Celiac disease seroprevalence in subjects with dyspeptic symptoms. A study on a Mexican population.

INTRODUCTION AND AIMS: Celiac disease (CD) is an autoimmune enteropathy that develops in genetically susceptible individuals. The typical gastrointestinal manifestation is diarrhea but symptoms of dyspepsia, such as epigastric pain, nausea, or satiety, can sometimes appear. Previous studies have reported that the prevalence of CD in patients with dyspepsia can be as high as 7%. The aim of the present study was to evaluate CD seroprevalence in subjects with dyspeptic symptoms and a control group in a Mexican population. MATERIAL AND METHODS: A case-control study was conducted on blood donors that answered the PAGI-SYM questionnaire for dyspepsia and in whom IgA antibodies to tissue transglutaminase 2 (IgA anti-tTG2) and IgG antibodies to deamidated gliadin peptide (IgG anti-DGP) were determined. CD seroprevalence in subjects with dyspeptic symptoms and in asymptomatic subjects was compared. RESULTS: A total of 427 subjects (76.3% men), with a mean patient age of 34 years (range of 18-65 years) were included. Of those participants, 87 (20.3%) had symptoms of dyspepsia (group A) and 340 (79.6%) were asymptomatic (group B). Antibodies were positive in one (1.15%) of the group A subjects (1/87, 95% CI 0.2-6 %), whereas they were positive in 4 (1.18%) of the group B subjects (4/340, 95% CI 0.4-2.9%, p = 0.59). CONCLUSIONS: CD seroprevalence in the study population with dyspeptic symptoms (1%) was not different from that of the control population. Thus, CD screening in Mexican patients with dyspepsia is not justified.

Prevalence of metabolic associated fatty liver disease (MAFLD) in patients with gallstone disease. Study on a cohort of cases in South-Southeastern Mexico.

INTRODUCTION: Metabolic (dysfunction) associated fatty liver disease (MAFLD) and gallstone disease are entities that share similar risk factors. Numerous publications confirm their elevated frequency, but few studies have considered their prevalence and possible association. AIMS: To determine the prevalence of MAFLD in patients with gallstone disease and the usefulness of liver biopsy for diagnosing the liver disease. MATERIALS AND METHODS: A prospective study was conducted on patients that underwent laparoscopic cholecystectomy, in whom liver biopsy was performed. VARIABLES ANALYZED: Anthropometric characteristics, biochemical profile, conventional ultrasound, risk factors, and histopathologic study of the liver biopsy. STATISTICAL ANALYSIS: Descriptive statistics were carried out for the quantitative variables and the Student's t test and multivariate analysis through binary logistic regression were employed for the continuous variables, utilizing IBM-SPSS, 25.0 (Windows) software. RESULTS: A total of 136 patients were classified into 2 groups: 40 (29.41%) with normal liver and 96 (70.59%) with MAFLD. Of the 136 patients, 71 patients (52.21%) corresponded to hepatic steatosis, 21 (15.44%) to steatohepatitis, and 4 (2.94%) to cirrhosis. Perisinusoidal inflammation was found in 39 cases (28.68%) and fibrosis was found in 10 (7.35%). The risk factors for both groups were age, diabetes, high blood pressure, and obesity. Glucose, triglyceride, and aminotransferase levels were significantly higher in the MAFLD group and conventional ultrasound demonstrated moderate concordance for its detection. DISCUSSION AND CONCLUSIONS: The results confirmed the elevated frequency of MAFLD associated with gallstone disease, justifying liver biopsy during cholecystectomy for diagnosing MAFLD.

Prevalence of methanogens and associated factors in patients with irritable bowel syndrome and healthy controls in a Southeastern Mexican population.

INTRODUCTION: Methane (CH4) is an inert gas produced by colonic anaerobes and has been associated with different intestinal diseases, including irritable bowel syndrome (IBS). According to geographic region, the prevalence of methanogens varies, being higher in Africa (80%) and lower in the United States (35-40%). In Mexico, the prevalence of methanogens is unknown. AIM: To evaluate the prevalence of CH4 producers and associated factors in a group of patients with IBS and controls in a Mexican population. MATERIALS AND METHODS: A baseline fasting measurement of alveolar H2 and CH4 gas was carried out, by gas chromatography (stationary phase), in consecutive patients diagnosed with IBS and a control group. Subjects with baseline levels of H2 of 0 ppm and CH4 ≥ 5 ppm were classified as methanogenic. RESULTS: A total of 132 controls (53.8% women) and 67 patients with IBS (76% women) were included. The overall prevalence (n = 199) of methanogenic subjects was 38% (n = 76) (95% CI: 0.31-0.45) and they had a greater prevalence of overweight/obesity (56.5 vs 39.8%, P = .028). The prevalence of methanogens in the healthy controls was 41.6% (95% CI: 0.33-0.49), whereas, in the patients with IBS, it was 31.4% (n = 21, 71% IBS-C and 29% IBS-M). CONCLUSIONS: The prevalence of methanogens in our study on a Mexican population was comparable to that reported in other populations and was associated with overweight/obesity. One-third of the patients with IBS presented with methanogens. Said microorganisms were particularlyassociated with the constipation-predominant IBS subtype.

Knowledge acquired from Clinical Guidelines on the Diagnosis and Treatment of Acute Pancreatitis by attending physicians and residents in hospitals in Veracruz. / Conocimiento de las Guías Clínicas de Diagnóstico y Tratamiento de la Pancreatitis Aguda en médicos adscritos y residentes de los hospitales de Veracruz.

INTRODUCTION: Clinical practice guidelines on the diagnosis and treatment of acute pancreatitis (CPGDTAP) have been designed in an effort to reduce the morbidity and mortality of that severe disease. AIM: To identify the knowledge acquired from CPGDTAP in hospitals in Veracruz. MATERIALS AND METHODS: A descriptive, observational, multicenter study was conducted at four hospitals in Veracruz, through the application of a survey to evaluate the knowledge of attending physicians and residents that treat patients with acute pancreatitis. Descriptive statistics were employed to analyze the results. RESULTS: A total of 74 physicians were surveyed: 55.41% of whom were attending physicians and 44.59% of whom were resident physicians. The majority of physicians (67.57%) were familiar with CPGDTAP from the Asociación Mexicana de Gastroenterología (AMG), followed by those of the General Health Council of the Mexican Department of Health (CENETEC, the Spanish acronym) (54.05%) and the American College of Gastroenterology (ACG) (48.65%). A total of 97.30% of the physicians routinely use a nasogastric tube, 79.73% considered early enteral nutrition to be very important, as did 98.65% regarding generous fluid replacement, 85.14% did not routinely use antimicrobials, 63.51% ordered a CAT scan at 72h or later, and 87.84% answered that infected necrosis was the indication for surgery, preferably after the third week. DISCUSSION AND CONCLUSIONS: In our hospital environment, the CPGDTAP issued by the AMG and CENETEC were the most well-known, but their recommended measures were given importance by under 85% of the physicians surveyed. Therefore, the diffusion of the knowledge they contain is advisable to guarantee optimal results in acute pancreatitis management.

Influence of socioeconomic and cultural factors in the etiology of cirrhosis of the liver. / Influencia los factores socioeconómicos y culturales en la etiología de la cirrosis hepática.

INTRODUCTION: Cirrhosis of the liver is a serious public health problem worldwide, with regional variations determined by cultural factors and economic development. AIM: To know the characteristics of the social, cultural, and economic factors of the patients with cirrhosis of the liver in Veracruz. MATERIALS AND METHODS: A multicenter, retrolective, relational research study was conducted on patients with cirrhosis of the liver at five healthcare institutions in Veracruz. The variables analyzed were etiology, age, sex, civil status, educational level, occupation, and income. Descriptive and inferential statistics were utilized, and statistical significance was set at a P<.05. The Windows IBM-SPSS version 25.0 program was employed. RESULTS: A total of 182 case records of patients with cirrhosis of the liver were included. The etiologic factors were chronic alcohol consumption (47.8%), viral disease (28.5%), nonalcoholic fatty liver disease (NAFLD) (8.79%), autoimmune liver disease (4.4%), cholestasis (1.64%), and cryptogenic liver disease (8.8%). Mean patient age was 66.14±13.91, with a predominance of men (58.79%). In comparing the socioeconomic and cultural factors related to etiology, secondary and tertiary education and singleness were statistically significant in male alcoholics (P<.05), viral diseases and NAFLD were significantly associated with women with no income (P<.05), cryptogenic liver disease was significantly associated with women (P<.05), and cholestasis and autoimmune liver disease were not significantly associated with any of the factors. CONCLUSIONS: The study results revealed the influence of socioeconomic and cultural factors related to the different causes of cirrhosis of the liver in our environment.

Cancer of the digestive system in Veracruz. The magnitude of the problem by 2025. / Cáncer del aparato digestivo en Veracruz. La magnitud del problema al año 2025.

INTRODUCTION: Malignant tumors of the digestive system are a public health problem with epidemiologic variations attributed to factors resulting from the aging of the population and lifestyle changes. Therefore, estimating the future magnitude of the problem is prudent. AIM: To determine the epidemiologic projection up to 2025 of malignant tumors of the digestive system in Veracruz. MATERIALS AND METHODS: A predictive, analytic, observational study was conducted on patients belonging to the Public health sector of Veracruz that presented with digestive system cancer, within the time frame of 2000-2016, carrying out a disease projection up to 2025. The IBM SPSS 22.0 program was utilized for the statistical analysis, employing simple linear regression. A comparative analysis of the data was carried out and results are shown in scatter graphs. RESULTS: A total of 2,540 cases were included in the study. Mean patient age was 63.25±13.43, with a predominance of men at 56.65%. The most frequent tumor locations were in the colon and rectum (25.04%), liver (23.66%), and stomach (21.93%). Less frequent sites were the esophagus (4.88%) and small bowel (5.08%). A general 7.63% increase in the disease was predicted for 2025, with increases to 11.51% for esophageal cancer, 7.22% for gastric cancer, 9.09% for colorectal cancer, 5.98% for liver cancer, 7.88% for pancreatic cancer, and 6.86% for cancer of the gallbladder and bile ducts. Only cancer of the small bowel showed a predicted decrease to 3.33%. DISCUSSION AND CONCLUSIONS: The results of the present study predict that digestive system cancers in Veracruz will increase importantly by 2025, with colorectal cancer, hepatocellular carcinoma, and gastric cancer as the most frequent tumors, in descending order. The other cancers are estimated to maintain a discrete line of growth. In addition to predicting the behavior of those cancers, the results of the present study are useful for estimating the resources that will be needed for their care by 2025.

Safety of laparoscopic subtotal cholecystectomy in acute cholecystitis. Experience in Southeast Mexico. / Seguridad de la colecistectomía subtotal laparoscópica en colecistitis aguda. Experiencia en el sureste de México.

INTRODUCTION: Subtotal cholecystectomy has been employed in cases of tecnically difficult cholecystectomy to prevent common bile duct injury. Given that there are few reports in Mexico on the theme, we consider it important to present the 18-year experience of a surgical group in the South-Southeast of Mexico. AIM: To determine the safety of laparoscopic subtotal cholecystectomy in patients with acute cholecystitis. MATERIALS AND METHODS: A retrospective, observational, and comparative study was conducted on patients with gallstones that underwent laparoscopic cholecystectomy. The variables analyzed were: anthropometric characteristics, comorbidities, conversion rate, surgery duration, hospital stay, and morbidity and mortality. STATISTICAL ANALYSIS: Descriptive statistics were applied through measures of central tendency and dispersion and standard deviation, utilizing the SPSS v22 program. RESULTS: A total of 1,101 medical records of patients with gallstones were reviewed. Of those patients, 223 presented with acute cholecystitis (20.25%) and they were divided into 2 groups: A) total cholecystectomy (82.95%) and B) subtotal cholecystectomy (17.05%). The anthropometric characteristics, risk factors, conversion rate, and hospital stay were similar in both groups. Only surgery duration was longer in the subtotal cholecystectomy group. Complications were more frequent, there was 1 death, and there was no bile duct injury in the subtotal cholecystectomy group. Those results were not statistically significant between the two groups. CONCLUSIONS: Subtotal cholecystectomy is a valuable resource in patients with acute cholecystitis. In our case series, it was a safe and reliable procedure for preventing bile duct injury. A larger number of cases are needed to corroborate those results.

The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon. / Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon.

Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.

Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon / The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon

Desde la publicación en 2008 de las guías de diagnóstico y tratamiento de la enfermedad diverticular del colon de la Asociación Mexicana de Gastroenterología ha habido avances significativos en el conocimiento de esta enfermedad. Se realizó una revisión sistemática de la literatura en PubMed de enero de 2008 a julio de 2018 con el fin de revisar y actualizar las guías 2008 y proporcionar nuevas recomendaciones basadas en la evidencia. Se incluyeron todas las publicaciones en español e inglés, de alta calidad. Se redactaron los enunciados, que fueron votados utilizando el método Delphi. Se estableció la calidad de la evidencia y la fuerza de las recomendaciones según el sistema GRADE para cada enunciado. Cuarenta y tres enunciados fueron finalmente votados y calificados. Se informan nuevos datos sobre definición, clasificación, epidemiología, fisiopatología y factores de riesgo. Se revisó con especial énfasis la utilidad de la tomografía computarizada y de la colonoscopia, así como los métodos endoscópicos para el control de la hemorragia. Se discutió sobre el tratamiento ambulatorio de la diverticulitis no complicada, el papel de la rifaximina y la mesalazina, en el manejo de la diverticulitis aguda complicada tanto en sus alternativas mínimamente invasivas hasta las opciones quirúrgicas con énfasis en sus indicaciones, limitaciones y contraindicaciones. Los nuevos enunciados proporcionan directrices basadas en la evidencia actualizada. Se presentan la discusión, el grado y la fuerza de la recomendación de cada uno de ellos.

Frequency of human papillomavirus infection in patients with gastrointestinal cancer. / Frecuencia de infección por virus del papiloma humano en pacientes con cáncer del aparato digestivo.

INTRODUCTION AND AIM: Cancer is the result of the interaction of genetic and environmental factors. It has recently been related to viral infections, one of which is human papillomavirus. The aim of the present study was to describe the frequency of human papillomavirus infection in patients with digestive system cancers. MATERIALS AND METHODS: A prospective, multicenter, observational study was conducted on patients with gastrointestinal cancer at 2public healthcare institutes in Veracruz. Two tumor samples were taken, one for histologic study and the other for DNA determination of human papillomavirus and its genotypes. Anthropometric variables, risk factors, sexual habits, tumor location, and histologic type of the cancer were analyzed. Absolute and relative frequencies were determined using the SPSS version 24.0 program. RESULTS: Fifty-three patients were studied. They had gastrointestinal cancer located in: the colon (62.26%), stomach (18.87%), esophagus (7.55%), rectum (7.55%), and small bowel (3.77%). Human papillomavirus was identified in 11.32% of the patients, 66.7% of which corresponded to squamous cell carcinoma and 33.3% to adenocarcinoma. Only genotype 18 was identified. Mean patient age was 61.8±15.2 years, 56.60% of the patients were men, and 43.40% were women. A total of 15.8% of the patients had a family history of cancer and 31.6% had a personal history of the disease, 38.6% were tobacco smokers, and 61.4% consumed alcohol. Regarding sex, 5.3% of the patients said they were homosexual, 3.5% were bisexual, 29.8% engaged in oral sex, and 24.6% in anal sex. CONCLUSIONS: Our study showed that human papillomavirus infection was a risk factor for the development of gastrointestinal cancer, especially of squamous cell origin.

Approach, attitudes, and knowledge of general practitioners in relation to Helicobacter pylori is inadequate. There is much room for improvement! / El abordaje, las actitudes y el conocimiento acerca de Helicobacter pylori en médicos generales es deficiente. ¡Hay mucho que mejorar!

BACKGROUND: Helicobacter pylori (Hp) infection is one of the most common infections in humans. Due to its worldwide prevalence, a series of guidelines and recommendations has been developed for the appropriate screening, diagnosis, and management of patients with Hp infection. AIM: To evaluate the approach, attitudes, and knowledge of a group of Mexican general practitioners in relation to Hp. MATERIALS AND METHODS: A cross-sectional study was conducted that evaluated the knowledge of Hp diagnosis and treatment through the application of a questionnaire. RESULTS: From the total of 430 questionnaires delivered, information was obtained from 411 (95% response rate). The most frequent indications for eradication treatment were peptic ulcer (48.4%), gastroesophageal reflux disease (41.8%), and dyspepsia (39.2%). Thirty-one percent of the physicians surveyed used more than one test to look for Hp, and serology was the most commonly employed method. The most widely used antibiotic regimen was clarithromycin plus amoxicillin (63.8%), followed by metronidazole plus tetracycline (16%). Ninety-two percent of the physicians confirmed eradication through endoscopy for the histologic analysis and only 23% utilized the breath test. CONCLUSIONS: Our results show the lack of knowledge about the established diagnostic and treatment recommendations for Hp infection. The implementation of workshops, courses, and conferences, or the formulation of practical guidelines should be directed at primary care physicians to strengthen the practice of medicine based on scientific evidence.

The Mexican consensus on irritable bowel syndrome. / Consenso mexicano sobre el síndrome de intestino irritable.

BACKGROUND: Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociación Mexicana de Gastroenterología (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. AIMS: To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. METHODS: The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. RESULTS: Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. CONCLUSIONS: We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included.

Prevalence of celiac disease and related antibodies in patients diagnosed with irritable bowel syndrome according to the Rome III criteria. A case-control study.

BACKGROUND: The cost-effectiveness for screening for celiac disease (CD) in patients with irritable bowel syndrome (IBS), specifically in the diarrhea (IBS-D) subtype, is beneficial if the prevalence is >1%. However, recent studies have shown controversial results. In this large case-control study, our aim was to determine the prevalence of CD and a panel of related antibodies in patients diagnosed with IBS. MATERIALS AND METHODS: Four hundred IBS patients (Rome III) and 400 asymptomatic healthy controls were prospectively evaluated using antihuman tissue transglutaminase (h-tTG IgA) and deamidated gliadin peptide antibodies (DGP II IgA and DGP II IgG). Duodenal biopsy was performed on the patients that were positive for the h-tTG IgA and/or DGP II IgG antibodies. RESULTS: The mean age of the population was 44.47 ± 18.01 years and 335 (82%) of the subjects were women. Twenty-one patients and six controls had at least one positive test for CD (5.25% VS 1.5%, p = 0.003, OR 3.63 [95% CI 1.4-9.11]). Eighteen patients were positive for h-tTG and/or DGP-II IgG. Histologic confirmation of CD was 2.5% in the IBS patients vs 0.5% in the controls (p = 0.04, OR 5.21). The IBS-D subtype had the highest prevalence for serological positivity (12.7%). CONCLUSIONS: Up to 5.2% of the patients with IBS according to the Rome III criteria were positive for at least one of the CD-related antibodies and 2.5% had biopsy-confirmed CD. Therefore, in our population, screening for CD in subjects with IBS appears to be a reasonable strategy, especially in the IBS-D subgroup.

Prevalence of irritable bowel syndrome in caregivers of patients with chronic diseases.

BACKGROUND: Caregivers are an at-risk population for psychic and physical diseases such as irritable bowel syndrome (IBS). However, it is not known whether providing care for the chronically ill patient can be considered a risk factor for developing IBS. In this study, our aim was to evaluate the prevalence of IBS according to the Rome II criteria in a group of caregivers. METHODS: A cross-sectional study was conducted through an evaluation of caregivers of chronically ill patients. Subjects completed questionnaires including the Rome II Modular Questionnaire, the Hospital Anxiety and Depression Scale, the Zarit Caregiver Burden Interview (ZCBI) (an instrument for evaluating the burden experienced by caregivers), and the irritable bowel syndrome quality of life (IBS-QoL) questionnaire. KEY RESULTS: Ninety-six primary caregivers (mean age was 43.6 ± 13.7 years and 87% were women) were evaluated. The mean length of time providing care was 37.6 months (3-288 months). Forty-seven caregivers (49%) presented with IBS. The caregivers with IBS had higher scores in the global ZCBI score (47 ± 8 vs 28 ± 8, p = 0.001) and on the anxiety and depression scale (p = 0.001) than those that did not have IBS. A total of 72% were diagnosed with caregiver stress syndrome; 42 of them had IBS according to the Rome II questionnaire (60% vs 18%, p = 0.001, relative risk 3.28, 95% CI: 1.4-7.4). CONCLUSIONS & INFERENCES: Caregivers of chronically ill patients have a high prevalence of IBS, which is associated with depression, anxiety, and poor QoL.