Eosinophilic esophagitis in adults, an emerging cause of dysphagia. Description of 9 cases.

BACKGROUND: Eosinophilic esophagitis is a rare condition mainly affecting children, although the number of cases reported in adults is on the increase. It is characterized by intense infiltration of eosinophilic leukocytes in the esophageal mucosa, without involvement of other sections of the alimentary canal. MATERIAL AND METHODS: Over the past year, following the performance of endoscopies and biopsies, our service identified nine patients who were diagnosed with suffering from this disorder. Each patient sought medical help for episodes of long-term, self-limited dysphagia or food impaction in the alimentary canal. RESULTS: Endoscopy revealed esophageal stenosis in the form of simultaneous contraction rings or regular stenosis. In six cases, the manometric study showed a nonspecific motor disorder of severe intensity affecting the esophageal body, and another patient had a disorder characterized by the presence of simultaneous waves and secondary peristaltic waves in the three thirds of the organ. These disorders are presumably due to eosinophilic infiltration of the muscular layer or ganglionar cells of the esophagus, and account for symptoms in these patients. Although the etiopathogenesis of this illness is uncertain, it is clearly an immunoallergic manifestation. CONCLUSIONS: As the number of diagnosed cases is on the increase, eosinophilic esophagitis is in adults a specific entity within the differential diagnosis of dysphagia in young males with a history of allergies. Eosiniphilic esophagitis responds in a different number of ways to therapies used. We successfully used fluticasone propionate, a synthetic corticoid applied topically, which proved to be efficient in the treatment of this illness by acting on the pathophysiological basis of the process. It does not have any adverse effects, thus offering advantages over other therapies such as systematic corticoids or endoscopic dilations.

Esofagitis eosinofílica del adulto, causa emergente de disfagia. Presentación de 9 casos / Eosinophilic esophagitis in adults, an emerging cause of dysphagia. Description of 9 cases

Introducción: la esofagitis eosinofílica es una enfermedad poco frecuente, propia de la edad pediátrica, aunque cada vez son más los casos descritos en pacientes adultos. Se caracteriza por la intensa infiltración de la mucosa esofágica por leucocitos eosinófilos, en ausencia de afectación de otros tramos del tubo digestivo. Material y métodos: en nuestro servicio hemos identificado durante el último año a 9 pacientes que fueron diagnosticados de esta entidad tras la endoscopia y toma de biopsias. Todos consultaron por episodios de disfagia autolimitada de larga evolución o por impactación de alimento en esófago. En la endoscopia se observaron estenosis esofágicas, en forma de anillos de contracción simultánea o estenosis regulares. Resultados: el estudio con manometría esofágica demostró la existencia de un trastorno motor de cuerpo esofágico de tipo inespecífico e intensidad severa en 6 casos, y en otro paciente un trastorno caracterizado por la presencia de ondas simultáneas en los tres tercios del órgano y ondas secundarias peristálticas. Dichos trastornos son debidos presumiblemente a la infiltración eosinofílica de la capa muscular o de las células ganglionares del esófago, y justifican los síntomas de estos pacientes. Conclusiones: aunque la etiopatogenia de la enfermedad no es bien conocida, parece claro que se trata de una manifestación inmunoalérgica. Su prevalencia diagnóstica está en aumento, por lo que la esofagitis eosinofílica del adulto es una entidad específica en el diagnóstico diferencial de la disfagia en varones jóvenes con antecedentes de alergia. La esofagitis eosinofílica presenta una respuesta variable a las terapias utilizadas. Nosotros hemos utilizado con éxito el propionato de fluticasona, un corticoide sintético de aplicación tópica, eficaz en el tratamiento de esta entidad al actuar sobre la base fisiopatológica del proceso. Carece de efectos adversos, por lo que presenta ventajas frente a otras terapias como los corticiodes sistémicos o las dilataciones endoscópicas

Background: eosinophilic esophagitis is a rare condition mainly affecting children, although the number of cases reported in adults is on the increase. It is characterized by intense infiltration of eosinophilic leukocytes in the esophageal mucosa, without involvement of other sections of the alimentary canal. Material and methods: over the past year, following the performance of endoscopies and biopsies, our service identified nine patients who were diagnosed with suffering from this disorder. Each patient sought medical help for episodes of long-term, self-limited dysphagia or food impaction in the alimentary canal. Results: endoscopy revealed esophageal stenosis in the form of simultaneous contraction rings or regular stenosis. In six cases, the manometric study showed a nonspecific motor disorder of severe intensity affecting the esophageal body, and another patient had a disorder characterized by the presence of simultaneous waves and secondary peristaltic waves in the three thirds of the organ. These disorders are presumably due to eosinophilic infiltration of the muscular layer or ganglionar cells of the esophagus, and account for symptoms in these patients. Although the etiopathogenesis of this illness is uncertain, it is clearly an immunoallergic manifestation. Conclusions: as the number of diagnosed cases is on the increase, eosinophilic esophagitis is in adults a specific entity within the differential diagnosis of dysphagia in young males with a history of allergies. Eosiniphilic esophagitis responds in a different number of ways to therapies used. We successfully used fluticasone propionate, a synthetic corticoid applied topically, which proved to be efficient in the treatment of this illness by acting on the pathophysiological basis of the process. It does not have any adverse effects, thus offering advantages over other therapies such as systematic corticoids or endoscopic dilations

[Idiopathic thrombocytopenic purpura as an extraintestinal manifestation of Crohn's disease]. / Púrpura trombocitopénica idiopática como manifestación extraintestinal de la enfermedad de Crohn.

Idiopathic thrombocytopenic purpura is an infrequent extraintestinal manifestation of inflammatory bowel disease. It is particularly rare in association with Crohn's disease. In these cases it presents certain peculiarities with respect to its normal clinical features, occurring more frequently when Crohn's disease is mainly colonic and usually appearing after the diagnosis of Crohn's disease has been made. Moreover, it usually complicates the clinical course of both diseases. We present a case of idiopathic thrombocytopenic purpura in a 14-year-old girl in whom the two diseases first presented simultaneously. The clinical course was poor and both diseases were refractory to habitual treatment.

[Bone metabolism in non-cholestatic chronic hepatopathy]. / Metabolismo óseo en la hepatopatía crónica no colestásica.

BACKGROUND: Osteoporosis may be associated with parenchymal hepatopathy and chronic alcoholism. Biochemical studies which are linked with bone metabolism and the bone densitometry may help to understand its physiopathology, before the symptoms appear and its consequences become inevitable. PATIENTS AND METHODS: The study of bone metabolism and densitometry has been carried out in a population of 86 males, distributed in 4 groups: group I, control (17 men), group II, patients with chronic hepatopathy without alcoholism (25 patients), group III, chronic alcoholic without hepatopathy (21 patients), and group IV, patients with chronic alcoholic hepatopathy (23 patients). The results of densitometry and biochemical parameters in relation with bone metabolism are cross checked among these 4 groups. RESULTS: We found out that patients with chronic alcoholic hepatopathy have bone mineral density (BMD), at femoral level, significatively lower than that of the other 3 groups (p < 0.05). In chronic hepatopathy, regardless of its etiology, significant alterations in biochemical parameters of bone metabolism found, consisting basically in shrinked plasmatic level of 25-hydroxivitamin-D (25-OH-D) (p < 0.05). The plasmatic levels of calcitriol, magnesium and intact parathyroid hormone (PTHi) were significantly lower in chronic alcoholic hepatopathy than in the others 3 groups (p < 0.001, p < 0.001 and p < 0.05, respectively). CONCLUSIONS: Chronic hepatopathy is associated with deficiency in vitamin D. Alcoholism added to chronic hepatopathy has a negative influence on the plasmatic levels of calcitriol, magnesium and PTHi as well as in the femur BMD. Alcoholism not associated with chronic hepatopathy is not sufficient to cause significant alterations in the studied parameters.

[Ultrasonographic aspects of cystic papillary tumor of the pancreas. Apropos of 2 cases]. / Aspectos ecográficos del tumor papilar quístico del páncreas. A propósito de 2 casos.

Cystic papillary pancreatic tumor is an infrequent neoplasm of unknown origin which is presented almost exclusively in young women. It is characterized by an anodyne clinical symptomatology with it frequently treated as an accidental finding. Ultrasonography and computerized axial tomography have a priority role in the study of this entity but the definitive diagnosis is based on the histologic findings. The treatment of choice is surgical removal and although it is a malignant tumor, good evolution is observed with recurrence not being expected. Two new cases of cystic papillary tumor are presented comparing the ultrasonographic appearance of the same with other pancreatic cystic neoplasms. Although the ultrasonographic findings are not characteristic they may be suggestive of papillary tumor.

[Melanoma of the small intestine and adenocarcinoma of the colon]. / Melanoma de intestino delgado y adenocarcinoma de colon.

The clinical case of a 73-years old male who was admitted for diarrhea and loss of weight is presented. Barium enema and colonoscopy demonstrated small size polyps in the sigmoid colon, one of which had a histologic diagnosis of adenocarcinoma. Abdominal examination detected a mass in the mesohypogastrium which did not appear to be related to the previous findings. CAT and intestinal transit confirmed a second tumor in the small bowel with the histologic diagnosis of a resected specimen being melanoma.