Helicobacter pylori: qué debemos saber en el año 2018. Revisión de la evidencia y nuevas recomendaciones de tratamiento / Helicobacter pylori: what should we know in the year 2018. Review of the evidence and new treatment recommendations

Helicobacter pylori (HP) is the most widely chronic human infection around the world, and the main risk factor for the development of gastric cancer. Our country has high rates of this neoplasia and a high prevalence of HP infection. Even both have fallen in the last year, is a major concern to diagnose the population infected with HP in early stages, before the development of premalignant lesions and properly eradicate this infection. In this review, we discussed the different methods for the diagnosis of HP and factors that change positivity as the use of proton pump inhibitors. Also, we discussed the factors to be considered in the choice of the treatment, like local resistance to antibiotics, specially clarithromycin. In the last years has been documented in Chile a significant increase in resistance to clarithromycin, from 20 to 46%, which predicts inadequate effectiveness for the classic triple therapy. As the result of the previous analysis we discussed new possible therapies, including bismuth quadruple therapy and concomitant therapy. (AU)

Péptidos inmunogénicos del gluten en deposiciones: nuevo método para evaluar la adherencia a la dieta en pacientes celíacos / Immunogenic gluten peptides in stools: new method to evaluate in the dietary adherence in celiac patients

Celiac disease (CD) is an autoimmune pathology caused by the ingestion of gluten in genetically susceptible people, currently considered multisystemic. The treatment of CD is a lifelong strict Gluten-Free Diet (GFD), which allows a symptomatic improvement in most patients and achieve intestinal mucosa healing confirmed with histological study. The adherence to the GFD is variable, arguing as possible factors related to failure the economic, cultural, social aspects and the consumption of gluten inadvertently. The management of celiac patients contemplates instructing in the proper follow-up of GFD and evaluating their adherence. So far, the only way to assess adherence to GFD is through surveys, self-reports of eating habits and serology, being the main disadvantage the subjectivity factor. Recently the immunogenic gluten peptides have acquired relevance for the objective evaluation of the adherence to the GFD and the measurement appears as an efficient and sensitive option to determine the gluten intake, providing relevant information for the clinical management.

Dolor torácico no cardigénico / Non-cardiac chest pain

El dolor torácico no cardiogénico se define como episodios recurrentes de dolor subesternal en pacientes que no poseen una causa cardiológica luego de un estudio acabado. Representa un dilema clínico dado que el dolor frecuentemente es indistinguible de un dolor de origen coronario llevando a extensas y costosas evaluaciones. Diversos mecanismos han sido implicados en su origen, entre ellos el reflujo gastroesofágico, alteraciones de la motilidad, hipersensibilidad visceral y comorbilidad psicológica. Junto a ello, diversos test diagnósticos están disponibles en la práctica clínica para identificar el origen del dolor, incluyendo la pH metría de 24 horas, estudios de motilidad esofágica, endoscopía digestiva alta, test de probación y tratamientos de prueba. Su tratamiento idealmente debiera estar enfocado a corregir el mecanismo subyacente y aliviar los síntomas. Inhibidores de la bomba de protones, antidepresivos, relajantes de la musculatura lisa y terapia cognitiva conductual aparecen como medidas terapéuticas de utilidad.

Noncardiac chest pain is defined by recurrent episodes of subesternal chest pain in patients lacking a cardiac cause after a comprehensive evaluation. It is a diagnostic dilemma, chest pain is often indistinguishable from cardiac cause leading to extensive and expensive evaluations. Pathophysiologically, gastroesophageal reflux disease, esophageal dismotility, esophageal hypersensitivity, and psychological comorbidities have been implicated. A variety of diagnostic tests are available in the clinical practice to identify the origin of pain, including ambulatory pH testing, esophageal motility, upper endoscopy, provocative testing and even therapeutic trails. Ideally treatment should be aimed at correcting the underlying mechanism and relieving symptoms. Proton pumps inhibitors, antidepressants, smooth muscle relaxants and cognitive behavorial therapy appear to be useful for the treatment of these patients.

¿Cómo estudiar al paciente con disfagia? / How to evaluate the patient with dysphagia?

Dysphagia is a frequent cause of consultation for gastroenterologists and is generally due to either mechanical obstruction or esophageal motor disorders. The assessment of patient demographics and symptoms are useful for determining the potential causes and the subsequent investigation. Oropharyngeal dysphagia is usually caused by neurological or anatomical conditions. Videofluoroscopy is the best test for the assessment of this type of dysphagia. Esophageal dysphagia has many causes, these could be studied using different types of tests. Upper endoscopy and barium swallow are de first-line investigation techniques, especially in those patients with a history suggestive of a mechanical obstruction. Esophageal motility could be assessed by different techniques; in the last years high-resolution manometry and impedance have been developed. Recently, new tests like high frequency intraluminal ultrasound and EndoFLIP® (Endolumenal Functional Lumen Imaging Probe) have become available, but are currently limited to research.

La disfagia es un motivo de consulta frecuente al gastroenterólogo y generalmente se debe a obstrucciones mecánicas del esófago o a alteraciones de la motilidad. Las características del paciente y la sintomatología son claves para tratar de determinar su causa y poder planificar el estudio. La disfagia oro-faríngea es causada frecuentemente por alteraciones neurológicas o anatómicas. Para su evaluación el mejor examen es el estudio de vídeo deglución. La disfagia esofágica posee múltiples causas, las que pueden ser evaluadas a través de diferentes exámenes. La endoscopia digestiva alta y la radiografía baritada son los exámenes de primera línea, especialmente cuando se sospecha la presencia de alguna causa mecánica. La motilidad esofágica puede ser evaluada a través de diferentes técnicas, habiéndose desarrollado en los últimos años la manometría de alta resolución y el monitoreo de impedancia. Están en desarrollo nuevas técnicas como el ultrasonido esofágico y en EndoFLIP® (Endolumenal Functional Lumen Imaging Probe), cuyo uso aún se encuentra limitado al campo de la investigación.

Nuevos métodos para el diagnóstico del reflujo y de los trastornos motores esofágicos: manometría de alta resolución e impendanciometría multicanal PH / New diagnostic tests for gastroesophageal reflux and esophageal motor disorders: high resolution manometry and PH impedance

Esophageal diagnostic tests have dramatically changed over the past decade. High-resolution manometry has been developed, a technique based on the use of a high number of pressure sensors so that esophageal intraluminal pressure can be monitored as a continuum. Impedance pH monitoring has also been developed. High resolution manometry works together with esophageal pressure topography. In conjunction, these technologies have several advantages compared with conventional manometry. The contractility of the esophagus can be viewed simultaneously in a uniform format, standardized objective metrics can be systematically applied for test interpretation, and the topographic pattern of contractility is more easily recognizable and has greater replicability than conventional manometry. Sensitivity for detecting achalasia has been improved and in addition, it has led to the subcategorization of achalasia into three clinically relevant subtypes based on the contractile function of the esophageal body. Esophageal impedance pH monitoring provides quantitative data on esophageal acid exposure and has the ability to correlate the symptoms with acid exposure events. It allows for the detection of different types of reflux, therefore it is considered the most sensitive tool for the assessment of all types of gastroesopheageal reflux. High resolution manometry and pH impedance monitoring have lead to an improvement of esophageal disorder diagnosis and classification.

En la última década ha habido importantes avances en los métodos de estudio del esófago. Se ha desarrollado la manometría de alta resolución, técnica basada en el uso de una importante cantidad de sensores de presión de modo que la presión intraluminal esofágica puede ser monitorizada como en un continuo. También se ha desarrollado la impedanciometría multicanal pH. La manometría de alta resolución va acoplada con el análisis topográfico de presiones. Estas dos tecnologías juntas tienen múltiples ventajas comparado con la manometría convencional. La contractibilidad del esófago puede ser vista simultáneamente en un formato uniforme, se pueden aplicar mediciones objetivas en la interpretación del examen y el patrón topográfico de contractibilidad es más fácil de reconocer y tiene mayor reproducibilidad que la manometría convencional. Ha mejorado la sensibilidad para detectar acalasia y se ha categorizado este trastorno motor en tres subtipos clínicamente relevantes basados en la función contráctil del esófago. A su vez, el monitoreo de impedancio-pH provee datos cuantitativos con respecto a la exposición ácida del esófago y tiene la capacidad de correlacionar los síntomas con los eventos de exposición ácida. Permite la detección de diferentes tipos de reflujo, por lo cual en estos momentos es considerada como la herramienta más sensible para la detección de todo tipo de reflujo. Tanto la manometría de alta resolución como el monitoreo de pH-impedancia han permitido un mejor diagnóstico y clasificación de la patología esofágica.

Identificación de las competencias del gastroenterólogo chileno: técnica delphi modificada / Competencies of a chilean gastroeneterologist: modified delphi technique

Introduction: The importance of identifying the final competences of pre and postgraduate students is a growing a concern at national and international level due to the need of developing curricula aimed at educating competent professionals that respond to the society´s needs. Objetive: To identify the competencies of a general gastroenterologist (GG). Methods: Modified Delphi technique with a 3-round survey to a group of experts at national level. Sixty-eigth experts were surveyed including gastroenterologists, professionals of related specialties, representatives of scientific societies, and organizations that provide accreditation of both medical study programs and specialties certification. The first survey proposed a list of 224 competencies. Then, in the second and third rounds, the experts must prioritize the competencies according to the importance, usin a 0-4 Likert-type scale. Results: In the first round, 41 experts (60.3 percent) prioritized the 332 identified competencies. Og those, 255 were considered important or very important. In the third round, 252 competencies were confirmed as relevant by 38 experts (55.9 percent). Of the 49 practical procedures identified, only 15 were finally considered as part of the competencies of the GG.A significant percentage of procedures were considered of a higher level of training, particularly, complex endoscopic procedures. Conclusion: Identified competencies will be highly useful in the desing of competencies based curricula and in the implementation of evaluation systems appropriate for each competency. Specialty programs and their graduates might be evaluated according to these competencies.

Introducción: Identificar las competencias terminales de los egresados de pre y postgrado es de creciente interés nacional e internacional debido a la necesidad de desarrollar currículos enfocados en la formación de profesionales competentes, que respondan a las necesidades de la sociedad. El Gastroenterólogo General (GG), debe adquirir competencias cognitivas, destrezas psicomotrices y actitudes. Objetivo: Identificar las competencias del GG. Método: Encuesta de 3 rondas con técnica Delphi modificada a un grupo de expertos a nivel nacional para priorizar las competencias del GG según importancia utilizando una escala Likert de 0 a 4. Se encuestó a 68 expertos incluyendo gastroenterólogos, profesionales de especialidades relacionadas, representantes de Sociedades Científicas, organismos acreditadores de programas y certificadores de especialidades médicas. Resultado: En la primera ronda, se ofreció una lista de 224 competencias a 37 profesionales (54,4 por ciento del total de expertos) quienes agregaron 108 competencias adicionales. En la segunda ronda, 41 expertos (60,3 por ciento) priorizaron las 332 competencias identificadas. De ellas, 255 fueron consideradas importantes o muy importantes. En la tercera ronda, 252 competencias fueron confirmadas como relevantes por 38 expertos (55,9 por ciento). De los 49 procedimientos prácticos identificados, sólo 15 fueron finalmente considerados como parte de las competencias del GG. Un alto porcentaje de los procedimientos fueron considerados en un nivel de entrenamiento superior, en particular los procedimientos endoscópicos complejos. Conclusión: Las competencias identificadas serán de gran utilidad en el diseño de currículos basados en competencias e implementación de sistemas de evaluación apropiados para cada competencia. Los programas de especialidad así como sus egresados podrán ser evaluados de acuerdo a estas competencias.

Sobrecrecimiento bacteriano intestinal / Small intestinal bacterial overgrowth

El sobrecrecimiento bacteriano intestinal (SBI) es una condición causada por un número anormal de bacterias en el intestino delgado. Se le define como la presencia de más de 105 UFC/ ml de bacterias de tipo colónico a nivel del intestino delgado. Los principales factores que restringen la colonización bacteriana en el intestino delgado son la barrera ácida gástrica, la inmunidad mucosa y sistémica y la motilidad intestinal. Cuando estos factores fallan se desarrolla SBI. Los principales factores asociados a la presencia de esta condición son: aclorhidria o hipoclorhidria, edad avanzada, cirugías, cirrosis hepática, diabetes mellitus, diversas enfermedades inmunológicas y ausencia del receptor farsenoide X. Existe controversia acerca de su asociación con trastornos funcionales digestivos, especialmente con síndrome de intestino irritable. Se le considera como un síndrome de malabsorción aunque sus manifestaciones clínicas son variables de un sujeto a otro. Los principales síntomas son la presencia de diarrea, esteatorrea, dolor abdominal crónico, distensión abdominal y flatulencia. El estándar de oro para su diagnóstico es el aspirado y cultivo de fluido del intestino delgado. Dado que es un test invasivo suelen utilizarse para su diagnóstico los test de aire espirado, con glucosa y lactulosa. Su tratamiento implica solucionar la condición predisponente cuando es posible, y administrar antibióticos de amplio espectro, metronidazol, ciprofloxacino y la rifaximina (por 10 días) son los más utilizados. Dada su elevada tasa de recurrencia debe valuarse la posibilidad de terapia cíclica. El uso de probióticos está en estudio.

Small intestinal bacterial overgrowth (SIBO) is a clinical condition caused by an increased level of bacteria in the small intestine. It is defined as the presence of more than 10ª elevate a 5 CFU/ml of colonic type bacteria within the small intestine. The main factors that prevent bacterial colonization in the small intestine are gastric acid, mucosal and systemic immunity, and intestinal motility. When one or more of these mechanisms fail, SIBO can occur. The main predisposing factors for SIBO are: achlorhydria or hypochlorhydria, old age, surgeries, liver cirrhosis, diabetes mellitus, different immunological diseases and the absence of the farsenoid X receptor. The association with functional gastrointestinal diseases, particularly irritable bowel syndrome, is controversial. SIBO is generally considered a malabsorption syndrome; although clinical manifestations can be largely different in each subject. Common symptoms are diarrhea steatorrhea, chronic abdominal pain, bloating and flatulence. The culture of jejunal aspirate is considered the gold standard diagnostic test, however, due to the fact that it is an invasive test, glucose and lactulose breath tests are currently used in clinical practice. SIBO therapy is based on treatment of predisposing condition, whenever possible, and the administration of wide-spectrum antibiotics. Metronidazole, ciprofloxacin and rifaximin (10 days) are the most frecuently used antibiotics in clinical practice. SIBO recurrence is high, and future trials are needed to assess the usefullness of cyclic courses of antibiotics. The use of probiotic sis being studied.

Estudio comparativo de dos equipos para el test de H2 en aire espirado / Evaluation of breath H2 measured by means of two different analyzers

El test de hidrógeno (H2) en aire espirado es ampliamente utilizado en el estudio de malabsorción de hidratos de carbono, sobrecrecimiento bacteriano intestinal (SBI) y tiempo de tránsito orocecal (TTOC). Objetivo: Comparar los resultados obtenidos por dos equiposde detección de H2, uno de ellos de introducción reciente en nuestro medio. Material y Métodos: 50 pacientes, edad promedio 38,5 +/- 5,2 años (rango 7-77 años), 40 mujeres, se les realizó el test de H2 en aire espirado en paralelo con ambos equipos bajo métodos estandarizados. En 25 de ellos se investigó la presencia de malabsorción de lactosa, y en los otros 25, la presencia de SBI con lactulosa. Se evaluaron los valores de H2 obtenidos con ambos equipos. Resultados: Las lecturas de H2 con ambos equipos no mostraron diferencias significativas tanto para lactosa (p > 0,1), como para lactulosa (p > 0,5). Tampoco hubo diferencias en el TTOC de los pacientes (90 +/- 33,75 min v/s 90.8 +/- 32,42 min) (p > 1). Se obtuvo un índice de concordancia Kappa de 0,92 entre ambos equipos con el test con lactosa y con lactulosa. Conclusión: El equipo portátil es altamente confiable, entregando resultados con una excelente concordancia con respectoal equipo de referencia.

The hydrogen (H2) breath test (BT) is widely used to investigate carbohydrates malabsorption, small intestinal bacterial overgrowth (SIBO) and orocaecal transit time (OTT). Aim: To compare the results of two hydrogen breath devices, one of them, of recent introduction in our country. Methods: Fifty patients were included, mean age 38.5 +/- 5.2years (range 7-77 yrs), 40 women, H2 BT was performed in parallel with both analyzers under standardized methods. Lactose malabsorption was investigated in 25 patients with lactose, and the presence of SIBO in the resting 25 patients, with lactulose, hydrogen values obtained with both devices were evaluated. Results: No differences were observed between the H2 concentrations for lactose BT (p > 0.1) as well as lactulose BT (p > 0.5)and also between the OTT measured by the two devices (90 +/- 33.75 min. v/s 90.8 +/- 32.42 min) (p > 1). We detected a Kappa concordance index of 0.92 for both equipments. Conclusion: The portable device is highly reliable to detect the presence of breath hydrogen, giving results with an excellent concordance to the reference device.

El uso de inhibidores de bomba de protones y el hábito de fumar no modifican la tasa de sobrecrecimiento bacteriano intestinal en pacientes con patología digestiva funcional / Small intestinal bacterial overgrowth is not influenced by proton pump inhibitors and smoking habit in patient with funtional gastrointestinal disorders

Background: Drug induced inhibition of acid secretion has been associated to small intestinal bacterial overgrowth (SIBO). Smoking is followed by an increase of exhaled and orocecal transit time (OCTT). Aim: To investigate if the use of proton pump inhibitiors (PPI) and smoking can modifie the incidence of SIBO in patients with functional gastrointestinal disease. Patients and Methods: Questionnaires performed before a study for SIBO in patients with functional gastrointestinal disorders were analyzed. The use PPI and the smoking habit were recorded. The presence of SIBO and the OCTT was determined by means of the lactulose hydrogen breath test. Results: 437 patients, mean age 45 years (range: 14-93), 337 (77 percent) female, entered in the study SIBO was present in 356 patients, and 81 patients had normal H2 breath test. Both groups had a similar distribution of gender and age. The percentage of SIBO was no different in patients using PPI or presenting smoking habit Conclusions: Use of PPI and smoking habit are not risk factors for the development of SIBO in patients with functional disorders.

Los fármacos que inhiben la secreción gástrica favorecen el sobrecrecimiento bacteriano intestinal (SBI), mientras que el habito de fumar puede aumentar los niveles de H2 espirado y el tiempo de transito orocecal (TTOC). Objetivo: Investigar si el uso de inhibidores de la bomba de protones (IBP) y el habito de fumar modifican la incidencia de SBI en pacientes con trastornos digestivos funcionales. Pacientes y Métodos: Se analizaron encuestas de pacientes con patología digestiva funcional previas a un estudio de SBI Se consignaron el uso de IBP Y el hábito tabáquico en los 6 meses que precedieron al examen. La presencia de SBI y el tiempo de transito orocecal (TTOC) se determinaron con el test de hidrógeno en aire espirado con lactulosa. Resultados: 437 pacientes, con edad x 45 años (rango: 14-93),337 (77 por ciento) mujeres. Con SBI 356 pacientes, sin SBI 81 pacientes. Ambos grupos fueron comparables en cuanto a distribución por sexo y edad. El porcentaje de pacientes con SBI no fue diferente en pacientes con antecedente de uso de IBP o con hábito tabaquito. Conclusiones: El antecedente del uso de IBP y el tabaquismo no constituyen un factor de riesgo para SBI en pacientes con patología digestiva funcional.

Sobrecrecimiento bacteriano en trastornos funcionales del intestino / Small intestinal bacterial overgrowth in patients with functional gastrointestinal diseases[

Background: Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders. Aim: To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID). Material and methods: Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO. Results: We studied 367 patients with a mean age of 50 years (87 percent females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76 percent of patients with IBS, 73 percent of those with functional constipation, 69 percent of those with functional diarrhea and 68 percent of those with functional bloating. Conclusions: This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients.

Prevalencia de la infección por helicobacter pylori según ensayo de la ureasa en pacientes derivados a la Unidad de Endoscopía del Hospital Clínico de la Universidad de Chile / Prevalence of infection by helicobacter pylori by urease test in patients derivates to the endoscopic section of Hospital Clínico de la Universidad de Chile

Helicobacter pylori is a pathogenic bacterium that infects a significant number of individuals. In Chile about 79 percent of the population is colonized. Aims: This study evaluate the prevalence of the H. pylori infection in symptomatic outpatients. Materials and Methods: 276 non selected patients were enrolled from Endoscopic Unit of Clinical Hospital of the University of Chile. The bacterium was detected by urease test. Results: H. pylori infection was found in 44,9 percent patients. Infection was higher in younger patients, 53,8 percent between 21-60 years, and was lower in older patients, 25,6 percent in older than 60 years. The risk of being H. pylori carrier is twofold higher in persons younger than 60 years as compared to those older than 60 years. Conclusion: The age would be modifier factors for H. pylori infection risk.

Barostato rectal en el síndrome de intestino irritable / Rectal barostat in irritable bowel syndrome

Background: Many patients with irritable bowel syndrome (IBS) have lowered sensory thresholds to rectal distention when compared to control subjects, a phenomenon called visceral hypersensitivity. Aim: To investigate the usefulness of a rectal barostat as a diagnostic tool in IBS and if there are differences in visceral hypersensitivity in different groups of IBS patients. Patients and Methods: Ten healthy subjects and 19 IBS patients, defined using Rome II criteria (12 with constipation, three with diarrhea and four alternating between diarrhea and constipation), were studied. Sequential isobaric rectal distentions, from 2 mmHg up to a maximal pressure of 52 mmHg or when the patients reported pain, were carried out. Visceral hypersensitivity was defined as a pain threshold under 38 mmHg. Results: Only 26 percent of IBS patients had visceral hypersensitivity (16 percent and 43 percent of patients with IBS and constipation and IBS and diarrhea or alternating symptoms, respectively, p =NS). Pain threshold in controls, patients with IBS and constipation and patients with IBS and diarrhea or alternating symptoms was 43.8±6.6, 45.3±9.2 and 40.8±9.2 mmHg, respectively (p =NS). Conclusions: Our results do not support the usefulness of the electronic rectal barostat as a diagnostic method to diagnose IBS.

Alteraciones motoras gastrointestinales en la enfermedad de Chagas / Gastrointestinal motility disturbances in Chagas disease

Serum antibodies against Trypanosoma Cruzi have been observed in 19 percent of the Chilean population. Marked differences in organ involvement have been reported in patients with Chagas disease. Chagas disease is rarely an aetiological factor for achalasia in Chile, which is different from reports in other countries of South America. In contrast, a high incidence of megacolon among these patients have been reported. Aim: To study the incidence of gastric and small intestinal motor disorders among these patients and their relationship to esophageal and colon motility disorders. Patients and Methods: We studied 18 patients, 12 women (mean age 45 years); with positive antibodies against T Cruzi. Seven had radiological evidence of megacolon and no one had radiological or manometric evidence for achalasia. Non specific motor esophageal abnormalities were found in 11 patients. Nine had an abnormal electrocardiogram, suggesting a myocardial disease. A questionnaire for gastrointestinal symptoms, an electrogastrography and a small intestinal motility study, were performed in each patient. Results: All patients had evidences of abnormalities in at least one segment of the digestive tract. Twelve patients had an abnormal electrogastrographic study, with bradygastria as the most common finding. Nine had an abnormal small intestinal manometry with a myophatic pattern evidenced by a decreased amplitude of contractions (18.5±3 mmHg). Also an increased number of clustered contractions was observed. Conclusions: Gastric dysrhythmias and small intestinal motor abnormalities are frequently associated to non specific esophageal motor disorders and megacolon in patients with Chagas disease (Rev Méd Chile 2004; 132: 939-4).

Electrogastrografía de superficie: una nueva técnica para el estudio de la motilidad gástrica en nuestro medio / Cutaneous electrogastrography: a recently incorporated technique for the study of gastric motility

Background: Gastric electrical activity can be accurately recorded and analyzed by cutaneous electrogastrography. Different types of abnormalities have been described in a variety of disorders. Aim: To analyze a group of asymptomatic subjects and assess the prevalence and patterns of dysrrhythmias in patients with type 1 and 2 diabetes and patients with functional dyspepsia. Patients and methods: One hundred subjects were studied (32 male, mean age 45 years old, 10 asymptomatic, 11 type 1 diabetics, 22 type 2 diabetics and 57 subjects with functional gastrointestinal disturbances). Gastric myoelectrical activity was recorded using surface electrogastrography for 1 hour in the fasting state and 1 hour after a test meal (350 kcal). Results: The electrogastrogram was normal in 90 percent of asymptomatic controls. It was abnormal in 64 percent of type 1 diabetic patients, in 55.5 percent of type 2 diabetic patients and in 61 percent of patients with functional dyspepsia. Different types of dysrrhythmias were observed in each group. Conclusions: Electrogastrography might define a subgroup of patients with electrical rhythm disturbances, that may have a different approach to treatment than patients with normal gastric electrical activity

Inmunoglobulina A ¿un predictor de daño hepático crónico por alcohol? / Immunoglobulin A: predictor of alcoholic chronic liver damage?

La relación entre etiología, severidad del daño hepático y niveles aumentados de IgA ha sido motivo de controversia. Nuestros objetivos fueron a) analizar el efecto del alcohol sobre la concentración sérica de IgA en pacientes con cirrosis alcohólica, b) estudiar la relación entre IgA y severidad del daño hepático y c) evaluar el efecto de la suspensión del consumo de alcohol sobre sus niveles. Se estudiaron 48 pacientes cirróticos, 30 alcohólicos y 18 no alcohólicos. En todos se midieron inmunoglobulinas séricas (IgA, IgG, IgM) y se determinó la puntuación de Child-Pugh. En 16 pacientes alcohólicos se realizó una segunda determinación de inmunoglobulinas luego de al menos 7 meses de abstinencia. Los valores de la IgA fueron significativamente mayores en pacientes alcohólicos y cifras más elevadas se observaron en la medida que aumentó el grado de insuficiencia hepática, de acuerdo a los niveles de Child-Pugh. No se observó relación entre los valores de IgA y transaminasas. Estos valores aumentados de IgA se mantienen más allá de los seis meses