Esofagitis necrotizante aguda / Acute necrotizing esophagitis / Esofagite necrotizante aguda

La esofagitis necrotizante aguda es un trastorno poco común que puede ser causa de hemorragia digestiva alta. Predomina en el sexo masculino en la sexta década de la vida. El diagnóstico es endoscópico y muestra una mucosa esofágica de apariencia negra que afecta al esófago distal en toda su circunferencia y se detiene abruptamente en la unión gastroesofágica. Clínicamente suele presentarse con hematemesis y melenas, shock hipovolémico por sangrado masivo, siendo otras manifestaciones el dolor epigástrico, molestia retroesternal y disfagia. Se vincula a pacientes con antecedentes de enfermedad cardiovascular, alcoholismo, diabetes mellitus, desnutrición, hernia hiatal, estenosis gastroduodenal, cáncer, así como pacientes en shock, traumatizados, sometidos a cirugía mayor e inmunosuprimidos. El tratamiento se basa en fluidoterapia, inhibidores de la bomba de protones y suspensión de la vía oral, siendo controvertido el uso de antibioticoterapia. Su pronóstico es malo y dependerá de la gravedad de la enfermedad esofágica y del terreno del paciente, con una mortalidad de hasta el 36 %. Presentamos el caso clínico de un paciente de 81 años, hipertenso, que presenta hematemesis, confirmándose en la endoscopía una esofagitis necrotizante aguda, que evoluciona favorablemente con tratamiento médico.

Acute necrotizing esophagitis is a rare disorder that can cause upper gastrointestinal bleeding. It predominates in males in the sixth decade of life. The diagnosis is endoscopic and shows a black-appearing esophageal mucosa that affects the entire circumference of the distal esophagus and stops abruptly at the gastroesophageal junction. Usually, patients present with hematemesis and melena, with other manifestations such as epigastric pain, retrosternal discomfort, dysphagia, and hypovolemic shock. Almost all patients reported comorbidities: cardiovascular disease, alcoholism, diabetes mellitus, malnutrition, hiatal hernia, gastroduodenal stenosis, and malignant neoplasia; is related as well to patients with shock, trauma, undergoing major surgery, and immunosuppression. The treatment is based on fluid reposition, proton pump inhibitors and suspension of the oral route, the use of antibiotic therapy being controversial. Its prognosis is poor and will depend on the severity of the esophageal disease and the patient comorbidities, with a mortality rate up to 36 %. Case: A 81-year-old male patient with hypertension, who presented hematemesis, confirmed by endoscopy as acute necrotizing esophagitis, whose evolution was favorable with medical treatment.

A esofagite necrosante aguda é uma doença rara que pode causar hemorragia digestiva alta. Predomina no sexo masculino na sexta década de vida. O diagnóstico é endoscópico e mostra uma mucosa esofágica circunferencial difusa com aspecto preto que envolve quase universalmente o esôfago distal e para abruptamente na junção gastroesofágica. Clinicamente, geralmente se apresenta com hematêmese e melena, com outras manifestações sendo dor epigástrica, desconforto retroesternal, disfagia e choque hipovolêmico. Está relacionado a pacientes com histórico de doenças cardiovasculares, alcoolismo, diabetes mellitus, desnutrição, hérnia hiatal, estenose gastroduodenal e neoplasia maligna, bem como pacientes em choque, trauma, cirurgia de grande porte e imunossupressão. O tratamento é a medicação dietética higiênica baseada em fluidoterapia, inibidores da bomba de prótons e suspensão da via oral, sendo o uso de antibioticoterapia controverso. Seu prognóstico é ruim e dependerá da gravidade da doença esofágica e do terreno do paciente, com mortalidade de até 36 %. Apresentamos o caso clínico de um paciente hipertenso de 81 anos que apresentou hematêmese, confirmada por endoscopia como esofagite necrosante aguda, que evoluiu favoravelmente com tratamento higiênico-dietético e medicamentoso.

Analysis of risk factors of radiation-induced toxicity in limited-stage small cell lung cancer treated with hypofractionated intensity-modulated radiotherapy / 中华肿瘤杂志

Objective: To compare the incidence of radiation-related toxicities between conventional and hypofractionated intensity-modulated radiation therapy (IMRT) for limited-stage small cell lung cancer (SCLC), and to explore the risk factors of hypofractionated radiotherapy-induced toxicities. Methods: Data were retrospectively collected from consecutive limited-stage SCLC patients treated with definitive concurrent chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2022. The enrolled patients were divided into two groups according to radiation fractionated regimens. Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) was used to evaluate the grade of radiation esophagus injuries and lung injuries. Logistic regression analyses were used to identify factors associated with radiation-related toxicities in the hypofractionated radiotherapy group. Results: Among 211 enrolled patients, 108 cases underwent conventional IMRT and 103 patients received hypofractionated IMRT. The cumulative incidences of acute esophagitis grade ≥2 [38.9% (42/108) vs 35.0% (36/103), P=0.895] and grade ≥ 3 [1.9% (2/108) vs 5.8% (6/103), P=0.132] were similar between conventional and hypofractionated IMRT group. Late esophagus injuries grade ≥2 occurred in one patient in either group. No differences in the cumulative incidence of acute pneumonitis grade ≥2[12.0% (13/108) vs 5.8% (6/103), P=0.172] and late lung injuries grade ≥2[5.6% (6/108) vs 10.7% (11/103), P=0.277] were observed. There was no grade ≥3 lung injuries occurred in either group. Using multiple regression analysis, mean esophageal dose ≥13 Gy (OR=3.33, 95% CI: 1.23-9.01, P=0.018) and the overlapping volume between planning target volume (PTV) and esophageal ≥8 cm(3)(OR=3.99, 95% CI: 1.24-12.79, P=0.020) were identified as the independent risk factors associated with acute esophagitis grade ≥2 in the hypofractionated radiotherapy group. Acute pneumonitis grade ≥2 was correlated with presence of chronic obstructive pulmonary disease (COPD, P=0.025). Late lung injuries grade ≥2 was correlated with tumor location(P=0.036). Conclusions: Hypofractionated IMRT are tolerated with manageable toxicities for limited-stage SCLC patients treated with IMRT. Mean esophageal dose and the overlapping volume between PTV and esophageal are independently predictive factors of acute esophagitis grade ≥2, and COPD and tumor location are valuable factors of lung injuries for limited-stage SCLC patients receiving hyofractionated radiotherapy. Prospective studies are needed to confirm these results.

Eficácia e segurança do Esomeprazol e Lansoprazol comparados ao Omeprazol para o tratamento de doença do refluxo gastroesofágico em adultos: revisão rápida / Effectiveness and safety of esomeprazole and lansoprazole compared to omeprazole for the treatment of gastroesophageal reflux disease in adults: rapid review

Tecnologia: Esomeprazol e lansoprazol. Indicação: Tratamento de doença do refluxo gastroesofágico em adultos. Pergunta: Esomeprazol e lansoprazol são mais eficazes e toleráveis que o omeprazol já incorporado ao SUS para o tratamento de Doença do Refluxo Gastroesofágico (DRGE) em adultos? Métodos: Uma revisão rápida de evidências, uma revisão de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foram selecionadas três revisões sistemáticas com meta-análise, que atendiam aos critérios de inclusão. Conclusão: O esomeprazol era mais eficaz para cicatrização da lesão nos casos de esofagite erosiva, prevenção da mucosa do esôfago, maior controle de ácido no tratamento de curto prazo (4 e 8 semanas) de esomeprazol 40mg e tratamento de longo prazo (6 meses) de esomeprazol 20mg. A taxa de resposta no alívio dos sintomas, o esomeprazol 20mg e 40mg apresentou ser mais eficaz, especialmente, na azia e dor epigástrica. Quanto ao perfil de segurança, não houve diferença significativa entre as taxas de eventos adversos, todos medicamentos eram parecidos entre si

Technology: Esomeprazole and Lansoprazole. Indication: Treatment of gastroesophageal reflux disease in adults. Question: Are Esomeprazole and Lansoprazole more effective and tolerable than omeprazole already incorporated into SUS for the treatment of Gastroesophageal Reflux Disease (GERD) in adults? Methods: A rapid review of evidence, an overview of systematic reviews, with bibliographic survey carried out in the PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed using AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Results: Three systematic reviews with meta-analysis were selected, which met the inclusion criteria. Conclusion: Esomeprazole was more effective in achieving wound healing in cases of erosive esophagitis, prevention of esophageal mucosa, greater acid control in short-term treatment (4 and 8 weeks) of esomeprazole 40mg and long-term treatment (6 months) of esomeprazole 20mg. the response rate in symptom relief, esomeprazole 20mg and 40mg proved to be more effective, especially in heartburn and epigastric pain. As for the safety profile, there was no significant difference between the rates of adverse events, all drugs were similar to each other

Erosive esophagitis secondary to radiotherapy: Case report / Esofagitis erosiva secundaria a radioterapia: reporte de un caso

Abstract Introduction: Erosive esophagitis secondary to radiotherapy is an unusual complication in the oncological treatment of thoracic tumors. This pathological entity is associated with multiple complications, which is a clinical challenge for health workers unfamiliar with the clinical manifestations. Clinical case: A 64-year-old woman with a 3-day clinical picture of chest pain radiating to the epigastrium with 10/10 intensity. On physical examination, she was tachycardic, hypotensive, and with intense pain in the upper hemiabdomen region; she had no signs of peritoneal irritation on deep palpation. Paraclinical tests showed no signs of local or disseminated infection, but endoscopy of the digestive tract reported post-radiation esophagitis. Discussion: Erosive esophagitis after radiotherapy occurs in less than 1 % of cases, and clinical manifestations such as dysphagia, odynophagia, and abdominal pain are common. Initial symptomatic management is preserved, with supportive measures such as intravenous hydration and proton pump inhibitors (PPIs). In case of intolerance to the oral route, therapy with nutritional support is indicated via nasogastric tube or gastrostomy in the most severe cases.

Resumen Introducción: la esofagitis erosiva secundaria a la radioterapia es una complicación inusual del tratamiento oncológico de los tumores torácicos. Esta entidad patológica está asociada con múltiples complicaciones, lo que resulta un reto clínico para los profesionales en salud que están poco familiarizados con las manifestaciones clínicas. Caso clínico: mujer de 64 años con cuadro clínico de 3 días de dolor torácico irradiado al epigastrio con intensidad 10/10. En el examen físico se encontró taquicárdica, hipotensa, con dolor intenso en la región hemiabdominal superior; a la palpación profunda no tenía signos de irritación peritoneal. Los paraclínicos no mostraron signos de infección local o diseminada, pero la endoscopia de vías digestivas reportó esofagitis posirradiación. Discusión: la esofagitis erosiva posterior a la radioterapia se presenta en menos del 1 % de los casos, las manifestaciones clínicas como disfagia, odinofagia y dolor abdominal son frecuentes; el manejo sintomático inicial es conservado, con medidas de soporte como hidratación intravenosa e inhibidores de la bomba de protones (IBP). En caso de intolerancia a la vía oral se indica terapia con soporte nutricional por sonda nasogástrica o gastrostomía en los casos más graves.

Hemorragia del tracto digestivo superior, enfoque para el médico general / Upper digestive tract bleeding, approach for the general Practitioner / Hemorragia do trato digestivo superior, enfoque para o médico geral

La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.

Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.

A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.

Correlación diagnóstica entre fibrolaringoscopia y videoendoscopia digestiva alta en pacientes con reflujo gastroesofágico y reflujo laringofaríngeo / Diagnostic Correlation Between Fiberlaringoscopy and Upper Gastrointestinal Video Endoscopy in Patients with Gastroesophagic Reflux and Laryngopharyngeal Reflux

Introducción: el reflujo laringofaríngeo (RLF) se origina por el flujo retrógrado de contenido gástrico hacia la faringe, pero es una entidad diferente de la enfermedad por reflujo gastroesofágico (ERGE). El objetivo del estudio fue determinar la correlación entre los signos endoscópicos de la fibrolaringoscopia y la videoendoscopia digestiva alta (VEDA). Material y métodos: estudio observacional, retrospectivo y analítico. Se incluyeron pacientes que consultaron por sintomatología de RLF y ERGE. Los hallazgos visualizados por fibrolaringoscopia flexible, VEDA y biopsia de mucosa gástrica de cada paciente se compararon con la prueba de chi-cuadrado (χ²). Se consideró significativo un valor de p ≤ 0,05. Resultados: se incluyeron 318 pacientes entre 18 y 84 años. Se encontró que el 100 % de los pacientes con esofagitis tenía laringitis (p = 0,001); el 100 % de los pacientes con hernia hiatal tenían RLF (p = 0,001); el 97 % de los pacientes con Helicobacter pylori en la mucosa gástrica tenían RLF (p = 0.001). El 71 % de los pacientes con hernia hiatal tenían esofagitis (p = 0,001). Se encontró una asociación lineal entre la edad y la hernia hiatal con la edad y el RLF (p = 0,03). Conclusiones: en este estudio, los signos encontrados en la fibrolaringoscopia tuvieron una asociación estadística con la VEDA. Aproximadamente el 90 % de los pacientes con signos de laringitis tuvo una correlación con algún grado de esofagitis, esófago de Barrett, hernia hiatal y Helicobacter pylori. También se encontró que la laringitis por RLF y la hernia hiatal se relacionaron directamente con el incremento de la edad.

Introduction: Laryngopharyngeal reflux (LPR) is caused by the retrograde flow of gastric contents towards the pharynx, but it is a different entity from gastroesophageal reflux disease (GERD). The objective of the study was to determine the relationship between the endoscopic signs of fiber laryngoscopy and upper gastrointestinal video endoscopy. Material and methods: Observational, retrospective and analytical study. Patients who consulted for LPR and GERD symptoms were included. The findings visualized by flexible fiber laryngoscopy, upper gastrointestinal video endoscopy and gastric mucosal biopsy of each patient were compared with the Chi-square (χ²) test. A value of p ≤ 0.05 is estimated significantly. Results: 318 patients between 18 and 84 years old were included. A relationship was found in 100% of the patients with esophagitis had laryngitis (p = 0.001); 100% of the patients with hiatal hernia had LPR (p = 0.001); 97% of patients with Helicobacter pylori in the gastric mucosal have LPR (p= 0.001); 71% of patients with hiatal hernia had esophagitis (p = 0.001). A linear association was found between age and hiatal hernia with age and LPR. (p = 0.03). Conclusions: In this study, the signs found in fiber laryngoscopy had a statistical association with the upper gastrointestinal video endoscopy. Approximately 90% of patients with signs of laryngitis had correlation with some degree of esophagitis, Barrett's esophagus, hiatal hernia and Helicobacter pylori. It was also found that LPR and hiatal hernia were directly related to increasing age

Comparison between herbs used for the treatment of gastroesophageal reflux diseases(GERD)

Background:An abnormality that causes reflux is termed as Gastroesophageal reflux disease (GERD), which is symptomatic by nature and adds to the long-term effects.Objective:The aim of this study is to observe and monitor the effects of a herbal ttratment of GERD with SiniZuojin Decoction (SNZID)and to assess its mediation impacts regarding the use of the medication in patients with Gastrointestinal EBB ailment.Materials and Methods:The cohort research methodology was used inthe study.The research included 2581 individual patients who were older than 18 years of age and were suffering from Gastrointestinal ebbailment. The patients were selected from various government herbal clinics in eastern China, including the states of Anhui, Fujian, Jiangsu, Jiangxi, Shandong, and Zhejiangover, from 2008 to 2018. Results:The study was conducted with a total of 2581 patients. The thorough assessment indicated that Sini Zuojin Decoction (SZD)notwithstanding standard stomach remedies pack was more effective than the traditionalist stomach suppositories bundle (RR=1.34, with CI=95% [1.47, 1.38], and P-value = 0.008); Test packs including SZD was essentially better contrasted with traditional stomach medicines(TSM)gearshifts in developing dyspepsia, substernal chest plague, decreasing regurgitation, and vomiting (P < 0.0002); SNZJD plus traditional stomach medicines(SPTSM)could by and large lessen full-scale sign scores with liberal ampleness (P < 0.00002). The replication degree and antagonistic effects regarding Sacroiliac Joint Dysfunction(SJD)treatment were basic. As confirmed through the TSA regarding thorough assessment, the results were significant, yet repeat security consequences were uncertain. As shown by the computation of the Grading of Recommendations Assessment, Development and Evaluation(GRADE)strategy, the idea regarding verification was minimal. Moreover, Schizoaffective disorder(SZD)may treat Gastrointestinal ebb ailment by presenting the onsetof the infection and controlling factors that may contribute to Gastrointestinal ebb ailments.Conclusion:The research evaluated the efficiency of Sini Zuojin Decoction in treating patients suffering from Gastrointestinal Ebb Ailments. [Ethiop. J. Health Dev.2022: 36(2) (00-00)]

Candidiasis y Candida albicans / Candidiasis and Candida albicans

La candidiasis es una enfermedad micótica debida a levaduras pertenecientes al género Candida. Dentro del gran conjunto de microorganismos que colonizan al ser humano, Candida albicans es el agente etiológico más comúnmente detectado ya que habita como comensal en las superficies mucosas y la piel. C. albicans participa en procesos de fermentación de azúcares y asimilación de nutrientes, pero, en algunas ocasiones se relaciona con procesos patológicos. En los últimos años los avances tecnológicos y médicos; así como el aumento en la incidencia de infecciones por el virus de la inmunodeficiencia humana, el auge creciente de la terapia inmunomoduladora y el uso de antibióticos de amplio espectro durante largos períodos de tiempo se han convertido en los factores de riesgo más importantes para la creciente incidencia de infecciones por microorganismos del género Candida. Debido a esto, resulta imperativo el conocimiento de esta enfermedad y sus formas clínicas más importantes, así como el abordaje diagnóstico y el tratamiento actual; información que recolectamos en este documento para brindar una visión general sobre esta patología(AU)

Candidiasis is a fungal disease caused by yeasts belonging to the genus Candida. Within the large group of microorganisms that colonize humans, candida albicans is the most commonly detected etiological agent since it inhabits mucosal surfaces and skin as a commensal. C. albicans participates in sugar fermentation processes and assimilation of nutrients but, on some occasions, it is related to pathological processes. In recent years, technological and medical advances; As well as the increase in the incidence of human immunodeficiency virus infections, the growing boom in immunomodulatory therapy and the use of broad-spectrum antibiotics for long periods of time have become the most important risk factors for the increasing incidence of infections by microorganisms of the genus Candida. Due to this, knowledge of this disease and its most important clinical forms, as well as the current diagnostic approach and treatment, is imperative; information that we collect in this document to provide an overview of this condition(AU)

CARACTERIZAÇÃO DAS ENDOSCOPIAS DIGESTIVAS ALTAS REALIZADAS NO MUNICÍPIO DE MOSSORÓ-RN / CHARACTERIZATION OF HIGH DIGESTIVE ENDOSCOPIES PERFORMED IN THE MUNICIPALITY OF MOSSORÓ-RN

Objetivou-se caracterizar as EDA realizadas na Comunidade de Saúde de Mossoró, RN, no período de 2008 a 2013, definindo a taxa de exames normais e a prevalência dos principais achados sugestivos de patologias digestivas. Trata-se de um estudo transversal e retrospectivo, no qual se analisou 10311 laudos de EDA. As análises estatísticas foram realizadas pelo SPSS (Statistical Package for the Social Sciences, versão 20.0), com nível de confiança95% e um p < 0,05, utilizando-se testes Qui-quadrado. Pelos dados levantados, constatamos que a EDA é um exame prático e seguro, com raríssimas complicações, sendo a agitação e a presença de alimento no estômago as limitações mais comuns. Na análise descritiva geral observou-se que a maioria dos exames foi realizada no gênero feminino, formando mais de 70% da amostra total. A faixa etária predominante, independente do gênero, foi 41 a 60 anos. As patologias frequentes no segmento esofágico foram as Esofagites. No segmento gástrico, a maior frequência de achados foram as Gastrites, que são mais frequentes com o avançar da idade. Na Transição Gastroduodenal, as úlceras de Canal Pilórico são os achados mais descritos, mas observamos também modestos achados de duodenites. No duodeno, os principais achados foram úlceras duodenais, seguidas pelas duodenites e sinais de atrofia. Portanto, as EDA são mais realizadas no gênero feminino, mas apresentam maior percentual de exames normais, sendo a maior frequência de achados encontrada no gênero masculino. Assim, após analisar as 10.311 EDA, é possível prever os achados mais comuns encontrados a EDA.

This study aimed to characterize the EDA held in Mossoro Health Community, RN, from 2008 to 2013, setting the rate of normal examinations and the prevalence of the main findings suggestive of digestive pathologies. It is a cross-sectional retrospective study, which analyzed 10,311 reports of EDA. Statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 20.0), with a confidence level 95% and p <0.05, using chi-square tests. Raised by the data, we found that EDA is a practical and safe exam, with very few complications, agitation and presence of food in the stomach the most common limitations. In general descriptive analysis it was observed that most of the exams was held in females, forming more than 70% of the total sample. The predominant age group, regardless of gender, was 41-60 years. The frequent pathologies in esophageal segment were Esophagitis. Gastric segment, the highest frequency of findings were Gastritis, which are more common with advancing age. Gastroduodenal in Transition, the Channel Pyloric ulcers are the most described findings, but also observed modest findings of duodenitis. In the duodenum, the main findings were duodenal ulcers, followed by duodenitis and signs of atrophy. Therefore, the EDA are more performed in females, but have a higher percentage of normal results, with the highest frequency of findings found in males. So after analyzing 10,311 EDA, it is possible to predict the most common findings EDA.

Avaliação da microbiota intestinal em adultos com esofagite erosiva / Assessment of the intestinal microbiota in adults with erosive esophagitis

ABSTRACT BACKGROUND: The intestinal microbiota influences the appropriate function of the gastrointestinal tract. Intestinal dysbiosis may be associated with a higher risk of esophageal lesions, mainly due to changes in gastroesophageal motility patterns, elevation of intra-abdominal pressure, and increased frequency of transient relaxation of the lower esophageal sphincter. OBJECTIVE: The aim of this study was to evaluate the intestinal microbiota in individuals with erosive esophagitis and in healthy individuals using metagenomics. METHODS: A total of 22 fecal samples from adults aged between 18 and 60 years were included. Eleven individuals had esophagitis (eight men and three women) and 11 were healthy controls (10 men and one woman). The individuals were instructed to collect and store fecal material into a tube containing guanidine solution. The DNA of the microbiota was extracted from each fecal samples and PCR amplification was performed using primers for the V4 region of the 16S rRNA gene. The amplicons were sequenced using the Ion Torrent PGM platform and the data were analyzed using the QIIME™ software version 1.8. Statistical analyses were performed using the Mann-Whitney non-parametric test and the ANOSIM non-parametric method based on distance matrix. RESULTS: The alpha-diversity and beta-diversity indices were similar between the two groups, without statistically significant differences. There was no statistically significant difference in the phylum level. However, a statistically significant difference was observed in the abundance of the family Clostridiaceae (0.3% vs 2.0%, P=0.032) and in the genus Faecaliumbacterium (10.5% vs 4.5%, P=0.045) between healthy controls and esophagitis patients. CONCLUSION: The findings suggest that reduced abundance of the genus Faecaliumbacterium and greater abundance of the family Clostridiaceae may be risk factors for the development of erosive esophagitis. Intervention in the composition of the intestinal microbiota should be considered as an adjunct to current therapeutic strategies for this clinical condition.

RESUMO CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é uma das enfermidades mais comuns na prática clínica e possui fisiopatologia multifatorial. Disbiose da microbiota intestinal pode ter influência em mecanismos envolvidos nesta doença, como mudanças nos padrões motores gastrointestinais, elevação da pressão intra-abdominal e aumento da frequência de relaxamentos transitórios do esfíncter esofágico inferior. Contudo, a avaliação da microbiota intestinal, neste contexto, ainda é pouco documentada. OBJETIVO: Este estudo avaliou a microbiota bacteriana intestinal, em indivíduos com doença do refluxo gastroesofágico erosivo e em indivíduos saudáveis, utilizando técnicas de metagenômica. MÉTODOS: Estudo incluiu amostras fecais de 22 adultos, com idades entre 18 e 60 anos: 11 com esofagite erosiva (oito homens e três mulheres) e 11 controles saudáveis (dez homens e uma mulher). Os pacientes foram orientados a coletar e armazenar o material fecal em tubo contendo solução de guanidina. O DNA da microbiota foi extraído das amostras de fezes e amplificação por PCR foi realizada usando iniciadores para a região V4 do gene 16S rRNA. Os amplicons foram seqüenciados usando a plataforma Ion PGM Torrent e os dados foram analisados usando o software QIIME™ versão 1.8 (Quantitative Insights Into Microbial Ecology). Análise de estatística foi realizada utilizando-se o teste não paramétrico de Mann-Whitney e o teste ANOSIM, método não paramétrico baseado em matriz de distância. RESULTADOS: Os índices de alfa-diversidade e beta-diversidade foram semelhantes entre os dois grupos, sem diferença estatisticamente significante. Não houve diferença estatisticamente significante no nível de filo, classe e ordem. Entretanto, observou-se diferença estatisticamente significante na abundância da família Clostridiaceae (0,3% vs 2,0%, P=0,032) e no gênero Faecaliumbacterium (10,5% vs 4,5%, P=0,045) entre controles saudáveis e pacientes com DRGE erosiva, respectivamente. CONCLUSÃO: Os achados sugerem que menor abundância do gênero Faecaliumbacterium e maior abundância da família Clostridiaceae, nos pacientes com DRGE, podem influenciar na fisiopatologia desta doença.

Caracterización de los trastornos manométricos esofágicos en pacientes con enfermedad por reflujo gastroesofágico refractario con síntomas esofágicos / Characterization of esophageal motility disorders in refractory gastroesophageal reflux disease patients with esophageal symptoms

Resumen Introducción: La enfermedad por reflujo gastroesofágico (ERGE) refractaria puede conducir a complicaciones potenciales como la esofagitis persistente, estenosis esofágica, anillo de Schatzki y esófago de Barrett. Este estudio describe la motilidad en pacientes con ERGE refractaria y su relación con síntomas esofágicos. Método: Se realizó un estudio observacional analítico a partir de una cohorte retrospectiva en pacientes con diagnóstico de ERGE refractaria y síntomas esofágicos a quienes se les realizó manometría esofágica de alta resolución más impedanciometría. Se describen las características clínicas y demográficas, y la asociación entre los trastornos manométricos y los síntomas esofágicos. Resultados: Se incluyeron 133 pacientes (edad promedio: 54,1 ± 12,5 años). La pirosis y regurgitación (69,2 %) y la disfagia esofágica (13,5 %) fueron los síntomas más comunes. La motilidad normal (75,2 %), el aclaramiento completo del bolo (75,2 %) y la motilidad esofágica inefectiva (MEI) (18 %) fueron los hallazgos manométricos más frecuentes. La unión gastroesofágica tipos II y IIIb estuvieron presentes en el 35,3% y 33,8 % de los casos, respectivamente. La aperistalsis (3,8 %) y el esófago en martillo neumático (Jackhammer; 0,8 %) fueron infrecuentes. El aclaramiento incompleto del bolo se asoció con disfagia esofágica (p = 0,038) y a MEI (p = 0,008). Ningún síntoma esofágico se relacionó significativamente con trastornos de motilidad. Conclusiones: Los resultados de nuestro estudio sugieren que los trastornos de motilidad son infrecuentes en los pacientes con ERGE refractaria. Adicionalmente, sugieren que la presencia de alteraciones de motilidad esofágica no se relaciona con la presencia de síntomas esofágicos y, por tanto, que el tipo de síntoma presentado no permite predecir la existencia de dichos trastornos.

Abstract Introduction: Refractory gastroesophageal reflux disease (GERD) can lead to potential complications such as persistent esophagitis, esophageal stricture, Schatzki ring, and Barrett's esophagus. This study describes motility in patients with refractory GERD, and its association with esophageal symptoms. Materials and methods: An analytical observational study was carried out in a retrospective cohort of patients diagnosed with refractory GERD and esophageal symptoms who underwent high-resolution esophageal manometry and impedance testing. Clinical characteristics, demographics, and the association between motility disorders and esophageal symptoms are described. Results: 133 patients were included (mean age 54.1 ± 12.5 years). Heartburn and regurgitation (69.2%), and esophageal dysphagia (13.5%) were the most common symptoms. Normal motility (75.2%), complete bolus clearance (75.2%), and ineffective esophageal motility (IEM) (18%) were the most frequent manometric findings. Type II and IIIb gastroesophageal junction were observed in 35.3% and 33.8% of the cases, respectively. Esophageal aperistalsis (3.8%) and Jackhammer esophagus (0.8%) were rare findings. Incomplete bolus clearance was associated with esophageal dysphagia (p=0.038) and IEM (p=0.008). No esophageal symptoms were significantly related to motility disorders. Conclusions: The results of the present study suggest that motility disorders are rare in patients with refractory GERD. They also suggest that esophageal motility disorders are not associated with the presence of esophageal symptoms and, therefore, the type of symptom experienced does not allow predicting the existence of such disorders.

Caracterización de pacientes con lesiones premalignas de esófago / Characterization of patients with esophagus premalignant lesions

Introducción: Los tumores de esófago constituyen lesiones benignas o malignas, que afectan las diferentes capas del órgano. Objetivo: Caracterizar a pacientes con lesiones premalignas de esófago halladas en endoscopia bucal, según variables seleccionadas. Métodos: Se efectuó un estudio observacional, descriptivo y transversal en el Servicio de Gastroenterología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, durante el 2015. El universo estuvo constituido por 57 pacientes de 20 años y más, con diagnóstico endoscópico e histológico de lesión premaligna de esófago. Las variables analizadas fueron: edad, sexo, lesiones premalignas de esófago, grado de esofagitis y diagnóstico histológico. Resultados: La endoscopia mostró un predominio de la esofagitis por reflujo en los pacientes de 62 años y más (61,7 %), así como del grado A de la clasificación de los Ángeles en ambos sexos (39,7 y 30,1 % de mujeres y hombres, respectivamente). Según el diagnóstico histológico primaron la esofagitis crónica (48,4 %) y la esofagitis crónica con displasia (17,1 %). Conclusiones: La identificación de pacientes con lesiones premalignas de esófago constituye el punto de partida para futuras acciones preventivas e intervencionistas, con vistas a disminuir la incidencia del cáncer de esófago.

Introduction: The esophagus malignancies constitute benign or malignant lesions that affect the different layers of the organ. Objective: To characterize patients with esophagus premalignant lesions found in oral endoscopy, according to selected variables. Methods: An observational, descriptive and cross-sectional study was carried out in the Gastroenterology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, during 2015. The universe was constituted by 57 patients aged 20 and over, with endoscopic and histologic diagnosis of esophagus premalignant lesion. The analyzed variables were: age, sex, esophagus premalignant lesions, degree of esophagitis and histologic diagnosis. Results: The endoscopy showed a prevalence of the esophagitis by reflux in patients aged 62 and over (61.7 %), as well as of the grade A of Los Angeles classification in both sexes (39.7 and 30.1% of women and men, respectively). According to the histologic diagnosis there was a prevalence of chronic esophagitis (48.4 %) and chronic esophagitis with dysplasia (17.1 %). Conclusions: The identification of patients with esophagus premalignant lesions constitutes the starting point for future preventive and interventionists actions, aimed at diminishing the incidence of esophagus cancer.

Hallazgos en la endoscopia digestiva alta en niños con talla baja / Findings of upper gastrointestinal endoscopy in children with short stature

Resumen Introducción: en el estudio de la baja talla de origen digestivo en niños no hay un patrón de paraclínicos preestablecido; sin embargo, la endoscopia de vías digestivas puede ser una herramienta útil para tal fin. Objetivo: reportar una serie de casos de niños con diagnóstico de baja talla a quienes se les indicó una endoscopia de vías digestivas altas como parte de su estudio. Reporte de casos: se incluyeron 15 niños entre los 2 y 16 años de edad, 53,3% niñas, 26,7% desnutridos según el índice de masa corporal y la talla para la edad, 66,7% con baja talla grave y 33,3% con baja talla moderada. El 53,3% presentó dolor abdominal, el 46,7% no tuvo ganancia de peso, el 26,7% tuvo inapetencia y el 13,3% tuvo vómito, entre otros. Entre el 40,0% y el 93,4% presentaron macro- o microscópicamente esofagitis, gastritis y duodenitis. Los hallazgos microscópicos más importantes fueron duodenitis crónica con giardiasis, úlceras duodenales, hiperplasia nodular linfoide duodenal, Helicobacter pylori y duodenitis crónica eosinofílica. Conclusiones: a pesar de que la endoscopia de vías digestivas es un método poco utilizado y no bien descrito en el estudio de niños con baja talla, este reporte de casos describe organicidad en un 80,0% de los niños analizados.

Abstract Introduction: The study of short stature of digestive origin in children shows no pre-established laboratory patterns. However, endoscopy of the digestive tract may be a useful tool for this purpose. Objective: To report a series of cases of children with a diagnosis of short stature who underwent upper digestive tract endoscopy as part of their study. Case report: 15 children between the ages of 2 and 16 years were included; 53.3% were girls. 26.7% presented with malnutrition according to their body mass index and height-for-age, 66.7% had short stature, and 33.3% moderate short stature. Abdominal pain was reported in 53.3% of the cases, and no weight gain in 46.7%. Other symptoms were lack of appetite in 26.7%, vomiting in 13.3%, among others. Between 40% and 93.4% of the children presented macro and/or microscopic esophagitis, gastritis, and duodenitis. The most important microscopic findings were chronic duodenitis with giardiasis, duodenal ulcers, duodenal nodular lymphoid hyperplasia, Helicobacter pylori, and chronic eosinophilic duodenitis. Conclusions: Although endoscopy of the digestive tract is a method barely used and not well described in the study of children with short stature, this case report describes organicity in 80% of the children analyzed.

Isolation and characterization of the aerobic bacterial microbiota of the esophagus and its probable association with obstructive caseous lesions in green turtles (Chelonia mydas) / Isolamento e caracterização da microbiota bacteriana aeróbia do esôfago e sua provável associação com lesões caseosas obstrutivas em tartarugas-verdes (Chelonia mydas)

Caseous lesions in the esophagus of green turtles (Chelonia mydas) from the coast of Brazil have been described as obstructive lesions and can lead to the death of these animals. However, their etiology remains unclear. The aim of this study was to isolate and characterize the aerobic bacterial microbiota of the esophagus of green turtles (C. mydas) from the Brazilian coast and to verify its possible participation in the etiology of caseous lesions. For this, 42 animals were used, 33 alive and healthy and 9 naturally dead that had esophageal lesions confirmed by necropsy, from Anchieta and Piúma beaches, Espírito Santo. Microbiological tests and morphological evaluation of the esophagus were performed. We isolated 14 different bacterial agents from healthy animal samples, with the prevalence of Pseudomonas aeruginosa being (36.36%), Staphylococcus aureus (33.33%), Aeromonas hydrophila (27.27%), and Vibrio alginolyticus (24.24%). In dead animals, only three distinct agents were isolated: S. aureus (50.00%), A. hydrophila (25.00%), and V. alginolyticus (25.00%). Morphological evaluation revealed a predominance of the lesions at the gastroesophageal junction, with multifocal-to-coalescent distribution, discrete intensity, and absence of obstruction. Ulcerations and caseous exudates, inflammatory infiltrates, parasitic eggs, and giant foreign body cells were also observed as well as bacterial lumps and glandular alterations, such as necrosis, adenitis, and fragments of adult parasites. There was a positive correlation between bacterial lumps and microbiological culture and a negative correlation between bacterial lumps and microbiological culture with parasites. Thus, it was noted that the esophageal aerobic microbiota of C. mydas was predominantly composed of Gram-negative bacteria such as P. aeruginosa, A. hydrophila, and V. alginolyticus, in addition to several enterobacteria and Gram-positive bacteria, such as S. aureus. These agents are opportunists and may be involved in the etiology of caseous esophagitis in association with other pathogens as co-factors working in association or, even in a secondary way.(AU)

A ocorrência de lesão caseosa no esôfago de tartarugas-verdes (Chelonia mydas) da costa do Brasil tem sido descrita como de caráter obstrutivo e pode causar a morte dos animais. No entanto, sua etiologia permanece pouco esclarecida. Objetivou-se isolar e caracterizar a microbiota aeróbica esofágica das tartarugas-verdes (C. mydas) da costa brasileira e verificar sua possível participação na etiologia das lesões caseosas. Foram utilizados 42 animais, 33 vivos e hígidos e nove mortos naturalmente que apresentavam lesão esofágica confirmada pela necropsia, provenientes de Anchieta e Piúma, Espírito Santo, nos quais foram feitos testes microbiológicos e avaliação morfológica do esôfago. Foram isolados 14 agentes bacterianos diferentes nas amostras de animais saudáveis, com prevalência de Pseudomonas aeruginosa (36,36%), Staphylococcus aureus (33,33%), Aeromonas hydrophila (27,27%) e Vibrio alginolyticus (24,24%). Nos animais mortos, foram isolados apenas três agentes distintos: S. aureus (50,00%), A. hydrophila (25,00%) e V. alginolyticus (25,00%). A avaliação morfológica revelou predominância da lesão em junção gastroesofágica, com distribuição multifocal a coalescente, intensidade discreta e ausência de obstrução. Observou-se ainda ulceração e exsudato caseoso, infiltrado inflamatório, ovos de parasitos e células gigantes do tipo corpo estranho, além de grumos bacterianos e de alterações glandulares, como necrose, adenite e fragmentos de parasitos adultos. Houve correlação positiva dos grumos bacterianos com cultivo microbiológico e negativa dos grumos bacterianos e cultivo microbiológico com parasitos. Assim, nota-se que a microbiota esofágica aeróbica de C. mydas é constituída predominantemente por bactérias Gram-negativas como P. aeruginosa, A. hydrophila e V. alginolyticus, além de diversas enterobatérias e por Gram-positivas, como S. aureus. Esses agentes são oportunistas e podem estar envolvidos na etiologia da esofagite caseosa em associação a outros patógenos como co-fatores agindo em associação, ou mesmo, por via de infecção secundária.(AU)

Revisión teórica de los factores de riesgos asociados a hemorragia digestivas altas en pacientes geriátricos / Theoretical review of risk factors associated with high digestive hemorrhage in geriatric patients

La hemorragia digestiva alta aguda (HDAA) es la emergencia gastrointestinal más frecuente. En los ancianos se asocia con tasas de internación, morbilidad y mortalidad más elevadas que en las personas jóvenes, probablemente por la prevalencia más elevada de múltiples comorbilidades, como las enfermedades pulmonares y cardiovasculares. Objetivo: Describir los fundamentos teóricos de los factores de riesgos asociados a hemorragia digestivas altas. Metodología: Documental, descriptiva. Resultados: diversos estudios demuestran que los factores de riesgos asociados a las hemorragias digestivas altas son: la úlcera péptica gastroduodenal y várices esofágicas, complicaciones graves con alto riesgo de mortalidad en pacientes de edades avanzadas, por lo que se debe actuar con rapidez, eficacia y efectividad. Conclusión: la bibliografía consultada revela: que a pesar de los avances de la tecnología y de la farmacología, la tasa de mortalidad global por hemorragia digestiva alta no ha mejorado. Esta realidad se explica por el aumento significativo en la edad de los pacientes que hoy ingresan a los servicios de urgencias con esta complicación. En la HDAA es fundamental intentar identificar y tratar la fuente del sangrado, para lo cual resulta esencial la endoscopia temprana(AU)

Acute upper gastrointestinal bleeding (HDAA) is the most frequent gastrointestinal emergency. In the elderly, it is associated with higher hospitalization, morbidity and mortality rates than in young people, probably due to the higher prevalence of multiple comorbidities, such as pulmonary and cardiovascular diseases. Objective: To describe the theoretical foundations of the risk factors associated with upper gastrointestinal bleeding. Methodology: Documentary, descriptive. Results: various studies show that the risk factors associated with upper gastrointestinal bleeding are, gastroduodenal peptic ulcer and esophageal varices, serious complications with a high risk of mortality in elderly patients, therefore, it is necessary to act quickly, efficiently and effectiveness. Conclusion: the bibliography consulted reveals: that despite advances in technology and pharmacology, the overall mortality rate from upper gastrointestinal bleeding has not improved. This reality is explained by the significant increase in the age of patients who today enter the emergency services with this complication. In HDAA it is essential to try to identify and treat the source of the bleeding, for which early endoscopy is essential(AU)

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: aspectos terapéuticos (2a. Parte) / Ibero-Latinamerican Clinical Practical Guidelines on pediatric caustic esophagitis: therapeutical aspects (Part 2)

Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Esofagitis por píldoras / Pill-induced esophageal injury

Si bien no se encuentra entre las principales causas de disfagia u odinofagia, la lesión de la mucosa del esófago a causa de la medicación administrada como píldoras debe ser tenida en cuenta, en particular en algún grupo etario con patologías crónicas. Presentamos el caso de una mujer con dolor retroesternal de confuso diagnóstico y buena evolución con tratamiento conservador. El mecanismo preciso por el cual se producen las lesiones no está bien claro. La videoendoscopia digestiva alta es la herramienta clave para observar las lesiones producidas y realizar diagnóstico diferencial; además puede resolver algunas complicaciones. En la mayoría de los casos, el tratamiento es médico. Esta situación debe tenerse presente para realizar un correcto interrogatorio y examen endoscópico.

Dysphagia and odynophagia should be considered as symptoms of pill-induced esophageal injury, particularly in age groups with chronic diseases. We report a case of a female patient with retrosternal chest pain of unclear diagnosis and favorable outcome with conservative treatment. The precise mechanism of esophageal injury remains uncertain. Upper gastrointestinal videoendoscopy is the essential tool to examine the lesions, make differential diagnosis and treat some complications. Medical treatment is useful in most cases. This condition should be kept in mind for proper interrogation and endoscopic examination.

L-arginine-induced esophagitis, report of six cases / Reporte de seis casos de esofagitis inducida por L-arginina

Abstract Background: Drug-induced esophagitis is an uncommon diagnosis in the pediatric population. The following is a report of six adolescents with L-arginine-induced esophagitis. Case reports: All patients were under treatment with L-arginine for short stature. After using the prescribed medication for 1-3 months, all cases started with severe retrosternal pain, odynophagia, and dysphagia. The upper gastrointestinal endoscopies showed ulcers located in the mid esophageal mucosa. Conclusions: In the presence of acute severe odynophagia, dysphagia, and retrosternal pain, drug-induced esophagitis should be considered as a possible diagnosis. Treatment includes liquid diet, pain control, sucralfate, omeprazole, and interruption of L-arginine. In addition, the physician should explain preventive measures focused on patient and family education on the drug side effects and precise instructions on how to take medications, as well as a careful balance of risk and benefits of any medication. At present, there are no clinical trials that support the use of L-arginine in treatment of short stature.

Resumen Introducción: La esofagitis inducida por medicamentos es un diagnóstico poco frecuente en pacientes pediátricos. A continuación, se describe una serie de seis casos de pacientes menores de 15 años con esofagitis inducida por L-arginina. Casos clínicos: Los seis casos se encontraban en tratamiento con L-arginina por talla baja e iniciaron con dolor retroesternal, odinofagia y disfagia de rápida instalación. Cuatro de ellos acudieron al servicio de urgencias por la intensidad de los síntomas. Los hallazgos en la endoscopia del tubo digestivo alto fueron úlceras en la mucosa del esófago a la altura del tercio medio, zona de estrechez natural por la compresión del bronquio izquierdo. Conclusiones: En presencia de odinofagia, disfagia, dolor retroesternal y el antecedente de la ingesta de L-arginina, la esofagitis inducida por fármacos debe considerarse como una posibilidad diagnóstica. El tratamiento está basado en el manejo del dolor, sucralfato, omeprazol, así como la suspensión del medicamento y medidas preventivas centradas en la educación del paciente y los familiares sobre los riesgos y beneficios de un medicamento y la forma correcta de administrarlo.

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: fisiopatología y diagnóstico clínico-endoscópico (1a Parte) / Ibero-latinamerican clinical practical guidelines on pediatric caustic esophagitis: physiopathology and clinical-endoscopic diagnosis (1st Part)

Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.