Predictive features for histology of gastric subepithelial lesions / Fatores preditivos da histologia nas lesões subepiteliais gástricas

ABSTRACT BACKGROUND Gastric subepithelial lesion is a relatively common diagnosis after routine upper endoscopy. The diagnostic workup of an undetermined gastric subepithelial lesion should take into consideration clinical and endoscopic features. OBJECTIVE We aimed to investigate the association between patients' characteristics, endoscopic and echographic features with the histologic diagnosis of the gastric subepithelial lesions. METHODS This is a retrospective study with 55 patients, who were consecutively diagnosed with gastric subepithelial lesions, from October 2008 to August 2011. Patients' characteristics, endoscopic and echografic features of each gastric subepithelial lesion were analysed. Histologic diagnosis provided by EUS-guided fine needle aspiration or endoscopic/surgical resection was used as gold standard. RESULTS The probability of gastrointestinal stromal tumors to be located in the cardia was low (4.5%), while for leiomyoma it was high (>95%). In addition, there was a higher risk of gastrointestinal stromal tumors in patients older than 57 years (OR 8.9; 95% CI), with lesions ≥21 mm (OR 7.15; 95% CI), located at 4th layer (OR 18.8; 95% CI), with positive Doppler sign (OR 9; 95% CI), and irregular outer border (OR 7.75; 95% CI). CONCLUSION The location of gastric subepithelial lesions in the gastric cardia lowers the risk of gastrointestinal stromal tumors. While gastric subepithelial lesions occurring in elderly patients, located in the gastric body, with positive Doppler signal and irregular outer border increase the risk of gastrointestinal stromal tumors.

RESUMO CONTEXTO O diagnóstico das lesões subepiteliais gástricas é relativamente comum após a endoscopia digestiva alta de rotina. A posterior investigação diagnóstica de uma lesão subepitelial gástrica indeterminada deve levar em consideração os aspectos clínicos e endoscópicos. OBJETIVO O objetivo foi avaliar a associação entre as características particulares dos pacientes, endoscópicas e ecográficas dos casos de lesões subepiteliais gástricas com os seus diagnósticos histológicos finais. MÉTODOS Estudo retrospectivo com 55 pacientes, consecutivamente diagnosticados com lesão subepitelial gástrica de outubro de 2008 a agosto de 2011. As características do paciente, endoscópica e ecográfica de cada caso com lesão subepitelial gástrica foram analisadas. O diagnóstico histológico fornecido pela punção aspirativa com agulha fina guiada por ecoendoscopia e/ou a ressecção endoscópica/cirúrgica foram utilizadas como padrão-ouro. RESULTADOS A probabilidade de tumor estromal gastrintestinal ser localizado na cárdia foi baixa (4,5%), enquanto que para o leiomioma foi elevada (>95%). Além disso, houve um maior risco de tumor estromal gastrintestinal em pacientes acima de 57 anos (OR 8,9; IC 95%), com lesão ≥21 mm (OR 7,15; IC 95%), localizada na 4ª camada (OR 18,8; IC 95%), com sinal positivo no Doppler (OR 9; IC 95%), e borda externa irregular (OR 7,75; IC 95%). CONCLUSÃO A localização de uma lesão subepitelial gástrica na cárdia reduz o risco de tumor estromal gastrintestinal. Enquanto que lesões subepiteliais gástricas que ocorrem em pacientes idosos, localizadas no corpo gástrico, com sinal positivo no Doppler e com borda externa irregular aumentam significativamente o risco de tumor estromal gastrintestinal.

Amiloidosis por cadenas livianas de inmunoglobulina con compromiso gástrico al debut: revisión de la literatura basada en un caso clínico / Gastric AL amyloidosis as initial manifestation: literature review from a case report

Systemic amyloidosis comprises a group of diseases characterized by low molecular weight subunit protein deposit in organs, including the gastrointestinal tract. The most frequent clinical manifestations are gastrointestinal bleeding, malabsorption syndrome, protein-losing enteropathy and chronic intestinal dysmotility. The diagnosis is confirmed with gastrointestinal tissue biopsy positive to Congo red stain or recognizing the amyloid fibrils by electron microscopy. The treatment is based in the management of gastrointestinal symptoms and chemotherapeutic drugs, including melphalan and prednisone or cyclophosphamide, bortezomib and prednisone. The bone marrow transplant is reserved for 70-year-old patients or younger without advanced comorbidities. We present a case of a patient with weight loss, anorexia, nausea and early satiety.

La amiloidosis sistémica a un conjunto de enfermedades caracterizadas por el depósito de subunidades fibrilares proteicas de bajo peso molecular en órganos, incluyendo el sistema digestivo. Sus manifestaciones clínicas más frecuentes son la hemorragia digestiva, síndrome malabsortivo, gastro-enteropatía perdedora de proteínas y dismotilidad gastrointestinal crónica. El diagnóstico se confirma con una biopsia de tejido gastrointestinal positiva a tinción rojo Congo o la visualización de fibrillas de amiloide mediante microscopia electrónica. El tratamiento está basado el manejo de los síntomas gastrointestinales y el oncológico, donde destacan esquemas quimioterapéuticos que incluyen melfalan y prednisona o ciclofosfamida, bortezomib y prednisona. El trasplante de médula ósea está reservado a pacientes menores de 70 años sin comorbilidades avanzadas. Presentamos en este artículo el caso de un paciente con baja de peso, anorexia, náuseas y saciedad precoz.

Rendu-Osler-Weber syndrome: dermatological approach

The Rendu-Osler-Weber syndrome is a rare systemic fibrovascular dysplasia, recognized by mucocutaneous telangiectasias, arteriovenous malformations, epistaxis and family history. Recurrent bleeding, hypoxemia, congestive heart failure, portosystemic encephalopathy, and symptoms related to angiodysplasia of the central nervous system may occur. Since the treatment is based on supportive measures, early recognition is of utmost importance. This article reports the case of a 53-year-old male patient who presented telangiectasias on fingers, oral cavity and nasal mucosa for 10 years, with a history of recurrent epistaxis of varying severity since childhood. Mother, sister and daughter have similar lesions.

Endoscopic and iistopathologic gastric changes in chronic users of proton-pump inhibitors / Alterações endoscópicas e histopatológicas gástricas em pacientes usuários crônicos de inibidores de bomba de prótons

Background Proton-pump inhibitors have been used for at least two decades. They are among the most commonly sold drugs in the world. However, some controversy remains about the indications for their use and the consequences of their prolonged use. Objectives To evaluate and compare the endoscopic and histopathologic gastric changes in chronic users of proton-pump inhibitors to changes in non-users. Methods A prospective study performed at a tertiary Public Hospital involving 105 patients undergoing upper-gastrointestinal endoscopy. Subjects included 81 proton-pump inhibitor users and 24 non-users (control group). Biopsies of the antral-type mucosa, the antral-fundic transition, and the fundus were evaluated by the Sydney System. The presence of erosion or ulceration, lymphatic follicles, reactive gastropathy, and polypoid or epithelial hyperplasia was also determined. Serum levels of gastrin were measured. Results We found two polyps, one in each group, both of which were negative for Helicobacter pylori. There were two cases of parietal cell hyperplasia in users of proton-pump inhibitors. Gastrin was elevated in 28 users of proton-pump inhibitors and in four members of the control group. We did not find statistically significant differences in the endoscopic or histopathologic findings between the two groups. Conclusions Chronic use of proton-pump inhibitors for the duration examined was not associated with significant gastric changes. An interesting finding was that the 4 chronic users of proton-pump inhibitors who had serum gastrin levels above 500 pg/mL also had positive serology for Chagas disease. .

Contexto Os inibidores da bomba de prótons são usados há pelo menos duas décadas e estão entre as drogas mais vendidas no mundo. Ainda existem controvérsias sobre as indicações e as consequências de seu uso a longo prazo. Objetivos Avaliar as alterações endoscópicas e histopatológicas gástricas em usuários crônicos de inibidores da bomba de prótons e comparar com controles. Métodos Estudo prospectivo reali­zado em Hospital Público terciário com 105 pacientes, 81 usuários de bomba de prótons e 24 controles, submetidos a endoscopia digestiva alta. As biópsias das mucosas do tipo antral, da transição antro fúndica e fúndica foram avaliadas segundo a Classificação de Sidney e verificando também erosão ou úlcera, folículo linfático, gastropatia reativa, hiperplasia epitelial e pólipo. Realizada também a dosagem sérica da gastrina. Resultados Encontramos dois pólipos, um em cada grupo, ambos negativos para Helicobacter pylori e dois casos de hiperplasia de células parietais nos usuários de inibidores da bomba de prótons. A gastrina estava aumentada em 28 usuários de inibidor da bomba de protóns e em 4 do grupo controle. Não encontramos diferenças estatisticamente significantes nos achados endoscópicos e histopatológicos dos dois grupos. Conclusões O uso crônico de inibidores da bomba de prótons no período examinado não se associou com alterações gástricas significantes. O achado mais importante foi a positividade das sorologias para doença de Chagas nos quatro pacientes do grupo de usuários crônicos de inibidores que apresentavam níveis de gastrina sérica superiores a 500 pg/ mL .

The hydrogen sulfide donor, Lawesson's reagent, prevents alendronate-induced gastric damage in rats

Our objective was to investigate the protective effect of Lawesson's reagent, an H2S donor, against alendronate (ALD)-induced gastric damage in rats. Rats were pretreated with saline or Lawesson's reagent (3, 9, or 27 µmol/kg, po) once daily for 4 days. After 30 min, gastric damage was induced by ALD (30 mg/kg) administration by gavage. On the last day of treatment, the animals were killed 4 h after ALD administration. Gastric lesions were measured using a computer planimetry program, and gastric corpus pieces were assayed for malondialdehyde (MDA), glutathione (GSH), proinflammatory cytokines [tumor necrosis factor (TNF)-α and interleukin (IL)-1β], and myeloperoxidase (MPO). Other groups were pretreated with glibenclamide (5 mg/kg, ip) or with glibenclamide (5 mg/kg, ip)+diazoxide (3 mg/kg, ip). After 1 h, 27 µmol/kg Lawesson's reagent was administered. After 30 min, 30 mg/kg ALD was administered. ALD caused gastric damage (63.35±9.8 mm2); increased levels of TNF-α, IL-1β, and MDA (2311±302.3 pg/mL, 901.9±106.2 pg/mL, 121.1±4.3 nmol/g, respectively); increased MPO activity (26.1±3.8 U/mg); and reduced GSH levels (180.3±21.9 µg/g). ALD also increased cystathionine-γ-lyase immunoreactivity in the gastric mucosa. Pretreatment with Lawesson's reagent (27 µmol/kg) attenuated ALD-mediated gastric damage (15.77±5.3 mm2); reduced TNF-α, IL-1β, and MDA formation (1502±150.2 pg/mL, 632.3±43.4 pg/mL, 78.4±7.6 nmol/g, respectively); lowered MPO activity (11.7±2.8 U/mg); and increased the level of GSH in the gastric tissue (397.9±40.2 µg/g). Glibenclamide alone reversed the gastric protective effect of Lawesson's reagent. However, glibenclamide plus diazoxide did not alter the effects of Lawesson's reagent. Our results suggest that Lawesson's reagent plays a protective role against ALD-induced gastric damage through mechanisms that depend at least in part on activation of ATP-sensitive potassium (KATP) channels.

Manejo de pólipos gástricos / Management of gastric polyps

Most of gastric polyps are benign and do not need specific treatment. However, some types have significant malignant potential that can lead to gastric cancer if they are not managed appropriately. The malignant potential depends on the histological type of the polyp, therefore it is important to sample and make biopsies.

La mayoría de los pólipos gástricos son benignos y no requieren tratamiento específico; no obstante, algunos de ellos pueden malignizarse. Si estos pólipos no son tratados pueden ser causa de cáncer gástrico. El potencial maligno depende del tipo histológico del pólipo, por lo que estas lesiones debieran ser siempre biopsiadas.

Prevalence of upper digestive endoscopy and gastric histopathology findings in morbidly obese patients / Prevalência de achados gástricos endoscópicos e histopatológicos em pacientes obesos

CONTEXT: The prevalence of obesity has been increasing in modern society. Roux-en-y gastric bypass is a bariatric surgery that involves the exclusion of significant part of the stomach. Atrophy, intestinal metaplasia and gastric cancer have been associated with infection by Helicobacter pylori. OBJECTIVES: To evaluate the presence of endoscopy findings and histological changes in morbid obese patients for the presence of inflammatory cells, inflammatory activity, lymphoid hyperplasia, H. pylori infection, atrophy and intestinal metaplasia in the gastric mucosa. METHODS: Upper digestive endoscopy and gastric histopathological were studied in 126 obese patients in the preoperative evaluation for bariatric surgery. RESULTS: Upper digestive endoscopy abnormalities were diagnosed in 73/126 (57.9%) patients. In three patients (2.4%) the upper gastrointestinal endoscopy diagnosed gastric ulcer and one patient (0.8%) had duodenal ulcer. The histopathological from gastric biopsies of these obese patients showed 65.1% of mucosa inflammation, inflammatory activity in 50.0%, infection by H. pylori in 53.2%, lymphoid hyperplasia in 50.0% and atrophy and/or intestinal metaplasia in 16.7%. CONCLUSIONS: In present study, with routine preoperative upper gastrointestinal endoscopy and histopathological examination, were detected 57.9% patients with endoscopy abnormalities, high prevalence of infection by H. pylori (53%) and 16.7% of gastric atrophy and/or intestinal metaplasia.

CONTEXT: A prevalência de obesidade tem aumentado significativamente nos últimos anos. Bypass gástrico em Y-de-Roux, uma das técnicas cirúrgicas realizadas no tratamento da obesidade, envolve exclusão de parte do estômago. Atrofia, metaplasia intestinal e câncer gástrico têm sido associados com infecção pelo Helicobacter pylori. OBJETIVOS: Avaliar a prevalência de achados endoscópicos e alterações histopatológicas em pacientes obesos mórbidos em relação à presença de células inflamatórias, atividade inflamatória, hiperplasia linfóide, infecção pelo H. pylori, atrofia e metaplasia intestinal na mucosa gástrica. MÉTODOS: Achados na endoscopia digestiva alta e histopatologia gástrica foram analisados em 126 pacientes obesos na avaliação pré-operatória de cirurgia bariátrica. RESULTADOS: Anormalidades endoscópicas do trato digestivo superior foram diagnosticadas em 73/126 pacientes, com três pacientes (2,4%) apresentando úlcera gástrica e um paciente (0,8%) com úlcera duodenal. A histopatologia das biopsias gástricas dos obesos estudados revelou 65,1% de processo inflamatório na mucosa, atividade inflamatória em 50,0%; infecção pelo H. pylori em 53,2%, hiperplasia linfóide em 50,0%, atrofia e/ou metaplasia intestinal em 16,7%. CONCLUSÕES: No presente estudo, através de endoscopia digestiva alta e histopatologia de biopsias gástricas, foram detectados 57,9% de pacientes com anormalidades endoscópicas, prevalência de infecção pelo H. pylori em 53% e atrofia e/ou metaplasia intestinal em 16,7%.

Protection of estrogen in portal hypertension gastropathy: an experimental model / Proteção do estrogênio na gastropatia da hipertensão portal: um modelo experimental

CONTEXT: Portal hypertension is a complication secondary to cirrhosis that is characterized by increased blood flow and/or vascular resistance in the portal system, causing the appearance of a hyperdynamic collateral circulation. Partial portal vein ligation is an experimental model used in rats to study the pathophysiological mechanisms involved in pre-hepatic portal hypertension. Estrogen E2 is an antioxidant molecule with various physiological actions. OBJECTIVES: To evaluate the antioxidant activity of endogenous estrogen in an experimental model of partial portal vein ligation by comparing intact with castrated rats. METHODS: Twenty Wistar rats, weighing on average 250 g were used and divided into four groups: sham-operated (SO); intact (I) with partial portal vein ligation (I + PPVL), castrated (C) and castrated with partial ligation of the vein (C + PPVL). Day 1: castration or sham-operation; day 7, PPVL surgery; on day 15 post-PPVL, portal pressure in the mesenteric vein of rats was measured on polygraph Letica. Lipid peroxidation in the stomach was assessed using the technique of thiobarbituric acid reactive substances and activity of antioxidant enzymes superoxide dismutase, catalase and glutathione peroxidase. Statistical analysis was done with ANOVA - Student-Newman-Keuls (mean ± SE), and P<0.05 was considered as significant. RESULTS: Portal pressure was significantly increased in C + PPVL as compared to the other groups. There was no significant difference in the group of intact rats. TBARS showed significant damage in C and C + PPVL in relation to others. Antioxidant enzymes were significantly increased in the castrated rats with subsequent PPVL as compared to the other groups. CONCLUSION: We suggest that estrogen E2 plays a protective role in intact compared with castrated rats because it presents hydrophenolic radicals in its molecule, thus acting as an antioxidant in this experimental model.

CONTEXTO: A hipertensão portal é uma complicação secundária à cirrose que tem como característica aumento do fluxo sanguíneo e/ou resistência vascular no sistema porta, causando o surgimento de uma circulação colateral hiperdinâmica. A ligadura parcial de veia porta é o modelo experimental utilizado em ratos para estudar os mecanismos fisiopatológicos envolvidos na hipertensão portal pré-hepática. O estrogênio E2 é uma molécula antioxidante com diferentes ações fisiológicas. OBJETIVOS: Verificar a ação antioxidante do estrogênio endógeno em modelo experimental de ligadura parcial de veia porta comparando ratas intactas com ratas castradas. MÉTODOS: Foram utilizadas 20 ratas Wistar, pesando em média 250 g, divididas em quatro grupos: "sham-operated" (SO); intactas com ligadura parcial da veia porta (I + LPVP); castradas (C) e castradas com ligadura parcial da veia porta (C + LPVP). No 1º dia: castração ou "sham-operated"; no 7º dia cirurgia de LPVP; no 15º dia após a LPVP, foi verificada a pressão portal na veia mesentérica das ratas, no polígrafo Letica. A lipoperoxidação no estômago foi avaliada através da técnica das substâncias reativas ao acido tiobarbitúrico e a atividade das enzimas antioxidantes superóxido dismutase, catalase e glutationa peroxidase. A análise estatística utilizada foi ANOVA - Student-Newmann-Keuls, (Média ± EP) e foi considerado significativo para P<0.05. RESULTADOS: A pressão portal mostrou aumento significativo no grupo C + LPVP em relação aos demais, não houve diferença significativa no grupo das ratas intactas. O TBARS mostrou dano estatisticamente significativo no grupo C e C + LPVP em relação aos demais. Quanto às enzimas antioxidantes, as ratas castradas e com posterior ligadura parcial de veia porta tiveram aumento significativo em relação às demais. CONCLUSÃO: Sugere-se que o estrogênio E2, por apresentar radicais hidrofenólicos em sua molécula, desempenha um papel protetor nas ratas intactas em comparação com as castradas, agindo assim, como antioxidante, neste modelo experimental.

Gastric Duplication Cyst Removed by Endoscopic Submucosal Dissection / 대한소화기학회지

Duplication cysts are uncommon congenital malformations that may occur anywhere throughout the alimentary tract. The stomach is an extremely rare site of occurrence. Here, we report a case of gastric duplication cyst initially presenting with a gastric submucosal tumor. A 28-year-old man complained of dyspepsia lasting 1 year and upper endoscopy revealed an ellipsoid submucosal tumor at the greater curvature of the antrum. We intended to use the injection-and-cut technique: however, after saline injection, the lesion was dented and impossible to grasp with a snare. Therefore, we decided to perform endoscopic submucosal dissection and removed the tumor without complication. Histopathology revealed a 0.6x0.6 cm-sized duplication cyst, and there has been no recurrence in 2 years.

Sarcoidosis pulmonar y gástrica: caso clínico / Pulmonary and gastric sarcoidosis: report of one case

We report a 66 year-old woman with a history of pulmonary sarcoidosis, diagnosed with a lung biopsy in 1993 and treated with prednisone for 2 years. She presented at our institution in 1999 with a stage IV disease and important functional and clinical impairment. A bronchial biopsy disclosed non caseating granulomas. Tuberculosis was intensively studied and persistently negative. Due to frequent nausea and vomiting an endoscopic gastric biopsy was performed which revealed non caseating granulomas involving the gastric mucosa. There was no evidence of Helicobacter pylori and stains for fungi and acid-fast bacilli were negative. Treatment with prednisone relieved digestive symptoms, although a control biopsy of the gastric mucosa revealed persistence of non caseating granulomas. Both lung stage IV and gastric sarcoidosis are uncommon forms of the disease.

Gastric polyps: a retrospective analysis of 26, 000 digestive endoscopies

BACKGROUND: Gastric polyps are small gastric lesions, asymptomatic in most cases and are generally discovered inadvertently during upper digestive endoscopy. AIM: To retrospectively review the characteristics and frequency of gastric polyps, derived from the gastric mucosal epithelium in a large series of endoscopies. METHODS: One hundred and fifty three patients in a series of 26,000 consecutive upper digestive endoscopies done over a 5-year period, being that each patient had only one examination were analyzed and their histological and Yamada classification, as well as their location, size, histopathological findings and treatment studied. All patients had at least one gastric polyp, as confirmed by histological examination. RESULTS: The polyps were classified as hyperplastic, adenomatous and fundic gland polyps. The most of them measure less than 1 cm (hyperplastic polyps - 60,5 percent; adenomatous polyps - 73,6 percent; fundic gland polyps - 72 percent). Hyperplastic polyps were the most frequent and accounted for 71.3 percent of the cases, whereas fundic gland polyps accounted for 16.3 percent and adenomatous polyps for 12.4 percent. Hyperplastic and adenomatous polyps were primarily single, whereas fundic gland polyps tended to be multiple. A carcinoma was detected in one hyperplastic polyp (0.9 percent) and in two adenomatous polyps (10.5 percent). High grade dysplastic foci were found in four adenomatous polyps (21 percent). CONCLUSIONS: The digestive endoscopy is the safest and efficient method for the diagnosis of the gastric polyps, that in most of the patients does not show characteristic symptoms. The histopathological definition is not possible to the endoscopic glance being needed the pathologist's aid, once the conduct to be adopted will depend on the result of the biopsy.

RACIONAL: Os pólipos gástricos são pequenas lesões gástricas, assintomáticos na maioria dos casos, e são diagnosticados por acaso durante a endoscopia digestiva alta. OBJETIVOS: Avaliar retrospectivamente as características e freqüência dos pólipos gástricos, oriundos da mucosa gástrica em uma casuística extensa de endoscopias digestivas. MÉTODOS: Cento e cinqüenta e três doentes em uma casuística de 26.000 endoscopias digestivas altas realizadas durante 5 anos, sendo que cada doente realizou apenas um exame, foram analisados quanto às características histopatológicas, classificação de Yamada, localização, tamanho e tratamento. Todos os casos tinham pelo menos um pólipo gástrico, confirmado pelo exame histopatológico de biopsia endoscópica. RESULTADOS: Os pólipos foram classificados como hiperplásicos, adenomatosos e de glândulas fúndicas. A maioria deles era menor que 1 cm (pólipos hiperplásicos - 60,5 por cento; pólipos adenomatosos - 73,6 por cento; pólipos de glândulas fúndicas - 72 por cento). Os pólipos hiperplásicos foram os mais freqüentes e diagnosticados em 71,3 por cento dos casos, enquanto os de glândulas fúndicas somaram 16,3 por cento e os adenomatosos foram 12,4 por cento. Os pólipos hiperplásicos e os adenomatosos, na maioria das vezes, foram únicos, enquanto os de glândulas fúndicas tenderam a ser múltiplos. Carcinoma foram detectados em um pólipo hiperplásico (0,9 por cento) e em dois adenomatosos (10,5 por cento). Focos de displasia de alto grau foram encontrados em quatro pólipos adenomatosos (21 por cento). CONCLUSÕES: A endoscopia digestiva é o método mais seguro e eficiente para o diagnóstico dos pólipos gástricos, que na maioria dos doentes não apresenta sintomas característicos. A definição histopatológica não é possível ao olhar endoscópico, necessitando-se do auxílio do patologista, uma vez que do resultado da biopsia dependerá a conduta a ser adotada.

Magnifying Endoscopy in Upper Gastrointestinal Tract / 대한소화기학회지

For the diagnosis of upper gastrointestinal (GI) lesions, magnification method is usually used in conjunction with chromoscopy, enabling the endoscopist to view subtle mucosal patterns in exquisite detail. Recently published datas have shown that magnifying endoscopy might be a valuable adjunct for the diagnosis, detection, and characterization of inflammatory and neoplastic lesions of the upper GI tract. It is also proven to be an useful surveillance protocol in identifying dysplastic epithelium or early cancer within a segment of Barrett's esophagus. Possible indications for magnifying endoscopy in upper GI tract include screening and surveillance of Barrett's esophagus, defining the extent of esophageal and gastric adenocarcinoma, detecting synchronous/metachronous gastric and esophageal cancers, diagnosing Helicobacter pylori infection, and recognizing minimal mucosal changes in gastroesophageal reflux disease. By grading the quality of evidence for the currently published trials, it is clear that the majority are case series, case reports, and/or observational studies without randomization, control, or blinding. Moreover, other evidence-based criteria such as independent, blind comparisons of magnifying endoscopy with a standard method which evaluates this technology in an appropriate spectrum of patients to whom the test may be applicable, and standardizing methodology would be crucial before magnifying endoscopy becomes a standard procedure in clinical practice. In the future, a uniform classification system for staining and magnifying patterns should be devised and observer agreement should be tested. Futher studies then could be performed based upon consistent, validated, and standardized terminologies and criteria.

Angiodysplasia of cardia of stomach--a case report.

Angiodysplasia of gastrointestinal tract is still thought to be an entity of unknown aetiology. This lesion is most commonly observed in elderly patients presenting with severe and persistent iron deficiency anaemia, following occult blood loss or acute episodes of haematemesis. In the stomach antral vascular ectasia is the most common presentation. We report an autopsy case of vascular ectasia in the cardia of stomach in a young patient with clinical symptoms of anaemia as the presentation and an associated secondary hemosiderosis of liver.

Traitement endoscopique des lesions de Dieulafoy

Dieulafoy's lesion is a rare and important cause of gastrointestinal hemorrhage. It is a relatively large artery which lies in close proximity to the mucosal surface. Hemorrhage is often torrential and life threatening. Endoscopy is the most sensitive diagnostic test. Many reports described successful hemostasis utilizing a variety of endoscopic modalities in > 95% of cases. We report an upper gastrointestinal hemorrhage in a patient with Dieulafoy lesion treated successfully by injection, and a literature review

Helicobacter spp na mucosa gástrica de cães (canis familiaris) - utilização de diferentes métodos de diagnóstico e avaliação dos achados histopatológicos / Helicobacter spp in the gastric mucosa of dogs (Canis familiaris) - use of different methods of diagnosis and evaluation of histopathological findings

A infecção por Helicobacter spp em cães possui alta prevalência, variando de 61% a 100% em vários estudos, entretanto, a relação destas bactérias com as patologias gástricas caninas ainda não está estabelecida. Os objetivos desta pesquisa foram descrever os achados macroscópicos e microscópicos da mucosa gástrica, avaliar a presença de Helicobacter spp na mucosa gástrica de cães, comparar os diferentes testes de diagnóstico, determinar a correlação entre eles e a colonização bacteriana e descrever as alterações histopatológicas..Observou-se percentuais de concordância entre os testes utilizados. O alto percentual de cães infectados por Helicobacter spp e ausência de correlação com as patologias gástricas nesses animais, indicam a necessidade de mais estudos, visando estabelecer o verdadeiro papel desta infecção com as gastropatias caninas. Devido à possibilidade de transmissão zoonótica, torna-se impostante pesquisar a patogenicidade das espécies que infectam o homem e o cão.

Left Paramedian Abomasopexy in Cattle

Aims of surgery of left displacement of the abomasum (LDA) are to return the abomasum to its original position and create a permanent attachment in the position to prevent recurrence. Left paramedian abomasopexy was performed on six Holstein cows with LDA because normal position of the fundus of the abomasum is located in the left of the midline and the displacement initially only involves the fundus of the abomasum. All cows were recovered without recurrence of LDA. It is considered that the left paramedian abomasopexy could be a major alternative as a surgical treatment of LDA.

Historia de las manifestaciones gastrointestinales del lupus eritematoso sistemico / History of the gastrointestinal manifestations in systemic lupus erythematosus

En este articulo revisamos la historia de las manifestaciones gastrointestinales en el Lupus Eritematoso Sistemico desde el siglo XIX hasta nuestros dias, recorriendo cada uno de los organos involucrados en este sistema y haciendo especial mencion de la gastropatia, enteritis, ileitis, sindrome de malabsorcion, vasculitis y vasculopatia intestinal, trombosis mesenterica, pancreatitis, ascitis, peritonitis, hepatitis autoinmune, entre otros

Gastropatía portal hipertensiva en el Hospital Nacional del Sur - IPSS Arequipa / Portal hypertensive gastropathy at Hospital Nacional del Sur - IPSS Arequipa

Se realizó un estudio prospectivo analítico de pacientes con cirrosis hepática e hipertensión portal con el fin de estudiar una reciente patología conocida como gastropatía portal hipertensiva. El 73.3 por ciento de los pacientes cirroticos hospitalizados en nuestro servicio presentaron Gastropatía Portal Hipertensiva, siendo la mayoría varones después de la cuarta década de la vida. El tipo más frecuente fue la leve en el 60.6 por ciento, predominando el patrón endoscópico en mosaico o piel de culebra, el patrón "cherry red spots" fue el patrón más frecuente en el tipo severo. Las lesiones se localizaron con más frecuencia en cuerpo y fondo. El 100 por ciento de nuestros pacientes presentaron algún tipo de alteración vascular en la mucosa y algún grado de infiltrado inflamatorio linfoplasmocitario. No se encontró relación entre el grado de hipertensión portal o la severidad de la enfermedad hepática con la presencia de gastropatía portal hipertensiva. Recomendamos que todo paciente con hipertensión portal se debe evaluar en busca de alteraciones de la mucosa gástrica compatibles con gastropatía portal hipertensiva. Esta patología debe ser mejor estudiada en nuestro medio y así definir mejor los criterios diagnósticos, endoscópicos e histopatológicos.