The Comparative Anatomy of the Upper Digestive System in 26 Species of Zoophagous-Polyphagous Palearctic Birds / Anatomía Comparada del Sistema Digestivo Superior en 26 Especies de Aves Paleárticas Zoófagas-Polífagas

SUMMARY: Birds are the most diversified organisms on Earth, with species covering various niches in each major biome, being essential to understand the modern ecosystem. This study concentrates on the diversification of the anatomical structure of the upper digestive tract for 26 species of zoophage-polyphagous birds and the anatomical differences in the digestive system to reveal aspects related to their evolution and diversification. The trophic spectrum of the selected birds includes several categories of food, or, as in the case of strictly carnivorous birds, to a single food category. After performing the dissections, the digestive tract was separated from the carcass and each digestive segment was measured and analysed. In this study, it was demonstrated that the birds' feeding behaviour influence the macroscopic particularities of the digestive system, more visible in the cranial portion (oropharyngeal cavity, esophagus, proventriculus and gizzard), with little descriptive information in the literature. The tongue is poorly developed and immobile in piscivorous birds, while the tongue of insectivorous birds is long and moves considerably away from the tip of the bill. The esophagus was stretchable and presents longitudinal folds on its entire surface in piscivorous species and not extensible in insectivorous birds.

Las aves son los organismos más diversificados de la Tierra, con especies que cubren varios nichos en cada bioma principal, siendo esenciales para comprender el ecosistema moderno. Este estudio se concentra en la diversificación de la estructura anatómica del tracto digestivo superior para 26 especies de aves zoófago-polífagas y las diferencias anatómicas en el sistema digestivo para revelar aspectos relacionados con su evolución y diversificación. El espectro trófico de las aves seleccionadas incluye varias categorías de alimentos o, como en el caso de las aves estrictamente carnívoras, una sola categoría de alimentos. Después de realizar las disecciones, se separó el tracto digestivo de la canal y se midió y analizó cada segmento digestivo. En este estudio se demostró que el comportamiento alimentario de las aves influye en las particularidades macroscópicas del sistema digestivo, más visibles en la porción craneal (cavidad orofaríngea, esófago, proventrículo y molleja), con poca información descriptiva en la literatura. En las aves piscívoras, la lengua está poco desarrollada e inmóvil, mientras que la lengua de las aves insectívoras es larga y se aleja considerablemente de la punta del pico. El esófago era estirable y presentaba pliegues longitudinales en toda su superficie en especies piscívoras y no extensible en aves insectívoras.

Upper gastrointestinal bleeding in mechanically ventilated patients in medical ICU: A single-center study

Aims Upper Gastrointestinal bleeding (UGIB) in critically ill patients under mechanical ventilation (MV) is a significant cause of morbidity and mortality. Therefore, it aimed to study the incidence, predictors, and etiology of UGIB in critically ill patients under MV. Patients and Methods Three hundred and sixty critically ill patients were managed by mechanical ventilation. The patients were evaluated by complete clinical examination, APACHE II score, liver and kidney function tests, and abdominal ultrasound. In addition, upper gastrointestinal endoscopy was done for survived patients with UGIB during MV after weaning with a stable clinical condition for at least 48 hours. Results 41 patients (11.4 %) had UGIB; 15 patients (36.6%) survived and death occurred in 26 (63.4%). Upper endoscopy revealed large ulcers > 2 cm in the gastric antrum (n=1), multiple antral ulcers (n=2), large >2cm corporeal gastric ulcers (n=2) [all were Forrest Ib with oozing surface], bleeding small duodenal bulb ulcers < 2cm (n=1) [Forrest Ia with spurting], small ulcers in the lower esophagus with lower end esophagitis (n=2), black esophagus (n=1), ulcer on top of grade III oesophageal varices (n=2), severe portal hypertensive gastropathy (n=3), candida esophagitis and gastritis (n=1). Logistic regression analysis revealed that the independent variables of UGIB were elevated serum creatinine, APACHE II score >14, peak inspiratory pressure ≥ 30cmH2O, and prolonged aPTT. Conclusions : Mechanically ventilated patients had a high risk of upper gastrointestinal bleeding, which the postulated parameters can predict for adequate prophylaxis.

Hemobilia, una causa infrecuente de hemorragia del tracto digestivo superior / Hemobilia, a rare cause of upper gastrointestinal bleeding

Resumen La hemobilia es una causa poco frecuente de hemorragia del tracto gastrointestinal superior. La principal etiología es de origen iatrogénico y la posibilidad de hemobilia debe considerarse en cualquier paciente con hemorragia gastrointestinal y un historial reciente de procedimientos hepatobiliares. Otras causas menos frecuentes incluyen el trauma de abdomen, la enfermedad oncológica de la vía biliar o las enfermedades inflamatorias del páncreas o la vía biliar. La presentación clínica varía según la gravedad del sangrado; generalmente se presenta con dolor abdominal, ictericia y melenas, aunque puede cursar al ingreso con rectorragia e hipotensión. Un alto porcentaje de estas presenta resolución espontánea, sin requerir procedimientos adicionales. La angiografía es el estándar de oro para el diagnóstico de la hemobilia, pero los avances en la angiotomografía permiten que esta sea una opción menos invasiva y con mayor disponibilidad. La angioembolización es el tratamiento principal para estos pacientes, pero existen otras alternativas como la colocación de stent vascular o de stent en el conducto biliar.

Abstract Hemobilia is a rare cause of upper gastrointestinal (GI) tract bleeding. Its main etiology is iatrogenic, and the possibility of hemobilia should be considered in any patient with GI bleeding and a recent history of hepatobiliary surgery. Other less frequent causes include abdominal trauma, oncologic disease of the biliary tract, or inflammatory diseases of the pancreas or bile duct. Its clinical presentation varies depending on the severity of the bleeding. It usually presents with abdominal pain, jaundice, and tarry stools, although patients may also present with rectorrhagia and hypotension on admission. A high percentage of these symptoms have a spontaneous resolution, without requiring additional procedures. Angiography is the gold standard for the diagnosis of hemobilia, but advances in computed tomography angiography make it a less invasive and more widely available option. Endovascular embolization is the main treatment for these patients, but there are other alternatives such as vascular or bile duct stent placement.

Aspectos clínicos y etiológicos de la hemorragia digestiva alta y sus escalas de evaluación / Clinical and etiological aspects of upper gastrointestinal bleeding and its evaluation scales

Resumen Introducción: La hemorragia digestiva alta es frecuente, con diversas etiologías, métodos de diagnóstico y tratamiento para el manejo de estos pacientes, además, cuenta con escalas de predicción clínica. Objetivo: Describir aspectos clave relacionados con la etiología, diagnóstico, factores de riesgo y escalas de evaluación que se han usado en pacientes con esta entidad. Metodología de búsqueda: Fueron incluídos artículos publicados en idiomas español e inglés, la mayoría entre 2013 y 2019 que tengan contenido relacionado con el objetivo del presente manuscrito. Conclusiones: La hemorragia digestiva alta es la principal emergencia gastroenterológica, con diferentes etiologías y métodos de diagnóstico y tratamiento orientados a mejorar la supervivencia de estos pacientes, actualmente se recomiendan diferentes escalas de evaluación para predecir desenlaces de estos pacientes, pero los estudios han tenido diferencias en los resultados encontrados, lo que sucita una oportunidad de investigación para beneficio de los pacientes y la práctica clínica. MÉD.UIS.2020;33(3):9-20

Abstract Introduction: Upper gastrointestinal bleeding it's a frequent clinical situation, has different etiologies, diagnostic methods and treatments for the management of these patients, in addition, has clinical scales to predict outcomes in those patients. Objective: To describe key points related to the etiology, diagnosis, risk factors, and evaluation scales that have been used in patients with this entity. Methodology: Articles published in spanish and english were included, the majority between 2013 and 2019 that have content related to the objective of this manuscript. Conclusions: Upper gastrointestinal bleeding is the main gastroenterological emergency, with different etiologies and methods of diagnosis and treatment aimed at improving the survival of these patients; currently, different evaluation scales are recommended to predict outcomes in these patients, but studies have differences in the results between them, which creates an opportunity of clinical research for patients and clinical practice benefit. MÉD.UIS.2020;33(3):9-20.

Hipertensión portal secundario a trombosis de la vena porta y várices esofágicas / Secondary portal hypertension to portal venous thrombosis and esophageal varices

Resumen La hipertensión portal se define como la alteración patológica en el gradiente de presión a nivel del sistema portal, es decir, la diferencia entre la presión de la vena porta y la vena cava inferior. El valor normal es entre 1-5 mm Hg y se considera hipertensión cuando es mayor de 10 mm Hg. En este artículo, se describe el caso de una paciente de 5 años con un cuadro de hipertensión portal secundario a várices esofágicas y trombosis de la vena porta, confirmado por endoscopia de vías digestivas alta y angioresonancia magnética. La paciente fue atendida en la Fundación Clínica Infantil Club Noel de la ciudad de Cali, Colombia, entre los meses de diciembre del 2018 y febrero del 2019.

Abstract Portal hypertension is defined as the pathological increase in the portal pressure gradient, which is the difference between the pressure of the portal vein and the inferior vena cava. Normally portal vein pressure ranges between 1-5 mmHg and is considered hypertension when it is higher than 10 mmHg. In this study the case of a 5-year-old patient that suffers from secondary portal hypertension to portal venous thrombosis and esophageal varices is presented. The diagnostic is confirmed by an endoscopy of the upper gastrointestinal tract and by a magnetic angioresonance. The patient was treated at the Fundacion Clinica Infantil Club Noel located in Cali, Colombia, between the months of December 2018 and February 2019.

Impact of the COVID-19 pandemic in the time to endoscopy in patients with upper gastrointestinal bleeding / Impacto de la pandemia de COVID-19 en el tiempo hasta la endoscopia en pacientes con hemorragia digestiva alta

ABSTRACT Introduction : During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. Objective : The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. Materials and methods : We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. Results : With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer during the pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. Conclusion : The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.

RESUMEN Introducción : Durante la pandemia de COVID-19, los procedimientos endoscópicos se asocian con un alto riesgo de infección por SARS-CoV-2. Sin embargo, en casos de hemorragia digestiva alta (HDA), se debe dar prioridad a una endoscopia precoz. Objetivo : El objetivo principal fue comparar el tiempo transcurrido desde la llegada al hospital y la realización de la endoscopia entre ambos grupos. Materiales y métodos : Realizamos un estudio retrospectivo. Los datos contienen información de pacientes que acudieron al hospital con HDA y fueron sometidos a endoscopia entre el 19 de octubre de 2019 y el 6 de junio de 2020. Los pacientes se dividieron en 2 fases: prepandémica y pandémica. Se comparó el tiempo transcurrido entre la llegada al hospital y la realización de la endoscopia en ambas fases, así como otros indicadores como la estancia hospitalaria y la mortalidad intrahospitalaria. Resultados : Con información de 219 pacientes, la mediana de edad fue de 69 años. Se realizaron 154 y 65 endoscopias en fase prepandémica y pandémica, respectivamente. El tiempo entre la llegada al hospital y la realización de la endoscopia fue significativamente mayor durante la pandemia (10,00 frente a 13,08 horas, valor de p = 0,019). Sin embargo, no hubo diferencias significativas en la estancia hospitalaria ni en la mortalidad. Conclusión : El manejo de pacientes con HDA durante la pandemia de COVID-19 es complejo y requiere la aplicación del juicio clínico para decidir el mejor momento para realizar una endoscopia sin afectar la atención del paciente.

Hemorragia digestiva alta variceal y no variceal: mortalidad intrahospitalaria y características clínicas en un hospital universitario (2015-2017) / Variceal and non-variceal upper gastrointestinal bleeding. Analysis of 249 hospitalized patients

Background: Upper gastrointestinal bleeding (UGIB) is one of the main reasons of hospitalization due to gastrointestinal causes. Reported mortality rates range from 5 to 12%. Aim: To determine hospital mortality and associated risk factors in hospitalized patients with UGIB. To compare the clinical characteristics and outcomes of patients with variceal versus non-variceal UGIB. Material and Methods: Review of medical records of 249 patients (62% males) discharged with the diagnosis of UGIB at a clinical hospital between 2015 to 2017. Demographic and clinical characteristics and adverse clinical outcomes (surgery, length of hospital stay and in-hospital mortality) were recorded. A comparative analysis between patients with Variceal and Non-variceal UGIB was carried out. Results: Seventy two percent of UGIB were non-variceal (peptic ulcer in 44%). Two patients required surgery (both died). Median of length of hospital stay was seven days (interquartile range (IQR) 4-13). Overall hospital mortality was 13 and 4% in variceal and non-variceal UGIB, respectively (p = 0.024). The variables associated with mortality were: red blood cell transfusion (odds ratio (OR): 18.7, p < 0.01), elevated creatinine on admission (OR: 3.30, p = 0.03) and variceal bleeding (OR: 3.23, p = 0.02). Conclusions: Hospital mortality of UGIB remains high, especially in variceal UGIB. Elevated creatinine levels on admission, the need of transfusion of red blood cells and variceal etiology are risk factors for mortality.

Tratamiento quirúrgico de la hemorragia digestiva alta por enfermedad de Dieulafoy / Surgical treatment of upper gastrointestinal bleeding dueto Dieulafoy disease

La enfermedad de Dieulafoy constituye menos del 2 % de las causas de hemorragia digestiva alta. Corresponde a la presencia de un vaso sanguíneo arterial de trayecto tortuoso, que protruye a través de un defecto mucoso localizado, generalmente, proximal en el estómago. Se presenta como una hematemesis masiva, a veces recu-rrente, con inestabilidad hemodinámica. La endoscopia es el método diagnóstico y terapéutico de elección. Si esta fracasa, está indicado practicar una angiografía selectiva que permita identificar el punto sangrante y producir un embolismo. En algunas ocasiones, ninguna de estas dos técnicas consigue detener la hemorragia, en cuyo caso está indicada una cirugía urgente. Se deben practicar resecciones gástricas limitadas (gastrectomías en cuña o tubulares) a la zona sangrante localizada mediante las pruebas anteriores; así, se evitan grandes gastrectomías que implican la práctica de anastomosis por el gran riesgo de dehiscencia que estas últimas cuando hay inestabilidad hemodinámica.Se presenta el caso de un paciente con hemorragia digestiva alta secundaria a enfermedad de Dieulafoy, que precisó intervención quirúrgica urgente por la imposibilidad de resolver el sangrado mediante endoscopia. Se describen el diagnóstico y el tratamiento de la enfermedad de Dieulafoy como causa de hemorragia digestiva alta en el adulto, y se presenta una revisión de la literatura científica

Dieulafoy's disease constitutes less than 2% of the causes of upper gastrointestinal bleeding. It corresponds to the presence of a tortuous arterial blood vessel which protrudes through a localized mucosal defect, usually proximal in the stomach. It presents as a massive hematemesis, sometimes recurrent, with hemodynamic instability.Endoscopy is the diagnostic and therapeutic method of choice. If this fails, it is indicated to perform a selective angiography to identify the bleeding point and embolize it. In some cases, none of these two techniques manages to stop the bleeding, in which case urgent surgery is indicated. Limited gastric resections (wedge or tubular gastrectomies) should be performed to the bleeding area, thus avoiding large gastrectomies that involve anastomosis due to the high leak risk they have in hemodynamically unstable patients.We present the case of a patient with upper gastrointestinal bleeding secondary to Dieulafoy's disease, who required urgent surgical intervention due to the impossibility of resolving the bleeding endoscopically. The diagnosis and treatment of Dieulafoy's disease as a cause of upper gastrointestinal bleeding in adults are described and a review of the scientific literature is presented

Complications of upper gastrointestinal foreign body in children and related risk factors / 中国当代儿科杂志

OBJECTIVE@#To study the complications of upper gastrointestinal foreign body in children and related risk factors.@*METHODS@#Clinical data were collected from 772 children with upper gastrointestinal foreign bodies who were treated at the outpatient service or were hospitalized from January 2014 to December 2018. A multivariate logistic regression analysis was used to investigate the risk factors for the development of complications in children with upper gastrointestinal foreign bodies.@*RESILTS@#The upper gastrointestinal foreign bodies were taken out by electronic endoscopy for the 772 children. There were 414 boys and 358 girls, with a median age of 2.8 years. Children under 3 years old accounted for 59.5%. The foreign bodies were mainly observed in the esophagus (57.5%) and the stomach (28.9%), with a retention time of ≤24 hours in 465 children (60.2%) and >24 hours in 307 children (39.8%). The types of upper gastrointestinal foreign bodies mainly included round metal foreign bodies (37.2%), long foreign bodies (24.7%), sharp foreign bodies (16.2%), batteries (14.4%), corrosive substances (4.8%), and magnets (2.7%). As for the severity of complications, 47.7% (368 children) had mild complications, 12.7% (98 children) had serious complications, and 39.6% (306 children) had no complications. The logistic regression analysis showed that an age of 24 hours were risk factors for the development of complications in these children (OR=2.141, 7.373, 6.658, 8.892, and 6.376 respectively, P<0.05).@*CONCLUSIONS@#An understanding of the above high-risk factors for the complications of upper gastrointestinal foreign bodies is helpful to choose appropriate intervention methods and thus reduce the incidence of serious complications.

Utilidad de la escala de Glasgow-Blatchford en pacientes con hemorragia digestiva alta no variceal, con alto y bajo riesgo de complicaciones atendidos en el Servicio de Urgencias del Hospital Santo Tomas, 2015-2016 / Glasgow-Blatchford usefulness in patients with non variceal upper gastrointestinal bleeding with low and high risk of complications seen at the Emergency Department of Santo Tomas Hospital, 2015-2016

Introducción: La escala de Glasgow-Blatchford (GBS) nos permite clasificar al paciente como riesgo alto o bajo de presentar complicaciones. En los pacientes identificados como "bajo riesgo", la realización de una endoscopia temprana, podría disminuir los días intrahospitalarios y en el coste global. En nuestro medio, desconocemos la utilidad de la escala de GBS. Objetivo: Describir la utilidad de la escala de Glasgow-Blatchford (GBS) en la estratificación del riesgo en los pacientes con hemorragia digestiva alta (HDA) no variceal atendidos en el servicio de urgencias en un hospital de tercer nivel. Materiales y métodos: Se incluyeron prospectivamente 218 pacientes, y se les realizó en las primeras 24-48 h endoscopia urgente. Éstos se estratificaron, según la escala de GBS, en bajo riesgo (GBS ≤ 2), y alto riesgo (GBS ≥ 3). Se calculó la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de la escala de GBS en nuestro medio basándonos en el requerimiento de tratamiento endoscópico, radiológico (embolización arterial), transfusión de hemoderivados y/o cirugía, como estándar de oro para clasificar a los pacientes en alto riesgo. Resultados: Se incluyó un total de 218 pacientes, con edad media de 56 ± 18 años, de los cuales 121/218 (55%) fueron varones. 156/218 precisaron intervención por lo que fueron clasificados como "alto riesgo" mientras 62/218 no precisaron y se clasificaron como "bajo riesgo". Un valor de corte de GBS ≤ 2 mostró una sensibilidad del 98% con un VPN de 100%. La utilidad de la escala de GBS mostró un área bajo la curva ROC 0,83 (IC 95% 0,75-0,90). Conclusión: La escala de GBS utilizada pacientes con HDA no variceal atendidos en el servicio de urgencias posee una validez diagnóstica adecuada para predecir la necesidad de intervención.

Introduction: The Glasgow-Blatchford (GBS) scale allows us to classify the patient as a high or low risk of presenting complications. In the patients identified as "low risk", the performance of an early endoscopy could reduce the intrahospital days and the overall cost. In our environment, we do not know the usefulness of the GBS scale. Objective: To describe the utility of the Glasgow-Blatchford scale (GBS) in the stratification of risk in patients with non-variceal upper gastrointestinal bleeding (HDA) seen in the emergency department of a tertiary hospital. Materials and methods: 218 patients were prospectively included, and they were performed in the first 24-48 hr an urgent endoscopy. These were stratified, according to the GBS scale, at low risk (GBS ≤ 2), and high risk (GBS ≥ 3). We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the GBS scale in our setting based on the requirement of endoscopic, radiological treatment (arterial embolization), transfusion of blood products and / or surgery, as our gold standar to classify patients as "high risk". Results: A total of 218 patients were included, with a mean age of 56 ± 18 years, of which 121/218 (55%) were male. 156/218 required intervention for what were classified as "high risk" while 62/218 did not specify and classified as "low risk". A cut-off value of GBS ≤ 2 showed a sensitivity of 98% with a NPV of 100%. The utility of the GBS scale showed an area under the ROC curve 0.83 (95% CI 0.75-0.90). Conclusion: The GBS scale used in patients with non-variceal UGB attended in the emergency department has adequate diagnostic validity to predict the need for intervention.

Distribución Topográfica y Manejo de Tumores Neuroendocrinos del Tubo Digestivo / Topographic Distribution and Management of Neuroendocrine Tumors of the Digestive Tube

Introducción: Los tumores neuroendocrinos (TNE) son un grupo de neoplasias que se originan a partir de células enterocromafínicas, especialmente ubicadas en el tubo digestivo. El objetivo del presente estudio es escribir la distribución topográfica, el manejo multidisciplinario y diagnóstico patológico según la OMS de los tumores neuroendocrinos del tubo digestivo. Métodos: El presente es un estudio descriptivo, retrospectivo de los casos con diagnóstico anatomopatológico confirmado de tumor neuroendocrino localizados en el tubo digestivo entre enero del 2011 a diciembre del 2018 en el Instituto Oncológico Nacional del Ecuador- SOLCA de Guayaquil. Se describe topografía y tipo de tratamiento establecido con frecuencias y porcentajes. Resultados: Ingresaron al estudio 21 casos. La localización más frecuente fue el apéndice cecal n = 8 (38 %), en estómago n=4 (19 %), intestino delgado n=3 (14 %). El diagnóstico patológico en estadio G1 (65 %); G2 (24%) y G3 (12%). La primera línea de tratamiento fue la cirugía con intención curativa n=19 (90.5 %) y tratamiento endoscópico n=2 (9.5 %). Los pacientes sometidos a cirugía, n=16/19; (84 %) obtuvieron niveles de resección 0 (R0) y permanecieron en observación clínica, los demás sujetos en el estudio recibieron tratamiento adyuvante con somatostatina sola n=1 (4.8 %) o combinación de somatostatina y radioterapia n=2 (9.5 %). Conclusión: El diagnóstico de tumor neuroendocrino de tubo digestivo es una etiología oncológica poco frecuente. El tratamiento quirúrgico en esta serie de casos está enfocada en una acción curativa de tipo quirúrgico.

Introduction: Neuroendocrine tumors (NETs) are a group of neoplasms that originate from enterochromaffin cells, especially located in the digestive tract. The objective of the present study is to write the topographic distribution, the multidisciplinary management and pathological diagnosis according to the WHO of the neuroendocrine tumors of the digestive tract. Methods: This is a descriptive, retrospective study of the cases with a confirmed anatomopathological diagnosis of neuroendocrine tumor located in the digestive tract between January 2011 to December 2018 at the National Oncology Institute of Ecuador- SOLCA of Guayaquil. The topography and type of treatment established with frequencies and percentages are described. Results: 21 cases were entered into the study. The most frequent location was the cecal appendix n = 8 (38%), stomach n = 4 (19%), small intestine n = 3 (14%). The pathological diagnosis in stage G1 (65%); G2 (24%) and G3 (12%). The first line of treatment was surgery with curative intent n = 19 (90.5%) and endoscopic treatment n = 2 (9.5%). Patients undergoing surgery, n = 16/19; (84%) obtained resection levels 0 (R0) and remained under clinical observation, the other subjects in the study received adjuvant treatment with somatostatin alone n = 1 (4.8%) or combination of somatostatin and radiotherapy n = 2 (9.5%). Conclusion: The diagnosis of neuroendocrine tumor of the digestive tract is a rare oncological etiology. The surgical treatment in this series of cases is focused on a surgical action of a surgical type.

Endoscopic Features of Upper Gastrointestinal Tract in Patients with Systemic Sclerosis Compared to the Healthy Control

OBJECTIVE: To characterize the endoscopic features of upper gastrointestinal tract in patients with systemic sclerosis (SSc) compared with those in the healthy controls. METHODS: Data on esophagogastroduodenoscopy (EGD) in 180 patients with SSc (SSc group) were compared with that from the 181 age- and sex-matched healthy control who underwent EGD for routine check-up (control group). Clinical data of participants at the time of EGD (defined as baseline) were collected from electric medical record. Endoscopic findings were evaluated by two experts with blinded to their clinical features. Primary outcome of the study was prevalence of each endoscopic lesion between the two groups. RESULTS: The mean±standard deviation age and disease duration in the SSc group at baseline were 55.3±11.8 and 2.9±3.7 years, respectively. Compared to the control group, SSc group more frequently showed reflux esophagitis (32.8% vs. 9.4%, p < 0.001). In contrast, prevalence of atrophic gastritis was significantly lower in the SSc group (8.3% vs. 29.3%, p < 0.001). This result was consistent in the multivariable analysis where patients' age and concomitant proton pump inhibitor use were adjusted. There was no case of gastric antral vascular ectasia (GAVE) in both groups. However, 29 (16.1%) patients in SSc group showed a clinically significant anemia (hemoglobin < 10 mg/dL), with none of the endoscopic features showed significant associations with the outcome. CONCLUSION: Patients with SSc showed significantly lower prevalence of atrophic gastritis. There was no case of GAVE, which suggests that clinical phenotype of the SSc could be different according to the ethnicity or geographic region.

Management of upper gastrointestinal bleeding

This paper will describe the common symptoms, signs and causes of upper gastrointestinal bleeding. We will then provide advice on the management of upper gastrointestinal bleeding at primary care level

Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional high-resolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the anti-reflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.

What Is Appropriate Upper Endoscopic Interval Among Dyspeptic Patients With Previously Normal Endoscopy? A Multicenter Study With Bayesian Change Point Analysis

BACKGROUND/AIMS: Appropriate interval for performing follow-up endoscopy among dyspeptic patients without abnormal findings on previous endoscopy is unclear. We analyzed the multicenter-collected data from the Korean Society of Neurogastroenterology and Motility. METHODS: We collected clinical data of the patients who visited the gastroenterology department and underwent 2 or more sessions of upper endoscopy during 2012–2017 at 6 university hospitals in Korea. Patients with endoscopic interval between 90 days and 760 days were included. For those with multiple endoscopic sessions, only the first 2 were analyzed. Positive outcome was defined as adenoma or cancer in the upper gastrointestinal tract. To identify the point of change and estimate the properties of the stochastic process before and after the change, we used Bayesian regression with Metropolis-Hastings algorithm. RESULTS: There were 1595 patients. Mean age was 58.8 years (standard deviation, 12.8). Median interval of endoscopy was 437 days (standard deviation, 153). On follow-up endoscopy, there were 12 patients (0.75%) who had neoplasia (4 with gastric cancer and 8 with gastric adnoma). As with the prior hypothesis, we presumed the change point (CP) of increase in frequency of organic lesion as 360 days. After random-walk Metropolis-Hastings sampling with Markov-Chain Monte Carlo iterations of 5000, the CP was 560 days (95% credible interval, 139–724). Estimated average of frequency of dysplastic lesions increased by a factor of 4.4 after the estimated CP. CONCLUSION: To rule out dysplastic lesions among dyspeptic patients who had previously normal endoscopy, a 2-year interval could be offered as follow-up interval for repeat upper endoscopy.

Infectious Diseases of the Upper Gastrointestinal Tract

Infectious diseases of the upper gastrointestinal tract are rare, but certain bacteria including Treponema pallidum and Mycobacterium tuberculosis may infect the esophagus, stomach, and duodenum even in an immunocompetent individual. Gastric syphilis is difficult to diagnose because it presents with non-specific symptoms and diverse endoscopic findings. Nevertheless, gastric syphilis should be considered in the differential diagnosis when a patient presents with chronic inflammatory gastric lesions such as multiple erosive/ulcerative lesions and stricture or with other evidence of syphilis. Histological evaluation and specific serological tests should be performed if syphilis is suspected. Esophageal and gastroduodenal tuberculosis also exhibits non-specific clinical manifestations. The diagnosis is confirmed by mucosal biopsy or aspiration cytology revealing the presence of caseating granulomata and/or acid-fast bacilli. Mycobacterial culture and polymerase chain reaction should be incorporated into routine diagnostic studies to improve the diagnostic sensitivity. The diagnosis of tuberculosis is occasionally confirmed indirectly by an excellent response of the patient to anti-tubercular therapy.

Remission of diffuse ulcerative duodenitis in a patient with ulcerative colitis after infliximab therapy: a case study and review of the literature

Although ulcerative colitis (UC) is confined to colonic and rectal mucosa in a continuous fashion, recent studies have also demonstrated the involvement of upper gastrointestinal tract as diagnostic endoscopy becomes more available and technically advanced. The pathogenesis of UC is not well established yet. It might be associated with an inappropriate response of host mucosal immune system to gut microflora. Although continuous and symmetric distribution of mucosal inflammation from rectum to colon is a typical pattern of UC, clinical feature and course of atypically distributed lesions in UC might also help us understand the pathogenesis of UC. Herein, we report a case of duodenal involvement of UC which successfully remitted after infliximab therapy. Endoscopic and pathologic findings before and after administration of anti-tumor necrosis factor suggest that the pathogenesis of upper gastrointestinal involvement of UC may be similar to that of colon involvement.

Fecal Microbiota Transplantation: An Update on Clinical Practice

Fecal microbiota transplantation (FMT) is an infusion in the colon, or the delivery through the upper gastrointestinal tract, of stool from a healthy donor to a recipient with a disease believed to be related to an unhealthy gut microbiome. FMT has been successfully used to treat recurrent Clostridium difficile infection (rCDI). The short-term success of FMT in rCDI has led to investigations of its application to other gastrointestinal disorders and extra-intestinal diseases with presumed gut dysbiosis. Despite the promising results of FMT in these conditions, several barriers remain, including determining the characteristics of a healthy microbiome, ensuring the safety of the recipient with respect to long-term outcomes, adequate monitoring of the recipient of fecal material, achieving high-quality control, and maintaining reasonable costs. For these reasons, establishing uniform protocols for stool preparation, finding the best modes of FMT administration, maintaining large databases of donors and recipients, and assuring that oral ingestion is equivalent to the more widely accepted colonoscopic infusion are issues that need to be addressed.