Frequency of Helicobacter pylori Infection in Patients Requiring GI Endoscopy in Seven Units in Three Antioquia Subregions

Aim: To determine the frequency of Helicobacter pylori and sociodemographic factors, life habits, and personal and family history of gastroduodenal diseases in patients who required and were taken to GI endoscopy (symptomatic or by screening) in seven endoscopy units in three Antioquia subregions. Materials and methods: A cross-sectional study conducted between 2016 and 2018 included 272 participants. Sociodemographic factors, life habits, and personal and family history were related to H. pylori infection. Descriptive statistics and bivariate analysis were performed to establish the association between the variables, and multivariate analysis (binomial regression) was used to adjust the prevalence ratios of the associated factors. A p-value ≤ 0.05 was considered statistically significant. Results: The frequency of H. pylori infection was 55.9%, with differences by subregion (Valle de Aburrá metropolitan area: 54.3%, Oriente: 64%, and Urabá: 79.2%). Factors associated with H. pylori infection were male sex (adjusted prevalence ratio [APR] = 1.26; 95% confidence interval [CI] = 1.04-1.52), age 18-55 years (APR = 1.62; CI 95% = 1.22-2.16), absence of drinking water (APR = 1.40; 95% CI: 1.15-1.72) and educational level below university (APR = 1.73; 95% CI% = 1.26-2.38). Conclusion: The frequency of H. pylori was higher than in other recent studies because different diagnostic tests were used for its detection, and differences were found in the frequency of infection by region, which is explained by the heterogeneity in the populations analyzed. This study suggests the need to improve the population's living conditions to reduce H. pylori and direct measures of primary prevention of the infection, especially in family groups, men, individuals between 18 and 55 years old without drinking water, and with an educational level lower than university.

Objetivo: determinar la frecuencia de Helicobacter pylori y la presencia de factores sociodemográficos, hábitos de vida y antecedentes personales y familiares de enfermedades gastroduodenales en pacientes que requirieron y fueron llevados a endoscopia digestiva (sintomáticos o por tamización) en siete unidades de endoscopia de tres subregiones de Antioquia. Materiales y métodos: estudio transversal realizado entre 2016 y 2018 que incluyó a 272 participantes. Los factores sociodemográficos, hábitos de vida, antecedentes personales y familiares se relacionaron con la infección por H. pylori. Se realizó estadística descriptiva y análisis bivariado para establecer la asociación entre las variables y el análisis multivariado (regresión binomial) para ajustar las razones de prevalencia de los factores asociados. Un valor p ≤ 0,05 se consideró estadísticamente significativo. Resultados: la frecuencia de infección por H. pylori fue de 55,9%, con diferencias por subregión (área metropolitana del Valle de Aburrá: 54,3%, oriente: 64% y Urabá: 79,2%). Los factores asociados a la infección por H. pylori fueron sexo masculino (razón de prevalencia ajustada [RPA] = 1,26; intervalo de confianza [IC] del 95% = 1,04-1,52), edad de 18-55 años (RPA = 1,62; IC 95% = 1,22-2,16), ausencia de agua potable (RPA = 1,40; IC 95%: 1,15-1,72) y nivel educativo inferior al universitario (RPA = 1,73; IC 95% = 1,26-2,38). Conclusión: la frecuencia de H. pylori fue mayor que en otros estudios recientes porque se emplearon diferentes pruebas diagnósticas para su detección y se demostraron diferencias en la frecuencia de la infección por región, lo cual se explica por la heterogeneidad en las poblaciones analizadas. Este estudio sugiere la necesidad de mejorar las condiciones de vida de la población para reducir la infección por H. pylori y dirigir medidas de prevención primaria de la infección especialmente en los grupos familiares, en hombres, individuos entre 18 y 55 años, sin agua potable y con un nivel educativo inferior al universitario.

Estenosis gastroduodenal: una complicación infrecuente del carcinoma gástrico de células en anillo de sello / Upper gastrointestinal stenosis: a rare complication of gastric-signet ring cell carcinoma / Estenose gastroduodenal: uma complicação rara do carcinoma gástrico de células em anel de sinete

El carcinoma de células en anillo de sello es una variante histopatológica de cáncer gástrico que se encuentra en aumento, se caracteriza por un mal pronóstico. Se presenta el caso de un hombre joven al que se le hizo este diagnóstico en el contexto de una complicación rara como es el síndrome de estenosis gastroduodenal.

Signet ring cell carcinoma is a histopathological variant of gastric cancer that is increasing and is characterized by a poor prognosis. We present the case of a young man who underwent this diagnosis in the context of a rare complication such as upper gastrointestinal stenosis syndrome.

O carcinoma de células em anel de sinete é uma variante histopatológica do câncer gástrico que está aumentando e é caracterizado por um mau prognóstico. É apresentado o caso de um jovem que recebeu este diagnóstico no contexto de uma complicação rara como a síndrome de estenose gastroduodenal.

Application value of manual anastomosis of gastroduodenum in totally laparoscopic distal gastrectomy / 中华消化外科杂志

Objective:To investigate the application value of manual anastomosis of gastro-duodenum in totally laparoscopic distal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 55 patients with gastric cancer who underwent totally laparoscopic distal gastrectomy combined with gastrointestinal anastomosis in the Tianjin Medical University Cancer Institute & Hospital from January 2020 to October 2022 were collected. There were 34 males and 21 females, aged 61(range, 29?75)years. Of 55 patients, 25 patients undergoing manual anastomosis of gastroduodenum were divided into the manual anastomosis group, 30 patients undergoing modified Delta anastomosis of gastroduodenum were divided into the modified Delta anastomosis group. Observation indicators: (1) surgical situations; (2) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using chi-square test or Fisher exact probility. Results:(1) Surgical situations. All 55 patients underwent surgery successfully, without conversion to laparotomy. The distance from the superior margin of tumor to the upper margin, anastomosis time, number of bookings used were (48±4)mm, (22.6±2.3)minutes, 3.2±0.5 in the manual anastomosis group, versus (41±4)mm, (14.0±1.4)minutes, 5.2±0.4 in the modified Delta anastomosis group, showing significant differences in the above indicators between the two groups ( t=5.04, 16.38, ?17.13, P<0.05). The location of tumor (antrum, gastric angle) was 18, 7 in the manual anastomosis group, versus 29, 1 in the modified Delta anastomosis group, showing a significant difference between the two groups ( P<0.05). (2) Postoperative complications. There was no patient undergoing anastomotic fistula in both of manual anastomosis group and modified Delta anastomosis group, and there was 1 patient undergoing anastomotic stenosis in the modified Delta anastomosis group. Conclusion:Compared with modi-fied Delta anastomosis of gastroduodenum,totally laparoscopic distal gastrectomy with manual anas-tomosis of gastroduodenum can remove more gastric tissue, and decrease the number of bookings used.

Paliación endoscópica con stent duodenal en cáncer gástrico estadio IV complicado con estenosis gastroduodenal / Endoscopic stenting for palliation of Stage IV gastric cancer with malignant gastric outlet obstruction. A clinical case / Paliação endoscópica com stent duodenal em câncer gástrico estágio IV complicado por estenose gastroduodenal. Caso clínico

Resumen: Introducción: el cáncer gástrico es la quinta neoplasia en frecuencia a nivel mundial. Su diagnóstico suele ser tardío. La estenosis gastroduodenal es una complicación frecuente, que condiciona el pronóstico y el tratamiento. Contamos con varias modalidades en cuanto a la paliación de esta complicación. Destacamos el tratamiento quirúrgico mediante derivación digestiva (gastroenteroanastomosis), y el tratamiento endoscópico, mediante colocación de un stent o prótesis metalica autoexpandible (PMA). El objetivo es exponer el caso clínico de una paciente portadora de un cáncer gástrico avanzado complicado con estenosis gastroduodenal en la cual se optó por la colocación de una PMA. La bibliografía comparativa entre ambas técnicas es controvertida. Existen estudios importantes que recomiendan la técnica quirúrgica frente a la endoscópica, y viceversa. Con este fin se han realizado múltiples trabajos. Los posibles beneficios de la paliación endoscópica son: menor estadía hospitalaria, rápido reintegro a la vía oral. El caso clínico expuesto por el contrario no se benefició de la menor estadía hospitalaria, en parte, por ser necesaria su internación por comorbilidades médicas. No presentó complicaciones posteriores relacionadas al procedimiento. Conclusiones: la elección de la técnica a utilizar deberá ser individualizada, teniendo en cuenta el paciente, sus comorbilidades, recursos técnicos, experiencia del personal, y recursos económicos. Se necesitan más estudios para demostrar beneficio de la técnica paliativa más adecuada.

Abstract: Introduction: gastric cancer is the fifth neoplasm in terms of global incidence and its diagnosis often comes late. Gastric outlet obstruction is a frequent complication that influences prognosis and treatment. Among the various modalities available for palliation of this complication, we stand out two: surgical treatment by means of a digestive derivation: gastrojejunostomy and endoscopic treatment, by placing a stent or a steel mesh self-expanding endoprosthesis (EMP). The study aims to present the clinical case of a patient carrier of advanced gastric cancer with gastric outlet obstruction, who was treated by placing a self-expandable metallic stent. Comparative bibliography of both techniques is controversial. A number of important studies recomend the surgical technique instead of endoscopic treatment, and viceversa. For this reason, several studies have been conducted. The potential benefits of endoscopic palliation are the following: shorter hospital stay, fast return to oral intake. However the clinical case presented did not benefit from a shorter hospital stay, since it required longer hospitalization, partly due to medical comorbilities. There were no complications after the procedure. Conclusions: the specific technique to treat the condition needs to be chosen for each individual case, considering the particular patient and his or her comorbilities, technical resources, the experience of the medical staff and economic resources. More studies are necessary to prove the benefits of the most appropriate palliative technique.

Resumo: Introdução: o câncer gástrico é a quinta neoplasia em frequência no mundo. Seu diagnóstico costuma ser tardio. A estenose gastroduodenal é uma complicação frequente, que determina o prognóstico e o tratamento. Existem várias modalidades quanto à paliação desta complicação entre os quais destacamos o tratamento cirúrgico por derivação digestiva: gastro enteroanastomose e o tratamento endoscópico, com colocação de Stent ou Prótese Metálica Autoexpansível (PMA). O objetivo deste trabalho é apresentar o caso clínico de um paciente com câncer gástrico avançado complicado por estenose gastroduodenal em que se optou pela colocação de PMA. A bibliografia comparativa entre as duas técnicas é controversa. Existem estudos importantes que preconizam a técnica cirúrgica em detrimento da endoscópica e vice-versa. Para isso, vários trabalhos foram realizados. Os possíveis benefícios da paliação endoscópica são: menor tempo de internação, rápida reintrodução à via oral. Neste caso o paciente não se beneficiou do menor tempo de internação, em parte, porque a internação foi necessária por comorbidades médicas. Não foram observadas complicações subsequentes relacionadas ao procedimento. Conclusões: a escolha da técnica a ser utilizada deve ser individualizada, levando em consideração o paciente, suas comorbidades, os recursos técnicos, a experiência da equipe e os recursos econômicos. Mais estudos são necessários para demonstrar o benefício da técnica paliativa mais adequada.

Conducta actual frente la hemorragia digestiva alta: desde el diagnóstico al tratamiento / Current behavior against Upper Digestive Hemorrhage: from diagnosis to treatment

Resumen La hemorragia digestiva alta (HDA) es una emergencia médico-quirúrgica común que debe ser tratada precozmente por su alta morbimortalidad. Corresponde a sangrado del esófago, estómago o del duodeno proximal, y se divide en etiología no variceal y variceal. Dentro de las no variceales destaca la úlcera péptica como la más frecuente, siendo esta producida por un desbalance entre factores protectores y agresivos. Por otro lado, en las hemorragias variceales destacan las várices gastroduodenales, las cuales son consecuencia del aumento de la presión portal. La incidencia de la HDA a nivel mundial varía entre 37 a 172 casos por cada 100.000 habitantes por año y la mortalidad entre un 5 y un 14% según diferentes estudios. Lamentablemente, no existen cifras nacionales fidedignas de incidencia y prevalencia. El médico debe conocer bien la presentación clínica y la fisiopatología para ser asertivo en la sospecha, diagnóstico y manejo de esta patología. En cuanto al tratamiento, el enfrentamiento se divide en el manejo de urgencias y luego endoscópico, puesto que la resucitación temprana intensiva puede reducir la morbimortalidad en pacientes con HDA. A continuación se hará una revisión actualizada enfocada en los aspectos más relevantes del manejo de esta patología. Se obtuvieron los datos de Pubmed y Scielo, específicamente la búsqueda de artículos originales y de revisiones sistemáticas con las palabras "hemorragia digestiva alta", "úlcera péptica", "várices esofágicas" y otras relacionadas. Los criterios usados fueron artículos preferentemente menores a 5 años de publicación en revistas científicas de alto índice de impacto.

Upper gastrointestinal bleeding (UHD) is a common medical-surgical emergency that must be treated early due to its high morbidity and mortality. It corresponds to bleeding from the esophagus, stomach, or proximal duodenum, and is divided into non-variceal and variceal etiology. Among the non-variceal, the peptic ulcer stands out as the most frequent, being this produced by an imbalance between protective and aggressive factors. On the other hand, in variceal hemorrhages gastroduodenal varices stand out, are a consequence of increased portal pressure. The incidence of HDA worldwide varies between 37 to 172 cases per 100,000 inhabitants per year and mortality between 5 to 14% according to different studies. Unfortunately, there are no reliable national statistics of incidence and prevalence. The physician must have a good understanding of the clinical presentation and pathophysiology to be assertive in the suspicion, diagnosis, and management of this pathology. Regarding treatment, the confrontation is divided into emergency management and then endoscopic, because early intensive resuscitation can reduce morbidity and mortality in patients with UHD. This is an updated review which will be focused on the most relevant aspects of the management of this pathology. Data were obtained from Pubmed and Scielo, specifically searching for original articles and systematic reviews with the words "upper gastrointestinal bleeding", "peptic ulcer", "esophageal varices" and other related words. The criteria used were articles preferably less than 5 years old in scientific journals with a high impact index.

Descripción de la resistencia de Helicobacter pylori a seis antibióticos de uso frecuente en Colombia / Helicobacter pylori susceptibility to six commonly used antibiotics in Colombia

Resumen Helicobacter pylori (H. pylori) es un bacilo gramnegativo microaerófilo, capaz de colonizar la mucosa gástrica. Este microorganismo infecta a más de la mitad de la población mundial, por lo que se ha convertido en la infección bacteriana más común. La prevalencia de la infección y de las enfermedades asociadas a ella es alta, sobre todo en países en vías de desarrollo. El tratamiento recomendado para la erradicación es la triple terapia; sin embargo, su eficacia ha disminuido por el desconocimiento del patrón de susceptibilidad bacteriano por parte del personal médico y dada la aparición de cepas resistentes. La resistencia en H. pylori se asocia con la capacidad de adaptación de la bacteria a ambientes hostiles y al uso de los antibióticos. En Colombia, existen reportes acerca de que H. pylori presenta resistencia a amoxicilina, metronidazol, claritromicina, furazolidona, levofloxacina y tetraciclina. Los estudios del patrón de susceptibilidad determinaron que la frecuencia de resistencia de H. pylori es variable y demuestran la falta de datos en la mayoría del territorio del país. Sobre la base de lo anterior, el objetivo de esta revisión es describir los porcentajes de resistencia de H. pylori a los antibióticos amoxicilina, metronidazol, claritromicina, furazolidona, levofloxacina y tetraciclina, usados en el tratamiento de la infección en los estudios realizados en Colombia.

Abstract Helicobacter pylori (H. pylori) is a microaerophilic gram-negative bacillus that colonizes the gastric mucosa. It infects more than half the world's population, making it the most common bacterial infection. The prevalence of infection and associated diseases is high in developing countries. The recommended treatment for its eradication is triple therapy; however, its efficacy has decreased due to the lack of knowledge of the bacterial susceptibility pattern among the medical staff and the emergence of resistant strains. H. pylori susceptibility is associated with the bacteria's ability to adapt to hostile environments and the use of antibiotics. In Colombia, it has been reported that H. pylori is resistant to amoxicillin, metronidazole, clarithromycin, furazolidone, levofloxacin, and tetracycline. Studies on the susceptibility pattern have determined that the frequency of H. pylori susceptibility is variable and demonstrate the lack of data in most of the Colombian territory. With this in mind, the objective of this review is to describe the percentage of resistance to amoxicillin, metronidazole, clarithromycin, furazolidone, levofloxacin and tetracycline, which are used for the treatment of H. pylori infection, according to studies conducted in Colombia.

Presence of Helicobacter pylori infection in gastroduodenal perforations

Background: Gastroduodenal perforations constitute one of the commonest surgical emergencies encountered. Helicobacter pylori is a gram negative bacterium that has infected more than half the world’s population. The most commonly recognized manifestation of H. pylori infection in India is peptic ulcer disease. Although the relationship between H. pylori infection and peptic ulcer has been well defined, the relationship of H. pylori infection with gastroduodenal perforation is still controversial. The objective of the study was to determine the presence of H. pylori in gastroduodenal perforations.Methods: We conducted a prospective study, noting the number of cases which turned out to be positive for H. pylori in cases of gastroduodenal perforations intraoperatively, using rapid urease test.Results: Out of 100 cases of gastroduodenal perforations operated, 74% were positive for the test. Gastric perforations positive for the test were 81.4% and duodenal perforations positive for the test were 68.42%.Conclusions: There is a positive attribution between H. pylori infection and gastroduodenal perforations.

A rare case of gastroduodenal artery aneurysm in a highly active antiretroviral therapy induced acute pancreatitis case presenting with lump in abdomen

Gastroduodenal artery (GDA) aneurysm is a rare but potentially fatal vascular disease, with chronic pancreatitis being reported as the commonest etiological factor. Rupture, which is not uncommon, carries a high risk of mortality. The typical patient with palpable epigastric mass, upper gastrointestinal bleeding and pain, may not present in the emergency and the lesion is often picked up incidentally on abdominal ultrasound or a computed tomography. We describe a critical case presenting with lump in abdomen which was found out to be gastroduodenal artery aneurysm on scanning, developing in a patient with recurrent highly active antiretroviral therapy (HAART) induced pancreatitis managed with transfemoral catheter embolization. The patient in question succumbed due to post procedure hepatic failure. The management of aneurysms since historic times have been challenging, the open procedures are being gradually replaced by endovascular techniques, which are yielding better results.

Is Helicobacter pylori Infection Associated with Perforated Gastro-Duodenal Ulcer

About 95% of the patients suffering from duodenal ulcer and 70-80% of the gastric ulcer patients are found to be Helicobacter pylori (H. pylori) positive. Although the role of H. pylori is well known in peptic ulcer disease aetiology, its role in perforated peptic ulcer is not well established. There are conflicting results in the literature regarding its association, with some studies showing high prevalence of H. pylori infection in gastro-duodenal perforation patients and also its eradication prevented the relapse of ulcer while others showing low or lack of association, suggesting a different pathogenesis for perforated peptic ulcer.METHODSGroup-I patients were operated for gastro-duodenal perforation and group-II patients were with the upper gastrointestinal endoscopic diagnosis of peptic ulcer disease. The mucosal biopsy samples taken from antrum from both the groups were tested with rapid urease test and histopathological examination to detect H. pylori.RESULTSThe prevalence of H. pylori infection was significantly less in patients with perforated gastro-duodenal ulcer than with peptic ulcer disease (p-value-0.026; OR – 0.31).CONCLUSIONSThrough this study it was found that alcohol intake and smoking were significant risk factors associated with perforation of gastro-duodenal ulcer whereas NSAIDs use was not significantly associated. H. pylori infection was not significantly associated with perforated gastro-duodenal ulcer suggesting that some other factors were involved in perforation.

In Silico Screening Of Zinc Database For Discovery Of Novel Urease Inhibitors As A Remedy To Gastro-Duodenal Ulcer Caused By Helicobacter Pylori

Design and synthesis of novel urease inhibitors taking center stage now days with specific attention as a remedy to Helicobacter pylori infection. A number of inhibitors fail in vivo and in clinical trial owing to the toxicity and hydrolytic profile. In the present study, we are making an attempt to screen a large small molecule database, ZINC, for a potential urease inhibitor. The structure based drug discovery approach has been adopted with acceptable ADMET parameters so that the lead molecules may have fair chances of passing in vitro and in vivo trails. The lead molecule in our study, with ID ZINC90446454 is a urea derivative and predicted to be nontoxic. It comes out to be a promising drug candidate with pKd value 7.83, LE 0.429 and LD50 value 10100 mg/kg body weight. Its sulfanyl derivative, with predicted high LD50 (10100 mg/kg body weight), exhibits the feasibility of a disulfide covalent bond with Cys321 in the active site. The derivative may serve as a novel covalent inhibitor with high specificity, high potency and low toxicity. The derivative, in future, may be a successful drug candidate for H. pylori induced gastro-duodenal ulcer.

Métodos de diagnóstico para la detección de la infección por Helicobacter pylori / Diagnostic methods for detection of Helicobacter pylori infection

Helicobacter pylori (H. pylori) is a Gram-negative bacterium that survives in gastric acidity. Approximately 50% of the world population is a carrier of this infection and the prevalence is higher in African and Latin American populations. The clinical manifestations associated with this infection are gastritis, peptic ulcers, MALT lymphoma, gastric cancer (GC), and other extra-digestive pathologies. Chronic H. pylori infection is the most important risk factor for GC development. There are several diagnostic methods to detect H. pylori infection. The most widely used invasive methods are the rapid urease test and Giemsa staining in gastric biopsies. Culture and molecular techniques are very useful for the study of H. pylori presence and antibiotic resistance, but they are not easily available in health centers. The most widely used non-invasive methods are the urea breath test and bacterial antigens in stools. Serological studies are used for population studies. The use and indication of the diagnostic method for detecting H. pylori infection will depend on the clinical manifestations, risk factors for GC, and the age of the patient.

Helicobacter pylori (H. pylori) es una bacteria Gram negativa que sobrevive a la acidez gástrica. Se estima que aproximadamente el 50% de la población mundial es portadora de esta infección, siendo mayor la prevalencia en poblaciones africanas y latinoamericanas. Entre las manifestaciones clínicas asociadas a esta infección se encuentra gastritis, úlceras pépticas, linfoma MALT, cáncer gástrico y otras patologías extradigestivas. La infección crónica por H. pylori es el factor de riesgo más importante para el desarrollo de CG. Existen diversos métodos diagnósticos para detectar la infección por H. pylori, los métodos invasivos más utilizados son la prueba rápida de ureasa y tinción de Giemsa en biopsias gástricas. El cultivo y las técnicas moleculares son de gran utilidad para el estudio de presencia de H. pylori y estudios de resistencia antibiótica, pero suelen estar poco disponibles en los centros de atención en salud. Los métodos no invasivos más utilizados son la prueba de aire espirado con urea marcada y antígeno bacteriano en deposiciones. Los estudios serológicos son utilizados para estudios poblacionales. El uso e indicación de cada uno de los métodos de diagnóstico para la detección de infección por H. pylori, dependerá de las manifestaciones clínicas, los factores de riesgo de CG y la edad del paciente.

Dual endovascular repair (coils and stent) of a true aneurysm of the gastroduodenal artery / Reparo endovascular duplo (molas e stent) de aneurisma verdadeiro da artéria gastroduodenal

Abstract We report a case of an asymptomatic gastroduodenal artery aneurysm diagnosed in a 39 year-old woman. An abdominal ultrasound study showed an aneurysmal dilatation of the gastroduodenal artery with 2 x 2 cm diameter. To confirm this finding, she then underwent a computed tomography scan of the abdomen and pelvis that showed a saccular aneurysm of the gastroduodenal artery. A dual endovascular approach was used to exclude the aneurysm by stent-assisted coil embolization. Complete exclusion of the aneurysm sac was confirmed on final angiography. She was discharged from the hospital on postoperative day 1.

Resumo Relatamos um caso de aneurisma de artéria gastroduodenal assintomático diagnosticado em uma mulher de 39 anos. Uma ultrassonografia abdominal mostrou uma dilatação aneurismática associada à artéria gastroduodenal com 2 x 2 cm de diâmetro. Para confirmar esse achado, foi realizada uma tomografia computadorizada do abdome e da pelve, que revelou um aneurisma sacular da artéria gastroduodenal. Uma abordagem endovascular dupla foi utilizada para exclusão do aneurisma mediante embolização com molas assistida por stent. A exclusão completa do saco aneurismático foi confirmada na angiografia final. A paciente recebeu alta hospitalar no primeiro dia de pós-operatório.

Úlcera gastroduodenal isquémica como complicación de la quimioembolización transarterial hepática de hepatocarcinoma / Ischemic gastroduodenal ulcer as a complication of hepatic hepatocarcinoma transarterial chemoembolization

La quimioembolización transarterial hepática es uno de los tratamientos del carcinoma hepatocelular irresecable en el que se han descrito de forma infrecuente lesiones isquémicas asociadas. Ante la aparición de sintomatología gastrointestinal alta inusual o que exceda el denominado síndrome postquimiembolización tras el procedimiento debe valorarse la realización de una gastroscopia para descartar la aparición de dichas complicaciones. Las variantes anatómicas con origen común de arterias gástricas y hepáticas pueden favorecer la migración de las microesferas hacia territorio gástrico obligando a valorar la eventual modificación de la técnica para prevenirlo.

Transarterial hepatic chemoembolization is one of the treatments of unresectable hepatocellular carcinoma in which associated ischemic lesions have been described infrequently. When unusual upper gastrointestinal symptoms or exceeding the so-called post-chemoembolization syndrome after the procedure, the performance of a gastroscopy should be assessed to rule out the occurrence of these complications. The anatomical variants with common origin of gastric and hepatic arteries can favor the migration of the microspheres into gastric territory, forcing the possible modification of the technique to prevent it.

Delayed Hemorrhage from Gastroduodenal Artery Pseudoaneurysm following Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Head Mass / 대한췌담도학회지

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established procedure for the diagnosis of pancreatobiliary disease. Serious complications such as perforation, pancreatitis, hemorrhage, and sepsis are rarely reported. To our knowledge, delayed hemorrhage after EUS-FNA is very rare and hemorrhage from iatrogenic pseudoaneurysm has yet to be reported. We report a case of delayed hemorrhage from gastroduodenal artery pseudoaneurysm, which developed after EUS-FNA of a solid pancreatic lesion. A 68-year-old man presented with tarry stool 10 days after EUS-FNA of a 1.5 cm-sized pancreatic head mass. Abdominal computed tomography showed a 2-cm-sized intensely enhancing round lesion near pancreatic head. EUS-FNA was negative for malignancy. The patient refused admission for further evaluation. Twelve days later, he reported to the emergency room with persistent tarry stool. Angiography showed a gastroduodenal artery pseudoaneurysm. Subsequent coil embolization resulted in successful hemostasis. The patient underwent pylorus-preserving pancreaticoduodenectomy and was diagnosed with stage IIB pancreatic cancer.

Correlation of Serum Pepsinogens and Helicobacter pylori Infection With Aspirin-associated Gastroduodenal Injury / 胃肠病学

Background:It is widely accepted that even low-dose aspirin can cause upper gastrointestinal injury.Studies showed the correlation of serum pepsinogens (PGs) with gastric acid secretion and Helicobacter pylori (Hp) infection is independently associated with peptic ulcer disease.Aims:To study the correlation of serum PGs and Hp infection with gastroduodenal injury induced by aspirin therapy.Methods:Two hundred and forty patients taking aspirin for 1-3 months admitted from Aug.2013 to May 2016 at the East Hospital Affiliated to Tongji University were enrolled.The levels of serum PG Ⅰ,PGⅡ and gastrin 17 (G17) were determined by ELISA.The Hp infection was detected by 14C-urea breath test.The modified Lanza score was used to assess the severity of gastroduodenal mucosal injury endoscopically.Results:The median serum PG Ⅰ level (154.61 ng/mL vs.117.15 ng/mL,P =0.00) and Hp infection rate (75.0％ vs.40.0％,P =0.00) in patients with intensive gastroduodenal injury (IGI) were significantly higher than those in patients with mild gastroduodenal injury (MGI),while no significant differences in serum PG Ⅱ and G17 levels were seen between the two groups (P ＞ 0.05).Univariate and multivariate analyses showed that serum PG Ⅰ and Hp infection were independent risk factors for aspirin-associated gastroduodenal injury.ROC curve analysis revealed that serum PG Ⅰ was the best indicator of aspirin-associated IGI,and the cut-off value,sensitivity and specificity were 125.50 ng/mL,80.15％ and 62.54％,respectively.The risk of IGI was significantly increased in patients with serum PG Ⅰ ≥ 125.50 ng/mL and positive for Hp infection (OR =16.87,95％ CI:2.04-135.44).Conclusions:High serum PG Ⅰ level (≥ 125.50 ng/mL) and Hp infection are risk factors for aspirin-associated gastroduodenal injury.Their combination detection can be used to identify potential patients with high risk of aspirin-associated gastroduodenal injury.

Pancreatitis aguda debido a intususcepción gastroduodenal / Acute pancreatitis due to gastroduodenal intussusception

Introducción: Los pólipos gástricos adenomatosos son poco frecuentes y generalmente se encuentran en el examen endoscópico de rutina. La intususcepción gastroduodenal es una complicación poco frecuente de los pólipos gástricos y ha sido raramente descrita como una causa de pancreatitis aguda. Caso clínico: Presentamos el caso de un varón de 68 años el cual ingresa de urgencia con dolor abdominal, náuseas y vómitos catalogados en un inicio como pancreatitis aguda de etiología biliar; incidentalmente se descubre un pólipo gástrico pediculado intususceptado a duodeno como causa de la pancreatitis aguda. Se realizó tratamiento endoscópico de urgencia y tratamiento definitivo con cirugía abierta.

Introduction: Adenomatous gastric polyps are uncommon and are usually found in the routine endoscopic examination. Gastroduodenal intussusception is a rare complication of those gastric polyps and has rarely been described as a cause of acute pancreatitis. Case report: We present the case of a 68 year old man who admitted to emergency with abdominal pain, nausea and vomiting initially classified as acute biliary pancreatitis etiology; a pedunculated gastric polyp intussuscepted into duodenum as a cause of acute pancreatitis was incidentally discovered, emergency endoscopic treatment and definitive treatment with open surgery was performed.

Comportamiento de la hemorragia digestiva alta en el quinquenio 2009 a 2013 / Behavior of the high digestive bleeding in the five-year period 2009-2013

Introducción: la hemorragia digestiva alta constituye un problema frecuente de salud en el mundo; así se comporta en Cuba, en la provincia Matanzas y en el hospital de estudio. Actualmente es considerada como causa mayor de morbimortalidad. Objetivo: determinar el comportamiento de la hemorragia digestiva alta en el Hospital Militar de Matanzas. Materiales y Métodos: se realizó una investigación descriptiva, en un periodo de cinco años que incluyó a todos los pacientes ingresados con ese diagnóstico, y los que durante su ingreso por otra causa presentaron episodios de hemorragia. El índice de Rockall permitió evaluar la necesidad de cirugía, recidiva y mortalidad. Resultados: la mayoría de los pacientes pertenecieron al grupo de riesgo intermedio. Los hombres fueron los más afectados, el grupo de tercera edad presentó mayor incidencia. La gastritis hemorrágica fue la primera causa de sangrado. La hipertensión arterial resultó ser el factor de riesgo relevante y el tabaquismo el hábito tóxico más frecuente. Conclusiones: como beneficio relevante se demostró la importancia de la endoscopia precoz para el diagnóstico de la causa, tratamiento y pronóstico de la hemorragia. Se observó una buena correlación entre el pronóstico del paciente al ingreso y su estado al final del tratamiento (AU).

Introduction: the high digestive hemorrhage is a frequent health problem in the world; it behaves the same in Cuba, in the province of Matanzas and in the hospital where the study was carried out. Currently it is considered a major cause of morbi-mortality. Objective: to determine the behavior of the high digestive bleeding in the Military Hospital of Matanzas. Materials and Methods: a descriptive research was carried out in a five-year period. It included all the patients admitted with that diagnosis and those who presented episodes of hemorrhage even if they were admitted by any other cause. The Rockall index allowed to assess the necessity of surgery, the recidivism and mortality. Results: most of the patients belonged to the intermediate risk group. Male patients were the most affected one; the group of elder people showed higher incidence. Hemorrhagic gastritis was the first cause of bleeding. Arterial hypertension was the relevant risk factor and smoking the most frequent toxic habit. Conclusions: as a relevant benefit it was showed the importance of precocious endoscopy for the diagnosis of the hemorrhage cause, treatment and prognosis. It was observed a good correlation between the patient´s prognosis at the admission and his status at the end of the treatment (AU).

Understanding the Rome IV: Gastroduodenal Disorders / 대한내과학회지

Gastroduodenal symptoms are very common in the general population. The symptoms are classified into four categories according to the newly revised Rome IV criteria: functional dyspepsia (including postprandial discomfort and epigastric pain syndrome), belching disorders (including excessive gastric and supragastric belching), chronic nausea and vomiting syndrome (including chronic nausea vomiting syndrome, cyclic vomiting syndrome, and cannabinoid hyperemesis syndrome), and rumination syndrome. Newly developed diagnostic criteria are based on recently published studies. These revised criteria will be very helpful for appropriately managing these patients in a clinical situation.

Clinical observation of endoscopic X-ray combined with metal stent implantation in treatment of gastroduodenal malignant obstruction / 中国内镜杂志

Objective To investigate the clinical value of endoscopic stent implantation combined with X-ray monitoring in the treatment of malignant gastroduodenal obstruction. Methods 70 cases of malignant obstruction of stomach and duodenum from January 2013 to December 2015 were enrolled. According to the patients' hospitalization sequence, the odd number of patients were enrolled in the study group, the even number of patients were enrolled in the control group, 35 cases in each. The difference is that the study group were performed in metallic stent placement under fluoroscopic monitoring and endoscopic direct vision, while the control group only under endoscopic direct vision. Record the operation time, the success rate and accuracy of disposable implantation, diseases, thedisplacement and falling of the stent, and complications. we statistically analyzed the data. Results The operation time of the intervention group on average was (9.71 ± 3.60) min, while the control group was (21.01 ± 5.20) min. The success rate and accuracy of disposable implantation of the intervention group was 97.14%, while the control group was 77.14%; After 4 weeks after stent patency rate were 97.14%, 74.28% in the control group; Two groups are with the same diseases. All of the patients had small amount of bleeding, which were stoped after treatment. There was no gastrointestinal ulcers, 1 case with stent displacement, 1 case with gastrointestinal complications, 1 case with metabolic complications in the intervention group. There was 4 cases with stent displacement, 6 cases with gastrointestinal complications, 7 case with metabolic complications the control group. Conclusion Gastroscope-X-ray combined with metallic stent implantation in the treatment of malignant gastroduodenal obstruction, short operation time, high success rate, stent implantation of accurate positioning, less complications, long survival, is a kind of method is simple and feasible, safe and effective.

PCR-based analysis of Helicobacter pylori virulent genotypes among dyspeptic patients from Chittagong, Bangladesh

Aims: Helicobacter pylori is a causative agent of gastroduodenal diseases in Bangladesh as well as throughout the world. This study aimed to determine the H. pylori cagA, vacA and iceA virulent genotypes by PCR directly in gastric biopsies from dyspeptic patients of Chittagong, Bangladesh and evaluating the association of these genotypes with clinical manifestations. Methodology and results: CLO (Campylobacter-Like Organism) test and Hp16s PCR (16S rRNA based H. pylori specific PCR) was performed to confirm H. pylori infection. Among 111 patients, H. pylori infection was found in 60 patients by CLO test, while Hp16s PCR revealed that 54 patients were H. pylori positive. PCR amplification of the H. pylori virulence genes was successful in 35 gastric biopsies amongst the 54 Hp16s PCR positive biopsies. The positive rates for the cagA, vacAs1, vacAs2, vacAm1, vacAm2, iceA1, iceA2 genes were 34.3%, 71.4%, 8.6%, 62.9%, 28.6%, 20% and 11.4%, respectively. The allelic variant vacAs1m1 had a predominant percentage with 51.4%, followed by vacAs1m2, vacAs2m2 and vacAs1m1m2 with 14.3%, 5.7% and 2.9%, respectively. Among the subtypes of vacAs1, only s1a was detected in 54.3% of biopsies while none of the cases showed the s1b and s1c genotypes. However, there was no statistically significant association (p>0.05) observed between the virulent genotypes and clinical conditions. Conclusion, significance and impact of study: We found that cagA, vacAs1m1 and iceA1 were the most frequent H. pylori genotypes in severe clinical outcomes of the infection. The data in this study would provide a basis for understanding the diverse virulence pattern of this bacterium in Bangladeshi dyspeptic patients.