Diarrea aguda / Acute diarrhea

En este artículo se enfocará la diarrea aguda del adulto desde una perspectiva clínica, incorporando definiciones básicas de epidemiología, fisiopatología, enfrentamiento clínico, estudio cuando corresponda y tratamiento. Se presentarán nuevas herramientas diagnósticas basadas en biología molecular, de reciente introducción en clínica y que han significado un aporte en casos seleccionados. Además, se enfrentan situaciones especiales como la diarrea del viajero y de los pacientes inmunocomprometidos. La diarrea asociada a antibióticos se tratará en un artículo aparte.

In this article of acute diarrhea in adults, will present from a clinical perspective, including different basic definitions from epidemiology, pathophysiology, clinical approach, corresponding studies and treatment. It includes new diagnostic tools based on molecular biology, of recent use in medical practice, that have had a relevant effect in selected cases. It also includes special situations, such as traveler's diarrhea and immunosuppressed patients. We exclude from this article antibiotics-related diarrhea.

Aplicación de la serología para confirmar la erradicación de helicobacter pylori en pacientes con úlcera péptica / Serological asssessment of helicobacter pylori eradication in peptic ulcer patients

Background: Measurement of changes in serum antibodies is an excellent predictor of Helicobacter pylori eradication after antibiotic treatment. Aim: To measure the changes in serum antibody titers to Helicobacter pylori, before and after treatment. Material and methods: IgG antibodies to H. pylori were prospectively evaluated in 107 duodenal ulcer patients treated either with antibiotics (amoxicillin, metronidazole and bismuth subsalicylate) plus omeprazole or omeprazole alone. IgG antibody levels were determined using an "in house" ELISA in sera from 49 eradicated patients that received quadruple therapy and 58 non-eradicated patients (12 in whom antibiotic therapy failed and 46 that received omeprazole alone). Endoscopy, urease test, microscopy, and culture of gastric biopsies confirmed H. pylori eradication. Results: Patients in whom H. pylori was eradicated, showed a maintained drop in serum antibody titers that ranged from 15 percent, 62 percent, 74 percent to 76 percent at 28 days, 4, 8 and 12 months respectively. Such reduction was not observed in patients treated with omeprazole. Patients, in whom quadruple therapy failed to eradicate H. pylori, showed a discrete and transient decrease in antibody titers. By the fourth month, patients in whom eradication with quadruple therapy was not achieved, irrespective of whether they received quadruple therapy or omeprazole alone. Conclusions: A 45 percent decrease in IgG titer after 4 months is indicative of therapeutic success in H. pylori eradication. Therefore, serology may be useful to monitor the outcome of antibiotic therapy

Respuesta de anticuerpos IgG en pacientes colonizados por helicobacter pylori / Antibodies to helicobacter pylori in colonized patients with gastric symptoms and in asymptomatic groups

The IgG antibody response specific to Helicobacter pylori was evaluated through ELISA in a group of 92 gastric patients colonized by this bacteria. 74 had gastritis and 19 gastroduodenal ulcer. Three control groups were studied in a similary way: normal adult volunteers (n=17), adults with E coli or S typhi bacteremia (n=30) and normal infants (n = 30). IgG antibody response to H pylori was demonstrated in 98% of colonized patients and 0% of infants. Asymptomatic individuals and those with bacteremia had high rates of antibody response (76 and 90% respectively), although this rate and also the titers of antibody response were significantly lower than that of colonized patients (p < 0.05). ELISA reactive sera from colonized patients and asymptomatic individuals evidenced a similar antibody pattern when tested by blotting. This profile was absent in non reactive sera, including those with high antibody titers to C jejuni. The presence of specific IgG antibodies to H pylory in the majority of colonized gastric patients and asymptomatic adults suggest that this infection is very common in our population