Amiloidosis por cadenas livianas de inmunoglobulina con compromiso gástrico al debut: revisión de la literatura basada en un caso clínico / Gastric AL amyloidosis as initial manifestation: literature review from a case report

Systemic amyloidosis comprises a group of diseases characterized by low molecular weight subunit protein deposit in organs, including the gastrointestinal tract. The most frequent clinical manifestations are gastrointestinal bleeding, malabsorption syndrome, protein-losing enteropathy and chronic intestinal dysmotility. The diagnosis is confirmed with gastrointestinal tissue biopsy positive to Congo red stain or recognizing the amyloid fibrils by electron microscopy. The treatment is based in the management of gastrointestinal symptoms and chemotherapeutic drugs, including melphalan and prednisone or cyclophosphamide, bortezomib and prednisone. The bone marrow transplant is reserved for 70-year-old patients or younger without advanced comorbidities. We present a case of a patient with weight loss, anorexia, nausea and early satiety.

La amiloidosis sistémica a un conjunto de enfermedades caracterizadas por el depósito de subunidades fibrilares proteicas de bajo peso molecular en órganos, incluyendo el sistema digestivo. Sus manifestaciones clínicas más frecuentes son la hemorragia digestiva, síndrome malabsortivo, gastro-enteropatía perdedora de proteínas y dismotilidad gastrointestinal crónica. El diagnóstico se confirma con una biopsia de tejido gastrointestinal positiva a tinción rojo Congo o la visualización de fibrillas de amiloide mediante microscopia electrónica. El tratamiento está basado el manejo de los síntomas gastrointestinales y el oncológico, donde destacan esquemas quimioterapéuticos que incluyen melfalan y prednisona o ciclofosfamida, bortezomib y prednisona. El trasplante de médula ósea está reservado a pacientes menores de 70 años sin comorbilidades avanzadas. Presentamos en este artículo el caso de un paciente con baja de peso, anorexia, náuseas y saciedad precoz.

Endoscopic and iistopathologic gastric changes in chronic users of proton-pump inhibitors / Alterações endoscópicas e histopatológicas gástricas em pacientes usuários crônicos de inibidores de bomba de prótons

Background Proton-pump inhibitors have been used for at least two decades. They are among the most commonly sold drugs in the world. However, some controversy remains about the indications for their use and the consequences of their prolonged use. Objectives To evaluate and compare the endoscopic and histopathologic gastric changes in chronic users of proton-pump inhibitors to changes in non-users. Methods A prospective study performed at a tertiary Public Hospital involving 105 patients undergoing upper-gastrointestinal endoscopy. Subjects included 81 proton-pump inhibitor users and 24 non-users (control group). Biopsies of the antral-type mucosa, the antral-fundic transition, and the fundus were evaluated by the Sydney System. The presence of erosion or ulceration, lymphatic follicles, reactive gastropathy, and polypoid or epithelial hyperplasia was also determined. Serum levels of gastrin were measured. Results We found two polyps, one in each group, both of which were negative for Helicobacter pylori. There were two cases of parietal cell hyperplasia in users of proton-pump inhibitors. Gastrin was elevated in 28 users of proton-pump inhibitors and in four members of the control group. We did not find statistically significant differences in the endoscopic or histopathologic findings between the two groups. Conclusions Chronic use of proton-pump inhibitors for the duration examined was not associated with significant gastric changes. An interesting finding was that the 4 chronic users of proton-pump inhibitors who had serum gastrin levels above 500 pg/mL also had positive serology for Chagas disease. .

Contexto Os inibidores da bomba de prótons são usados há pelo menos duas décadas e estão entre as drogas mais vendidas no mundo. Ainda existem controvérsias sobre as indicações e as consequências de seu uso a longo prazo. Objetivos Avaliar as alterações endoscópicas e histopatológicas gástricas em usuários crônicos de inibidores da bomba de prótons e comparar com controles. Métodos Estudo prospectivo reali­zado em Hospital Público terciário com 105 pacientes, 81 usuários de bomba de prótons e 24 controles, submetidos a endoscopia digestiva alta. As biópsias das mucosas do tipo antral, da transição antro fúndica e fúndica foram avaliadas segundo a Classificação de Sidney e verificando também erosão ou úlcera, folículo linfático, gastropatia reativa, hiperplasia epitelial e pólipo. Realizada também a dosagem sérica da gastrina. Resultados Encontramos dois pólipos, um em cada grupo, ambos negativos para Helicobacter pylori e dois casos de hiperplasia de células parietais nos usuários de inibidores da bomba de prótons. A gastrina estava aumentada em 28 usuários de inibidor da bomba de protóns e em 4 do grupo controle. Não encontramos diferenças estatisticamente significantes nos achados endoscópicos e histopatológicos dos dois grupos. Conclusões O uso crônico de inibidores da bomba de prótons no período examinado não se associou com alterações gástricas significantes. O achado mais importante foi a positividade das sorologias para doença de Chagas nos quatro pacientes do grupo de usuários crônicos de inibidores que apresentavam níveis de gastrina sérica superiores a 500 pg/ mL .

Helicobacter pylori as a potential target for the treatment of central serous chorioretinopathy

OBJECTIVES: The objective of this study was to evaluate the relationship between the treatment of Helicobacter pylori gastric infection and changes in best-corrected visual acuity and macular detachment in patients with chronic central serous chorioretinopathy. METHODS: Seventeen patients diagnosed with central serous chorioretinopathy were examined for gastric infection with Helicobacter pylori using the urease test and gastric biopsy. Helicobacter pylory-positive patients were treated with the appropriate medication. The response to therapy was monitored by evaluating the best-corrected visual acuity and optical coherence tomography. The data were analyzed using Student's t-test before and after treatment. RESULTS: Fourteen patients (15 eyes) aged 30-56 years (mean 43.4 ± 8.3 years) were positive for Helicobacter pylori. Most of the positive patients had gastric symptoms (78.5%); one had bilateral central serous chorioretinopathy. The mean baseline best-corrected visual acuity was 20/98 (logMAR = 0.53 ± 0.28). Three months after starting treatment with antibiotics, the serous detachment had resolved in 14 of 15 eyes, but two cases required laser treatment. The follow-up period ranged from 6 to 27 months. The mean final best-corrected visual acuity differed significantly from baseline. CONCLUSION: Our findings suggest that Helicobacter pylori infection may be present in many chronic central serous chorioretinopathy patients and that treatment for the infection may have a favorable effect on the outcome of chronic central serous chorioretinopathy. Due to the possibility of the spontaneous regression of chronic central serous chorioretinopathy and the high prevalence of the infection in the general population, prospective and masked clinical trials are necessary to confirm that treatment for Helicobacter pylori infection may benefit patients with chronic central serous chorioretinopathy.

Primary gastric fundus tuberculosis in immunocompetent patient: a case report and literature review

We report on a 29-year-old Pakistani man who presented to the clinic with epigastric pain, of one-month duration. He did not report fever, cough, vomiting blood, passing black stools, loss of appetite or diarrhea. However, he had lost 7 kg since his symptoms had begun. Clinical examination was unremarkable. Laboratory results were within normal limits. An abdominal CT scan showed a mass with enhancement in the stomach. Gastric endoscopy revealed an ulcerative mass in the fundus. An endoscopic-biopsy specimen revealed caseating granulomas with acid-fast bacilli. The patient was diagnosed to have primary gastric tuberculosis, and antituberculous medications were initiated. Cultures of the gastric mass subsequently grew Mycobacterium tuberculosis sensitive to isoniazid and rifampcin. Follow-up after six months showed a good response to treatment; an upper gastrointestinal tract endoscopy after six months was normal.

Current management of Helicobacter pylori infection.

Helicobacter pylori is commonly found throughout the world. It is associated with a wide range of gastroduodenal diseases. Knowledge regarding the characteristic organism, behaviour, and related clinical conditions is extensive. Indeed, the bacteria is not the only factor which can cause the diseases, the host as well as environmental factors are also important. Largely, H. pylori is disappearing worldwide due to eradication of this organism allowing frequency of an H. pylori negative ulcer to relatively increase and may be more difficult to treat. The PPI triple therapy remains the first line of treatment with quadruple therapy as the second rescue line. The rising of bacterial resistant strains is a new problem which requires new drugs to improve the efficacy of the current regimens.

Gastropatia hipertensiva portal / Portal hypertensive gastrophaty

A gastropatia hipertensiva portal (GHP) é uma patologia descrita recentemente sendo uma importante causa de hemorragia digestiva alta. Sua principal forma de apresentaçäo é a perda crônica de sangue pelo trato gastrointestinal, algumas vezes com intensa anemia. Todavia, näo säo raros os casos de hematêmese e melena com instabilidade hemodinâmica. O tratamento clínico adequado e preventivo pode evitar deterioraçäo da funçäo hepática. Através deste manuscrito o autor define GHP, descreve as classificaçöes propostas e reve os aspectos fisiopatológicos, histológicos e endoscópicos da GHP. A sua correlaçäo com os níveis de pressäo portal e a funçäo hepática também säo abordados bem como suas manifestaçöes clínicas e tratamento.

Sífilis gástrica. Reporte de los dos primeros casos en Cuba / Gastric syphilis. Report on first 2 cases in Cuba

Two 28 and 25 year old female patients were studied. Endoscopic analysis of their stomachs showed an hyperemic mammillation picture, neoplasia compatible, in the first patient, and an ulcerous lesion in the second one. Both findings were the result of a positive serological test to discard syphilis. All this, together with a cutaneous and epidemiological history, represented an assumed diagnosis of a secondary stage syphilis with gastric disorders. Although it was not necessary, one case was submitted to a specific spirochaeta stain, but results were negative. The true diagnosis resulted from a penicillin treatment, which provoked a cutaneous-visceral history regression as well as a diminishing in V.D.R.L. titles

Lorazepam na ansiedade em gastroenterologia / Lorazepam in anxiety in gastroenterology

A açäo ansiolítica do lorazepam em gastroenterologia foi avaliada em 177 pacientes portadores de diagnósticos diversos nos quais a ansiedade apresentava participaçäo significativa. Observou-se rápida e acentuada reduçäo da ansiedade psicológica e somática e boa tolerabilidade. Os resultados obtidos, juntamente com os conhecimentos disponíveis sobre a farmacologia do lorazepam, demonstraram sua grande utilidade em gastroenterologia