones a la hora de establecer el tratamiento en una mujer con SGUM. Se ha realizado una búsqueda en bases de datos, incluyendo investigaciones originales, consensos de expertos, revisiones sistemáticas y metaanálisis. Se ha revisado la evidencia actual para diversas modalidades terapéuticas farmacológicas y no farmacológicas (no hormonales), encontrando que los hidratantes y los lubricantes son la primera línea terapéutica para proporcionar alivio, a corto plazo, de la sequedad vaginal (leve a moderada) y la dispareunia; sin embargo, el tratamiento ha de ser individualizado. Existen numerosos tratamientos disponibles, cada uno con beneficios y limitaciones y se destacan las sustanciales lagunas, en la evidencia científica, de terapias seguras y efectivas, así como la necesidad de realizar investigaciones futuras..(Au)

The genitourinary syndrome of menopause (SGUM) describes the symptoms and signs of the vulvo-vaginal and lower urinary tract, of a chronic and progressive nature, secondary to a clinical state of hypoestrogenism that characterizes postmenopause. The present review aims to describe and analyze the different non-hormone therapeutic alternatives, with their advantages and disadvantages, in order to offer readers a full range of options when establishing treatment in a woman with SGUM. A database search, including original research, expert consensus, systematic reviews and meta-analysis. The current evidence for various pharmacological and non-pharmacological (non-hormonal) therapeutic modalities has been reviewed, finding that moisturizers and lubricants are the first line of therapy to provide short-term relief of vaginal dryness (mild to moderate) and dyspareunia; however, treatment must be individualized. It is concluded that there are numerous treatments available, each with benefits and limitations. Substantial gaps in the scientific evidence for safe and effective therapies are highlighted, as well as the need for future research..(Au)

Gastrite crônica por Helicobacter pylori em pacientes com condições pré-malignas: avaliação dos sistemas OLGA e OLGIM e desempenho de biomarcadores séricos / Helicobacter pylori chronic gastritis on patients with premalignant conditions: olga and olgim evaluation and serum biomarkers performance

ABSTRACT BACKGROUND: H. pylori chronic atrophic gastritis is a premalignant lesion, and its staging, according to OLGA and OLGIM systems aims to identify patients at increased risk of developing gastric cancer and optimize their follow-up. GastroPanel®, serum biomarkers panel including pepsinogen I (PGI), pepsinogen II (PGII), Gastrin 17 (G17) and anti- H. pylori antibodies is a noninvasive test for adenocarcinoma risk assessment in chronic H. pylori gastritis patients. OBJECTIVE: Prospective study to evaluate the concordance between OLGA and OLGIM grading systems, as well as to evaluate GastroPanel´s performance in patients with premalignant lesions secondary to H. pylori chronic gastritis in Brazil. METHODS: Patients with H. pylori chronic gastritis with premalignant lesions confirmed by histology were recruited from the gastrointestinal clinic of a University Hospital. All participants underwent endoscopic examination with biopsies which were reported according to updated Sydney system and premalignant lesions grading systems (OLGA and OLGIM). Blood samples were collected for biomarkers serological analysis (GastroPanel®, Biohit, Helsinki, Finland). The cut off values used to define high risk patients were those recommended by the manufacturer: PGI ≤30 µm/L and PGI/PGII ≤3. RESULTS: 41 patients were recruited: 28 women, 13 men, mean age 67.3 (47-89, SD: 9.6) years. By OLGA system, were obtained: OLGA 0 (n=1), OLGA I (n=7), OLGA II (n=17), OLGA III (n=9), and OLGA IV (n=7). By OLGIM system, were obtained: OLGIM 0 (n=14), OLGIM I (n=5), OLGIM II (n=10), OLGIM III (n=10), and OLGIM IV (n=2). Regarding histological staging among patients staged as low risk (OLGA/OLGIM 0, I and II) and high risk (OLGA/OLGIM III and IV) for gastric cancer development, the concordance rate found between both classifications was 85.4%. Considering high risk patients, those patients thus included in at least one of the systems the final distribution of our sample considered 24 low-risk and 17 high-risk patients for the development of gastric cancer. To determine by GastroPanel® whether the patient would be at low or high risk of developing gastric cancer, PGI showed a sensitivity, specificity and accuracy of 0.47 (95%CI: 0.26-0.69), 0.67 (95%CI: 0.47-0.82), and 0.58 (95%CI: 0.43-0.72), respectively, while PGI/PGII showed sensitivity, specificity and accuracy of 0.06 (95%CI: 0.01-0.27), 0.83 (95%CI: 0.64-0.93) and 0.51 (95%CI: 0.36-0.66), respectively. CONCLUSION: The histological classifications OLGA and OLGIM presented a substantial concordance rate among themselves. Simultaneous use of both histological classification systems increased the identification's rate of high-risk patients. Biomarker analysis was not effective to distinguish low to high risk patients in the studied population. Further studies are needed to validate its use in clinical practice in Brazil.

RESUMO CONTEXTO: Gastrite atrófica crônica por H. pylori constitui lesão pré-maligna e seu estadiamento de acordo com os sistemas OLGA e OLGIM, visa identificar pacientes com maior risco de desenvolver câncer gástrico e otimizar seu acompanhamento. GastroPanel® é um teste não invasivo composto por painel de biomarcadores séricos incluindo pepsinogênio I (PGI), pepsinogênio II (PGII), gastrina 17 (G17) e anticorpos anti- H. pylori para avaliação de risco de adenocarcinoma gástrico em pacientes com gastrite crônica por H. pylori. OBJETIVO: Estudo prospectivo para avaliar a concordância entre os sistemas de classificação OLGA e OLGIM, bem como avaliar o desempenho do GastroPanel® em pacientes com lesões pré-malignas secundárias à gastrite crônica por H. pylori no Brasil. MÉTODOS: Pacientes com gastrite crônica por H. pylori portadores de lesões pré-malignas confirmadas por histologia (gastrite atrófica e metaplasia intestinal) foram recrutados no ambulatório de gastroenterologia de um hospital universitário. Todos os participantes foram submetidos a exame endoscópico com biópsias de antro e corpo gástricos analisadas de acordo com o Sistema Sydney atualizado e estadiadas pelos Sistemas OLGA e OLGIM de classificação das gastrites. Amostras de sangue foram coletadas para análise sorológica de biomarcadores (GastroPanel®, Biohit, Helsinki, Finlândia). Os valores de corte utilizados para definir pacientes de alto risco para desenvolvimento de câncer gástrico foram os recomendados pelo fabricante: PGI ≤30 µm e PGI/PGII ≤3. RESULTADOS: Foram recrutados 41 pacientes: 28 mulheres, 13 homens, idade média 67,3 (47-89, DP: 9,6) anos. Pelo sistema OLGA, foram obtidos: OLGA 0 (n=1), OLGA I (n=7), OLGA II (n=17), OLGA III (n=9) e OLGA IV (n=7). Pelo sistema OLGIM, foram obtidos: OLGIM 0 (n=14), OLGIM I (n=5), OLGIM II (n=10), OLGIM III (n=10) e OLGIM IV (n=2). Em relação ao estadiamento histológico entre os pacientes de baixo risco (OLGA/OLGIM 0, I e II) e alto risco (OLGA/OLGIM III e IV) para o desenvolvimento de câncer gástrico, a taxa de concordância encontrada entre as duas classificações foi de 85,4%, com valor kappa=0,678 (IC95%: 0,440-0,916). Considerando como pacientes de alto risco, aqueles assim estadiados em pelo menos um dos sistemas, a distribuição final de nossa amostra encontrou 24 pacientes de baixo risco e 17 de alto risco para o desenvolvimento de câncer gástrico. Na determinação pelo GastroPanel® para classificação do paciente como de baixo ou alto risco para desenvolvimento de câncer gástrico, PGI mostrou sensibilidade, especificidade e acurácia de 0,47 (IC95%: 0,26-0,69), 0,67 (IC95%: 0,47-0,82) e 0,58 (IC95%: 0,43-0,72), respectivamente, enquanto a razão PGI/PGII mostrou sensibilidade, especificidade e acurácia de 0,06 (IC95%: 0,01-0,27), 0,83 (IC95%: 0,64-0,93) e 0,51 (IC95%: 0,36-0,66), respectivamente. CONCLUSÃO: As classificações histológicas OLGA e OLGIM apresentaram taxa de concordância substancial entre si. O uso simultâneo de ambos os sistemas de classificação histológica aumentou a taxa de identificação de pacientes de alto risco para desenvolvimento de câncer gástrico. Os resultados do GastroPanel® não foram eficazes para distinguir pacientes de baixo e alto risco para desenvolvimento de câncer gástrico na população estudada. Mais estudos são necessários para validar seu uso na prática clínica no Brasil.

Helicobacter pylori y cáncer gástrico / Helicobacter pylori and gastric cancer

Introducción: El Helicobacter pylori se ha relacionado con el desarrollo de gastritis crónica atrófica, metaplasia intestinal y displasia, lesiones que pueden evolucionar a carcinoma gástrico. Existen investigaciones que demuestran que la erradicación de esta bacteria disminuye el riesgo de progresión histopatológica de las lesiones preneoplásicas, excepto la metaplasia intestinal y la displasia. Se realizó una revisión de los artículos publicados en las bases de datos Pubmed, Scielo, Medline y Cochrane, relacionados con el tema. Objetivo: Profundizar en los conocimientos relacionados con la infección por Helicobacter pylori y cáncer gástrico. Desarrollo: El adenocarcinoma es el tumor gástrico más frecuente y el Helicobacter pylori es el agente etiológico principal. En poblaciones de riesgo elevado, el adenocarcinoma gástrico de tipo intestinal, se precede de lesiones preneoplásicas (atrofia, metaplasia intestinal y displasia) que evoluciona al cáncer invasor. Conclusiones: Helicobacter pylori favorece la carcinogénesis gástrica, aunque existen otros factores de riesgo para el surgimiento del cáncer gástrico como son: la historia familiar, la pobre ingestión de frutas y vegetales y el bajo nivel socioeconómico(AU)

Introduction: Helicobacter pylori has been linked to the development of chronic atrophic gastritis, intestinal metaplasia, and dysplasia, lesions that can progress to gastric carcinoma. There is research showing that the eradication of this bacterium reduces the risk of histopathological progression of preneoplastic lesions, except for intestinal metaplasia and dysplasia. A bibliographic review was made of the articles published in the Pubmed, Scielo, Medline and Cochrane data bases, related to the topic, belonging to authors dedicated to the study of this problem. Objective: To go deepen in the knowledge related to Helicobacter pylori infection and gastric cancer. Development: Adenocarcinoma is the most frequent gastric tumor and Helicobacter pylori is the main etiologic agent. In high-risk populations, gastric adenocarcinoma of the intestinal type, is preceded by preneoplasic lesions (atrophy, intestinal metaplasia, and dysplasia), that progresses to invasive cancer. Conclusions: Helicobacter pylori favors gastric carcinogenesis, although there are other risk factors for the development of gastric cancer such as: family history, poor intake of fruits and vegetables, and low socioeconomic leve(AU)

¿Por qué es importante detectar la gastritis atrófica y la metaplasia intestinal gástrica? ¿Cuál es la forma adecuada de hacerlo? / Why is it important to detect atrophic gastritis and gastric intestinal metaplasia? What is the proper way to do it?

RESUMEN La metaplasia intestinal gástrica y la gastritis atrófica son condiciones precancerosas conocidas (CPCs) del estómago, lo que significa que los pacientes con CPCs están en riesgo de desarrollar cáncer gástrico y, por lo tanto, el diagnóstico y la categorización de riesgo para estos pacientes es un tema relevante. El objetivo de esta revisión es proporcionar una actualización sobre el problema, el diagnóstico y el manejo de las CPCs con énfasis en el papel de la detección endoscópica adecuada.

ABSTRACT Gastric intestinal metaplasia and atrophic gastritis are a known precancerous condition (PCC) of the stomach, meaning that patients with PCC are at risk for gastric cancer and so, diagnosis and risk categorization for these patients is relevant. The aim of this review is to provide an update regarding the problem, diagnosis, and management of PCCs with an emphasis on the role of appropriate endoscopic detection.

Acurácia diagnóstica do painel gástrico para gastrite atrófica em brasileiros e o efeito dos inibidores de bomba de prótons / Diagnostic accuracy of gastropanel® for atrophic gastritis in brazilian subjects and the effect of proton pump inhibitors

ABSTRACT BACKGROUND: It has been proposed that the combination of gastrin-17 (G-17), pepsinogens I and II (PGI and PGII), and anti-Helicobacter pylori (H. pylori) antibodies (GastroPanel®, BIOHIT HealthCare, Helsinki, Finland) could serve as biomarkers of atrophic gastritis. OBJECTIVE: This study aimed to ensure the diagnostic accuracy of GastroPanel® and evaluate the effect of proton pump inhibitors (PPIs) on these biomarkers. METHODS: Dyspeptic patients who underwent gastrointestinal endoscopy were enrolled in the present study. Histological findings, which were the gold standard to stratify groups, were as follows: no atrophy (controls); antrum atrophy; corpus atrophy; multifocal atrophy; and neoplasia. G-17, PGI, PGII, and anti-H. pylori immunoglobulin (Ig)G antibodies were assayed using commercially available kits. The ratio of PGI/PGII was calculated. RESULTS: Among 308 patients, 159 (51.6%) were PPI users. The overall prevalence of atrophy was 43.8% (n=135). Ninety-two (29.9%) patients were H. pylori positive according to anti-H. pylori IgG levels. G-17 levels were not low in those with antrum atrophy but were high in those with corpus and multifocal atrophies. PGI levels were significantly lower in those with corpus and multifocal atrophies. The sensitivity of PGI <30 µg/L to detect corpus atrophy was 50% (95% CI 27.8-72.1%), with a specificity of 93.2% (95% CI 84.3-97.5%), a positive likelihood ratio of 7.4 (95% CI 2.9-19.2), and a negative likelihood ratio of 0.5 (95% CI 0.3-0.8). A small number of subjects (n=6) exhibited moderate to intense atrophy (4%), among whom 66.7% exhibited decreased PGI levels. PPI significantly increased the levels of G-17 and PGI, except in those with corpus and multifocal atrophies, in whom PGI levels were not increased by PPIs. CONCLUSION: GastroPanel® (Gastrin-17, PGI, and PGI/PGII ratio) did not demonstrate high sensitivity for detecting gastric atrophy.

RESUMO CONTEXTO: Foi proposto que a combinação de gastrina 17 (G-17), pepsinogênios I e II (PGI e PGII), e anticorpos anti-Helicobacter pylori (H. pylori) (GastroPanel®, BIOHIT HealthCare), poderiam indicar gastrite atrófica. OBJETIVO: Portanto, o objetivo foi averiguar a acurácia diagnóstica do painel gástrico e avaliar o efeito dos inibidores de bomba de prótons (IBP) nesses marcadores. MÉTODOS: Pacientes dispépticos que se submeteram à endoscopia gastrointestinal entraram no estudo. Os achados histológicos foram o padrão ouro para estratificar os grupos: sem atrofia (controles), atrofia de antro, atrofia de corpo, atrofia multifocal e neoplasia. G-17, PGI, PGII, e anticorpos IgG anti-H. pylori foram determinados por kits comerciais. A razão PGI/PGII foi calculada. RESULTADOS: Entre 308 pacientes que foram incluídos, 159 estavam usando IBP (51,6%). A prevalência de atrofia foi de 43,8% (135 pacientes). H. pylori foi positivo em 92 (29,9%) pacientes por IgG anti-H. pylori. G-17 não estava diminuída na atrofia do antro, mas estava elevada nas atrofias do corpo e multifocal. PGI estava significantemente menor nas atrofias de corpo e multifocal. A sensibilidade da PGI <30 µg/L de indicar atrofia do corpo foi 50% (95%IC 27,8-72,1%) com especificidade de 93,2% (95%IC 84,3-97,5%), razão de verossimilhança positiva de 7,4 (95%IC 2,9-19,2) e razão de verossimilhança negativa de 0,5 (95%IC 0,3-0,8). O número de indivíduos com atrofia moderada para intensa foi pequeno (n=6;4%), dos quais 66,7% tinham diminuição dos níveis de PGI. IBP significantemente aumentou os níveis de G-17 e PGI, exceto nas atrofias de corpo e multifocal que não apresentaram aumento de PGI. CONCLUSÃO: O painel gástrico não teve alta sensibilidade de indicar gastrite atrófica.

Tumor neuroendocrino Tipo 1: reporte de un caso y revisión de la literatura / Localized neuroendocrine tumor of the stomach: a case report and literature review

Resumen Introducción: Los tumores neuroendocrinos (TNE), son tumores compuestos por células productoras de péptidos y aminas. Los TNE gástricos, representan el 1% de todas las neoplasias, sin embargo su incidencia ha ido en aumento. Son generalmente asintomáticos y no funcionantes. El tratamiento es generalmente la resección local. Caso Clínico: paciente de 48 años con sospecha de cáncer gástrico; su estudio demuestra un TNE gástrico bien diferenciado tipo 1. Se realiza etapificación y se define en comité oncológico la vigilancia endoscópica. El hallazgo de un TNE, en el estudio de cáncer gástrico, es un hallazgo poco frecuente. Debido al aumento progresivo en la realización de endoscopías digestivas altas, secundario a la alta prevalencia de cáncer gástrico en nuestro país, se espera que aumenten hallazgos como un TNE. Es por esto que realizamos una revisión de la literatura y planteamos algunas conclusiones al respecto.

Introduction: Neuroendocrine tumors (NETs) are composed of cells that produce peptides and amines. Gastric NETs represent 1% of all neoplasms; however their incidence has been increasing. They are usually asymptomatic and non-functioning. The treatment is usually local resection. Case Report: We present the case of a 48-year-old patient who was suspected of gastric cancer; her study shows a well-differentiated type 1 gastric NET. Staging is performed and endoscopic surveillance is defined in the oncology board. The finding of a NET, in the study of gastric cancer, is a rare finding. Due to the progressive increase in the performance of upper gastrointestinal endoscopies, secondary to the high prevalence of gastric cancer in our country, it is expected to increase findings as a NET. That is why we conducted a review of the literature and made some conclusions about it.

Historia del manejo de rinitis atrófica / The history of the treatment of atrophic rhinitis

La rinitis atrófica es una enfermedad crónica progresiva caracterizada por dilatación anormal de las cavidades nasales con atrofia de la mucosa, submucosa y cornetes nasales subyacentes. Los factores etiopatogénicos aún son desconocidos. Su presentación clínica consiste en congestión nasal paradójica asociado a secreciones viscosas, con presencia de costras secas de mal olor. La higiene nasal con irrigación de alto volumen y baja presión es el estándar de tratamiento médico. El tratamiento quirúrgico busca reducir el tamaño de las cavidades nasales y promover la regeneración de la mucosa nasal así como también su vascularización y lubricación. A lo largo de la historia se han descrito múltiples procedimientos quirúrgicos que han buscado estrechar la cavidad nasal para permitir el paso de aire de forma más fisiológica. Por otra parte, se han propuesto intervenciones radicales como el cierre de las fosas nasales para disminuir los síntomas y mejorar la calidad de vida. En este artículo se resumen los principales manejos y procedimientos propuestos junto con sus resultados y conclusiones. Si bien la mayoría de las técnicas descritas ya no se utilizan en la actualidad, es importante conocerlas ya que aún existen pacientes que fueron sometidos a ellas pudiendo presentar complicaciones y/o efectos adversos.

Atrophic rhinitis is a chronic progressive disease characterized by abnormal dilatation of the nasal cavities with atrophy of the mucosa, nasal submucosa and underlying nasal turbinates. The etiopathogenic factors are still unknown. Its clinical presentation consists of paradoxical nasal congestion associated with viscous secretions, usually with the presence of dry, bad-smelling crusts. Nasal hygiene with high pressure irrigation remains the standard of medical treatment. Surgical treatment seeks to reduce the size of nasal cavities and promote regeneration of nasal mucosa as well as its vascularization and lubrication. Throughout history, multiple surgical procedures have been described that have sought the narrowing of the nasal cavity to allow the passage of air more physiologically. On the other hand, radical interventions have been proposed such as the closure of the nostrils to reduce symptoms and improve quality. This article summarizes the main proposed procedures along with their results and conclusions. Although most of the techniques described are no longer used today, it is important to know them since there are still patients who were subjected to them and may present complications and / or adverse effects.

Evaluation of upper endoscopic findings in patients with restless legs syndrome and gastric complaints / Avaliação dos achados endoscópicos superiores em pacientes com síndrome das pernas inquietas e queixas gástricas

Abstract Background: The effect of gastrointestinal system disorders on Restless Legs Syndrome/Willis-Ekbom disease (RLS/WED) has been previously demonstrated by using serological tests. However, this association has not been supported by histopathological studies so far. Objective: To investigate the relationship between RLS/WED, upper endoscopic imaging and histopathological results in patients diagnosed with RLS who underwent endoscopy because of gastrointestinal system (GIS) complaints. Methods: Case-control study, including 100 patients diagnosed with RLS who presented dyspeptic complaints and underwent upper GIS endoscopy and 106 age- and sex-matched controls. RLS diagnosis was evaluated according to the four main diagnostic criteria determined by the International RLS Study Group. All patients underwent upper GIS endoscopic intervention and at least one gastric and/or antral biopsy. Results: There was no significant difference between patients and controls in relation to endoscopically seen gastric ulcer, duodenal ulcer, gastroesophageal reflux disease (GERD) findings and Helicobacter pylori (HP) positivity (p>0.05). Intestinal metaplasia and mucosal atrophy were more common in RLS/WED patients compared to controls (p=0.026 and p=0.017, respectively). Additionally, ferritin levels were found to be lower than the reference value. Conclusions: The detection of increased severity of intestinal metaplasia, mucosal atrophy, and gastric inflammation in RLS/WED patients with dyspeptic complaints may entail the close gastrointestinal system evaluation of these patients. However, larger randomized and controlled trials are required on this subject where patients are evaluated by upper GIS endoscopic biopsy.

Resumo Introdução: Os efeitos das doenças do sistema digestório sobre a Síndrome das Pernas Inquietas/doença de Willis-Ekbom (SPI/DWE) foram demonstrados previamente por testes sorológicos. No entanto, até o momento tal associação não foi corroborada por estudos histopatológicos. Objetivo: Investigar a relação entre a SPI/DWE, imagens de endoscopia digestiva alta e resultados histopatológicos em pacientes diagnosticados com SPI/DWE com queixas do sistema digestório. Métodos: Estudo caso-controle incluindo 100 pacientes com SPI/DWE e queixas dispépticas que foram submetidos à endoscopia digestiva alta, e 106 controles emparelhados para idade e sexo. O diagnóstico de SPI/DWE foi determinado com base nos quatro principais critérios do International RLS Study Group. Todos os pacientes foram submetidos à intervenção endoscópica do sistema digestório superior e a pelo menos uma biópsia gástrica e/ou antral. Resultados: Não houve diferença significativa entre os grupos em relação à úlcera gástrica endoscopicamente observada, úlcera duodenal, doença do refluxo gastroesofágico (DRGE) e positividade para Helicobacter pylori (HP) (p>0,05). Metaplasia intestinal e atrofia da mucosa foram mais comuns em pacientes com SPI/DWE em comparação aos controles (p=0,026 e p=0,017, respectivamente). Níveis de ferritina encontravam-se abaixo do valor de referência. Conclusão: A detecção de metaplasia intestinal grave, atrofia de mucosa e inflamação gástrica em pacientes com SPI/DWE com queixas dispépticas pode justificar a avaliação cuidadosa do sistema digestório nestes pacientes. Entretanto, são necessários estudos controlados e com amostras maiores com pacientes avaliados com biópsia por via endoscópica.

Carcinoma gástrico: revisión bibliográfica / Gastric Carcinoma: literature review

Resumen El carcinoma gástrico hoy en día es una de las principales causas de mortalidad a nivel mundial por neoplasias y especialmente en países como Costa Rica, que se cataloga como un país de alta incidencia. Existen múltiples factores de riesgo, siendo el primero y más importante la infección por Helicobacter pylori, que desencadena una cascada de diferentes lesiones, iniciando en atrofia gástrica, que puede llegar a finalizar en cáncer invasivo. Existen otros factores que pueden influir en un ambiente pro-carcinogénico tales como fumado, obesidad, la dieta, entre otros. Múltiples naciones han desarrollado diferentes guías de tamizaje para disminuir la mortalidad; sin embargo, en países con alta incidencia sigue siendo el estándar realizar estudios de imagen y endoscopia luego de determinada edad dependiendo de factores de riesgo.

Abstract Gastric carcinoma is nowadays one of the main causes of mortality worldwide due to neoplasms and especially in countries such as Costa Rica, which is classified as a high incidence country. There are multiple risk factors, starting with Helicobacter pylori infection being the most important one; after the infection a cascade with different lesions is triggered, first it begins with gastric atrophy and then eventually lead to an invasive cancer. There are other factors that can influence a pro-carcinogenic environment such as smoking, obesity, diet, among others. Multiple nations have developed different screening guidelines to reduce mortality, however in countries with high incidence it is still the gold-standard to perform imaging and endoscopy studies after a certain age and depending on risk factors.

Infecção por Helicobacter pylori e lesões precursoras de câncer gástrico: prevalência e fatores associados em um laboratório de referência no Sudeste do Brasil / Helicobacter pylori infection and gastric cancer precursor lesions: prevalence and associated factors in a reference laboratory in southeastern brazil

ABSTRACT BACKGROUND: Helicobacter pylori infection is the most important risk factor for gastric atrophy and intestinal metaplasia, both considered gastric cancer precursor lesions. Therefore, the investigation of the occurrence of H. pylori infection, precursor lesions and associated factors guides the adoption of specific strategies for the control this type of cancer. OBJECTIVE: To evaluate the prevalence of H. pylori infection in patients undergoing upper digestive endoscopy, as well as the prevalence of intestinal metaplasia, atrophy and chronic inflammation and their association with H. pylori infection. METHODS: A retrospective study was performed based on reports of gastric endoscopic biopsies performed in a private laboratory affiliated to the Brazilian Public Health System (SUS). Patients were evaluated for age, gender and type of health service. The samples were evaluated for the presence of H. pylori, and also of chronic inflammation, intestinal metaplasia and glandular atrophy. RESULTS: Of a total of 4,604 patients (mean age 51±16.6), 63.9% were female and 63.1% coming from private health care service. The prevalence of H. pylori infection was 31.7% (n=1,459), and the percentage of infection was significantly higher in patients from public health service (42.0%) in relation to patients from private health service (25.6%). Among H. pylori (+) patients, a higher percentage of intestinal metaplasia (17.7% vs 13.3%) and glandular atrophy (17.6% vs 6.9%) were observed when compared to those H. pylori (-) (P<0.01). From the patients H. pylori (+) with at least one type of precursor lesion (n=418), 161 (38.5%) had metaplasia and chronic inflammation, 160 (38.3%) had atrophy and chronic inflammation and finally 97 (23.2%) presented metaplasia, atrophy and chronic inflammation simultaneously. CONCLUSION: The present study reinforces the association of H. pylori infection with gastric cancer precursor lesions in a Brazilian population, emphasizing the importance of infection prevention measures, as well as the treatment of infected patients, especially in regions with lower socioeconomic levels that show a higher prevalence of infection by H. pylori.

RESUMO CONTEXTO: A infecção por Helicobacter pylori é o fator de risco mais importante para atrofia gástrica e metaplasia intestinal, ambas consideradas lesões precursoras do câncer gástrico. Portanto, a investigação da ocorrência de infecção por H. pylori, das lesões precursoras e dos fatores associados orienta a adoção de estratégias específicas para o controle deste tipo de câncer. OBJETIVO: Avaliar a prevalência de infecção por H. pylori em pacientes submetidos à endoscopia digestiva alta, bem como a prevalência de metaplasia intestinal, atrofia e inflamação crônica e a associação destas com a infecção por H. pylori. MÉTODOS: Foi realizado um estudo retrospectivo com base em laudos de biópsias endoscópicas gástricas realizadas em laboratório privado afiliado ao Sistema Único de Saúde (SUS). Os pacientes foram avaliados quanto à idade, sexo e tipo de serviço de saúde. As amostras foram avaliadas quanto à presença de H. pylori e também de inflamação crônica, metaplasia intestinal e atrofia glandular. RESULTADOS: Do total de 4.604 pacientes (idade média de 51±16,6), 63,9% eram do sexo feminino e 63,1% provenientes de serviços de saúde privado. A prevalência de infecção por H. pylori foi de 31,7% (n=1.459) e o percentual de infecção foi significativamente maior nos pacientes do serviço público de saúde (42,0%) em relação aos pacientes do serviço privado de saúde (25,6%). Entre os pacientes com H. pylori (+), foi observado maior percentual de metaplasia intestinal (17,7% vs 13,3%) e atrofia glandular (17,6% vs 6,9%) quando comparados aos H. pylori (-) (P<0,01). Dos pacientes H. pylori (+) com pelo menos um tipo de lesão precursora (n=418), 161 (38,5%) apresentaram metaplasia e inflamação crônica, 160 (38,3%) apresentaram atrofia e inflamação crônica e, finalmente, 97 (23,2%) apresentaram metaplasia, atrofia e inflamação crônica simultaneamente. CONCLUSÃO: O presente estudo reforça a associação da infecção por H. pylori com lesões precursoras de câncer gástrico em uma população brasileira, enfatizando a importância de medidas de prevenção de infecção, bem como o tratamento de pacientes infectados, principalmente em regiões com níveis socioeconômicos mais baixos que apresentam maior prevalência de infecção por H. pylori.

Morfología y repercusiones diagnóstico-terapéuticas de las lesiones preneoplásicas gástricas / Morphology and diagnostic determinants of gastric precancerous conditions

El carcinoma gástrico (CG) de tipo intestinal se origina en un epitelio displásico, que a su vez se desarrolla en medio de una atrofia gástrica (AG) y metaplasia intestinal (MI). La infección por Helicobacter pylori (HP) es la causa más frecuente de AG, causando una pangastritis atrófica multifocal. Entre otras condiciones que producen inflamación crónica de la mucosa gástrica se encuentran también la gastritis autoinmune y la anemia perniciosa. El marco conceptual sobre el cual descansa gran parte de la investigación actual y nuestra comprensión de los cambios que ocurren en la mucosa gástrica se debe a la denominada "cascada de Correa"; quien planteó que la mucosa gástrica crónicamente inflamada, da paso a la AG, que va adquiriendo focos de MI y en dicho epitelio se desarrollará finalmente una displasia (DIS). Se ha acuñado el término lesiones preneoplásicas gástricas (LPG), para referirse a: AG, MI y DIS.Después de la erradicación de HP, se ha demostrado una reducción general de la incidencia de CG; efecto que no es tan claro, cuando la pangastritis por HP ha evolucionado a AG extensa. De tal modo que el efecto de la erradicación de HP medido a través de EC, ha sido poco consistente. La AG grave diagnosticada por histología representa la condición de mayor riesgo. Por otra parte, la MI puede ser de tipo intestinal (delgado-entérica ó incompleta) y la colónica (colónica ó completa) considerándose a esta última, como la variedad de peor pronóstico. El diagnóstico histológico de este tipo de lesiones determina que quien las padece, debe someterse a vigilancia endoscópica. El objetivo de este manuscrito fue resumir la evidencia existente respecto de las LPG, en términos de su caracterización morfológica y sus repercusiones diagnóstico-terapéuticas (significado patológico, graduación del riesgo, vigilancia recomendada; y factores de riesgo).

Gastric carcinoma (GC) of intestinal type, originates from a dysplastic epithelium, which in turn develops in the midst of gastric atrophy (GA) and intestinal metaplasia (IM). Helicobacter pylori (HP) infection is the most frequent cause of GA, causing a multifocal atrophic pangastritis. Among other conditions that produce chronic inflammation of gastric mucosa are also autoimmune gastritis and pernicious anemia. The conceptual framework on which much of current research rests and our understanding of the changes that occur in the gastric mucosa is due to the so-called "Correa waterfall"; who stated that gastric mucosa chronically inflamed, gives way to the GA, which is acquiring foci of IM and in said epithelium a dysplasia (DIS) will eventually develop. The term precancerous conditions (PCC) of the gastric mucosa have been coined to refer to: GA, IM and DIS. After HP eradication, a general reduction in the incidence of GC has been demonstrated; effect that is not so clear, when pangastritis by HP has evolved to extensive GA. Thus, the effect of HP eradication measured through clinical trials has been inconsistent. Severe GA diagnosed represents the highest risk condition. On the other hand, IM can be enteric (grade I), enterocolic (grade II) or colonic (grade III); considering IM III as the variety with the worst prognosis. Histological diagnosis of gastric PCC, determines that the one who suffers them, must undergo endoscopic surveillance. The aim of this manuscript was to update morphological aspects and diagnostic-therapeutic scope of gastric PCC.