Morbilidad y mortalidad de pacientes operados de cáncer de esófago / Morbidity and Mortality of Patients Operated on for Esophageal Cancer

Introducción: El tratamiento principal del cáncer esofágico es la esofagectomía. Objetivo: Determinar la morbilidad y mortalidad de los pacientes operados de cáncer esofágico. Métodos: Se realizó un estudio observacional, descriptivo y transversal en 87 pacientes operados de cáncer esofágico en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba durante el período comprendido de 2014 a 2018. Resultados: Dos pacientes en estadio II (100,0 por ciento) recibieron tratamiento quirúrgico curativo y 12 en estadio III (17,9 por ciento). Recibieron tratamiento quirúrgico paliativo 55 (82,1 por ciento) enfermos en estadio III y 18 (100,0 por ciento) en estadio IV. Predominó la técnica transhiatal de Denk-Sloan-Orringer aplicada en 10 (71,4 por ciento) pacientes. La gastrostomía predominó como proceder paliativo para alimentación en 53 (76,2 por ciento) pacientes. Se reportaron 45 complicaciones; el 53,3 por ciento de tipo médica, en las que prevalecieron las respiratorias: bronconeumonía (13,3 por ciento) y distrés respiratorio (11,1 por ciento). En cambio, el 46,7 por ciento de las complicaciones fueron de tipo quirúrgicas: infección del sitio operatorio (20,0 por ciento), seguida de la fuga anastomótica (15,6 por ciento). Fallecieron 16 (18,4 por ciento) pacientes del total de la serie. Las causas de muerte predominantes fueron el distrés respiratorio (31,3 por ciento) y la disfunción múltiple de órganos (25,0 por ciento). Conclusiones: La esofagectomía abierta o mínimamente invasiva se erige como el tratamiento quirúrgico de elección para el tratamiento del cáncer esofágico con intención curativa, proceder con elevada morbilidad y mortalidad a escala mundial. Los resultados de esta investigación coinciden con los reportados en la literatura médica nacional y extranjera(AU)

Introduction: The main treatment for esophageal cancer is esophagectomy. Objective: To determine the morbidity and mortality of patients operated on for esophageal cancer. Methods: An observational, descriptive and cross-sectional study was carried out with 87 patients operated on for esophageal cancer in the general surgery service of Hospital Provincial Docente Saturnino Lora, of Santiago de Cuba, during the period from 2014 to 2018. Results: Curative surgical treatment was received by 2 patients (100.0 percent) in stage II and 12 patients (17.9 percent) in stage III. Palliative surgical treatment was received by 55 ill patients (82.1 percent) in stage III and 18 ill patients (100.0 percent) in stage IV. There was a predominance of the Denk-Sloan-Orringer transhiatal technique, applied in 10 (71.4 percent) patients. Gastrostomy predominated in 53 (76.2 percent) patients as a palliative procedure for feeding. Forty-five complications were reported, 53.3 percent of which were medical, with respiratory complications prevailing: bronchopneumonia (13.3 percent) and respiratory distress (11.1 percent). On the other hand, 46.7 percent of the complications were surgical: surgical site infection (20.0 percent), followed by anastomotic leak (15.6 percent). Out of the total series, 16 (18.4 percent) patients died. The predominant causes of death were respiratory distress (31.3 percent) and multiple organ dysfunction (25.0 percent). Conclusions: Open or minimally invasive esophagectomy stands out as the surgical treatment of choice for esophageal cancer with curative purposes, being a procedure with high morbidity and mortality worldwide. The results of this research coincide with those reported in the national and foreign medical literature(AU)

Complicaciones de la esofagectomía por cáncer de esófago / Complications of Esophagectomy for Esophageal Cancer

Introducción: La esofagectomía es uno de los procedimientos con más alta morbilidad posoperatoria en cirugía oncológica digestiva. Objetivo: Describir las complicaciones relacionadas con la esofagectomía subtotal programada según variables de interés. Métodos: Se realizó un estudio descriptivo y transversal en los Servicios de Cirugía General de los hospitales "Saturnino Lora" y "Juan Bruno Zayas" de Santiago de Cuba, desde 2010 hasta 2019. La población estuvo conformada por 81 pacientes, de la cual se reclutó una muestra aleatoria de 68 enfermos sometidos a esofagectomía subtotal programada por cáncer de esófago. Fueron investigadas las siguientes variables: presencia de complicaciones posoperatorias y tipo de técnica quirúrgica utilizada. Además, se clasificaron en grados según Dindo Clavien. Resultados: Todos los enfermos fueron operados por técnica abierta mediante esofagectomía subtotal programada, donde la resección mediante la técnica de Ivor-Lewis se realizó en el 69,2 por ciento. Para todas las técnicas quirúrgicas empleadas predominó la atelectasia (39,7 por ciento) como complicación posquirúrgica, y entre las infecciosas la neumonía en 30 enfermos (44,1 por ciento), mientras que para las complicaciones quirúrgicas no infecciosas el neumotórax fue mayormente incidente, para el 25,0 por ciento. El mayor número de complicaciones se ubicó en el grado II de Dindo Clavien. Conclusiones: La presencia de complicaciones posquirúrgicas de la enfermedad es notable, en correspondencia a lo reflejado por la literatura médica. Existió relación significativa entre la presencia del hábito de fumar, de enfermedad pulmonar obstructiva crónica y la de toracotomía con algunas de las complicaciones encontradas(AU)

Introduction: Esophagectomy is one of the procedures with the highest postoperative morbidity in digestive cancer surgery. Objective: To describe the complications related to scheduled subtotal esophagectomy according to variables of interest. Methods: A descriptive and cross-sectional study was carried out in the General Surgery Services at Saturnino Lora and Juan Bruno Zayas hospitals in Santiago de Cuba, from 2010 to 2019. The population consisted of 81 patients, out of which a random sample of 68 patients undergoing elective subtotal esophagectomy for esophageal cancer was selected. The variables investigated were presence of postoperative complications and type of surgical technique used. In addition, they were classified in grades according to Clavien-Dindo. Results: All the patients were operated by open technique by programmed subtotal esophagectomy, the resection by the Ivor-Lewis technique was performed in 69.2 percent. For all the surgical techniques used, atelectasis (39.7 percent) prevailed as a postsurgical complication, and among the infectious complications, pneumonia prevailed in 30 patients (44.1 percent), while for non-infectious surgical complications, pneumothorax was mostly incidental for 25.0 percent. The highest number of complications was in Clavien-Dindo grade II. Conclusions: The presence of post-surgical complications of the disease is notable, corresponding to what is reflected in the medical literature. There was significant relationship between the presence of smoking, chronic obstructive pulmonary disease and thoracotomy with some of the complications found(AU)

Caracterización de la fuga anastomótica en operados por cáncer del esófago en Cuba / Characterization of Anastomotic Leak in Patients Operated on for Esophageal Cancer in Cuba

Introducción: La fuga anastomótica es la principal complicación de la cirugía del esófago, con altos índices de incidencia y mortalidad. Objetivo: Identificar los factores involucrados en la aparición de la fuga anastomótica en pacientes operados de cáncer de esófago en Cuba en el periodo de 1988 al 2020. Métodos: Se realizó una investigación observacional clínico epidemiológica multicéntrica, no randomizada, en el periodo de 1988 al 2020. El universo y la muestra quedaron constituidos por 2844 y 595 enfermos de 9 centros hospitalarios. Algunas variables estudiadas incluyeron sexo, edad, variedad histológica, intervención quirúrgica realizada, comorbilidades y su interrelación con la fuga anastomótica. Resultados: La fuga anastomótica predominó en el grupo de mayores de 55 años (17,8 por ciento), en el sexo femenino 65 (10,9 por ciento), en los no fumadores 79 (13,3 por ciento) y en los que no ingerían bebidas alcohólicas con 100 pacientes (16,8 por ciento). En enfermos con niveles de albúmina normales 98 (16,5 por ciento), con proteínas bajas 94 (15,7por ciento) y cifras normales de hemoglobina 105 (17,6 por ciento). En la variedad histológica adenocarcinoma 65 (10,9 por ciento), la técnica quirúrgica transhiatal 69 (11,6 por ciento), realizada de forma manual 123 (20,7 por ciento), de localización cervical 111 (18,6 por ciento), en cara anterior 57 (9,6 por ciento), en un plano 78 (13,1 por ciento), en la variante término-lateral 120 (20,2 por ciento). Conclusiones: La fuga anastomótica predominó en mujeres mayores de 50 años, con adenocarcinoma, operadas con técnicas transhiatales, manuales, en un plano, termino-laterales, en cara anterior y con hipoproteinemia(AU)

Introduction: Anastomotic leak is the main complication of esophageal surgery, with high incidence and mortality rates. Objective: To identify the factors involved in the appearance of anastomotic leak in patients operated on for esophageal cancer in Cuba in the period from 1988 to 2020. Methods: A nonrandomized, multicenter, clinical-epidemiological and observational investigation was carried out in the period from 1988 to 2020. The universe and the sample consisted of 2844 and 595 patients from nine hospital centers. Some of the variables studied included sex, age, histological variety, surgical intervention performed, comorbidities, and their interrelation with anastomotic leak. Results: Anastomotic leak prevailed in the group aged over 55 years (17.8 percent), in the female sex (65; 10.9 percent)), in nonsmokers (79; 13.3 percent)) and in those who did not ingest alcoholic beverages (100, 16.8; as well as in patients with normal albumin levels (98; 16.5), with low proteins (94; 15.7 percent) and with normal levels of hemoglobin (105; 17.6 percent). In the histological variety of adenocarcinoma (65; 10.9 percent), there was a predominance of the transhiatal surgical technique (69; 11.6 percent), performed manually (123; 20.7 percent), of cervical location (111; 18.6 percent), in the anterior face (57; 9.6 percent), in one plane (78; 13.1 percent), and in the termino-lateral variant (120; 20.2 percent). Conclusions: Anastomotic leak prevailed in women aged over 50 years, with adenocarcinoma, operated on through transhiatal techniques, manually, in one plane, using the termino-lateral variant, in the anterior face and with hypoproteinemia(AU)

Acalasia y su relación con el cáncer esofágico / Esophageal acalasia and its relationship with esophageal cancer

Resumen La acalasia es un trastorno motor primario de la musculatura lisa esofágica que se caracteriza por disfagia, pseudorregurgitación y baja de peso. El tratamiento puede ser endoscópico o quirúrgico. Sólo se conocen los resultados a largo plazo de la cirugía, mientras que los endoscópicos tienen aún un seguimiento muy corto y no permiten sacar conclusiones valederas. La acalasia es una lesión que tiene una probabilidad significativamente mayor de desarrollar un cáncer esofágico, ya sea de tipo epidermoide, por inflamación crónica y retención de comida en el esófago, o un adenocarcinoma, secundario a reflujo gastroesofágico, que aparece posterior a cualquier tratamiento. Las publicaciones muestran que alrededor de 3% a 4% de los pacientes presentan a largo plazo, sobre 10 a 15 años postratamiento, el desarrollo de un cáncer avanzado del esófago. Se concluye que es indispensable un seguimiento clínico y endoscópico en forma rutinaria a estos pacientes.

Achalasia is a primary motor disorder of the esophageal smooth muscle characterized by dysphagia, pseudoregurgitation, and weight loss. Treatment can be endoscopic or surgical. The long-term results are only known from surgery, while endoscopic results still have a very short follow-up and do not allow us to draw valid conclusions. Achalasia is a lesión that has a significantly higher probability of developing esophageal cancer, whether of the epidermoid type, due to chronic inflammation and food retention in the esophagus, or an adenocarcinoma, secondary to gastroesophageal reflux, which appears after any treatment. Publications show that about 3 to 4% of patients present in time, about 10 to 15 years after treatment, the development of advanced cancer of the esophagus. It is concluded that clinical and endoscopic follow-up is essential in these patients on a routine basis.

Esôfago de Barrett: o estado da arte / Barrett's Esophagus: the state of the art

Objetivo: Demonstrar fatores envolvidos nos distúrbios do sono em profissionais que fazem plantões. Métodos: Trata-se de estudo transversal, cuja amostra foi composta de 244 voluntários, plantonistas da área da saúde, sendo 191 do sexo feminino, que responderam a um questionário socioeconômico, associado à aplicação da Escala de Sonolência de Epworth e ao Índice de Qualidade do Sono de Pittsburgh. Os dados foram analisados pelos coeficientes de Spearman e de Kendall Tau, com distribuição de probabilidade gama. Resultados: Houve significância (p<0,05) com o Índice de Qualidade do Sono de Pittsburgh e a atividade física (+0,216), ergonomia (+0,148), filhos (-0,146), valor da remuneração (+0,112) e disfunção durante o dia (+0,352). Também houve significância com a Escala de Sonolência de Epworth e atividade física (+0,138), renda familiar (-0,118), trabalho semanal (-0,151), latência do sono (-0,106), duração do sono (-0,107), eficiência do sono (-0,139) e disfunção durante o dia (+0,170). Por fim, a eficiência do sono teve significiância com profissão (-0,209), tabagismo (+0,402), Escala de Sonolência de Epworth (-0,139) e dissonias com a obesidade (índice de massa corporal >30; razão de chance de 1,40; intervalo de confiança de 95% de 1,02-1,94). Conclusão: As medidas autorrelatadas são prontamente obtidas com questionários validados, como a Escala de Sonolência de Epworth e o Índice de Qualidade do Sono de Pittsburgh, encontrando-se correlações com renda familiar, ter ou não filhos, índice de massa corporal, atividade física, ergonomia, condições de trabalho, tabagismo e componentes biopsicossociais. Em virtude do caráter transversal deste estudo é indispensável mais estudos com maior follow-up

Objective: To demonstrate factors involved in sleep disorders in professionals who take shifts. Methods: This is a cross-sectional study whose sample consists of 244 volunteers, on-duty health workers, 191 females, who answered a socioeconomic questionnaire, associated with application of the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Data were analyzed with Spearman's and Kendall Tau coefficients, and gamma probability distribution. Results: There was significance (p<0,05) with the Pittsburgh Sleep Quality Index and physical activity (+0,216), ergonomics (+0,148), children (-0,146), the wage (+0,112), dysfunction during the day (+0,352). Also there was significance with the Epworth Sleepiness Scale and physical activity (+0,138), family income (-0,118), weekly workload (-0,151), sleep latency (-0,106), sleep duration (-0,107), sleep efficiency (-0,139), and dysfunction during the day (+0,170). Finally, sleep efficiency was significant with occupation (-0,209), smoking habits (+0,402), Epworth Sleepiness Scale (-0,139), dyssomnia with obesity (body index mass >30; OR of 1,40; CI 95% 1,02-1,94). Conclusion: Self-reported measures are readily obtained with validated questionnaires such as Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, with correlations with family income, having children or not, body mass index, physical activity, ergonomics, working conditions, smoking habits, and biopsychosocial components. Due to the cross-sectional nature of this study, further research with longer follow-up is indispensable

Caracterización clínico-patológica del cáncer esofágico avanzado en el Hospital Universitario Comandante Faustino Pérez. Matanzas / Clinic-pathologic characterization of the advanced esophagus cancer in the University Hospital Comandante Faustino Perez, Matanzas

RESUMEN Introducción: el cáncer de esófago en estadio avanzado, es uno de los más agresivos. En Cuba ocupa el décimo lugar entre las causas de muerte. Objetivo: caracterizar clínico y patológicamente a los pacientes con cáncer esofágico diagnosticados en el hospital estudiado. Materiales y métodos: se realizó un estudio prospectivo-descriptivo donde se efectuó una caracterización clínico-patológica a 59 pacientes con el diagnóstico endoscópico e histológico de cáncer de esófago, en el Hospital Faustino Pérez Hernández de Matanzas, de enero del 2016 a diciembre del 2017. Se estudiaron variables como: grupo etáreo, sexo, antecedentes patológicos personales y familiares, factores de riesgo, síntomas y signos predominantes en el diagnóstico, tiempo de aparición de los síntomas, tipo endoscópico, localización, tipo histológico, grado de diferenciación histológica, estadio de la enfermedad, tipo de tratamiento y tiempo de vida posterior al diagnóstico. Resultados: predominó el sexo masculino (88.1%) en pacientes mayores de 60 años (52.6%). La disfagia, la astenia y la anorexia fueron los síntomas más frecuentes; el etilismo crónico y el hábito de fumar fueron los factores de riesgo predominantes. La localización anatómica más frecuente fue el tercio medio (54.2%), el tipo endoscópico vegetante (88.1%) y el tipo histológico carcinoma epidermoide bien diferenciado (55.9%). Hubo relación entre el tiempo de inicio de los síntomas entre 3 y 6 meses antes del diagnóstico y el estadio IV de la enfermedad que predominó en 29 pacientes (49.2%). La mayoría de los pacientes recibieron tratamiento oncológico combinado con cirugía paliativa (47.5%) o ningún tratamiento (45.8%) pues el 50.8% de los pacientes fallecieron al mes del diagnóstico demostrando que el diagnóstico del cáncer esofágico se realiza casi siempre en estadios avanzados de la enfermedad cuando son posible pocas opciones terapéuticas. Conclusiones: el cáncer de esófago aún sigue diagnosticándose de forma tardía en estadios avanzados, con elevada prevalencia del carcinoma epidermoide sobre el adedocarcinoma que indica pocas acciones de salud preventivas sobre los factores de riesgo en la población estudiada, existiendo relación entre el estadio avanzado de la enfermedad y el poco tiempo de vida de estos pacientes posterior al diagnóstico.

ABSTRACT Introduction: the advanced-stage esophagus cancer is one of the most aggressive cancers. In Cuba, it is in the tenth place among the death reasons. Objective: to clinically and pathologically characterize the patients with esophageal cancer diagnosed in the mentioned hospital. Materials and methods: a prospective-descriptive study was carried out based on the clinical-histological characterization of 59 patients with the endoscopic and histological diagnosis of esophageal cancer in the Hospital "Faustino Pérez Hernández", of Matanzas, in the period from January 2016 to December 2017. The studied variables were: age group, sex, personal and familiar pathological antecedents, risk factors, symptoms and signs that were predominant in the diagnosis, time passed since the symptoms appeared, endoscopic kind, location, histological kind, level of histological differentiation, disease stage, kind of treatment, and life time after the diagnosis. Results: male sex predominated (88.1 %) in patients older than 60 years (52.6 %). Dysphagia, asthenia and anorexia were the most frequent signs. Alcoholism and smoking were the predominant risk factors. The most frequent anatomic location was the middle third (54.3 %); the endoscopic vegetating kind (88.1 %) and the histological kind well-differentiated epidermoid carcinoma (55.9 %) prevailed. The authors found a relation between the beginnings of the symptoms 3 to 6 months before the diagnosis and the disease IV stage predominating in 29 patients (49.2 %). Most of patients underwent oncologic treatment combined with palliative surgery (47.5 %) or no treatment (45.8 %), because 50.8 % of the patients died a month after the diagnosis, showing that the diagnosis of esophageal cancer is almost always achieved at advanced stages of the disease, when few therapeutic options are possible. Conclusions: esophageal cancer is still being diagnosed late, in advanced stages, with a higher prevalence of the epidermoid carcinoma over the adenocarcinoma. It indicates few health preventive actions on the risk factors among the studied population. There is a relation between the disease advanced stage and the few time patients live after the diagnosis.

Baixa prevalência de esôfago de Barrett em área de risco para câncer esofágico no Sul do Brasil / Low prevalence of barrett's esophagus in a risk area for esophageal cancer in south of brazil

ABSTRACT BACKGROUND: Barrett's esophagus a complication of gastroesophageal reflux disease (GERD) is a precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has been increasing in most Western countries. Rio Grande do Sul (RS), the Southernmost state of Brazil has the highest rates of esophageal cancer with low prevalence of esophageal adenocarcinoma. OBJECTIVE: To investigate the prevalence of Barrett's esophagus among patients underwent to upper gastrointestinal endoscopy in the last 5 years. METHODS: The records of patients underwent upper gastrointestinal endoscopy between 2011 and 2015 were analyzed. Demographic data, GERD symptoms, endoscopic findings, extension and histological diagnosis of columnar epithelia of the esophagus were recorded. Significance among the variables was accessed by chi-square test and Fisher's exact test with 95% CI. RESULTS: A total of 5996 patients underwent to upper gastrointestinal endoscopy in the period were included. A total of 1769 (30%) patients with GERD symptoms or esophagitis and 107 (1.8%) with columnar lined esophagus were identified. Except for eight patients, the others with columnar lined esophagus had GERD symptoms or esophagitis. Barrett's esophagus defined by the presence of intestinal metaplasia occurred in 47 patients; 20 (43%) with segments over 3 cm and 27 (57%) with segments shorter than 3 cm. The global prevalence of Barrett's esophagus was 0.7% and in GERD patients 2.7%. The odds ratio for the occurrence of columnar lined esophagus in patients with GERD was 30 (95%CI=15.37-63.34). The odds ratio for the presence of intestinal metaplasia in long segments was 8 (95%CI=2.83-23.21). CONCLUSION: GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett's esophagus than short segments. Barrett's esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett's esophagus represented globally 0.3% and 1.1% in GERD patients.

RESUMO CONTEXTO: Esôfago de Barrett, complicação da doença do refluxo gastroesofágico (DRGE), é lesão precursora do adenocarcinoma esofágico. O adenocarcinoma esofágico apresenta incidência crescente principalmente no ocidente. O estado do Rio Grande do Sul apresenta as taxas mais altas de câncer esofágico no Brasil, porém com baixa prevalência de adenocarcinoma. OBJETIVO: Investigar a prevalência de esôfago de Barrett em pacientes submetidos a endoscopia digestiva alta nos últimos 5 anos. MÉTODOS: Revisão de prontuários dos pacientes submetidos a endoscopia digestiva alta entre 2011 e 2015. Registrados dados demográficos, sintomas de DRGE, achados endoscópicos, extensão e diagnóstico histológico de epitelização colunar do esôfago. A significância entre as variáveis foi acessada pelos testes do qui-quadrado e exato de Fisher com IC95%. RESULTADOS: Foram incluídos 5996 pacientes. Identificamos 1769 (30%) com sintomas de DRGE ou esofagite e 107 (1,8%) com epitelização colunar. À exceção de oito pacientes com epitelização colunar, os demais apresentavam sintomas de DRGE ou esofagite. Esôfago de Barrett definido pela presença de metaplasia intestinal ocorreu em 47 pacientes; 20 (43%) com segmentos acima de 3 cm e em 27 (57%) com segmentos menores. A prevalência global de esôfago de Barrett foi 0,7% e em pacientes com DRGE foi 2,7%. A razão de chances para a ocorrência de epitelização colunar em pacientes com DRGE foi 30 (IC95%=15,37-63,34) e para a ocorrência de metaplasia intestinal em segmentos longos foi 8 (IC95%=2,83-23,21). CONCLUSÃO: Pacientes com DRGE apresentaram risco 30 vezes maior que pacientes sem DRGE para a ocorrência de epitelização colunar. O risco de ocorrência de esôfago de Barrett em segmentos longos foi oito vezes maior. A prevalência global de esôfago de Barrett foi 0,7%. Em pacientes com DRGE a prevalência foi 2,7%. Segmentos longos de esôfago de Barrett representaram globalmente 0,3% e em pacientes com DRGE 1,1%.

Guía de práctica clínica para la enfermedad por reflujo gastroesofágico / Clinical practice guideline for disease caused by gastroesophageal reflux

Objetivo: brindar una guía de práctica clínica basada en la evidencia más reciente para el diagnóstico y tratamiento del reflujo gastroesofágico teniendo en cuenta la efectividad y seguridad de las intervenciones dirigidas a pacientes, personal asistencial, administrativo y entes gubernamentales de cualquier servicio de atención en Colombia. Materiales y métodos: esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad; 1 guía cumplió los criterios de adaptación, por lo que se decidió adaptar 3 preguntas clínicas. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas con base en la metodología GRADE. Las recomendaciones de la guía fueron socializadas en una reunión de expertos con entes gubernamentales y pacientes. Resultados: se desarrolló una guía de práctica clínica basada en la evidencia para el diagnóstico y tratamiento de pacientes con reflujo gastroesofágico en Colombia. Conclusiones: el diagnóstico y manejo oportuno de los pacientes con ERGE contribuirá a disminuir la carga de la enfermedad en Colombia, así como de las enfermedades asociadas.

Objective: To provide a clinical practice guideline with the latest evidence for diagnosis and treatment of gastroesophageal reflux for patients, caregivers, administrative and government bodies at all levels of care in Colombia. Materials and Methods: This guide was developed by a multidisciplinary team with the support of the Colombian Association of Gastroenterology, Cochrane STI Group and Clinical Research Institute of the Universidad Nacional de Colombia. Relevant clinical questions were developed and the search for national and international guidelines in databases was performed. Existing guidelines were evaluated quality and applicability. One guideline met the criteria for adaptation, so the group decided to adapt 3 clinical questions. Systematic literature searches were conducted by the Cochrane Group. The tables of evidence and recommendations were made based on the GRADE methodology. The recommendations of the guide were socialized in a meeting of experts with government agencies and patients. Results: An evidence-based Clinical Practice Guidelines for the diagnosis and treatment of gastroesophageal reflux was developed for the Colombian context. Conclusions: The opportune detection and appropriate management of gastroesophageal reflux would contribute to the burden of the disease in Colombia and its associated diseases.

Risk factors for esophageal cancer in a low-incidence area of Brazil / Fatores de risco para o câncer de esôfago em uma área de baixa incidência no Brasil

Esophageal cancer is the eighth commonest type of cancer worldwide, occupying sixth place in terms of mortality. Smoking and alcohol use are known risk factors for this type of cancer. The aim here was to evaluate the risk factors for esophageal cancer in a low-incidence area.

Case-control study in Goiânia, with 99 cases of esophageal cancer and 223 controls.

The variables were sociodemographic, dietary, occupational and lifestyle data. The sample was analyzed using the chi-square test, Mann-Whitney test and Mantel-Haenszel approach for multivariate analysis. Odds ratios (OR) were calculated with 5% significance and 95% confidence intervals.

The risk of esophageal cancer was higher in patients ≥ 55 years (OR = 1.95; P < 0.001). Patients from rural areas were at greater risk of esophageal cancer (OR = 4.9; P < 0.001). Smoking was a risk factor among the cases (OR = 3.8; P < 0.001), as was exposure to woodstoves (OR = 4.42; P < 0.001). The practice of oral sex was not a risk factor (OR = 0.45; P = 0.04). Consumption of apples, pears, vegetables, cruciferous vegetables and fruit juices were protective against esophageal cancer.

In a region in which the incidence of esophageal cancer is low, the most significant risk factors were exposure to woodstoves, smoking and living in rural areas. .

O câncer de esôfago é o oitavo tipo mais comum em todo o mundo, ocupando o sexto lugar em termos de mortalidade. Fatores de risco conhecidos para esse tipo de câncer são o consumo de tabaco e o álcool. O objetivo foi avaliar os fatores de risco para câncer de esôfago em uma área de baixa incidência.

Estudo caso-controle em Goiânia, com 99 casos de câncer de esôfago e 223 controles.

As variáveis foram dados sociodemográficos, alimentares, ocupacionais e de estilo de vida. A amostra foi analisada pelo teste do qui-quadrado, Mann-Whitney e de Mantel-Haenszel para análise multivariada. Foram calculados a odds ratio (OR) com significância em 5% e o intervalo de confiança de 95%.

O risco de câncer de esôfago foi maior em pacientes ≥ 55 anos (OR = 1,95, P < 0,001). Pacientes de áreas rurais estavam em risco maior de câncer de esôfago (OR = 4,9; P < 0,001). O tabagismo foi um fator de risco entre os casos (OR = 3,8; P < 0,001), bem como exposição ao fogão a lenha (OR = 4,42; P < 0,001). A prática do sexo oral não foi fator de risco (OR = 0.45; P = 0,04). Consumo de maçãs, peras, legumes, vegetais crucíferos e sucos de frutas foi protetor contra o câncer de esôfago.

Em uma região em que a incidência de câncer de esôfago é baixa, os fatores de risco mais significativos foram a exposição a fogão a lenha, tabagismo e viver em zona rural. .

Obtaining informed consent in an illiterate population

Esophageal cancer is highly prevalent among the Turkman people in Northeastern Iran. In order to evaluate its etiology, there is an on-going prospective cohort study in this area involving approximately 50000 subjects over the age of 40 years. The majority of these subjects are illiterate, thus obtaining informed consent is very important and difficult. Initially, we explained the aim and study method to religious leaders and health-sanitary officials. One week prior to obtaining informed consent, potential participants were given adequate information about the research process by trained health personnel at their own home. Thus, participants had sufficient time to consider the research and consult with local health personnel, religious authorities, family, neighbors, friends and those who previously participated in the study. Potential participants could observe the research process directly and then be included in the study if they agreed. A total of 50045 individuals agreed to participate in the study, of which 70% were illiterate. There were no refusals due to the medical ethical aspects of this study. The method of awareness in this study can be a useful pattern for research on elderly and illiterate individuals who are participants in research studies in Iran and other countries

Esôfago de Barrett progride para câncer em apenas 0, 12% por ano nos cinco primeiros anos / Barretts esophagus progresses to cancer at only 0.12% per year over the first five years

Os resultados1 encontraram taxa muito baixa de progressão para o câncer entre os pacientes que têm esôfago de Barrett. Aalta taxa de detecção durante o primeiro ano após o diagnósticoda metaplasia sugere uma possível utilidade em se repetir aendoscopia em seis meses ou um ano. Mas a predisposição paraa vigilância generalizada e permanente de todos os pacientescom esôfago de Barrett deve ser ponderada à luz desses achados epidemiológicos.

Risk factors and survival analysis of the esophageal cancer in the population of Jammu, India.

Objective: To identify the risk factors of esophageal cancer and study their effect on the survival rates patients of Jammu region, India. Materials and Methods: Detailed information was collected on socio-demographic, dietary and clinico-pathological parameters for 200 case control pairs. Discrete (categorical) data of 2 independent groups (control and cases) were summarized in frequency (%) and compared by using Chi-square (χ2 ) test. The mean age of two independent groups was compared by independent Student's t-test. To find out potential risk factor (s), the variable (s) found significant in univariate analysis were further subjected to multivariate logistic regression analysis. The association of potential risk factors with patients survival (3-year overall survival) was done by Kaplan-Meier survival curve analysis using Log-rank test. A 2-tailed (a = 2) P < 0.05 was considered statistically significant. Results: Out of the 63 response parameters, seven were found highly significant on multivariate analysis. The mean (± SD) age was 56.74 ± 10.76 years, the proportions of males were higher than females, mostly illiterate and lower income group. Among dietary characteristics, snuff was highest (OR = 3.86, 95% CI = 2.46-6.08) followed by salt tea (OR = 2.53, 95% CI = 1.49-4.29), smoking (OR = 1.97, 95% CI = 1.18-3.30), sundried food (OR = 1.77, 95% CI = 1.10-2.85) and red chilly (OR = 1.76, 95% CI = 1.07-2.89). Probability of survival lowered significantly (P < 0.05 or P < 0.01 or P < 0.001) in those consuming tobacco in the form of snuff (Log-rank c 2 = 24.62, P = 0.000) and smoking (Log-rank c 2 = 5.20, P = 0.023) as compared to those who did not take these. Conclusions: The analysis finally established snuff (smokeless tobacco) as the most powerful risk factor of esophageal cancer in Jammu region, followed by the salt tea, smoking and the sundried food.

Obesity and Functional Gastrointestinal Disorders / 대한소화기학회지

Obesity is prevalent in Korea. An increase in food intake and a decrease in energy expenditure are responsible for obesity. Gut hormones play a role in controlling food intake. Obesity is suggested to be linked to common gastrointestinal functional disorders. Obesity is associated with an increased risk of gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma. Epidemiologic studies indicate that obesity is associated with chronic gastrointestinal symptoms. This association suggests the possibility that obesity and functional gastrointestinal disorders may be pathophysiologically linked. However, data on the relationship between obesity and functional gastrointestinal disorders are inconsistent. In this paper, we review the role of gastrointestinal hormones in food intake and the relationship between obesity and functional gastrointestinal disorders.

Quality of drinking water and high incidence rate of esoph-ageal cancer in Golestan Province of Iran: a probable link

Golestan Province in northern Iran is known to be a high-risk area for esophageal cancer [EC]. Of a long list of multiple risk factors, this study focuses on a possible link between the epidemiologic patterns of EC and the anomalous concentration of some ions and elements in the drinking water sources. A total of 183 samples from 45 villages covering a wide range of EC mortality rates are collected and analyzed. The results demonstrate that NO3, SO42, Sb, and Sr exceed the recommended maximum concentration level [MCL] in drinking water. This is more prominent in the villages with high esophageal cancer mortality rate, suggesting a possible link between EC incidence and water quality. Se concentration in drinking water increases from low to the high EC areas, a finding contrary to the expected trend. It is concluded that Se deficiency does not play a major role in the etiology of EC in the Golestan Province. The statistical results obtained from Mann-Whitney and Kruskal-Wallis tests along with cluster analysis are consistent with the observed trend of EC mortality rate in Golestan Province

Consumo de tabaco y alcohol en pacientes con cáncer esofágico y su relación con el tipo histológico: Hospital Vargas de Caracas período 2004 - 2009 / Consumption of snuff and alcohol use in patients with esophageal cancer and its relation to histological type: Hospital Vargas de Caracas period 2004 - 2009

El Cáncer de Esófago ocupa el noveno lugar entre las neoplasias malignas a nivel mundial y está asociado al hábito tabáquico y alcohólico. En el Hospital Vargas de Caracas ocupa el lugar número 11 entre las primeras 15 (2.5%) causas de egresos por cáncer al año. Determinar el consumo de tabaco y alcohol en pacientes ingresados por Cáncer de esófago en el "Hospital Vargas de Caracas" durante el período 2004 - 2009. Se realizó estudio retrospectivo y descriptivo, luego de la revisión de historias de 24 pacientes ingresados con diagnóstico de cáncer de esófago. Se utilizaron medidas de tendencia central para interpretación de resultados. 21 (87.5%) de los pacientes fueron masculinos y 3 (12.5%) femeninos. La edad promedio fue de 61 años. El 83.3% (20) refirieron hábito tabáquico de más de 24 paquetes/año y hábito alcohólico mayor a 120 gr/día. Histológicamente 87.5% (21) correspondió a Carcinoma Epidermoide localizado en 1/3 medio de esófago en 58.3% (14). Adenocarcinoma fue diagnosticado en 3 pacientes (12.5%). El hallazgo histopatológico más frecuente fue el carcinoma epidermoide en el 87.5% de las historias revisadas. El 83% de los pacientes tenía una asociación importante al hábito tabáquico y alcohólico, por lo que recomendamos implementación de Programa conjunto de promocióny prevención en salud entre la Sociedad Venezolana de Gastroenterología y la Sociedad Anticancerosa de Venezuela, de lucha contra los factores de riesgo de esta enfermedad...

Esophageal Cancer ranks ninth among malignant neoplasias worldwide and is associated to smoking and alcohol consumption. In "HospitalVargas de Caracas" its ranked number 11 among the top 15 (2.5%) cases of cancer annually discharged. Determine the tobacco and alcohol consumption in patients admitted for esophageal cancer in "Hospital Vargas de Caracas" during the period 2004 to 2009. We performeda retrospective, descriptive study, after reviewing the charts of 24 patients admitted for esophageal cancer diagnosis. We used central tendency measures for interpretation of results. 21 (87.5%) patients were male and 3 (12.5%) female. The average age was 61 years. 83.3% (20) reported smoking over 24 packs-years and alcohol consumption greater than 120 g / day. Histologically, 87.5% (21) corresponded to squamous cell carcinoma located in 1 / 3 of the esophagus in 58.3% (14). 3 patients (12.5%) were diagnosed with Adenocarcinoma. Squamous cell carcinoma in 87.5% was the most common histopathological finding among the reviewed charts. 83% of patients had a significant association to smoking and alcohol, thus, we recommend the implementation of a joint prevention and health promotion program about the management of risk factors of this disease between the Venezuelan Society of Gastroenterology and Venezuela's Anti-Cancer Society, the control of risk factors of this disease...

Prevalence of esophageal cancer risk factors among Turkmen and non-Turkmen ethnic groups in a high incidence area in Iran

Golestan Province in north-eastern Iran has one of the highest incidence rates for esophageal squamous cell carcinoma [ESCC] worldwide. Earlier studies have reported higher incidence rates in the areas of Golestan which are mainly inhabited by individuals of the Turkmen ethnic group. However, it is not clear whether in those areas the incidence among Turkmens is higher in comparison to non-Turkmens. Some previous studies have suggested that environmental factors might play a more essential role in ESCC carcinogenesis in Golestan than a genetic background. If environmental factors instead of a genetic background are the major risk factors, therefore the prevalence of known environmental risk factors would not significantly differ among ESCC cases of different ethnic groups. To investigate the role of environmental factors versus genetic background by using the above concept, we have compared the prevalence of known risk factors for ESCC among Turkmen and non-Turkmen ESCC cases. Study participants were histopathologically proven ESCC cases from Golestan Province. They were recruited in the study from December 2003 to June 2007. The prevalence of the most important known risk factors for ESCC in Turkmen and non-Turkmen ESCC cases was compared using Chi-squared and Fisher's exact tests. Of 300 ESCC cases recruited in the study, 171 [57.0%] and 129 [43.0%] cases were Turkmen and non-Turkmen, respectively. In the majority of the investigated risk factors which included tobacco, nass, and opium use, hot and extremely hot tea consumption, as well as decreased levels of education; there was no significant difference between Turkmen and non-Turkmen ESCC cases in the prevalence of exposure. Our findings support the suggestion that a substantial difference between Turkmens and non-Turkmens in terms of genetic susceptibility to ESCC is unlikely. Nevertheless, the moderate effect of genetic factors cannot be ruled out. Further studies to investigate potential environmental and genetic risk factors of ESCC in Golestan and the interaction between environmental and genetic factors are warranted

Esophageal cancer in Iran: a review

Esophageal cancer is the second and third most common malignancy in Iranian males and females, respectively, claiming lives of approximately 5800 Iranians each year. Squamous cell carcinoma [SCC] is presently the most common type accounting for about 90% of all esophageal cancers in Iran. Recent studies have shown that there is a gradual increase in the incidence of adenocarcinoma of the distal esophagus along with gastric cardia adenocarcinoma. Thirty-five years ago, the age standardizied rate [ASR] of esophageal SCC in the city of Gonbad [Golestan Province, northeast of Iran] was found to be one of the highest rates for any single cancer that had been reported worldwide [ASR >100/10[5]/year]. Recent studies have shown that the incidence of SCC in Gonbad has declined to less than half of what it was in the past. This decline in the incidence of esophageal SCC parallels an improvement in the socioeconomic situation of people living in this region. According to recent cancer registry data in Iran there is still an obvious intracountry variability between the incidence of esophageal cancer in the south with an ASR of 3 for males and 2 for females in Kerman and 43 and 36 in the northeastern province of Golestan. The reasons for this very high rate of SCC in northeastern Iran have been the subject of several studies during the past 35 years. According to results of these studies the suspected risk factors are: low intake of fruits and vegetables, drinking hot tea, consumption of opium products and tobacco, H.pylori infection in the stomach, using unhealthy drinking water from cisterns and genetic susceptibility. The main suspected mutagens are polycyclic aromatic hydrocarbons [PAH] and N-nitroso compounds. In order to embark primary and secondary prevention of this fatal cancer, further prospective studies are presently underway in the region. The Golestan esophageal cancer cohort study which follows of 50,000 subjects is on going. We expect simple and feasible evidence based preventive strategies to be implemented in the future according to the results of this study

Câncer de esôfago: perfil das manifestações clínicas, histologia, localização e comportamento metastático em pacientes submetidos a tratamento oncológico em um centro de referência em Minas Gerais / Esophageal cancer: profile of clinical manifestations, histology, location and metastatic behavior in patients undergoing cancer treatment at a cancer center in Minas Gerais

O câncer de esôfago (CE) é uma neoplasia com uma incidência crescente, com taxas de mortalidade próximas às taxas de incidência. Sua etiologia está associada ao tipo histológico da doença, sendo o carcinoma de células escamosas o mais comum e fortemente relacionado ao tabagismo e etilismo, e o adenocarcinoma associado ao esôfago deBarrett. Além desses fatores sabidamente conhecidos, o risco de desenvolver este tumor está aumentado em pessoasque ingerem alimentos e bebidas quentes (mate) e que possuem nutrição deficiente (hipovitaminose A, C e E); hátambém uma predisposição genética que ainda é pouco definida. Manifestações clínicas comuns durante a evoluçãodessa doença incluem: disfagia, odinofagia, desconforto retroesternal, hiporexia, náusea, vômitos, emagrecimento.Tais queixas merecem uma avaliação criteriosa, pois, quando essas se manifestam, a doença já se encontra, na maioria das vezes, em um estágio avançado, não sendo possível uma abordagem curativa destes pacientes. Os protocolos de tratamento do CE incluem cirurgia, quimioterapia e radioterapia, mas o melhor tratamento ainda é motivo de estudos. Este trabalho teve como objetivo descrever e analisar o perfil das manifestações clínicas, a relaçãoentre o tipo histológico e a localização, idade e comportamento metastático e terapêutica, de pacientes portadores deCE submetidos a tratamento oncológico no Centro de Oncologia e Radioisótopos (COR), Ipatinga-MG. Foi feita análise retrospectiva dos prontuários de 109 pacientes com diagnóstico de CE, de maio de 2004 a fevereiro de 2007. Para cálculos estatísticos, foi utilizado o programa Epi Info 6.04d.

[Relation between drinking water hardness and the incidence of esophageal and gastric cancers]

Esophageal and gastric cancers are among the most prevalent cancers in the world which cause a high mortality rate annually. Several risk factors are supposed for them. Water hardness is considered as a protective factor against above cancers. This ecologic study was designed to determine the correlation between water hardness and upper gastrointestinal cancers. In this ecological study data on water components in Golestan's urban areas were obtained during 2004-05 and the averages were reported. All cases of esophageal and gastric cancers resided in urban areas which were diagnosed during this period were recruited to estimate the incidence and age standardized rates [ASR]. The province was divided into low, intermediate and high incidence, based on 33% and 66% quartiles of both cancers. Pearson correlation coefficient test and regression model were used to analyze the data. The water hardness was in the normal standard range permitted for the drinking water, and did not have any relation with the risk of esophageal and gastric cancers. This study showed that water hardness has no effect on the incidence of esophageal and gastric cancer in this area