The Mexican consensus on non-cardiac chest pain. / Consenso mexicano sobre dolor torácico no cardiaco.

INTRODUCTION: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. AIM: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. METHODS: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i)definitions, epidemiology, and pathophysiology; (ii)diagnosis, and (iii)treatment. The statements underwent 3rounds of voting, utilizing the Delphi system. The final statements were those that reached >75% agreement, and they were rated utilizing the GRADE system. RESULTS AND CONCLUSIONS: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy.

[Motor disorders of the smooth muscle of the esophagus]. / Trastornos motores del músculo liso del esófago.

Dysphagia and/or chest pain are the symptoms that characterize the motor abnormalities of the esophagus. These symptoms are not specific for motor disorders and can be seen with mucosal lesions. Symptom varies in severity and can be severe enough to put in risk the patient life. Motor dysfunction of the esophagus can be idiopathic, when it is not related to another systemic disease, or secondary, when it is associated to a generalized disease. Diagnosis and characterization of the motor disorders of the esophagus are best performed by manometry. In the present work, we expose some of the relevant clinical aspects and the manometric criteria currently accepted to classify motility disorders. Some treatment aspects are also reviewed.

[Late complication of diabetes mellitus of pancreatic origin]. / Complicaciones tardías de la diabetes mellitus de origen pancreático.

At Instituto Nacional de la Nutrición SZ in Mexico City, we reviewed 30 years of experience and selected 46 patients with Pancreatic Diabetes (PD), without family history of Diabetes Mellitus (DM) with at less two years of follow-up. Alcoholic chronic pancreatitis (CP) was found in 36 patients, in seven it was idiophatic and in three was secondary to pancreatectomy. We compared the evolution of this patients with a group of (DM) patients similar in age, sex, glucemic control and time of onset. There were no statistical differences between groups in the follow-up of diabetic complications, only it was found a tendency to have higher lipid levels, macroangiopathy and retinopathy in those with DM. We concluded that CP have similar evolution as DM and could have deleterous complications in the large follow up.

[Hepatic fibropolycystic disease in Mexico. Study of 82 cases]. / Enfermedad fibropoliquística hepática en Mexico. Estudio de 82 casos.

We analyzed 82 cases of hepatobiliary fibropolycystic disease (FPD) that were seen at the Instituto Nacional de la Nutrición "Salvador Zubirán" in Mexico City in the thirty-year period comprised from 1956 to 1986. The different entities that compose FPD were distributed as follows: 61 (74%) cases of polycystic liver disease, 13 (16%) cases of choledochal cyst, and 8 (10%) cases of congenital hepatic fibrosis; there were 5 (6%) cases of Caroli's disease, 3 associated with congenital hepatic fibrosis and 2 with choledochal cyst. Polycystic liver disease predominated in females (67%) and presented at 54 +/- 12 years (mean +/- SEM) with pain, a mass, symptoms related to renal insufficiency or incidentally; polycystic kidneys were present in 61%. Liver function tests were normal in 94%. Choledochal cyst also predominated in females and presented at a mean age of 19 years with cholangitis. Liver function tests were abnormal in 69%. Congenital hepatic fibrosis (50% male) presented with variceal hemorrhage or cholangitis (in 3 patients associated with Caroli's disease). Polycystic kidneys were present in five patients. Four of the five patients with Caroli's disease were female and presented at a mean age of 19 years with cholangitis. It never presented as an isolated disease, but was associated more frequently to congenital hepatic fibrosis. The diseases that are part of the hepatobiliary polycystic disease vary in severity and thus the prognosis in an individual patient is determined by the type of fibropolycystic disease present. This is the largest series of this disease published in our country.

Microcystic adenoma of the pancreas.

Three cases of pancreatic microcystic adenoma (PMA) are presented. These tumors comprise less than 1% of all pancreatic tumors in a large series, and exhibit a benign course, in contrast to mucinous cystadenomas, which have a definite malignant potential. The cases here presented are middle and advanced aged women who complained of epigastric discomfort and mild weight loss. Two of them also had a palpable epigastric mass and one of them diabetes mellitus. They were treated surgically with total excision of the tumor. During surgery and thereafter no evidence of spreading beyond the pancreas was found. CT scan shows a characteristic image of PMA, which may then be confirmed by a percutaneous biopsy. If the patient is asymptomatic or a poor surgical risk, it is reasonable to rely on this evidence and follow the patient rather than operate.