Avaliação dos danos do DNA na mucosa esofágica e sangue periférico de portadores da doença do refluxo gastroesofágico / Evaluation of DNA damage in the esophageal mucosa and peripheral blood of patients with gastroesophageal reflux disease

RACIONAL: A doença do refluxo gastroesofágico é a afecção digestiva de maior prevalência. Os portadores podem apresentar na evolução algumas complicações, sendo o esôfago de Barrett a de maior importância, tendo em vista seu potencial de malignidade. Todavia os processos inflamatórios do trato gastrointestinal podem apresentar degeneração maligna. OBJETIVOS: Avaliar os possíveis danos do DNA em portadores de esofagite de refluxo gastroesofágico de vários graus e verificar a aplicação do ensaio Cometa na detecção dos mesmos. MÉTODOS: Foram estudados 25 pacientes distribuídos em quatro grupos: controle (n=5), esofagite leve (n=8), esofagite severa (n=5) e câncer (n=7). O ensaio Cometa foi realizado no sangue periférico (linfócitos) e biópsia do terço distal do esôfago. RESULTADOS: O ensaio Cometa detectou danos no DNA nos pacientes com esofagite leve e severa (sangue periférico e biópsia), sendo que na esofagite severa a intensidade dos danos foi maior (p<0,05). Os danos do DNA dos pacientes com esofagite severa e câncer não mostraram diferença significativa e a intensidade dos mesmos corresponde ao ensaio Cometa classe 4 (maior que 95 por cento de danos). CONCLUSÕES: 1) As frequências de quebras do DNA da mucosa esofágica e linfócitos estão diretamente relacionadas ao grau de inflamação; 2) a esofagite severa apresenta praticamente a mesma frequência de danos no DNA do câncer esofágico; 3) o ensaio Cometa mostrou-se muito sensível para a detecção dos danos do DNA.

BACKGROUND: The gastroesophageal reflux disease is the most prevalent digestive disorder. Patients with it may present some complications during its development, and Barrett's esophagus is the most important in view of its potential malignancy. However, the inflammatory processes of the gastrointestinal tract may show malignant degeneration. AIM: To assess possible DNA damage in patients with gastroesophageal reflux esophagitis of various degrees and to evaluate the application of the Comet assay in its detection. METHODS: Twenty-five patients were studied. They were divided into four groups: control (n=5), mild esophagitis (n=8), severe esophagitis (n=5) and cancer (n=7). The Comet assay was performed on peripheral blood cells (lymphocytes) and biopsy of the distal esophagus. RESULTS: The Comet assay detected DNA damage in patients with mild and severe esophagitis (peripheral blood and biopsy), and damage intensity was greater in severe esophagitis (p<0,05). DNA damage in patients with severe esophagitis and cancer did not show significant difference, and its intensity corresponds to class-4 Comet assay (greater than 95 percent of damage). CONCLUSIONS: 1) The frequencies of DNA breakage in the esophageal mucosa and lymphocytes are directly related to inflammation level; 2) severe esophagitis shows virtually the same DNA damage frequency as that of esophageal cancer; 3) the Comet assay showed to be very sensitive for DNA damage detection.

Modificaciones estructurales en el estómago y el hígado de Paralabrax maculatofasciatus (Steindacher, 1868) ante situaciones de estrés crónico / Structural modifications in the stomach and liver of Paralabrax maculatofasciatus (Steindacher, 1868) under chronic stress conditions

Para determinar el efecto del estrés a nivel del aparato digestivo, organismos de la especie Paralabrax maculatofasciatus fueron sometidos a dos modelos de estrés: el primero por descenso en el nivel del agua (n=84) por 30 y 60 minutos diariamente, y el segundo por cultivo a altas densidades (n=96) de 1,6 y 3,2 kg/100 1. Se tomaron muestras de estómago e hígado y se fijaron en formol al 10%. Los tejidos fueron incluidos en parafina, realizándose cortes de 6 um que se tiñeron con H-E. En ambas condiciones de estrés el estómago presentó cambios morfológicos importantes tales como hipertrofia y atrofia en la capa mucosa. En el hígado se observaron cambios de coloración y textura, así como hemolisis, inflamación y necrosis. Por descenso en el nivel del agua el estómago presentó diferencias morfométricas significativas (P<0,05), entre los diferentes tiempos de exposición al estrés y/o entre los días de muestreo en algunos de los parámetros medidos. Por cultivo a altas densidades, se observaron diferencias significativas en algunos parámetros, 4 de ellos presentaron interacción densidad-muestreo y el resto presentaron diferencias significativas sin interacción. El hígado presentó diferencias significativas (P<0,05) en el perímetro nuclear entre los diferentes días de muestreo. El estrés provocado por alta densidad de cultivo resultó ser el factor que provocó daños tisulares más severos en los órganos estudiados, de ahí la importancia de mantener las condiciones adecuadas en los cultivos, como son el nivel de agua y el número de organismos por estanque.

To determine stress effects at histological level in the digestive system, organisms of Paralabrax maculatofasciatus were submitted to 2 stress models. One of decreasing the water level (n=84) for 30 and 60 min daily, and another at high density cultures (n=96) of 1.6 and 3.2 Kg/1001. Stomach and the liver samples were fixed in 10% formalin, embedded in paraffin wax, sectioned at 6 urn and stained with haematoxylin-eosin. In both stress conditions, the stomach showed important morphological changes in the mucosa layer, such as hypertrophy and atrophy. In the liver, coloration and texture changes were observed as well as haemolisis, inflammation and necrosis. In the water decrease model, the mucosa layer of stomach showed significant morphometric differences (P<0.05), between different times of stress exposure and/or between different days, in some of the measured parameters. In the high-density model, significant differences in the stomach mucosa showed a sampling-density interaction in 4 parameters and 6 other parameters showed differences with no interaction. Liver showed significant differences in nuclear perimeter between sampling-days. Stress caused by high-density culture proved to be the factor that caused the most serious tissue damage.

Immunological non invasive blood tests to evaluate gastric mucosa in Iraqi dyspeptic patients

Dyspepsia is a common symptom in general practitioner. Using non invasive serological biomarkers would help to identify individuals at increased risk of atrophic gastritis and gastric cancer. In present study, the evaluation of the utility of a serological gastric panel test combining pepsinogen I [PGI], pepsinogen II [PGII], pepsinogenl/pepsinogenll ratio [I/II], gastrin-17 [G-17] [basal and stimulated] and Helicobacter pylori [HP] IgG antibodies as a screening method and to predict the state of gastric mucosa: non atrophic, atrophic gastritis and its sequel of developing gastric carcinoma and intestinal metaplasia. Prediction of gastric mucosa using non invasive immunological blood tests from dyspeptic patients. The serological gastro panel test was evaluated in [54] Iraqi dyspeptic patients divided into two groups: [HP+] and [HP-]. Levels of PGI, PGll, PGI/PGII ratio, G-l 7 basal and stimulated and HP IgG antibodies were determined through a specific immunological non invasive Enzyme Linked Immuno Sorbent Assay [ELISA] test from Biohit PlC, Helsinki, Finland. Using fasting and postprandial samples from those patients. 60% of dyspeptic patients complain from epigastric pain and 62.96% of them had HP+. There were significant increase in PGI, PGII [p<0.05] in NAG. ln case of I/II ratio, there was no significant difference between two groups of HP+ and HP-. The other parameter was done is basal 0-17 which is significantly increased in HP+ [p>0.05] and postprandial G-l7 showed no significant difference between two groups. Most of those Iraqi dyspeptic patients had non atrophic gastritis due to Helicobacter pylori infection that leads to increased in the PGI, PGII, G-17 through many mechanisms. If HP not treated properly this may leads to atrophic gastritis, peptic ulcer and gastric carcinoma. Gastric panel test was considered as a non endoscope immunological blood test in the diagnosis of atrophic gastritis and its outcome in dyspeptic patients

Acid-base disarrangement and gastric intramucosal acidosis predict outcome from major trauma / Desarranjo ácido-base e acidose gástrica intramucosal predizem desfecho de trauma grave

INTRODUCTION: This prospective non-interventional study intended to assess the prognostic value of gastric intramucosal acidosis in patients with severe trauma admitted to a medical/surgical ICU. METHODS: Gastric tonometer catheters were introduced to measure air PCO2 level (Tonocap device) in forty consecutive critically ill trauma patients. Gastric intramucosal pH, air PCO2 gradient, lactate and acid-base parameters were measured at admission and at 6, 12 and 24 h thereafter. RESULTS: The median age, mean APACHE II and SOFA scores were higher in nonsurvivors than in survivors (p<0.05). There were significant differences in the PCO2 gradient between survivors and nonsurvivors at 12 and 24 hours (10±7 vs. 24±19 mmHg, 13±16 vs. 29±25 mmHg; p<0.05). Gastric intramucosal pH values were lower in nonsurvivors than in survivors, on admission and after 12 or 24 hours (p<0.05). Arterial pH and bicarbonate were lower, lactate concentration higher, and base excess more negative in nonsurvivors. Prediction of outcome (mortality and MODS) at 24 hours of ICU assessed by their ROC curves was similar (p=NS). At 24 hours, air PCO2 gradient > 18 mmHg carried a relative risk of 4.6 for death, slightly higher than a HCO3 <20 mEq/L (RR=4.29) or base excess of <-2 mmol/L (RR=3.65). CONCLUSION: Bicarbonate, base deficit, lactate, gastric intramucosal pH and PCO2 gradient discriminate survivors from nonsurvivors of major trauma. A critical air PCO2 gradient carried the greatest relative risk for death at 24 hours of ICU. Inadequate regional blood flow as detected by a critical PCO2 gradient seems to contribute to morbidity and mortality of severe trauma patients.

INTRODUÇÃO: O objetivo deste estudo prospectivo, não-intervencionista, foi avaliar o valor prognóstico da acidose gástrica intramucosal em pacientes com trauma grave admitidos numa UTI. MÉTODOS: Cateteres tonométricos gástricos foram introduzidos para medir o nível de PCO2 aéreo em 40 pacientes traumatizados. O pH gástrico intramucosal, o gradiente de PCO2 aéreo, o lactato e os parâmetros ácido-base foram medidos na admissão e 6, 12 e 24 h após a admissão. RESULTADOS: A idade mediana, o APACHE II e os escores SOFA médios foram maiores nos não-sobreviventes que nos sobreviventes (p<0.05). Não houve diferenças significativas para o gradiente de PCO2 entre sobreviventes e não-sobreviventes após 12 e 24 horas (10±7 vs. 24±19 mmHg, 13±16 vs. 29±25 mmHg; P<0.05). Os valores de pH gástrico intramucosal foram menores nos não-sobreviventes que nos sobreviventes na admissão e após 12 ou 24 horas (P<0.05). O pH arterial e o bicarbonato foram menores, a concentração de lactato maior, o excesso de base mais negativo nos não-sobreviventes. Predição do desfecho (mortalidade e FMOS) nas 24 horas de UTI acessada pelas curvas ROC foi similar (p=NS). Nas 24 horas, um gradiente de PCO2 aéreo >18 mmHg acarretou um risco relativo de 4.6 para óbito, um pouco maior que um HCO3 <20 mEq/L (RR=4.29) ou um excesso de base <-2 mmol/L (RR=3.65). CONCLUSÃO: Bicarbonato, déficit de base, lactato, pH gástrico intramucosal e o gradiente de PCO2 discriminaram os sobreviventes dos não-sobreviventes de trauma. Um gradiente crítico de PCO2 aéreo acarretou o maior risco relativo para óbito após 24 horas de UTI. Fluxo sangüíneo regional inadequado detectado por um gradiente crítico de PCO2 parece contribuir para a morbidade e mortalidade de pacientes traumatizados graves.

Study of the correlation between; nitric oxide profile, degree of liver injury and structural vascular changes of the gastric mucosa in chronic hepatitis C virus related liver diseases

Nitric oxide [NO] plays an important role in HCV associated hepatic dysfunction and in the pathogenesis of portal hypertension. This study was designed to correlate serum nitrite and nitrate levels with the degree of liver injury and gastric mucosal changes in HCV patients at different stages of the disease. 80 HCV infected patients were classified equally into 4 groups; chronic hepatitis C, Child A, B and C cirrhosis groups. 20 healthy subjects were allocated as a control group. For all patients, serum nitrite and nitrate levels, HCV RNA and liver test profile were evaluated. Liver biopsies for chronic hepatitis C and Child-A cirrhotic patients were obtained for grading, staging and expression of interferon gamma [INF- gamma] and pentosidine. Esophagogastrodudenoscopy to evaluate the degree of portal hypertensive gastropathy [PHG] and expression of vascular endothelial growth [VEGF] by histopathology. Serum NO profile was significantly higher in all HCV infected patients than healthy subjects. A significant correlation between IFN-gamma expression and both of serum NO and viral load. Also, hepatic pentosidine expression was correlating with staging and fibrosis. Also both of serum NO and gastric VEGF were over expressed and correlating with the degree of PHG. In HCV infected patients, serum NO was significantly overexpressed and correlating with the severity of chronic liver disease. Our study supports the role of direct viral cytopathic effect in HCV patients because of the significant correlation of viral load with both of serum NO and hepatic IFN-gamma expression. Pentosidine might be considered a marker of oxidative stress and fibrosis in chronic HCV liver disease

Resultados inmediatos y tardíos de la miotomía de Heller laparoscópica en pacientes con acalasia esofágica / Laparoscopic Heller myotomy for esophageal achalasia

Background: Achalasia is characterized by an incomplete relaxation of the lower esophageal sphincter. The best treatment is surgical and the laparoscopic approach may have good results. Aim: To assess the results of laparoscopic Heller myotomy among patients with achalasia. Material and methods: Prospective study of patients subjected to a laparoscopic Heller myotomy between 1995 and 2004. Clinical features, early and late operative results were assessed. Results: Twenty seven patients aged 12 to 74 years (12 females) were operated. All had disphagia lasting for a mean of 32 months. Mean lower esophageal sphincter pressure ranged from 18 to 85 mmHg. Eight patients received other treatments prior to surgery but symptoms persisted or reappeared. The preoperative clinical score was 7. No patient died and no procedure had to be converted to open surgery. In a follow up of 21 to 131 months, all patients are satisfied with the surgical results and the postoperative clinical score is 1. Only one patient with a mega esophagus maintained a clinical score of six. Conclusions: In this series of patients, laparoscopic Heller myotomy was an effective and safe treatment for esophageal achalasia.

Experimental model in the qualitative and quantitative assessment of non-Helicobacter gastric microflora under proton pump inhibitors action / Modelo experimental na avaliação qualitativa e quantitativa da microflora gástrica não-Helicobacter sob ação de inibidores de bomba de próton

PURPOSE: To evaluate models of gastric material collection from Wistar rats with and without using proton pump inhibitors(PPIs). METHODS: Twenty-four rats underwent intraperitoneal omeprazol treatment, and other 12 received similar treatment with 0.9 percent saline. All animals underwent collection of gastric material samples, after stomach removal, by either biopsies, or aspirates, or swabs. Samples were bacteriologically processed in order to identify species and strains. Values are described as natural logarithm of colony former units per mL [Ln(CFU/mL)]. Kruskal-Wallis and Mann-Whitney non-parametric tests were used, and p<0.05 was set as statistically significant. RESULTS: Significant difference was not seen for Ln (UFC/mL) values among the three methods of collection irrespective of using or not omeprazol. Also, significant difference was not seen in Ln (UFC/mL) values when comparing a method with each others, either using omeprazol or placebo. A significant increase of bacteria strains occurred when PPI was used, and this was seen on the three ways of collection, mainly in biopsy and swab. CONCLUSION: No difference occurred among the three methods of collecting bacteria samples from stomachs of rats, either when using placebo or omeprazol. A remarkable change is seen on animals bacterial microflora when PPIs are used, and bacteria are better identified when swab and biopsy are used.

OBJETIVO: Avaliar modelos de coleta de material gástrico de ratos da linhagem Wistar, com e sem o uso de inibidores de bomba de próton (IBPs). MÉTODOS: 24 ratos foram submetidos a tratamento com omeprazol intraperitoneal e 12 outros ratos receberam tratamento semelhante com solução salina a 0,9 por cento. Os animais foram submetidos a coleta de amostras de material gástrico, após retirada do estômago, utilizando-se de biópsias, aspirados ou swabs. Os materiais obtidos foram processados bacteriologicamente para identificação de espécimes quanto ao gênero. Os valores são descritos em logaritmo natural das unidades formadoras de colônias por mL [Ln(UFC/mL)]. Utilizou-se os testes não-paramétricos de Kruskal-Wallis e Mann-Whitney, considerando-se p<0,05 como estatisticamente significativo. RESULTADOS: Não se observou diferença significativa da quantidade de Ln(UFC/mL) entre os três métodos de coleta, independente do uso de omeprazol. Também não se observou diferença significativa de Ln(UFC/mL) ao comparar-se os métodos individualmente entre si nas condições de uso de omeprazol ou placebo. Houve aumento significativo da variedade de gêneros de bactérias com o uso de IBP, nos 3 métodos de coleta, sendo isto mais perceptível na biópsia e swab. CONCLUSÃO: Não houve diferença entre os três métodos de coleta de amostras bacterianas de estômago de ratos, tanto em uso de placebo quanto em uso de omeprazol. Nota-se uma mudança evidente da microflora bacteriana nos animais em uso de IBPs, sendo melhor identificado pelos métodos de swab e biópsia.

Effect of partial sleep deprivation on gastric functions in rats

Sleep deprivation has been associated with metabolic abnormalities, host defense failure and a variety of health problems including gastric discomforts. However, the effects of partial sleep deprivation on gastric functions have not been clearly elucidated. The present study aimed to investigate the effects of partial sleep deprivation for 2 weeks on gastric acid secretion, gastric mucosal integrity and gastric motility in rats. A specific apparatus was designed to induce sleep deprivation in our lab through random lighting of 4 lamps and ringing of a bell. Partial sleep deprivation was continued for 12 hours daily for 2 weeks. 80 male rats were used in this study, 40 as control and the other 40 were subjected to sleep deprivation. Control and partially sleep deprived rats were classified into 5 groups: in the 1[st] group, gastric contents were collected 3 hours after pyloric ligation and titrated for measurement of gastric free and total acid secretion. In the 2[nd] group, gastric mucosa was examined for detection of ulcers and calculation of mean ulcer index. In the 3[rd] group, calculation of ulcer index was done following oral administration of aspirin. In the 4[th] group, basal gastric content was determined and in the 5[th] group, gastric content after 4 hours fasting was determined and the values obtained were used to calculate percentage of food emptied through the 4 hours fasting period to the basal gastric content. Partial sleep deprivation significantly increased gastric acid secretion, induced the formation of gastric ulcers and increased ulcer index following aspirin administration. Sleep deprivation also inhibited gastric motility and emptying when compared to sleep undisturbed control group. Our results suggest that partial sleep deprivation could impair gastric functions especially gastric motility which has not been previously clarified

Epithelial effects of proteinase-activated receptors in the gastrointestinal tract

The intestinal epithelium plays a crucial role in providing a barrier between the external environment and the internal milieu of the body. A compromised mucosal barrier is characteristic of mucosal inflammation and is a key determinant of the development of intestinal diseases such as Crohn's disease and ulcerative colitis. The intestinal epithelium is regularly exposed to serine proteinases and this exposure is enhanced in numerous disease states. Thus, it is important to understand how proteinase-activated receptors (PARs), which are activated by serine proteinases, can affect intestinal epithelial function. This review surveys the data which demonstrate the wide distribution of PARs, particularly PAR-1 and PAR-2, in the gastrointestinal tract and accessory organs, focusing on the epithelium and those cells which communicate with the epithelium to affect its function. PARs have a role in regulating secretion by epithelia of the salivary glands, stomach, pancreas and intestine. In addition, PARs located on subepithelial nerves, fibroblasts and mast cells have important implications for epithelial function. Recent data outline the importance of the cellular site of PAR expression, as PARs expressed on epithelia may have effects that are countered by PARs expressed on other cell types. Finally, PARs and their ability to promote epithelial cell proliferation are discussed in terms of colon cancer.

Efeitos sistêmicos e regionais da hemodiluição isovolêmica aguda moderada e intensa / Systemic and regional effects of moderate and severe acute normovolemic hemodilution

A hemodiluição isovolêmica (HD) aguda visa minimizar os efeitos colaterais de transfusões de sangue. As células da mucosa intestinal são vulneráveis à isquemia. Foi avaliada a hipótese de que durante a HD moderada (HDM) e intensa (HDI), os parâmetros hemodinâmicos não refletem a isquêmia da mucosa gástrica. Foram utilizados 21 cães. A HD foi feita com Hetastarch 6 por cento(1:1). Foi observada diminuição do hematócrito arterial nos grupos HDM e HDI. A PAM não alterou nos 3 grupos e o DC aumentou após a HD. O PCO2-gap diminuiu apenas no grupo HDI. Pode-se concluir que tanto a HDM como a HDI tem estabilidade hemodinâmica e os parâmetros hemodinâmicos não retratam a isquêmia da mucosa gástrica / Acute normovolemic hemodilution (HD) is used to decrease side effects of blood transfusions. Intestinal mucosal cells are vulnerable to ischemia. We tested the hypothesis that during moderate (MHD) and severe (SHD) hemodilution, hemodynamic parameters do not reflect the ischemia of gastric mucosal. 21 mongrel dogs were utilized. The HD was done with 6 ppwwer cent Hetastarch (1:1). We observed a fall of the arterial hematocrit in MHD and SHD. The MAP did not change in the 3 groups and the CO elevated after the HD. The PCO2-gap rose only in the SHD group. We concluded that both MHD and SHD have hemodynamic stability and the hemodynamic parameters do not reflect ischemia of the gastric mucosal...

Cirugía anti-reflujo laparoscópica para el tratamiento de la enfermedad por reflujo gastro-esofágico: experiencia en 125 casos / Laparoscopic anti-reflux surgery for the treatment of disease gastroesophageal reflux: experience in 125 cases

Evaluar la cirugía anti-reflujo laparoscòpica para el tratamiento de la enfermedad por reflujo gastro-esofágico. Se realizaron 125 operaciones anti-reflujo en igual número de pacientes, 62 (49,6 por ciento correspondieron al sexo masculino y 63 (50,4 por ciento) al sexo femenino. Edad promedio de 46,63 años ± 7,25 años. Los síntomas más frecuentes fueron pirosis (98,4 por ciento) y regurgitación (97,6 por ciento). La mayoría de los pacientes 85 (68 por ciento), tenían 10 años o más de tratamiento médico. Se realizó la operación de Nissen modificada "Floppy Nissen" en 76 pacientes (60,8 por ciento), en 23 pacientes (18,4 por ciento) se realizó la técnica de Toupet y en 4 pacientes (3,2 por ciento) la técnica de Dor. Las patologías asociadas (29 en total) estuvieron presentes en 28 pacientes (22,4 por ciento). Todas estas patologías fueron resueltas en el mismo acto operatorio. Las complicaciones fueron leves en su mayoría (infecciones locales, seromas, etc). Hubo una perforación de la unión gastro-esofágica que ameritó conversión. Un paciente (0,8 por ciento), ameritó reintervención por disfagia severa. No hubo mortalidad post-operatoria. Centro Médico "Dr. Rafael Guerra Méndez", Valencia-Venezuela. Tasa de éxito del 91,2 por ciento para la desaparición de los síntomas. La cirugía anti-reflujo es el método más eficaz para el tratameito de la enfermedad por reflujo gastro-esofágico de curso progresivo y con respuesta deficiente al tratamiento médico. Es necesario establecer con exactitud el defecto funcional del esófago a fin de seleccionar la técnica más adecuada. La estancia hospitalaria, los costos, la morbilidad y la mortalidad se reducen con el abordaje laparoscópico.

Heterotopia de mucosa gástrica associada à heterotopia pancreática em esôfago cervical: relato de caso e revisão da literatura / Associated gastric and pancreatic heterotopia in the cervicl esophagus: case report and literature review

A mucosa gástrica heterotópica no esôfago cervical é relativamente freqüente, assim como a heterotopia pancreática na junção esofagogástrica. A ocorrência de heterotopia pancreática no esôfago superior e sua associação com heterotopia gástrica é extremamente rara. Há 12 casos relatados de heterotopia pancreática no esôfago cervical e apenas dois casos de associação entre heterotopia pancreática e gástrica. Apresenta-se um caso dessa associação em um homem branco de 55 anos de idade, com queixas de disfagia e pirose

Helicobacter pylori en la patología gastroduodenal / Helicobacter pylori in the gastroduodenal pathology

Actualmente se acepta que helicobacter pylori, inicialmete denominado campylobacter pyloides, es la causa fundamental de gastritis crónica activa, y está presente en la mucosa gástrica de la totalidad de pacientes con la úlcera duodenal, aunque no se ha demostrado una relación casual directa con la enfermedad ulcerosa péptica. La asociación entre gastritis antral y ulcera duodenal, es un hecho conocido desde hace muchos años, y puede afirmarse que en todos los pacientes con este tipo de úlcera existe una inflamación de la mucosa gástrica, fundamentalmente a nivel del antro, de ahi que existen una serie de datos que apoyan el papel patogénico directo de helicobacter pylori en la gastritis crónica activa, entre lo que se destaca la estrecha relación entre la infección y la presencia de un infiltrado gastritis, pudiendo además desempeñar un posible papel patogénico en el cáncer gástrico. Es así que muchos estudios epidemiológicos realizados para conocer la prevalencia del helicobacter pylori en las patologías gastroduodenales en todo el mundo, motivo por el cual describiremos la prevalencia de la infección por helicobacter pylori en paciente diagnosticados de adenocarcinoma gástrico, comparándola con la observada en la gástritis crónica. Los resultados que obtuvimos fue que helicobacter pylori se detectó en el 67% de los pacientes con gastritis histológica, mientras que únicamente el 29% de los casos con adenocarcinoma gástrico fue considerado helicobacter pylori(+). De este modo se doncluyó que la prevalencia por la infección por helicobacter pylori diagnosticado por métodos microbiológicos e histológicos en pacientes con adenocarcinoma gástrico (29%) es significativamente inferior a la evidencia en los pacientes con gastritis crónica, considerando su lesíon precursora.

Estudio de asociación entre esofagitis endoscópica y deterioro de parámetros motores esofágicos en pacientes con enfermedad por reflujo gastroesofágico / Study of correlation between endoscopic esophagitis and impairment of motor esophageal parameters in patients with gastroesophageal reflux disease

La enfermedad por reflujos gastroesofágico para muchos es una condición que se puede sobrellevar, sin embargo, para otros puede progresar a síntomas invalidantes, inflamación y lesión de la mucosa esofágica, condición que suele ir a la cronicidad con sintomatología recurrente. La endoscopia permite valorar el grado de afectación de la mucosa esofágica por el reflujo, y la manometría esofágica permite conocer los parámetros motores esofágicos. El objetivo de este trabajo es mostrar el grado de asociación entre la gravedad de la esofagitis endoscópica y las alteraciones motoras esofágicas en una muestra noaleatoria y secuencial de pacientes con enfermedad por reflujo gastroesofágico. El grupo de estudio está compuesto por 127 pacientes (45 hombres y 82 mujeres), con una edad media de 48,8 años; y, además, por 33 individuos control (23 hombres y 10 mujeres), con una edad media de 39,5 años. Del análisis se puede reportar que existen diferencias significativas al comparar entre los grupos en estudio, las variables tono basal del esfínter esofágico inferior (p=0,0001), presión de reposo del cuerpo esofágico, amplitud de las ondas y aparición de ondas terciarias (p < 0,05). En resumen, se presenta una serie de pacientes con ERGE en los que se constata un deterioro progresivo del tono basal del EEI y una hipoperistalsis del cuerpo esofágico en los pacientes con ERGE respecto de los controles, y en los pacientes con ERGE y esofagitis respecto de los sujetos sin esofagitis endoscópica

Perforación gástrica en el recién nacido secundaria a gastritis necrosante / Gastric perforation secondary to necrotizing gastritis in a newborn

Introducción. La perforación gástrica en la etapa del neonato es una entidad poco frecuente, con morbilidad y mortalidad elevada. Existen múltiples causas; sin embargo, la presentación espontánea secundaria a gastritis necrosante con trombosis de los vasos venosos de la submucosa gástrica resulta poco frecuente. Caso clínico. Se presenta el caso de un recién nacido de 38.5 semanas de edad gestacional con antecedente de asfixia neonatal y con peso al nacer de 3 175 g que presentó ruptura gástrica espontánea en el tercer día de vida; fue intervenido de gastrostomía con cierre primario y se egresó sin complicaciones. Se revisan las etiologías más frecuentes en la etapa neonatal y se describe la probable relación de la asfixia con relación a la perforación gástrica debida a trombosis de los plexos sanguíneos submucosos y la lesión gástrica provocada. Conclusión. Se sugiere que un manejo agresivo durante la etapa de choque, con el empleo de antimicrobianos y la realización de laparotomía exploratoria de urgencia en este tipo de pacientes, está asociado con un mayor porcentaje de supervivencia, en comparación con la alta mortalidad referida en algunas series en el pasado.

Gastropatia da hipertensão portal na esquistossomse manônica: associação com helicobater pylori / Mansonica esquistosomiasis portal hypertensive gastropathy: association with helicobater pylori

O povo brasileiro, principalmente no nordeste, em razão da pobre condição socio-economico, está exposta a infecção pelo shistosoma mansoni e pelo H. pylori, o que justifica em estabelecer as repercussões desta associação na mucosa gástrica. Foram incluídos na presente investigação 80 pacientes com sintomas dispéticos. Os pacientes foram investigados por meio de ultra-sonografia de abdome, endoscopia do trato digestivo superior com biópsia da mucosa gástrica para o teste da urese e coloração pelo giemsa. No grupo I, ocorreu gastropatia hpipertensiva portal em 84por cento, com padrão mosaico em 72por cento, sendo leve em 71 por cento e grave em 29por cento. A alterações mais graves foram encontradas no segmento gástrico proximal. erosões gástricas antrais foram encontradas em 72 por cento o que sugere a necessidade de adaptar uma classificação própria para a gastropatia hipertensiva na esquistossomose mansônica. Helicobater pylori foi encontrado em 40por cento dos pacientes no grupo I, e em 69por cento no grupo II. Nos pacientes em que ocorreu associação de gastropatia hipertensiva e infecção pelo H. Pylori, foram observadas alterações histopatológicas peculiares como: infiltrado polimorfonuclear em 91por cento e agregado linfocitário em 27por cento,úlcera duodenal em 9por cento e úlcera gástrica em 3por cento. Os resultados da presente investigação sugere que a gastropatia hipertenseiva portal na esquistossomose pode modificar a mucosa gástrica tornando-a menos dusceptível à infecção pela H. pylori. Por outro lado quando ocorre a associação da infecção pele H. pylori e esquistossomose, apesar de não influenciar fundamentalmente na patogênese da gastropatia da hipertensão portal, pode reproduzir as caracteristicas endoscópicas da infecção pelo H. Pylori

Role of nitric oxide in stress-induced gastric damage in cholestatic rats

In this study the effect of nitric oxide synthesis inhibition on stress-induced gastric damage was evaluated in bile.duct ligated sham operated and unoperated rats. Animals were injected intraperitoneally with N g nitro-L-arginine methylester [L-NAME] 40 mgl/kg, L-arginine, 200 mg/kg or saline, 30 min before water-immersion stress. One hour after water immersion, the animals were killed and tneir stomachs were removed for measurement of gastric mucosal damage The results showed that L-NAME significantly enhances the development of gastric mucosal lesion in sharm operated and unoperated rats, while in bile duct ligated animals L-NAME decreases and L-arginine enhances the potentiation of stress-induced gastric mucosal damage. The results suggest that inhibition of nitric oxide synthase with L-NAME has different effects on stress-induced gastric damage in cholestatic rats compared with normal animals

A tonometria como índice prognóstico / The tonommetry as a prognostic index

Foram estudados prospectivamente 16 pacientes gravemente enfermos cujo índice Apache médio foi de 27. Todos os pacientes tiveram pHi monitorado desde a admissao até a alta ou a morte. Nove nao sobreviventes tiveram valores de pHi significantemente reduzidos enquanto sete sobreviventes tiveram estes valores superiores a 7,30. Quando 7,30 foi considerado o valor limítrofe (Cult-off), o pHi teve 100 por cento de sensibilidade e especificidade na prediçao dos resultados. Concluímos que o pHi é mais sensível que o Apache II em prognosticar os resultados em pacientes gravemente doentes.

Monitorización intraoperatoria del pH intramucoso gástrico / Intrasurgical monitorization of the gastric intramucosal pH

Eighteen patients subjected to abdominal surgery were studied. All received general anesthesia and hemodynamic parameters were maintained within 20 percent of basal values. A tononeter was placed in the stomach after induction of anesthesia. Arterial blood gases and samples from the tonometer were obtained 30 minutes after induction and at 2 hours of surgery. Intramucosal pH was calculated using Henderson-Haselbach equations. Basal gastric mucosal pH was 7.4ñ0.1 and did not change during surgery. Two patients had a pH persistently below 7.35 without hemodynamic alterations or systemic acidosis. Gastric mucosal pH is not modified by abdominal surgery and some patients have low values despite the absence of hemodynamic derangement

Rol de la oxido nitrico sintetasa inducible en el dano agudo de la mucosa gastrica en el estres, en ratas / Role of the inducible nitric oxide synthase in the acute gastric mucosal damage in the stress, in rats

En diferentes grupos de ratas Wistar, sometidas a estrés por inmovilización e inmersión en agua a 18 graus Celsius durante 6hs, fue estudiado el rol del óxido nítrico (NO) en su fisiopatología; donde fueron usados agonistas y antagonistas de las isoenzimas NO Sintetasa Constitutiva (NOSc) y de la NO Sintetasa inducible (NOSi). Como agonistas de la NOSc se usaron dosis de L-arginina y como antagonistas de la L-NMMA. Se comprobó que la sobredosis de L-arginina agravó las lesiones agudas gastricas. Como agonistas de la NOSi se usó la NMDA y como antagonista la dexametasona y la aminoguanidina. Se comprobó que el agonista agravó las lesiones g stricas del estrés, en contraste, tanto dexametasona como aminoguanidina dieron una marcada protección de la mucosa gastrica. Se concluyó que la producción del NO dado por la NOSi, desempeña un papel preponderante en la fisiopatologia de las lesiones agudas gastricas en el estrés.