Analysis of the Influence of Interleukin-1ß Gene Polymorphism on Gastric Inflammatory Response and Precancerous Lesions Development in Patients with Functional Dyspepsia.

The present study aimed to evaluate the influence of the IL1B -31C/T polymorphism on gastric inflammatory response and precancerous lesions development - atrophic gastritis (AG) and intestinal metaplasia (IM) - in patients positive for Helicobacter pylori infection with functional dyspepsia (FD). The diagnosis of FD followed the Rome III criteria, and the H. pylori infection was evaluated by urease test and histological examination of gastric biopsies (corpus, antrum, and incisura). The severity of chronic inflammation and inflammatory activity, as well as the presence of precancerous lesions were evaluated accordingly to the updated Sydney System. Genotyping of the IL1B -31C/T polymorphism (rs1143627) was performed by polymerase chain reaction-restriction fragment length polymorphism. A total of 303 patients positive for H. pylori infection with FD were analyzed (81.8% women; mean age of 46.3 ± 12.3 years). No differences were observed in overall genotype frequencies among outcomes evaluated. However, in the dominant -31C allele model (CC+CT vs. TT), the frequency of the TT genotype was significantly higher among patients with moderate/severe chronic inflammation of the antrum than the frequency of the CC+CT genotypes (80.8% vs. 65.2%; OR = 2.25; 95% CI = 1.23-4.24; P = .005). The presence of AG and IM in the gastric mucosa of patients was of 19.5% and 19.1%, respectively. No significant association was observed concerning the frequencies of the genotypes of IL1B -31C/T polymorphism with development of precancerous lesions. In conclusion, our data suggest that genetic variants of the IL1B -31C/T polymorphism play a role in chronic inflammation of the gastric mucosa in H. pylori-infected FD patients.

Potential roles of Helicobacter pylori treatment, body mass index and waist circumference in the causation of erosive esophagitis: a randomized clinical trial (HEROES-GERD).

BACKGROUND: In recent decades, the prevalence of gastroesophageal reflux disease (GERD) and obesity has been increasing while Helicobacter pylori infection has been decreasing. OBJECTIVE: To evaluate if H. pylori treatment, excess body weight and other anthropometric measurements are associated with incident erosive esophagitis, as a secondary objective of a trial which tested the efficacy of treatment of H. pylori on the symptoms of functional dyspepsia. SUBJECTS/METHODS: Upper gastrointestinal endoscopy and anthropometric assessments were performed, at baseline and after 12 months, in H. pylori positive patients with functional dyspepsia who had no baseline reflux symptoms or esophagitis. Patients were randomly assigned to receive omeprazole, amoxicillin, and clarithromycin (antibiotic group; n = 201) or omeprazole plus placebo (control group; n = 203). The primary outcome was the incidence of esophagitis 12 months after randomization, according to treatment groups, and the association of BMI and other anthropometric measurements. RESULTS: Four hundred and four patients were included (mean age, 46.1 years; 78.7% women). The 12-month follow-up endoscopic esophagitis rates for the antibiotic and control groups were 10.9% (22/201) and 9.4% (19/203), respectively (p = 0.60). The number needed to harm was 67. Baseline anthropometric measurements were performed in 94% (380/404) of patients. The 12-month follow-up esophagitis rates for overweight and normal body weight patients were 13.6% (29/213) and 6.0% (10/167), respectively (p = 0.015); rates for patients with and without increased baseline waist circumference were 15.4% (24/156) and 6.7% (15/224), respectively (p = 0.006). Following logistic regression, only the combination of increased baseline body mass index and waist, but not H. pylori treatment, was independently associated with new-onset esophagitis (OR 2.88; 95% CI: 1.28-6.45). CONCLUSIONS: Excess body weight and concomitant increased waist circumference, but not H. pylori treatment, predicts new-onset esophagitis.

Diagnosis and management of Barrett's metaplasia: What's new.

Barrett's esophagus (BE) is a complication of gastroesophageal reflux disease, and a premalignant lesion for esophageal adenocarcinoma (EAC). Observational studies suggest that endoscopic surveillance is associated with the detection of dysplasia and EAC at an early stage along with improved survival, but controversies still remain. The management of patients with BE involves endoscopic surveillance, preventive and clinical measures for cancer, and endoscopic and surgical approaches to treatment. Deciding upon the most appropriate treatment is a challenge. This study presents the results and the effectiveness of these practices.

Doença celíaca: "Procura e encontrarás" / Celiac Disease: "Search and you will find"

A doença celíaca, que é causada pela ingestão do glúten, é hoje reconhecida como a doença auto-imune mais prevalente mundialmente e que se manifesta com um amplo espectro de manifestações clínicas com gravidade variável. A forma de apresentação clássica ocorre em crianças onde tipicamente há diarréia crônica, retardo de crescimento, baixo peso, anemia e distensão abdominal. No adulto predominam as manifestações extra-intestinais, que podem acometer vários órgãos e sistemas. O diagnóstico de DC requer achados histopatológicos característicos em biópsia duodenal feita por endoscopia (aumento dos linfócitos intra-epiteliais, hiperplasia de criptas e atrofia das vilosidades) seguida por uma melhora clínica e histológica após dieta isenta de glúten. O grande desafio para os médicos clínicos e das diversas especialidades é identificar a grande população de pacientes não diagnosticados que existem na comunidade e oferecer tratamento com dieta isenta de glúten, o que melhora a qualidade de vida e previne o surgimento de complica- ções (AU)

Celiac Disease (CD) is an autoimmune disease with a worldwide high prevalence. It is caused by ingestion of gluten and has a wide spectrum of clinical findings with different degrees of severity. The classical presentation is an infant with chronic diarrhea, delayed growth, low weight, anemia and abdominal distention. In adults is more common to find extra intestinal symptoms. The diagnosis of CD is achieved by histopathological findings in duodenal biopsy obtained by upper GI endoscopy (increase of intraepithelial lymphocytes, crypt hyperplasia and villi atrophy) with clinical and histological improvement after a gluten-free diet. The big challenge is to identify the undiagnosed cases in the population and treat them with a gluten-free diet, which will avoid further complications and improve their quality of life (AU)

Predictive factors of oxygen desaturation of patients submitted to endoscopic retrograde cholangiopancreatography under conscious sedation

RACIONAL: A hipoxemia pode ocorrer durante a colangiopancreatografia endoscópica retrógrada, provavelmente induzida pela analgesia e sedação realizadas, além da posição do paciente em pronação, que dificulta a ventilação adequada. A hipoxemia e a hipoventilação podem não ser observadas pela equipe de enfermagem. OBJETIVOS: Estudo transversal para investigar possíveis fatores preditivos de dessaturação de oxigênio em pacientes sedados com midazolam associado à meperidina durante a colangiopancreatografia endoscópica retrógrada. PACIENTES E MÉTODOS: O total de 186 pacientes foi monitorado com oxímetro de pulso continuamente. Foi utilizada a regressão de poisson para medir o efeito independente de cada fator ajustado para os efeitos de cada um dos outros fatores. As variáveis estudadas foram: idade, gênero, níveis de hematócrito e hemoglobina, uso de escopolamina, exame diagnóstico ou terapêutico escores da Sociedade Americana de Anestesiologia (ASA), duração do exame, sedativo midazolam usado na média de 0,07 mg/kg e a droga analgésica meperidina na média de 0,7 mg/kg, tituladas de acordo com as reações do paciente. RESULTADOS: Não dessaturaram 113 (60,8%) pacientes, dessaturação moderada (SpO2 <92%) 22 (11,8%) pacientes e dessaturação grave (SpO2 <90%) 51 (27,4%) pacientes. A dessaturação foi reconhecida somente através do oxímetro de pulso. Não houve necessidade de utilizar qualquer droga antagonista do sedativo e do analgésico nos pacientes que apresentaram dessaturação grave, que foram estimulados à respiração profunda e foi instalado oxigênio a 2 L/min em cateter nasal. As variáveis detectadas como preditivas de dessaturação foram idade >60 anos e escore ASA III. O tempo do exame foi levemente significativo para a dessaturação. CONCLUSÕES: As variáveis idade de 60 anos ou mais e escore ASA III foram identificadas como risco aumentado para dessaturação para pacientes submetidos a colangiopancreatografia endoscópica retrógrada sob sedação consciente. Longo tempo de exame sugere dessaturação de oxigênio do paciente. Tais pacientes requerem uma monitorização mais acurada da equipe de enfermagem para a dessaturação e hipoventilação, alertando para a depressão respiratória. O uso do oxímetro de pulso e a solicitação de respiração profunda durante o exame auxilia a diminuir tais riscos.

Predictive factors of oxygen desaturation of patients submitted to endoscopic retrograde cholangiopancreatography under conscious sedation.

BACKGROUND AND AIMS: Hypoxemia can occur during endoscopic retrograde cholangiopancreatography probably induced by the analgesia and sedation done. Moreover the patients prone position difficults the adequate ventilation. The hypoxemia and hypoventilation may not be noticed by nursing staff. A transversal study was used to investigate possible predictive factors of oxygen desaturation in sedated patients with midazolam associated to meperidine undergoing endoscopic retrograde cholangiopancreatography. PATIENTS AND METHODS: A total of 186 patients were monitored with continuous pulse oximetry. Poisson regression was used to measure the independent effect of each factor adjusted for effects of each of the other factors. The variables studied were: age, gender, hematocrit and hemoglobin levels, scopolamine use, diagnostic or therapeutic exam, American Society of Anesthesiologists Scores (ASA), duration time of exam, sedative used midazolam in the average of 0.07 mg/kg and analgesic drug meperidine in the average of 0.7 mg/kg that was titrated according patients reaction. RESULTS: No desaturation was found in 113 (60.8%) patients, mild desaturation (SpO2 <92%) in 22 (11.8%) and severe desaturation (SpO2 <90%) in 51 (27.4%). This desaturation was recognized only by the pulse oximeter. There was no need to use any antagonist drug of the sedatives in patients who had severe desaturation, they were just stimulated to deep breaths and oxygen was offered at 2 liters per minute via catheter. The variables found to predict desaturation were age >60 years old and ASA score III. The duration of exam was barely significant for desaturation. CONCLUSIONS: The variables of age of 60 years old or more, and ASA III score are identified as increased risk for desaturation for patients who undergo endoscopic retrograde cholangiopancreatography under conscious sedation. Long time of exam suggests the patient oxygen desaturate. Such patients require very close monitoring to desaturation and hypoventilation by the assistants and nursing staff alerting to respiratory depression. The use of pulse oximeter and asking for deep breaths during the exam helps to diminish such risks.

Does methylene blue detect intestinal metaplasia in Barrett's esophagus?

BACKGROUND: Methylene blue has been used to selectively stain areas of specialized intestinal metaplasia in Barrett's esophagus. The sensitivity, specificity, and negative and positive predictive values for the detection of specialized intestinal metaplasia by methylene blue chromoendoscopy were determined in patients with Barrett's esophagus. METHODS: Thirty patients with Barrett's esophagus underwent endoscopy with biopsy specimens obtained from areas that stained positive and negative with methylene blue. Histopathologic findings were compared with methylene blue chromoendoscopy findings. RESULTS: Two hundred ninety-two biopsy specimens (mean 9.7/patient) were obtained: 203 from stained and 89 from unstained areas. Sensitivity, specificity, and negative and positive predictive values for detection of specialized intestinal metaplasia were, respectively, 72%, 46%, 22%, and 89%. Comparing 187 biopsy specimens from patients with long-segment Barrett's esophagus with 105 specimens from patients with short-segment Barrett's esophagus, the sensitivity, specificity, and negative and positive predictive values were, respectively, 77% versus 63% (p = 0.044), 79% versus 21% (p < 0.002), 28% versus 14% (p = 0.219), and 97% versus 73% (p < 0.002). The odds ratio for detection of specialized intestinal metaplasia in stained areas was 12.40 in long-segment and 0.45 in short-segment Barrett's esophagus. CONCLUSIONS: Data from this study confirm the value of methylene blue chromoendoscopy for detection of specialized intestinal metaplasia in long-segment Barrett's esophagus, but not in short-segment Barrett's esophagus.

Gastrostomia endoscópica percutânea (PEG): avaliação e perspectivas / Percutaneous endoscopic gastrostomy (PEG): assessment and prospects

Desde sua criação em 1980, a gastrostomia endoscópica percutânea (PEG) tem sido incorporada às rotinas de tratamento de pacientes criticamente enfermos com dificuldades na deglutição. A expectativa de tempo mínimo de uso deve ser de duas a quatro semanas, com média de tempo de permanência de cerca de 216 dias. As contra-indicações absolutas são peritonite difusa, expectativa de vida muito curta, anorexia nervosa. O procedimento de inserção é rápido (14 min em média), realizado com anestesia local, necessitando auxílio endoscópico para visualização e posicionamento do aparato; É recomendável o uso de antibiotico-profilaxia. Os índices de complicações variam de acordo com as co-morbidades dos pacientes submetidos à gastrostomia e com a experiência da equipe multidisciplinar que insere e mantém os cuidados pós-procedimento. Complicações leves são da ordem de 6 a 30 por cento e as graves de 3 a 8por cento. Quando comparadas com a técnica cirúrgica com anestesia geral, houve menor mortalidade e menor índice de complicações graves. Trata-se de uma opção com provável melhor resultado nutricional e estético, com o benefício de menor morbimortalidade em relação aos métodos cirúrgico

Prevalência de adenocarcinoma do esôfago e da junçäo esofagogástrica durante 10 anos nun centro de referência para câncer no Sul do Brasil / Prevalence of adenocarcinoma of the esophagus and esophagogastric junction during a 10 year period in a cancer referral center in Southern Brazil

A incidência do adenocarcinoma do esôfago e junção esofagogástrica tem aumentado dramaticamente nos EUA e na Europa, mas dados epidemiológicos no Brasil são escassos. Objetivo e métodos - Foram revisados os casos de câncer envolvendo o esôfago e confirmados, histologicamente, num período de 10 anos (1987-1996) obtidos por biopsia durante endoscopia digestiva alta, para determinar a prevalência desse tumor em um centro médico de referência para câncer, no Sul do Brasil. Os casos de câncer foram classificados em três categorias: adenocarcinoma, carcinoma epidermóide e outros. Resultados - Entre 349 casos de câncer; encontrou-se adenocarcinoma em 53 (15,2 por cento), carcinoma epidermóide em 283 (81,1 por cento) e outras neoplasias em 13 (3,7 por cento). Conclusões - A prevalência encontrada de adenocarcinoma na população estudada foi de 15 por cento.