Esclerodermia y alteraciones esofágicas documentadas por manometría / Scleroderma and Esophageal Alterations Documented by Manometry

Introducción: Las manifestaciones gastrointestinales y en especial la disfunción esofágica son frecuentes en pacientes con diagnóstico de esclerosis sistémica. Objetivos: Determinar los hallazgos manométricos en el esófago de pacientes con esclerosis sistémica. Métodos: Se realizó un estudio descriptivo de corte transversal, en 86 pacientes con diagnóstico de esclerosis sistémica que fueron atendidos en el Servicio de Reumatología del Hospital Hermanos Ameijeiras, en el período comprendido de enero de 2020 a diciembre de 2021. Resultados: La edad media fue de 49,5 ± 15,3 años, (94,3 por ciento) en el sexo femenino. El (90,7 por ciento) tenía trastornos de la motilidad esofágica, principalmente los trastornos mayores (58,1por ciento) y el esfínter esofágico corto (62,8 por ciento). La presencia de síntomas como la regurgitación, la pirosis y la disfagia se relacionaron de forma significativa en la mayoría de los parámetros manométricos. De igual forma, el tiempo de evolución de la enfermedad (10,1 ± 9,1 frente a 5,9 ± 5,9 años), el fenómeno de Raynaud (93,9 por ciento frente a 25,0 por ciento) y la esclerosis sistémica difusa (96,2 por ciento frente a 82,4 por ciento) fueron significativamente mayores en pacientes con trastornos de la motilidad esofágica. La edad y el sexo no mostraron una asociación significativa con las alteraciones manométricas. Conclusiones: Se concluye que los pacientes con esclerosis sistémica difusa, fenómeno de Raynaud, a partir de la presencia de los síntomas y de la evolución de la enfermedad tienen una elevada probabilidad de padecer trastornos de la motilidad esofágica(AU)

Introduction: Gastrointestinal manifestations, and especially esophageal dysfunction, are common in patients diagnosed with systemic sclerosis. Objectives: To determine the manometric findings in the esophagus of patients with systemic sclerosis. Methods: A descriptive cross-sectional study was carried out on 86 patients with a diagnosis of systemic sclerosis who were treated in the Rheumatology Service of Hermanos Ameijeiras Hospital from January 2020 to December 2021. Results: The mean age was 49.5 ± 15.3 years, (94.3percent) in females. 90.7percent had esophageal motility disorders, mainly major disorders (58.1percent) and 62.8percent had short esophageal sphincter. The presence of symptoms such as regurgitation, heartburn and dysphagia were significantly related to most manometric parameters. Similarly, the duration of the disease (10.1 ± 9.1 versus 5.9 ± 5.9 years), Raynaud's phenomenon (93.9percent versus 25.0percent) and sclerosis diffuse systemic (96.2percent vs. 82.4percent) were significantly higher in patients with esophageal motility disorders. Age and sex did not show significant association with manometric alterations. Conclusions: It is concluded that patients with diffuse systemic sclerosis, Raynaud's phenomenon, based on the presence of symptoms, and the evolution of the disease, have high probability of suffering from esophageal motility disorders(AU)

Detección molecular y genotipificación de Helicobacter pylori en biopsias gástricas de pacientes adultos sintomáticos de la ciudad de Santa Fe, Argentina / [Molecular detection and genotypification of Helicobacter pylori in gastric biopsies from symptomatic adult patients in Santa Fe, Argentina].

Our goals were: a) to detect Helicobacter pylori in gastric biopsies of symptomatic adults by PCR, b) to detect the presence of the cagA gene as well as of the allelic variants of the vacA gene, and c) to correlate genotypes with the endoscopic diagnoses. H. pylori was detected in 81

(39/48) of patients by nested PCR for hsp60. The presence of cagA was detected in 15/22 of samples and vacA s1 - m1 was the most frequent allelic combination (15/22). Gastritis, the most frequent diagnosis, was associated with genotype cagA+ in 10/13 of patients. In this group, 9/13 showed the allelic variant vacA s1- m1. The variant vacA s2 - m2 was detected in 3/3 of gastritis cases by H. pylori with the cagA- genotype. These results are the first reported in our region and provide data of epidemiological interest.

The resistance to fluconazole in patients with esophageal candidiasis / Resistência ao fluconazol em pacientes com candidíase esofágica

CONTEXT: Esophageal candidiasis is often observed in patients with risk factors for its development and fluconazole is the therapeutic choice for the treatment of this disease. OBJECTIVES: To determine its frequency, by performing upper digestive endoscopy; to determine Candida species involved in its pathogenesis and verify their distribution according with the predisposing factors and to determine susceptibility to fluconazole in the samples. METHODS: From March 2006 to April 2007, all patients submitted to esophagogastroduodenoscopy at the Digestive Endoscopy Unit in the Oswaldo Cruz University Hospital, Recife, PE, Brazil, were eligible for the study. Samples were collected from patients who presented lesions consistent with esophageal candidiasis in order to identify Candida species and verify their susceptibility to fluconazole. The predisposing factors for the occurrence of esophageal candidiasis were described. RESULTS: Of 2,672 patients referred to upper endoscopy at the Digestive Endoscopy Unit, 40 (1.5 percent) had endoscopic findings compatible with esophageal candidiasis. The average age was 49.1 years. Twenty one patients (52.5 percent) were less than 50 years old, of which 82.6 percent were infected with HIV. Most of them (52.5 percent) were males and 65.0 percent were inpatients. Diseases were identified in 90 percent of the patients and 21 (52.5 percent) were HIV positive. Concerning endoscopic findings, severe forms of esophagitis were found in 50 percent of the patients with CD4 count <200. Non-albicans Candida species were isolated in 22.7 percent of HIV positive and in 45 percent HIV negative patients. A total of 6 (14.28 percent) samples were resistant to fluconazole, while 2 (4.76 percent) samples had dose depending susceptibility to this drug. CONCLUSIONS: Esophageal candidiasis prevalence was low, although within the results described by other authors. Male and inpatients were the most affected. The species isolated...

CONTEXTO: A candidíase esofágica é comumente observada em pacientes com fatores de risco para seu desenvolvimento. OBJETIVOS:Determinar a freqüência da candidíase esofágica, por meio da endoscopia digestiva alta; identificar as espécies de Candida envolvidas na patogênese da candidíase esofágica e sua distribuição de acordo com o fator predisponente; determinar a susceptibilidade ao fluconazol nas amostras coletadas. MÉTODOS: De março de 2006 a abril de 2007, os pacientes submetidos a esofagogastroduodenoscopia no Hospital Universitário Oswaldo Cruz, Recife, PE, foram considerados elegíveis para o estudo. Aqueles que apresentaram lesões compatíveis com candidíase esofágica tiveram amostras coletadas para a identificação das espécies de Candida, de sua sensibilidade ao fluconazol e descritos os fatores de risco para a doença. RESULTADOS: Dos 2.672 pacientes encaminhados para endoscopia, 40 (1,5 por cento) apresentaram achados compatíveis com candidíase esofágica. A média de idade foi de 49,1 anos. Vinte e um pacientes (52,5 por cento) tinham menos que 50 anos, dos quais 82,6 por cento eram infectados pelo HIV. A maioria (52,5 por cento) era homens e 65,0 por cento encontravam-se internados. Fatores predisponentes foram identificados em 90 por cento da amostra, sendo que 21 (52,5 por cento) eram HIV positivos. As formas mais graves de esofagite foram encontradas em 50 por cento dos pacientes com CD4 <200. Espécies de Candida não-albicans foram detectadas em 22,7 por cento dos pacientes HIV positivos e em 45 por cento dos pacientes não infectados. A resistência ao fluconazol foi observada em seis amostras (14,28 por cento) e a sensibilidade dose-dependente em duas (4,76 por cento). CONCLUSÃO:A prevalência de candidíase esofágica foi baixa, embora dentro de variação esperada. Pacientes homens e que estavam internados foram os mais acometidos. Houve variação nas espécies encontradas, de acordo com as características dos grupos estudados. Tanto...

Mucosa gástrica heterotópica en esófago proximal: incidencia en nuestro medio / Incidence of heterotopic gastric mucosa of the proximal esophagus in Chile

Heterotopic Gastric mucosa (HGM) has been described in the duodenum, Meckel's diverticulum and proximal esophagus. The aim of this research was to assess the frequency and clinical aspects of HGM in cervical esophagus in a group of unselected patients. Methods: A prospective precise endoscopic evaluation, war perfomed in 200 unselected patients, referred for diagnostic upper GI endoscopy, in whom the esophageal pull through was very slow, with a careful observation of the esophagus. The presence, size, macroscopic aspects and associated symptoms were recorded. Results: Four patients (2 percent) had HGM in this serie. Lesions presented as an area of gastric appearing mucosa, surrounded for normal esophageal mucosa, with a maximum size of 2 cm. No erosions, ulcers or local malignan lesions were diagnosed. One patient had upper dysplagia. Conclusion: Systematic endoscopic examination of the upper esophagus was followed by the observation of HGM which was sometime associated to symptoms.

Se ha observado mucosa gástrica Heterotópica (MGH) en el duodeno, divertículo de Meckel, y en el esófago proximal. El objetivo del presente trabajo fué caracterizar la frecuencia y presentación de MGH en esófago cervical en un grupo no seleccionado de pacientes. Métodos: Se evaluaron endoscópicamente en forma prospectiva, 200 pacientes sucesivos, a los cuales se realizó retirada endoscópica lenta con observación minuciosa del esófago superior, se registró la presencia de MGH tamaño, aspecto macroscópico y síntomas asociados. Resultados: En 4 pacientes (2 por ciento) se encontró MGH. Un paciente presentaba disfagia moderada. Las lesiones presentaron un aspecto de mucosa gástrica en mucosa esofágica normal, sin erosiones, úlceras o sospecha de malignidad, con un diámetro máximo de 2 cm. Conclusión: La observación dirigida del esófago superior permite describir la presencia de MGH a este nivel, la que puede asociarse a sintomatología.

Esophageal Involvement in Behcet's Disease

Esophageal involvement in Behcet's disease is very rare, and normally is observed as aphtosis and esophagitis, but serious complications such as erosions, perforations, and stenosis may occur. We carried out this prospective study to evaluate the prevalence of esophageal involvement in Behcet's disease and to establish if routine endoscopy and/or manometry are necessary. Twenty-three patients who fulfilled the diagnostic criteria of the international study group for Behcet's disease were enrolled. None were taking drugs or had disease that might produce esophageal abnormalities or alter any existing changes due to the Behcet's disease itself. Twenty- three patients underwent esophagogastroduodenoscopy by a single observer. Esophageal biopsies were performed in thirteen patients and esophageal manometry in twenty. At the beginning of the study, the disease activity was defined by the presence of more than one symptom related to Behcet's disease, and upon the classification of Behcet's disease. Of the twenty three patients enrolled two were excluded from final analysis because of the presence of hiatus hernia. Thus, 13 men and 8 women, ranging in age from 20 to 63 years with a mean age of 36.2 years were included. Ten patients (47.6%) had active disease and four (19%) complained of upper gastrointestinal symptoms at the time of the study. Fourteen patients had endoscopic, manometric and/or microscopic abnormalities. Esophageal manometry was performed in twenty patients and was abnormal in 7 cases (35%). Esophageal biopsies were done in 13 patients and revealed histopathological abnormalities in 5 cases. Microscopic findings showed vasculities in one case, and non-specific inflammatory infiltration mainly consisting of neutrophils in 4 cases. Our results suggest that the prevalence of esophageal involvement in Behcet's disease is rather high and occur even in asymptomatic patients, but that this usually does not result in specific abnormalities.

Prevalencia de patología esofágica según hallazgos histopatológicos en pacientes asistidos por un servicio especializado, 1978-1996 / Prevalence of esophageal pathology according to histopathologic findings in patients who attend a specialized service, 1978-1996

Con el objetivo de determinar la prevalencia de patología esofágica según hallazgos histopatológicos de pacientes asistidos en el Hospital Regional Universitario "José María Cabral y Báez" de Santiago, República Dominicana, se realizó un estudio descriptivo, retrospectivo período 1978-1996, para tal propósito, se procedió a la revisión de los archivos del Departamento de Patología que registra las biopsias realizadas a pacientes que acudían a la consulta de gastroenterología con diagnóstico de afección esofágica y que luego necesitaron ser sometidos a la realización de biopsia diagnóstica. El universo en estudio es de un total de 42 pacientes. La patología más frecuente fue la Esofagitris Crónica en 14.2// (6 pacientes). El sexo más afectado fue el masculino en un 69// (29 pacientes) y la edad más frecuente osciló entre los grupos de edad de 40-59 años en 40.7// (17 pacientes) y 60-79 años en 38// (16 pacientes)

Estallido del esófago / Esophageal bursting

Se cuestiona el término de rotura esofágica espontánea, prefiriéndose el de estallido. Se revisaron 30 casos, propios y de la literatura nacional. La lesión derecha no es tan rara como se supone (27%); los izquierdos ocurrieron casi todos en el extremo inferior no así los derechos que tuvieron cierta predominancia sobre el tercio medio. En el 70% hubo antecedentes digestivos. Los síntomas más frecuentes fueron dolor, hidroneumotórax y "shock" y los errores diagnósticos, infarto de miocardio, afecciones pleurales, mal asmático y pancreatitis aguda. La mortalidad (83%) está relacionada con la demora en el diagnóstico. Insistimos en la necesidad de tener presente esta patología en todo episodio agudo toracoabdominal y/o de hemiabdomen superior.