Hipocalcemia, hipomagnesemia y uso crónico de inhibidores de la bomba de protones / Hypocalcemia, hypomagnesemia, and chronic use of proton pump inhibitors

Introducción: Los inhibidores de la bomba de protones son fármacos usados en múltiples gastropatías. El omeprazol pertenece a este grupo de medicamentos y es aprobado y catalogado como indispensable por la Organización Mundial de la Salud. Esto ha causado que su uso se vuelva constante y hasta cierto punto equívoco. Pese a ser medicamentos seguros muestran efectos secundarios, dentro de los cuales uno ocasional es el trastorno hidroelectrolítico. Objetivo: Presentar un caso clínico en el cual se constató la presencia de efectos secundarios tras el uso de un fármaco de uso constante por la comunidad médica: el omeprazol. Caso clínico: Se presenta a continuación el caso clínico de un paciente masculino con antecedente de hipertensión arterial y gastropatía crónica que muestra uso por 8 años consecutivos de inhibidores de la bomba de protones, al cual se le diagnostica hipomagnesemia e hipocalcemia. Se obtuvieron resultados de laboratorio normales tras administración de suplementos orales y uso de ranitidina con supresión de terapéutica con omeprazol. Conclusiones: Un control constante de los fármacos que usan los pacientes crónicos es fundamental en atención primaria de salud. El uso de inhibidores de la bomba de protones se ha convertido en rutinario y es necesario corroborar siempre la dosis y el tiempo de uso de los fármacos además de la relación con otros medicamentos que use el paciente(AU)

Introduction: Proton-pump inhibitors are drugs used in multiple gastropathies. Omeprazole belongs to this group of medicines; it is approved and classified as essential by the World Health Organization. This has permitted for its use to become constant and, to some extent, misleading. Despite being safe drugs, they show side effects, among which an occasional one is fluid and electrolyte disorders. Objective: To present a clinical case in which the occurrence of side effects was verified after the administration of a drug constantly used by the medical community. Clinical case: The following is a clinical case of a male patient with a history of arterial hypertension and chronic gastropathy, characterized by the usage of proton-pump inhibitors for eight consecutive years, diagnosed with hypomagnesemia and hypocalcemia. Normal laboratory results were obtained after oral supplementation and usage of ranitidine with suppression of omeprazole therapy. Conclusions: Constant control of the drugs used by chronic patients is essential in primary health care. The usage of proton-pump inhibitors has become a routine. It is always necessary to check the dose and time for using the drugs as well as the relationship with other drugs used by the patient(AU)

Gastrointestinal and external parasites of the white-crested elaenia Elaenia albiceps chilensis (Aves, Tyrannidae) in Chile / Parasitas gastrointestinais e externos de guaracava de crista branca Elaenia albiceps chilensis (Aves, Tyrannidae) de Chile

The objective of this study is to evaluate the ectoparasites and helminths of the white-crested elaenia, Elaenia albiceps chilensis. Feather mites Anisophyllodes elaeniae, Trouessartia elaeniae, and Analges sp. were detected in 51% of birds (n=106), whereas 24% were infected with lice (Tyranniphilopterus delicatulus, Menacanthus cfr. distinctus, and Ricinus cfr. invadens). Helminths Viguiera sp. and Capillaria sp. were found in five of the birds that were necropsied (n=20). With the exception of A. elaeniae, T. elaeniae, and T. delicatulus, all parasites represented new records found for the white-crested elaenia, and therefore for the Chilean repertoire of biodiversity.

O objetivo deste estudo foi avaliar a fauna de ectoparasitas e helmintos do guaracava de crista branca Elaenia albiceps chilensis. Em 51% das aves (n=106), foram detectados os ácaros de pena Anisophyllodes elaeniae, Trouessartia elaeniae e Analges sp. enquanto 24% foram infectadas por piolhos (Tyranniphilopterus delicatulus, Menacanthus cfr. distinctus e Ricinus cfr. invadens. Em contrapartida, em cinco aves necropsiadas foram encontrados os helmintos Viguiera sp. e Capillaria sp. Com exceção de A. elaeniae, T. elaeniae e T. delicatulus, todos os parasitas representam novos registros para a guaracava de crista branca e, portanto, para a diversidade da fauna parasitária do Chile.

Anisakiasis: Report of 15 Gastric Cases Caused by Anisakis Type I Larvae and a Brief Review of Korean Anisakiasis Cases

The present study was performed to report 15 anisakiasis cases in Korea and to review the Korean cases reported in the literature. Total 32 Anisakis type I larvae were detected in the stomach of 15 patients by the endoscopy. Single worm was detected from 12 cases, and even 9 larvae were found from 2 cases. Epigastric pain was most commonly manifested in almost all cases, and hemoptysis and hematemesis were seen in 1 case each. Symptom manifestations began at 10-12 hr after eating fish in 73.3% cases. Endoscopy was performed 1-2 days after the symptom onset in most cases. The common conger, Conger myriaster, was the probable infection source in 7 cases. In the review of Korean anisakiasis cases, thus far, total 645 cases have been reported in 64 articles. Anisakis type I larva was the most frequently detected (81.3%). The favorable infection site of larvae was the stomach (82.4%). The common conger was the most probable source of human infections (38.6%). Among the total 404 cases which revealed the age and sex of patients, 185 (45.8%) were males, and the remaining 219 (54.2%) were female patients. The age prevalence was the highest in forties (34.7%). The seasonal prevalence was highest in winter (38.8%). By the present study, 15 cases of gastric anisakiasis are added as Korean cases, and some epidemiological characteristics of Korean anisakiasis were clarified.

Prevalence of iffection with caga-positive heliobacter pylori strains among chhildren and adolescents in southern Brazil / Prevalência da infecção por cepas de Helicobacter pylori cagA-positivo em crianças e adolescentes do Sul do Brasil

Context Helicobacter pylori (H. pylori) has a worldwide distribution, but the prevalence of infection, virulence factors, and clinical presentation vary widely according to the studied population. In Brazil, a continental country composed of several ethnicities and cultural habits, the behavior of infection also appears to vary, as many other studies have shown. Objectives Describe the prevalence of infection with cagA-positive H. pylori strains in a group of children and adolescents who underwent esophagogastroduodenoscopy in Porto Alegre, Rio Grande do Sul. Methods Fifty-four gastric biopsy specimens of children and adolescents with H. pylori infection demonstrated by histology, urease test and molecular analysis were tested for the presence of cagA positive H. pylori strains by the polymerase chain reaction method. Results he prevalence of cagA-positive H. pylori was 29.6% (95% confidence interval, 18 to 43.6%). There were no statistically significant differences in clinical or demographic characteristics or in the endoscopic and histological features of patients infected with cagA-positive strains as compared with those infected by cagA-negative strains. Conclusions he study showed a low prevalence of infection with cagA-positive H. pylori strains among children and adolescents who underwent EGD in southern Brazil, in comparison to studies conducted with children from other regions of Brazil. There was no association between the presence of cagA-positive strains and more severe clinical presentations in the studied sample. .

Contexto Helicobacter pylori (H. pylori) tem distribuição geográfica universal, embora a prevalência da infecção, os fatores de virulência, bem como a apresentação clínica, variem de acordo com a população estudada. No Brasil, um país continental composto por várias etnias e hábitos culturais diversos, o comportamento da infecção também parece variar, como muitos estudos têm demonstrado. Objetivos Descrever a prevalência da infecção por cepas de H. pylori cagA-positivo em um grupo de crianças e adolescentes submetidos a esofagogastroduodenoscopia em Porto Alegre, Rio Grande do Sul. Métodos Cinquenta e quatro (54) fragmentos de biópsia gástrica com presença de H. pylori demonstrada pela análise histológica, teste da urease e análise molecular foram testados para a presença de cepas de H. pylori cagA-positivo pelo método da reação em cadeia da polimerase. Resultados prevalência de cepas de H. pylori cagA-positivo foi de 29,6% (intervalo de confiança de 95%, 18% a 43,6%). Não houve diferenças estatisticamente significativas nas características clínicas e demográficas e nos achados endoscópicos e histológicos entre os pacientes infectados por cepas de H. pylori cagA-positivo em comparação com os cagA-negativo. Conclusões O estudo demonstrou uma baixa prevalência de infecção por cepas de H. pylori cagA-positivo nas crianças e adolescentes submetidas a esofagogastroduodenoscopia no Sul do Brasil em comparação com os estudos realizados com crianças de outras regiões do Brasil. Não houve associação entre a presença de cepas cagA-positivo e desfechos clínicos desfavoráveis na amostra estudada. .

Upper gastrointestinal bleeding in children in southern Iran.

Objective. To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods. Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results. From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion. The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.

Correlation between Helicobacter pylori infection, gastric diseases and life habits among patients treated at a university hospital in Southeast Brazil

Helicobacter pylori is considered a significant agent in the development of various gastric diseases. However, the diseases caused by this bacterium are known as being multi-factorial, with the genotype, immune system and life habits of the host playing important roles in the establishment of the clinical outcome. Also, H. pylori exhibit a high degree of genetic variability, contributing to the complexity of the host-pathogen relationship. These observations, considered together with the widely-varying origins and social habits of the Brazilian population, lead us to speculate about the influence of these life habits on H. pylori infection and the clinical outcome. Therefore, in this study we evaluated the relationship between H. pylori infection and certain diseases in 172 patients treated at the Hospital das Clínicas of Ribeirão Preto (HCRP), Brazil, taking into account their different life habits, such as non-steroidal anti-inflammatory drugs and alcohol ingestion, and smoking habit. Our analysis indicated that H. pylori infection is not affected by any of the life habits evaluated but is associated with the development of peptic ulcers (gastric and duodenal ulcer) and inverse correlate with gastroesophageal reflux disease (GERD). No correlation was found between the infection with this bacterium and gastritis or intestinal metaplasia. However, gastritis and erosive gastritis were directly correlated with non-steroidal anti-inflammatory drugs (NSAID) ingestion. Moreover, ingestion of alcohol beverages exhibited a protective effect on gastritis development in men. Our data also indicated that to achieve reliable detection of this bacterium in biopsies, two or three detection methods should be used.

Helicobacter pylori associated gastroduodenal problem among the Nepalese.

Present study was undertaken during a period of eighteen months (April 2001 to October 2002) to see an association of Helicobacter pylori with the gastric problems among the Nepalese. This study comprised of 203 subjects (Males: 154 and Females: 49) aged 21 to 71 years with gastric problems. The biopsy samples taken from the stomach and duodenum using endoscope were tested for the presence of H. pylori by in-house rapid urease test (RUT) and culture. Representative samples were also tested by PCR. Of the total 203, 60 (29.5%) were RUT positive. Marginally high RUT positive rate was observed in males compared with females (P>0.95). Same was true with ethnic group with a marginally higher positive rate among Tibeto-Burmans compared with Indo-Aryans (P>0.05). Age-wise, higher incidence (34.4%) was observed in the age group of 36 to approximately 50 years followed by over 50 years (29.0%), and 21 to approximately 35 years (24.4%) (P>0.05). Both RUT and culture positive rate increased with the severity of the problem. RUT results were confirmed also by PCR. All RUT positive patients were given a full course of new triple therapy (combination of two antibiotics: Clarythromycin and Amoxycillin and a proton-pump inhibitor: Omeprazole) for two weeks followed by extended monotherapy with Omeprazole for up to six weeks. Of the total, 168 (82.7%) patients were available for follow-up and all of them showed an improved condition with negative RUT.

Achados endoscópicos em pacientes com esofagie: análise dos fatores preditores / Upper gastrointestinal endoscopic findings in patients with esophagitis: predactive factors

Introdução: A doença do refluxo gastroesofágico é uma condição clínica freqüente, com alto custo diagnóstico e terapêutico. Os achados endoscópicos incluem a esofagite erosiva e não erosiva. Objetivo: Determinar os fatores associados às formas erosivas e não erosivas de esofagite. Método: Realizou-se análise retrospectiva de dados de exames endoscópicos do Hospital Estadual de Sapopemba da FMUSP, no período de janeiro a junho de 2005, com diagnóstico endoscópico de esofagites erosiva e não erosiva. Pacientes com exame endoscópico normal foram incluídos como controle. Avaliaram-se sexo, faixa etária, incidência de infecção pelo Helicobacter pylori, presença de hérnia hiatal e patologias gastroduodenais associadas. Resultados: No período foram realizados 1.834 exames endoscópicos, com diagnóstico endoscópico de esofagite em 408 (22%) e exame normal em 190 (10,3%). Nos pacientes com esofagite, 57% eram do sexo feminino e 43% do masculino. No entanto, a proporção de pacientes do sexo masculino com esofagite erosiva foi maior quando comparada com a do feminino (p < 0,05). Hérnia hiatal esteve presente na minoria dos casos (26%), porém, demonstrou-se correlação positiva entre hérnia hiatal e gravidade de esofagite (p < 0,05). A pesquisa de Helicobacter pylori pelo método da urease foi realizada em 75% dos casos, obtendo-se positividade em cerca de 53% dos pacientes-controle e em 51 % dos pacientes com esofagite (p = 0,84). A maior parte dos pacientes com esofagite apresentou, concomitantemente, afecções gástricas e/ou duodenais (73%). Endoscopicamente, gastrites estavam presentes em 53% dos casos, úlceras gástricas em 7%, duodenites em 18% e úlceras duodenais em 16%. As formas erosivas de esofagite tiveram relação direta com a intensidade das patologias gastroduodenais. Conclusão: No presente estudo, identificaram-se fatores relacionados à esofagite como idade mais avançada, sexo masculino, hérnia hiatal, e patologias gastroduodenais. Não houve correlação entre esofag

Estudo de prevalência e achados histopatológicos da gastropatia hipertensiva portal em pacientes com doença parenquimatosa crônica de fígado / Prevalence and histopathologic findings of portal hypertensive gastropathy in patients with chronic parenchymatous disease of the liver

Objetivos: A prevalência da gastropatia hipertensiva portal (GHP) em pacientes com doença parenquimatosa crônica do fígado (DPCF) é bastante variável na literatura. A hemorragia secundária à GHP ocorre em 2,5% dos pacientes cirróticos. O estudo tem como objetivos avaliar a prevalência e achados histopatológicos da GHP em pacientes com DPCF. Métodos: Selecionaram-se 106 pacientes com diagnóstico clínico e laboratorial de DPCF internados no Serviço de Endoscopia Digestiva (SED) e Centro de Hemorragia Digestiva (CHD) do Hospital Geral Roberto Santos (HGRS). Tais pacientes foram submetidos à endoscopia digestiva alta (EDA) com biópsias gástricas. Utilizou-se a classificação de McCormack para o diagnóstico endoscópico de GHP. Observou-se na histologia (HE e Giemsa) a presença de gastrite ativa e crônica, metaplasia intestinal, Helicobacter py/ori e congestão vascular. Outras variáveis de relevância foram registradas: sexo, idade média, classificação de Child-Pugh e etiologia da DPCF. Utilizou-se para análise dos dados o programa SPSS. Resultados: A prevalência da GHP por endoscopia foi de 67,9% (72/ 106 pacientes), sendo 60,4% (64/106) com grau moderado e 7,5% (oito/106) com grau intenso. Foram realizadas biópsias de antro e corpo em 91,5% dos pacientes (97/106). Os pacientes com GHP apresentaram à histologia: gastrite ativa -10,3% (10/97); metaplasia intestinal -8,2% (oito/97); H. py/ori -13,4% (13/97); congestão vascular -43,3% (42/97); gastrite crônica -58,8% (57/97). Conclusão: A prevalência de GHP em pacientes com DPCF foi significativa neste estudo, de acordo com a literatura. Congestão vascular e gastrite crônica foram achados histopatológicos freqüentes

Metaplasia intestinal especializada de esôfago distal na doença do refluxo gastroesofágico: prevalência e aspectos clínico-epidemiológicos / Specialized intestinal metaplasia of distal esophagus in the gastroesophageal reflux disease: prevalence and clinical-demographic features

RACIONAL: A metaplasia intestinal especializada pode ser classificada, de acordo com os achados endoscópicos e histológicos, em Barrett longo, Barrett curto e metaplasia intestinal da cárdia. O esôfago de Barrett é doença adquirida que ocorre em aproximadamente 10 por cento a 13 por cento dos indivíduos com doença do refluxo gastroesofágico e representa uma condição pré-neoplásica. É caracterizado por substituição do epitélio escamoso estratificado pelo metaplásico colunar especializado, contendo células caliciformes. OBJETIVOS: Determinar, prospectivamente, a prevalência e as características clínico-epidemiológicas da metaplasia intestinal especializada de esôfago distal na doença do refluxo gastroesofágico. MÉTODOS: Entre abril e outubro de 2002, 402 pacientes com sintomas da doença do refluxo gastroesofágico foram avaliados através de questionário padronizado que abordava as variáveis demográficas e foram submetidos a exame endoscópico com biopsias 1 cm abaixo da junção escamocolunar, nos quatro quadrantes. RESULTADOS: Metaplasia intestinal especializada foi encontrada em 18,4 por cento dos pacientes: 0,5 por cento Barrett longo, 3,2 por cento Barrett curto e 14,7 por cento metaplasia intestinal da cárdia. Houve tendência de maior número de homens apresentando esôfago de Barrett e mulheres com metaplasia intestinal da cárdia. Todos com esôfago de Barrett eram da raça branca. Não houve relação entre a intensidade dos sintomas da doença do refluxo gastroesofágico e a presença de metaplasia intestinal especializada. O tempo de duração de sintomas superior a 5 anos foi uma tendência nos portadores de esôfago de Barrett. Este grupo também apresentou mais hérnia de hiato e esofagite mais intensa do que aqueles com metaplasia intestinal da cárdia. Não houve relação entre uso de tabaco ou álcool e metaplasia intestinal especializada. CONCLUSÕES: Esôfago de Barrett foi mais relacionado ao sexo masculino, com sintomas de longa cronicidade, esofagite mais intensa e sem associação com tabaco ou álcool.

Spontaneous gastrointestinal perforation in the neonate.

Twenty seven cases of spontaneous gastro-intestinal perforation were treated from 1981 to 1990. Four perforations were in the stomach, 17 in the small bowel and seven in the large bowel. One of them had dual perforation, one in the stomach and another in the duodenum. The exact etiology remained obscure. Various factors observed were maternal obstetric complications, prematurity and perinatal asphyxia. Stress should be laid on early diagnosis by following up 'at risk neonates' thus, giving a better overall survival rate.