Penetrating gastric ulcer as a manifestation of multisystemic tuberculosis / Úlcera gástrica penetrante como manifestación de tuberculosis multisistémica

We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months. An abdominal CT scan showed marked gastric dilatation due to extrinsic compression from lymphadenopathies around the second portion of the duodenum. The upper endoscopy revealed the presence of a penetrating gastric ulcer in the greater curvature. Biopsies of the lesions showed hystiocytes with granulomatous features and Acid Fast Bacilli (AFB) positive, and the cultures grew Mycobacterium tuberculosis sensitive to Isonazid and Rifampin. Subsequently anti-TB regimen was initiated achieving great clinical and endoscopic improvement.

Se presenta un caso de una mujer de 30 años de edad con historia de dolor abdominal, fiebre, poca tolerancia oral y pérdida de peso por 6 meses. Un CT scan abdominal muestra dilatación marcada gástrica debido a una compresión extrínseca por adenopatías alrededor de la segunda porción del duodeno. Una endoscopía alta revela la presencia de una úlcera gástrica penetrante en la curvatura mayor. Las biopsias mostraron histiocitos con granulomatosis y bacilos acid fast positivos y en los cultivos crecieron micobacterium tuberculosis sensibles a isoniacidad y rifampicina. Subsecuentemente se inició el régimen anti TBC lográndose una mejoría clínica y endoscópica evidente.

Sobre utilización de Inhibidores de la acidez gástrica en pacientes pediátricos / Overuse of acid-suppressive therapy in pediatric patients

Objetivos: Evaluar los patrones de prescripción deranitidina y omeprazol en pacientes pediátricos ingresados enun hospital de niños; la adecuación de dichas prescripcionesy los costos generados por prescripciones incorrectas.Pacientes y Métodos: estudio de utilización demedicamentos para observar pacientes ingresados en elHospital de Niños (Córdoba –Argentina) durante 1 mes.Resultados: Durante el mes de estudio ingresaron 680pacientes, de los cuales 415 (61%) recibieron inhibidoresde la acidez gástrica (IAG). De estos, 330 pacientes (79,5%)no presentaron factores de riesgo para desarrollar úlcerapor estrés, y en 293 pacientes (70,6%) las indicacionesse consideraron incorrectas. Sólo 81 pacientes (19,5%)presentaron indicaciones y dosis correctas de IAG. Seencontró una relación de la prescripción con el ingreso aquirófano y con el uso concomitante de corticoides a dosisbajas. El consumo innecesario de IAG generó un gasto directomensual de US$ 470,42

Objectives: To evaluate prescription patterns of intravenous ranitidine and omeprazolein pediatric patients hospitalized in a children’s hospital, the adequacy of said prescriptionsand the costs originated by incorrect prescriptions.Patients and Methods: A study of medication usage was designed to observe all patientshospitalized at Hospital de Niños (Córdoba- Argentina) during one month.Results: During the month of study 680 patients were hospitalized, 415 (61%) ofthem received acid-suppressive drugs (ASD). From these, 330 patients (79.5%) did notshow risk factors to develop stress ulcer and indications were considered incorrect in 293patients (70.6%). Only 81 patients (19.5%) showed correct indications and doses of ASD.A relationship was found between prescription and access to the operating room alongwith the concomitant use of corticoid in low doses. The unnecessary consumption of ASDgenerated a direct monthly expenditure of USD 470.42

Caracterìsticas de fìstulas enterocutàneas en pacientes postoperados del tubo digestivo concurrentes al servicio de cirugìa general del HC-IPS. Periodo de marzo-mayo del 2009 / Characteristics of postoperative enterocutaneous fistulas in patients with concurrent gastrointestinal tract of general surgery at the HC-IPS marzo-may period of 2009

Se denomina fìstula a un trayecto cuyas paredes estàn formadas,generalmente,por tejido de granulaciòn y que comunica dos superficies revestidas de epitelio.

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.

Cytomegalovirus Induced Gastric Ulcer as a Principal Manifestation in the Initial Stage of Hodgkin's Disease / 대한소화기학회지

Cytomegalovirus (CMV) is an important cause of opportunistic infection in immunocompromised patients. CMV infection occurs as a result of the cell-mediated immunity change in lymphoma patients. Although CMV can cause ulceration anywhere in the gastrointestinal (GI) tract in immunocompromised patients, only a few case reports about CMV GI infection in malignant lymphoma have been documented in literature. Furthermore, it was rare that CMV gastric ulcer with massive bleeding presented as an initial manifestation in a patient who has been not diagnosed lymphoma. We report a case of CMV induced gastric ulcer as an initial manifestation in patient with Hodgkin's disease.

Comparison of Clinical Characteristics and Outcomes between Geriatric and Non-geriatric Patients in Peptic Ulcer Bleeding / 대한소화기학회지

BACKGROUND/AIMS: In geriatric patients with peptic ulcer, the use of NSAID and prevalence of chronic illness have been increased, but the Helicobacter pylori (H. pylori) infected portion decreased. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with peptic ulcer bleeding and compare with non-geriatric patients (less than 65 years old). METHODS: We conducted a retrospective study of 88 patients with peptic ulcer bleeding treated with therapeutic endoscopy from January 2006 to December 2006. We compared the clinical characteristics and outcomes of geriatric patients (n=34, 38.6%) with those of non-geriatric patients (n=54, 61.4%). RESULTS: Hypertension (52.9% vs. 24.1%), cardiovascular disease (35.3% vs. 13.0%), and chronic obstructive pulmonary disease (20.6% vs. 3.7%) were more prevalent in the geriatric group, compared with the non-geriatric group (p0.05). The amount of transfusion length of ICU stay, rebleeding rate, operation rate and mortality were not different between the two groups. The length of hospital stay in the geriatric patients was significantly longer than the non-geriatric group (12.3+/-10.6 vs. 7.2+/-5.9 days, p<0.05). In multiple regression analysis, old age was a significant risk factor for longer hospital stay (p<0.05). CONCLUSIONS: The geriatric patients with bleeding peptic ulcer had longer hospital stay than the non-geriatric patients in our study. The important emerging etiologies such as ulcerogenic drug and associated chronic illness should be checked and treated in these patients.

Impact of helicobacter pylori infection on circulating interleukin-1beta [IL-1BETA] in gastroduodenal disorders

Helicobacter pylori [H. pylori] infection in characterized by marked changes in cytokine production, resulting from the immune response to infection. The H. pylori-associated diseases present with manifestations varying from mild non-ulcer dyspepsia or peptic ulcer disease [PUD] to gastric cancer. Study the effect of H. pylori infection on circulating serum levels of IL-1beta in some gastroduodenal disorders. According to upper gastrointestinal [GI] tract symptoms, upper GI endoscopy [including gastric pH measurement, ultra-rapid urease test-for the diagnosis of H-pylori infection, and biopsy], and histo-pathological examination, 80 patient with gastroduodenal disorders [20 gastric ulcer, 20 duodenal ulcer, 10 gastritis, 10 duodenitis and 20 gastric cancer] were studied. In addition, 10 apparently healthy subjects served as a control group. Circulating serum IL-1beta levels were determined for all subjects, by ELISA. The majority of gastroduodenal disorders studied had evidence of H. pylori infection and significantly higher serum IL-1beta than control subjects, being more in gastric disorders [gastritis, cancer and ulcer]. Gastric pH was significantly higher in patients with gastric disorders [gastric cancer, gastric ulcer and gastritis]. IL-1beta correlates positively with H. pylori infection in patients with duodenal ulcer and gastric ulcer. Meanwhile, it correlates negatively with gastric pH, in patients with gastric ulcer. Gastric pH and serum IL-1beta are significantly higher in cancer patients than in non-cancer patients. On other hand, H. pylori infection is detected more significantly in non-cancer patients. The mean serum IL-1beta was found to be significantly higher in patients with positive H. pylori infection than in those negative for H. pylori infection. IL-1beta is in an important pro-inflammatory cytokine with profound effects. Its acid inhibitory properties uniquely qualify it as a major player in the host's response to H. pylori infection and the diseases associated with it

Non-healing Iatrogenic Gastric Ulcers after Endoscopic Mucosal Resection for Gastric Epithelial Neoplasia: Report of Two Cases / 대한소화기학회지

Endoscopic mucosal resection (EMR) is widely accepted as a standard treatment for early gastric cancer or gastric adenoma. However, EMR inevitably results in the formation of large iatrogenic ulcer at the resected area. Although the characteristics of EMR-induced ulceration are not fully understood, this type of ulcer is thought to heal faster and to recur less often than non-iatrogenic gastric ulcer. Current available evidences have suggested that EMR-induced ulcers heal within 2-3 months. Herein, we report two cases of non-healing persistent gastric ulcers after EMR. One is a case of gastric carcinoma which developed at the same site of previous EMR site for the low grade dysplasia. The other is a case in which persistent EMR-induced ulcer was healed in the long run after Helicobacter pylori eradication therapy.

Estudio de la prueba de la ureasa o test de aliento (TA) y correlación con biopsia gástrica para la detección de Helicobacter Pylori (Hp) en pacientes dispépticos del Hospital Nacional Cayetano Heredia-Lima / Study of the test of ureasa or test of breath (TA) and correlation with gastric biopsy for the detection of Helicobaster Pylori (HP) in dyspeptic patients of the Hospital National Cayetano Heredia-Lima

Objetivo: Determinar la utilidad del test de la ureasa o test del aliento con carbono 14 en la detección de la infección por Helicobacter pilory (Hp) en pacientes dispépticos del Hospital Nacional Cayetano Heredia. Material y Método: Se incluyó a 31 pacientes dispépticos que acudieron a la consulta externa del Servicio de Gastroenterología del HNCH en el mes de setiembre de 2004 y que aceptaron voluntariamente participar en este estudio y a los cuales se les indicó endoscopía alta y biopsia gástrica. A todos ellos se les realizó igualmente el TA, que se realizó con cápsulas de urea marcada con carbono 14 (C14) comercializadas por el Instituto Peruano de Energía Nuclear (IPEN) y con reactivos producidos por el mismo instituto. El diagnóstico de Hp se basó en el análisis histológico con coloración de hematoxilina-eosina. Resultados: De los 31 Test del aliento, hubo un falso negativo y 30 estudios correlacionaron de las biopsias, de los cuales 23 estudios fueron positivos y 7 negativos. Conclusiones: El test del aliento realizado en el IPEN con C14 demuestra en este estudio una sensibilidad de 96.6 por ciento y una especificidad del 100 por ciento, que lo hace una herramienta diagnóstica para la infección por Hp muy confiable.

Objective: To establish the utility of the IPEN ureasa test or breath test with C14, in the detection of Helicobacter pylori infection in dyspeptic patients at the HNCH. MATERIAL AND METHODS: 31 dyspeptic patients that attended the outpatient GI clinic during September2004 were included. All of them had an upper endoscopy , gastricbiopsies, and a Breath Test with C14, done at the IPEN (Peruvian Institute of Nuclear Energy) . The diagnosis of HP infection was based on the histopathology report. RESULTS: Of the 31 Breath Test , one was a false negative and in 30 there was a good correlation with the biopsies results , 23 demonstrated the HP infection and in 7 this was not present. CONCLUSION: The IPEN Breath Test showed in this study a sensibility of 96.6 per centand a specificity of 100 per cent , demonstrating that is a very useful diagnostic tool for HP infection.

Upper Gl endoscopy - A review of 500 cases at Sheikh Zayed Medical College/Hospital Rahim Yar Khan

To document various endoscopic findings in patients undergoing upper Gl endoscopy in our endoscopy unit. Observational. The data of 500 patients who underwent upper Gl endoscopy in Endoscopy Unit of Sheikh Zayed Medical College/Hospital from November 2005 to May 2007 was analyzed. Demographic features, reasons for referral and endoscopic diagnoses were noted. Among 500 patients, 57% were referred due to upper Gl bleeding, 9% due to dysphagia, 8% due to persistent vomiting and 7% due to dyspeptic symptoms. Common endoscopic diagnoses were esophageal varices [44%], reflux esophagitis [9%], gastritis [4%] and gastric ulcer [4%].The most common presenting complaint was upper Gl bleeding and the most common endoscopic finding was esophageal varices

Ulceras gástricas y duodenales / Gastric and duodenal ulcers

Se realiza un enfoque fundamentalmente diagnóstico y terapéutico de las hemorragias digestivas altas cuyo origen topográfico, etiológico han sido determinados y tratados por endoscopia. Quedan comprendidos en el tema los distintos estadios de las ulceras gastroduodenales de acuerdo a la clasificación de Forrest. Se afirman los conceptos de diagnósticos positivos y la importancia del tratamiento endoscópico temprano. El objetivo del estudio fue evaluar la eficacia del tratamiento endoscópico. A los pacientes se les realizo endoscopia alta en las primeras 24 hs del ingreso en el Servicio de Urgencias de Cirugía del Hospital Central del Instituto de Previsión Social (IPS), en caso de observarse sangrado activo, se les aplicó tratamiento endoscópico (escleroterapia con polidocanol mas adrenalina). El tratamiento mostró eficacia respecto a la hemostasia inicial, la necesidad de cirugía y la mortalidad. La hemostasia definitiva se logró en el 94% de los pacientes. Palabras claves: ulceras gastroduodenales, endoscopia digestiva alta.

Malignant lymphoma of stomach associated with duodenal carcinoid.

We report a 73-year-old man with diffuse large B-cell lymphoma of the stomach in whom distal gastrectomy specimen revealed coexisting carcinoid tumor of the duodenum. Postoperatively the patient received six cycles of chemotherapy (CHOP regimen) and was asymptomatic nine months later.

Hemorragia digestiva alta por malformaciones vasculares / Vascular malformations as cause of upper gastrointestinal bleeding

Hemos abordado 4 diferentes patologías vasculares de tubo digestivo superior que suelen presentarse con HDA, sus características clínico endoscópicas y un aporte respecto a la terapéutica con énfasis en el abordaje endoscópico.

Morphological spectrum of gastric lesions - endoscopic biopsy findings

A retrospective study was carried out to determine the morphological spectrum of gastric lesions at Pathology Department of Army Medical College, Rawalpindi for the duration of 02 years. Descriptive Study. The gastric mucosal biopsies of 787 patients received from Gastroenterology unit of Military Hospital Rawalpindi from January 2002 to December 2003, were studied by routine histopathology methods. A high frequency of gastric disease in males with a male to female ratio of 6:1 and an age range of 09 years to 85 years were observed. The clinical presentations mostly seen were abdominal pain, dyspepsia, vomiting, diarrhoea, decreased appetite and weight loss. On endoscopy the most frequently suspected lesions were gastritis 662[84.12%], stomach growth 45[5.72%], gastric ulcers 10[1.27%], while 70[8.89%] cases showed unremarkable mucosa. The histopathology revealed chronic non-specific gastritis 676[85.89%] followed by malignant tumours 45[5.72%], benign neoplasms 3[0.38%] and gastric ulcer 10[1.27%]. A number of biopsies 53[6.73%] were unremarkable histologically. The more prevalent lesions in this series were chronic active gastritis followed by tumours and gastric ulcers. H. pylori associated gastritis was seen in majority of the patients. Thus gastric biopsy is an essential tool for diagnosis and confirmation of clinically suspected cases

Decrease in prevalence of peptic ulcer and gastric adenocarcinoma at the Policlínico Peruano Japonés, Lima, Peru, between the years 1985 and 2002. Analysis of 31,446 patients / Disminución de la prevalencia de la úlcera péptica y el adenocarcinoma gástrico en el policlínico Peruano-Japonés, Lima, Perú

Aim: To determine the prevalence of peptic ulcer and gastric adenocarcinoma in a population of middle and high socio-economic status in Lima, Peru, between 1985 and 2002. Materials and methods: The prevalence of gastroduodenal ulcer and gastric adenocarcinoma was determined after studying by esophagogastroduodenoscopy 31,446 patients at the Policlínico Peruano Japonés (PPJ) between 1985 and 2002. All patients had chronic upper gastrointestinal symptoms and had endoscopically proven diagnosis of active peptic ulcer or histological diagnosis of gastric adenocarcinoma. Results: Analysis of PPJ population identified a decrease in the prevalence of gastric ulcer and duodenal ulcer from 3.15% and 5.05% respectively in 1985, to 1.62% and 2.00% respectively in 2002. Gastric adenocarcinoma prevalence also decreased from 3.19% in 1988 to 0.92% in 2002. The prevalences of gastric ulcer (OR=1.49, 95% IC 1.26-1.77, p<0.001), duodenal ulcer (OR=1.32, 95% IC 1.15- 1.51, p<0.001) and gastric adenocarcinoma (OR=1.53, 95% IC 1.25-1.86, p<0.001), decreased in the last eight years. Conclusions: Over the study period, there was a significant decrease in the prevalence of peptic ulcer and gastric adenocarcinoma at the PoliclínicoPeruano Japonés, where patients from middle and high socio economic status are attended.

Objetivo: Determinar la prevalencia de la úlcera péptica y el adenocarcinoma gástrico, en una población de nivel socioeconómico medio y alto en Lima, Perú, entre los años 1985 y 2002. Material y métodos: Se determinó la prevalencia de la úlcera gastroduodenal y el adenocarcinoma gástrico, después de evaluar por esofagogastroduodenoscopía 31,446 pacientes en el Policlínico Peruano Japonés (PPJ) entre 1985 y 2002. Todos los pacientes presentaron síntomas crónicos del tracto gastrointestinal superior, y en ellos se realizó el diagnóstico endoscópico de úlcera péptica activa e histológico de adenocarcinoma gástrico. Resultados: Luego del análisis de la población estudiada se identificó una disminución de la prevalencia de úlcera gástrica y úlcera duodenal de 3,15% y 5,05% respectivamente en 1985, a 1.62% y 2.00% respectivamente en el año 2002. La prevalencia de adenocarcinoma gástrico también disminuyó de 3,19% en 1992 a 0,92% en el año 2002. Las prevalencias de ulcera gástrica (OR =1.49, 95% IC 1.26-1.77, p<0.001), úlcera duodenal (OR =1.32, 95% IC 1.15-1.51, p<0.001) y adenocarcinoma gástrico (OR =1.53, 95% IC 1.25-1.86, p<0.001), disminuyeron en los últimos 8 años cuando comparamos con los primeros años. Conclusiones: Durante este período de estudio se observó una significativa disminución de la prevalencia de la úlcera péptica y el adenocarcinoma gástrico en pacientes peruanos de nivel socio económico medio y alto que son atendidos en este nosocomio.

Prevalencia de la infección por Helicobacter pylori en pacientes dispépticos / Histologic alterations of the gastric mucous and prevalence of Helicobacter pylori in dyspeptic patients

Un estudio en pacientes dispépticos puede permitirnos arrojar alguna claridad sobre aspectos epidemiológicos importantes relacionados con la infección por Helicobacter pylori en nuentro medio. Se realizó un estudio descriptivo, prospectivo, donde el universo estuvo constituido por pacientes con síntomas dispépticos, a los que se les indicó una endoscopia superior, durante el período comprendido entre marzo del 2000 y marzo del 2002. La muestra quedó constituida por 200 pacientes, 108 de sexo femenino y 92 de sexo masculino con promedio de edad de 52 años. Se tomaron muestras de biopsia gástrica para histología y para test de ureasa. En pacientes con úlcera duodenal se encontró una prevalencia de la infección por Helicobacter pylori de 99.0. En 22 pacientes con úlcera gástrica se encontró una prevalencia de 91.0. La prevalencia de la infección encontrada en los pacientes con gastritis crónica fue 94.0. En pacientes con histología normal la infección tuvo una prevalencia de 68.0