Endoscopie digestive haute à l'hôpital national de Zinder: indications et résultats / Upper digestive endoscopy at Zinder National Hospital: indications and results

Objectif : déterminer les indications et résultats de l'endoscopie digestive haute (EDH) à l'Hôpital National de Zinder. Matériels et méthodes : il s'agit d'une analyse rétrospective des comptes rendus d'EDH, à partir des registres d'endoscopie digestive du 1er Janvier 2020 au 28 Février 2021, portant sur 667 examens, soit une fréquence mensuelle de 48 EDH. . Résultats : l'âge moyen des patients était de 38,98±14,84 (13-80 ans) avec un sex ratio de 1,02. Les épigastralgies représentent 42,8% (n= 363) d'indication d'EDH, la dyspepsie 15,2% (n=129), les douleurs abdominales diffuses 11,9% (n= 101), les vomissements 8,1% (n= 69), la recherche des signes endoscopiques d'hypertension portale 5,1% (n= 43), la dysphagie 4,9% (n=42) et les hémorragies digestives 3,2% (n=27). Selon le segment anatomique concerné, l'estomac comptait pour 55,51% (n=419), l'œsophage 19,6% (n=148) et le duodénum 6,68% (n=50). Les lésions inflammatoires représentent 63,04% (n=475), les ulcères 6,65% (n=50), les tumeurs 3,03% (n=23) et les lésions diverses 27,28% (n=205). La biopsie était réalisée chez 22 patients (3,46%) et 10 comptes rendus histologiques étaient parvenus, repartis en 06 adénocarcinomes gastriques, 02 gastriques chroniques avec métaplasie intestinale, 01 carcinome épidermoÏde de l'œsophage et 01 polype gastrique hyperplasique. Conclusion : Les épigastralgies dominent les indications de l'EDH. La pathologie digestive haute est certes dominée par les lésons inflammatoires, mais les ulcères et les tumeurs sont de plus en plus diagnostiqués. Ces lésions allaient être mieux évaluées si des biopsies systématiques étaient réalisées chez nos patient

Objective: to determine the indications and results of upper digestive endoscopy (EDH) at the Zinder National Hospital. Materials and methods: this is a retrospective analysis of EDH reports, from digestive endoscopy registers from January 1, 2020 to February 28, 2021, covering 667 examinations, or a monthly frequency of 48 EDH. Results: the average age of patients was 38.98±14.84 (13-80 years) with a sex ratio of 1.02. Epigastralgia represents 42.8% (n = 363) of indication of EDH, dyspepsia 15.2% (n = 129), diffuse abdominal pain 11.9% (n = 101), vomiting 8.1% (n = 69), search for endoscopic signs of portal hypertension 5.1% (n = 43), dysphagia 4.9% (n = 42) and digestive hemorrhages 3.2% (n = 27Depending on the anatomical segment concerned, the stomach accounted for 55.51% (n=419), the esophagus 19.6% (n=148) and the duodenum 6.68% (n=50). Inflammatory lesions account for 63.04% (n=475), ulcers 6.65% (n=50), tumours 3.03% (n=23) and miscellaneous lesions 27.28% (n=205). The biopsy was performed in 22 patients (3.46%) and 10 histological reports were obtained, divided into 06 gastric adenocarcinomas, 02 chronic gastric with intestinal metaplasia, 01 epidermoidal carcinoma of the esophagus and 01 hyperplastic gastric polypConclusion: Epigastralgia dominates the indications of HRE. Upper digestive pathology is certainly dominated by inflammatory lesons, but ulcers and tumors are increasingly diagnosed. These lesions would be better evaluated if systematic biopsies were performed in our patients

Comportamiento clínico, endoscópico e histológico del cáncer gástrico diagnosticado en el Hospital "Dr. Mario Muñoz Monroy" / Histological, endoscopic and clinical behavior of gastric cancer diagnosed in the Hospital "Dr. Mario Muñoz Monroy"

RESUMEN Introducción: en los últimos años, se aprecia a nivel global un aumento del cáncer gástrico. La mayoría de los tumores gástricos primarios son malignos. En Matanzas, existe un incremento de esta patología. Objetivo: determinar el comportamiento clínico, endoscópico e histológico del cáncer gástrico diagnosticado. Materiales y métodos: se realizó un estudio observacional, descriptivo y prospectivo en el Departamento de Gastroenterología del Hospital "Dr. Mario Muñoz Monroy", de la ciudad de Matanzas, en el período de enero del 2017 a octubre del 2019. El universo fue 25 pacientes que presentaron cáncer gástrico por diagnóstico endoscópico e histológico. Resultados: el grupo de edad más afectado correspondió a los pacientes entre 61 y 70 años, (44 %). El sexo masculino predominó en un 68 %. Los factores de riesgo de mayor incidencia, fueron la dieta inadecuada y el hábito de fumar. Las manifestaciones clínicas más relevantes fueron: epigastralgia, plenitud gástrica y pérdida de peso. La variedad hística que predominó fue el adenocarcinoma difuso y la localización el antro. Conclusiones: el cáncer gástrico constituye un problema de salud que, al actuar sobre los factores de riesgo se puede disminuir su incidencia; con un diagnóstico precoz se logrará disminuir la mortalidad (AU).

ABSTRACT Introduction: an increase of gastric cancer is appreciated in the world in the last years. Most of the primary gastric tumors are malignant. There is an increase of this disease also in Matanzas. Objective: to determine the histological, endoscopic and clinical behavior of the diagnosed gastric cancer. Materials and methods: a prospective, descriptive and observational study was carried out in the Department of Gastroenterology of the Hospital "Mario Munoz Monroy, of Matanzas, in the period from January 2017 to October 2019. The universe were 25 patients presenting gastric cancer by histologic and endoscopic diagnosis. Results: The most affected age group was the one of patients among 61 and 70 years old (44 %). Male sex predominated in 68 %. The risk factors having higher incidence were an inadequate diet and smoking. The more relevant clinical manifestation were epigastralgia, gastric fullness and weight loss. The predominating tissue variety was the diffuse adenocarcinoma and antrum location. Conclusions: gastric cancer is a health problem the incidence of which could be reduced when acting on its risk factors; with a precocious diagnosis mortality will be reduced (AU).

Esofagite eosinofílica numa consulta de alergia alimentar: caracterização e comparação entre idade pediátrica e idade adulta / Eosinophilic esophagitis at a food allergy appointment: characterization and comparison between pediatric and adult ages

Introdução: Esofagite eosinofílica (EoE) é uma doença inflamatória crônica do esôfago, mediada imunologicamente e caracterizada por sintomas relacionados com disfunção esofágica e infiltração da mucosa esofágica por eosinófilos (Eo). Os objetivos foram caracterizar os doentes com diagnóstico de EoE e analisar as diferenças entre doentes com diagnóstico em idade pediátrica (Cr, < 18 anos) e adulta (Ad, ≥ 18 anos). Métodos: Estudo observacional retrospetivo dos doentes seguidos no serviço de Imunoalergologia, no período de Fev/2009 a Jul/2017, com diagnóstico de EoE. Foram divididos em dois grupos, Cr e Ad, caracterizados de acordo com dados demográficos, história de atopia, sintomas, sensibilizações alimentares, IgE Total, eosinofilia, achados na endoscopia digestiva alta e biópsias. Avaliou-se a correlação entre sensibilização alimentar, clínica grave (ClinG), ou seja, idas ao serviço de urgência ou internamento por complicações de EoE ou histologia grave (HistG), biópsia com Eo > 50 e/ou microabcessos. Resultados: 74 pacientes (81% sexo masculino, média de idades 27±17 anos), 36 Cr e 38 Ad. Os sintomas mais frequentemente reportados foram, no grupo Cr disfagia (73%) e refluxo gastroesofágico (46%), enquanto no grupo Ad impactação (85%) e disfagia (56%). Foram referidos antecedentes de atopia em 96% das Cr, e 67% dos Ad. Em 77% das Cr e 69% dos Ad havia sensibilização alimentar. Os achados endoscópicos mais frequentes no grupo Cr foram estriação (65%) e placas brancas (50%), enquanto que no grupo Ad foram placas brancas (42%) e anéis esofágicos (35%). HistG (46%) associou-se a ClinG (35%), p = 0,001, nas Cr, mas o mesmo não foi objetivado no grupo Ad [ClinG (22%) e HistG (17%), p = 0,5]. Conclusão: Os nossos resultados estão de acordo com o descrito na literatura, observando-se um predomínio do sexo masculino e uma maior frequência de história de atopia e sensibilização alimentar no grupo Cr. As situações graves de impactação e estenose esofágica foram mais frequentes nos Ad, e objetivou-se uma associação de histologia grave com clínica grave, apenas nas Cr.

Background: Eosinophilic esophagitis (EoE) is an immunologically mediated chronic inflammatory disease of the esophagus characterized by symptoms related to esophageal dysfunction and eosinophilic infiltration in the esophageal mucosa. This study aimed to characterize patients with a diagnosis of EoE and analyze differences between patients with EoE diagnosed at pediatric age (Ch, <18 years) and at adult age (Ad, ≥18 years). Methods: This was a retrospective study of patients with a diagnosis of EoE who were followed in the immunoallergology department from February 2009 to July 2017. Patients were divided into Ch and Ad groups and characterized according to demographic data, history of atopy, symptoms, food sensitization, total IgE, eosinophils (Eo), upper digestive endoscopy (UDE) findings, and biopsy findings. Correlations were assessed between food sensitization, clinical severity (SClin; determined by number of ER visits or hospital admissions for EoE complications), and severe histology (SHist; defined as biopsy with Eo >50 and/or microabscesses). Results: 74 patients (81% male, mean age 27±17 years), 36 Ch and 38 Ad. The most commonly reported symptoms were dysphagia (73%) and gastroesophageal reflux (46%) in the Ch group, and impaction (85%) and dysphagia (56%) in the Ad group. History of atopy was reported in 96% of Ch vs 67% of Ad. Food sensitization was found in 77% of Ch vs 69% of Ad. The most common UDE findings were striation (65%) and white plaques (50%) in the Ch group, and white plaques (42%) and esophageal rings (35%) in the Ad group. SHist (46%) was associated with SClin (35%) in Ch (p=0.001), but not in Ad (SClin [22%] and SHist [17%], p=0.5). Conclusion: Our results are consistent with those reported in the literature, with a male predominance and a higher prevalence of atopy and food sensitization in Ch. Severe impaction and esophageal stenosis were more frequent in Ad, but an association between SHist and SClin was found only in Ch.

Frequência de câncer gástrico no serviço de endoscopia de um hospital-escola de Goiânia / Gastric cancer frequency in the endoscopy service of a university hospital in Goiânia

Introdução: as neoplasias gástricas estão entre as principais causas de mortalidade por câncer no Brasil e no mundo. São a quarta causa mais comum de câncer e a segunda causa de morte por doença maligna no mundo. Elas se desenvolvem por meio de um longo período de lesões pré-cancerígenas, o que pode levar de anos a décadas. O diagnóstico do câncer gástrico é feito através da endoscopia digestiva alta com biópsia, sendo o método mais eficaz. Objetivo: o presente estudo objetiva descrever a frequência dos casos de câncer gástrico diagnosticados pelo Serviço de Endoscopia Digestiva da Santa Casa de Misericórdia de Goiânia no ano de 2013. Método: trata-se de um estudo populacional, de caráter analítico e quantitativo. Na pesquisa foram coletados dados secundários provenientes dos registros de exames de endoscopia digestiva alta da referida instituição, sendo incluídos exames endoscópicos com relato de realização de biópsia para estudo histopatológico. As variáveis analisadas foram: sexo, idade, faixa etária, classificação endoscópica e tipo histológico. Resultados: dos 121 pacientes incluídos inicialmente, 12 tiveram diagnóstico confirmado pelo exame histopatológico, o que corresponde a uma frequência de câncer de 9,92% na amostra. Dentre os pacientes diagnosticados com câncer, oito (66,67%) são do sexo masculino e quatro (33,33%) do sexo feminino. A média de idade dos pacientes diagnosticados com câncer foi de 61,78 anos, variando entre 33,92 anos e 81,75 anos, com mediana de 65,63 anos. No tocante à localização das lesões neoplásicas, quatro (33,33%) localizavam-se no antro, três (25%) no corpo, duas (16,67%) na incisura angularis, duas (16,67%) no piloro e uma (8,33%) com acometimento de todo o órgão. Ao histopatológico foram diagnosticados três casos (25%) de adenocarcinoma gástrico microtubular, dois casos (16,67%) de adenocarcinoma gástrico tubular, dois casos (16,67%) de adenocarcinoma gástrico mucinoso, dois casos (16,67%) de adenocarcinoma pouco diferenciado, um caso (8,33%) de adenocarcinoma gástrico sem outra especificação (SOE), um caso (8,33%) de neoplasia pouco diferenciada e um caso de adenocarcinoma com células em anel de sinete (8,33%). Conclusão: a frequência dessa enfermidade no Serviço avaliado não predominou em um sexo em relação ao outro, predominando na faixa etária entre 60 e 69 anos, com quatro acometimentos nesse grupo. O tipo histológico mais frequente foi o adenocarcinoma gástrico microtubulare o antro foi o local mais frequentemente acometido. No futuro podem ser avaliadas informações clínicas para uma maior compreensão do comportamento desta doença em nosso local de estudo.

Introduction: gastric cancer are among the leading causes of cancer mortality both in Brazil and worldwide. It is the fourth most common cause of cancer and the second leading cause of death from malignancy in the world. It develops through a long period of pre-cancerous lesions, which may take years to decades. The diagnosis of gastric cancer is done by upper gastrointestinal endoscopy with biopsy, the most effective method. Aim: this study aims to describe the frequency of gastric cancer cases diagnosed by the Digestive Endoscopy Service of Santa Casa de Misericórdia de Goiânia in 2013. Methods: this is a populational, analytical and quantitative study. In the survey it were collected secondary data from the examination records of endoscopy of the institution. It were included endoscopic examinations with reports of a biopsy for histopathological study. The variables analyzed were: age, gender, age group, endoscopic classification and histologic type. Results: of the 121 patients initially included, 12 had a diagnosis confirmed by histopathological exam, which corresponds to a 9.92% cancer rate in the sample. Among patients diagnosed with cancer, eight (66.67%) were male and four (33.33%) female. The average age of patients diagnosed with cancer was 61.78 years, ranging from 33.92 years to 81.75 years, with a median of 65.63 years. Regarding the location of neoplastic lesions, four (33.33%) were located in the den, three (25.00%) in the body, two (16.67%) in incisura angularis, two (16.67%) in pylorus and one (8.33%) with involvement of the entire organ. The histopathological diagnosis were: three cases (25%) of microtubule gastric adenocarcinoma, two cases (16.67%) of tubular adenocarcinoma, two cases (16.67%) of mucinous adenocarcinoma, two cases (16.67%) of poorly differentiated adenocarcinoma, one case (8.33%) of gastric adenocarcinoma not otherwise specified (NOS), one case (8.33%) of poorly differentiated cancer and one case with signet ring cell adenocarcinoma (8.33%). Conclusion: the frequency of this disease in the assessed service did not prevail in one sex over the other, it were predominant in the age group of 60-69 years with four involvements in this group. The most common histological type was microtubule gastric adenocarcinoma and the den was the site most commonly affected. In the future it can be assessed clinical information for a better understanding of the behavior of this disease in our study site.

Análise das indicações, achados e complicações da endoscopia digestiva alta em uma população pediátrica / Analysis of indications, complications and found the upper digestive endoscopy in a pediatric population

Introdução: a endoscopia digestiva com aparelhos flexíveis de fibras óticas começou a ser realizada na década de 60 em adultos e, em meados dos anos 70, nas crianças. Desde então, as técnicas e habilidades do método avançaram bastante a ponto do procedimento ser indicado pela maioria dos gastroenterologistas pediátricos para fins diagnósticos e terapêuticos. Objetivo: avaliar as indicações, achados e complicações da endoscopia digestiva alta em uma população pediátrica atendida no Instituto do Aparelho Digestivo de Goiânia. Métodos: foram avaliados dados referentes à identificação, achados endoscópicos e a ocorrência de complicações decorrentes do exame e/ou sedação de pacientes, com idade de zero a treze anos, submetidos à endoscopia digestiva alta (EDA). Resultados: durante o período foram realizados 312 exames de EDA em um grupo que teve média de idade de 6,4 ± 4,0 anos, variando de 9 meses a 13 anos, dos quais 156 (50,0%) eram do gênero masculino. A dor abdominal (DA) foi a principal indicação, sendo o motivo para realização do exame em 129 (41,3%) pacientes, seguida da suspeita de doença do refluxo gastroesofágico (DRGE) em 110 pacientes (35,3%) e da suspeita de alergia alimentar (AA), não incluindo a suspeita de esofagite eosinofílica (EoE) em 21(6,7%). Dentre os achados endoscópicos, a esofagite péptica isolada ou associada a outros achados estava presente em 252 (80,8%) pacientes; a duodenite isolada ou não foi observada em 128 (41,0%) pacientes e a gastrite isolada ou não em 56 (17,9%). O exame foi normal em 26 (8,3%) pacientes, dos quais 18 (69,2%) eram do sexo feminino e 8 (30,8%) masculino. A DA foi a indicação para a realização do exame em 17 (65,4%) destes pacientes, seguida por suspeita de DRGE em 5 (19,2%) pacientes. Não foram observadas complicações relacionadas nem ao procedimento anestésico, nem tão pouco ao procedimento endoscópico. Conclusão: no presente estudo, 91,7% da população apresentaram alterações endoscópicas, sugerindo que a nossa população foi adequadamente triada. No presente estudo, a principal indicação do exame foi a DA (41,3%), seguida da suspeita de DRGE (35,3%) e da suspeita de AA (6,7%).

Endoscopy with flexible fiber optic devices began to be held in the 60s in adults and in the mid 70s in children. Since then, techniques and abilities of this method made significant progress, the point of the procedure is indicated by most pediatric gastroenterologists for diagnostic and therapeutic purposes. Aim: Evaluate the indications, findings and complications of upper endoscopy in a pediatric population treated at the Institute of Digestive Goiânia. Methods: we avaluate data about identification, endoscopic and complications arising from the examination and / or sedation of patients aged from zero to thirteen years who underwent upper endoscopy (EDA). Results: in the period 312 EDA were performed, the mean age of the group was 6.4 ± 4.0 years, ranging from 9 months to 13 years, of whom 156 (50.0%) were male. Abdominal pain (DA) was the main indication being the reason for the examination in 129 (41.3%) patients, followed by suspected gastroesophageal reflux disease (GERD) in 110 patients (35.3%) and suspected food allergy (AA), not including the suspected eosinophilic esophagitis (EoE), 21 (6.7%). Among the endoscopic findings, peptic esophagitis alone or associated with other findings was present in 252 (80.8%) patients; duodenitis alone or not was observed in 128 (41.0%) patients and gastritis alone or not in 56 (17.9%). The examination was normal in 26 (8.3%) patients, of whom 18 (69.2%) were female and 8 male (30.8%). The DA was the indication for the examination in 17 (65.4%) of these patients followed for suspected GERD in 5 (19.2%) patients. No complications related to EDA or anesthetic procedure were observed. Conclusion: In this study, 91.7% of the population had endoscopic changes, suggesting that our population has been adequately screened. In the present study, the main indication for examination was the DA (41.3%), followed by suspected GERD (35.3%) and suspicion of AA (6.7%).

Metoclopramida mejora la calidad de la endoscopia digestiva superior en paciente con hemorragia digestiva superior activa / Metoclopramide improves the quality of upper gastrointestinal endoscopy in patients with upper gastrointestinal bleeding

La hemorragia digestiva superior aguda (HDSA), es una causa frecuente de hospitalización, se ha estimado una incidencia de 50 a 150 episodios por 100.000 habitantes por año y está asociada a una morbimortalidad significativa. Datos recientes sugieren que algunas medidas terapéuticas, como el uso endovenoso de la eritromicina y la metoclopramida mejoran la visualización endoscópica en pacientes con HDSA; sin embargo, los estudios al respecto no son concluyentes. Determinar la utili-dad de la metoclopramida endovenosa (EV) en mejorar la calidad de la EDS en pacientes con HDSA, a fin de reducir en los pacientes con sangrado agudo la necesidad de cirugía, el uso de transfusiones sanguíneas, el tiempo de hospitalización y la morbimortalidad. Estudio prospectivo, transversal, aleatorizado, llevado a cabo desde Enero-Mayo 2010 en la unidad de gastroenterología del Hospital Dr. Miguel Pérez Carreño. Fueron incluidos todos los pacientes con evidencia clínica de HDSA, con signos y síntomas de menos de 12 horas de evolución, edad ≥18 años. La población a estudiar se dividió en dos grupos: grupo A pacientes que recibieron 10 mg de metoclopramida EV 30-40 minutos previos al estudio; grupo B no recibió metoclopramida EV y fueron elegidos aleatoriamente. La EDS fue realizada en las primeras 6 horas de la admisión. Los criterios de exclusión fueron: sensibilidad conocida a la metoclopramida, disminución del estado de conciencia (por imposibilidad de fir-mar el consentimiento informado) embarazo o lactancia y lavado gástrico previo. Fueron incluidos un total de 44 pacientes, 25 del sexo masculino y 19 femenino, de los cuales 22 recibieron metoclopramida y 22 pacientes restantes no recibieron ningún procinético previo al estudio endoscópico. En el grupo A, se diagnosticó la etiología del sangrado en la primera endoscopia en 17 pacientes, requiriendo la realización de 2 o más endoscopias en 5 casos. En el grupo B, 12 pacientes fueron diagnosticados en la primera...

Active upper gastrointestinal bleeding (AUGIB) is known as a frecuent cause of admission, is estimated to be 50 to 150 per 100,00 each year and it is associated with a significant mortality. There is evidence that suggest that prompt Upper Digestive Endoscopy (UDE) assessment in patients with upper gastrointestinal bleeding is safe and effective, however, in patients with active or recent bleeding the quality of endoscopic examination may be limited by the presence of clots and residual blood, especially in gastric fundus. Recent data suggest that another therapeutic measures as intravenous erythromycin and metoclopramide improve endoscopic visualization in patients with AUGIB, however, few studies confirm these information. The aim of this study was to determine the utility of intravenous metoclopramide to improve upper digestive endoscopy quality in patients with AUGIB preventing the need for additional endoscopy attempts, surgery, blood transfusions, time of hospitalization and mortality. A transversal, randomized prospective study was developed between January and May 2010 at the Gastroenterology department of Dr. Miguel Pérez Carreño Hospital. All patients with clinical evidence of AUGIB were included; the symptoms must be assessed in the first 12 hours, and all of them must be over 18 year old. The subjects were divided into two groups: group A were people with upper gastrointestinal bleeding who received metoclopramide (10 mg) 30 to 40 minutes before UDE and group B did not receive metoclopramide before UDE. They were randomly chosen and compared. Upper digestive endoscopy was performed within the first six hours of admission. Exclusion criteria were: Known sensitivity or intolerance to metoclopramide, altered state of consciousness, pregnancy, lactancy and previous gastric lavage. There were 44 patients (25 males - 19 females), of which 22 received intravenous metoclopramide. Twenty two patients did not receive promotility agents before the UDE...

Evaluación del test diagnóstico índice número de plaquetas/diámetro mayor del bazo, como predictor de la presencia de várices esofágicas en cirrosis hepática / Evaenluation of the diagnostic test of index platelet counts / size sple, as a predictor of the presence of esophageal varices in cirrhosis

OBJETIVO: Evaluar el índice número de plaquetas/diámetro mayor del bazo (P/DMB) como un método diagnóstico no invasivo de la presencia de várices esofágicas (VE) en pacientes con cirrosis hepática.MATERIAL Y MÉTODOS: Estudio de Test Diagnósticos, análisis retrospectivo. Se recolectaron los datos de pacientes, con el diagnóstico de cirrosis hepática, en el Servicio de Gastroenterología del Hospital Nacional Daniel Alcides Carrión (HNDAC), entre Septiembre 2010 y Enero 2011 posteriormente se calculó la sensibilidad, especificidad, valor predictivo positivo y negativo, razón de probabilidades positiva y negativa; utilizando a la endoscopía digestiva alta como patrón de oro.RESULTADOS: Se evaluaron los datos de 47 pacientes, la edad promedio fue de 60,74 años; la etiología fue consumo de alcohol en el 25,5%, y no determinada en el 48,9% de pacientes. El 25% de pacientes no presentaron VE y 74,5% las presentaron. El índice P/DMB se comparó con la endoscopía, encontrándose una Sensibilidad de 40%, Especificidad de 75%, Valores predictivos positivo y negativo de 82% y 30% respectivamente; y razón de probabilidades positiva y negativa de 1,6 y 0,8 respectivamente. CONCLUSIONES: El índice P/DMB no es una prueba diagnóstica efectiva para el diagnóstico de la presencia de VE en la muestra estudiada.

AIM: To evaluate the platelet count/spleen diameter (PC/SD) ratio as a non invasive diagnostic test to predict esophageal varices (VE) in patients with cirrhosis. METHODS: Diagnostic test study, retrospective analysis. Data was collected from patients with diagnosis of liver cirrhosis at gastrointestinal unit of Hospital Nacional Daniel Alcides Carrión between September 2010 and January 2011. Using a PC/SD ratio with a cut off value of 909, sensitivity, specificity, Positive and negative predictive values, positive and negative likelihood ratios were calculate. RESULTS: There were 47 patients; mean age of 60,74; etiology: alcoholic (25,5%); undeterminated (48,9%). Twenty-five percent patients had varices and 74,5% had no varices. The PC/SD ratio had a sensitivity of 40%, specificity of 75%, PPV of 82%, NPV 30%, LR (+) of 1,6 and LR (-) of 0,8. CONCLUSIONS: The PC/SD ratio was not an effective diagnostic test for esophageal varices.

Hallazgos endoscópicos-morfológicos en la esofagitis eosinofílica / Endoscopic-morphological findings in eosinophilic esophagitis

La esofagitis eosinofílica es una condición recientemente descrita, que puede presentarse a cualquier edad y es actualmente la causa más común de disfagia e impactación alimentaria en el adulto, otros síntomas incluyen pirosis, náuseas, vómitos y dolor retroesternal. El diagnóstico comienza con la sospecha clínica, sin embargo el médico se apoya fuertemente en los hallazgos endoscópicos y morfológicos para obtener el diagnóstico en los pacientes con esta entidad. Describir los hallazgos endoscópicos y morfológicos en pacientes con esofagitis eosinofílica. Se realizó un análisis descriptivo, retrospectivo, transversal. Se incluyeron 7 pacientes con historia clínica sugestiva de esofagitis eosinofílica. Se realizó endoscopia digestiva superior en estos pacientes en busca de hallazgos endoscópicos reportados para esta entidad (como son surcos longitudinales, anillos concéntricos) y se tomaron biopsias de todos los segmentos esofágicos obteniéndose el diagnóstico histológico morfológico en presencia de hiperplasia acentuada del estrato basal, presencia de eosinófilos intraepiteliales, y un contaje mayor de 24 eosinófilos por campo de mayor aumento (40x). El 86% de nuestros pacientes fueron masculinos, en edades comprendidas entre los 21 y 43 años. La evolución del cuadro clínico fue de 1 a 72 meses y los síntomas de presentación más comunes fueron disfagia (100%), pirosis (71,4%) y la impactación alimentaria (57,1%). Los hallazgos endoscópicos más frecuentes fueron los surcos longitudinales (100%) y los anillos concéntricos (71,4%), solo se observó estrechez en un paciente. Todos los pacientes estudiados presentaron hiperplasia de la capa basal, eosinófilos intraepiteliales y contaje aumentado de eosinófilos. Los hallazgos endoscópicos y morfológicos permiten obtener el diagnóstico de esofagitis eosinofílica, en pacientes con historia clínica sugestiva de esta entidad...

Eosinophilic esophagitis is a recently-described condition that may be present at any age and currently is the most common cause of dysfagia and food impactation in adults; other symptoms include heartburn, nausea, vomits, and retrosternal pain. Diagnosis begins with the clinical suspicion; however, the physician strongly relies on endoscopic and morphological findings for obtaining the diagnosis in patients with this entity. Describing the endoscopic and morphological findings in patients with eosinophilic esophagitis. A cross-sectioned retrospective descriptive analysis was performed. 7 patients were included, who had a clinical record that suggested eosinophilic esophagitis. An upper digestive endoscopy was performed in these patients to look for the endoscopic findings reported for this entity - such as longitudinal grooves, concentric rings - and biopsy samples were taken of all the esophageal segments, and the histological morphological diagnosis was obtained in the presence of basal layer hyperplasia, presence of intraepithelial eosinophils, and a count higher than 24 eosinophils per higher power field (40x). 86% of patients were males between ages ranging from 21 and 43. The clinical setting evolution was 1-72 months, and the more-commonly present symptoms were: dysfagia (100%), heartburn (71.4%), and food impactation (57.1%). The most frequent findings were longitudinal grooves (100%), and concentric rings (71.4%); narrowness was found in one patient only. All patients in the study showed basal layer hyperplasia, intraepithelial eosinophils, and increased count of eosinophils. Endoscopic and morphological findings allow to obtaining the eosinophilic esophagitis diagnosis in patients whose clinical record suggests this entity...

Clinical, endoscopic and prognostic aspects of primary gastric non-hodgkin's lymphoma associated with acquired immunodeficiency syndrome

Primary gastric non-Hodgkin's lymphoma (NHL) is a co-morbidity that can be observed during the clinical course of acquired immunodeficiency syndrome (AIDS). We evaluated the prevalence, clinical-evolutive aspects and form of endoscopic presentation of primary gastric NHL associated with AIDS. Two hundred and forty-three HIV patients were submitted to upper digestive endoscopy, with evaluation of clinical, endoscopic and histological data. A CD4 count was made by flow cytometry and viral load was determined in a branched-DNA assay. Six cases (five men; mean age: 37 years; range: 29-46 years) of primary gastric NHL were detected. The median CD4 count was 140 cells/mm³ and the median viral load was 40,313 copies/mL. Upper digestive endoscopy revealed polypoid (in four patients) ulcero-infiltrative (two patients) and ulcerated (two patients) lesions and combined polypoid and ulcerated lesions (two patients). Histology of the gastric lesions demonstrated B cell NHL (four patients) and T cell NHL (two patients). Five of the six patients died of complications related to gastric NHL. We concluded that primary gastric NHL is an important cause of mortality associated with AIDS.

Estenose péptica do esôfago em crianças: incidência e achados clínicos / Esophageal peptic stricture in children: incidence and clinical findings

Introdução: estenose péptica de esôfago resulta da inflamação crônica da mucosa, causada pela doença do refluxo gastroesofágico. O objetivo deste estudo é apresentar a experiência com estenose péptica de esôfago, em um serviço de endoscopia digestiva pediátrica, analisando os achados clínicos e, principalmente, a diminuição da incidência dessa entidade nos dias atuais. Métodos: estudo retrospectivo de janeiro de 1996 a setembro de 2002. As dilatações foram realizadas com velas de Savary-Gilliard. O número de estenoses por ano, relativo ao número de endoscopias, foi avaliado através dos testes do qui-quadrado e da tendência linear. Resultados: no período de 6,5 anos, 1.636 crianças e adolescentes foram submetidos a endoscopia digestiva alta. Desses, 26 eram portadores de estenose péptica. As idades desses pacientes variaram de 10 meses a 16 anos, com uma média de 6,5 anos, sendo que 69% eram meninos.Treze pacientes eram portadores de condições predisponentes ou associadas a refluxo mais grave. Nenhum era portador de esôfago de Barrett. Foram realizadas 69 sessões de dilatação (2,65/paciente). Um paciente apresentou pneumomediastino, após a dilatação. Todos os outros apresentaram boa resposta às dilatações. O número de estenoses pépticas diminuiu com o passar dos anos, embora o número total de endoscopias tivesse aumentado. Conclusões: as dilatações com velas de Savary foram eficazes em diminuir a disfagia dos pacientes portadores de estenose péptica. Houve uma diminuição da incidência de estenose péptica, apesar do aumento do número de endoscopias nesse serviço pediátrico (AU)

Introduction: esophageal peptic stricture results of chronic mucosal inflammation caused by gastroesophageal reflux disease. The aim of this study is to present the experience with esophageal peptic strictures in a pediatric gastrointestinal endoscopy unit showing clinical aspects and mainly the decreasing incidence of this entity nowadays. Methods:retrospective study from January 1996 to September 2002. The esophageal dilations were performed with Savary-Gilliard bougies. The number of the strictures per year, relatively to endoscopies number, was evaluated by qui-square test and linear tendency. Results: in the period of 6.5 years 1,636 children and adolescents were submitted to upper digestive endoscopy. Twenty-six individuals had a peptic esophageal stricture. The ages varied between 10 months and 16 years with a mean age of 6.5 years and 69% were male patients. Thirteen patients had an associated or predisposing condition to more severe gastroesophageal reflux. There was no Barrett esophagus. We have done 69 esophageal dilations sessions (2.65/patient). One patient presented with pneumomediastine post-dilation. All the others presented a good outcome. The total number of strictures decreased with time although total number of endoscopic procedures increased. Conclusions: dilations with Savary-Gilliard bougies were efficacious to decrease the disphagia of the esophageal peptic strictures in children. There was a decreasing incidence of peptic strictures although the increasing incidence of endoscopic examinations performed in this pediatric endoscopy unit (AU)