Tratamiento de primera línea para erradicación de Helicobacter pylori: todavía una terapia eficaz / First-line treatment for eradication of Helicobacter pylori: Still an effective therapy

Resumen Objetivo: Este estudio tiene como objetivo principal determinar la respuesta al esquema de tratamiento de primera línea con triple terapia estándar (amoxicilina, claritromicina, omeprazol), para erradicación de Helicobacter pylori en una determinada población, para determinar si este esquema propuesto en guías internacionales es aún una opción adecuada para pacientes en una determinada región de Costa Rica. Métodos: Se realizó una búsqueda en el servicio de gastroenterología del Hospital San Francisco de Asís, Grecia, Alajuela, Costa Rica; de todos los pacientes con infección por Helicobacter pylori y que recibieron tratamiento de primera línea con triple terapia (amoxicilina, claritromicina y omeprazol) por 14 días, en el periodo comprendido entre febrero 2017 a febrero 2019, incluyendo para el análisis solamente en los que se contaba con una prueba confirmatoria posterior a tratamiento, ya fuera por antígeno fecal de H. pylori o biopsia convencional. Resultados: Se identificaron un total de 369 casos. El diagnóstico se realizó con biopsia en el 96,4% de los pacientes. La respuesta al tratamiento de primera línea se alcanzó en un 90.5% corroborada por antígeno fecal en el 92.1% de los casos. Conclusiones: Este estudio muestra que la terapia triple con amoxicilina, claritromicina e Inhibidor de bomba de protones por 14 días mantiene un adecuado nivel de eficacia. Sin embargo, hay que tomar en cuenta que estos datos son únicamente de un área de atracción determinada y puede que no reflejen la realidad de todo el país.

Abstract Aim: The main objective of this study is to determine the response to the firstline treatment regimen with triple standard therapy (amoxicillin, clarithromycin, omeprazole), to eradicate Helicobacter pylori in a certain population. The goal is to determine if the proposed regimen in international guidelines services is still a suitable option for patients in a certain region of Costa Rica. Methods: The study took place in San Francisco de Asís Hospital, Grecia, Alajuela, Costa Rica. All patients with a Helicobacter pylori infection that were given first- line treatment with triple therapy (amoxicillin, clarithromycin and omeprazole) for its eradication for 14 days, in the period between February of 2017 and February of 2019, were included in the study. Results: A total of 369 cases were identified. The diagnosis was made with biopsy in 96.4% of patients. Response to first-line treatment was achieved in 90.5% corroborated by fecal antigen in 92.1% of all cases. Conclusions: This study shows that triple therapy with amoxicillin, clarithromycin and omeprazole for 14 days maintains an adequate level of efficacy. However, it must be considered that these results are from a specific area and may not reflect the reality of the entire country.

Associação entre Infecção por Heicobacter Pylori e Hipertensão Arterial Sistêmica: Metanálise / Association between Helicobacter Pylori Infection and Systemic Arterial Hypertension: A Meta-Analysis

Resumo Fundamento: Estudos epidemiológicos recentes demonstraram que alterações na microbiota e seus metabólitos estão associadas à hipertensão arterial sistêmica. A Helicobacter pylori (H. pylori) é um dos patógenos bacterianos mais comuns, e a possível associação entre a infecção por H. pylori e a hipertensão é controversa. Objetivos: Este estudo teve o objetivo de esclarecer a associação entre eles e proporcionar uma nova base teórica para detectar a patogênese da hipertensão. Métodos: Foram selecionados estudos caso-controle e transversais sobre a associação entre H. pylori e hipertensão, publicados de 1996 a 2019 indexados nos bancos de dados PubMed, Google Scholar, Chinese Wan Fang Data, e Chinese National Knowledge Infrastructure (CNKI). As razões de chance (RC) combinadas e o intervalo de confiança (IC) 95% foram estimados. O I² foi realizado para avaliar a heterogeneidade estatística. O viés de publicação foi avaliado utilizando-se os testes de Beggs e de Egger. Os dados extraídos foram analisados no software Stata 12.0. A significância estatística foi definida com um p-valor < 0,05. Resultados: Foram cadastrados 17 estudos envolvendo 6376 casos de hipertensão e 10850 controles. A taxa de infecção por H. pylori em pacientes hipertensos e em controles foi de 64,9% e 56,3%, respectivamente. Foi demonstrada uma associação significativamente positiva entre a infecção por H. pylori e a hipertensão, com uma RC global de 2,07 (IC 95%: 1,46-2,94; p < 0,05). A análise de subgrupos revelou que a prevalência de infecção por H. pylori foi associada à hipertensão na região da Ásia e no grupo de caso-controle, as RC (IC 95%) foram 2,26 (1,51-3,38) e 2,53 (1,72-3,72), respectivamente. Depois de estratificar por métodos de detecção, ainda existiam diferenças entre os subgrupos (todos p < 0,05). Conclusão: Esta metanálise indicou que a infecção por H. pylori está associada positivamente à hipertensão.

Abstract Background: Recent epidemiological studies have shown that alterations in microbiota and its metabolites are associated with systemic arterial hypertension. Helicobacter pylori (H. pylori) is one of the most common bacterial pathogens, and the potential association between H. pylori infection and hypertension are controversial. Objective: This study aimed to clarify their association and provide a new theoretical basis for uncovering the pathogenesis of hypertension. Methods: Case-control and cross-sectional studies on the association between H. pylori and hypertension published from 1996 to 2019 indexed in PubMed, Google Scholar, Chinese Wan Fang Data, and Chinese National Knowledge Infrastructure (CNKI). The pooled odds ratios (OR) and 95% confidence interval (CI) were estimated. I2 was performed to evaluate the statistical heterogeneity. Publication bias was evaluated using Begg's and Egger's test. The extracted data was analyzed in Stata 12.0. Statistical significance was defined as p-value < 0.05. Results: A total of 17 studies involving 6,376 cases of hypertension and 10,850 controls were enrolled. H. pylori infection rate in hypertension patients and controls were 64.9% and 56.3%, respectively. A significantly positive association was shown between H. pylori infection and hypertension with an overall OR of 2.07 (95% CI: 1.46-2.94; p < 0.05). Subgroup analysis revealed that the prevalence of H. pylori infection was associated with hypertension in the region of Asia and the case-control group, ORs (95% CI) were 2.26 (1.51-3.38) and 2.53 (1.72-3.72), respectively. After stratifying by detection methods, differences still existed in subgroups (all p < 0.05). Conclusion: This meta-analysis indicated that H. pylori infection is positively associated with hypertension.

Soroprevalência e fatores associados a infecções crônicas entre idosos residentes na comunidade / Seroprevalence and factors associated with chronic infections among community-dwelling elderly individuals

Resumo Infecções crônicas podem contribuir com o processo de envelhecimento, mas isso ainda é pouco explorado na América Latina. O objetivo foi avaliar a prevalência e os fatores associados ao citomegalovírus (CMV), Herpes simples 1 (HSV-1), Chlamydia pneumoniae e Helicobacter pylori entre idosos. Participaram 1.320 indivíduos da linha de base da Coorte de Idosos de Bambuí. Foram avaliados anticorpos (IgG) para as infecções e variáveis exploratórias (sociodemográficas, comportamentos em saúde e condições de saúde). Utilizaram-se modelos de regressão de Poisson com variância robusta. A prevalência foi de 99,4% para CMV, 96,7% para HSV-1, 56,0% para C. pneumoniae e 70,5% para H. pylori. Os mais velhos, mulheres, fumantes, diabéticos, incapazes e com maiores níveis de IL-6 tinham maior prevalência de CMV. HSV-1 foi menos frequente entre as mulheres. Infecção por C. pneumoniae foi maior entre os mais velhos e diabéticos; e menor entre mulheres e os menos escolarizados. H. pylori foi menos frequente entre as mulheres e naqueles com maiores níveis de IL-1β, mas mais comuns entre os fumantes. Os achados mostram elevada prevalência de infecções crônicas e diferentes perfis epidemiológicos para cada patógeno, permitindo a detecção de grupos vulneráveis a essas infecções.

Abstract Chronic infections can contribute to the aging process, but this issue is less studied in Latin America. The aim was to assess the prevalence and factors associated with cytomegalovirus (CMV), Herpes Simplex 1 (HSV-1), Chlamydia pneumoniae and Helicobacter pylori among the elderly. A total of 1,320 individuals participated from the baseline of the Elderly Cohort of Bambuí. IgG antibodies against infections and explanatory variables (sociodemographic factors, health behaviors and health conditions) were evaluated. Poisson regression models with robust variance were used. Seroprevalence rates were 99.4% for CMV, 96.7% for HSV-1, 56% for C. pneumoniae and 70.5% for H. pylori. Elderly men, women, smokers, diabetics, the disabled and those with high levels of IL-6 had a higher prevalence of CMV. HSV-1 was less frequent among women. The prevalence of C. pneumoniae was higher at ages >75 and among diabetics; it was lower among women and individuals with less schooling. H. pylori was less frequent among women and those with detectable levels of IL-1β, but more common among smokers. The findings show a high prevalence of chronic infection and a different epidemiologic profile for each pathogen, making it possible to detect groups that are vulnerable to these infections.

Helicobacter pylori and colorectal neoplasms: a concise review / Helicobacter pylori e neoplasias colorretais: revisão concisa

ABSTRACT Helicobacter pylori is the main etiological agent of all malignant tumors caused by an infectious disease. It is a major, at times dominant, factor in the pathogenesis of a large spectrum of diseases such as acute and chronic gastritis, gastric and duodenal ulcers, gastric carcinoma, and lymphoma. Epidemiological and experimental studies suggest that H. pylori chronic infection may be related to different extragastric diseases, including colorectal neoplasms. This concise review aims to explore the association of H. pylori infection with colorectal cancer and adenoma, including the recent epidemiological findings, the diagnostic methods employed to detect H. pylori and virulent factors, and the potentially involved mechanisms. Furthermore, is attempted to establish the current data integration for causal inference using the Bradford-Hill causality criteria. The weak, although global, strength of the epidemiological positive association between H. pylori infection and colonic neoplasms associated to new mechanisms postulated to explain this interaction, including intestinal dysbiosis, should stimulate future studies. Prospective confirmatory studies to establish the role of H. pylori eradication in the process of carcinogenic transformation of the colonic epithelium may define its eventual role in the treatment and prevention of colonic neoplasms.

RESUMO Helicobacter pylori é o principal agente etiológico dos tumores malignos causados por doenças infecciosas. Constitui fator importante, às vezes dominante, na patogênese de um amplo espectro de doenças como gastrite aguda e crônica, úlceras gástricas e duodenais, carcinoma gástrico e linfoma. Estudos epidemiológicos e experimentais sugerem que a infecção crônica por H. pylori pode estar relacionada a diferentes doenças extragástricas, incluindo neoplasias colorretais. Esta concisa revisão tem como objetivo explorar a associação da infecção por H. pylori com câncer colorretal e adenoma, incluindo os recentes achados epidemiológicos, os métodos de diagnóstico empregados para detectar H. pylori e seus fatores de virulência com os mecanismos potencialmente envolvidos nesta relação. Além disso, procura-se estabelecer a integração dos dados atuais na busca de inferência causal com o emprego dos critérios de causalidade de Bradford-Hill. A associação epidemiológica positiva entre infecção por H. pylori e neoplasias do cólon embora classificada como fraca - porém global - do ponto de vista epidemiológico, quando associada a mecanismos recentemente postulados para explicar essa interação, incluindo disbiose intestinal, deverá estimular a realização de investigações futuras. Estudos prospectivos confirmatórios para estabelecer o papel da erradicação do H. pylori no processo de transformação carcinogênica do epitélio do cólon são aguardados para definir seu eventual papel no tratamento e prevenção de neoplasias do cólon.

Caracterización clínico epidemiológica de la infección por Helicobacter pylori en pacientes con úlcera péptica / Clinical-Epidemiological Characterization of Helicobacter pylori Infection in Patients with Peptic Ulcer

Introducción: La infección por H. pylori es considerada como la enfermedad bacteriana crónica más prevalente en el ser humano, pues infecta a más del 50 por ciento de la población mundial. Objetivo: Describir las características clínico epidemiológicas de la infección por H. pylori en pacientes con diagnóstico endoscópico de úlcera péptica. Métodos: Estudio descriptivo realizado en el Policlínico Camilo Cienfuegos; durante el año 2018, en 42 pacientes de 18 y más años, con diagnóstico endoscópico de úlcera péptica e informe del resultado de estudio histológico para el diagnóstico de infección por H. pylori. Se revisaron las historias clínicas y se confeccionó una planilla de recolección de datos que incluyó las variables: grupo de edades, sexo, manifestaciones clínicas, tipo de úlcera, número de lesiones, úlcera activa y metaplasia intestinal. Se utilizó la media y la desviación estándar (DE) y se identificaron los límites de clases superior e inferior. Se calcularon los porcentajes con IC = 95 por ciento. Se estimó la prevalencia general y específica de infección por H. pylori por grupo de edades y sexo. Resultados: El promedio de edad fue de 46,7 años ± 12,02 años. La prevalencia fue de 59,5 por ciento, superior en mayores de 65 años y en hombres. Conclusiones: El estudio permitió describir las características clínico epidemiológicas de la infección por H. pylori en pacientes con diagnóstico endoscópico de úlcera péptica. Fue más frecuente la presencia de síndrome dispéptico, con una única úlcera duodenal en fase activa y sin metaplasia intestinal(AU)

Introduction: Helicobacter pylori infection is considered the chronic bacterial disease most prevalent in humans, since it infects more than 50% of the world population. Objective: To describe the clinical-epidemiological characteristics of H. pylori infection in patients with an endoscopic diagnosis of peptic ulcer. Methods: Descriptive study carried out at Camilo Cienfuegos Polyclinic, during 2018. The study included 42 patients aged 18 and over who had an endoscopic diagnosis of peptic ulcer and a histological study result positive for H. pylori infection. The medical records were reviewed and a data collection form was prepared, which included the following variables: age group, sex, clinical manifestations, type of ulcer, number of lesions, active ulcer, and intestinal metaplasia. The mean and standard deviation (SD) were used, and the upper and lower class limits were identified. The percentages were calculated, with confidence interval at 95 percent. The general and specific prevalence of H. pylori infection was estimated by age group and sex. Results: The mean age was 46.7 years ± 12.02 years. The prevalence was 59.5 percent, higher among those over 65 years of age and among men. Conclusions: The study permitted to describe the clinical-epidemiological characteristics of H. pylori infection in patients with an endoscopic diagnosis of peptic ulcer. The presence of dyspeptic syndrome was more frequent, with a single duodenal ulcer in the active phase and no intestinal metaplasia(AU)

Análisis multivariado HJ-Biplot de la ocurrencia de Helicobacter pylori como riesgo para cáncer gástrico, en la ciudadela el Cristo de Consuelo, Milagro Ecuador / HJ-Biplot multivariate analysis of the occurrence of Helicobacter pylori as a risk for gastric cancer, in the citadel of El Cristo de Consuelo, Milagro Ecuador

El Helicobacter pylori, es el causante del mayor número de úlceras y cáncer gástrico a nivel mundial. Población de 15 a 20 años, de escasos recursos y con mayor precariedad en el funcionamiento de los servicios públicos como es el agua potable son altamente vulnerables. Por lo que se planteó como objetivo, realizar un análisis multivariado HJ-Biplot de la ocurrencia de H. pylori como riesgo para cáncer gástrico, en la ciudadela el Cristo de Consuelo, Milagro Ecuador. Estudio epidemiológico transversal, descriptiva y de tipo observacional, contó con una población finita de 230 personas. Técnicas de recolección de datos: la encuesta, la observación directa y la detección de H. pylori en las muestras de heces. El análisis de las muestras biológicas se realizó mediante el método de Elisa en muestras de suero y heces. A los datos obtenidos se les aplicó el método de análisis multivariado bidireccional llamado HJ-Biplot, reflejándose en las variables las relaciones de las composiciones químicas, físicas y biológicas. Los resultados conforman dos grupos de puntos de muestra que coinciden satisfactoriamente con las estaciones de la región. Con este estudio se demuestra que los métodos estadísticos multivariantes son valiosos para interpretar conjuntos de datos complejos, concretamente, para la red de prevalencia de cáncer gástrico causado por el bacilo H. pylori, ha ido en aumento en los últimos años tanto en el Ecuador como en el resto del mundo. Es necesario que se establezcan los mecanismos de control de los agentes causantes de la propagación de este bacilo lo que incidirá en la disminución en la tasa de crecimiento del cáncer gástrico(AU)

Helicobacter pylori is the cause of the highest number of ulcers and gastric cancer worldwide. Population aged 15 to 20 years, with limited resources and with greater precariousness in the operation of public services such as drinking water, are highly vulnerable. Therefore, the objective was to carry out a multivariate HJ-Biplot analysis of the occurrence of H. pylori as a risk for gastric cancer, in the citadel of Cristo de Consuelo, Milagro Ecuador. Cross-sectional, descriptive and observational epidemiological study, had a finite population of 230 people. Data collection techniques: survey, direct observation and detection of H. pylori in stool samples. Analysis of biological samples was performed using the Elisa method in samples of serum and feces. The obtained data were applied the method of bi-directional multivariate analysis called HJ-Biplot, reflecting in the variables the relationships of the chemical, physical and biological compositions. The results form two groups of sample points that successfully coincide with the stations in the region. This study shows that multivariate statistical methods are valuable for interpreting complex data sets, specifically for the prevalence network of gastric cancer caused by the H. pylori bacillus, which has been increasing in recent years both in Ecuador and in the rest of the world. it is necessary to establish the control mechanisms of the agents that cause the spread of this bacillus, which will affect the decrease in the growth rate of gastric cáncer(AU)

Gênero, idade, achados endoscópicos, urease e Helicobacter pylori: ausência de correlação dentro de uma amostra de população com alta prevalência de câncer gástrico na Amazônia / Gender, age, endoscopic findings, urease and helicobacter pylori: all uncorrelated within a sample of a high gastric cancer prevalence population in amazon

ABSTRACT BACKGROUND: It is widely assumed that gender, age, gastritis and Helicobacter pylori , all have some degree of correlation and, therefore, can synergistically lead to the development of gastric cancer. OBJECTIVE: In this cross-sectional study, we expected to observe the above mentioned correlation in the analysis of medical records of 67 patients of both sexes (female, n=44), mean age ± standard deviation: 41±12 years old, all from Belém (capital of Pará State, Brazilian Amazon), a city historically known as one with the highest gastric cancer prevalence in this country. METHODS: All patients were submitted to upper gastrointestinal endoscopy for gastric biopsy histopathological analysis and rapid urease test. All diagnoses of gastritis were recorded considering its topography, category and the degree of inflammatory activity, being associated or not associated with H. pylori infection. RESULTS: The results show that no statistically relevant associations were found among the prevalences of the observed variables. CONCLUSION: The authors hypothesize that observed risk factors associated to gastric cancer might be lesser synergistic than is usually expected.

RESUMO CONTEXTO: É amplamente assumido que gênero, idade, gastrite e Helicobacter pylori , todos têm algum grau de correlação e, portanto, podem sinergicamente levar ao desenvolvimento de câncer gástrico. OBJETIVO: Neste estudo transversal, esperamos observar a correlação acima mencionada na análise de prontuários de 67 pacientes de ambos os sexos (sexo feminino, n=44), média de idade ± desvio padrão: 41±12 anos, todos de Belém (capital do Estado do Pará, Amazônia Brasileira), uma cidade historicamente conhecida como sendo uma das que apresenta maior prevalência de câncer gástrico no país. MÉTODOS: Todos os pacientes foram submetidos à endoscopia digestiva alta para análise histopatológica da biópsia gástrica e teste rápido da urease. Todos os diagnósticos de gastrite foram registrados considerando sua topografia, categoria e grau de atividade inflamatória, sendo associada ou não associada à infecção por H. pylori . RESULTADOS: Os resultados mostram que não foram encontradas associações estatisticamente relevantes entre as prevalências das variáveis observadas. CONCLUSÃO: Os autores levantam a hipótese de que os fatores de risco associados ao câncer gástrico podem ser menos sinérgicos do que o esperado.

Mutaciones del gen ARN ribosómico 23S de Helicobacter pylori asociadas con resistencia a claritromicina en pacientes atendidos en una unidad de endoscopia de Medellín, Colombia / Mutations in the Helicobacter pylori 23S rRNA gene associated with clarithromycin resistance in patients at an endoscopy unit in Medellín, Colombia

Resumen Introducción. La claritromicina es el antibiótico de primera línea para el tratamiento de la infección por Helicobacter pylori. La resistencia bacteriana se produce principalmente por mutaciones puntuales del gen ARN ribosómico 23S (ARNr 23S). Objetivo. Determinar la frecuencia de las mutaciones puntuales A2143G y A2142G del gen ARNr 23S asociadas con la resistencia de H. pylori a la claritromicina en muestras de pacientes con manifestaciones dispépticas en Medellín, región noroccidental de Colombia. Materiales y métodos. Se extrajo ADN a partir de muestras de biopsia gástrica obtenidas de pacientes con manifestaciones dispépticas atendidos en una unidad de endoscopia entre el 2016 y el 2017. Mediante reacción en cadena de la polimerasa (PCR), se amplificaron las regiones s y m del gen vacA y una región del gen ARNr 23S bacteriano. La presencia de las mutaciones A2142G y A2143G se determinó por la técnica de polimorfismos de longitud de fragmentos de restricción (RFLP) con las enzimas BbsI y BsaI, respectivamente. Resultados. Se encontró una prevalencia de infección de 44,2 % (175/396), según el informe de histopatología. En 143 de estas 175 muestras positivas se amplificaron las tres regiones del genoma bacteriano. Se identificaron las mutaciones A2143G y A2142G en 27 muestras (18,8 %; 27/143), la mutación más frecuente fue la A2143G (81,5 %; 22/27). Conclusiones. Hubo una gran prevalencia de mutaciones asociadas con la resistencia de H. pylori a la claritromicina en la población de estudio. Se requieren estudios adicionales para establecer la resistencia bacteriana en la población colombiana y, así, determinar los tratamientos de primera línea y de rescate.

Abstract Introduction: Clarithromycin is the first-line antibiotic for the treatment of Helicobacter pylori infection. Bacterial resistance is mainly due to the presence of specific mutations in the 23S ribosomal RNA (rRNA) gene. Objective: To determine the frequency of A2143G and A2142G specific mutations in the 23S rRNA gene associated with clarithromycin resistance of H. pylori in samples from patients with dyspeptic manifestations in Medellín, northwestern Colombia. Materials and methods: DNA was extracted from gastric biopsy samples of patients with dyspeptic manifestations seen at an endoscopy unit in Medellín between 2016 and 2017. PCR was performed to amplify the bacterial s and m vacA regions, and a region in the 23S rRNA gene. The presence of the A2142G and A2143G mutations was determined using the restriction fragment length polymorphism (RFLP) technique with the BbsI and BsaI enzymes, respectively. Results: The prevalence of infection was 44.2% (175/396), according to the histopathology report. The positive samples were analyzed and the three regions of the bacterial genome were amplified in 143 of the 175 samples. The A2143G and A2142G mutations were identified in 27 samples (18.8%, 27/143). The most frequent mutation was A2143G (81.5%, 22/27). Conclusions: We found a high prevalence of H. pylori mutations associated with clarithromycin resistance in the study population. Further studies are required to determine the bacterial resistance in the Colombian population in order to define first line and rescue treatments.

La microbiota según la topografía gástrica en pacientes con bajo y con alto riesgo de cáncer gástrico en Nariño, Colombia / Microbiota according to gastric topography in patients with low or high risk of gastric cancer in Nariño, Colombia

Resumen Introducción. La inflamación del antro gástrico por Helicobacter pylori aumenta el riesgo de úlcera duodenal, y la del cuerpo gástrico puede producir gastritis atrófica e incrementar la probabilidad de cáncer gástrico. Estas reacciones inflamatorias diferenciadas según su localización, podrían explicarse por la composición de la microbiota gástrica asociada con H. pylori. Objetivo. Identificar y comparar la microbiota del antro y del cuerpo del estómago en individuos de dos poblaciones: una con alto riesgo y otra con bajo riesgo de cáncer gástrico en Nariño, Colombia. Materiales y métodos. Se incluyeron biopsias del cuerpo y el antro gástrico de pacientes con gastritis no atrófica o con gastritis atrófica y metaplasia. La microbiota se definió por secuenciación de la región V3-V4 del gen 16S del ARNr de H. pylori (illumina-MiSeq™). Las unidades taxonómicas operativas se clasificaron utilizando las bases de datos BLASTn y RDPII. Las diferencias entre las poblaciones microbianas del antro y del cuerpo gástrico se evaluaron mediante el análisis de varianza multivariado con base en permutaciones (Permutational Multivariate Analysis of Variance, PERMANOVA) y análisis multivariados. Resultados. La clase Epsilonproteobacteria representada por H. pylori fue más abundante en las biopsias del antro y del cuerpo de los individuos con gastritis no atrófica (>50 %), en tanto que, en los individuos con gastritis no atrófica, esta clase correspondió al 20 % con una mayor diversidad metagenómica. La infección por H. pylori disminuyó significativamente la diversidad metagenómica del antro (p=0,005), en comparación con la del cuerpo gástrico. Conclusiones. Los grupos bacterianos involucrados en la disbacteriosis pueden colonizar ambas regiones topográficas del estómago, independientemente de las reacciones sectorizadas de inflamación. La infección por H. pylori asociada con la microbiota gástrica está relacionada con su localización en el estómago, el tipo de lesión y el mayor o menor riesgo de cáncer gástrico, lo que sugiere su importancia en la disbacteriosis y la de esta en la enfermedad gástrica.

Abstract Introduction: Inflammation in the gastric antrum caused by Helicobacter pylori increases the risk of duodenal ulcer while inflammation in the body generates atrophic gastritis and increased risk of gastric cancer. These inflammatory responses according to gastric topography could be explained by the composition of the gastric microbiota associated with H. pylori. Objective: To identify and compare the microbiota of the gastric antrum and body of individuals from two populations, one with high risk and one with low risk of gastric cancer from Nariño, Colombia. Materials and methods: Biopsies of the gastric antrum and body of patients with non-atrophic gastritis or metaplastic atrophic gastritis were included. The microbiota was defined by sequencing the 16S rRNA gene, V3-V4 region, (illumina-MiSeq™). The operational taxonomic units were classified using the BLASTn and RDPII databases. The differences among microbial populations were evaluated with the PERMANOVA and multivariate analyses. Results: The Epsilonproteobacteria class represented by H. pylori was more abundant in the antrum and body biopsies of individuals with metaplastic atrophic gastritis (>50%) while in individuals with non-atrophic gastritis it was 20 % and had greater metagenomic diversity. Helicobacter pylori infection significantly decreases the metagenomic diversity of the gastric antrum (p=0.005) compared to that of the body. Conclusions: The bacterial groups involved in the dysbiosis can colonize both topographic regions of the stomach, regardless of the sectorized inflammation responses. Helicobacter pylori infection associated with the gastric microbiota is related to its localization in the stomach, the type of lesion, and the population at risk of gastric cancer, which suggests its importance in microbial dysbiosis and gastric disease.

Nuevos retos en el tratamiento de la infección por helicobacter pylori / New challenges in the treatment of the infection for helicobacter pylori

RESUMEN La infección por helicobacter pylori afecta aproximadamente al 50% de la población mundial, es causante de gastritis crónica, úlcera péptica, cáncer gástrico y linfoma del tejido linfoide asociado a la mucosa. Desde su descubrimiento, la erradicación ha sido uno de los más importantes retos en Gastroenterología. En muchos países se desconoce la prevalencia de resistencia primaria del microorganismo a los diferentes antibióticos que empíricamente se utilizan, y por no realizar pruebas de rutina que verifican su erradicación en la práctica diaria, se ignora la efectividad de los esquemas prescritos. El incremento progresivo de la resistencia a la claritromicina y metronidazol, unido a una ausencia de antibioticoterapia alternativa, desafía la capacidad para eliminar de manera efectiva a ésta bacteria. El subcitrato de bismuto ha resurgido y su adición en la terapia ha permitido aumentar las tasas de curación por encima del 90%. Actualmente se invoca que para mejorar la eficacia en el tratamiento se debe combinar una supresión potente del ácido gástrico en tratamientos combinados cuádruples con una duración de 14 días, para la mayoría de los casos. La adherencia al tratamiento es crucial para obtener buenos resultados terapéuticos.

ABSTRACT The infection for helicobacter pylori affects approximately to the world population's 50%, it is causing of chronic gastritis, peptic ulcer, gastric cancer and linfoma associated to the mucous one. From their discovery, the eradication has been one of the most important challenges in Gastroenterología. In many countries the prevalencia of primary resistance is ignored from the microorganism to the different antibiotics that empirically they are used, and for not carrying out routine tests that verify its eradication in the daily practice, the effectiveness of the prescribed outlines it is ignored. The progressive increment of the resistance to the claritromicina and metronidazol, together to an absence of alternative antibioticotherapy, challenges the capacity to eliminate from an effective way to this bacteria. The bismuth subcitrato has resurged and its addition in the therapy has allowed to increase the cure rates above 90%. At the moment it is invoked that to improve the effectiveness in the treatment, that is should combine a potent suppression of the gastric acid in combined quadruple treatments with a duration of 14 days, for most of the cases. The adherence to the treatment is crucial to obtain therapeutic good results.

Susceptibilidad antimicrobiana y mutaciones en el gen ARNr 23S de Helicobacter pylori en pacientes dispépticos / Antimicrobial susceptibility and mutations in the 23S rRNA gen of Helicobacter pylori in dyspeptic patients

RESUMEN Con el objetivo de evaluar la susceptibilidad antimicrobiana y detectar mutaciones puntuales en el gen ARNr 23S en cepas de Helicobacter pylori se realizó un estudio transversal que incluyó a 95 pacientes con dispepsia atendidos en una clínica privada de Lima. Mediante endoscopía se colectaron biopsias de antro para el aislamiento de cepas de Helicobacter pylori para la evaluación de la susceptibilidad antimicrobiana empleando la técnica de microdilución en caldo. La detección de mutaciones puntuales se desarrolló mediante PCR-RFLP. El porcentaje de infección por Helicobacter pylori fue de 46,3%, se observaron valores de resistencia de 52,3% a claritromicina, 29,6% a metronidazol, 45,5% a levofloxacino y 4,6% a amoxicilina. El porcentaje de mutaciones puntuales A2142G y A2143G asociados a resistencia a claritromicina fue 43,5%. En conclusión, encontramos que las tasas de resistencia antimicrobiana y el porcentaje de cepas de Helicobacter pylori circulantes en una clínica privada de Lima fueron elevadas.

ABSTRACT In order to evaluate antimicrobial susceptibility and detect specific mutations in the 23S rRNA gene in Helicobacter pylori strains, a cross-sectional study was performed on 95 patients with dyspepsia treated in a private clinic in Lima. Antrum biopsies were collected by endoscopy for isolation and evaluation of antimicrobial susceptibility using the broth microdilution method. The detection of specific mutations was developed by PCR-RFLP. The percentage of infection by Helicobacter pylori was 46.3%. Resistance values of 52.3% to clarithromycin, 29.6% to metronidazole, 45.5% to levofloxacin, and 4.6% to amoxicillin were observed. The percentage of specific A2142G and A2143G mutations associated with clarithromycin resistance was 43.5%. In conclusion, we found that antimicrobial resistance rates and the percentage of Helicobacter pylori strains circulating in a private clinic in Lima were high.

Helicobacter pylori: resistencia múltiple en pacientes de Bogotá, Colombia / Helicobacter pylori: Multiple resistance in patients from Bogotá, Colombia

Resumen Introducción. La resistencia a los antibióticos es la principal causa del fracaso del tratamiento contra Helicobacter pylori; la claritromicina y el metronidazol son los antibióticos que generan mayor resistencia. En Colombia, la resistencia primaria a estos dos antibióticos y el uso excesivo de levofloxacina han alcanzado los límites aceptados (13,6, 83 y 16 %, respectivamente). A pesar de ello, se usa el tratamiento empírico combinando estos antibióticos en pacientes en los que ha fallado anteriormente. Objetivo. Determinar la resistencia a los antibióticos en pacientes previamente tratados para H. pylori en Bogotá, Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo en el que se evaluó mediante dilución en agar la resistencia a la amoxicilina, la claritromicina, la levofloxacina y el metronidazol en 10 aislamientos provenientes de 5 pacientes con tres o cuatro tratamientos fallidos para H. pylori. La resistencia a los antibióticos se confirmó mediante secuenciación de ADN (Magrogen, Korea). Resultados. Ocho de los aislamientos presentaron resistencia a dos o más antibióticos y todos fueron resistentes a la levofloxacina. Los patrones de sensibilidad de los aislamientos provenientes del antro pilórico y del cuerpo del estómago, fueron diferentes en tres de los pacientes. Conclusión. Hasta donde se sabe, esta es la primera evidencia de resistencia múltiple de H. pylori en Colombia en pacientes previamente tratados. Los resultados evidenciaron las consecuencias del uso de un esquema ineficaz de tratamiento antibiótico y la necesidad de evaluar la sensibilidad a los antibióticos en diferentes sitios anatómicos del estómago. La resistencia múltiple limita el número de antibióticos útiles para erradicar H. pylori.

Abstract Introduction: The main cause for Helicobacter pylori infection treatment failure is antibiotic resistance, where clarithromycin and metronidazole play the main role. In Colombia, primary resistance as a consequence of the use of these two antibiotics and excessive levofloxacin use is above the accepted limit (13.6%, 83%, and 16%, respectively). Despite this fact, empirical therapies that include the combination of these antibiotics are used in patients with previous therapeutic failure. Objective: To determine antibiotic resistance in patients previously treated for H. pylori in Bogotá, Colombia. Materials and methods: We conducted a descriptive study that included ten isolates obtained from five patients with three or four previous failed treatments for H. pylori. Antibiotic resistance to amoxicillin, clarithromycin, levofloxacin, and metronidazole was investigated by agar dilution and confirmed by DNA sequencing (Magrogen, Korea). Results: Eight isolates were resistant to two or more antibiotics. All isolates were resistant to levofloxacin. Susceptibility patterns in isolates from the gastric antrum and the body of the stomach were different in three patients. Conclusion: As far as we know, this is the first evidence of multiple H. pylori resistance in Colombia in previously treated patients. Results demonstrated the consequences of using an ineffective antibiotic scheme and the need to assess antibiotic susceptibility in different anatomical sites of the stomach. The consequences of multiple resistance decrease possible antibiotic effectiveness to eradicate H. pylori in the future.

Prevalencia de tipos histológicos de pólipos gástricos en pacientes adultos de un hospital público de Lima-Perú, en el periodo 2007 al 2016 / Prevalence of histological types of gastric polyps in adult patients from a public hospital in Lima-Peru (2007 - 2016)

Objetivos: Determinar la prevalencia de pólipos gástricos detectados mediante endoscopía digestiva alta, en pacientes mayores de 18 años del Hospital Cayetano Heredia, en el periodo 2007-2016. Materiales y métodos: Estudio retrospectivo de corte transversal, realizado con datos de biopsias gástricas de pacientes sometidos a endoscopía digestiva alta entre enero de 2007 y julio de 2016. Se evaluó cambios histológicos asociados, datos demográficos y características endoscópicas, las cuales fueron sometidas a análisis estadístico mediante STATA v14.2. Resultados: En una población de 16 552 endoscopías realizadas, se encontró 407 biopsias compatibles con pólipos gástricos, lo cual da una prevalencia de 2,5%. Los pólipos gástricos fueron más frecuentes en mujeres (62,38%). La mediana de edad fue de 61 años (52-71 años). El tipo histológico más frecuente fue el pólipo glandular fúndico (PGF) (44,85%), seguido de pólipo hiperplásico (38,48%) y adenomatoso (15,23%). La localización más frecuente fue en fondo/cuerpo (48,65%, p=0,001) Se detectó la presencia de Helicobacter pylori (Hp) en el 30,6% de las biopsias compatibles con pólipos. Conclusión: La prevalencia de pólipos gástricos es similar con otras regiones del mundo; los PGF e hiperplásicos son los más frecuentes. Los pólipos adenomatosos estuvieron en mayor relación a cambios como metaplasia y displasia.

Objectives: Establish the prevalence of gastric polyps detected by upper gastrointestinal endoscopy in patients older than 18 years old during the period from 2007 - 2016 in Cayetano Heredia Hospital. Materials and methods: Retrospective cross- sectional study, performed with data from the gastric biopsies reports of patients that have undergone upper gastrointestinal endoscopy between January 2007 and July 2016. Demographic data, endoscopic characteristics of the polyps and associated histological changes of the surrounding gastric mucosa were evaluated, which were subjected to statistical analysis using STATA v14.2. Results: In a population of 16 552 endoscopies, 407 gastric polyps biopsies were found. These results give a prevalence of 2.5% .Gastric polyps were detected predominantly in women (62.38%). The median age was 61 years (52-71 years). The most frequent histological type was the fundic gland polyp (FGP) (44.85%), followed by the hyperplastic (38.48%) and adenomatous (15.23%) polyp. The most frequent location was in the fundus / corpus (48.65%, p = 0.001). The presence of Hp was detected in 30.6% of the biopsies with polyps. Conclusion: The prevalence of gastric polyps is similar to other regions of the world; PGF and hyperplastic are the most frequent. Adenomatous polyps showed a greater relationship with and metaplasia and dysplasia.

Helicobacter pylori: qué debemos saber en el año 2018. Revisión de la evidencia y nuevas recomendaciones de tratamiento / Helicobacter pylori: what should we know in the year 2018. Review of the evidence and new treatment recommendations

Helicobacter pylori (HP) is the most widely chronic human infection around the world, and the main risk factor for the development of gastric cancer. Our country has high rates of this neoplasia and a high prevalence of HP infection. Even both have fallen in the last year, is a major concern to diagnose the population infected with HP in early stages, before the development of premalignant lesions and properly eradicate this infection. In this review, we discussed the different methods for the diagnosis of HP and factors that change positivity as the use of proton pump inhibitors. Also, we discussed the factors to be considered in the choice of the treatment, like local resistance to antibiotics, specially clarithromycin. In the last years has been documented in Chile a significant increase in resistance to clarithromycin, from 20 to 46%, which predicts inadequate effectiveness for the classic triple therapy. As the result of the previous analysis we discussed new possible therapies, including bismuth quadruple therapy and concomitant therapy. (AU)

Caracterización de la infección por Helicobacter pylori en niños y adolescentes en un servicio ambulatorio / Characterization of Helicobacter pylori infection in children and adolescents in an ambulatory service

Introducción: la infección por Helicobacter pylori es muy común, particularmente en los países en vías de desarrollo, y juega un rol importante en la enfermedad ácido péptica. Objetivos: conocer la prevalencia y algunos datos clínico epidemiológicos, describir los hallazgos endoscópicos (gastritis eritematosa, nodular y úlcera duodenal), y relacionarlos con los hallazgos histológicos; describir la asociación entre los grados histológicos de la gastritis crónica y la positividad de la prueba de ureasa rápida y la presencia de Helicobacter pylori según histología, así como identificar la relación de los pacientes con gastritis crónica antral y úlcera duodenal por Hp, con la edad. Métodos: se realizó un estudio tipo descriptivo prospectivo durante 3 años se hizo una encuesta de síntomas a pacientes y/o padres y examen físico. Se realizó panendoscopia, previo consentimiento informado, y 2 biopsias de mucosa antral para prueba de ureasa rápida, así como estudio histopatológico (hematoxilina-eosina y Giemsa) para determinar el grado de gastritis y presencia de Helicobacter pylori según sistema Sydney. Se demostró la infección por uno de los métodos. Resultados: se seleccionaron 196 pacientes entre 7-18 años (media 14,6) de 471 (41,6 por ciento). El 53 por ciento era del sexo femenino, y el 59,7 por ciento tenía entre 10 y 14 años. Por endoscopia, el 49,5 por ciento tenía gastritis eritematosa antral, el 36,8 por ciento gastritis nodular astral, y el 13,7 por ciento úlcera duodenal con gastritis asociada. Con antecedentes familiares de úlcera péptica estuvo el 29,6 por ciento, con epigastralgia el 85,2 por ciento, con acidez el 46,4 por ciento con vómitos el 21 por ciento y con náuseas el 16,3 por ciento. En relación con el tiempo de evolución al diagnóstico, predominó el grupo de más de un año (24,5 por ciento), seguido del de 4-6 meses (22,4 por ciento). Todos presentaron gastritis crónica de diferentes grados: ligera (34,7 por ciento), moderada (37,2 por ciento) y severa (28,1 por ciento), con Helicobacter pylori por ureasa rápida 83,2 por ciento y 93,4 por ciento por histología, con coincidencia de ambos métodos en 150 (76,5 por ciento). Se observó presencia de nódulos linfoides en 41,8 por ciento. Conclusiones: la infección por Helicobacter pylori es frecuente en niños y adolescentes, causa lesiones inflamatorias gastroduodenales, en particular, gastritis nodular antral. Se encuentra una asociación importante del Helicobacter pylori por ambos métodos diagnósticos. Se recomienda seguimiento por biopsia, en especial, a los que continúan con infección crónica y presenten nódulos linfoides, por el riesgo de presentar linfoma gástrico de células B del tejido linfoide asociado a mucosa (linfoma MALT), si no se consigue la erradicación del Helicobacter pylori(AU)

Introduction: Helicobacter pylori infection is very common, particularly in developing countries, and plays an important role in acid peptic disease. Objectives: to know the prevalence and some clinical epidemiological data for describing the endoscopic findings (erythematous gastritis, nodular and duodenal ulcer), and to relate them with the histological findings; to describe the association among the histological degrees of chronic gastritis and the positivity of the rapid urease test, and the presence of Helicobacter pylori according to histology, as well as identifying by Hp with age the number of patients with chronic antral gastritis and duodenal ulcer. Methods: a prospective, descriptive study was carried out during 3 years, and a survey of symptoms was made to patients and / or parents and also physical examination. Panendoscopy was performed with prior informed consent, and also 2 antral mucosa biopsies for rapid urease test, as well as histopathological study (hematoxylin-eosin and Giemsa) to determine the degree of gastritis and the presence of Helicobacter pylori according to the Sydney system. Infection was demonstrated by one of the methods. Results: 196 patients among 7-18 years (mean 14.6) were selected of 471 (41.6 percent). 53 percent were female, and 59.7 percent were among 10 and 14 years old. By endoscopy, 49.5 percent had antral erythematous gastritis, 36.8 percent astral nodular gastritis, and 13.7 percent duodenal ulcer with associated gastritis. 29.6 percent had a family history of peptic ulcer, 85.2 percent of epigastralgia, 46.4 percent with acidity, 21 percent with vomiting, and 16.3 percent with nausea. In relation to the time of evolution to the diagnosis, the group of more than one year prevailed (24.5 percent followed by the one of 4-6 months (22.4 percent). All presented chronic gastritis of different degrees: light (34.7 percent), moderate (37.2 percent) and severe (28.1 percent), with Helicobacter pylori by rapid urease 83.2 percent, and 93.4 percent by histology with coincidence of both methods in 150 (76.5 percent). The presence of lymphoid nodules was observed in 41.8 percent. Conclusions: Helicobacter pylori infection is frequent in children and adolescents causing gastroduodenal inflammatory lesions, in particular antral nodular gastritis. An important association of Helicobacter pylori is found by both diagnostic methods. Follow-up by biopsy is recommended, especially those who continue with chronic infection and have lymphoid nodules due to the risk of presenting B-cell gastric lymphoma of the lymphoid tissue associated to the mucosa (MALT lymphoma), if Helicobacter pylori eradication is not achieved(AU)

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.

Asociación clínica, patológica y microbiológica de Helicobacter pylori en biopsias gástricas en el departamento de Caldas-Colombia / Clinical, pathological and microbiological association of Helicobacter pylori in gastric biopsies in the department of Caldas-Colombia

Objectivo: Establecer la asociación clínica, patológica y microbiológica de Helicobacter pylori en biopsias gástricas en una población del departamento de Caldas (Colombia). Materiales y método: Se incluyeron 72 pacientes que fueron remitidos para endoscopia digestiva a la clínica San Marcel de la ciudad de Manizales durante el segundo semestre de 2015; a quienes se les tomaron dos biopsias del antro y dos del cuerpo del estómago para estudio histopatológico y cultivo microbiológico. Los datos fueron sometidos a procedimientos estadísticos descriptivos y relacionales. Resultados: se encontró una proporción de H. pylori del 47,2% por análisis histológico y del 26,4% por cultivo microbiológico, con predominio del sexo femenino. Siendo la epigastralgia el principal motivo de consulta asociado a la infección por H. pylori. Conclusión: se encontró asociación entre motivo de consulta, sexo femenino, cultivo microbiológico y presencia histológica de H. pylori. La edad se asoció al diagnóstico endoscópico establecido. El cultivo presentó frente al hallazgo histopatológico una especificidad elevada (84,2%) y una baja sensibilidad (38,2%).

Objective: To establish the clinical, pathological and microbiological association of Helicobacter pylori in gastric biopsies in a population of the department of Caldas (Colombia). Materials and methods: We included 72 patients, who were referred for digestive endoscopy to the San Marcel clinic in the city of Manizales during the second half of 2015; two biopsies of the antrum and two of the body of the stomach were taken for histopathological study and microbiological culture. Data were submitted to descriptive and relational statistical procedures. Results: H. pylori was found in 47.2% by histological analysis and 26.4% by microbiological culture, with predominance in the female sex. Epigastralgia is the main reason for consultation associated with H. pylori infection. Conclusion: we found an association between the reason for consultation, female sex, microbiological culture and histological presence of H. pylori. Age was associated with established endoscopic diagnosis. The culture presented a high specificity (84.2%) and a low sensitivity (38.2%), compared to the histopathological finding.

Cáncer gástrico: algunas consideraciones sobre factores de riesgo y Helicobacter pylori / Gastric cancer: some considerations on risk factors and Helicobacter

RESUMEN La Organización Mundial de la Salud señala que el cáncer gástrico es una neoplasia frecuente en el mundo contemporáneo. Constituye la segunda causa de muerte en el hombre y la tercera en las mujeres. Numerosos son los factores de riesgo que se asocian con la aparición del cáncer gástrico, en determinadas regiones del mundo. El descubrimiento del Helicobacter pylori y la asociación con las enfermedades gastroduodenales ha revolucionado los aspectos fisiopatológicos y terapéuticos hasta el punto de considerar la bacteria como agente precursor del cáncer gástrico. Por tal motivo se realizó una revisión de los factores de riesgo y el papel del Helicobacter pylori en la formación de la neoplasia gástrica, con el objetivo de aportar conocimientos relacionados con el cáncer gástrico y su prevención (AU).

ABSTRACT The World Health Organization points out that gastric cancer is a frequent neoplasia in the contemporary world. It is the second cause of death in men and the third one in women. There are several risk factors associated to the development of gastric cancer in specific regions of the world. The discovery of Helicobacter pylori and its association to gastro duodenal diseases has renewed the physiopathological and therapeutic aspects up to the point of considering the bacteria as precursor agent of gastric cancer. For that cause, it was carried out a review of the risk factors and the role of Helicobacter pylori in the formation of gastric neoplasia, with the objective of giving out knowledge related to gastric cancer and its prevention (AU).

Upper gastrointestinal endoscopy applied in pediatrics: endoscopic and histological findings, including Helicobacter pylori / Endoscopia digestiva alta aplicada em pediatria: hallazgos endoscópicos e histológicos incluyendo al Helicobacter pylory

Objective: To present and discuss the endoscopic and histological results, as well as the incidence of Helicobacter pylori and other diseases, indications and characteristics of upper digestive endoscopies performed in children. Material and methods: Twenty-five endoscopies were performed in children aged six months to 11 years (mean 7.69 years), from February 2013 to January 2016. In 200 patients, endoscopies were diagnostic and serial biopsies were performed (esophagus, stomach and duodenum), in 120 of them. Results: The indication of endoscopy was diagnosed in 88.89% of the patients, and in 26 patients, a therapeutic procedure was performed. The most frequent endoscopic findings were esophagitis in 49 patients, gastritis in 84 and duodenitis in 16 patients. Four duodenal ulcers were diagnosed. In the therapeutic endoscopies, six gastrostomies were performed, 14 foreign body withdrawals, five nasoenteral tube passages and esophageal dilatation. The H. pylori survey was performed by anatomopathological method and was positive in 26 (13%) of the 200 patients in whom it was searched. Conclusion: pediatric endoscopy is an important niche of the digestive endoscopy, where it is important to emphasize the relevance of the institutional structure that performs these procedures, in order to conduct them safely, being able to treat possible and feasible complications

Objetivo: Presentar y discutir los hallazgos endoscópicos e histológicos, así como la incidencia de Helicobacter pylori y otras enfermedades, indicaciones y características de endoscopia digestiva alta realizada en niños. Material y métodos: Fueron realizadas 225 endoscopias en niños de seis meses a 11 años (media de 7,69 años) a partir de febrero de 2013 hasta enero de 2016. En 200 pacientes, en las endoscopias diagnósticas se llevan a cabo biopsias seriadas (esófago, estómago y duodeno) en 120 de ellos. Resultados: La indicación de endoscopia fue diagnóstica en el 88,89% de los pacientes y en 26 pacientes se realizaron un procedimiento terapéutico. Los hallazgos endoscópicos más frecuentes fueron esofagitis en 49 pacientes, gastritis y duodenitis 84 y en 16 pacientes se diagnosticaron cuatro úlceras duodenales. En endoscopias terapéuticas fueron realizadas seis gastrostomías, catorce extracciones de cuerpos extraños, cinco pasajes de sonda nasogástrica y una dilatación esofágica. El estudio de H. pylori se realizó por el método histopatológico y fué positivo en 26 (13%) de 200 pacientes en los que se han buscado. Conclusión: La endoscopía pediátrica es un nicho importante de la endoscopía digestiva donde es importante enfatizar la relevancia de la estructura institucional que realiza estos procedimientos para conducirlos con seguridad y ser capaces de tratar las complicaciones posibles