Enfermedad es inflamatorias intestinales: colitis ulcerosa y enfermedad de crohn: Parte 2 tratamiento / Inflammatory bowel disease: ulcerative colitis and Crohn's disease: Part 2 treatment

Las Ell se están diagnosticando cada vez con mayor frecuencia en nuestro medio. Son enfermedades de curso crónico que generan una alta morbilidad, ausentismo laboral, hospitalizaciones e intervenciones quirúrgicas; todo ello afecta seriamente la calidad de vida de los pacientes, lo que, sumado al alto costo de algunos medicamentos en nuestro medio, conspira contra la adherencia al tratamiento. Este es complejo: a menudo requiere cambio de drogas y ajuste de dosis a las condiciones particulares de cada paciente. El objetivo del presente trabajo es entregar información que ayude al mejor manejo terapéutico de estos enfermos. Se describen los principios generales que guían el tratamiento, los principales fármacos empleados, y finalmente, se dan algunas guías para el manejo de las diversas categorías de pacientes. Se insiste en la estrecha colaboración que debe existir entre el Cirujano y el Gastroenterólogo para obtener los mejores resultados.

The in flammatory bowel disease had been more frequently diagnosed. There are chronic diseases that produce high morbidility , work absenteeism, hospitalizations and surgery, affecting in the life qua lit y patients. Also the high costs of medicaments conspire with the treatment adherence. This is a serious matter because requires a change of drugs and adjustment to the particular conditions of each patient. The aim of the present article is give information to help for a better therapeutic management in this patients. Describes the general principles of treatment, the main pharmacos used, and finally it gives guides for management in the different patients categories. The authors insist in the importance of a narrow collaboration between the gastroenterologist and the surgeon, for the best results.

Enfermedad es inflamatorias intestinales: colitis ulcerosa y enfermedad de Crohn: Parte 1: Epidemiología, cuadro clínico y diagnóstico / Inflammatory bowel disease: ulcerative colitis and Crohn's disease: Part 1: epidemiology, clinical features and diagnosis

La Enfermedad de Crohn y la colitis ulcerosa representan las dos principales expresiones clínicas de las enfermedades inflamatorias intestinales (Ell) crónicas. La epidemiología de las El! ha cambiado en el tiempo; una vez consideradas infrecuentes; ahora son un importante problema gastroenterológíco en los países en vías de desarrollo con cambios demográficos. La etiología de las EII es aún desconocidos, pero es indudable que este es complejo y multifactorial. Las EII poseen un importante componente genético, genes relacionados con la respuesta inmune innata han sido descritos en la patogénesis de estas enfermedades. Estudios sugieren claramente que el proceso patológico de las EII consiste en una respuesta inmune local alterada frente a antígenos bacterianos de la flora intestinal comensal. El diagnóstico de las Ell se basa en la existencia de un cuadro clínico compatible sumado a la presencia de alteraciones endoscópica, histológicas y radiológicas características y no sobre la base de un único marcador de enfermedad.

Crohn 's disease and ulcerative colitis represent the two main forms of chronic inflammatory bowel diseases (IBD). The epidemiology of IBO has changed face over time; once considered rare, it is now a major gastroenterologic problem in the developed world with changing demographics. The origin of ISD remains unknown, but it is undoubted/y complex and multifactorial. The ISO have an important genetic background, genes related to the innate immune response have been observed to be involved in the pathogenesis of these diseases. Studies clearly suggest that the pathologic process in IBO consists of a dysregulated host immune response directed against bacterial antigens of the normal intestinal flora. The diagnosis of IBO is based on the composite clinical picture and endoscopic, histologic and radiologic characteristic and not on the basis of a single disease marker.

Infliximab en el tratamiento de la enfermedad de Crohn: Estudio preliminar / Infliximab in the treatment of patients with Crohn's disease: Preliminary report

Background: Tumor necrosis factor alpha, interleukin 6 and 1 have a pathogenic role in Crohn's disease. Infliximab, a monoclonal antibody against tumor necrosis factor, is useful in the treatment of Crohn's disease, specially when the disease is active and associated to fistula formation. Aim: To assess the effectiveness of Infliximab in patients with Crohn's disease. Material and methods: Twelve patients with Crohn's disease (aged 16 to 63 years, 10 women) refractory to treatment with steroid, 5-aminosalicylic acid, antimicrobials and immunomodulatory drugs, were studied. A single intravenous 5 mg/kg dose Infliximab was administered. The Crohn's disease activity index (CDAI) was measured before and one week after the administration of the drug. Results: CDAI before and after Infliximab administration was 357±62 and 138±122 score points, respectively (p <0.005). According to this score, five patients had a severe and seven a moderate disease flare. The disease remitted in 7 (58%) and a clinical response was observed in 75%. Conclusions: A single dose of Infliximab was effective to induce remission of the disease in 75% of this selected group of patients with Crohn's disease.

El Paciente digestivo funcional refractario: un desafío a la relación médico paciente / The refractory patient with a functional disorder of the gastrointestinal tract

A group of patients with functional disorders of the gastrointestinal tract, manifest symptoms that are chronic, severe and invalidating. Their refractoriness to different treatments is a great challenge for physicians. They normally have a severe psychological and social dysfunction and an abnormal behavior towards their disease. All these factors lead these patients to perpetuate their illness condition. On the other hand, physicians usually have a negative reaction to their demands, leading to a non-satisfactory patient-physician relationship and to the failure of the healing process. Training in the systemic, biopsychosocial model of diseases and in interpersonal communication skills is required for an adequate management of these patients

Factores de riesgo nutricionales en la litiasis vesicular: análisis epidemiológico / Nutritional risk factors for gallstones: epidemiological analysis

This article reviews the role of nutrition in the incidence of gallstones. The epidemiological situation of gallbladder disease has wide worldwide geographical variations, being Pima Indians and the Chileans the most affected populations. The main nutritional risk factor is obesity. Other risk are serum cholesterol and triglyceride levels, unbalanced and excessive caloric intake, fasting periods of more than eight hours, hypocaloric diets of less than 700 Kcal/day, specially in obese subjects and parenteral nutrition lasting more than two weeks. The main conclusion of this revision is that nutritional behaviors of the population must be improved through public health programs, to reduce the incidence of obesity and related nutritional imbalances