Caracterización clínico-histopatológica de la gastritis crónica / Clinical-histopathological characterization of chronic gastritis

La gastritis es una enfermedad con una alta morbilidad a nivel mundial, el principal factor de riesgo es la infección por Helicobacter pylori. Objetivo: Describir las características clínicas, histopatológica y endoscópicas en una población con gastritis crónica. Material y métodos: Se realizó un estudio observacional de tipo descriptivo, retrospectivo, se incluyeron 49 pacientes que acudieron a la consulta externa del área de gastroenterología, de 18 a 65 años, a quienes se realizó el estudio histopatológico y endoscópico en el Servicio de Gastroenterología en el Hospital General Quevedo, de Los Ríos-Ecuador, durante septiembre 2017 ­ septiembre 2018. Resultados: Se observó predominio del género masculino (65%); en mayores de 40 años (55%), la epigastralgía y la sensación de acidez estomacal, 39% y 35% respectivamente, fueron los síntomas más frecuentes, La positividad para Helicobacter pylori, alcanzó el 86%, y la lesión no erosiva un 73%, existió mayor presencia de la forma no atrófica (84%) sobre la atrófica. Conclusiones: La gastritis crónica predominó en el grupo etario mayor a 40 años y de género masculino, siendo los factores de riesgo de mayor prevalencia la infección por Helicobacter pylori y los asociados al consumo de antiinflamatorios no esteroideos, mala alimentación, alcohol y tabaco, los síntomas como epigastralgía y la sensación de acidez estomacal fueron los más frecuentes. El hallazgo endoscópico fue mayor para las formas no erosivas, y de acuerdo a la histopatología la gastritis no atrófica antral moderada fue la más frecuente(AU)

Gastritis is a disease with high morbidity worldwide, the main risk factor is Helicobacter pylori infection. Objective: To describe the clinical, histopathological and endoscopic characteristics in a population with chronic gastritis. Material and methods: An observational, descriptive, retrospective study was carried out, including 49 patients who attended the outpatient consultation of the gastroenterology area, aged 18 to 65 years, who underwent a histopathological and endoscopic study in the Gastroenterology Service at the Quevedo General Hospital, Los Ríos-Ecuador, during September 2017 - September 2018. Results: A predominance of the male gender was observed (65%); In people over 40 years of age (55%), epigastralgia and the sensation of heartburn, 39% and 35% spectively, were the most frequent symptoms, the positivity for Helicobacter pylori, reached 86%, and the non-erosive lesion 73 %, there was a greater presence of the non-atrophic form (84%) over the atrophic one. Conclusions: Chronic gastritis predominated in the age group over 40 years of age and male, the most prevalent risk factors being Helicobacter pylori infection and those associated with the consumption of non-steroidal anti-inflammatory drugs, poor diet, alcohol and tobacco. symptoms such as epigastric pain and the sensation of heartburn were the most frequent. The endoscopic finding was greater for non-erosive forms, and according to histopathology, moderate antral non-atrophic gastritis was the most frequent(AU)

Alterações gastrointestinais durante o acompanhamento nutricional de pacientes oncológicos em acompanhamento ambulatorial de quimioterapia / Gastrointestinal changes during nutritional follow-up of cancer patients undergoing outpatient chemotherapy

ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.

RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.

Erradicación de Helicobacter pylori en pacientes con dispepsia funcional / Helicobacter pylori eradication in patients with functional dyspepsia

La dispepsia constituye un motivo de consulta frecuente en atención primaria. A propósito de un paciente con diagnóstico de dispepsia funcional, la autora se plantea si el tratamiento de erradicación del Helicobacter pylori podría mejorar los síntomas. Luego de una búsqueda rápida se encontró evidencia que señala que el tratamiento de la infección por este germen podría ser beneficiosa para aliviar los síntomas de la dispepsia funcional a largo plazo, aunque con mayor riesgo de efectos adversos, por lo que otros tratamientos alternativos continúan siendo ser una opción válida en el manejo de los pacientes con este problema de salud. (AU)

Trastornos gastrointestinales funcionales después de un episodio de dengue no grave sin signos de alarma / Post-infectious functional gastrointestinal disorders in children after a non-severe dengue episode without warning signs

RESUMEN Introducción. La patogenia de los trastornos funcionales gastrointestinales involucra agentes infecciosos como los virus. Objetivo. Investigar el desarrollo de trastornos funcionales gastrointestinales en niños, a los 3, 6, 9 y 12 meses después de un episodio de dengue no grave sin signos de alarma. Materiales y métodos. Se hizo un estudio de cohorte de 73 niños con diagnóstico de dengue no grave sin signos de alarma atendidos en el Hospital Universitario del Valle "Evaristo García" y de 62 niños sanos de Cali, Colombia. Mediante el 'Cuestionario para síntomas gastrointestinales pediátricos Roma III' (Questionnaire for Pediatric Gastrointestinal Symptoms Rome III, QPGS-III), se determinaron los trastornos gastrointestinales funcionales a los 3, 6, 9 y 12 meses de seguimiento después de un episodio de dengue no grave sin signos de alarma. Se calcularon las medidas de tendencia central, riesgo relativo y prueba de ji al cuadrado, y se usó la prueba exacta de Fisher con un nivel de significación (p) menor de 0,05. Resultados. Se incluyeron 135 niños de 10,7±1,9 años; 51,1 % de ellos correspondía al sexo masculino y 19,3 % presentaba algún trastorno funcional gastrointestinal (9,6 % con dolor abdominal relacionado). El riesgo de presentar algún trastorno funcional gastrointestinal con dolor abdominal relacionado a los 3, 6, 9 y 12 meses de seguimiento en niños con dengue no grave sin signos de alarma fue mayor que sin dicho antecedente, pero sin diferencias significativas. Conclusión. Los resultados del estudio sugieren que el dengue no grave sin signos de alarma no incrementó el riesgo de trastornos gastrointestinales funcionales y dolor abdominal relacionado a lo largo de 12 meses de seguimiento.

ABSTRACT Introduction: The pathogenesis of functional gastrointestinal disorders involves infectious agents such as viruses. Objective: To study the development of functional gastrointestinal disorders 3, 6, 9 and 12 months after an episode of non-severe dengue without warning signs in children. Materials and methods: We conducted a cohort study in 73 children diagnosed with non-severe dengue without warning signs at Hospital Universitario del Valle "Evaristo García" and 62 healthy children from Cali, Colombia. Using the Questionnaire for Pediatric Gastrointestinal Symptoms Rome III (QPGS-III) in Spanish we identified functional gastrointestinal disorders 3, 6, 9, and 12 months after non-severe dengue without warning signs. Measurements of central tendency, relative risk, chi square, and Fisher's exact test were performed, with p<0.05 being significant. Results: We included 135 children who were 10.7±1.9 years old; 51.1% of them were male and 19.3% had a functional gastrointestinal disorder (9.6% of them had abdominal pain related to functional gastrointestinal disorders). There was a greater risk to present a functional gastrointestinal disorder and related abdominal pain in children after non-severe dengue without warning signs at 3, 6, 9, and 12 months of follow-up, but without significant differences. Conclusion: Our study suggests that non-severe dengue without warning signs does not increase the risk of functional gastrointestinal disorders and related abdominal pain for up to 12 months of follow-up.

Rehabilitación protésica de adultos mayores con dispepsia funcional / Prosthetics rehabilitation in elderly with functional dyspepsia

Se realizó un estudio descriptivo y transversal de 71 adultos mayores con dispepsia funcional, atendidos en el Servicio de Gastroenterología del Policlínico Sur Asdrúbal López Vázquez de la provincia de Guantánamo, desde mayo de 2012 hasta igual mes de 2014, con el objetivo de evaluar la efectividad de la rehabilitación protésica en estos pacientes. En la serie predominaron el sexo femenino (53,7 por ciento), el grupo etario de 60-69 años (53,7 por ciento), la sensación de plenitud y la saciedad precoz como síntomas principales, así como los dientes perdidos, según el índice de mortalidad dentaria (30,4 por ciento). El tratamiento rehabilitador permitió eliminar casi el total de los síntomas encontrados, por lo cual resultó efectivo y constituye un elemento a tener en cuenta para eliminar o disminuir los síntomas en ancianos con este trastorno

A descriptive and cross-sectional study of 71 elderly with functional dyspepsia, assisted in the Gastroenterology Service of Asdrúbal López Vázquez Southern Polyclinic in Guantánamo, was carried out from May, 2012 to the same month in 2014, with the objective of evaluating the effectiveness of the prosthetics rehabilitation in these patients. In the series there was a prevalence of the female sex (53.7 percent), 60-69 age group (53.7 percent) and early sensation of filling as main symptoms, as well as the lost teeth, according to the dental mortality rate (30.4 percent). The rehabilitative treatment allowed to eliminate almost all the symptoms found, reason why it was effective and constitutes an element to take into account to eliminate or diminish the symptoms in elderly with this disorder

Patologías funcionales post-infecciosas: epidemiología, factores de riesgo y tratamiento / Post-infectious functional gastrointestinal disorders: epidemiology, risk factors and treatment

Infectious gastroenteritis is a risk factor for developing post-infectious functional gastrointestinal disorders (PI-FGDs), mainly irritable bowel syndrome (IBS) and functional dyspepsia (FD). It is a significant subgroup of patients due to frequent episodes of gastrointestinal infections. Symptoms in PI-FGD patients can prevail for more than twelve months, especially if infective agents are bacteria or parasites. Symptoms are indistinguishable from their non-infective equivalents (IBS and FD). Risk factors for developing PI-FGD are: female gender, type and severity of the gastrointestinal infection, high anxiety levels and younger age. Main pathogenic mechanisms are alteration of permeability and immunity. Mucosa inflammation prevails only at early stage; however, with follow-up it can be reduced or normalized. Nevertheless, certain alterations prevail, such as hypersensitivity. These events are treated in the same way as IBS or FD.

La gastroenteritis infecciosa es un factor de riesgo para desarrollar un trastorno digestivo funcional postinfeccioso (TDF-PI), principalmente síndrome de intestino irritable (SII) y dispepsia funcional (DF). Es un subgrupo de pacientes relevante debido a lo frecuente que son las infecciones gastrointestinales. Los síntomas en los pacientes con TDF-PI se pueden prolongar por más de un año, especialmente cuando los agentes infecciosos son bacterias o parásitos. Los síntomas son indistinguibles con respecto a los de sus equivalentes no infecciosos (SII y DF). Los factores de riesgo para desarrollar TDF-PI son el sexo femenino, el tipo y la severidad de la infección gastrointestinal, los niveles altos de ansiedad, y la menor edad. Los principales mecanismos patogénicos son la alteración de la permeabilidad y de inmunidad. La inflamación de la mucosa predomina solo al principio pero con el seguimiento esta disminuye o se normaliza, a pesar de lo cual ciertas alteraciones como la hiperensibilidad permanecen. Estos cuadros se tratan de la misma manera que un SII o DF.

Estrés laboral y su correlación con la prevalencia de dispepsia funcional en militares en actividad que acudieron al hospital geriátrico del ejército / Relationship between the frequency of work-related stress and prevalence of functional dyspepsia in Lima Geriatric Army Hospital

Objetivo: Determinar la relación existente entre la frecuencia de estrés laboral y la prevalencia de dispepsia funcional en una muestra de 218 militares mayores de 50 años durante el año 2010 en el Hospital Militar Geriátrico de Lima. Materiales y métodos: Investigación descriptiva- explicativa; para la obtención de datos acerca del estrés se empleó la Escala de Sucesos Vitales de Holmes-Rahe y fichas clínicas para el registro clínico y de endoscopia alta que cumplan criterios de Roma III para dispepsia funcional. Para el procesamiento y análisis de datos se empleó el paquete de programas estadísticos SPSS (Statistical Packagefor Social Sciences). Resultados: el 100% de militares presentaron algún nivel de estrés laboral durante el año de estudio; así, el 36,7% presentó un alto nivel, el 31,2% nivel medio o moderado, y el 32,1% presentó nivel bajo de estrés; de estos porcentajes los niveles medio y alto de estrés representaron el 67,9%. Estos resultados permiten establecer que el estrés laboral es un malestar frecuente en la población estudiada (Chi2 tabular = 3,841, chi2 observado = 27,908). Con relación a la dispepsia funcional se determinó una prevalencia de 37,2%, porcentaje que indica que es una patología frecuente en dichos militares (Z tabular = 1,96, Zc = 9,163). Conclusiones: Existe una relación significativa entre la frecuencia de estrés laboral y la prevalencia de dispepsia funcional en militares en actividad mayores de 50 años (Chi2 tabular= 5,991, chi2 observado =28,878, coeficiente de contingencia=0,342).

Objective: To determine the relationship between the frequency of work-related stress and prevalence of functional dyspepsia in a sample of 218 military older 50 years in 2010 in Lima Military Hospital Geriatric. Materials and methods: Descriptive and explanatory study and for the data collection on stress, were used the Vital Events Scale Holmes-Rahe and clinical records for clinical and upper endoscopy registration that comply the criteria of Rome III for functional dyspepsia. For processing and data analysis the statistical software package SPSS (Statistical Package for Social Sciences) was used. Results: 100% of military showed some level of work stress during the study year; thus, 36.7% had a high level, 31.2% medium or moderate level, and 32.1% had low stress level; these percentages medium and high stress levels accounted for 67.9%. These results establish that job stress is a common discomfort in the study population (tabulated Chi2 = 3.841, chi2 observed = 27,908). Regarding functional dyspepsia prevalence of 37.2%, which indicates that it is a common condition in those military (tabular Z = 1.96, Z c = 9.163) it was determined. Conclusions: There is a significant relationship between the frequency of work-related stress and prevalence of functional dyspepsia in military activity in older than 50 years (tabulated Chi2 = 5.991, chi2 observed = 28,878, contingency coefficient = 0.342).

Lipase Supplementation before a High-Fat Meal Reduces Perceptions of Fullness in Healthy Subjects

BACKGROUND/AIMS: Postprandial symptoms of fullness and abdominal discomfort are common after fatty meals. Gastric lipases hydrolyze 10% to 20% of dietary triglycerides during the stomach trituration period of digestion. The aim of this study was to evaluate the effects of acid-resistant lipase on upper gastrointestinal symptoms, including fullness and bloating, as well as on gastric myoelectrical activity after healthy subjects ingested a high-fat, liquid meal. METHODS: This study utilized a double-blind, placebo-controlled, crossover design with 16 healthy volunteers who ingested either a capsule containing 280 mg of acid-resistant lipase or a placebo immediately before a fatty meal (355 calories, 55% fat). Participants rated their stomach fullness, bloating, and nausea before and at timed intervals for 60 minutes after the meal. Electrogastrograms were obtained to assess the gastric myoelectrical activity. RESULTS: Stomach fullness, bloating, and nausea increased significantly 10 minutes after ingestion of the fatty meal (p<0.01), whereas normal gastric myoelectrical activity decreased and tachygastria increased (p<0.05). With lipase, reports of stomach fullness were significantly lower compared with placebo (p<0.05), but no effect on gastric myoelectrical activity or other upper gastrointestinal symptoms was observed. CONCLUSIONS: The high-fat meal induced transient fullness, bloating, nausea, and tachygastria in healthy individuals, consistent with post-prandial distress syndrome. Acid-resistant lipase supplementation significantly decreased stomach fullness.

Alimentary factors in the development of gastric intestinal metaplasia in functional dyspeptic patients / Fatores alimentares envolvidos no desenvolvimento de metaplasia intestinal em dispépticos funcionais

CONTEXT: Intestinal metaplasia of the stomach is a lesion in which metaplasia of gastric epithelial cells occurs for an intestinal phenotype. Gastric intestinal metaplasia is a lesion associated with an increase in the risk of gastric carcinoma development. Epidemiologic studies indicate a relation between dietary habits and stomach cancer development, some habits increasing the risk for it, and others have a protective effect, suggesting that antioxidants, such as vitamins A, C, and E, decrease the risk of this type of cancer. The relationship of these alimentary factors and intestinal metaplasia is unknown. METHODS: It is a case-control, observational study in which 320 patients with functional dyspepsia, divided in two groups, were assessed. The case I group (individuals with intestinal metaplasia) had their dietary pattern compared to that of the control group, constituted of individuals similar to those in the case group but without intestinal metaplasia, through a food frequency questionnaire. RESULTS: The analysis of the dietary pattern of functional dyspeptic patients with intestinal metaplasia, and its comparison with those without intestinal metaplasia, showed a higher frequency of canned and smoked foods consumption in the first group and, on the other hand, a higher consumption of fruits and vegetables in patients without intestinal metaplasia. No effect of salt consumption was detected. CONCLUSIONS: The results obtained in this study suggest changes in the diet, with a decrease in the consumption of smoked and canned foods, and an increase in the consumption of fruits and vegetables, can lead to a diminution of gastric intestinal metaplasia cases.

CONTEXTO: A metaplasia intestinal do estômago é uma lesão onde ocorre a metaplasia das células epiteliais gástricas para um fenótipo intestinal. A metaplasia intestinal gástrica é considerada uma lesão associada ao aumento do risco de desenvolvimento de carcinoma gástrico. Estudos epidemiológicos indicam uma relação entre hábitos alimentares e o risco de desenvolvimento de câncer de estômago: tanto podendo ter efeito carcinogênico gástrico, como fator protetor, sugerindo que os antioxidantes como as vitaminas A, C e E diminuem o risco desse tipo de câncer. Não se conhece a influência desses fatores alimentares na metaplasia intestinal gástrica. MATERIAL: Trata-se de estudo caso-controle, observacional, para o qual foram avaliados 320 pacientes com dispepsia funcional, separados em dois grupos, um grupo de casos I (indivíduos com metaplasia intestinal) teve seus hábitos alimentares comparados aos do grupo de casos-controle (sem metaplasia intestinal), através de um questionário de frequência de consumo alimentar. RESULTADOS: Ao analisarmos o padrão alimentar dos pacientes dispépticos funcionais com metaplasia intestinal e compará-lo com o padrão daqueles que não possuem metaplasia intestinal, constatou-se que os pacientes com metaplasia intestinal consomem mais alimentos como os enlatados e defumados, enquanto os pacientes sem metaplasia intestinal apresentam consumo expressivamente maior de frutas em geral e vegetais. Diferença no padrão de consumo de sal não foi identificada. CONCLUSÕES: Através dos resultados obtidos no presente estudo podemos supor que a modificação da dieta, por meio da diminuição na ingestão de alimentos como defumados e enlatados e acréscimo na ingestão de frutas e vegetais pode levar a diminuição de casos de metaplasia intestinal.

[Diagnostic accuracy of helicobacter stool antigen in dyspeptic patients before eradication therapy]

The aim of this study was to assess and compare the diagnostic accuracy of Helicobacter pylori stool antigen [HpSA] test with three other invasive and non-invasive diagnostic methods. A total of Fifty-two dyspeptic patients were included. None of the patients had previous eradication therapy for Helicobacter pylori. Endoscopic biopsy samples were obtained for histology examination and Rapid Urease Test [RUT]. Urea Breath Test [UBT] and HpSA were also performed. Patients were considered Helicobacter pylori positive when 2 of 3 tests [histology examination, RUT and UBT] were positive [gold standard]. Diagnostic accuracy of HpSA was assessed performing a Receiver Operating Curve [ROC] analysis. Twenty-three Were men and 29 Were women, with a mean age of 42.3 years of the Patients. The prevalence of Helicobacter pylori infection was 67.3%. ROC curve analysis was showed a significant area under curve of 94.6% [p=0.0001]. Cut-off value was estimated to be 0.1. The sensitivity, specificity, positive and negative predictive values of HpSA wa 91.4%, 94.1%, 97% and 84%, respectively. HpSA level significantly increased with increasing in bacterial load. HpSA was proved to be a highly accurate, simple and non-invasive test for the diagnosis of Helicobater pylori infection before treatment in dyspeptic patients

Examination of Geographical, Clinical and Intrahost Variations in the 3' Repeat Region of CagA Gene in Helicobacter pylori

The size variation of the cytoxin-associated protein (cagA), which is dependent on the 3' repeat region (3'RR) of the cagA gene, is known to play a crucial role in the pathogenesis of Helicobacter pylori infection. The present study evaluated the relationship between the 3'RR variation and the geographic distribution, clinical manifestations, and locations of colonization in the stomach. We evaluated the 3'RR of H. pylori isolates from 78 patients with gastric cancer, peptic ulcer, and non-ulcer dyspepsia from Japan, Hong Kong, India, and the United States and assessed the variations of 3'RR according to the geographical and clinical characteristics. Sixty eight (87.2%) patients had the same 650 bp band without geographical differences. The frequency of polymorphisms in the 3'RR did not differ when compared to the clinical manifestations (P=0.868). The length of 3'RR did not differ by location of colonization. In conclusion, the 3'RR variation of cagA gene is not associated with the geographical and clinical characteristics of the patients studied.

Follicular Dendritic Cell Sarcoma of the Abdomen: the Imaging Findings

Follicular dendritic cell sarcoma is a rare neoplasm that originates from follicular dendritic cells in lymphoid follicles. This disease usually involves the lymph nodes, and especially the head and neck area. Rarely, extranodal sites may be affected, including tonsil, the oral cavity, liver, spleen and the gastrointestinal tract. We report here on the imaging findings of follicular dendritic cell sarcoma of the abdomen that involved the retroperitoneal lymph nodes and colon. It shows as a well-defined, enhancing homogenous mass with internal necrosis and regional lymphadenopathy.

The Reversed Halo Sign: Another Atypical Manifestation of Sarcoidosis

No abstract available.

Clinical Significance of Incidentally Detected Eosinophilic Esophagitis with Pathologic Review / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic esophagitis (EE) is a chronic inflammatory disorder characterized by abnormal dense eosinophilic infiltration of esophageal mucosa and results in dysphasia and food impaction. EE is being increasingly recognized in adults. The prevalence is largely unknown. This study was performed to evaluate the detection rate of EE diagnosed based on pathologic criteria and to define the clinical characteristics of EE in Korea. METHODS: We reviewed biopsy specimen of the 1,609 patients who underwent esophageal biopsy from January 2006 till August 2008. The presence of more than 20 eosinophils per high power field in biopsy specimens was considered cases of EE. Clinical information and endoscopic findings were obtained. RESULTS: 7 (0.4%) patients were diagnosed as EE based on pathologic criteria retrospectively. Clinical symptoms were epigastric pain (43%), regurgitation (29%), dyspepsia (14%), and no symptom (14%). Endoscopic findings were whitish exudates or granules (57%), esophageal polyp (29%), and hyperemic change (14%). Two patients received treatment. One patient with bronchial asthma improved after treatment with inhaled corticosteroid, and one patient improved after 8 week proton pump inhibitor therapy. CONCLUSIONS: Eosinophilic esophagitis was found in 0.4% of the total esophageal biopsied cases. Our results suggest that Korean patients with eosinophilic esophagitis showed symptoms mimicking gastroesophageal reflux disease and atypical endoscopic findings. Therefore, regardless of the gross appearance of the mucosa, meticulous diagnostic approaches are needed for patients with swallowing difficulty and lack of response to proton pump inhibitor.

Could gastric histology be a useful marker for making decision on Helicobacter pylori eradication therapy in patients with dyspepsia? / É a histologia gástrica um marcador útil na decisão de erradicar o Helicobacter pylori nos pacientes com dispepsia?

CONTEXT: It still remains an open debate whether Helicobacter pylori eradication is beneficial or not for the improvement of symptoms in functional dyspepsia. Differences in geographic distribution, the worldwide H. pylori genetic variability and the fact that the outcome of infection is strongly related to the virulence of the infecting strain are factors that might be driving ongoing controversies. OBJECTIVE: To study the correlation between gastric histology and H. pylori serology status in patients with dyspepsia. METHODS: This is a cross-sectional study where 40 consecutive dyspeptic patients (28 women and 12 men, mean age 48.5 years) with endoscopically normal stomachs were selected from the endoscopy unit at a university hospital in Recife, PE, Northeast of Brazil, between March 1998 and July 1999. Patients underwent gastric mucosal biopsy and serological tests (anti-Hp and anti-CagA antibodies). Gastric biopsies were examined using H-E and Giemsa stains and gastritis was classified and graded (mild, moderate or severe) according to "the updated Sydney System - Houston, 1994". RESULTS: Among 40 patients with dyspepsia the gastric histology revealed that about » had moderate (25 percent) or severe (2.5 percent) gastritis. This subgroup of patients also had a greater positive frequency of anti-Hp (100 percent vs 41 percent; P = 0.0005) and anti-CagA (91 percent vs 58 percent; P = 0.09) antibodies when compared with those with normal histology (27.5 percent) or mild gastritis (45 percent). CONCLUSION: Since upper gastrointestinal endoscopy is part of the functional dyspepsia investigation and serology for anti-CagA antibody is not available in daily clinical practice, by biopsying gastric mucosa we would only be able to selectively apply H. pylori eradication therapy for those with histology that best correlate with virulent infecting strains (moderate or severe gastritis) - around » of our study patients with dyspepsia.

CONTEXTO: O benefício da terapia de erradicação do H. pylori como parte do tratamento da dispepsia funcional ainda é uma questão em aberto. Diferenças na distribuição geográfica, a ampla variabilidade genética e o fato de que a expressão clínica da infecção está fortemente relacionada com a virulência das cepas infectantes, são fatores que provavelmente guiam as controvérsias. OBJETIVO: Estudar a correlação entre histologia gástrica e sorologia para H. pylori em doentes com dispepsia. MÉTODOS: Estudo descritivo-transversal com 40 pacientes consecutivos com sintomas dispépticos (28 mulheres e 12 homens, média de idade de 48,5 anos) e achado endoscópico de estômago normal, selecionados a partir da sala de endoscopia (Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, PE.) entre março de 1998 e julho de 1999. Todos foram submetidos a biopsias gástricas e testes sorológicos (anti-Hp e anti-CagA). As biopsias foram analisadas pelos métodos de H-E e Giemsa e os achados de gastrite classificados de acordo com o Sistema Sydney atualizado. RESULTADOS: A histologia dos 40 pacientes revelou que cerca de » apresentava gastrite moderada (25 por cento) ou severa (2,5 por cento). Esse grupo também apresentava maior frequência de positividade anti-Hp (100 por cento vs 41 por cento; P = 0,0005) e anti-CagA (91 por cento vs 58 por cento; P = 0,09) quando comparado com os casos com histologia normal (27,5 por cento) ou gastrite leve (45 por cento). CONCLUSÃO: Considerando que a endoscopia digestiva alta é parte da rotina de investigação da dispepsia funcional e que a sorologia anti-CagA não está disponível na prática clínica diária, através da histologia pode-se selecionar e aplicar terapia de erradicação do H. pylori apenas para os casos que muito provavelmente estão associados a cepas patogênicas de H. pylori (doentes com gastrite moderada ou severa) - cerca de » da presente amostra.

Hallazgos endoscópicos en pacientes ambulatorios referidos a endoscopia por síntomas digestivos altos / Endoscopic findings in ambulatory patients referred to endoscopy for upper digestive symptoms

Antecedentes: La realización de endoscopia como primer estudio de un paciente con dispepsia es muy controvertida. Objetivos: Conocer la frecuencia de patología orgánica en pacientes con dispepsia a quienes se les solicita endoscopia digestiva alta, tanto desde la atención primaria como desde los consultorios de especialidades. Métodos: Se analizó la base de datos de endoscopias de nuestro centro en el período 1999-2002. Los diagnósticos de cáncer se confirmaron histológicamente. Resultados: En 10.275 endoscopias practicadas en ese período, 1.488 fueron por dispepsia, 2.536 por síndrome ulceroso y 1.055 por reflujo gastroesofágico. En el grupo con dispepsia se encontró patología orgánica en un 33 por ciento, predominando la gastritis significativa y la esofagitis erosiva. La frecuencia de cáncer gástrico fue baja (0,1 por ciento) y sólo apareció en pacientes sobre 40 años y especialmente en mayores de 60. Lo mismo ocurrió en pacientes referidos por síndrome ulceroso y por reflujo gastroesofágico. Conclusiones: Solicitar endoscopia a pacientes con dispepsia está justificado porque un tercio de ellos tienen patologías de fácil y efectivo tratamiento. El acceso irrestricto a la endoscopia como screening de cáncer gástrico no parece en cambio ser útil en pacientes de menores de 60 años.

Background: The performance of upper digestive endoscopy as a first line study in patients with dyspepsia is highly controversial. Objectives: To investigate the frequency of organic diseases in dyspeptic patients referred from Primary Care centers or from Gastroenterology clinics for upper digestive endoscopy. Methods: The Endoscopy database of our unit was reviewed for the period 1999-2002. The endoscopic diagnosis of gastric cancer was confirmed by positive biopsies. Results: Out of 10.275 endoscopies performed in the study period, the reference diagnosis was: dyspepsia 1.488; ulcer syndrome 2.536 and gastroesophageal reflux 1.055. In the dyspepsia group, 33 percent of cases had some organic pathology, mainly gastritis and erosive esophagitis. The frequency of gastric cancer was low (0.1 percent) and it was found only in patients older than 40 years and specially older than 60 years. Similar results were found in patients referred for ulcer syndrome or gastroesophageal reflux. Conclusions: An upper digestive endoscopy in the initial work up of patients with dyspepsia seems to be acceptable one third of them present organic diseases with easy and effective therapies. On the other hand the irrestrictive acces to endoscopy as screening of gastric cancer does not seem to be useful in patients under 60 years.

frequency of GAstric malignancy in patients undergoing endoscopy for dyspepsia

To find out the frequency of Gastric Malignancy in endoscoped patients presenting with dyspepsia. A descriptive study carried out for 12 years. Gastroenterology Department of CMH Quetta from 1991-95, CMH Peshawar 1995-2000 and CMH Lahore 2000-2003. Patients came from Baluchistan, Sind, NWFP, and Punjab respectively. Hundred adult patients, who presented with symptoms suggestive of upper digestive tract disease and were confirmed to have gastric malignancy on histopathology of the gastric lesion. Out of 5000 patients presenting with dyspepsia, 100 patients were ascertained to have gastric malignancy on endoscopic biopsy and registered in the study. Twenty four [24%] were female and 76 [76%] male. The Age ranged from 25 to 85 years with average 54.51 years. Ninety four [94%] patients had adenocarcinoma including 20[20%] signet ring carcinoma, 4[4%] lymphoma, 1[1%] adenosquamous carcinoma and 1[1%] had leiomyoblastoma. Eighty- five [85%] were registered in Peshawar and Quetta out of two thousands i.e. one out of every 23rd gastroscoped patient, while 15[15%] were diagnosed in Lahore out of 3000 i.e. one out of 200. Gastric Malignancy is the cause of dyspepsia in 4. 25% patients in Baluchistan and NWFP and 0.5% in Punjab, who presented with upper digestive tract disturbances, substantive enough to warrant endoscopy. Hence gastric malignancy is much more common in Baluchistan and NWFP as compared to Punjab. The average age is 54 .51 years

study of duodenal intraepithelial lymphocytic population and its relation to coeliac disease in a cohort of patients in the Nile delta of Egypt

Coeliac disease is the permanent intolerance to dietary gluten, the major protein component of wheat. Recent epidemiological studies have provided evidence showing that this disorder is common in various parts of the world. The counting and the immunoprofile of intraepithelial lymphocytes of the small bowel have been proposed as methods to measure mucosal infiltration in gluten-sensitive patients. The aim of the present study was to quantify and define the immunohistochemical profile of intraepithelial lymphocytes in the duodenal mucosa of patients suffering non-ulcer dyspepsia, and compare them with known cases of coeliac disease. Archival paraffin wax embedded duodenal sections from 50 endoscopic biopsies were stained using CD3, CD4, and CDS antibodies. Sections were obtained from 24 patients with confirmed coeliac disease, 20 patients with non-ulcer dyspepsia, and 6 patients with functional dyspepsia as control. Patients with non-ulcer dyspepsia were on gluten containing diets. The number of intraepithelial lymphocytes was quantified in five different villi by counting the number of lymphocytes/100 epithelial cells in each villus, and calculating the mean. Endomysial antibodies and testing for Helicobacter pylori were done in all cases. A positive correlation was observed between the degree of villous atrophy and CD3, CD4, and CD8+ intraepithelial lymphocytes. A positive correlation was also observed with the lamina propria lymphoid aggregates. H. pylori infection had a positive correlation with the degree of lymphoid aggregation in the lamina propria. Although the difference between potential coeliac disease and non-coeliac controls was significant, these lesions overlapped considerably. Clinicians as well as pathologists should increase the index of suspicion of coeliac disease. The frequent occurrence of duodenal intraepithelial lymphocyte expansions in other diseases may justify the use of immunohistochemical examination of duodenal biopsy specimens from patients suffering from dyspepsia