Seropositividad de H. pylori y Fiebre Tifoidea en Pacientes iraquíes con dispesia / Seropositivity of H. pylori and Typhoid Fever in Dyspesia Iraqi Patients

Background: There are many studies highlight the association between Helicobacter pylori seropositivity with typhoid fever in human populations and there is no study in Iraq. Aim: Our study designed to estimate the correlation between seroprevelace of H. pylori and Typhoid fever in clinically examined patients as dyspeptic and typhoid fever infected. Methods: From May (2016) to February (2018), a total of 213 patients (134 females and 79 male) attending an enterology outpatient clinic in AL-Najaf province, Iraq. The patients with age range from 10 to 90 years and with symptoms of dyspepsia and typhoid fever (as fever, diarrhea, headache), were referred to serologic diagnosis of antibodies against H. pylori (IgG) and Typhoid (IgG and/or IgM), using the Rapid Tests Cassette. Results: Of a total of 213 clinically examined as dyspeptic and typhoid fever infected patients,134 (63.0%) were females and 79 (37.0%) were males.In this study, 82 (38.5 %) of 213 patients were seropositive for typhoid fever and 131 patients were seronegative. Moreover, 128 (60.1 %) of 213 patients were seropositive for H.pylori IgG (51 case,39.8%, typhoid seropositive, and 77 case,60.2%, typhoid seronegative) and 82 were seronegative. The serologic co-infection diagnosed in 51 (24.0%) patients. The seropositivity of typhoid fever was higher in H. pylori seropositive patients, co-infections (62.2 %), than H. pylori seronegative patients (37.8%). The co-infection was more in female (64.7%) than male (35.3%). In respect of age H. pylori seropositivity was more prevelance (25.8%) in 30s age group where as co-infection was more prevalence in 40s age group (29.4%). But the statistical analysis showed insignificant association of H. pylori with typhoid fever (P value = 0.6203), gender (P value = 0.4770) and age groups (P value = 0.0745). Conclusion: Our study indicates that H. pylori seropositive dyspepsia more susceptiple to typhoid fever particularly in female and 40s ages and suggest there was insignificant relationship amongst seropositivity of H. pylori and typhoid fever within dyspepsia patient

Estudo do Uso do Dabigatrana em Hospital Público Brasileiro Especializado em Cardiologia / Study of Dabigatran Use in a Brazilian Public Hospital Specialized in Cardiology

Fundamentos: Durante a comercialização de novos medicamentos, efeitos inéditos podem ser descobertos. O dabigratana é um anticoagulante aprovado pela ANVISA em 2008. Objetivos: Avaliar segurança, efetividade, perfil de eventos adversos e adesão terapêutica ao dabigatrana (110 e 150 mg) prescrito para pacientes com fibrilação atrial não valvar. Métodos: Pacientes em uso de dabigatrana foram submetidos a entrevistas ao longo do primeiro ano de tratamento, avaliando-se a prescrição em função da dose, idade, gênero e fatores de risco, bem como a prevalência de eventos adversos e o perfil dos pacientes envolvidos. Resultados: O estudo começou com 139 pacientes havendo redução do número de sujeitos em uso do anticoagulante ao final (10% dose 110 mg e 30% dose 150 mg), sem variação nas proporções dos indivíduos quanto ao gênero (homens@65%), faixa etária (idade inferior a 75 anos@80%), escores de risco para eventos tromboembólicos (CHA2 DS2-VASc≥2 @80%) e hemorrágicos (HASBLED<3 @50% dose 110mg e @85% dose 150 mg). O evento adverso mais comum foi a dispepsia (≥10%), independentemente do gênero, porém com menor frequência na faixa etária superior a 75 anos (@20% dos casos). A dispepsia relacionada ao dabigatrana foi principalmente associada a sua combinação com betabloqueadores (@70%), porém, minoritariamente com antidiabéticos (@20%), antiplaquetários (@10%), inibidores da bomba de prótons (@30%) e antagonistas de receptores H2 (@3%). A adesão foi de @60%, independentemente dos eventos adversos relatados. Não foram observados casos de evento tromboembólico e nem sangramento maior

Background: During its commercialization phase, unprecedented effects of new medicaments can be discovered. Dabigatran is an anticoagulant approved by Brazilian National Health Surveillance Agency in 2008. Objectives: To assess safety, effectiveness adverse event profile and adherence to dabigatran (110 mg and 150 mg) prescribed for patients with non-valvular atrial fibrillation. Methods: Patients taking dabigatran were subjected to interviews during the first year of treatment, evaluating the prescription depending on the dose, age, gender and risk factors as well as the prevalence of adverse events and the profile of the patients involved. Results: Between the beginning and the end of the study there was a reduction in the number of subjects using this anticoagulant (10% for the dose of 110 mg and 30% for the dose of 150 mg), without changes in the proportions of individuals regarding to gender (men @65%), age (age <75 anos @80%), anticoagulation previous history (@85%) and risk scores for thromboembolic (CHA2DS2≥VASc = 2 @80%) and bleeding (HASBLED <3 @50% dose 110 mg and @85% dose 150 mg) events. The most common adverse event was dyspepsia (≥10%), regardless of gender, but less frequently in patients over 75 years of age (@20% of cases). Dyspepsia related to dabigatran was mainly associated to its combination with beta-blockers (@70%), but minoritarily with oral hypoglycemic (@20%), antiplatelet agents (@10%), proton pump inhibitors (@30%) and antagonists H2 (@3%). Therapeutic adherence was @60% regardless of the described adverse events. There were no cases of thromboembolic event and major bleeding. Conclusions: Dabigatran has shown to be safe and effective in the evaluated conditions

Celiac disease prevalence is not increased in patients with functional dyspepsia / A prevalência de doença celíaca não é aumentada em pacientes com dispepsia funcional

ABSTRACT BACKGROUND Previous evidence trying to assess the risk of celiac disease among dyspeptic patients has been inconclusive, showing in some cases notorious discrepancies. OBJECTIVE To determine the prevalence of celiac disease in patients with dyspepsia compared to healthy controls without dyspepsia. METHODS Adult patients under evaluation for dyspepsia were invited to participate. These patients were offered an upper gastrointestinal endoscopy with duodenal biopsies. On the other hand, asymptomatic adult volunteers who performed a preventive visit to their primary care physician were invited to participate and agreed to undertake an upper gastrointestinal endoscopy with duodenal biopsies as well. Those patients with histologic signs of villous atrophy were furtherly evaluated and serological tests were performed in order to determine celiac disease diagnosis. Celiac disease prevalence was compared between groups. RESULTS Overall, 320 patients with dyspepsia and 320 healthy controls were recruited. There were no significant differences in terms of gender or age between groups. Celiac disease diagnosis was made in 1.25% (4/320) of patients in the dyspepsia group versus 0.62% (2/320) in the control group. CONCLUSION Patients with dyspepsia who underwent routine duodenal biopsies did not show an increased risk for celiac disease when compared to healthy individuals.

RESUMO CONTEXTO As evidências ao avaliar o risco da doença celíaca entre pacientes dispéptico têm sido inconclusivas, mostrando discrepâncias notórias em alguns casos. OBJETIVO Determinar a prevalência da doença celíaca em pacientes com dispepsia em comparação com controles saudáveis sem dispepsia. MÉTODOS Pacientes adultos sob avaliação para dispepsia foram convidados a participar. A estes pacientes foi oferecida uma endoscopia digestiva com biópsias duodenais. Por outro lado, voluntários adultos assintomáticos, que realizaram uma visita preventiva ao seu médico de atenção primária foram convidados a participar e concordaram em realizar endoscopia digestiva com biópsias duodenais também. Naqueles pacientes com sinais histológicos de atrofia das vilosidades foram melhor avaliados e foram realizados testes sorológicos para determinar o diagnóstico de doença celíaca. A prevalência de doença celíaca foi comparada entre os grupos. RESULTADOS No total, 320 pacientes com dispepsia e 320 controles saudáveis foram recrutados. Não houve nenhuma diferença significativa entre os grupos em termos de sexo ou idade. O diagnóstico de doença celíaca foi feito em 1,25% (4/320) dos pacientes no grupo de dispepsia, contra 0,62% (2/320) no grupo controle. CONCLUSÃO Pacientes com dispepsia submetidos a biópsias duodenais de rotina não têm risco aumentado para a doença celíaca quando comparados com indivíduos saudáveis.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

Objectives To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. Subjects and methods A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Results Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Conclusions Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients. .

Current Issues in Functional Dyspepsia / 대한소화기학회지

Functional dyspepsia is one of the most common gastrointestinal disorders encountered in clinical practice. Functional dyspepsia is currently defined by Rome III criteria as the chronic dyspeptic symptoms (postprandial fullness, early satiety, epigastric pain or burning) in the absence of underling structural or metabolic disease that readily explain the symptoms. According to the Rome III consensus, functional dyspepsia can be subdivided into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Although the Rome III criteria have been published more than 8 years ago, not much effort has been put into validating these criteria and direct scientific evidence supporting the validity of the subdividing functional dyspepsia into PDS and EPS are lacking. This article is intended to review the validity of the Rome III criteria on the subdivisions of functional dyspepsia, i.e. PDS and EPS. The impact of sleep disorder, Helicobacter pylori-associated dyspepsia, and the emerging drug therapies in functional dyspepsia will also be discussed in this article.

The Risk Factors and Quality of Life in Patients with Overlapping Functional Dyspepsia or Peptic Ulcer Disease with Gastroesophageal Reflux Disease

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD), functional dyspepsia (FD), and peptic ulcer disease (PUD) impact the daily lives of affected individuals. The aim of this study was to compare the risk factors and impacts on life quality of overlapping FD or PUD in patients with GERD. METHODS: Data from patients diagnosed with GERD were collected between January and November 2009. FD was defined using the Rome III diagnostic criteria. The overlapping GERD-FD or GERD-PUD groups were classified as concomitant GERD and FD or peptic ulcers. The characteristics of these individuals were analyzed. RESULTS: There were 63, 48, and 60 patients in the GERD only, overlapping GERD-FD, and overlapping GERD-PUD groups, respectively. Significantly younger age, female gender, lower body weight and body mass index, and higher rates of tea consumption were noted in the GERD-FD group. Patients in the GERD-FD group exhibited the lowest quality of life scores, both with respect to physical and mental health, on the Short Form 36 domains. CONCLUSIONS: Patients with concomitant GERD and FD were more likely to be younger and female. Overlapping GERD and FD had the worst impact on the quality of life of the affected individuals.

Frecuencia de trastornos digestivos funcionales y enfermedad por reflujo gastroesofágico en pacientes con dispepsia no investigada que acuden al Hospital Nacional Cayetano Heredia, Lima, Perú / Frecuency of functional gastrointestinal disorders and esophageal reflux disease in adults with non investigated dyspepsia in the Hospital Nacional Cayetano Heredia, Lima, Peru

Objetivo: Evaluar la frecuencia de trastornos digestivos funcionales y enfermedad por reflujo gastroesofágico en pacientes adultos con dispepsia no investigada en un hospital docente localizado en Lima, Perú. Material y métodos: Estudio descriptivo realizado en el Hospital Nacional Cayetano Heredia, Lima, Perú. Se recolectaron los resultados de las endoscopías y de los cuestionarios para Trastorno Digestivo Funcional (TDF) y Enfermedad por Reflujo Gastro Esofágico (ERGE) aplicados a pacientes con criterios de selección que acudieron al servicio de gastroenterología desde julio hasta diciembre del 2011. Resultados: 110 pacientes participaron en el estudio, 70,9% fueron mujeres y la edad promedio fue 49,4 años (rango 20-77, DE: ±13,1). 82 pacientes (76,4%) presentaron algún TDF. El más común fue dispepsia funcional (71,8%), seguido por el trastorno por eructos (57,3%), trastorno por náuseas y vómitos (27,3%) y síndrome de intestino irritable (18,2%). 91 pacientes (82,7%) presentaron ERGE, siendo el síntoma más común la regurgitación (80,0%). Las endoscopias mostraron que 25 pacientes (22,7%) tenían alguna lesión estructural. Conclusiones: Se encontró una alta frecuencia de ERGE, trastorno por eructos, trastorno por nauseas y vómitos y síndrome de intestino irritable entre los pacientes con dispepsia no investigada. Además, se encontró una alta frecuencia de superposición de trastornos en un mismo paciente. Nuestros resultados sugieren la necesidad de reconocer los diferentes tipos de TDF para evitar el sub-diagnóstico de éstos desórdenes.

Objective: To assess the frequency of functional gastrointestinal disorders and gastroesophageal reflux disease in adults with uninvestigated dyspepsia in a general teaching hospital in Lima, Peru. Material and methods: Cross-sectional descriptive study performed at Hospital Nacional Cayetano Heredia Lima, Peru. Data was collected from questionnaires for Functional Gastrointestinal Disorders (FGID) based on Rome III criteria and from surveys for diagnosis of GERD applied to eligible patients who visited the gastroenterology unit from July to December 2011. Also, we collected the endoscopy’s reports. Results: Among 110 patients who participated in the study, 70.9% were female and the mean age was 49.4 years (range 2077, SD: ± 13.1). FGID was found in 82 subjects (74.6%) based on Rome III criteria. The most common FGID was functional dyspepsia (71.8%), followed by belching disorder (57.3%), nausea and vomiting disorder (27.3%) and irritable bowel syndrome (18.2%). Ninety-one patients (82.7%) were diagnosed of GERD, being the most common symptom regurgitation (80.0%). Structural abnormalities were found by upper endoscopy in 25 patients (22.7%). Conclusions: We found a high frequency of GERD, belching disorder, nausea and vomiting disorder and irritable bowel syndrome among adult patients with uninvestigated dyspepsia. In addition, we found a high frequency of overlapping disorders in the same patient. Our results suggest the necessity to recognize the different types of FGID in order to avoid the under diagnosis of common conditions in the outpatient setting.

Duodenitis en pacientes con dispepsia: correlación endoscópica e histológica / Duodenitis in patients with dyspepsia: endoscopic and histological correlation

Introducción: la duodenitis es una condición frecuente, con el desarrollo de la endoscopia digestiva se han propuesto diferentes nomenclaturas para su descripción, sin una efectiva unanimidad de conceptos y la asociación clínica-histopatológica no está clara. Objetivo: evaluar la correlación endoscópica e histopatológica de la duodenitis en pacientes ambulatorios con síntomas de dispepsia. Pacientes y métodos: estudio descriptivo, prospectivo, de corte transversal y analítico. Se realizó endoscopia digestiva superior diagnóstica a 39 pacientes con síntomas de dispepsia de la consulta de Gastroenterología, con toma de muestra de mucosa duodenal para análisis histopatológico. Se estableció el grado de duodenitis según clasificación endoscópica ajustada (Sistema Sydney) y se determinó la correlación entre el grado de duodenitis endoscópica y el diagnóstico histopatológico. Resultados: se incluyeron 32 pacientes, 18 femeninos (56,25%) y 14 masculinos (43,75%). La media de edad fue 47,5 ±15,4 años; el síntoma predominante fue Epigastralgia (59,36%). Hubo concordancia de 100% entre las anormalidades endoscópicas y las alteraciones histopatológicas (p <0,01). Se obtuvo una sensibilidad de las alteraciones endoscópicas frente a las histopatológicas de 97% con especificidad de 100%. La relación entre los hallazgos endoscópicos y el reporte histopatológico fue estadísticamente significativa, p < 0,01, con una correlación positiva sustancial alta, c= 0,74. Conclusión: la endoscopia digestiva superior permitió evaluar y clasificar correctamente la presencia de duodenitis, con una alta correlación con el diagnóstico histopatológico.

Introduction: Duodenitis is a common condition, with the development of digestive endoscopy different nomenclatures have been proposed for their description, without an effective unanimity of concepts and the clinic-histopathological association is unclear. Objective: Evaluate the endoscopic and histopathological correlation of duodenitis in ambulatory patients with symptoms of dyspepsia. Patients and methods: Descriptive, prospective, cross-sectional and analytical study. Upper digestive diagnostic endoscopy was performed in 39 patients with symptoms of dyspepsia of the Gastroenterology consultation, with sampling of the duodenal mucosa for histopathological analysis. The degree of duodenitis was established according the adjusted endoscopic classification (Sydney System) and the correlation between the degree of endoscopic duodenitis and the histopathological diagnosis was determined. Results: 32 patients were included, 18 female (56.25%) and 14 male (43.75%). The mean age was 47.5 ± 15.4 years; the predominant symptom was Epigastric pain (59.36%). There was 100% concordance between the endoscopic abnormalities and the histopathological alterations (p < 0.01). The sensitivity of the endoscopic alterations compared to the histopathological was 97% and the specificity 100%. The relation between the endoscopic findings and the histopathological report was statistically significant, p < 0.01, with a high positive substantial correlation, c = 0.74. Conclusion: Upper digestive endoscopy allowed evaluate and correctly classify the presence of duodenitis, with a high correlation with the histopathological diagnosis.

Dolor abdominal crónico en pediatría / Chronic abdominal pain in children

Chronic Abdominal Pain (CAP) in children is a common cause to seek medical care. This paper summarizes current physiological and biochemical concepts that help in understanding the symptomatology. A review of the main etiological causes connected to CAP is offered, as well as a systematic process to evaluate and diagnose each. Recommendations for management and referral are provided.

El dolor abdominal crónico en niños es una causa común de consulta médica. El presente trabajo resume los conceptos fisiológicos y bioquímicos actuales que apuntan hacia el cabal entendimiento de la sintomatología. En este artículo se presenta una revisión de las principales causales etiológicas asociadas al dolor abdominal crónico, como asimismo un proceso sistemático para evaluar y diagnosticar cada caso. Igualmente, se proporcionan recomendaciones para su manejo y derivación a especialista.

Eficacia de la triple cura y su relación con el genotipo de Helicobacter pylori: pacientes con dispepsia de la region centroccidental de Venezuela / Pharmacological triple therapy`s efficacy and it`s association with Helicobacter pylori`s genotype: patients suffering from dyspepsia on Venezuela`s central western region

Introducción: El Helicobacter pylori es una bacteria reconocida como agente causal de gastritis crónica, además de asociarse al desarrollo de úlcera gástrica, duodenal y está relacionada con el desarrollo de cáncer gástrico. Materiales y métodos: Se realizó un estudio de tipo experimental, incluyendo a los pacientes que acudieron a la consulta de Gastroenterología del Hospital "Dr. Antonio María Pineda" Barquisimeto en los meses de juniooctubre de 2009 presentando dispepsia, criterios de inclusión y exclusión; se les practicó endoscopia digestiva superior con biopsia de mucosa gástrica para test de ureasa rápida, estudio histológico y determinación de los genotipos de cagA y vacA H. pylori por Reacción en Cadena de la Polimerasa (PCR). Al confirmar la infección por la bacteria se indicó tratamiento con amoxicilina, claritromicina y pantoprazol durante 14 días consecutivos. A las 8 semanas de culminada la medicación, se practicó el segundo estudio endoscópico superior con toma de biopsias para test de ureasa rápida y estudio anatomopatológico. Resultados: Un total de 60 pacientes fueron incluidos, 76,7% mujeres y 23,3% hombres, edad promedio 38,3 años. La prevalencia de infección por H. pylori fue de 98,3% por test de ureasa y 86,67% por histología, el síntoma más frecuente asociado antes, durante y posterior a la medicación con triple cura fue la epigastralgía. Hubo un predominio de los genotipos cagA en 84,5% y las formas alélicas s1/m1 55,2%. El 56,3% de los pacientes que presentaban genotipo vacA s1/m1 respondió al tratamiento. Un 56,7% de los pacientes no respondió a la terapia triple, el 66,7% contaba con la forma alélica s2/m2 del vacA y 57,1% presentaba el genotipo cagA-positivo. Conclusión: La triple cura resulto ineficaz en el tratamiento para la infección por Helicobacter pylori en la población estudiada y presentar la forma alélica vacA s1/m1 es estadísticamente significativo para responder a esta terapia farmacológica...

Introduction: Helicobacter pylori is a bacteria known as causal agent of chronic gastritis, as well as being associated to the development of gastric and duodenal ulcer and related to the development of gastric cancer. Goal: to establish the triple therapy based pharmacological treatment efficacy on patients with dyspepsia and proved H. pylori infection. Materials and methods: It was done an experimental type study, including patients that underwent evaluation on "Dr. Antonio Maria Pineda" University Hospital´s gastroenterology service, in Barquisimeto, between June – October 2009, who presented dyspepsia and fulfilled the inclusion exclusion criteria, they underwent a superior digestive endoscopy with gastric mucous membrane biopsy for fast urease test, histologic evaluation, and polymerase chain reaction (PCR) test aid establishment of cagA and vacA H. pylori genotype. When H. pylori infection was confirmed, a 14 continuous days amoxicillin, clarithromycin and pantoprazole based treatment was prescribed. 8 weeks later the ending of the pharmacological treatment a second superior digestive endoscopy including rapid urease test and histopathological assessment biopsy was performed. Results: 60 patients were included, 76,7% women and 23,4% men, average age 38,3 years old. The H. pylori’s prevalence were 98,3% by rapid urease test and 86,67 by histological assess, the most frequent related symptom before, through an after pharmacological triple therapy was epigastric pain. There was cagA genotype and s1/m1 allelic form predominance by 84, 5% and 55,2% respectively. 56,3% of vacA s1/m1 patients had a positive response to treatment. Triple therapy failed on 56,7% of patients, of them, 66,7% had the s2/m2 vacA´s allelic form and 57,1% had cagA genotype...

[Celiac disease in dyspeptic patients]

The screening of patients with dyspepsia, may allow an early identification of affected individuals. The aim of this study was to determine the prevalence of celiac disease in dyspeptic patients submitted to routine diagnostic upper gastrointestinal endoscopy. From November 2007 to October 2008, 407 patients who underwent endoscopy for any reason [193 male, 214 women; mean age36.1 years] were studied in this work. Histological characteristics in duodenal biopsy specimens for celiac disease were evaluated according to the modified Marsh Classification1999. In addition, all patients were tested for total immunoglobulin A and antitransglutaminase [tTG] antibodies. The patients with IgA deficiency were tested with IgG tTG. Duodenal histology showed the malabsorption pattern [Marsh I-IIIc] in 26 [6.4%] cases and 33 cases had serological positive test for tTGA. In term of the serological analysis, 10 out of 33 tTGA positive patients had malabsorption pattern [Marsh I,-IIIc], and all of them had a positive tTGA [2.45%]. Four of the 407 recruited patients were IgA deficient and none of them were positive for IgG tTG. In this study, about 6.4% of patients had malabsorption pattern and 8.1% presented with positive serology for CD. However, both histology and serology were positive in 10/407 [2.45%]. The high prevalence of celiac among dyspeptic symptomatic individuals indicates that they are a higher risk group for developing celiac disease

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47 percent, for NERD in 48 percent, and for EE patients in 48 percent of cases. Esophagitis was present in 42 percent of patients with IBS and in 45 percent of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: ucus in feces, abdoinal distension, nausea and gastritis; and oen ore frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95 percent CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

O objetivo deste estudo foi analisar os dados de endoscopia e sintomas de 118 pacientes mexicanos com síndrome do intestino irritável (IBS), dispepsia, doença do refluxo não-erosiva (NERD) e esofagite erosiva (EE). Os pacientes com IBS preencheram os critérios para dispepsia em 47 por cento, para NERD em 48 por cento, e para pacientes EE em 48 por cento dos casos. Esofagite estava presente em 42 por cento dos pacientes com IBS e em 45 por cento dos pacientes com dispepsia. A maior prevalência de hérnia de hiato foi encontrada na EE em comparação com NERD. Azia e eructação ácida foram associadas à presença de esofagite; eructação ácida, regurgitação e dor noturna, com duodenite; e azia e regurgitação com hérnia de hiato. Os homens relataram mais frequentemente sintomas como muco nas fezes, distensão abdominal, náuseas e gastrite, enquanto que as mulheres mais frequentemente relataram esofagite e duodenite. Os pacientes com NERD (OR 2,54, IC 95 por cento 1,08-5,99, p = 0,04), apresentaram tenesmo e saciedade precoce, e os homens tiveram um risco aumentado relacionado a fezes endurecidas ou fragmentadas. Em conclusão, quase metade dos pacientes mexicanos com NERD, EE e dispepsia preenchem os critérios para a IBS. Um grande número de sintomas foi correlacionado com a endoscopia, esta correlação pode ser utilizada para aumentar a indicação da endoscopia e sua aplicação em estudos clínicos.

Hallazgos clínicos, endoscópicos e histológicos asociados a la infección por Helicobacter pylori considerando los genotipos CAG A y VAC A en pacientes con dispepsia: Servicio de Gastroenterología Hospital Central Universitario “Antonio María Pineda” Barquisimeto Estado Lara / Clinical, endoscopic and histological findings associated with helicobacter pylori infection considering genotypes CAG A and VAC A in patients with dyspepsia: Gastroenterology Department Hospital Central Universitario

La dispepsia afecta la calidad de vida de muchos pacientes y en muchos casos está asociada a la infección por Helicobacter pylori. Esta bacteria es reconocida como el agente causal de la gastritis crónica, se asocia al desarrollo de úlceras gástrica y duodenal y está relacionada con el desarrollo de cáncer gástrico. Como objetivo primario se planteó establecer los hallazgos clínicos, endoscópicos e histológicos asociados a la infección por Helicobacter pylori considerando los genotipos cag A y vac A en pacientes con dispepsia que acudieron al Servicio de Gastroenterología del Hospital Central Universitario “Antonio María Pineda”. Se trata de un estudio epidemiológico descriptivo de corte transversal. La población estuvo conformada por los pacientes con dispepsia que acudieron al servicio y el muestreo fue de tipo no probabilístico intencional, puesto que se tomó a la población que consultó con síntomas dispépticos y que cumplieron con los criterios de inclusión y exclusión establecidos. Dichos pacientes se interrogaron sobre síntomas dispépticos, se les realizó endoscopia digestiva superior, se describieron los hallazgos endoscópicos y se les tomó muestra para estudio histológico y de genotipificación. Se encontró una incidencia de infección por H. pylori de 98,5%, la infección predominó en el sexo femenino, los genotipos cag A positivos y las formas alélicas m1/s1 son los más frecuentes en la población estudiada y, los mismos se asocian con gastritis crónica, úlceras gástricas y metaplasia intestinal incompleta...

Dyspepsia affects quality of life for many patients and often is associated with Helicobacter pylori infection. This bacterium is recognized as the causative agent of chronic gastritis, is associated with development of gastric and duodenal ulcers and, with the development of gastric cancer. Primary objective was raised to establish the clinical, endoscopic and histological findings associated with Helicobacter pylori infection considering genotypes cag A and vac A in patients with dyspepsia who attended the Gastroenterology Service of Hospital Central Universitario “Antonio María Pineda”. This is a cross-sectional descriptive epidemiological study. The population consisted of patients with dyspepsia who attended the gastroenterology service. The sampling was intentionally non-probabilistic, since we only took the people who consulted with dyspeptic symptoms and met the established criteria of inclusion and exclusion. These patients were questioned about dyspeptic symptoms, underwent upper gastrointestinal endoscopy, endoscopic findings were described and samples were taken for histology and genotyping. We found an incidence of H. pylori of 98.5%, infection prevailed in females, the genotypes cag A positive and m1/s1 allelic forms are most frequent in the population studied and, the same is associated with chronic gastritis, gastric ulcers and intestinal metaplasia incomplete...

Rabeto plus: a valuable drug for managing functional dyspepsia.

The aim of the study was to evaluate and document the efficacy and tolerability of rabeto plus (FDC of rabeprazole and itopride) in management of functional dyspepsia. It was an open, prospective, non-comparative, multidose study. The patients with functional dyspepsia (NERD or non-erosive reflux disease) attending OPD of a leading, tertiary care, teaching hospital in West Bengal (BS Medical College, Bankura) were inducted in the study. A total of 46 adult patients of either sex with functional dyspepsia and a clinical diagnosis of NERD were given 1 capsule of rabeto plus before breakfast, for up to 4 weeks. Primary efficacy variables were relief from symptoms of heartburn, nausea, vomiting, waterbrash and fullness. Secondary efficacy variables were global assessment of efficacy and toleration by patients and treating physicians. The tolerability was assessed on the basis of record of spontaneously reported adverse events with their nature, intensity and outcome. Out of 55 patients enrolled in the study, 46 completed the study as planned, while 9 patients were lost to follow-up (dropped). Most patients reported near total symptom relief by the end of study. Total symptom score showed remarkable and significant improvement from baseline to end of the study. Importantly, none of the patients reported any side-effect. All participants tolerated the drug well. Moreover, response to study drug was rated as excellent or good by over 93% patients and their treating physicians. This means that 9 out 10 patients receiving rabeto plus reported desired symptom relief from dyspepsia. Thus it was concluded that rabeto plus is a valuable drug for treatment of functional dyspepsia or NERD.

Tumor gástrico: presentación de caso / Gastric tumour: presentation of case

En el presente reporte de caso se presenta una paciente femenina de 76 años de edad, sin antecedentes patológicos anteriores, que consultó por dispepsia rebelde a tratamiento y pérdida de peso. Se estudió mediante radiografías de esófago-estómago-duodeno contrastadas y endoscopia digestiva superior. Resultó que sólo fue posible su diagnóstico: carcinoma difuso con células en anillo de sello, mediante estudio anatomopatológico cuyas muestras se obtuvieron mediante el proceder endoscópico.

In this presentation of a case we present a female 76-years-old patient, without previous pathologic background, assisted by tenacious to treatment dyspepsia and weight loss. We carried the study through oesophagus-stomach-duodenal radiography and upper digestive endoscopy. The diagnosis: signet ring cell carcinoma, was only possible by anatomopathologic study, samples obtained by endoscopic procedure.

Prevalence of celiac disease in dyspeptic patients

RACIONAL: A doença celíaca, uma das mais comuns enteropatias inflamatórias mediadas por um componente da dieta, ocorre em resposta à intolerância ao glúten nos indivíduos geneticamente predispostos. Com a disponibilidade dos exames sorológicos, essa enfermidade tem se mostrado mais freqüente que no passado, contudo seu diagnóstico ainda é, habitualmente, tardio. A pesquisa de intolerância ao glúten em pacientes com sintomas dispépticos, possível manifestação clínica da doença celíaca, pode permitir uma detecção mais precoce dos indivíduos afetados. OBJETIVO: Determinar a prevalência de doença celíaca em pacientes dispépticos submetidos a endoscopia digestiva alta de rotina.PACIENTES/MÉTODOS: Achados endoscópicos, análise histológica da mucosa duodenal e resultado de testes sorológicos de 142 pacientes consecutivos com dispepsia foram obtidos entre outubro de 2001 e outubro de 2003, e comparados. RESULTADOS: O padrão endoscópico sugestivo de doença celíaca foi encontrado em quatro pacientes. O teste IgG-AGA foi positivo em 24 pacientes. Dois dos pacientes IgG-AGA positivos também apresentaram teste IgA-EMA positivo e padrão endoscópico e histológico duodenal compatíveis com doença celíaca. Alterações endoscópicas duodenais foram expressivamente mais evidentes nestes pacientes. A prevalência de doença celíaca observada neste estudo foi de 1,4%. CONCLUSÃO: Pacientes dispépticos, por sua elevada prevalência de doença celíaca, são um grupo de maior risco para essa patologia. Celíacos sem diagnóstico prévio podem ser identificados através de marcadores endoscópicos de atrofia vilositária duodenal. Entretanto, essas alterações endoscópicas podem ser insuficientes para que o diagnóstico seja estabelecido e, conseqüentemente, deve ser recomendada a inclusão de testes sorológicos para doença celíaca na investigação dos pacientes com dispepsia.

Seroprevalence of Helicobacter pylori among the diabetic population in Bangladesh: a comparative serological study on the newly diagnosed and older diabetics.

This prospective study was designed to find out the prevalence of H. pylori infection among the diabetic population in Bangladesh with a comparison between the newly diagnosed and older diabetics. For this study 520 diabetic patients: 152 (29%) newly diagnosed and 368 (71%) older diabetics of both sexes (250 male, 270 female) with a mean age of 58.5 +/- 12.04 years (range 10-70 years), were selected randomly from out and in-patient departments of BIRDEM, Dhaka. Mean fasting and 2 hours post load blood glucose level of the studied population was 10.53 +/- 4.08 mmol/L and 18.35 +/- 9.44 mmol/L respectively. The mean duration of the newly diagnosed diabetics was 0.44 +/- 0.35 years (range 2 days-1 year) and 6.78 +/- 5.45 (range 1-30) years for the older diabetics. H. pylori infection was defined as a true positive ELISA test result of > 1.5 standard deviation above the cut-off values of 15 AU/ml for adults and 10 AU/ml for children for anti H. pylori IgG. Of the studied population 441 (84.8%)--132 newly diagnosed and 309 (83.96%) older diabetics were seropositive for H. pylori infection. No significant differences were observed between the newly diagnosed and older diabetics (86.84% Vs 83.96%; p > 0.05).

Hemorragia digestiva superior por divertículos esofágicos: a propósito de un caso / Upper gastrointestinal bleeding by esophageal diverticulums: a purpose of a case

Se describe el caso de hemorragía digestiva superior por divertículos en el tercio medio del esófago en un paciente masculino con antecedentes de dispepsia de 8 años de evolución, tratado con analgésico no esteroideo por presentar patología urinaria, consulta por episodio de hematemesis y melena líquida cediendo con terapéutica endoscópica e insuflación de balón gástrico (sonda de Sengstaken-Blakemore). Podemos concluir que el manejo médico fue una alternativa de tratamiento en este paciente con inestabilidad hemodinámica y patología asociada que aumentaban la morbi-mortalidad

Helicobacter pylori in dyspeptic Jordanian patients.

To study the prevalence of Helicobacter pylori infection in dyspeptic Jordanian patients. PATIENTS AND METHODS: Two hundred and twenty seven consecutive dyspeptic Jordanian patients were studied with endoscopy, endoscopic biopsies, culture, and CLO urease testing for the detection of H. pylori. RESULTS: Helicobacter pylori positivity in both culture and CLO urease testing was 86%, being 78% in culture and 80% in CLO test separately. The majority of our patients were in the age range 21-60 years and H. pylori positivity was more than 90% in them. CONCLUSION: Helicobacter pylori is a common infection in dyspeptic Jordanian patients regardless of the underlying cause. Males were affected more than females.