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.

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.

Screening and Identifying Erosive Esophagitis in Children with Non-cardiac Chest Pain

Non-cardiac chest pain is a common disorder that leads to costly evaluations to distinguish it from cardiac pain. The present study aimed to clarify the clinical characteristics of erosive esophagitis in children with non-cardiac chest pain. Ninety nine patients (mean age, 9.55 ± 2.95 years, 49 girls) with non-cardiac chest pain were enrolled. Patients were classified into two groups: erosive esophagitis and non-erosive esophagitis-related non-cardiac chest pain by esophagogastroduodenoscopy. Children in the erosive esophagitis-related non-cardiac chest pain group were significantly older (10.95 ± 2.54 years vs. 8.52 ± 2.83 years). Multivariate logistic regression analysis identified the following predictors of gastroesophageal reflux: chest pain related to sleep (odds ratio = 18.05, 95% confidence interval: 3.18-102.49); unfavorable dietary habits (odds ratio = 7.11, 95% confidence interval: 1.53-32.87); chest pain related to food (odds ratio = 5.09, 95% confidence interval: 1.37-18.86); epigastric pain (odds ratio = 3.73, 95% confidence interval: 1.12-12.33); and nausea, vomiting, and/or regurgitation (odds ratio = 4.35, 95% confidence interval: 1.22-15.54). Gastroesophageal reflux disease should be considered first in children with non-cardiac chest pain. Children with gastroesophageal reflux disease should receive medical treatment and lifestyle modifications.

Ingesta de cáusticos en niños, experiencia de 3 años / Ingestion of caustic substances in children: 3 years of experience

Introdución: La ingesta accidental de cáusticos en pediatría no dispone de un consenso claro de actuación. El objetivo de este estudio fue caracterizar la población pediátrica atendida por ingesta de cáusticos en un centro asistencial. Pacientes y método: Estudio descriptivo de los pacientes atendidos en nuestro hospital por la ingesta de cáusticos durante el período 2008-2011. Resultados: Se atendieron 12 pacientes, edad media de 3,8 años (1-13 años). Predominio de varones (58,8%). Un 58,3% ingirió producto alcalino y un 41,6% ácido. El 58,3% no refería sintomatología, el resto refirió vómitos (33,3%), odinofagia (16,6%), hematemesis (8,3%), sialorrea (8,3%) y dificultad respiratoria (8,3%). El 75% presentaron lesiones en la cavidad oral. Todos, salvo un caso, fueron accidentales. Se realizó endoscopia al 100% entre las 12 y 24 h postingesta con hallazgos patológicos en un 41,6%. En el grupo ingesta de álcalis 2 pacientes presentaron lesiones (16,6%): una esofagitis grado 2B y una grado 3. En el grupo ingesta de ácidos 4 pacientes (33,3%) presentaron lesiones: una esofagitis aguda grado 1-2A, 2 gastritis agudas no erosivas y una gastritis aguda hemorrágica. Se realizó endoscopia de control según los hallazgos endoscópicos previos. Solo 2 presentaron complicaciones posteriores. Conclusiones: Destacamos la valoración endoscópica en las primeras 24 h en todas las ingestas sintomáticas y deliberadas, así como la reevaluación estrecha en las ingestas ácidas, por asociar lesiones diferidas.

Introduction: There is no clear consensus on the management of accidental ingestion of caustic substances in paediatrics. The aim of this study was to determine the profile of the paediatric population treated due to caustic ingestion in a Healthcare Centre. Patients and method: A descriptive study was conducted on patients treated for the ingestion of caustic substances in our hospital during the period 2008-2011. Results: A total of 12 patients were treated, with a mean age of 3.8 years (1-13 years), with the majority males (58.8%). An alkaline product was ingested by 58.3%, and an acid by 41.6%. The majority (58.3%) did not refer to symptoms and the remainder referred to vomiting (33.3%), odynophagia (16.6%), haematemesis (8.3%), hyper-salivation (8.3%) and shortness of breath (8.3%). Oral cavity lesions were observed in 75% of cases. All, except one, were accidental. An endoscopy was performed on all of them (100%) between 12 and 24 hours post-ingestion, with pathological findings in 41.6%. In the group that ingested an alkali, 2 (16.6%) patients had lesions, one a grade 2B and one a grade 3 oesophagitis. In the acid ingestion group, 4 (33.3%) patients had lesions; one grade 1-2A oesophagitis, two acute non-erosive gastritis, and one acute haemorrhagic gastritis. A follow-up endoscopy was performed depending on the previous endoscopic findings. Only two patients presented with complications. Conclusions: Emphasis is placed on the endoscopic evaluation in the first 24 hours of deliberate asymptomatic ingestions, as well as a strict follow-up in those that ingested acids, due to delayed associated lesions.

Esofagitis de cambios mínimos y su relación con los bucles capilares papilares intraepiteliales del esófago, en pacientes con enfermedad de reflujo gastroesofágico, usando endoscopios con flexible spectral imaging color enhancement / Minimal change esophagitis and its relation with esophageal intra papillary epithelial capillary loops in patients with gerd using flexible spectral imaging color enhancement endoscopes

La esofagitis de reflujo, es una entidad clínica que forma parte de la enfermedad de reflujo gastroesofágico (ERGE). A pesar que la endoscopia, tiene una excelente especificidad en 90% - 95%, su sensibilidad es sólo del 50%. Más del 50% de los pacientes con síntomas de ERGE han sido diagnosticados como enfermedad por reflujo no erosivo, (ERNE). El análisis más cuidadoso de los estudios publicados, reporta que la mayoría de los pacientes con ERNE tenían pequeños cambios en la mucosa del esófago distal, específicamente proximal a la línea Z; introduciéndose con estos hallazgos el término de esofagitis de cambios mínimos. Pero también cambios característicos de los bucles capilares papilares intraepiteliales (BCPIE) han sido demostrados, en pacientes con esofagitis de cambios mínimos por ERGE. Evaluar y comparar en pacientes con el diagnóstico de ERNE y en pacientes controles, la alteración morfológica de BCPIE en el esófago distal, con la intención de diagnosticar esofagitis de cambios mínimos, utilizando endoscopios de alta resolución con magnificación, cromoscopia electrónica e imagen espectral FICE. Estudio de corte transversal, prospectivo, con un muestreo no probabilístico, de tipo intencional y grupo control, realizado con pacientes que asistieron a la consulta ambulatoria del servicio de Gastroenterología del Hospital Universitario de Caracas y de la Clínica El Ávila, desde mayo de 2007 a noviembre de 2011. De 156 pacientes con diagnóstico de ERNE y 100 pacientes de grupo control. Grupo control: 100 pacientes, 3 pacientes con BCPIE tipo II (1%). Grupo ERNE 156 pacientes, 5 tenían un patrón: Tipo I considerado normal y 151 tenían un patrón de los BCPIE alterado: 146 con patrón de BCPIE Tipo II (96,68%), sensibilidad 97%, especificidad 97%; 5 (3,31%), tenían un patrón de BCPIE Tipo III sensibilidad 5% y especificidad 0%. Los cambios anatómicos encontrados en los BCPIE de la mucosa del esófago, cuando se hace una endoscopia digestiva...

Reflux esophagitis is a clinical entity that is part of Gastroesophageal Reflux Disease (GERD). Although endoscopy has an excellent specificity of 90% -95%, its sensitivity is only 50%. Over 50% of patients with symptoms of GERD have been diagnosed as non-erosive reflux disease (NERD). More careful analysis of the published studies reported that most NERD patients had minor changes in the distal esophageal mucosa, specifically proximal to the Z line; introducing with these findings the term of Minimal Change Esophagitis. Also changes characteristic of Intra Papillary Epithelial Capillary Loops (BCPIE) have been demonstrated in patients with Minimal Change Esophagitis by GERD. To evaluate and compare patients with the diagnosis of NERD and controls, BCPIE morphological alteration in the distal esophagus, with the intention of diagnosing minimal change esophagitis, using high-resolution magnification endoscopes, electronic and spectral imaging chromoscopy FICE. Prospective, cross-sectional study with a non-probability sampling, intentional kind and control group, of patients attending the outpatient clinic of the Department of Gastroenterology, University Hospital of Caracas and of Avila Clinic, from May 2007 to November 2011. Of 156 patients diagnosed with NERD and 100 patients in the control group. Control group: 100 patients, 3 patients with type II BCPIE (1%). NERD group 156 patients, 5 had a pattern: Type I considered normal and 151 had a pattern of altered BCPIE: 146 BCPIE with a Type II pattern (96, 68%), sensitivity 97%, specificity 97%; 5 (3, 31%), had BCPIE with a Type III pattern Sensitivity 5% and Specificity 0%. The anatomical changes found in BCPIE at the esophageal mucosa, when an endoscopy is performed in patients with GERD, allow the diagnosis of Minimal Change Esophagitis. The BCPIE type II pattern is the most frequently found in Minimal Change Esophagitis. The indication of Endoscopy with high definition magnification....

Esofagitis necrosante aguda. Reporte de un caso / [Acute necrotizing esophagitis. Case report].

Acute necrotizing esophagitis, also known as black esophagus, represents an extremely rare clinical entity, defined by the black pigmentation of the esophagus, secondary to necrosis of the mucosa and detected at endoscopy. We present a clinical case of this rare disease, with its manifestation, diagnosis, treatment, and we perform a review of the literature.

Cytomegalovirus esophagitis presents as chest pain in a renal transplant recipient

No abstract available.

Dilatación precoz: evolución y complicaciones en esofagitis caústicas grado II y III en niños / Earily dilatation: evaluation and complications in caustic esophagitis grade II and in children

La dilatación precoz en esofagitis caústica no está bien establecida. Objetivo: Evaluar el beneficio de la dilatación precoz, en la evolución y complicaciones de esofagitis caústicas grado II y III. Pacientes y Métodos: Estudio prospectivo de 32 niños, grupo A (dilatación precoz) y B (dilatación tardía). Se utilizo el índice de dilatación periódica para evaluar beneficio de la dilatación precoz. Resultados: edad promedio 2,3 años; 13 (40,62%) hembras y 19 (59,38%) varones; 21/32 (65,62%) desarrollaron estenosis esofágica, 6/15 (40,00%) grupo A, 15/17 (88,23%) grupo B (p=0,0041). Estenosis simples en 12/21 (57,14%), complejas 9/21 (42,85%), recurrentes 2/6 y refractaria 2/6, grupo A; 6/15 recurrente y 5/15 refractarias, 1/15 perforación esofágica, grupo B. El promedio de sesiones de dilatación 17 vs 44,6 (p=0,0297) e índice de dilatación periódica de 3,04 vs 4,11 (p=0.0002) grupo A y B respectivamente. Conclusiones: la dilatación precoz en esofagitis caústica es segura y contribuye a disminuir el número de sesiones de dilatación y complicaciones. Se destaca, la importancia de la prevención de la ingesta accidental de cáusticos.

Early dilatation in caustic esophagitis is not well established. Objective: Evaluate the benefits of early dilatation in the evolution and complications of grade I and II caustic esophagitis in children. Patients and Methods: Prospective study of 32 children, group A (early dilatation) and B (late dilatation). The periodic dilatation index was used to evaluate the benefits of early dilatation. Results: Average age 2,3 years old; 13 (40,62%) female and 19 (59,38%) male; 21/32 (65,62%) developed esophageal stenosis. 6/15 (40,00%) group A, 15/17 (88,23%) group B (p=0,0041). Simple stenosis in 12/21 (57,14%), complex 9/21 (42,85%), recurrent 2/6 and refractory 2/6, group A; 6/15 recurrent and 5/15 refractory, 1/15 esophageal perforation, group B. The average of dilatation sessions was 17 vs. 44,6 (p=0,0297) and periodic dilatation index was 3,04 vs. 4,11 (p=0.0002) group A and B respectively. Conclusions: early dilatation in caustic esophagitis is safe and contributes to decrease the number of dilatation sessions and complications.

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

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

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

Casos de correlación endoscópico-patológica / Cases with endoscopic-pathologic correlation

Presentamos el caso de una mujer de 42 años, obesa, con reflujo gastroesofágico patológico (RGEP) y una hernia hiatal por deslizamiento diagnosticada el año 2004. Desde entonces ha recibido omeprazol en forma discontinuada. Durante el 2007 los síntomas de RGEP se hacen más intensos e intolerables el último mes, con aumento de la pirosis, epigastralgia y dolor al pecho. La panendoscopia demuestra alteraciones características de esofagitis eosinofílica con aspecto anillado del esófago, surcos longitudinales y grumos blanquecinos. Las biopsias escalonadas del esófago confirman el diagnóstico con más de 20 eosinófilos intraepiteliales por campo de mayor aumento (CMA) y las biopsias de estómago y duodeno prácticamente no presentan eosinófilos. Las claves para el diagnóstico endoscópico e histopatológico se cumplen perfectamente en este caso.

We present an obese, 42 year-old lady, with gastro-esophageal reflux and a sliding hiatal hernia diagnosed in 2004. Since then she has been treated with Omeprazole. Since 2007 the gastro-esophageal reflux symptoms have become more severe. By a month ago the symptoms became intolerable with increased heartburn, epigastric and chest pain. The upper endoscopy showed characteristic changes of eosinophilic esophagitis with esophageal ringed appearance, longitudinal ridges and whitish spots. Serial biopsies of the esophagus confirmed the diagnosis with more than 20 intraepithelial eosinophils per field higher magnification (CMA) and biopsies of stomach and duodenum showed practically no eosinophils. The keys to the endoscopic and histopathological diagnosis are fulfilled in this case.

Intoxicación pediátrica por paraquat (gramoxone) supervivencia en dos casos / Pediatric intoxication with paraquat (gramoxone) survival of two children

El paraquat es un plaguicida agricola bipiridilo, cuyos efectos tóxicos más severos son año hepato-renal y fibrosis pulmonar irreversible. Se reportan dos casos de intoxicación en niños, por ingestión accidental de paraquat; ellos desarrollaron sialorrea, vómitos azul verdoso, lesión digestiva cáustica. dificultad respiratoria, daño hepato-renal, alteraciones radiológicas y presencia de paraquat en orina y sangre. Ambos pacientes recibieron el tratamiento disponible entre 24-48 horas despues de la ingestion y tuvieron una evolución satisfactoria. El tratamiento consistió basicamente en diálisis gastrointestinal, diuresis forzada ácida, N-acetilcisteína y dexametasona.

Paraquat is a bipyridyl agricultural pesticide, whose more severe effects are hepatic-renal damage and irreversible pulmonary fibrosis. Two children with paraquat accidental poisoning are reported; they developed syalorrhea, blue greenish vomiting, caustic digestive injury, breathing difficulty, liver and kidney damage, radiographic changes and presence of paraquat in blood and urine. Both patients received the available treatment 24-48 hours after ingetion and had a satisfactory autcome. The consisted basically of gatrointestinal dialysis, acidic forced diuresis, N-acetylcysteine and dexamethasone.

Ingestión de sustancias Cáusticas: reporte de un caso y revisión de la literatura / Ingestion of caustic substances: a case report and literature review

Introducción: La ingestión de sustancias cáusticas (IC) en niños, continúa siendo un campo difícil, debido a la poca clara relación entre los signos y síntomas y la extensión del daño del esófago.Objetivo: Describir el caso de un niño con IC y revisar la literatura del tema. Reporte del caso: Se trata de un masculino de 1 año 8 meses de edad, sin antecedentes de importancia, quien luego de ingesta accidental de líquido de radiador contenido en un frasco de yogurt, presenta vómito en 15 oportunidades. En Centro de Salud luego de la colocación de sonda nasogástrica para lavado gástrico es remitido a un Tercer Nivel de Atención, donde se le realiza una endoscopia digestiva alta (EVDA) luego de 28 horas de la IC. El reporte de la EVDA, indicó esofagitis caústica grado IIc, gastropatía severa, y píloro no franqueable con lesiones concéntricas. El manejo incluyó ayuno, líquidos endovenosos, corticoides, penicilina, y ranitidina Discusión: La EVDA, es el método más eficiente para evaluar la mucosa del tubo digestivo superior luego de la IC, que puede tener efectos catastróficos o puede resultar inofensiva. Se ha intentado correlacionar los signos y síntomas iniciales con la gravedad de las lesiones para evitar la realización de una EVDA innecesaria, sin embargo, sigue siendo controversial este tema. El manejo médico de la IC incluye antibióticos, esteroides y bloqueadores H2. Entre las complicaciones de la IC se encuentran la perforación, la mediastinitis, las fístulas a grandes vasos, la penetración al estómago y las estenosis.

Introduction: The ingestion of caustic substances (CI) in children, remains a difficult, due to lack clear relationship between the signs and symptoms and the extent of damage of the esophagusObjective: To describe the case of a child with CI and review the literature on the subject. Case report: This is a male 1 year 8 months old, with no previous medical history, who after accidental ingestion of radiator fluid contained in a jar of yogurt, vomiting occurs in 15 opportunities. Health Center after placement of a nasogastric tube for gastric lavage is referred to a tertiary care, where she underwent an upper endoscopy (UE) after 28 hours of the CI. The report of the UE, said caustic esophagitis grade IIc, severe gastropathy, and pylorus not passable with concentric lesions. The managemen included fasting, intravenous fluids, steroids, penicillin, and ranitidine Discussion: . The UE, is the most efficient method to evaluate the upper gastrointestinal mucosa after the IC, which can have catastrophic effects and can be harmless. It has tried to correlate the signs and symptoms with the severity of injuries to avoid making an unnecessary UE, however, this issue remains controversial. The medical management of IC including antibiotics, steroids and H2 blockers. Complications of the IC are perforation, mediastinitis, fistulas to large vessels, penetrationto the stomach and stenosis.

Esofagitis eosinofílica: una entidad emergente / Eosinophilic Esophagitis: an emerging entity

La esofagitis eosinofílica (EE) es una enfermedad primaria del esófago, previamente confundida con el reflujo gastroesofágico (RGE), cuyo conocimiento se ha desarrollado principalmente en la última década. Se define como la presencia de síntomas de disfunción esofágica (principalmente disfagia e impactación alimentaria), asociados a por lo menos una biopsia esofágica con más de 15 eosinófilos por campo de mayor aumento (CMA), y la exclusión de RGE. Su prevalencia va en aumento y afecta principalmente a niños y hombres jóvenes de raza blanca con historia previa de atopía. La EE sería causada por una reacción alérgica a ciertos alimentos y/o aeroalérgenos mediada por citoquinas y con cambios genéticos involucrados. La presentación clínica varía con la edad siendo la disfagia el síntoma más frecuente en todos los grupos etarios. El diagnóstico es clínico, endoscópico y anatomopatológico. Se requiere de una endoscopía digestiva alta (EDA) para evaluar hallazgos característicos y tomar biopsias para el estudio histológico. Los tratamientos actuales incluyen medidas dietéticas basadas en la eliminación de la exposición de alérgenos alimentarios y uso de corticoesteroides tópicos. El objetivo de esta revisión es analizar el estado actual de la definición de EE, historia, epidemiología, fisiopatología, diagnóstico y principalmente ayudara mejorar su sospecha diagnóstica y manejo.

Eosinophilic esophagitis (EE) is a primary disease of the esophagus, previously mistaken with gastroesophageal reflux disease (GERD). Its knowledge has developed over the last decade. EE is defined as the presence ofesophageal dysfunction symptoms (mostly dysphagia and food impaction) associated to at least 1 esophageal biopsy with 15 or more eosinophils in 1 high-power field and absence of GERD. Its prevalence is rising, affecting principally white boys and young males with previous history of atopy. EE would be caused by an allergic reaction to certain food and aeroallergens mediated by citoquines with genetic changes involved. Clinical presentation varies with age being dysphagia the most common symptom in all age goups. The diagnosis is clinical, endoscopic and histopathologic. It requires an endoscopy to evaluate mucosal findings and to take the biopsies. Treatment includes elimination diets and topical steroids. The purpose of this review is to analyze the current state of the definition, history, epidemiology, fisiopathology and the diagnosis of EE, with an emphasis on improving its suspicion index and initial management.