[Gastrointestinal inflammatory fibroid polyps. Clinical characteristics and follow-up in a series of 26 patients]. / Pólipo fibroide inflamatorio gastrointestinal. Características clínicas y seguimiento de una serie de 26 pacientes.

INTRODUCTION: Inflammatory fibroid polyp (IFP) is a protuberant lesion, located near the muscularis mucosae and composed of a proliferation of fusiform cells and conjunctive fibers surrounding capillaries and a variable inflammatory infiltrate. It is believed to be a poorly controlled inflammatory repair response. Our aim was to study the clinical, pathological and follow-up characteristics of a series of patients with IFP. PATIENTS AND METHOD: We studied 26 IFPs from 25 patients (16 women and 9 men) registered between 1985 and 2001 in a specific register of 3 centers in the city of Gerona (Spain). The variables analyzed were age, sex and clinical presentation, IFP localization and size, mucosal characteristics and associated disease, as well as follow-up information. Routine statistical analyses were performed. RESULTS: IFPs were antral in 16 patients, ileal in 7, jejunal in 2 and colonic in the remaining patient. Size determined whether they were symptomatic (35 +/- 13.6 mm) or asymptomatic (8.4 +/- 6.3 mm). Gastric polyps were significantly smaller than intestinal polyps. Symptomatic polyps (5 out of 16 gastric polyps and 9 out of 10 intestinal polyps) predominated in women and occurred at a significantly lower age than asymptomatic polyps (59.2 versus 74.1 years). Most gastric IFPs were associated with chronic atrophic gastritis while only one ileal polyp was associated with Meckels diverticulum. The mean length of follow-up was 60.6 months and, except in one patient who underwent incomplete resection, no recurrences of IFP were observed. CONCLUSION: IFP is a heterogeneous entity, depending on age at presentation, sex, size and location in the digestive tract. IFP does not recur after resection. The association of gastric IFP and chronic atrophic gastritis could suggest a modulatory effect of the mucosa on IFP growth.

Pólipo fibroide inflamatorio gastrointestinal. Características clínicas y seguimiento de una serie de 26 pacientes / Gastrointestinal inflammatory fibroid polyps. Clinical characteristics and follow-up in a series of 26 patients

INTRODUCCIÓN: El pólipo fibroide inflamatorio (PFI) es una lesión protuberante que se localiza cerca de la muscularis mucosae y está constituida por una proliferación de células fusiformes y fibras conjuntivas alrededor de los capilares y un infiltrado inflamatorio variable. Se considera una reacción inflamatoria reparadora mal controlada. El objetivo de este trabajo ha sido estudiar las características clínicas, anatomo-patológicas y de seguimiento de una serie de pacientes con PFI.PACIENTES Y MÉTODO: Se han estudiado 26 PFI (25 pacientes:16 mujeres y 9 varones) recogidos entre los años 1985 y2001 en un registro específico de 3 centros de la ciudad de Girona. Las variables analizadas fueron la edad, el sexo y la presentación clínica, la localización y el tamaño del PFI, las características de la mucosa y las enfermedades asociadas, así como información del seguimiento. Se realizaron las pruebas estadísticas habituales. RESULTADOS: El PFI fue antral en 16 casos, ileal en 7, yeyunalen 2 y colónico en el restante. Su tamaño condicionó su carácter sintomático (35 ± 13,6 mm) o asintomático (8,4 ±6,3 mm). Los pólipos gástricos fueron significativamente más pequeños que los intestinales. Los pólipos sintomáticos(5 de 16 gástricos y 9 de 10 intestinales) predominaron en mujeres y en edades significativamente inferiores que los asintomáticos (59,2 frente a 74,1 años). La mayoría delos PFI gástricos se asociaron a gastritis crónica atrófica, mientras que sólo un PFI ileal lo hizo a divertículo de Meckel. El seguimiento medio fue de 60,6 meses y, salvo en un caso de resección incompleta, no se constató recidiva del PFI. CONCLUSIÓN: El PFI es una entidad heterogénea según la edad de presentación, el sexo de los pacientes, su tamaño y la localización en el tubo digestivo. Tras la resección, el PFI no recidiva. La asociación de los PFI gástricos a gastritis crónica atrófica podría apuntar a un efecto modulador de la mucosa sobre el crecimiento del PFI

INTRODUCTION: Inflammatory fibroid polyp (IFP) is a protuberant lesion, located near the muscularis mucosae and composed of a proliferation of fusiform cells and conjunctive fiberssurrounding capillaries and a variable inflammatoryin filtrate. It is believed to be a poorly controlled inflammatory repair response. Our aim was to study the clinical, pathological and follow up characteristics of a series of patients with IFP.PATIENTS AND METHOD: We studied 26 IFPs from 25 patients(16 women and 9 men) registered between 1985 and 2001 ina specific register of 3 centers in the city of Gerona (Spain).The variables analyzed were age, sex and clinical presentation, IFP localization and size, mucosal characteristics and associated disease, as well as follow-up information. Routine statistical analyses were performed. RESULTS: IFPs were antral in 16 patients, ileal in 7, jejunal in 2and colonic in the remaining patient. Size determined whether they were symptomatic (35 ± 13.6 mm) or asymptomatic (8.4 ±6.3 mm). Gastric polyps were significantly smaller than intestinal polyps. Symptomatic polyps (5 out of 16 gastric polyps and9 out of 10 intestinal polyps) predominated in women and occurred at a significantly lower age than asymptomatic polyps(59.2 versus 74.1 years). Most gastric IFPs were associated with chronic atrophic gastritis while only one ileal polyp was associated with Meckel’s diverticulum. The mean length of follow up was 60.6 months and, except in one patient who underwent in complete resection, no recurrences of IFP were observed. CONCLUSION: IFP is a heterogeneous entity, depending on age at presentation, sex, size and location in the digestive tract. IFP does not recur after resection. The association of gastric IFP and chronic atrophic gastritis could suggest a modulatory effect of the mucosa on IFP growth

[Ribavirin treatment in patients with chronic hepatitis C refractory to interferon-alpha]. / Tratamiento con ribavirina en pacientes con hepatitis crónica C refractaria al interferón alfa.

Four patients with chronic hepatitis C who did not respond to treatment with alpha interferon were treated with oral ribavirin at a dose of 1.000-1.200 mg/day for 6 months. A marked, although transitory, decrease was observed in the transaminase values which returned to pre-treatment values on termination of the same. Normal transaminase values were only obtained at some point in the treatment in two patients. Ribavirin was well tolerated with very slight anemia being detected in all the cases. These results, which are superposable to those of other authors who have studied the effects of this antiviral agent in chronic hepatitis C, suggest that ribavirin may play a role in the treatment of this disease. Given the existing data, this role would be one of a drug associated with interferon with which it may have a synergic action rather than as a monotherapy.

Polymeric enteral diets as primary treatment of active Crohn's disease: a prospective steroid controlled trial.

Thirty two patients with active Crohn's disease were included in a controlled randomised trial to determine the efficacy and safety of polymeric enteral nutrition compared with steroids, to achieve and maintain clinical remission. The polymeric diet was administered through a fine bore nasogastric tube by continuous, pump assisted infusion (2800 (SEM 120) kcal/day). The steroid group received 1 mg/kg/day of prednisone. Both treatments were effective in inducing clinical remission: 15 of the 17 patients given steroids and 12 of the 15 patients assigned to the polymeric diet went into clinical remission (defined by a Van Hees index < 120) within four weeks of treatment. The percentage reduction of the Van Hees index was 34.8 (4.9)% for steroids and 32.3 (5)% for enteral nutrition (mean difference 2.5%; 95% CI--11.8% to +16.8%). Mean time elapsed to achieve remission was similar in both groups (2.0 (1) v 2.4 (1.2) weeks). Tolerance of the enteral diet was excellent. Four patients in the steroid group had mild complications attributable to this treatment. Ten patients (66.6%) in the steroid group and five (41.6%) in the enteral nutrition group relapsed within a year of discharge, but no differences were found in the cumulative probability of relapse during the follow up period. These results suggest that polymeric enteral nutrition is as safe and effective as steroids in inducing short term remission in active Crohn's disease.

[A prospective randomized study of the usefulness of weighted versus unweighted feeding tubes. A comparison of the transpyloric passage capacity, duration time and the signs of intolerance for enteral nutrition]. / Estudio prospectivo aleatorizado de la utilidad de las sondas lastradas versus no lastradas. Comparación de la capacidad de paso transpilórico, tiempo de duración y signos de intolerancia a la nutrición enteral.

Weighted feeding tubes for parenteral nutrition were designed to facilitate duodenal intubation and to reduce the risk of aspiration into the bronchi. The goal of the study was to compare the effectiveness of two types of tubes, weighted and unweighted, with regard to their ability to pass the pylorus in 24 hours' time, the time they remained, their involuntary detubation percentages, and the appearance of signs of digestive intolerance during enteral nutrition. Only patients who preserved some level of consciousness were included. Thirty-eight were fitted with weighted tubes, and 32 with unweighted tubes. Twenty-four feeding tubes reached the duodenum during the first day. The average time the tubes remained after insertion was 10.2 +/- 1.1 (range of 1-51) days. In 20 patients, the tube left the body unnoticed, and 15 displayed signs of intolerance to enteral nutrition, though it had to be suspended in the case of only 5. Weighted feeding tubes showed greater effectiveness in their duodenal intubation rate (47% versus 19%, p = 0.0058), the time they remained in the body (12.2 +/- 1.7 versus 7.9 +/- 1.1 days; p = 0.037) and their percentage of involuntary detubation (6 weighted tubes and 14 unweighted tubes, p = 0.009). There were no differences between the two tube types with regard to the appearance of signs of digestive intolerance. The weighted tubes that reached the duodenum (n = 18) were those which remained for the longest periods; 73% of them remained for over 8 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis.

To ascertain the role of total enteral nutrition, compared with total parenteral nutrition, as adjunct therapy to steroids in patients with severe acute ulcerative colitis, a prospective randomized trial was conducted in 42 of such patients. Inclusion criteria were the persistence of a moderate or severe attack of the disease (Truelove's index) after 48 h on full steroid treatment (prednisone 1 mg/kg/day). Patients were randomized to receive polymeric total enteral nutrition or isocaloric, isonitrogenous total parenteral nutrition as the sole nutritional support. Remission rate and need for colectomy were similar in both groups. No significant changes in anthropometric parameters were observed in either nutritional group at the end of the study. Median increase in serum albumin was 16.7% (-0.5% to +30.4%) in the enteral feeding group, and only 4.6% (-12.0% to +13.7%) in the parenteral nutrition patients (p = 0.019). Adverse effects related to artificial nutritional support were less frequent (9% vs. 35%, p = 0.046) and milder in enterally fed patients. Postoperative infections occurred more often with parenteral nutrition (p = 0.028). These results suggest that total enteral nutrition is safe and nutritionally effective in severe attacks of ulcerative colitis. It is also cheaper and associated with fewer complications than parenteral nutrition. Total enteral nutrition should be regarded as the most suitable type of nutritional support in these patients.

Efficacy of monopolar electrocoagulation in the treatment of bleeding gastric ulcer: a controlled trial.

With the aim of evaluating, in a controlled prospective fashion, the efficacy of monopolar electrocoagulation in the emergency treatment of bleeding gastric and stomal ulcers, 37 patients were studied: 16 were electrocoagulated (EC group) while the remaining 21 were treated by conventional methods (control group). The hemorrhage recurred in only one of the 16 patients belonging to the EC group, but in 11 of the 21 control patients (p less than 0.0005). Transfusion requirements were also reduced in the EC group (p less than 0.05), with no significant difference in relation to mortality. Stratifying the results according to hemorrhagic activity, electrocoagulation should be clearly effective in those patients with spurting hemorrhage, taking into account several limitations: deep ulcers bearing gross vessels, and lack of cooperation by the patient. Prophylactic treatment of the bleeding ulcer with a visible non-spurting vessel may be indicated whenever we make a proper selection of the patients with a greater possibility of hemorrhagic recurrence.

Vascular malformations of the stomach and duodenum: an endoscopic classification.

Having reviewed 47 cases of vascular malformations of the stomach and duodenum, we propose an endoscopic classification for these lesions: Pattern I (flat or slightly protruded, bright red lesions with frond-like margin) is the most usual form of presentation. The "telangiectatic form" (pattern II) is an endoscopic variation, with the same clinical and, possibly, pathogenic significance. Submucosal nodular forms (pattern III) are the most difficult to diagnose and treat. Electrocoagulation is the most pertinent treatment.