Recent research on the application of defoamers in children undergoing digestive endoscopy / 中国当代儿科杂志

Endoscopy is a common tool for the diagnosis and treatment of gastrointestinal disorders in children. The presence of bubbles in the gastrointestinal tract is one of the important factors affecting the clarity of endoscopic visual field, and the application of defoamers can significantly reduce bubbles in the gastrointestinal tract, improve the quality of gastrointestinal preparation, and further increase disease detection rate. Various studies have been conducted on gastrointestinal preparation before endoscopy in children, but there still lacks a uniform protocol for the application of defoamers. This article summarizes the use of defoamers in children before digestive endoscopy and related research advances and points out that existing studies on defoamers have a small sample size and that there are still controversies over the selection and timing of administration, so as to provide a reference for in-depth research on defoamers in the future.

Trastornos funcionales gastrointestinales. Cómo tratar sin medicar / Functional gastrointestinal disorders. How to manage them without medication

Los trastornos funcionales gastrointestinales (TFGI) se caracterizan por síntomas atribuibles al tracto gastrointestinal que no pueden ser explicados por anormalidades estructurales ni bioquímicas. Durante el primer año de vida, pueden generar mucho malestar en el lactante y preocupación en sus padres. Su diagnóstico se basa en criterios clínicos que expertos han determinado y en una historia clínica y un examen físico completo que descartan causas orgánicas. El objetivo de esta actualización es presentar estrategias para el manejo de los TFGI más frecuentes durante el primer año de vida: cólicos, regurgitaciones, disquecia y estreñimiento, bajo la visión de los nuevos conocimientos fisiopatológicos, que eviten los estudios y medicaciones innecesarias.

Functional gastrointestinal disorders (FGIDs) are characterized by symptoms attributable to the gastrointestinal tract that cannot be explained by the presence of structural or biochemical abnormalities. During the first year of life, FGIDs can cause great discomfort in infants and concern in their parents. The diagnosis of FGIDs is based on clinical criteria determined by experts and on a comprehensive case-taking process and physical exam to rule out organic causes. The objective of this update is to describe strategies for the management of the most frequent FGIDs during the first year of life: colics, regurgitations, dyschezia, and constipation, in light of new pathophysiological insights, to avoid unnecessary tests and medications.

Artículo de revisión: abordaje del síndrome de intestino irritable en APS / Review article: Irritable bowel syndrome approach in PHC

El síndrome de intestino irritable es un trastorno digestivo funcional recientemente reconocido como una alteración en el nivel intestino-cerebral que no se explica por alteraciones morfológicas, metabólicas o neurológicas demostrables por las técnicas diagnósticas habituales, caracterizándose por la presencia de dolor y distensión abdominal recurrente asociado a alteraciones del ritmo deposicional, ya sea en forma de constipación, diarrea o ambas. La prevalencia oscila entre los 6-11% dependiendo de los criterios diagnósticos utilizados y la zona geográfica, en Chile no hay datos actuales. Su fisiopatología es multifactorial, donde ninguno explica por si solo el síndrome. El diagnóstico es positivo basado en los criterios de Roma IV establecidos en el año 2016, a su vez es imperante establecer un subtipo de SII para realizar el manejo adecuado, es así como podemos tener un SII con predominio de constipación, diarrea, mixto o indeterminado. El manejo consta de la educación al paciente, una buena relación médico-paciente, dieta adecuada, actividad física aeróbica y otros tratamientos no farmacológicos, sumado a antiespasmódicos, antidiarreicos y fibra soluble, dependiendo del síntoma predominante.

Irritable bowel syndrome (IBS) is a functional digestive disorder recently recognized as an alteration in the gut-brain axis which can´t be explained by morphological, metabolic or neurological alterations demonstrable by the usual diagnostic techniques, characterized by the presence of recurrent abdominal pain and distention associated with alterations in the stool rhythm, either in the form of constipation, diarrhea or both. The prevalence ranges between 6-11% according to the diagnostic criteria used and the geographical area, in Chile there's no current data. Its pathophysiology is multifactorial, where any of them explains the syndrome itself. The diagnosis is positive based on the Rome IV criteria established in 2016, it is imperative to establish a subtype of IBS to carry out the appropriate management, This is how we can have IBS with a predominance of constipation, diarrhea, mixed or indeterminate Management consists of patient education, a good doctor-patient relationship, adequate diet, aerobic physical activity and other non-pharmacological treatments, added to antispasmodics, antidiarrheals and soluble fiber, depending on the predominant symptom.

Síndrome de Intestino Irritable en personal de enfermería de un Hospital de Cuenca-Ecuador / Irritable Bowel Syndrome in nursing staff at a hospital in Cuenca-Ecuador

INTRODUCCIÓN: El síndrome de intestino irritable (SII) es un trastorno funcional digestivo frecuente en personal de salud, con importantes repercusiones en la calidad de vida, en el trabajo, en el sistema de salud y la sociedad. El objetivo del presente estudio fue determinar la frecuencia de reporte del SII y sus subtipos en los historiales médicos del personal de enfermería de un hospital en Cuenca - Ecuador. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, en una muestra aleatoria de trabajadores del área de enfermería del José Carrasco Arteaga de Cuenca-Ecuador, entre junio 2017-abril 2018. De acuerdo con los criterios de Roma III, se valoraron los historiales médicos de los trabajadores para determinar la frecuencia de SII y sus subtipos. Finalmente, se describieron los factores sociodemográficos, laborales y psicológicos del personal de enfermería. RESULTADOS: Fueron evaluados los historiales médicos de 214 miembros del personal de enfermería (media de edad: 38.7±10.4 años, sexo: 95.3% de mujeres). Se encontró diagnóstico de SII en el 7.0% (15/214) del personal evaluado, siendo los subtipos indeterminado (7/15) y mixto (4/15) los más frecuentes. El 20% del personal del área de enfermería con SII tenía trastornos mentales (ansiedad, depresión y/o distimia) y el mismo porcentaje trabajaban por turnos CONCLUSIÓN: Los resultados obtenidos permiten evidenciar que el SII reportado en historiales médicos de personal de enfermería, en la ciudad de Cuenca-Ecuador, es menor a lo esperado (7%). Los subtipos de SII más frecuentes fueron el subtipo indeterminado, seguido del subtipo mixto.

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional-digestive disorder in health personnel, with significant repercussions on life quality, work, healthcare system and society. The aim of this study was to determine the frequency of reported IBS and its subtypes in the nursing staffs' medical records of a public hospital, in Cuenca - Ecuador. METHODOLOGY: A cross-sectional, descriptive study, with a randomized sample of nursing workers of Hospital Jose Carrasco Arteaga, Cuenca- Ecuador; between June 2017 and April 2018. According to Rome III criteria, medical records were assessed looking for IBS diagnosis and the subtype. Finally, sociodemographic, occupational and psychological factors among the nursing staff was also described. RESULTS: Two-hundred and fourteen medical records were evaluated (average age: 38.7 ± 10.4 years, 95.3% women). A diagnosis of IBS was found in 7.0% (15/214) of the personnel evaluated. The most frequent IBS subtypes were undetermined (46.7%, 7/15) and mixed (26.7%, 4/15). Twenty percent of the nursing staff with IBS, had mental disorders diagnosis (anxiety, depression and/or dysthymia), the same percent worked shifts. CONCLUSION: The diagnosis of IBS reported in the nursing staff medical records, in Cuenca- Ecuador was lower than expected (7%). The most frequent IBS subtypes were undetermined subtype, followed by mixed subtype.

Adaptación transcultural del componente de síntomas gastrointestinales de la escala CTCAE versión 4. 02 / Transcultural adaptation of the component of gastrointestinal symptoms of the CTCAE scale version 4. 02

Resumen Objetivo: Realizar la traducción y adaptación transcultural del componente de síntomas gastrointestinales (SGI) de la escala CTCAE versión 4.02 en pacientes ambulatorios tratados con quimioterapia en el Instituto Nacional de Cancerología en Bogotá. Métodos: Se realizó una búsqueda manual en medios electrónicos de escalas en idioma inglés o español que evaluarán la presencia, frecuencia o intensidad de SGI en pacientes oncológicos. La selección de los ítems fue efectuada por consenso informal de un comité técnico, el cual verificó la concordancia entre los principales SGI descritos en la literatura y los incluidos en la escala, ya que estos podrían afectar el estado nutricional. Posteriormente, para la adaptación transcultural, se siguieron los pasos y recomendaciones del manual ISPOR y del grupo de calidad de vida EORTC. La prueba piloto se efectuó en 30 pacientes seleccionados por conveniencia, quienes cumplieron los criterios de inclusión. Resultados: El 52% eran hombres; la edad promedio fue de 54,2 años (+/- 15,3 años). Los cánceres más frecuentes fueron: colorrectal (28%), estómago (16%) y mama (12%). Los 14 SGI incluidos en la escala fueron experimentados por todos los pacientes, por lo cual se conservaron, y no se requirió adicionar ningún otro. El tiempo promedio de aplicación del instrumento fue de 5 minutos y el 90% de los participantes lo consideró adecuado. Conclusiones: Se generó un instrumento de 14 ítems para medir SGI en pacientes oncológicos ambulatorios sometidos a quimioterapia, el cual es de rápida aplicación y utiliza lenguaje de fácil comprensión para el paciente. Aunque todavía quedan por definir sus propiedades clinimétricas.

Abstract Objective: To carry out the translation and transcultural adaptation of the gastrointestinal symptoms component (GIS) of the CTCAE, scale version 4.02, in outpatient patients treated with chemotherapy at the National Cancer Institute, Bogotá (Colombia). Methods: It was performed a manual search of scales on electronic media, in English or Spanish languages, which will evaluate the presence and intensity of GIS in oncological patients. The selection of the items was made by an informal consensus of a technical committee, which verified the concordance between the main GIS described in the literature and those included in the scale, all of which could affect the nutritional status. For transcultural adaptation, there were followed the steps and recommendations of the ISPOR Handbook, as well as those of the EORTC quality of life group. The pilot test was conducted in 30 patients selected for convenience, who met the inclusion criteria. Results: 52% were men; the average age was 54.2 years (+/-15.3 years). The most frequent cancers were: colorectal (28%), stomach (16%) and breast (12%). The 14 GIS included in the scale were experienced by all patients, so they were retained, and no other addition was required. The average time of application of the instrument was 5 minutes, and 90% of the participants considered it appropriate. Conclusions: A 14-item instrument was generated to measure GIS in cancer patients who undergo outpatient chemotherapy, which is of fast application and uses a language that is easily understood by patients. Its clinimetrics properties remain to be defined.

Manifestaciones gastrointestinales y hepáticas de COVID-19 en niños / Gastrointestinal and hepatic manifestations of COVID-19 in children

Resumen: SARS-CoV-2 es un virus de alta estabilidad ambiental. Es principalmente un patógeno respiratorio que también afecta el tracto gastrointestinal. El receptor ACE2 es el principal receptor de SARS- CoV-2, hay evidencia de su elevada presencia en intestino, colon y colangiocitos; igualmente se en cuentra expresado en hepatocitos pero en menor proporción. SARS-CoV-2 tiene un tropismo gas trointestinal que explica los síntomas digestivos y la diseminación viral en deposiciones. Las caracte rísticas de SARS-CoV-2 incluyen a la proteína S (Spike o Espícula) que se une de forma muy estable al receptor ACE2. La infección por SARS-CoV-2 produce disbiosis y alteraciones en el eje pulmón- intestino. A nivel intestinal y hepático produce una respuesta Linfocitos T evidente y una respuesta de citocinas que producirían daño intestinal inflamatorio. Las manifestaciones a nivel intestinal en orden de frecuencia son pérdida de apetito, diarrea, náuseas, vómitos y dolor abdominal. Éste último podría ser un marcador de gravedad. En niños la diarrea es habitualmente leve y autolimitada. A nivel hepático la hipertransaminasemia ocurre en 40-60% de los pacientes graves. SARS-CoV-2 puede per manecer en deposiciones un tiempo más prolongado que en secreciones respiratorias, este hallazgo influiría en la diseminación de enfermedad. En esta revisión se destaca la importancia de efectuar un reconocimiento precoz de las manifestaciones gastrointestinales y hepáticas, aumentar el índice de sospecha, efectuar un diagnóstico oportuno y reconocer eventuales complicaciones de la enferme dad. La potencial transmisión fecal oral puede influir en la diseminación de enfermedad. Reconocer este hallazgo es importante para definir aislamiento.

Abstract: SARS-CoV-2 is a high environmental stable virus. It is predominantly a respiratory pathogen that also affects the gastrointestinal tract. The ACE 2 receptor is the main receptor of SARS-CoV-2, with evidence of its high presence in the intestine, colon and cholangiocytes, and, in smaller proportion, in hepatocytes. SARS-CoV-2 has a gastrointestinal tropism that explains digestive symptoms and viral spread in stools. The characteristics of this virus include the S (Spike) protein that binds very stably to the ACE-2 receptor and, at the same time, SARS-CoV-2 produces dysbiosis and alterations in the gut-lung axis. It produces a clear T-cell response and a cytokines storm in the intestine and liver that would produce inflammatory bowel damage. Intestinal manifestations by order of frequency are loss of appetite, diarrhea, nausea and vomiting, and abdominal pain, where the latter could be a severity marker. In children, diarrhea is the most frequent symptom, usually mild and self-limiting. In the liver, hypertransaminasemia occurs in severe patients ranging from 40 to 60%. SARS-CoV-2 can re main in stools longer than in respiratory secretions, which would influence the spread of disease. This article highlights the importance of an early diagnosis of gastrointestinal and hepatic manifestations, increase the index of suspicion, make a timely diagnosis, and recognize eventual complications of the disease. The potential oral-fecal route of transmission may influence the disease spread. Recognizing this finding is important to define isolation.

Acrodermatitis enteropática ampollosa / Bullous Acrodermatitis Enteropathica

La acrodermatitis enteropática (AE) es una genodermatosis autosómica recesiva causada por la mutación del gen responsable de codificar a la proteína transportadora de Zinc (Zn) SLC39A4. A pesar de ser una rara enfermedad es de fácil manejo y gran relevancia clínica. Se caracteriza por la siguiente tríada: dermatitis acral y periorificial, diarrea y alopecia. Comunicamos un caso de presentación atípica en una lactante de 6 meses de edad con lesiones periorificiales y ampollas acrales que resolvió rápidamente con la terapia suplementaria con Zinc (AU)

Enteropathic acrodermatitis is an autosomal recessive genodermatosis caused by the mutation of the gene responsible for encoding the Zinc transporter protein SLC39A4. Despite being a rare disease, it is easy to manage and of great clinical relevance. It is characterized by the following triad: acral and periorificial dermatitis, diarrhea and alopecia. We report a case of atypical presentation in an almost 6-month-old infant with periorificial lesions and acral blisters that quickly resolved with supplemental Zinc therapy (AU)

Recomendaciones de la Sociedad de Gastroenterología del Perú para evitar la propagación del SARS-CoV-2 a través de procedimientos de endoscopía digestiva / Recommendations of the Society of Gastroenterology of Peru to avoid the spread of SARS-CoV-2 through digestive endoscopy procedures

RESUMEN El coronavirus SARS-CoV-2 produce la enfermedad llamada COVID-19, actualmente propagándose en una pandemia de rápida evolución. Puede transmitirse por contacto, gotas y aerosoles, y ha sido aislado en secreciones gastrointestinales y heces. Durante la endoscopía digestiva podría ocurrir la transmisión por cualquiera de estos mecanismos. Se recomienda limitar la endoscopía digestiva a casos de hemorragia digestiva, disfagia severa, cuerpo extraño en tracto digestivo, obstrucción biliar con dolor intratable o colangitis, pseudoquiste o necrosis pancreática encapsulada complicada, obstrucción gastrointestinal, y casos con riesgo de deterioro en el tiempo. Se recomienda tamizar a los pacientes en base a la temperatura, síntomas, y factores epidemiológicos para clasificarlos según su riesgo de infección. Para procedimientos en pacientes de riesgo bajo el personal debe usar bata descartable, guantes, protector ocular o facial, mascarilla quirúrgica estándar, gorro descartable, cubiertas descartables para zapatos. En casos de riesgo intermedio o alto, o COVID-19 confirmado, se debe incrementar la protección usando bata descartable impermeable, respirador N95 o similar, y doble guante. En caso de escasez puede ser necesario reutilizar los respiradores N95 hasta un máximo de 5 usos, siguiendo las recomendaciones de CDC sobre la colocación, retiro y almacenamiento para prevenir la contaminación secundaria por contacto. Asimismo todo el equipo de protección debe colocarse y retirarse siguiendo las recomendaciones del CDC. La presencia de personal en la endoscopía debe limitarse al mínimo indispensable. Dicho personal debe tener control diario de temperatura y si ésta es mayor a 37,3 ºC se debe proceder a la evaluación correspondiente. Después de cada procedimiento se debe desinfectar apropiadamente la camilla y superficies de la sala. La desinfección de alto nivel de los endoscopios elimina el SARS-CoV-2.

ABSTRACT The SARS-CoV-2 coronavirus produces the disease called COVID-19, currently spreading in a rapidly evolving pandemic. It can be transmitted by contact, drops and aerosols, and has been isolated from gastrointestinal secretions and faeces. During digestive endoscopy, transmission by any of these mechanisms could occur. It is recommended to limit digestive endoscopy to cases of digestive bleeding, severe dysphagia, foreign body in the digestive tract, biliary obstruction with intractable pain or cholangitis, pseudocyst or complicated encapsulated pancreatic necrosis, gastrointestinal obstruction, and cases at risk of deterioration over time. It is recommended to screen patients based on temperature, symptoms, and epidemiological factors to classify them according to their risk of infection. For procedures in low risk patients, personnel must wear a disposable gown, gloves, eye or face shield, standard surgical mask, disposable hat, disposable shoe covers. In cases of intermediate or high risk, or confirmed COVID-19, protection should be increased using disposable waterproof gown, N95 respirator or similar, and double glove. In case of shortage it may be necessary to reuse N95 respirators for up to 5 uses, following CDC recommendations for donning, removing and storing to prevent secondary contact contamination. Likewise, all protective equipment should be put on and removed according to CDC recommendations. The presence of personnel in endoscopy should be limited to the bare minimum. Said personnel must have daily temperature control and if it is above 37.3ºC, the corresponding evaluation must be carried out. After each procedure, the stretcher and room surfaces should be properly disinfected. High-level disinfection of endoscopes eliminates SARS-CoV-2.

Use of Mini-FLOTAC and Fill-FLOTAC for rapidly diagnosing parasitic infections in zoo mammals / Utilização do Mini-FLOTAC e Fill-FLOTAC no diagnóstico rápido de infecções parasitárias de mamíferos em zoológicos

Abstract Animals reared in restricted environments are highly susceptible to gastrointestinal infection by helminths and protozoa and therefore zoos are characterized as being parasite-rich environments. Successful implementation of control programs of these parasites in zoo environment depends upon precise and rapid diagnosing of gastrointestinal infections. The aim of this study was to demonstrate the role of the Mini-FLOTAC technique in combination with Fill-FLOTAC for rapidly diagnosing parasitic infections in zoo mammals. Fecal samples were collected from 70 animals in four different zoos located in central and southern Italy. All the samples were analyzed using Mini-FLOTAC in combination with Fill-FLOTAC. Out of the 70 pooled samples examined, 80% (24/30) were positive for at least one parasite. Among the gastrointestinal nematodes, Strongyles were the most frequent (40%), followed by Trichuris spp. (23.3%), Parascaris spp. (13.3%) and Capillaria spp. (3.3%). Among the protozoa, Blastocystis spp., Giardia spp. and Eimeria spp. were detected in 6.6%, 3.3% and 3.3%, respectively. These results show that Mini-FLOTAC in combination with Fill-FLOTAC can be used, not only for rapidly diagnosing parasitic infections in zoo mammals, but also for monitoring control programs in which large numbers of fecal samples need to be examined rapidly and reliably.

Resumo Animais criados em ambiente restritos são altamente suscetíveis a infecção gastrointestinal por helmintos e protozoários, constituindo os zoológicos em ambientes com alta contaminação por parasitos. O sucesso da implementação de programas de controle contra estes parasitos em zoológicos depende do rápido diagnóstico das infecções por parasitas gastrointestinais. O objetivo deste estudo foi demonstrar o papel da técnica do Mini-FLOTAC em combinação com o Fill-FLOTAC no diagnóstico rápido das infecções parasitárias em mamíferos em zoológicos. Amostras de fezes foram coletadas de 70 animais de quatro diferentes zoológicos no centro e sudoeste da Itália. Todas as amostras foram analisadas pela técnica do Mini-FLOTAC em combinação com o Fill-FLOTAC. Do total de 70 pools de fezes examinadas, 80% (24/30) foram positivas para pelo menos um parasito. Entre os nematoides gastrointestinais a maior frequência foi observada para estrongilídeos (40%), seguida por Trichuris spp. (23,3%), Parascaris spp. (13,3%) e Capillaria spp. (3,3%). Entre os protozoários Blastocystis spp., Giardia spp. e Eimeria spp. foram detectados em 6,6%, 3,3% e 3,3%, respectivamente. Estes resultados demonstram que a técnica do Mini-FLOTAC em combinação com o Fill-FLOTAC pode ser utilizada não somente para o diagnóstico rápido das infecções parasitárias em mamíferos em zoológicos, mas também no monitoramento de programas de controle onde grande número de amostras fecais devem ser examinadas de forma rápida e confiável.

Superposición de desórdenes gastrointestinales funcionales en escolares y adolescentes latinoamericanos / Overlapping of functional gastrointestinal disorders in latinamerican schoolchildren and adolescents

Resumen: Introducción: Hay pocos estudios sobre Desórdenes Gastrointestinales Funcionales superpuestos (DGFs-s). Objetivo: Describir la prevalencia y posibles factores de riesgo en niños Latinoamericanos (Latam) para presentar DGFs-s. Pacientes y Método: Estudio de prevalencia en niños escolares La tam entre 8-18 años. Se incluyeron variables sociodemográficas; se utilizaron los Criterios de Roma III en español, y se consideró DGFs-s cuando se presentaron 2, 3 o 4 y más DGFs en un mismo niño. El análisis estadístico incluyó t de student, chi cuadrado, prueba exacta de Fisher, análisis uni y multivariados y cálculo de los ORs e IC95%, siendo considerada una p < 0,05 significativa. Resul tados: Fueron analizados 6193 niños Latam (11,8 ± 2,2 años; 62,2% entre 8-12 años; 50,4% niñas; 68,0% colegio público), con diagnóstico de algún DGFs del 23,4%. Hubo superposición de DGFs en un mismo niño, en 8,4% (5,5% con 2 DGFs; 2,1% con 3 DGFs y 0,9% con 4 o más DGFs), siendo las principales superposiciones el Síndrome de intestino irritable (SII) + Dolor abdominal funcio nal (DAF) (2,6%) y el SII + DAF + Estreñimiento funcional (1,1%). Hubo predomino del género femenino. Conclusión: Hay una baja prevalencia de DGFs-s en escolares y adolescentes Latam, con predominio en el sexo femenino y de presentación muy variable.

Abstract: Introduction: There are few studies on overlapping Functional Gastrointestinal Disorders (FGIDs). Objective: To describe the prevalence and possible risk factors in Latin American children (Latam) to present overlapping FGIDs. Patients and Method: Prevalence study in Latam schoolchildren bet ween 8-18 years of age. Sociodemographic variables were included; the Rome III Criteria in Spanish were used, and overlapping FGIDs were considered when two, three or four and more FGIDs were presented in the same child. The statistical analysis included Student's T-test, chi-square test, Fisher's exact test, univariate and multivariate analysis, and calculation of ORs and 95% CI, being considered a significant p < 0.05. Results: 6,193 Latam children were analyzed (11.8 ± 2.2 years, 62.2% between 8-12 years of age, 50.4% girls, 68.0% public school), and 23.4% with a diagnosis of some kind of FGIDs. There was overlap of FGIDs in the same child, in 8.4% (5.5% with 2 FGIDs, 2.1% with 3 FGIDs and 0.9% with 4 or more FGIDs), the main overlaps were irritable bowel syndrome (IBS) + functional abdominal pain (FAP) (2.6%), and IBS + FAP + functional constipation (1.1%). There was predominance of the female gender. Conclusion: There is a low prevalence of overlapping FGIDs in Latam schoolchildren and adolescents, with a predominance in females and of very variable pre sentation.

Disminución en la frecuencia de infección por Helicobacter pylori en endoscopías digestivas altas / Helicobacter pylori infection detected during upper gastrointestinal endoscopy

Background: Helicobacter pylori (HP) is the most widespread chronic human infection worldwide and the most important pathogenic factor of gastric cancer. The calculated prevalence at the Clinical Hospital of the University of Chile from 2002 to 2005 was 44.9%. Aim: To determine the current prevalence of HP in patients undergoing an upper gastrointestinal endoscopy (UGI) and analyze its distribution according to age and endoscopic findings. Material and Methods: We reviewed 3.433 UGI performed during the year 2015, selecting those in which rapid urease test (RUT) was done. A positive RUT or a positive gastric biopsy (GB) were considered as HP infection. Results: RUT was done in 1862 UGI (55%) performed in patients aged 51 ± 17 years, (66% women). In 23% of these endoscopies, the RUT was positive. A GB was obtained 43% of endoscopies and 30% were positive for HP. In 105 patients the RUT was negative and the GB positive (rendering a 19.5% false negative rate). HP was detected by RUT and GB in 29% of endoscopies. The highest prevalence of infection (38.1%) was found between 40 and 49 years. HP infection had odds ratio of 4.24 for nodular gastropathy, 2.63 for gastric ulcer and 2.14 for duodenal ulcer (p < 0.05). Conclusions: HP prevalence in our center decreased significantly from 44.9% to 28.9% in 11 years. False negative RUT results may bias this finding. The use of proton pump inhibitors and antimicrobials that can interfere with the detection of HP should be registered to properly analyze the results of the RUT.

Síndromes linfoproliferativos gastrointestinales / Gastrointestinal lymphoproliferative syndrome

The gastrointestinal lymphoid system plays a relevant role. The daily and continuous interaction between gastrointestinal lymphocytes with food and intestinal microbes requires precise functioning. The pathologic spectrum of lymphocyte malfunction results in lymphomas. MALT lymphoma is the most frequently diagnosed lymphoma, but there are other lymphoproliferative diseases such as diffuse large B cell lymphoma, mantle cell lymphoma and T associated lymphoma. The gastroenterologist and the endoscopist need to know these diseases in detail to achieve early diagnosis and treatment.

El sistema linfoide de defensa abdominal tiene un relevante rol en el buen funcionamiento sistémico. La interacción diaria y continua con patógenos alimentarios y microbios comensales intestinales precisa un estrecho funcionamiento. Las alteraciones linfoides clonales favorecen el desarrollo de linfomas de diversos tipos. Si bien, el linfoma asociado a tejido linfoide de mucosas (MALT) es el más conocido en contexto de su asociación con Helicobacter pylori, el tracto gastrointestinal se puede ver afectado por otros linfomas como el linfoma difuso de células grandes B y linfomas indolentes como el linfoma folicular, el linfoma del manto y el linfoma T asociado a enteropatía. El gastroenterólogo y endoscopista precisan conocer en detalle estas entidades para un oportuno diagnóstico y adecuado tratamiento.

Diarrea aguda infecciosa: ¿qué debe saber un gastroenterólogo?, ¿cómo mejoramos el diagnóstico etiológico? / Acute infectious diarrhea: what should a gastroenterologist know? how do we improve the etiological diagnosis?

Acute infectious diarrhea is still a major public health problem, both in developing and developed countries, causing morbidity, mortality and high costs. Acute diarrhea particularly affects people in extrema age ranges, travelers and immunosuppressed individuals. Traditional microbiological study, based on cultures, direct microscope analysis, and antigen tests show poor performance, due to low sensitivity and specificity, slowness and the diversity of bacteria, viruses and parasites that complicate getting the results. New molecular techniques based on multiple polymerase chain reaction (PCR) kits allow for the identification, in few hours and simultaneously, of many agents, such as bacteria, viruses and parasites, with high sensitivity and specificity; which will probably transform etiological diagnosis of acute diarrhea

La diarrea aguda infecciosa continúa siendo un problema de salud pública tanto en países en vías de desarrollo como en países desarrollados, causando morbi-mortalidad y grandes gastos económicos. Las diarreas agudas son especialmente importantes en personas con edades extremas, viajeros e inmunodeprimidos. El estudio microbiológico tradicional basado en cultivos, análisis microscópico directo y pruebas de antígenos tiene un rendimiento pobre, dado por su baja sensibilidad y especificidad, lentitud y la gran diversidad de bacterias, virus y parásitos que dificultan la obtención de resultados. Las nuevas técnicas de diagnóstico molecular basadas en kits de reacción de polimerasa en cadena (PCR) múltiple permiten identificar en pocas horas y en forma simultánea una gran cantidad de agentes, tanto bacterias, virus, como parásitos, con alta sensibilidad y especificidad, lo que probablemente transformará el diagnóstico etiológico de las diarreas agudas.

Compromiso gastrointestinal por Triypanosoma cruzi: ¿cuándo buscar y cuándo tratar? / Digestive involvement by Trypanosoma cruzi: when to look for it and when to treat

Chagas disease is an endemic zoonosis that can cause chronic medical complications in a third of those infected, usually decades after infection. It mainly affects the peripheral nervous system of heart, esophagus and colon. At digestive level, motor dysfunction leads to the development of megaesophagus and megacolon whose predominant symptoms are dysphagia and constipation. It should be suspected in patients with epidemiological history and compatible symptoms. In the chronic phase it is confirmed with the detection of specific antibodies. The etiological treatment is effective in early stages after infection. In the chronic stage the management is symptomatic, medical and/or surgical.

La enfermedad de Chagas es una zoonosis endémica que puede producir complicaciones médicas crónicas en un tercio de los infectados, habitualmente décadas luego de la infección. Afecta principalmente el sistema nervioso periférico de corazón, esófago y colon. A nivel digestivo la disfunción motora lleva a la formación de megaesófago y megacolon cuyos síntomas predominantes son disfagia y constipación. Debe sospecharse en pacientes con antecedentes epidemiológicos y síntomas compatibles. En la fase crónica se confirma con la detección de anticuerpos específicos. El tratamiento etiológico es efectivo en las fases tempranas post-contagio. En la etapa crónica el manejo es sintomático, médico y/o quirúrgico.

Assessment of ultrasonographic and endoscopic changes in dogs with gastrointestinale disorders / Avaliação das mudanças ultrassonográficas e endoscópicas em cães com distúrbios gastrointestinais

The study has been conducted over a period of 4 years, on a total number of 133 dogs, all of those expressing gastrointestinal disorders. Ultrasound and endoscopic examinations were performed in all dogs in order to assess any significant correlations between ultrasonographic and endoscopic findings. The results confirm a significant correlation between the presence of diarrhoea and increased thickness of the large bowel wall, with P<0.5. Another extremely significant correlation we observed is the one between increased thickness of large bowel wall and loss of layering at this level, with P<0.5. Upper GI endoscopy revealed that dilated lacteals in the duodenum are significantly associated with the presence of diarrhoea, P<0.5 and, more importantly, there is a very significant correlation between dilated lacteals and the presence of striations (P<0.5), which confirms previous studies (Sutherland-Smith et al., 2007) that say the striated aspect of the intestinal mucosa is due to dilated lacteals.(AU)

O estudo foi conduzido durante um período de quatro anos, em um número total de 133 cães, todos os que expressam distúrbios gastrointestinais. Exames ultrassonográficos e endoscópicos foram realizados em todos os cães, a fim de se avaliarem as correlações significativas entre os achados ultrassonográficos e endoscópicos. Os resultados confirmam uma correlação significativa entre a presença de diarreia e o aumento da espessura da parede do intestino grande, com P<0,5. Outra correlação extremamente significativa observada é a única entre o aumento da espessura da parede do intestino grosso e a perda de camadas a esse nível, com P<0,5. GI superior endoscopia revelou que lacteals dilatados no duodeno estão significativamente associados com a presença de diarreia, P<0,5 e mais importante, não há uma correlação muito significativa entre lacteals dilatados e a presença de estrias (P<0,5), o que confirma estudos anteriores (Sutherland-Smith et al., 2007) que dizem que o aspecto estriado da mucosa intestinal está a ser dada pelos lacteals dilatados.(AU)

Analysis of double balloon enteroscopy: indications, findings, therapeutic and complications / Análise da enteroscopia por duplo balão: indicações, achados, terapêutica e complicações

ABSTRACT Background: The double balloon enteroscopy is an important method for the endoscopic approach of the small bowel that provides diagnosis and therapy of this segment's disorders, with low complication rate. Aim: Analysis of patients undergoing double balloon enteroscopy. The specific objectives were to establish the indications for this method, evaluate the findings by the double balloon enteroscopy, analyze the therapeutic options and the complications of the procedure. Methods: It is a retrospective analysis of 65 patients who underwent double balloon enteroscopy. Results: Sixty-five procedures were performed in 50 patients, 63.1% were women and 36.9% were men. The mean age was 50.94 years. The main indication it was gastrointestinal bleeding, followed by abdominal pain and Crohn's disease. Most procedures were considered normal. Polyps were the most prevalent finding, followed by angioectasias and duodenitis. In 49.2% of the cases, one or more therapeutic procedures were performed, (biopsy was the most prevalent). There was only one case of acute pancreatitis, which was treated clinically. Conclusion: The enteroscopy is good and safe method for the evaluation of the small bowel, and its main indications are gastrointestinal bleeding and abdominal pain. It has low complications rates and reduces the necessity of surgery.

RESUMO Racional: A enteroscopia por duplo balão é importante método endoscópico para abordagem do intestino delgado, permitindo o diagnóstico e a terapêutica de afecções com baixa taxa de complicações. Objetivo: Análise de pacientes submetidos à enteroscopia por duplo balão, estabelecendo as indicações para realização do exame e seus achados, analisando a terapêutica realizada e observando as complicações decorrentes do procedimento. Métodos: Estudo retrospectivo de análise de 65 prontuários de pacientes submetidos à enteroscopia por duplo balão. Os dados foram armazenados em planilhas e foi realizada a análise estatística. Resultados: Foram 65 enteroscopias em 50 pacientes, sendo 63,1% mulheres e 36,9% homens, com média de idade de 50,94 anos. A principal indicação foi sangramento intestinal, seguida por dor abdominal e doença de Crohn. A maioria dos procedimentos foi considerada normal, sendo que o achado mais prevalente foram os pólipos, seguido por angioectasias e duodenites. Em 49,2% dos exames foi realizado algum procedimento terapêutico, sendo a biópsia o mais prevalente. Houve apenas um caso de complicação de pancreatite aguda. Conclusão: A enteroscopia por duplo balão é bom e seguro método para a avaliação do intestino delgado, possuindo como principais indicações o sangramento intestinal e a dor abdominal. Possui baixas taxas de complicações e, por meio de suas opções terapêuticas, diminui a necessidade de procedimentos cirúrgicos.

Hirschsprung's disease - Postsurgical intestinal dysmotility / Doença de Hirschsprung - Dismotilidade intestinal pós-cirúrgica

Abstract Objective: To describe the case of an infant with Hirschsprung's disease presenting as total colonic aganglionosis, which, after surgical resection of the aganglionic segment persisted with irreversible functional intestinal obstruction; discuss the difficulties in managing this form of congenital aganglionosis and discuss a plausible pathogenetic mechanism for this case. Case description: The diagnosis of Hirschsprung's disease presenting as total colonic aganglionosis was established in a two-month-old infant, after an episode of enterocolitis, hypovolemic shock and severe malnutrition. After colonic resection, the patient did not recover intestinal motor function that would allow enteral feeding. Postoperative examination of remnant ileum showed the presence of ganglionic plexus and a reduced number of interstitial cells of Cajal in the proximal bowel segments. At 12 months, the patient remains dependent on total parenteral nutrition. Comments: Hirschsprung's disease presenting as total colonic aganglionosis has clinical and surgical characteristics that differentiate it from the classic forms, complicating the diagnosis and the clinical and surgical management. The postoperative course may be associated with permanent morbidity due to intestinal dysmotility. The numerical reduction or alteration of neural connections in the interstitial cells of Cajal may represent a possible physiopathological basis for the condition.

Resumo Objetivo: Descrever o caso de um lactente portador de doença de Hirschsprung na forma aganglionose colônica total que, após a ressecção cirúrgica do segmento agangliônico, manteve quadro irreversível de obstrução intestinal funcional; discutir as dificuldades no manejo dessa forma da aganglionose congênita e apontar um mecanismo patogenético plausível para o caso. Descrição do caso: O diagnóstico de doença de Hirschsprung na forma aganglionose colônica total foi definido em lactente aos dois meses de vida, após episódio de enterocolite, choque hipovolêmico e desnutrição grave. Após ressecção colônica, o paciente não recuperou a função motora intestinal que possibilitasse a alimentação via enteral. O exame do íleo remanescente pós-operatório mostrou presença de plexos ganglionares e redução numérica das células intersticiais de Cajal em segmentos proximais do intestino. Aos 12 meses de vida, o paciente mantém-se dependente de nutrição parenteral total. Comentários: A doença de Hirschsprung na forma aganglionose colônica total tem particularidades clínico-cirúrgicas que a diferenciam das formas clássicas e dificultam o diagnóstico e o manejo clínico-cirúrgico. A evolução pós-operatória pode associar-se à morbidade permanente decorrente de dismotilidade intestinal. A redução numérica ou as alterações das conexões neurais das células intersticiais de Cajal podem representar uma possível base fisiopatológica para a condição.