Diffuse hemorrhagic gastropathy as an infrequent complication of necrotizing acute pancreatitis.

Acute hemorrhagic gastropathy is characterized by the presence of acute gastrointestinal mucosal lesions (AGML) induced by irritation or ischemia due to exogenous or endogenous factors. Most frequent endoscopy findings include mucosal congestion, hyperemia, petechiae, acute hemorrhagic erosions and superficial ulceration. We report the case of diffuse hemorrhagic gastropathy caused by necrotizing acute pancreatitis.

Dietary Fat Patterns and Outcomes in Acute Pancreatitis in Spain.

Background/Objective: Evidence from basic and clinical studies suggests that unsaturated fatty acids (UFAs) might be relevant mediators of the development of complications in acute pancreatitis (AP). Objective: The aim of this study was to analyze outcomes in patients with AP from regions in Spain with different patterns of dietary fat intake. Materials and Methods: A retrospective analysis was performed with data from 1,655 patients with AP from a Spanish prospective cohort study and regional nutritional data from a Spanish cross-sectional study. Nutritional data considered in the study concern the total lipid consumption, detailing total saturated fatty acids, UFAs and monounsaturated fatty acids (MUFAs) consumption derived from regional data and not from the patient prospective cohort. Two multivariable analysis models were used: (1) a model with the Charlson comorbidity index, sex, alcoholic etiology, and recurrent AP; (2) a model that included these variables plus obesity. Results: In multivariable analysis, patients from regions with high UFA intake had a significantly increased frequency of local complications, persistent organ failure (POF), mortality, and moderate-to-severe disease in the model without obesity and a higher frequency of POF in the model with obesity. Patients from regions with high MUFA intake had significantly more local complications and moderate-to-severe disease; this significance remained for moderate-to-severe disease when obesity was added to the model. Conclusions: Differences in dietary fat patterns could be associated with different outcomes in AP, and dietary fat patterns may be a pre-morbid factor that determines the severity of AP. UFAs, and particulary MUFAs, may influence the pathogenesis of the severity of AP.

Gluten ataxia is better classified as non-celiac gluten sensitivity than as celiac disease: a comparative clinical study.

Gluten ataxia (GA) has customarily been considered to be the main neurological manifestation of celiac disease (CD). In recent years, the condition of non-celiac gluten sensitivity (NCGS) has been defined, which includes some patients who are not considered "true celiacs." We performed a comparative clinicopathological study of these three entities. We studied 31 GA, 48 CD and 37 NCGS patients, prospectively in the same center for a period of 7 years. The protocol study included two serological determinations for gluten sensitivity [anti-gliadin IgA and IgG (AGA) and anti-tissue transglutaminase IgA (TG) antibodies], HLA-DQ2 typing, and duodenal histological assessment. Demographics and investigative findings were compared. Females were 55 % in GA, 75 % in CD (p < 0.001), and 47 % in NCGS (N.S.). GA patients were older (59 ± 14 years) than CD (43 ± 13 years) and NCGS (41 ± 8 years) groups (p < 0.001). AGA positivity was higher in GA (100 %) than in CD (48 %) groups (p < 0.001), but similar to NCGS patients (89 %; N.S.); TG positivity was lower in GA (3.2 %) than in CD (33.3 %; p < 0.001), but similar to NCGS (2.7 %; N.S.). DQ2 (+) was lower in GA (32.2 %) than in CD (89.6 %; p < 0.001), but similar to NCGS (29.7 %; N.S.). Lymphocytic enteritis (Marsh type 1) was lower in GA (9.6 %) than in CD (66.7 %; p < 0.001), but similar to NCGS (10.8 %; N.S.). The other gluten sensitivity-related characteristics measured were different to CD patients, but very close to NCGS. We conclude that GA patients are better classified within the NCGS group, than within CD.

Endoscopic resection techniques and ablative therapies for Barrett's neoplasia.

Esophageal adenocarcinoma is the most rapidly increasing cancer in western countries. High-grade dysplasia (HGD) arising from Barrett's esophagus (BE) is the most important risk factor for its development, and when it is present the reported incidence is up to 10% per patient-year. Adenocarcinoma in the setting of BE develops through a well known histological sequence, from non-dysplastic Barrett's to low grade dysplasia and then HGD and cancer. Endoscopic surveillance programs have been established to detect the presence of neoplasia at a potentially curative stage. Newly developed endoscopic treatments have dramatically changed the therapeutic approach of BE. When neoplasia is confined to the mucosal layer the risk for developing lymph node metastasis is negligible and can be successfully eradicated by an endoscopic approach, offering a curative intention treatment with minimal invasiveness. Endoscopic therapies include resection techniques, also known as tissue-acquiring modalities, and ablation therapies or non-tissue acquiring modalities. The aim of endoscopic treatment is to eradicate the whole Barrett's segment, since the risk of developing synchronous and metachronous lesions due to the persistence of molecular aberrations in the residual epithelium is well established.

Kaposi's sarcoma: an opportunistic infection by human herpesvirus-8 in ulcerative colitis.

Kaposi's sarcoma is a vascular tumor caused by human herpesvirus-8 infection. Iatrogenic Kaposi's sarcoma often occurs in patients receiving immunosuppressive therapy. To date, a few cases of colonic Kaposi's sarcoma have been reported in ulcerative colitis patients treated with immunomodulators. We describe a 65-year-old male diagnosed with left-sided ulcerative colitis who was treated with methotrexate and low-dose steroids for greater than 6 years. He presented with several papular, violet lesions on both legs. Colonoscopy revealed the presence of multiple reddish, elevated lesions in the sigmoid colon and rectum. Histological evaluation of skin and colonic biopsies showed findings suggestive of Kaposi's sarcoma; immunohistochemistry for human herpesvirus-8 was positive in the colonic lesions. To avoid the need for further immunosuppressive treatment, the patient underwent a colectomy. Following immunomodulator discontinuation, the patient experienced spontaneous regression of his skin lesions. With the present case, we wish to stress the important interaction of immunosuppressive therapy (mainly corticosteroids) used in ulcerative colitis patients in relation to the development of colonic Kaposi's sarcoma. Human herpesvirus-8 infection should be recognized as a possible opportunistic infection in patients with inflammatory bowel disease.

Tumores benignos del hígado / Benign liver tumors

Entre los tumores hepáticos benignos se encuentra un amplio espectro de lesiones que se comportan de formas muy diversas y que, debido a esto, precisan una estrategia de tratamiento adaptada específicamente a cada uno de ellos. El tumor hepático benigno sólido más frecuente es el hemangioma seguido de la hiperplasia nodular focal, y el tumor quístico más frecuente es el quiste simple. La mayoría de estos tumores son asintomáticos, hallazgos casuales en pruebas de imagen realizadas por otros motivos, y generalmente no precisan tratamiento ni seguimiento. En ocasiones, el diagnóstico diferencial con tumores malignos hepáticos es difícil y esto constituye el principal motivo para la resección quirúrgica, así como la presencia de síntomas o complicaciones (AU)

There is a wide range of benign liver tumors that behave in very different ways and require a management strategy specifically tailored to each. The most common benign solid liver tumor is hemangioma followed by focal nodular hyperplasia; the most common cystic tumor is the simple cyst. Most of these tumors are asymptomatic and are discovered as incidental findings on imaging tests performed for other reasons. Usually, no treatment or follow-up is required. The differential diagnosis with malignant liver tumors is sometimes difficult. This difficulty, together with the presence of symptoms or complications, is the main reason for surgical resection (AU)

[Benign liver tumors]. / Tumores benignos del hígado.

There is a wide range of benign liver tumors that behave in very different ways and require a management strategy specifically tailored to each. The most common benign solid liver tumor is hemangioma followed by focal nodular hyperplasia; the most common cystic tumor is the simple cyst. Most of these tumors are asymptomatic and are discovered as incidental findings on imaging tests performed for other reasons. Usually, no treatment or follow-up is required. The differential diagnosis with malignant liver tumors is sometimes difficult. This difficulty, together with the presence of symptoms or complications, is the main reason for surgical resection.

[Luetic hepatitis. An emerging entity]. / Hepatitis luética. Una entidad emergente.

Liver involvement is unusual in the course of syphilitic infection. We present four cases of luetic hepatitis diagnosed at our hospital in the last 5 years. One patient was coinfected with hepatitis B virus and another patient was coinfected with hepatitis C virus and HIV. The presence of maculopapular skin lesions in palmoplantar distribution, as well as serological confirmation, were decisive for the diagnosis of syphilitic hepatitis, allowing early antibiotic therapy to be established, with clinical and analytical improvement in all patients. Luetic hepatitis should be considered in patients with risky sexual behavior, skin lesions and altered liver function tests with a predominance of cholestasis, despite the finding of other, more frequent, liver diseases, given that these entities may be concurrent. Early diagnosis of syphilis leads to effective treatment of the patient and to epidemiological control of the infection.

Hepatitis luética. Una entidad emergente / Luetic hepatitis. An emerging entity

La afectación hepática por sífilis es infrecuente. Se exponen 4 casos de hepatitis luética diagnosticados en los últimos 5 años. Uno presentaba coinfección por virus de la inmunodeficiencia humana y virus de la hepatitis C, y otro por virus de la hepatitis B. Las lesiones cutáneas maculopapulosas de extensión palmoplantar y la confirmación serológica fueron determinantes para llegar al diagnóstico. Ante el aumento de incidencia de las enfermedades de transmisión sexual, entre ellas la sífilis, es importante tener en cuenta el diagnóstico de hepatitis luética en aquellos pacientes que presentan hábitos sexuales de riesgo y alteración de pruebas de función hepática con predominio de colestasis, y no conviene descartarla a pesar del hallazgo de otras enfermedades hepáticas más frecuentes, dado que pueden coexistir. El diagnóstico precoz de la sífilis conduce a un tratamiento eficaz para el individuo y para el control epidemiológico de la infección(AU)

Liver involvement is unusual in the course of syphilitic infection. We present four cases of luetic hepatitis diagnosed at our hospital in the last 5 years. One patient was coinfected with hepatitis B virus and another patient was coinfected with hepatitis C virus and HIV. The presence of maculopapular skin lesions in palmoplantar distribution, as well as serological confirmation, were decisive for the diagnosis of syphilitic hepatitis, allowing early antibiotic therapy to be established, with clinical and analytical improvement in all patients. Luetic hepatitis should be considered in patients with risky sexual behavior, skin lesions and altered liver function tests with a predominance of cholestasis, despite the finding of other, more frequent, liver diseases, given that these entities may be concurrent. Early diagnosis of syphilis leads to effective treatment of the patient and to epidemiological control of the infection(AU)