Hernia hiatal gigante: reporte de un caso / Giant hiatal hernia: a case report

La hernia de hiato es una situación patológica que se da cuando parte del estómago se introduce hacia el tórax. El esófago entra en el abdomen desde el tórax a través de un agujero o hiato que se encuentra en el diafragma. El estómago protruye a través de este hiato debilitado y produce ardores (pirosis) y dolor torácico. La persistencia en el tiempo de esta hernia, puede provocar una metaplasia de la mucosa esofágica dando al lugar al esófago de Barret el cual puede malignizar produciéndose cáncer de esófago. (1) La hernia de hiato es relativamente frecuente, afectando hasta un 20 por ciento de la población. Del total de pacientes con el trastorno, cerca del 10 por ciento son asintomáticos, dependiendo del grado de protrución estomacal y de que tanto esté afectado el esfinter esofágico inferior (EEI). Un 40 por ciento de las hernias de hiato son hernias deslizantes, en las que el EEI protruye conjuntamente con una porción del estómago y solo un 5 por ciento son paraesofágicas, en la que solo una porción del estómago se hace intratorácica mientras tanto que el EEI permanece intraabdominal. Los síntomas más comunes de una hernia de hiato incluyen pirosis, dolor torácico, disfagia, palpitaciones y ocasionalmente regurgitación o reflujo gastroesofágico. El diagnóstico de una hernia hiatal comienza con el éxamen físico por razón de la sintomatología. Los estudios radiográficos y la endoscopia digestiva demuestran la hernia hiatal y ayudan a descartar otras causas de molestias digestivas altas. (2) Se recomienda un procedimiento quirúrgico conocida como fundoplicación de Nissen, (3) Cuando los síntomas causados por una hernia de hiato son tan severas que pueden resultar en lesiones al esófago o incluso cáncer del esófago. (6) Se trata de lactante mayor de seis meses de edad quien es natural de la localidad y procedente de Cordero, quien inicia enfermedad actual el día de hoy en la madrugada según refiere la madre, caracterizado por vómitos en número incontables.

Tratamiento de la infección por helicobacter pylori en pacientes con úlcera duodenal: estudio de costo beneficio / Treatment of helicobacter pylori infection in patients with duodenal ulcer: a cost benefit study

Background: Epidemiological differences suggest that treatments for H. pylori eradication should be locally validated. Aim: To perform a cost benefit study of different treatment options for H. pylori infection. Patients and methods: One hundred and sixty-seven patients with active duodenal ulcer and H. pylori infection who completed a 2-week treatment with one of the following regimens were included: famotidine plus amoxycillin plus metronidazole (FAM), omeprazole plus amoxycillin plus tinidazole (OAT) or lansoprazole plus clarithromycin plus amoxycillin in 3 (LAC1) or 2 (LAC2) daily doses. We compared efficacy, adverse effects and cost. Results: Eradication rate was 74.6, 72.9, 96.4 y 91.7 percent for FAM, OAT, LAC1 and LAC2 respectively (p<0.05). Direct cost ranged from US$ 50 for FAM to US$ 220 for LAC1. A decision analysis was carried out in a model including direct and indirect costs and considering retreatment with antibiotics after the first treatment failure and one-year treatment with H2-blockers in case of a second failure. FAM was selected as the most cost-effective option, with an estimated cost of about US$ 300 ñ 148 per patient. However, cost associated to LAC2 was very similar (US$ 320 ñ 58) and the lower standard deviation suggests less variation. Sensitivity analyses, considering reasonable fluctuation in parameters such as eradication rate, cost and follow-up period suggest that a regimen containing a proton pump inhibitor, clarithromycin and amoxycillin may be the most cost-effective treatment. Conclusions: These results should be confirmed in other settings, specially in ordinary clinical practice, far from clinical research

Simple closure of perforated duodenal ulcer.

A study was undertaken to evaluate the efficacy of simple closure followed by drug therapy in cases of perforated duodenal ulcer and to identify the risk factors in relation to the mortality. The male to female ratio was 5:1. Of the patients 59.2% were up to 50 years of age, while 40.8% were above the age of 50 years. Of the patients 47% were admitted 24 hours after the onset of peritonitis. All these patients were surgically treated with simple closure of the perforation with omental patch. Nine patients expired leading to 7.5% mortality. The risk factors identified for mortality were age 60 years and above, presence of shock on admission and delayed presentation. The mortality is directly related to the number of risk factors present in a given patient. At the time of discharge the patients were advised to take orally famotidine 40 mg at bed time for a period of 8 weeks. Eighty-one patients could be followed up and Visick grading was done. Sixty-two patients were in grade I, 11 in grade II, 3 in grade III and 5 in grade IV. The results indicate that simple closure followed by drug therapy is acceptable treatment for perforated duodenal ulcer.

Estudio en doble ciego con famotidina: pH y volumen gástrico / Study in double blind with famotidine: pH and gastric volume

Estudio prospectivo, aleatorio y en doble ciego. Noventa pacientes sometidos a cirugía abdominal recibieron preoperatoriamente 20 mg de famotidina intravenosa o un placebo. Se midió el pH y volumen gástrico postintubación traqueal (T1), al momento del vaciamiento total del estómago (T2) y antes de la extubación (T3). El pH gástrico fue significativamente superior en el grupo de pacientes que recibió famotidina en los tres tiempos de medición. El volumen gástrico fue significativamente inferior en el grupo con famotidina en el tiempo 1, no habiendo diferencia entre los dos grupos en los tiempos 2 y 3. La población "en riesgo" (pH < 3 y volumen > 25 ml) fue significativamente inferior en el grupo que recibió famotidina en los tres tiempos de medición

Efeitos dos bloqueadores H2 sobre o espraiamento de macrófagos in vitro / Effects of H2 blockers on the spreading of macrophages in vitro

Verificar se a cimetifdina, ranitidina e a famotidina, quando injetadas por via ip em camundongo, promovem ativaçäo macrofágica e se esta é alterada com o uso prévio de tioglicolato sódico. Tipo de estudo - Experimental. Animais - Camundongos isogênicos, Balb/c, 19-21g. Intervençiao - Utilizados oito grupos com 10 animais cada. Os animais foram tratados, por via ip, com cimetidina (100mg/Kg), ranitidina (62,5mg/Kg) e famotidina (50mg/Kg), sendo comparados com um grupo controle (salina). Vinte e quatro horas após a inoculaçäo, foi aplicada a técnica do espraiamento de macrófagos. Em etapa posterior, o mesmo procedimento foi realizado, porém em grupos tratados previamente com tioglicolato sódico (15mg/Kg). Análise estatística - Através dos testes de KrusKal-Wallis e Mann-Whitney. Resultados e conclusäo - A inoculaçäo dos anti-H2 em cavidade peritoneal de camundongos aumenta significantemente o espraiamento macrofágico, independentemente do uso prévio de um irritante peritoneal

Famotidina en el tratamiento agudo y de mantenimiento de úlcera duodenal / Famotidina in the acute and the support treatment for duodenal ulcer

16 pacientes entre 46 y 78 años, nueve varones y siete mujeres, fueron tratados con 20mg. de Famotidina, como dosis de mantenimiento, durante un año, todos ellos previamente curados en el lapso de ocho semanas con la dosis habitual (40mg.) y antiácidos, de lesiones agudas duodenales. En todos los casos, curaron sus lesiones primigenias en ocho semanas (cuatro en cuatro semanas). Todos completaron el tratamiento por un año. Catorce de ellos llegaron al año sin lesiones. Uno con erosión gástrica. Uno mantuvo durante todo el tratamiento una duodenitis superficial asintomática. Cuatro pacientes hicieron recidivas ulcerosas intratamiento que curaron sin alterar el mismo. Los sintomas mas frecuentes que permanecieron en el tiempo: Cefalea y flatulencia. De los 16 pacientes 14 terminaron curados, dos con lesiones gástricas, uno con duodenitis no resuelta durante todo el tratamiento (asintomático) y cuatro hicieron recidivas intratamiento

A single nocturnal dose of famotidine for the treatment of duodenal ulcer: evaluation of efficacy and safety.

The efficacy and safety of a single nocturnal dose of famotidine (40 mg) was evaluated in 30 consecutive patients of duodenal ulcer (DU). Three patients were lost for follow-up and therefore were excluded. The mean age of remaining 27 patients was 34.3 (+/- 9.9) years and male to female ratio was 8:1. The mean size of the DU was 1.21 (+/- 0.79) cm. After a 4-week therapy all patients showed significant improvement and repeat endoscopy in 24 out of 27 patients (89%, 95% confidence interval; 78% to 100%) showed healed ulcer. Clinical assessment of pain relief at 4-week showed significant drop in the mean score of baseline daytime (from 1.85 to 0.13) and baseline nocturnal pain (from 1.70 to 0.10) (p less than 0.0001 and less than 0.0001, respectively). Also shown was the significant decrease in the mean gastrointestinal symptoms score from 5.89 at baseline to only 0.89 at 4-week (p less than 0.0001). Despite that all those who failed to show ulcer healing at 4-week were smokers, logistic regression analysis could not identify smoking or any other risk factors as adverse predictors of ulcer healing. None of the patients experienced significant side effects or adverse reactions. We conclude, that a single nocturnal dose of famotidine is a practical, highly effective and safe approach for the management of DU.

Famotidine in acute duoendal ulcer

This is a 8 week open study in which the effect and tolerance of Famotidine, in a dose of 40 mg nocte was tried for the treatment of duodenal ulcer in 22 patients. Assessment was made clinically, biochemically and endoscopically. The healing rate at the end of 8 weeks was 95.45%. The drug was well tolerated with no significant side effect. In conclusion, Famotidine is an effective and safe Duodenal ulcer healing drug, which is well tolerated and has minimal side effects

Double-blind comparison of the safety and efficacy of famotidine with ranitidine in patients with endoscopically diagnosed peptic ulcer.

In a double-blind randomised trial, 40 patients with active gastric or duodenal ulcer were treated with a single nocturnal dose of famotidine 40 mg or ranitidine 300 mg for 4 to 8 weeks. Antacid tablets were allowed as additional treatment, only if needed, for pain relief. Endoscopy was repeated after 4 weeks, and if the ulcer had not healed at 6 and/or 8 weeks. Relief of upper gastro intestinal symptoms with which the patient presented and the number of antacid tablets consumed, if any, were recorded on weekly basis. Two patients in famotidine group and 5 patients in ranitidine group did not complete the therapy and were considered dropouts. At the end of therapy, ulcers in 100% of the patients receiving famotidine & 93% of patients receiving ranitidine were healed. This difference was not statistically significant. Relief from ulcer related symptoms was rapid in both the groups. None of the patients in either group reported side effects. Overall opinion of investigator was comparable for both the treatments; however, significantly (P = 0.0334) larger proportion (100%) of patients from famotidine group rated it as an excellent therapy compared to only 73% from ranitidine group. Famotidine provides excellent healing of ulcers and early relief of upper gastrointestinal symptoms in Indian patients with peptic ulcer.

Ulcera peptica: los nuevos farmacos son opciones terapeuticas ventajosas? / Peptic ulcer: are new drugs advantageous therapeutic options?

Se hace una revision de aspectos farmacologicos de antiacidos y antagonistas H2 en el tratamiento de la ulcera duodenal, se establecen diferencias, entre los farmacos del ultimo grupo, en relacion a sus ventajas terapeuticas y efectos colaterales, se establece por ultimo el costo de un curso de tratamiento de 8 semanas con Ranitidina y Famotidina, dandose enfasis a la relacion costo/beneficio