[The Mexican consensus on gastroesophageal reflux disease. Part II]. / Consenso mexicano de enfermedad por relujo gastroesofágico. Parte II.

OBJECTIVE: To update the themes of endoscopic and surgical treatment of Gastroesophageal Reflux Disease (GERD) from the Mexican Consensus published in 2002. METHODS: Part I of the 2011 Consensus dealt with the general concepts, diagnosis, and medical treatment of this disease. Part II covers the topics of the endoscopic and surgical treatment of GERD. In this second part, an expert in endoscopy and an expert in GERD surgery, along with the three general coordinators of the consensus, carried out an extensive bibliographic review using the Embase, Cochrane, and Medline databases. Statements referring to the main aspects of endoscopic and surgical treatment of this disease were elaborated and submitted to specialists for their consideration and vote, utilizing the modified Delphi method. The statements were accepted into the consensus if the level of agreement was 67% or higher. RESULTS: Twenty-five statements corresponding to the endoscopic and surgical treatment of GERD resulted from the voting process, and they are presented herein as Part II of the consensus. The majority of the statements had an average level of agreement approaching 90%. CONCLUSION: Currently, endoscopic treatment of GERD should not be regarded as an option, given that the clinical results at 3 and 5 years have not demonstrated durability or sustained symptom remission. The surgical indications for GERD are well established; only those patients meeting the full criteria should be candidates and their surgery should be performed by experts.

[Role of physical, psychological and sexual abuse in functional digestive disorders. A case-controls trial.]. / El papel del abuso físico, psicológicoy sexual en los trastornos funcionales digestivos.Un estudio de casos y controles.

INTRODUCTION: Abuse has been considered a significant factor on the development of functional gastrointestinal disorders (FGID), especially for severe and treatment-refractory patients. The aim of our study was to evaluate the presence of all FGID according to Rome II criteria, in a group of women with history of physical, psychological and/or sexual abuse. MATERIAL AND METHODS: A cross sectional study was performed in 96 women (37 +/- 12 years of age) with history of physical, psychological and/or sexual abuse (cases); and 96 open population women (36 +/- 14 years of age) (controls). The following evaluations were administered: Rome II questionnaire, a self-administered instrument to evaluate history of physical (beating), psychological(insults, public humiliation) and/or sexual abuse (rape, coercion), and HAD questionnaire. RESULTS: Among 96 women with history of abuse,91 (95%) reported to have suffered psychological abuse, 72 (75%) physical abuse, and 24 (25%)sexual abuse. Women with history of abuse had a higher prevalence of rumination (6% vs. 0%, p= 0.02), functional heartburn (26% vs. 13%, p =0.04), aerofagia (17% vs. 5%, p = 0.019), irritable bowel syndrome (38% vs. 18%, p = 0.002), fecalin continence (16% vs. 4%, p = 0.01), elevator anisyndrome (5% vs. 0%, p = 0.05), and proctalgia fugax (29% vs. 15%, p = 0.02) compared to controls. There was a positive correlation between anxiety (r = 0.5, p = 0.001) and depression scores(r = 0.45, p = 0.001), and the number of FGID. CONCLUSION: We demonstrated a high prevalence of FGID among women with history of physical,psychological, and/or sexual abuse. In this association,concomitant anxiety and depression play a significant role.

Single nucleotide polymorphisms (SNPs) at CDH1 promoter region in familial gastric cancer.

INTRODUCTION: Gastric cancer is the most frequent gastrointestinal malignancy in Mexico and the proportion of patients younger than 40 years is one of the highest reported in the world literature. Recently several families with familial diffuse gastric cancer have been identified at the National Institute of Medical Sciences and Nutrition. Germline mutations in the E-cadherin gene (CHD1) have been described that result in the development of diffuse hereditary gastric cancer in young patients. METHODS: The complete coding sequence at exons 1 to 16 and the promoter region of CDH1 was amplified by polymerase chain reaction in peripheral blood samples of two patients with early onset familial diffuse gastric cancer. RESULTS: No germline inactivating mutations of CHD1 were found on either patient. Single nucleotide polymorphisms -160 C->A were detected in the promoter region of CDH1 in both patients. CONCLUSIONS: The polymorphism -160 C->A theoretically confers an increased risk of developing diffuse gastric cancer. The relatives of these patients may an increased risk of gastric cancer among other tumors. There is presently not enough evidence to consider the -160 C->A polymorphism an etiologic factor of diffuse gastric cancer in these patients since the frequency and type of genetic alterations of CDH1 are largely unknown in the Mexican population. It will be necessary to conduct epidemiologic studies in the Mexican population to determine the influence that genetic alterations have on the genesis of diffuse gastric carcinoma.

Polimorfismos de nucleótido único (SNPs) en la región promotora CDH1 en cáncer gástrico familiar / Single nucleotide polymorphisms (SNPs) at CDH1 promoter region in familial gastric cancer

Introducción: el cáncer gástrico es la neoplasia más frecuentedel tracto gastrointestinal en México y la proporción de pacientesmenores de 40 años es una de las más altas reportadas en la literaturamundial. Recientemente se han identificado en el InstitutoNacional de Ciencias Médicas y Nutrición varias familias con cáncergástrico difuso familiar. Múltiples mutaciones germinales delgene de E-cadherina (CHD1) han sido descritas en relación al desarrollode cáncer gástrico difuso hereditario en pacientes jóvenes.Métodos: la secuencia codificadora completa exones 1 al 16y la región promotora de CDH1 fueron amplificadas mediantereacción en cadena de la polimerasa en muestras de sangre periféricade dos pacientes con diagnósticos de cáncer gástrico deaparición temprana familiar.Resultados: en ninguno de los 2 pacientes se detectaron mutacionesgerminales inactivadoras de CDH1. Se encontraron polimorfismosde nucleotido único C→A en la región promotora deCDH1 en la posición –160 en ambos pacientes.Conclusiones: el polimorfismo –160 C→A confiere teóricamenteun aumento en el riesgo de desarrollar cáncer gástrico difuso.Los miembros de las familias presentan un riesgo mayor paracáncer gástrico difuso al igual que otras neoplasias. No existe actualmenteevidencia suficiente para considerar al polimorfismo–160 C→A como un factor etiológico determinante de cáncergástrico difuso debido a que la frecuencia y tipo de alteraciones enel gen CDH1 en población mexicana se desconocen. Será necesariollevar a cabo estudios epidemiológicos en población mexicanaque determinen la influencia de diversas alteraciones genéticasen la génesis de esta neoplasia

Introduction: gastric cancer is the most frequent gastrointestinalmalignancy in Mexico and the proportion of patientsyounger than 40 years is one of the highest reported in theworld literature. Recently several families with familial diffusegastric cancer have been identified at the National Institute ofMedical Sciences and Nutrition. Germline mutations in theE-cadherin gene (CHD1) have been described that result in thedevelopment of diffuse hereditary gastric cancer in young patients.Methods: the complete coding sequence at exons 1 to 16 andthe promoter region of CDH1 was amplified by polymerase chainreaction in peripheral blood samples of two patients with early onsetfamilial diffuse gastric cancer.Results: no germline inactivating mutations of CHD1were found on either patient. Single nucleotide polymorphisms-160 C→A were detected in the promoter region ofCDH1 in both patients.Conclusions: the polymorphism -160 C→Α theoreticallyconfers an increased risk of developing diffuse gastric cancer.The relatives of these patients may an increased risk of gastriccancer among other tumors. There is presently not enough evidenceto consider the -160 C→Α polymorphism an etiologicfactor of diffuse gastric cancer in these patients since the frequencyand type of genetic alterations of CDH1 are largely unknownin the Mexican population. It will be necessary to conductepidemiologic studies in the Mexican population todetermine the influence that genetic alterations have on thegenesis of diffuse gastric carcinoma