Clinical assessment and health-related quality of life in patients with non-cardiac chest pain.

INTRODUCTION: Non-cardiac chest pain (NCCP) is mainly related to oesophageal disease, and in spite of being a common condition in Mexico, information regarding it is scarce. AIM: To assess the clinical characteristics and health-related quality of life of patients with NCCP of presumed oesophageal origin. MATERIAL AND METHODS: Patients with NCCP of presumed oesophageal origin with no previous treatment were included in the study. Associated symptoms were assessed and upper gastrointestinal endoscopy and 24-hour oesophageal pH monitoring were performed to diagnose gastroesophageal reflux disease, while oesophageal manometry was used to determine oesophageal motility disorders. The SF-36 Health-Related Quality of Life (HR-QoL) questionnaire was completed and its results compared to a control group without oesophageal symptoms. RESULTS: The study included 33 patients, of which 61% were women, and the mean age was 46.1 (±11.6) years. Causes of NCCP were gastroesophageal reflux disease in 48%, achalasia in 34%, and functional chest pain in 18%. The average progression time for chest pain was 24 (2-240) months, with ≤ 3 events/week in 52% of the patients. The most frequent accompanying symptoms were: regurgitation (81%), dysphagia (72%) and heartburn (66%). Patients with NCCP show deterioration in HR-QoL compared to the control group (P=.01), regardless of chest pain aetiology. The most affected areas were general perception of health, emotional issues, and mental health sub-scale (P>0.05). CONCLUSIONS: In our population, patients with NCCP show deterioration in HR-QoL regardless of the aetiology, frequency, and accompanying symptoms.

Clinical and manometric findings on elderly patients with achalasia.

INTRODUCTION: Data regarding the age impact on the clinical presentation and esophageal motility in adults with idiopathic achalasia are scarce. OBJECTIVE: To asses the clinical and manometric features of elderly patients with idiopathic achalasia. METHODS: The medical charts of 159 patients diagnosed with achalasia were divided into two groups according to the patients' age: ?60 years (n = 123) and >60 years (n = 36). Clinical and manometric findings [esophageal body aperistalsis, basal lower esophageal sphincter (LES) pressure and abnormal LES relaxation] of both groups were compared upon diagnosis. Patients with previous esophageal interventions were excluded. RESULTS: Only chest pain was more common in the ?60 year-old group (51.2% vs. 22.2%, p <0.003). This difference remained when comparing the group of men ≤60 years. Other presenting features (including sex, weight loss, and presence of dysphagia, regurgitation and heartburn) did not differ between the groups. The LES relaxation was incomplete in 70.4% of the cases. No differences on the basal LES pressure, residual LES pressure or the amplitude of the esophageal body contractions between both groups were found. Considering only the classic achalasia cases, symptomatic time before diagnosis was greater in ≤60 years compared with older patients: 24 vs. 12 months (p <0.05), respectively. CONCLUSIONS: These results suggest that chest pain is more common in younger male achalasia patients and residual LES pressure decreases with age.

[Evaluation of non-invasive fibrosis indices in Mexican patients with chronic hepatitis C]. / Evaluación de índices no invasivos de fibrosis en pacientes mexicanos con hepatitis crónica por virus C.

BACKGROUND: Among the many methods proposed to predict the presence of fibrosis in patients with chronic hepatitis C are the indices models obtained from serum biochemical tests, the aspartate aminotransferase-toplatelet ratio index (APRI) and the Forns index (FI). OBJECTIVE: To compare the diagnostic accuracy of the Forns index and APRI for predicting cirrhosis. METHODS: We included 105 patients with chronic hepatitis C and a liver biopsy. The FI and APRI were calculated from the biochemical tests of each patient. Receivers operating characteristic (ROC) curves were calculated to determine the best cutoff to discriminate between cirrhosis (F4), advanced fibrosis (F3-F4), and portal fibrosis (F1) according to the Knodell score. Diagnostic accuracy was assessed by obtaining sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) for each of the indices. RESULTS: ROC curves showed that the best cutoff for predicting cirrhosis (F4) for the FI is >7.64, with Sn 62.5% and Sp 91.8% (Area under the curve, AUC = 0.881), for advanced fibrosis (F3 - F4) the best cutoff value is >6.93 with Sn 42.9% and Sp 89.6% (AUC = 0.772). An APRI value of >1.74 was the best predictor for F4 with Sn 75% and Sp 82% (AUC = 0.799), and a cutoff value of >1.7 for predicting F3-F4 with Sn 47.6% and Sp 85.4% (AUC = 0.768). CONCLUSIONS: The results confirm the utility of both the FI and APRI for predicting advanced fibrosis and cirrhosis.

[Validation of a simplified 13C-urea breath test method for the diagnosis of Helicobacter pylori infection]. / Validación de método simplificado de la prueba en aliento con urea-13C para diagnóstico de infección por Helicobacter pylori.

OBJECTIVE: To validate a simplified 13C-urea breath test (13C-UBT) method for the diagnosis of H. pylori infection. MATERIAL AND METHODS: Patients referred for gastrointestinal endoscopy and biopsy were included, and a 13C-UBT was performed after a 6-hour fast. Breath samples were collected in 10 ml glass tubes before and 30 min after the simultaneous administration of 50 mg of 13C-urea and 2 g of citric acid in 200 ml of water. All breath samples were analyzed using isotope ratio mass spectrometry. The diagnosis of H. pylori infection was established with a positive culture and/or positive histology and serology. RESULTS: Eighty-eight patients were included, 49 female and 39 male with a mean age of 45 +/- 15 yrs. Fifty-one patients (57.95%) were positive and 30 (34.1%) negative for H. pylori. Seven cases (7.95%) were considered undetermined. The sensitivity, specificity, positive predictive value, and negative predictive value for 13C-UBT were 90.2, 93.3, 95.83, and 84.8%, respectively. Accuracy was 91.4%. CONCLUSIONS: The simultaneous administration of 50 mg of 13C-urea and 2 g of citric acid represents an alternative for the non-invasive diagnosis of H. pylori infection.

Validación de método simplificado de la prueba en aliento con urea-13C para diagnóstico de infección por Helicobacter pylori / Validation of a simplified method of the 13C urea breath test for diagnosis

Objetivo: validar un método simplificado de la prueba enaliento con urea-13C (PAU-13Cs) para el diagnóstico de infecciónpor Helicobacter pylori (H. pylori), con administración simultáneade 50 mg de urea-13C y 2 g de ácido cítrico.Material y métodos: se estudiaron 88 pacientes (49 mujeresy 39 hombres); con promedio de edad 45 ± 15 años, referidospara endoscopia gastrointestinal y toma de biopsias. La PAU-13Csse realizó en ayuno. Se recolectaron las muestras de aire espiradoen tubos de cristal de 10 ml, antes y 30 minutos después de administrarsimultáneamente 50 mg de urea-13C y 2 g de ácido cítricodisueltos en 200 ml de agua. Las muestras se analizaron por espectrometríade masas. El diagnóstico de infección se considerócuando el cultivo y/o la biopsia y serología fueron positivas paraH. pylori.Resultados: cincuenta y un pacientes (57,95%) fueron positivos,30 (34,10%) negativos para H. pylori y 7 (7,95%) casos seconsideraron indeterminados. La sensibilidad, especificidad, valorpredictivo positivo y negativo de PAU-13Cs fue de 90,2, 93,3,95,8 y 84,8%, respectivamente. Con exactitud de 91,4%.Conclusión: la administración simultánea de 50 mg de urea-13C y 2 g de ácido cítrico, representa una alternativa para el diagnósticono invasivo de infección por H. pylori, debido a que conservala certeza diagnóstica de la PAU-13C

Objective: to validate a simplified 13C-urea breath test (13CUBT)method for the diagnosis of H. pylori infection.Material and methods: patients referred for gastrointestinalendoscopy and biopsy were included, and a 13C-UBT was performedafter a 6-hour fast. Breath samples were collected in 10ml glass tubes before and 30 min after the simultaneous administrationof 50 mg of 13C-urea and 2 g of citric acid in 200 ml ofwater. All breath samples were analyzed using isotope ratio massspectrometry. The diagnosis of H. pylori infection was establishedwith a positive culture and/or positive histology and serology.Results: eighty-eight patients were included, 49 female and39 male with a mean age of 45 ± 15 yrs. Fifty-one patients(57.95%) were positive and 30 (34.1%) negative for H. pylori.Seven cases (7.95%) were considered undetermined. The sensitivity,specificity, positive predictive value, and negative predictivevalue for 13C-UBT were 90.2, 93.3, 95.83, and 84.8%, respectively.Accuracy was 91.4%.Conclusions: the simultaneous administration of 50 mg of13C-urea and 2 g of citric acid represents an alternative for thenon-invasive diagnosis of H. pylori infection

Case report of multiple myeloma and hypothyroidism in primary biliary cirrhosis.

A 71-year-old female with primary biliary cirrhosis, multiple myeloma and hypothyroidism is reported. The liver biopsy showed stage II-III histologic damage according to Scheuer's classification and the multiple myeloma was IgG-lambda type, stage II-A at the time of diagnosis. Another three cases of primary biliary cirrhosis associated with multiple myeloma were found in the literature. As a group, the four cases had mild or moderate liver damage, extensive bone lesions and three of four cases had multiple myeloma IgG-lambda type. Although this association could be incidental, there is evidence that implies a pathogenic relationship. This information is summarized in this report.

[Endoscopic biliary drainage in acute suppurative cholangitis]. / El drenaje biliar endoscópico en colangitis supurativa aguda.

Acute suppurative cholangitis is a life-threatening condition and prompt biliary decompression (BD) is essential for survival. The evolution of thirty-one patients (21 women and 10 men, mean age 64 years) with acute suppurative cholangitis attended from February 1989 to February 1994 treated by endoscopic cannulation and sphincterotomy for biliary drainage were retrospectively reviewed. The mean hospital stay was 18 +/- 12 days and during hospitalization there were 5 deaths, none related to biliary drainage. Sixteen patients had previous cholecystectomy, 12 patients had previous cholangitis in the last year, 23 patients had choledocholithiasis and an additional three patients pancreatobiliary neoplasias and common duct stones. Only 67.7% showed the classic Charcot's triad (fever, abdominal pain and jaundice). Total bilirubin, aspartate aminotransferase, alanine aminotransferase and total leukocytes decreased significantly (p < 0.05) after BD. Retroperitoneal perforation was the only complication is a safe and effective procedure for emergency biliary decompression in the treatment of acute suppurative cholangitis.

[Nutrition of patients with liver diseases. (lst of 2 parts)]. / Nutrición en pacientes con enfermedades hepáticas. (Primera de dos partes).

Diet may be modified and can alter the hepatic function or contributes to maintain it on excellent state. The objective of this paper was to review the recently advances on the clinical aspects of nutrition in chronic liver diseases and the underlying rationale for specific nutritional therapies focusing in the works in Mexico. Original papers in english and spanish informed on Medline until 1994 were included. We also review the national literature about nutrition aspects on liver diseases.