ABSTRACT
No disponible
Subject(s)
Aged , Humans , Fibrosis/complications , Gastrointestinal Agents/therapeutic use , Hydrothorax/drug therapy , Hydrothorax/etiology , Octreotide/therapeutic use , Drainage , Fibrosis/drug therapy , Hydrothorax/diagnosis , Treatment OutcomeABSTRACT
OBJECTIVES: 1. To determine the prevalence of Helicobacter pylori (H. pylori) infection in patients with gastroesophageal reflux disease (GERD), and to compare it with that in a control group. 2. To study the percentage of H. pylori-positive GERD patients according to different grades of esophagitis. MATERIAL AND METHODS: H. pylori prevalence by serological tests was compared among 692 patients with GERD and 200 healthy volunteer controls. Subsequently, the percentage of H. pylori was analyzed in the different grades of esophagitis, according to the Savary-Miller classification. RESULTS: no differences between the GERD group and control group were detected regarding age (50.5+/-14.7 vs 50.7+/-16.4 years, ns) and sex (63 vs 66% of men, ns); on the other hand the prevalence of H. pylori was 40% in the GERD group facing 66% in the control group, p <0.01. There were no differences in H. pylori prevalence according to the different grades of esophagitis, but logistical regression analysis showed that the absence of H. pylori infection was associated with the presence of grade IV esophagitis. CONCLUSIONS: the prevalence of H. pylori infection in GERD patients is lower than that of the general population, and its absence is associated with more severe grades of the disease. These results indicate that H. pylori plays a protective role against GERD.
Subject(s)
Gastroesophageal Reflux/complications , Helicobacter Infections/complications , Helicobacter Infections/epidemiology , Helicobacter pylori , Female , Humans , Male , Middle Aged , PrevalenceABSTRACT
OBJECTIVES: 1. To determine the progression of endoscopic affectation in patients with gastroesophageal reflux disease (GERD). 2. To analyze the clinical parameters associated to grade IV of esophagitis, as well as the degree of endoscopic progression. MATERIAL AND METHODS: between 1996 and 2002, 692 patients with GERD have been followed prospectively (66% men and 33% women, with a mean age of 50.7 years). All were submitted to initial upper endoscopy, without treatment, and different clinical parameters associated to grade IV esophagitis were analyzed. During follow up, a new endoscopy was repeated in the event of symptomatic relapse, comparing the new findings with those of the initial exploration. RESULTS: the initial endoscopy did not reveal signs of esophagitis in 49% of the patients. Grade I 11.2%, grade II 22%, grade III 8.1% and grade IV 8.7%. Multivariant analysis showed that advanced age (p <0.01), male sex (p <0.03), smoking (p <0.02) and absence of infection due to Helicobacter pylori (p <0.02) were independent factors associated to grade IV esophagitis. Throughout follow up, patients without esophagitis did not show evidence of esophagitis in successive endoscopies, and a higher grade was found in only 3 of the patients. CONCLUSIONS: the endoscopy did not reveal signs of esophagitis in approximately half of the patients. Advanced age, male sex, smoking and absence of Helicobacter pylori are risk factors associated with severe stages of esophagitis. Patients with reflux without esophagitis did not develop inflammatory disorders during follow-up, while those with esophagitis remained in the stage of the initial diagnosis.
Subject(s)
Endoscopy, Digestive System , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/physiopathology , Disease Progression , Esophagitis, Peptic/diagnosis , Esophagitis, Peptic/microbiology , Female , Follow-Up Studies , Gastroesophageal Reflux/therapy , Helicobacter Infections/diagnosis , Helicobacter Infections/microbiology , Helicobacter pylori/isolation & purification , Humans , Male , Middle Aged , Risk FactorsABSTRACT
AIM: To test the efficacy of an ultra-short intravenous triple therapy against Helicobacter pylori infection in patients with bleeding peptic ulcer against standard oral 1-week triple therapy in a randomised, double-blind prospective trial. PATIENTS: (n = 75) with haemorrhagic peptic ulcer and H. pylori infection were randomised into: an Intravenous Group to receive omeprazole, clarithromycin and amoxicillin-clavulanic acid intravenously b.d. for 3 days followed by 7 days of oral omeprazole plus placebo of clarithromycin and amoxicillin; an Oral Group to receive intravenous omeprazole plus placebo of clarithromycin and amoxicillin-clavulanic acid followed by 7 days of oral omeprazole, clarithromycin and amoxicillin b.d. Gastric biopsies were obtained for urease test. A 13C-urea breath test was performed to check for H. pylori eradication. RESULTS: Intention-to-treat eradication was 50% (19/38) in the Intravenous Group and 78% (29/37) in the Oral Group (odds ratio 3.63; 95% confidence interval 1.32-9.94; P < 0.01; number needed to treat (NNT) = 4). Per protocol eradication was 50% (14/28) in the Intravenous Group and 86% (24/28) in the Oral Group (P < 0.005). There were no statistically significant differences in adverse events between the two treatment groups. CONCLUSIONS: An ultra-short, 3-day, intravenous, triple therapy containing omeprazole, clarithromycin and amoxicillin-clavulanic acid cannot be recommended as an effective eradication regimen for H. pylori infection related to haemorrhagic gastro-duodenal ulcer.
Subject(s)
Helicobacter Infections/drug therapy , Helicobacter pylori , Peptic Ulcer Hemorrhage/drug therapy , Amoxicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Anti-Ulcer Agents/administration & dosage , Clarithromycin/administration & dosage , Clavulanic Acids/administration & dosage , Double-Blind Method , Drug Administration Schedule , Drug Combinations , Duodenal Ulcer/drug therapy , Female , Humans , Infusions, Intravenous , Male , Middle Aged , Omeprazole/administration & dosage , Recurrence , Stomach Ulcer/drug therapy , Treatment FailureABSTRACT
Objetivos: 1. Conocer el estadio de afectación endoscópica en pacientes con enfermedad por reflujo grastroesofágico (ERGE). 2. Analizar las variables clínicas asociadas a estadio IV de esofagitis, así como el grado de progresión endoscópica. Material y métodos: durante el periodo 1996-2002 se han seguido prospectivamente 692 pacientes con ERGE (66% hombres y 33% mujeres, con una edad media de 50,7 años). A todos ellos se les realizó endoscopia oral inicial, libres de tratamiento, y se analizaron diferentes variables clínicas asociadas a esofagitis grado IV. Durante el seguimiento se repitió nueva endoscopia en caso de recidiva sintomática, comparando los hallazgos con los de la exploración inicial. Resultados: un cuarenta y nueve por ciento de pacientes no mostraron signos de esofagitis en la endoscopia inicial. Grado I 11,2%, grado II 22%, grado III 8,1% y grado IV 8,7%. El análisis multivariante mostró que la edad avanzada (p<0,01), sexo masculino (p<0,03), hábito tabáquico (p<0,02) y ausencia de infección por Helicobacter pylori (p<0,02) fueron factores independientes asociados a esofagitis grado IV. A lo largo del seguimiento ningún paciente sin esofagitis presentó evidencia de la misma en endoscopias sucesivas, y solamente en 3 pacientes con esofagitis se constató un grado superior. Conclusiones: aproximadamente la mitad de pacientes con ERGE no muestra signos de esofagitis en la endoscopia. La edad avanzada, sexo masculino, hábito tabáquico y ausencia de Helicobacter pylori son factores de riesgo asociados a estadio severo de esofagitis. Los pacientes con reflujo sin esofagitis no desarrollan alteraciones inflamatorias a lo largo de su seguimiento, mientras que aquellos con esofagitis tienden a permanecer en el estadio de su diagnóstico inicial (AU)
Subject(s)
Female , Humans , Male , Middle Aged , Endoscopy, Digestive System , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/physiopathology , Helicobacter pylori/isolation & purification , Disease Progression , Esophagitis, Peptic/diagnosis , Esophagitis, Peptic/microbiology , Follow-Up Studies , Gastroesophageal Reflux/therapy , Helicobacter Infections/diagnosis , Helicobacter Infections/microbiology , Helicobacter Infections/therapy , Risk FactorsABSTRACT
OBJECTIVE: a) To analyse the probability of haemodynamic changes in patients with non-variceal upper gastrointestinal bleeding (NV-UGB), as well as the risk of bleeding in cases of peptic ulcer; and b) to compare an injection of epinephrine alone with epinephrine plus an sclerosing agent in ulcers with a high risk of persistent or recurrent bleeding. METHODS: We studied 500 consecutive patients (295 males/205 females) who were admitted because of an NV-UGB episode. Haemodynamic evaluation and upper endoscopy were performed in all patients. They were randomised to receive an injection of epinephrine 1:10.000 or epinephrine plus 2% polidocanol in case of active bleeding, visible vessel or unstable clot. RESULTS: 263/500 (52.6%) were taking NSAIDs before the acute bleeding. 70/96 (72.9%) patients with red haematemesis showed haemodynamic changes vs 15/107 (14%) with dark haematemesis and melena, and 29/281 (10.3%) with melena alone, p < 0.01, OR = 20. Duodenal ulcer was the cause of NV-UGB in 206 cases (40.6%) and gastric ulcer in 134 (27.2%). However, an endoscopic therapy was performed in 85 patients, 58 with gastric ulcers (19 with active bleeding, 33 with visible vessel and 6 with unstable clot) vs 27 with duodenal ulcers (6 with active bleeding, 19 with visible vessel and 2 with unstable clot), p < 0.01, OR = 4.7. 15/85 patients developed recurrent bleeding after injection therapy: 3 with a non-bleeding visible vessel and 10 with active bleeding (10 were treated with epinephrine and 2 with epinephrine plus 2% polidocanol, p < 0.04, OR = 8). A multivariate logistic regression analysis showed that age, active bleeding and type of injected agent were the only independent variables associated with failure of treatment and recurrent bleeding. CONCLUSIONS: a) 52.6% of patients with NV-UGB were taking NSAIDs before acute bleeding; b) epinephrine injection followed by a sclerosing agent is more effective in case of active bleeding; however, there is no difference in case of visible vessel or unstable clot; and c) age, active bleeding and type of treatment were the only independent variables associated with recurrent bleeding.
Subject(s)
Epinephrine/therapeutic use , Peptic Ulcer Hemorrhage/drug therapy , Sclerosing Solutions/therapeutic use , Vasoconstrictor Agents/therapeutic use , Adult , Aged , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Epinephrine/administration & dosage , Female , Gastroscopy , Hemodynamics/physiology , Humans , Male , Middle Aged , Peptic Ulcer Hemorrhage/chemically induced , Peptic Ulcer Hemorrhage/pathology , Secondary Prevention , Vasoconstrictor Agents/administration & dosageABSTRACT
Objetivos: a) analizar la probabilidad de afectación hemodinámica en pacientes con hemorragia digestiva alta no varicosa (HDA-NV), así como el riesgo de recidiva hemorrágica en los casos de úlcera gastroduodenal; b) comparar la inyección de adrenalina frente a la de adrenalina + agente esclerosante en aquellos casos con estigmas de sangrado que aconsejen realizar terapéutica endoscópica. Material y métodos: se estudiaron 500 pacientes consecutivos que fueron sometidos a endoscopia por episodio de HDA-NV.A todos ellos se les realizó historia clínica y valoración hemodinámica. Los casos que presentaban sangrado activo, vaso visible o coágulo inestable fueron aleatorizados a recibir inyección con adrenalina 1/10.000 o bien ésta más un agente esclerosante (polidocanol 2 por ciento).Resultados: 263/500 referían consumo de AAS/AINEs previo al episodio hemorrágico (52,6 por ciento). 96 pacientes presentaron hematemesis de sangre roja, de los cuales 70 presentaban afectación hemodinámica (72,9 por ciento), frente al 14 por ciento de los que referían hematemesis digerida y melenas y 10,3 por ciento de los que sólo referían melenas, p<0,01, odds ratio=20. La úlcera duodenal fue la responsable del sangrado en 206 casos (40,6 por ciento) y la gástrica de 134 (27,2 por ciento), pero en cambio se realizó terapéutica endoscópica en 58 casos de úlcera gástrica (19 con sangrado activo, 33 con vaso visible y 6 con coágulo inestable) frente a 27 de úlcera duodenal (6 con sangrado activo, 19 con vaso visible y 2 con coágulo inestable), p<0,01, odds ratio=4,7. De estos 85 pacientes tratados endoscópicamente, 15 sufren recidiva hemorrágica: 3 con vaso visible y 12 con sangrado activo, de los cuales se trataron 10 con adrenalina y 2 con adrenalina + agente esclerosante, p<0,04, odds ratio=8).El análisis de regresión logística multivariante mostró que sólo la edad, presencia de sangrado activo y tipo de tratamiento fueron variables independientes asociadas a fracaso de tratamiento y recidiva hemorrágica. Conclusiones: a) en nuestro medio el 52,6 por ciento de pacientes con HDA-NV refieren consumo previo de AAS/AINEs; b) la adición de un agente esclerosante a la adrenalina se muestra más eficaz en los casos de sangrado activo para la prevención de la recidiva hemorrágica ulcerosa, sin diferencias frente a la inyección exclusiva de adrenalina en casos de vaso visible o coágulo inestable; y c) la edad, presencia de sangrado activo y tipo de tratamiento fueron las únicas variables asociadas a fracaso de tratamiento endoscópico y recidiva hemorrágica (AU)
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Sclerosing Solutions , Vasoconstrictor Agents , Recurrence , Anti-Inflammatory Agents, Non-Steroidal , Epinephrine , Gastroscopy , Hemodynamics , Peptic Ulcer HemorrhageABSTRACT
Hepatocellular carcinoma mainly affects patients with liver disease and rarely develops in healthy liver. Cirrhosis greatly increases the risk of developing this malignancy and consequently these patients are candidates for close follow-up and surveillance. The most commonly used screening programs are abdominal ultrasonography and serum alpha-fetoprotein determination. Without treatment, the prognosis of hepatocellular carcinoma is poor and mortality continues to be significant even in patients with small tumors detected during follow-up. We present the case of a 71-year-old male patient with alcoholic cirrhosis. The patient was diagnosed during follow-up of a single hepatocellular carcinoma of 4 cm in diameter. Although he refused all treatment, evolution was favorable, serum alpha-fetoprotein levels returned to normal and ultrasonographic images compatible with hepatocellular carcinoma disappeared. Three years after diagnosis, the patient was completely asymptomatic.
Subject(s)
Carcinoma, Hepatocellular/pathology , Liver Cirrhosis/pathology , Liver Neoplasms/pathology , Neoplasm Regression, Spontaneous , Aged , Carcinoma, Hepatocellular/complications , Humans , Liver Cirrhosis/complications , Liver Neoplasms/complications , MaleABSTRACT
Objetivos: estudios recientes han encontrado una alta prevalencia de diabetes mellitus en pacientes infectados por el virus C (VHC). En este trabajo nos planteamos un doble objetivo: a) sustentar la hipótesis de la hiperinsulinemia como factor de riesgo para diabetes en estos pacientes, estudiando prospectivamente los valores de insulinemia basal en pacientes cirróticos no diabéticos infectados por el virus C, comparándola con la de cirróticos no diabéticos no virus C; y b) investigar en ambos grupos los factores implicados en el aumento de resistencia periférica a la insulina.Material y métodos: se realizó un estudio que incluyó a 32 pacientes cirróticos no diabéticos por VHC (grupo I) y 41 cirróticos no diabéticos de otras etiologías (grupo II). En ambos grupos se compararon las concentraciones de insulinemia basal, así como los factores asociados a resistencia insulínica: edad, índices antropométricos, estadio evolutivo de la cirrosis empleando la clasificación de Child-Pugh, ferritina plasmática y tratamiento con fármacos inductores de resistencia a la insulina.Resultados: la media de los valores de insulinemia basal en el grupo I fue de 21,5 µU/ml (18,6-24,4), frente a 14 µU/ml (1018) en el grupo II (p<0,001), y el porcentaje de hiperinsulinemia del 87,5 por ciento (72,5-95,9) frente al 56,1 por ciento (40,8-70,6), respectivamente (p<0,01). No se encontraron diferencias entre ambos grupos con respecto a las siguientes variables: edad [54,4 (48,360,6) frente a 59,5 años (56,3-62,7) NS], peso [72,9 (69,5-76,3) frente a 74,2 kg (70,8-77,7) NS], talla [163,6 (160,5166-7) frente a 161,3 cm (159,4-163,2) NS], índice de masa corporal [27,6 (26,1-29,1) frente a 28,4 kg/m2 (27,3-29,5) de talla NS] ni estadio de Child-Pugh (A: 31 frente a 27, B: 0 frente a 7, C: 1 frente a 7, NS). En cambio los valores de ferritina sérica en los pacientes del grupo I fueron más elevados que los del grupo II [123,3 (12,4-289,3) frente a 65,5 ng/ml (2,4-306) p<0,05], mientras que en el momento de inclusión en este estudio 3 pacientes del grupo I recibían diuréticos o bloqueantes no selectivos beta adrenérgicos, frente a 14 pacientes del grupo II, p<0,01.El estudio de regresión logística multivariado demostró que los valores de insulinemia (OR=1,21; IC 95 por ciento 1,09-1,34, p<0,001) y ferritina (OR=1,21; IC 95 por ciento 1,02-2,69, p<0,04) fueron variables independientes asociadas a la infección por VHC.Conclusiones: Los pacientes cirróticos no diabéticos debido al VHC tienen unos valores de insulinemia basal más elevados, así como una mayor prevalencia de hiperinsulinemia que la cirrosis debida a otras causas. Esta característica podría explicarse por un aumento de resistencia periférico a la insulina, mediado por el incremento de los depósitos de hierro que igualmente presentan estos pacientes, y puede ser el factor responsable del riesgo aumentado de desarrollar diabetes mellitus (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Hepatitis C , Hyperinsulinism , FerritinsABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Pancreatitis , Anti-Bacterial Agents , Acute Disease , Erythromycin , PancreatitisABSTRACT
Acquired systemic amyloidosis may develop during the course of a number of chronic inflammatory diseases, including inflammatory bowel disease. Amyloidosis, although rare, is life-threatening, especially when it involves the kidneys. It is important to recognize this complication, especially since colchicine has been proposed as a possible treatment.We present a 25-year-old female diagnosed at the age of 13 years with Crohn's disease with involvement of the terminal ileum and right colon. Surgery was performed because of inflammatory activity unresponsive to corticosteroid and immunosuppressive drugs. She subsequently presented nephrotic syndrome due to secondary amyloidosis, which responded well to colchicine treatment.
Subject(s)
Amyloidosis/drug therapy , Amyloidosis/etiology , Colchicine/therapeutic use , Crohn Disease/complications , Kidney Diseases/drug therapy , Kidney Diseases/etiology , Adult , Female , Humans , Nephrotic Syndrome/etiology , Remission InductionSubject(s)
Blood Glucose/metabolism , Body Height , Diabetes Mellitus/genetics , Hyperinsulinism/epidemiology , Adolescent , Adult , Body Mass Index , Cross-Sectional Studies , Female , Growth Disorders/epidemiology , Growth Disorders/genetics , Humans , Hyperinsulinism/blood , Hyperinsulinism/physiopathology , Premenopause , Reference ValuesABSTRACT
AIMS: a) To prospectively study the frequency of diabetes mellitus in cirrhotic patients with hepatitis C virus (HCV) infection, comparing it with that in cirrhotic patients without HCV infection and b) to investigate basal insulinemia values in both groups, as well as the possible factors causing insulinemia. MATERIAL AND METHODS: Fifty patients with cirrhosis due to HCV infection (group I) and 50 patients with cirrhosis due to other etiologic agents (group II) were studied. In both groups the percentage of diabetic patients, basal insulinemia values and the factors associated with insulin resistance were compared: age, anthropometric indexes, stage of cirrhosis according to Child-Pugh score, plasmatic ferritin concentrations and treatment with drugs inducing insulin resistance. RESULTS: The percentage of diabetics in group I was 36% (18/50) compared with 18% (9/50) in group II (p < 0.05) and basal insulinemia values were 23.5 +/- 9.7 microU/ml compared with 15.7 +/- 9.9 microU/ml respectively (p < 0.05). No differences between the groups were found in the following variables: age (58.7 +/- 16.2 vs. 60.6 +/- 10.0 years), weight (73.2 +/- 10.7 vs 73.9 +/- 11.2 Kg), height (161.9 +/- 8.8 vs. 161.1 +/- 6.8 cm), body mass index (28.2 +/- 3.1 vs. 28.5 +/- 5.2 Kg/height m2) or Child-Pugh stage (A: 40 vs 34, B: 7 vs. 10, C: 3 vs. 6, NS). In contrast, serum ferritin concentrations were much higher in patients in group I than in those in group II [137.7 (12.4-410.2) vs. 87.6 (2.4-420.0) ng/ml p < 0.05]. At the time of inclusion in this study 10 patients in group I were receiving diuretics or non-selective beta adrenergic blockers compared with 24 patients in group II (p < 0.05). CONCLUSIONS: Diabetes mellitus is more prevalent in patients with cirrhosis due to HVC than in those with cirrhosis due to other etiologic agents. Moreover, basal insulinemia values are higher in these patients, which could be explained by an increase in half insulin resistance associated with an increase in iron deposits.
Subject(s)
Diabetes Complications , Hepatitis C, Chronic/complications , Liver Cirrhosis/diagnosis , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Female , Humans , Hyperinsulinism/complications , Male , Middle Aged , Prevalence , Prospective StudiesABSTRACT
OBJECTIVES: Recent studies have reported a high prevalence of diabetes mellitus in populations infected with Virus C (HCV). The aim of this study is two-fold: a) to support the hypothesis of hyperinsulinemia as a risk factor for developing diabetes in these patients, with a prospective determination of baseline insulinemia in non-diabetic cirrhotic patients infected with HCV, comparing their values with those of a group of non-HCV non-diabetic cirrhotic patients; b) to investigate in both groups the factors associated to increased peripheral resistance to insulin. MATERIAL AND METHODS: Thirty two HCV cirrhotic diabetic patients (group I) and 41 non-diabetic cirrhotic patients of other etiologies (group II) participated in the study. Baseline insulinemia, as well as factors related to insulin resistance such as age, anthropometric indexes, stage of cirrhosis development using the Child-Pugh index, serum ferritin and treatment with insulin resistance inducing drugs were compared in both groups. RESULTS: Average baseline insulinemia in group I was 21.5 mU/ml (18.6-24.4), vs 14 mU/ml (10-18) in group II (p < 0.001), and the percentage of hyperinsulinemia was 87.5% (72.5-95.9) vs 56.1% (40.8-70.6), respectively (p < 0.01). No differences were observed between the two groups when comparing the following variables: age [54.4 (48.3-60.6) vs 59.9 (56.3-62.7) years of age, NS], weight [72.9 (69.5-76.3) vs 74.2 (70.8-77.7) kg, NS], height [163.6 (160.5-166.7) vs 161.3 (159.4-163.2)] cm, NS], body mass index [27.6 (26.1-29.1) vs 28.4 (27.3-29.5) kg/m2 of height, NS]; and Child-Pugh staging score (A: 31 vs 27; B: 0 vs 7; C: 1 vs 7, NS). However, serum ferritin levels in group I patients were higher than those in Group II [123.3 (12.4-289.3) vs 65.5 (2.4-306) ng/ml, p < 0.05]. It must be considered that at the recruitment 3 patients in Group I were taking either diuretics or non-selective beta-adrenergic blockers, compared to 14 patients in Group II, p < 0.01. Finally, the multivariate logistic regression analysis showed that insulinemia values (OR = 1.21; CI 95% 1.09-1.34, p < 0.001) and ferritin levels (OR = 1.21; CI 95% 1.02-2.69, p < 0.04) were independent variables associated to HCV infection. CONCLUSIONS: HCV-positive non-diabetic cirrhotic patients have higher baseline insulinemia levels and increased prevalence of hyperinsulinemia than cirrhosis due to other etiologies. This could be explained by an increase of peripheral insulin resistance, mediated by the increase of iron deposits in these patients, and could be responsible for the increased risk of developing diabetes mellitus.
Subject(s)
Ferritins/blood , Hepatitis C/blood , Hepatitis C/complications , Hyperinsulinism/complications , Female , Humans , Male , Middle AgedABSTRACT
No disponible
