Patología digestiva en niños infectados con el virus de inmunodeficiencia humana VIH en Santiago de Chile / Gastrointestinal diseases in children infected with the human immunodeficiency virus

Background: Human immunodeficiency virus (HIV) epidemiology has changed, affecting an increasing number of children. As in adults, the disease predominantly affects the digestive and respiratory systems. Aim: To report the gastrointestinal problems in HIV infected pediatric patients. Patients and methods : Twenty four HIV infected children (nine male, aged 1 to 12 years old, followed for 1 to 170 months), are reported. This group has been under care by a multiprofessional team. Results: Oral candidiasis was present in 21 (88 percent), esophagic candidiasis in 3 (13 percent), oral ulcers in 4 (17 percent). Diarrhea was observed in 18 children (75 percent) and in eight, it had a chronic evolution. Cryptosporidium parvum was the most frequent agent found in six cases (1 with acute and 5 with chronic diarrhea). Schlerosing cholangiopathy was observed in one case, with a fatal outcome, in association to microsporidiosis. Upper endoscopy was done in 11 patients, demonstrating microscopic inflammatory changes in esophagic, gastric and duodenal epithelia in all. Conclusions: Digestive problems are common in HIV infected pediatric patients. They must be always sought actively. Endoscopy is a valuable tool for the early diagnosis of these problems

Determinación de anticuerpos anti-transglutaminasa en el diagnóstico de enfermedad celíaca / Antitransglutaminase antibodies for the diagnosis of celiac disease

Background: The diagnosis of celiac disease is based in clinical features, serology and intestinal biopsy. There are recent reports that antiglutaminase antibodies have a good correlation with anti endomisial antibodies. Aim: To assess the sensitivity and specificity of antitransglutaminase antibodies in the diagnosis of celiac disease and their correlation with antiendomisial antibodies. Material and methods: Forty nine patients with celiac disease (mean age 30 years, 12 male) were studied. Thirty were symptomatic and 19, asymptomatic. As controls, 34 subjects (mean age 27 years, seven male), with normal duodenal biopsies, were studied. Sera was processed for the determination of antigliadin IgA by ELISA, antiendomisium IgA by indirect immunofluorescence, and antitransglutaminase IgA by ELISA. Results : Antigliadin antibodies had a sensitivity of 73 percent, a specificity of 96 percent, a positive predictive value of 93 percent and a negative predictive value of 82 percent for the diagnosis of celiac disease. Antiendomisium and antitransglutaminase antibodies had a specificity and positive predictive value of 100 percent, sensitivities of 89 and 92 percent respectively and negative predictive values of 92 and 94 percent respectively. No significant differences in the diagnostic yield of antiendomisium and antitransglutaminase antibodies, were observed. Conclusions: In this group of patients, antitransglutaminase antibodies had a high concordance with antiendomisium antibodies, for the diagnosis of celiac disease. Considering that the determination of antitransglutaminase antibodies is of lower cost and less complicated than antiendomisium antibodies, it is a useful tool for the diagnosis and follow up of patients with celiac disease

Enfermedad celíaca en el adolescente y adulto joven: un desafío para gastroenterólogos de niños y adultos / Celiac disease in adolescents and young adults: a follow up study

Background: Follow-up of celiac patients in Chile is often interrupted when adolescents are referred to adult gastroenterologists. Aim: To study the evolution of patients with celiac disease when they reach adolescence or young adulthood. Patients and methods: Current adherence to gluten-free diet and its relation to symptoms and circulating antiendomysial antibodies were evaluated in the 58 confirmed celiac patients older than 12 years of age controlled at 3 hospitals in Santiago. Results: Mean age at the moment of this assessment was 17.8 ñ 5 years, 65.5 percent were women, 12.5 percent were at nutritional risk (-IDS) while 20 percent were overweight/obese. Although all patients declared themselves asymptomatic, a focused questionnaire revealed that 26 percent suffered some symptoms. Only 24.1 percent followed a strict gluten-free diet. Eight of 20 patients who ate gluten-containing diets had negative antiendomysial antibodies (EMA), three of whom turned positive within 6 to 9 months. In three of four (asymptomatic) cases that accepted a new jejunal biopsy, histology was abnormal. One patient who followed a strict diet had EMA (+) and normal histology. Conclusions: These results confirm that after childhood, symptoms abate significantly in celiac patients. The observed sensitivity and specificity of EMA makes necessary to maintain small intestinal biopsies as the gold standard for diagnosis and confirmation of the disease

Registro computarizado de pH esofágico en niños con presunto reflujo gastroesofágico / Continuous 24 hour esophageal pH measurement in children with signs of gastroesophageal reflux

Objetivo: mostrar la utilidad de la monitorio del pH esofágico en la evaluación de pacientes con otros signos de reflujo gastroesofágico significativo. Pacientes y método: se describe una experiencia con la monitorio de pH esofágico en 81 de niños -48 varones (59,3 por ciento)- de un mes a 14 años de edad en un hospital público de Santiago de Chile referidos para el estudio a causa de episodios de apnea, signos radiológicos de reflujo (n: 72) u otros síntomas que sugerían reflujo oculto. Resultados: los registros continuos de pH fueron considerados anormales en 31 casos (38,3 por ciento). La alteración era leve en 22 (27,2 por ciento) y significativa en 9 (11,1 por ciento). No se encontró proporcionalidad entre las magnitudes del reflujo radiológico y del registro de pH, pues este último mostraba alteraciones intensas sólo en 9 de los 24 casos con signos radiológicos severos. Las alteraciones en el pH eran leves o no se registraron en los 15 restantes. Conclusiones: la monitoría del pH esofágico durante 24 h es útil, pero tiene limitaciones que no permiten considerarla como el patrón oro en la evaluación de los pacientes con reflujo gastroesofágico, por lo que sus resultados deben interpretarse a la luz de los antecedentes clínicos y los demás exámenes de apoyo al diagnóstico

Enfermedad de Wilson: una revisión a propósito de experiencia clínica en 16 pacientes / Wilson's disease: a review apropos of clinical experience in 16 patients

Wilson's disease is an inherited disorder of copper metabolism. We report 16 patients (6 males) with the disease; 6 had hepatic involvement and 3 were asymptomatic. The age onset was 9 years for hepatic and 17 years for neurologic involvement. The mean delay in diagnosis was 14 months. Chronic hepatitis, cirrhosis and fulminant hepatic failure were the clinical forms of liver disease. Patients with neurologic disorders had behavioral disturbances and extrapyramidal manifestations such as dystonia and parkinsonism. Patients had a good response to penicillamine, except 3 that died of liver complications, in whom the treatment was delayed or discontinued. We conclude that this metabolic disease must be suspected in pubertal children and in adults of less than 30 years old with liver disease of unknown origin or behavioral alterations associated to an extrapyramidal syndrome