[Esophagitis associated with use of alendronate in 5 postmenopausic patients]. / Esofagitis asociada con el uso de alendronato en 5 pacientes posmenopáusicas.

The bisphosphonate, alendronate sodium (e.g. Fosamax) is a bone resorption inhibitor used to treat postmenopausal osteoporotic women and osseous Paget's disease. Esophagitis is one of the adverse effects (AE) associated to its use. Five (5) patients with alendronate-associated esophagitis assisted in the Gastroenterologic Center, Rosario, Argentina, between October 1996 and December 1999 are described. The aim is to correlate the clinical, endoscopic and histopathological findings in 5 women (ages 57-71) complaining for upper digestive symptoms (dysphagia, epigastralgia, retrosternal pain.). All had osteoporosis treated with alendronate 10 mg/day and received detailed instructions about how to take the medication. The time from the beginning of alendronate intake and the appearance of the symptoms was elapsed 30, 35, 67, 85 and 90 days. The esophagitis was graded according to the Savary-Miller Classification. The videoscopy disclosed esophagitis of III and IV grades. Three patients had also antral and antroduodenal lesions, one of them associated to Helicobacter Pylori. Anatomopathologic findings confirm esophagitis and esophagic ulceration. Some authors claim that bisphosphonates as a new class of gastrotoxic drugs with AE similar to aspirin. Even when it is administrated according to the instructions of the manufacturers it should be used with caution. Our contribution emphasize the importance of this AE and suggest measures to diminish or suppress them, and take into consideration those patients who are taking aspirin. With alendronate, as well as with other potentially corrosive agents, is very important to take in mind the measures to prevent AE.

Esofagitis asociada con el uso de alendronato en 5 pacientes posmenopáusicas / Esophagitis associated with use of alendronate in 5 postmenopausic patients

The biphosphonate, alendronate sodium (e.g. Fosamax) is a bone resorption inhibitor used to treat posmenopausal osteoporotic women and osseous Pagets disease. Esophaghitis is one of the adverse effects (AE) associated to its use. Five (5) patients with alendronate-associated esophagitis assisted in the Gastroenterologic Center, Rosario, Argentina, between October 1996 and December 1999 are described. The aim is to correlate the clinical, endoscopic and histopathological findings in 5 women (ages 57-71) complained for upper digestive symptoms (disphagia, epigastrialgia, retroesternal pain). All had osteoporosis treated with alendronate 10 mg/day and received detailed instructions about how to take the medication. The time from the beginning of alendronate intake and the appearence of the symptoms was elapsed 30, 35, 67, 85 and 90 days. The esophagitis was graded according to the Savary-Miller Classification. The videoscopy disclosed esophagitis of III and IV grades. Three patients has also antral and antroduodenal lesions, one of them associated to Helicobacter pylori. Anatomopathological findings confirm esophagitis and esophagic ulceration. Some authors claim that disphosphonates as a new class of gastrotoxic drugs with AE similar to aspirin. Even when it is administrated according to the instructions of the manufactures it should be used with caution. Our contribution emphazise the importance of this AE and suggest measures to diminish or suppres them, and take into consideration those patients who are taking aspirin. With alendronate, as well as with other potentially corrosive agents, is very important to take in mind the measures to prevent AE. (Au)

Esofagitis asociada con el uso de alendronato en 5 pacientes posmenopáusicas. / [Esophagitis associated with use of alendronate in 5 postmenopausic patients]

The bisphosphonate, alendronate sodium (e.g. Fosamax) is a bone resorption inhibitor used to treat postmenopausal osteoporotic women and osseous Pagets disease. Esophagitis is one of the adverse effects (AE) associated to its use. Five (5) patients with alendronate-associated esophagitis assisted in the Gastroenterologic Center, Rosario, Argentina, between October 1996 and December 1999 are described. The aim is to correlate the clinical, endoscopic and histopathological findings in 5 women (ages 57-71) complaining for upper digestive symptoms (dysphagia, epigastralgia, retrosternal pain.). All had osteoporosis treated with alendronate 10 mg/day and received detailed instructions about how to take the medication. The time from the beginning of alendronate intake and the appearance of the symptoms was elapsed 30, 35, 67, 85 and 90 days. The esophagitis was graded according to the Savary-Miller Classification. The videoscopy disclosed esophagitis of III and IV grades. Three patients had also antral and antroduodenal lesions, one of them associated to Helicobacter Pylori. Anatomopathologic findings confirm esophagitis and esophagic ulceration. Some authors claim that bisphosphonates as a new class of gastrotoxic drugs with AE similar to aspirin. Even when it is administrated according to the instructions of the manufacturers it should be used with caution. Our contribution emphasize the importance of this AE and suggest measures to diminish or suppress them, and take into consideration those patients who are taking aspirin. With alendronate, as well as with other potentially corrosive agents, is very important to take in mind the measures to prevent AE.

Esofagitis asociada con el uso de alendronato en 5 pacientes posmenopáusicas / Esophagitis associated with use of alendronate in 5 postmenopausic patients

The biphosphonate, alendronate sodium (e.g. Fosamax) is a bone resorption inhibitor used to treat posmenopausal osteoporotic women and osseous Paget's disease. Esophaghitis is one of the adverse effects (AE) associated to its use. Five (5) patients with alendronate-associated esophagitis assisted in the Gastroenterologic Center, Rosario, Argentina, between October 1996 and December 1999 are described. The aim is to correlate the clinical, endoscopic and histopathological findings in 5 women (ages 57-71) complained for upper digestive symptoms (disphagia, epigastrialgia, retroesternal pain). All had osteoporosis treated with alendronate 10 mg/day and received detailed instructions about how to take the medication. The time from the beginning of alendronate intake and the appearence of the symptoms was elapsed 30, 35, 67, 85 and 90 days. The esophagitis was graded according to the Savary-Miller Classification. The videoscopy disclosed esophagitis of III and IV grades. Three patients has also antral and antroduodenal lesions, one of them associated to Helicobacter pylori. Anatomopathological findings confirm esophagitis and esophagic ulceration. Some authors claim that disphosphonates as a new class of gastrotoxic drugs with AE similar to aspirin. Even when it is administrated according to the instructions of the manufactures it should be used with caution. Our contribution emphazise the importance of this AE and suggest measures to diminish or suppres them, and take into consideration those patients who are taking aspirin. With alendronate, as well as with other potentially corrosive agents, is very important to take in mind the measures to prevent AE.

[Post-treatment assessment of Helicobacter pylori eradication, by polymerase chain reaction in gastric biopsies]. / Evaluación de la erradicación postratamiento del Helicobacter pylori por reaccion en cadena de la polimerasa en biopsias gástricas.

BACKGROUND: The pre-treatment detection of H.p. in the stomach of patients is easily achieved with routine methods. Conversely, with conventional methods, it is difficult to detect the presence of H.p. after treatment. OBJECTIVE: To estimate the actual percentage of successfully treated patients by using a more sensitive and specific technique (PCR) in the same biopsies where standard methods were negative for H.p. MATERIALS AND METHODS: We selected 97 treated patients (31 Gastric Ulcers/66 Duodenal Ulcers, 62 male/35 female, age: 49 +/- 14 years), in whom success of treatment was defined by histological means and CLO Test. In the same gastric biopsies H.p-DNA PCR was performed. Different therapeutic schemes were utilized, but all included Proton Pump Inhibitors + ATB. Eight weeks after the end of the treatment, without medication, the patients were controlled as follows: 5 biopsies per patient, 2 of antrum, 2 of corpus (in different zones) and 1 for CLO Test. H.p. eradication was defined on histological grounds (gastric biopsy histology: 10% formaldehide buffer fixation, paraffin inclusion, Giemsa, HE staining and inmunohistochemistry), CLO Test (Delta West Pty. Ltd. Bentley, Australia) and by the absence of H.p.-DNA by PCR (amplification of a 296 bp of the species-specific antigen of H.p. and visualization of the amplified product in agarose gel with Ethidium Bromide and UV light). RESULTS: [table: see text] CONCLUSIONS: The higher sensitivity of PCR (10(3) fold more than conventional methods) allowed us in this group of patients to detect 13% of false eradication. It would be necessary to follow up this group of patients in order to know whether they develop or not clinical symptoms and/or histological evidence of disease. If such a case PCR could become an important tool for treatment evaluation.

Evaluacion de la erradicacion postratamiento del Helicobacter pyloripor reaccion en cadena de la polimerasa en biopsias gastricas / Post-treatment control of Helicobacter pylori erradication, by polymerase chain reaction in gastric biopsies

Introducción: La detección del H.p. en el estómago de pacientes vírgenes de tratamiento ha sido solucionada; un aspecto no resuelto, al menos en nuestro medio, es la pesquisa del H.p. luego de la terapéutica, para asegurar su erradicación. Objetivos: Utilizar una metodología sensible y específica para evaluar la presencia del H.p. en biopsias gástricas postratamiento, comparándola con otras técnicas similares clásicas. De esa manera, aumentando la precisión en el diagóstico, se podrá diferenciar la recrudescencia (falsa erradicación) de la reinfección y conocer el exacto porcentaje de curación. Materiales y Métodos: La PCR para H.p. fue realizada en 97 pacientes (62 hombres y 35 mujeres) con edad propedio de 49 años (+/- 14), en los cuales ya se había confirmado la erradicación por histología-Giemsa más CLO TEST. La metodología fue la siguiente: se realizaron 5 biopsias gástricas endoscópicas por paciente, 2 de antro, 2 de cuerpo, y 1 para CLO; todos los pacientes fueron estudiados luego de 6 ou 8 semanas de terminado el tratamiento y durante ese período no recibieron ninguna medicación. La metodología fue: las biopsias gástricas fueron fijadas en formol buffer al 10 por ciento, incluídas en parafina, y se colorearon con Giemsa y hematoxilina-eosina. El CLO TEST usado fue de Delta West Pty. Ltd. Bentley. La PCR se efectuó amplificando un fragmento de 296 pares de bases correspondiente al gen codificante del antígeno especie especifico de Helicobacter pylori, y la visualización del producto amplificado se realizó por electroforesis en gel de agarosa teñido con bromuro de etidio y U.V. Resultados: ninguno de estos pacientes presentaba úlcera gástrica o duodenal en el momento del control.Conclusiones: La PCR puede detectar secuencias de ADN especificas del H.p., incluso en su forma cocoide de resistencia, como se observan postratamiento. Las tinciones más utilizadas en biopsia (Giemsa/W-S) detectan aproximadamente 100000 microorganismos por ml; la PCR puede detectar 100, vale decir que es tres órdenes más sensible que la metodología clásica. En nuestra experiencia detectamos un 13 por ciento de falsos erradicados, los cuales clínicamente deberán ser considerados como recrudescencia y no como reinfección.

Evaluacion de la erradicacion postratamiento del Helicobacter pyloripor reaccion en cadena de la polimerasa en biopsias gastricas / Post-treatment control of Helicobacter pylori erradication, by polymerase chain reaction in gastric biopsies

Introducción: La detección del H.p. en el estómago de pacientes vírgenes de tratamiento ha sido solucionada; un aspecto no resuelto, al menos en nuestro medio, es la pesquisa del H.p. luego de la terapéutica, para asegurar su erradicación. Objetivos: Utilizar una metodología sensible y específica para evaluar la presencia del H.p. en biopsias gástricas postratamiento, comparándola con otras técnicas similares clásicas. De esa manera, aumentando la precisión en el diagóstico, se podrá diferenciar la recrudescencia (falsa erradicación) de la reinfección y conocer el exacto porcentaje de curación. Materiales y Métodos: La PCR para H.p. fue realizada en 97 pacientes (62 hombres y 35 mujeres) con edad propedio de 49 años (+/- 14), en los cuales ya se había confirmado la erradicación por histología-Giemsa más CLO TEST. La metodología fue la siguiente: se realizaron 5 biopsias gástricas endoscópicas por paciente, 2 de antro, 2 de cuerpo, y 1 para CLO; todos los pacientes fueron estudiados luego de 6 ou 8 semanas de terminado el tratamiento y durante ese período no recibieron ninguna medicación. La metodología fue: las biopsias gástricas fueron fijadas en formol buffer al 10 por ciento, incluídas en parafina, y se colorearon con Giemsa y hematoxilina-eosina. El CLO TEST usado fue de Delta West Pty. Ltd. Bentley. La PCR se efectuó amplificando un fragmento de 296 pares de bases correspondiente al gen codificante del antígeno especie especifico de Helicobacter pylori, y la visualización del producto amplificado se realizó por electroforesis en gel de agarosa teñido con bromuro de etidio y U.V. Resultados: ninguno de estos pacientes presentaba úlcera gástrica o duodenal en el momento del control.Conclusiones: La PCR puede detectar secuencias de ADN especificas del H.p., incluso en su forma cocoide de resistencia, como se observan postratamiento. Las tinciones más utilizadas en biopsia (Giemsa/W-S) detectan aproximadamente 100000 microorganismos por ml; la PCR puede detectar 100, vale decir que es tres órdenes más sensible que la metodología clásica. En nuestra experiencia detectamos un 13 por ciento de falsos erradicados, los cuales clínicamente deberán ser considerados como recrudescencia y no como reinfección. (AU)