Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection. / Consenso sobre prevención, diagnóstico y tratamiento de la infección por Clostridium difficile.

In recent decades, Clostridium difficile infection (CDI) has become a worldwide health problem. Mexico is no exception, and therefore the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, endoscopists, internists, infectious disease specialists, and microbiologists) to carry out the "Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection", establishing useful recommendations (in relation to the adult population) for the medical community. Said recommendations are presented herein. Among them, it was recognized that CDI should be suspected in subjects with diarrhea that have a history of antibiotic and/or immunosuppressant use, but that it can also be a community-acquired infection. A 2-step diagnostic algorithm was proposed, in which a highly sensitive test, such as glutamate dehydrogenase (GDH), is first utilized, and if positive, confirmed by the detection of toxins through immunoassay or nucleic acid detection tests. Another recommendation was that CDI based on clinical evaluation be categorized as mild-moderate, severe, and complicated severe, given that such a classification enables better therapeutic decisions to be made. In mild-moderate CDI, oral vancomycin is the medication of choice, and metronidazole is recommended as an alternative treatment. In addition, fecal microbiota transplantation was recognized as an efficacious option in patients with recurrence or in the more severe cases of infection, and surgery should be reserved for patients with severe colitis (toxic megacolon), in whom all medical treatment has failed.

[Risk factors for peptic ulcer recurrence]. / Factores de riesgo para la recurrencia de úlcera péptica.

UNLABELLED: Prevalence of peptic ulcer (PU) and risk factors associated with its recurrence are unknown among the Mexican population. OBJECTIVE: To determine clinical features and risk factors associated with peptic ulcer recurrence. MATERIAL AND METHODS: Five-year follow-up study that included 211 men and 140 women 20 years age or older. PU diagnosis was made by clinical and endoscopic criteria. Associated risk factors such as NSAIDs use, smoking, alcohol consumption, and H. pylori infection were assessed. Clinical recurrence was defined as the time between basal diagnosis and the first PU clinical drop. RESULTS: Diagnosis of duodenal ulcer (DU) and gastric ulcer (GU) was documented in 41.9 and 58.1% of subjects. Predominant risk factor for DU was smoking, and NSAID intake for GU. H. pylori were documented in 39.3%. Sixty-five years of age or older (61 and 33% for GU and DU, respectively), and three or more associated risk factors (70%) were the main associated causes for PU recurrence. PU recurrence associated with Hp was 34%. CONCLUSIONS: GU frequency was the highest and associated risk factors for its recurrence were NSAID intake, 65 years of age or older, and Hp infection.

[Peptic ulcer with hemorrhage. An analysis of hospital discharges]. / Ulcera péptica con hemorragia. Análisis de egresos hospitalarios.

BACKGROUND: The gastric and duodenal ulcer is the most common cause of gastrointestinal bleeding in 25% of patients, and accounting annually for approximately 50-100 admissions per 100,000 population. OBJECTIVE: To determine prevalence of gastrointestinal bleeding in hospital admission, according to age and sex and identifying the risk factors. METHOD: Determined the prevalence rates of number of hospital discharges of patients with gastrointestinal bleeding for GU and DU during period 1991 to 1997. Determined the prevalence rates of peptic ulcer occurrence for age-adjusted rates, sex and seasonal variation for 1000 hospital discharges. We investigated the features of hemorrhage of the upper gastrointestinal tract, and identification of risk factors as NSAID, alcohol and tobacco. STATISTICAL ANALYSIS: Chi square and t Student. RESULTS: The annual prevalence rates were 46.6/1000 hospital discharges. There were more frequent between 6th to 8th decades, female sex and during May, June and November. The average stay of patients were 4.2 days (range 1 to 18). A total of 275 patients were found to have GU or DU with gastrointestinal bleeding, 66% were male and mean age was 57 years. The risk factors found were tobacco 52%, alcohol 40% and NSAID 44% (P < 0.05). Melena and hematemesis was found in 64% y 36% respectively. The GU (41%) was more frequent than DU (40%) (P NS). CONCLUSIONS: The annual prevalence rates were 46.6/1000 hospital discharges more frequent in males (66%) and gastric ulcer was found more frequent (41%) than DU (P NS).

[Survival analysis in cirrhotic patients]. / Análisis de supervivencia en pacientes cirróticos.

BACKGROUND: Hepatic cirrhosis (HC) is a chronic and progressive disease that, independently of its etiology, favors the presence of some complications that impair the survival of patients. AIMS: To determine the frequency, etiology, and main decompensation factors, as well as analyse survival curves in HC of a population of Durango, México. METHODS: Cirrhotic patients of both sexes from the Hospital General del IMSS in Durango were included. The etiology of cirrhosis, the factors of decompensation and the grade of portal hypertension (PHT) were determined. A 39 month follow-up was done, registering complications and cause of death. STATISTICAL ANALYSIS: Fisher's exact test, Friedman's variance analysis, Mantel-Haenzsel chi-square test and Kaplan-Meier methods were used. RESULTS: Fifty patients were studied, 30 female and 20 male. The mean age was 54.3 years old (range 32-74 years). The more frequent etiology was alcoholic in 42% patients (19 male and 2 female). Forty three patients (86%) had decompensation by ascitis; 19 (38%) had variceal bleeding, 18(36%) had encephalopathy and 16(32%) were icteric. Twenty six patients (52%) had PHT III, and 30 (60%) were Child-Pugh class B. CONCLUSIONS: Survival in the decompensated group at 19.8 months follow-up was 62% and 73% in the total group, 20% died. Statistical significance (p < 0.05) was found between PHT grade and Child-Pugh functional class; hepatic reserve correlated inversely with bleeding (p < 0.05) and encephalopathy (p < 0.05) probability. The advanced grade of PHT directly correlated with bleeding encephalopathy and mortality (p < 0.05). We did not find any association between the etiology of cirrhosis and the incidence of complications.