Enfermedad inflamatoria intestinal y embarazo: experiencia de 16 años / Pregnancy and inflammatory bowel disease: Experience in 17 patients

Background: Inflammatory bowel disease (IBD) has a peak incidence between 15 and 25 years of age, thereby affecting women of reproductive age. Fertility rates with inactive IBD are similar to the general population, and drugs currently used, with the exception of methotrexate and thalidomide, have a good safety and efficacy profile during pregnancy. Starting a pregnancy with inactive IBD significantly reduces the potential maternal and fetal complications. Aim: To assess the evolution of pregnancy and the underlying disease in women with IBD. Patients and Methods: Retrospective and prospective study of female patients with IBD controlled in our hospital who became pregnant from January 1994 to February, 2011. Results: We followed 17patients with a total of 19 pregnancies. In two patients the onset of IBD occurred during pregnancy and from the remaining, 11 patients became pregnant during remission of IBD. Most of the patients continued the same treatment during pregnancy and the few flares that occurred were treated satisfactorily. Major complications occurred in three patients, all associated with IBD activity. Fifteen patients had full-term deliveries and the majority of the newborns had normal weight and Apgar score. None had malformations. Conclusions: Pregnancies among patients with an inactive IBD, have a good evolution. A multidisciplinary approach and patient education are invaluable to achieve these good results.

Diagnóstico y tratamiento de las várices esófago gástricas en Chile: realidad nacional / Management of bleeding esophageal varices in public and private institutions in Chile

Background: The better treatment modalities for bleeding esophageal varices have improved the prognosis of cirrhosis. Aim: To inquire about diagnostic and treatment modalities for esophageal bleeding in Chile. Material and methods: An enquiry about diagnosis and treatment of esophageal bleeding was designed and electronically sent to public and private health institutions that could admit patients and were located in cides with more than 100,000 inhabitants. Results: The enquiry was answered by 31 of 35 public and 17 of 19 private health institutionis that were consulted. Emergency endoscopy was available in 6 of 27 public and in the 16 private institutionis that had an emergency room. Rubber band ligation was available in 16 public (52 percent) and in all private institutions. Cyanoacrylate injections were done in 10 public (32 percent) and 11 (65 percent) private institutions. No public institution installed transjugular intrahepatic portosystemic shunts, but 8 had occasional access to this technique. This procedure was done in 7 (41 percent) private institutions and all had access to it. Surgical treatment was feasible in 20 public (65 percent) and all private institutions. Primary prophylaxis was done in 18 public (58 percent) and 14 private (82 percent) institutions. Secondary prophylaxis was carried out in 26 public (84 percent) and 16 private (94 percent) institutions. Conclusions: Public health institutions have poor access to adequate diagnostic and treatment methods for esophageal bleeding. The primary and secondary prophylaxis of esophageal varices must be improved in both types of institutions.

Pioderma periileostómico: caso clínico / Peri-ileostomic pyoderma gangrenosum: report of one case

We report a 39 years old woman with Ulcerative Colitis unresponsive to medical treatment. A total colectomy with Brooke ileostomy was performed, as the first operation. After six weeks she developed a peri-ileostomic Pyoderma Gangrenosum. She was treated by a multidisciplinary team, and after seven months with local treatment and systemic medication, the skin healed. Her bowel transit was reconstructed later with an ileoanal pouch and she was reinserted into her previous job (Rev Méd Chile 2004: 132: 747-9).

Análisis histopatológico semicuantitativo de la gastritis crónica: índice de extensión y grado / Histopathological semiquantitative analysis of chronic gastritis: extension and grade index

Three endoscopic systematic biopsies were obtained from 261 patients showing chronic gastritis. Histopathologic features of chronic gastritis were graded from 0 to 3 points according to the Sydney System. In addition, an extension and grading histopathologic score was applied. This score was obtained from the sum of qualified grades for each feature in all three samples. Inflammation, activity, atrophy and intestinal metaplasia were predominantly grade 1 and H pylori density was predominantly grade 2. Only 2,6 percent of the sections whith out atrophy showed intestinal metaplasia, while 79,3 percent of the sections depicting grade 2-3 intestinal metaplasia showed moderate to severe atrophy. Inflammation was more severe in antral lesser curvature and the more severe atrophy was present in the antrum than in the corpus mucosa. Sydney System and extension and grading histopathologic score showed more extensive activity in patients older than 45 years. A lower histopathologic score of H pylori was seen in these patients. The presence of H pylori was directly correlated with inflammation severity and inversely with atrophy. These results, in accordance with data shown in the literature, suggest that the Sydney System and extension and grading histopathologic score can be applied to compare chronic gastritis features in different groups of patients

Frecuencia y caracteres histopatológicos de gastritis crónica en 300 pacientes sin lesiones endoscópicas / Frequency and histopathologic features of chronic gastritis in 300 patients without endoscopic lesions

Three gastric mucosal biopsies were obtained from 300 patients showing a normal upper digestive tract endoscopy. Histologically in 9 percent of the patients the biopsies were normal; in 87 percent showed a common-type chronic gastritis and in 4 percent showed a reactive (chemical or reflux-type) gastritis. Helicobacter pylori was present in 25.9 percent of the patients without gastritis, in 33.3 percent of the patients with reactive gastritis and in 87.7 percent of those with common-type gastritis. In 19.9 percent of the patients with common-type chronic gastritis there was intestinal metaplasia, consisting of type I metaplasia in 14.1 percent, type II in 3.1 percent and type III metaplasia in 2.3 percent. The association of type III intestinal metaplasia with the other forms of metaplasia, its lower frequency and its tendency to be present in older patients supports the hipothesis that type III incomplete colonic metaplasia represents a more advanced stage than complete and incomplete small bowel metaplasia of the gastric mucosa