Efficacy of the regional Mexican diet versus the Mediterranean diet in patients with MASLD: a 24-week non-inferiority trial.

In the present manuscript we present evidence of the improvement of MASLD with dietary intervention. It is known that the Mediterranean diet is the best intervention for this pathology, however, it cannot be established in all countries due to the diversity of foods. We create a Mexican diet with the nutrients of the Mediterranean diet for the treatment of our population.

Prevalence of Anti- Saccharomyces Cerevisiae Antibodies (ASCA) in Patients With Irritable Bowel Syndrome (IBS). A Case-control Study.

BACKGROUND: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction that affects patients' quality. Recent research has shown variations in the mycobiome of individuals with IBS, particularly involving Saccharomyces cerevisiae , and its association with dysbiosis and visceral hypersensitivity. However, the role of Anti-Saccharomyces cerevisiae antibodies (ASCA) in IBS remains unclear, despite their significance as markers of disease severity in inflammatory bowel disease. OBJECTIVE: This study aimed to investigate the role of ASCA in Mexican IBS patients compared with healthy controls (HCs) and determine whether these antibodies could help differentiate between IBS patients and healthy individuals. METHODS: Serum samples from 400 IBS patients and 400 HC were analyzed. ASCA IgG levels were measured using enzyme-linked immunosorbent assay (ELISA). The IBS patients were further categorized into subtypes: constipation predominant (IBS-C), diarrhea predominant (IBS-D), and mixed (IBS-M). RESULTS: Among the participants, 66 IBS patients (16.5%) and 63 HC (15.75%) tested positive for ASCA IgG. No significant difference was observed in ASCA IgG levels between the 2 groups ( P value: 0.8451). The prevalence of ASCA IgG positivity was 14.5% in IBS-C, 17.8% in IBS-D, and 15.9% in IBS-M. CONCLUSION: Surprisingly, a high prevalence of ASCA IgG was found in the HC group in Mexico. Furthermore, there was no significant difference in ASCA IgG levels between IBS patients and controls. These findings suggest that ASCA is not useful as a discriminatory biomarker for distinguishing IBS patients from healthy individuals and cannot serve as a surrogate marker for visceral hypersensitivity.

Higher cardiovascular risk scores and liver fibrosis risk estimated by biomarkers in patients with metabolic-dysfunction-associated fatty liver disease.

BACKGROUND: The definition of metabolic-dysfunction-associated fatty liver disease (MAFLD) allows identification of metabolically complicated patients. Fibrosis risk scores are related to cardiovascular risk (CVR) scores and could be useful for the identification of patients at risk of systemic complications. AIM: To evaluate the relationship between MAFLD and CVR using the Framingham risk score in a group of Mexican patients. METHODS: Cross-sectional, observational and descriptive study carried out in a cohort of 585 volunteers in the state of Veracruz with MAFLD criteria. The risk of liver fibrosis was calculated with aspartate aminotransferase-to-platelet ratio index, nonalcoholic fatty liver disease score and fibrosis-4, as well as with transient hepatic elastography with Fibroscan®. The CVR was determined by the Framingham system. RESULTS: One hundred and twenty-five participants (21.4%) with MAFLD criteria were evaluated, average age 54.4 years, 63.2% were women, body mass index 32.3 kg/m2. The Framingham CVR was high in 43 patients (33.9%). Transient elastography was performed in 55.2% of volunteers; 39.1% with high CVR and predominance in advanced fibrosis (F3-F4). The logistic regression analysis showed that liver fibrosis, diabetes and hypertension independently increased CVR. CONCLUSION: One of every three patients with MAFLD had a high CVR, and in those with high fibrosis risk, the CVR risk was even greater.

Análisis de la composición corporal y ángulo de fase por bioimpedancia en pacientes con MAFLD / Body composition and phase angle by bioimpedance in patients with MAFLD

Objetivo: Describir las características de la composición corporal y del ángulo de fase (AF) en pacientes con MAFLD de acuerdo con fibrosis y esteatosis hepática. Pacientes y métodos: Estudio transversal, observacional y descriptivo en una cohorte de 585 voluntarios de nuestro centro con criterios de MAFLD. El riesgo de fibrosis hepática se determinó por APRI, NAFLD score y FIB-4; en riesgo indeterminado y elevado de fibrosis se realizó elastografía hepática de transición (ET) con Fibroscan®. Se realizó análisis de la composición corporal por bioimpedancia (SECA®). Se incluyeron pacientes con registro de ET y SECA®. Resultados: Se evaluaron 125 participantes (21,4%), edad 53,9±13,9 años, 62,1% mujeres, IMC 33,2±5,8kg/m2. El análisis SECA® mostró media de masa grasa de 42%±7,32 y masa muscular de 21,18kg±6,6. El AF fue 5,1±0,69; en mujeres 4,92±0,62 y en hombres 5,41±0,70. El AF en pacientes sin fibrosis fue de 5,091 vs con fibrosis 5,121 (p=0,813). En fibrosis avanzada se reportó valor bajo en comparación con el resto de los grupos (p=0,031). El AF en S3 fue mayor en comparación con S1 y S2 (5,3 vs 4,82, 4,81) (p=0,027). Conclusiones: En MAFLD el AF fue menor vs población sana mexicana. En pacientes sin fibrosis y esteatosis severa el AF se eleva proporcional al incremento de masa grasa e del IMC, y en fibrosis hepática avanzada el AF disminuye.(AU)

Objective: To describe the characteristics of the body components and phase angle (PhA) of patients with MAFLD according to those different to fibrosis and hepatic steatosis. Material and methods: Observational and descriptive study in a cohort of 585 volunteers from our center with MAFLD criteria. The risk of liver fibrosis was determined by APRI, NAFLD score and FIB-4; at an indeterminate and high risk of fibrosis, a transient elastography (Fibroscan®) were realized. Bioimpedance body composition analysis (SECA®) was performed. Patients with ET and SECA® registry were included. Bioimpedance body composition analysis (SECA®) was performed. Patients with ET and SECA® registry were included. Results: 125 participants (21.4%) were evaluated, age 53.9±13.9 years, 62.1% women, BMI 33.2±5.8kg/m2. The SECA® analysis showed mean fat mass of 42%±7.32 and muscle mass 21.18kg±6.6. The PhA was 5.1±0.69, in women 4.92±0.62 and men 5.41±0.70. PhA in patients without fibrosis was 5.091 vs with fibrosis 5.121 (P=.813). In advanced fibrosis, it reported a low value compared to the rest of the groups (P=.031). The PhA in S3 was higher compared to S1 and S2 (5.3 vs 4.82, 4.81) (P=.027). Conclusions: In MAFLD, the PhA was lower than the healthy Mexican population. In patients without fibrosis and severe steatosis, PhA rises proportionally to the increase in fat mass and BMI and in advanced liver fibrosis, PhA decreases.(AU)

Body composition and phase angle by bioimpedance in patients with MAFLD. / Análisis de la composición corporal y ángulo de fase por bioimpedancia en pacientes con MAFLD.

OBJECTIVE: To describe the characteristics of the body components and phase angle (PhA) of patients with MAFLD according to those different to fibrosis and hepatic steatosis. MATERIAL AND METHODS: Observational and descriptive study in a cohort of 585 volunteers from our center with MAFLD criteria. The risk of liver fibrosis was determined by APRI, NAFLD score and FIB-4; at an indeterminate and high risk of fibrosis, a transient elastography (Fibroscan®) were realized. Bioimpedance body composition analysis (SECA®) was performed. Patients with ET and SECA® registry were included. Bioimpedance body composition analysis (SECA®) was performed. Patients with ET and SECA® registry were included. RESULTS: 125 participants (21.4%) were evaluated, age 53.9±13.9 years, 62.1% women, BMI 33.2±5.8kg/m2. The SECA® analysis showed mean fat mass of 42%±7.32 and muscle mass 21.18kg±6.6. The PhA was 5.1±0.69, in women 4.92±0.62 and men 5.41±0.70. PhA in patients without fibrosis was 5.091 vs with fibrosis 5.121 (P=.813). In advanced fibrosis, it reported a low value compared to the rest of the groups (P=.031). The PhA in S3 was higher compared to S1 and S2 (5.3 vs 4.82, 4.81) (P=.027). CONCLUSIONS: In MAFLD, the PhA was lower than the healthy Mexican population. In patients without fibrosis and severe steatosis, PhA rises proportionally to the increase in fat mass and BMI and in advanced liver fibrosis, PhA decreases.

Validation and diagnostic usefulness of gastroesophageal reflux disease questionnaire in a primary care level in Mexico.

BACKGROUND/AIMS: Different non-invasive diagnostics strategies have been used to assess patients with gastroesophageal reflux. Gastroesophageal reflux disease (GERD) questionnaire (GerdQ) is a 6-item, easy to use questionnaire that was developed primarily as a diagnostic tool for GERD in primary care. Our aim was to validate and assess diagnostic utility of GerdQ questionnaire in Mexican patients in the primary care setting. METHODS: The study was performed in 3 phases: (1) a questionnaire translation and comprehension study (n = 20), (2) are a reproduci-bility and validation study (50 patients and 50 controls) and (3) a study to assess the clinical utility in 252 subjects with GERD symptoms. Diagnostic accuracy was calculated using endoscopy and/or pH-metry as the gold standard. RESULTS: Internal consistency measured by the Cronbach's α coefficient was 0.81 for patients and 0.90 for healthy controls, with a mixed coefficient of 0.93. Reproducibility for GerdQ was very good and its discriminating validity was 88%. Most of the pa-tients with erosive reflux and non-erosive reflux with abnormal pH-metry had scores > 8, meanwhile most of the patients with functional heartburn and hypersensitive esophagus had < 8. Sensitivity, specificity and positive predictive value of GerdQ com-pared to the gold standard were 72%, 72% and 87%, respectively. CONCLUSIONS: In Mexico, the GerdQ questionnaire Spanish validated version is useful for GERD diagnosis in the primary care setting.(J Neurogastroenterol Motil 2014;20:475-482).

Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease. The experience of a center for digestive physiology in Southeastern Mexico.

BACKGROUND: Dental erosion (DE) is the loss of the hard tissues of the tooth produced by the action of gastric juice, pepsin and acid on the dental enamel, its frequency ranges from 5 to 53.41 %. In Mexico there are no reports on the frequency and possible association. OBJECTIVE: To establish the prevalence of dental erosion and its relationship to GERD. PATIENTS AND METHODS: Prospective, observational, descriptive and comparative study was conducted in 60 patients diagnosed with GERD and 60 healthy patients at the Institute of Medical and Biological Research of the Universidad Veracruzana in Veracruz city. Anthropometric characteristics, dietary habits, oral hygiene, alcohol consumption, smoking, ED index and Index of decayed/missing dental pieces/sealed and correlation between severity of ED and GERD were analyzed. RESULTS: 78.67 % of patients with GERD had ED, 23.33 % corresponded to grade 0, 41.67 % to N1, N2 and 23.33 % to 11.67 % to N3. Predominance of females (2,3:1). The mean age was 50.92 +/- 13.52 years. The severity of dental erosion was significantly related to the severity of reflux, halitosis, CPO index and poor eating habits. There was no statistically significant difference in the other variables analyzed. CONCLUSIONS: Dental erosion has a high frequency in patients with GERD and reflux characteristics are directly related to their severity and therefore should be considered as a manifestation of GERD extraesophageal.

Erosión dental, una manifestación extraesofágica de la enfermedad por reflujo gastroesofágico. Experiencia de un centro de fisiología digestiva en el sureste de México / Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease. The experience of a center for digestive physiology in Southeastern Mexico

Antecedentes: la erosión dental (ED) es la pérdida de los tejidos duros del diente producida entre otras cosas por la acción del jugo gástrico, la pepsina y el ácido sobre el esmalte dentario, su prevalencia varía entre 5 y 53,41 %. En México no existen publicaciones sobre su frecuencia y posible asociación. Objetivo: establecer la prevalencia de las erosiones dentales y su relación con la enfermedad por reflujo gastroesofágico (ERGE). Pacientes y métodos: estudio prospectivo, observacional, descriptivo y comparativo realizado en 60 pacientes con diagnóstico de ERGE y 60 sujetos sanos en el Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana en la ciudad de Veracruz. Se analizaron las características antropométricas, hábitos alimentarios, higiene oral, consumo de alcohol, tabaquismo, índice de ED e índice de piezas dentales cariadas/perdidas/obturadas (CPO) y la correlación entre severidad de ED y la ERGE. Resultados: El 78,67 % de los pacientes con ERGE presentaron ED; el 23,33 % correspondieron al grado N0, 41,67 % al N1, 23,33 % al N2 y 11,67 % al N3. Predominó el género femenino (2,3:1). La edad promedio fue 50,92 ± 13,52 años. La gravedad de la erosión dental se relacionó significativamente con la severidad del reflujo, halitosis, índice CPO y con malos hábitos alimentarios. No hubo diferencia estadísticamente significativa en las demás variables analizadas. Conclusiones: la erosión dental tiene una alta frecuencia en pacientes con ERGE y las características del reflujo se relacionan directamente con su severidad por lo cual debe ser considerada como una manifestación extraesofágica más de la ERGE (AU)

Background: Dental erosion (DE) is the loss of the hard tissues of the tooth produced by the action of gastric juice, pepsin and acid on the dental enamel, its frequency ranges from 5 to 53.41 %. In Mexico there are no reports on the frequency and possible association. Objective: To establish the prevalence of dental erosion and its relationship to GERD. Patients and methods: Prospective, observational, descriptive and comparative study was conducted in 60 patients diagnosed with GERD and 60 healthy patients at the Institute of Medical and Biological Research of the Universidad Veracruzana in Veracruz city. Anthropometric characteristics, dietary habits, oral hygiene, alcohol consumption, smoking, ED index and Index of decayed/missing dental pieces/sealed and correlation between severity of ED and GERD were analyzed. Results: 78.67 % of patients with GERD had ED, 23.33 % corresponded to grade 0, 41.67 % to N1, N2 and 23.33 % to 11.67 % to N3. Predominance of females (2,3:1). The mean age was 50.92 ± 13.52 years. The severity of dental erosion was significantly related to the severity of reflux, halitosis, CPO index and poor eating habits. There was no statistically significant difference in the other variables analyzed. Conclusions: Dental erosion has a high frequency in patients with GERD and reflux characteristics are directly related to their severity and therefore should be considered as a manifestation of GERD extraesophageal (AU)

[Merkel cell carcinoma experience in a reference medical center.] / Carcinoma de células de Merkel. Experiencia en un centro de referencia.

Background: Merkel cell carcinoma is a rare tumor that occurs on areas exposed to ultraviolet light. It is usually asymptomatic and it is diagnosed late often. The treatment is surgical, associated with adjuvant radiotherapy. The objective was to present the experience in the management of Merkel cell carcinoma in a reference medical center. Methods: all patients with Merkel cell carcinoma treated at the Instituto de Investigaciones Médico-Biológicas of the Universidad Veracruzana during the period 2008 to 2011 were studied. Sex, age, evolution time, tumor localization, size, metastases and treatment were analyzed. Results: of 3217 patients treated, three cases were Merkel cell carcinoma (0.09 %), their age was 52.1 ± 14.17, male predominance of 66.67 %; the evolution time was of 29.66 ± 35.36 months; the tumour localization was on inguinal region, anterior chest and left arm; the noodle size was of 6.0 ± 5.19 cm; two patients had lymph node metastases. In two cases, resection and lymphadenectomy were performed. They all received radiation therapy and chemotherapy in one case. Histologically the medium variant predominated; immunohistochemistry was positive in the three cases. One patient died ten months after the study was done. Conclusions: our experience is similar with others authors, Merkel cell carcinoma is a rare tumor, usually diagnosed late, and it has poor survival.

Introducción: el carcinoma de células de Merkel se presenta en las zonas expuestas a la luz ultravioleta, por lo general es asintomático, con diagnóstico tardío y su tratamiento es quirúrgico con radioterapia adyuvante. El objetivo es presentar la experiencia en el manejo del carcinoma de células de Merkel de un centro de referencia en Veracruz. Métodos: revisión de pacientes atendidos en el Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana entre enero de 2008 y junio de 2011. Resultados: de 3217 pacientes, tres tuvieron carcinoma de células de Merkel (0.09 %), la edad promedio fue de 52.17 ± 14.1 años, dos eran hombres; el tiempo de evolución fue de 29.66 ± 35.36 meses, las localizaciones fueron la región inguinal, la cara anterior del tórax y el brazo izquierdo; el tamaño fue de 6 ± 5.19 cm. Dos pacientes presentaban metástasis ganglionares; en dos se realizó resección y linfadenectomía; los tres recibieron radioterapia y uno, quimioterapia. Histológicamente predominó la variante intermedia. La inmunohistoquímica fue positiva en los tres. Un paciente falleció a los 10 meses. Conclusiones: los resultados concuerdan con los informados en la literatura. El carcinoma de células de Merkel es raro, habitualmente es diagnosticado tardíamente y su pronóstico es malo.

Application of colon capsule endoscopy (CCE) to evaluate the whole gastrointestinal tract: a comparative study of single-camera and dual-camera analysis.

BACKGROUND AND STUDY AIMS: Colon capsule endoscopy (CCE) was developed for the evaluation of colorectal pathology. In this study, our aim was to assess if a dual-camera analysis using CCE allows better evaluation of the whole gastrointestinal (GI) tract compared to a single-camera analysis. PATIENTS AND METHODS: We included 21 patients (12 males, mean age 56.20 years) submitted for a CCE examination. After standard colon preparation, the colon capsule endoscope (PillCam Colon™) was swallowed after reinitiation from its "sleep" mode. Four physicians performed the analysis: two reviewed both video streams at the same time (dual-camera analysis); one analyzed images from one side of the device ("camera 1"); and the other reviewed the opposite side ("camera 2"). We compared numbers of findings from different parts of the entire GI tract and level of agreement among reviewers. RESULTS: A complete evaluation of the GI tract was possible in all patients. Dual-camera analysis provided 16% and 5% more findings compared to camera 1 and camera 2 analysis, respectively. Overall agreement was 62.7% (kappa = 0.44, 95% CI: 0.373-0.510). Esophageal (kappa = 0.611) and colorectal (kappa = 0.595) findings had a good level of agreement, while small bowel (kappa = 0.405) showed moderate agreement. CONCLUSION: The use of dual-camera analysis with CCE for the evaluation of the GI tract is feasible and detects more abnormalities when compared with single-camera analysis.

[Mirizzi syndrome: experience at Spanish Hospital of Veracruz]. / Síndrome de Mirizzi. Experiencia del Hospital Español de Veracruz.

BACKGROUND: Mirizzi syndrome is a complication of gallbladder stones impacted in Hartmann's pouch or cystic duct with compression of the bile duct. The diagnosis is made by imaging studies, although most of them are found through intraoperative surgical findings. Treatment is cholecystectomy and bile duct restoration when needed. OBJECTIVE: to analyze a series of cases of Mirizzi syndrome and compare the results with those published in the literature. CLINICAL CASE: We report 4 cases with Mirizzi syndrome in a cohort of 1,034 cases studied in the Hospital Español of Veracruz over 21 years. RESULTS: In our series the frequency of Mirizzi syndrome was 0.38%, the average age was 32.1 ± 58.4 years, 50% were male gender and 25% had jaundice with a demonstrable liver profile. In 1 case, ultrasound suggested Mirizzi syndrome and percutaneous cholangiography and computed tomography confirmed the diagnosis. All patients underwent laparoscopic cholecystectomy, and 2 transcystic cholangiographies were performed. One case was classified as Type I-A and three as type I-B. (Beltran and Csendes). The postoperative evolution was satisfactory in all and no mortality was presented. CONCLUSIONS: Mirizzi syndrome should be suspected in patients with gallstones who develop obstructive jaundice and it must be confirmed with imaging studies. The surgeon must take extreme precautions to avoid accidental injury to the bile ducts.

Antecedentes: el síndrome de Mirizzi es una complicación de la litiasis vesicular por cálculos impactados en la bolsa de Hartmann o conducto cístico que comprimen la vía biliar principal; el diagnóstico se establece mediante estudios de imagen, aunque la mayor parte son hallazgos transoperatorios; su tratamiento es la colecistectomía con restauración de la vía biliar. Objetivo: analizar una serie de casos de síndrome de Mirizzi y comparar los resultados con lo publicado en la bibliografía mundial. Casos clínicos: se comunican cuatro casos con síndrome de Mirizzi de una cohorte de 1,034 casos con enfermedad litiásica vesicular del Hospital Español de Veracruz, en 21 años. La frecuencia en esta muestra es de 0.38%, con edad promedio de 32.1 ± 58.4 años; 50% son hombres y 25% tuvo ictericia y coluria con perfil hepático demostrativo. En un caso el ultrasonido sugirió síndrome de Mirizzi; el diagnóstico se corroboró por colangiografía percutánea y tomografía computada. A todos los pacientes se les realizó colecistectomía laparoscópica, y en dos se efectuó colangiografía transcística. Un caso correspondió al tipo I-A y 3 al tipo I-B según la Clasificación de Beltrán y Csendes. La evolución postoperatoria fue satisfactoria y no hubo mortalidad. Conclusiones: el síndrome de Mirizzi debe sospecharse en pacientes con litiasis vesicular con ictericia obstructiva. El cirujano debe extremar las precauciones para evitar lesionar la vía biliar.

Nuevos paradigmas en el manejo de la apendicitis / New paradigms in the management of appendicitis

Objetivo: Analizar y comparar los resultados obtenidos con las diferentes técnicas quirúrgicas que existen y el manejo conservador de la apendicitis. Sede: Instituto de Investigaciones Médico-Biológicas y Facultad de Medicina de la Universidad Veracruzana. Diseño: Revisión de la literatura. Material y métodos: Se procedió a la revisión bibliográfica de los principales artículos científicos publicados en los últimos 6 años, así como las bases de datos en las fuentes electrónicas de las bibliotecas EBSCOhost, Cochrane y UpToDate. Se analiza y presenta toda la literatura crítica sobre el tratamiento de la apendicitis complicada y no complicada por medio de cirugía convencional, cirugía laparoscópica, NOTES®, cirugía a través de un solo puerto, manejo médico y/o manejo conservador, publicadas entre los años 1996 y 2012. Resultados: La apendicetomía convencional ha sido durante muchos años el estándar de oro para su manejo. En 1982, se introdujo el abordaje laparoscópico que ha demostrado ser tan seguro y eficiente como la cirugía convencional; posteriormente, en 2004, se introdujo la cirugía endoscópica a través de orificios naturales (NOTES®), y en 2007, la cirugía a través de un solo puerto. Recientemente, han aparecido publicaciones sobre su manejo conservador con cirugía de intervalo, lo cual evita un gran número de intervenciones innecesarias con morbimortalidad, comparables a los pacientes sometidos a cirugía en forma urgente. Conclusiones: La apendicetomía continúa siendo el estándar de oro del manejo de la apendicitis aguda; sin embargo, han surgido alternativas de manejo diferentes al criterio quirúrgico tradicional, las cuales han demostrado ser útiles y permiten disminuir la cirugía innecesaria, sin incremento de la morbimortalidad.

Objective: To analyze and compare the results obtained with the diverse surgical techniques currently in use and the conservative management of appendicitis. Setting: Institute of Medical Biological Research and School of Medicine of the University of Veracruz, Mexico. Design: Review of the literature. Material and methods: We performed a bibliographical review of the main scientific articles published in the last 6 years, as well as of the databases contained in the EBSCOhost, Cochrane and UpToDate electronic libraries. We analyze and present critical literature on the management of complicated and non-complicated appendicitis by means of conventional surgery, laparoscopic surgery, NOTES® surgery, one-port surgery, medical handling and/or conservative management, published between 1996 and 2012. Results: Conventional appendicectomy has been for many years the gold standard for its management. In 1982, the laparoscopic approach was introduced and has shown to be as safe and efficient as conventional surgery; later on, in 2004, the natural orifice transluminal endoscopic surgery (NOTES®) was introduced, and surgery through only one port was introduced in 2007. Recently, reports on the conservative management with interval surgery have been published, which avoids a large number of unnecessary intervention with morbidity and mortality comparable to that of patients subjected to emergency surgery. Conclusions: Appendicectomy remains the gold standard for the management of acute appendicitis; however, alternatives have arisen for a different management to that of the traditional surgical criterion, which have demonstrated to be useful and have allowed diminishing unnecessary surgeries, without increasing morbidity and mortality.

Heller myotomy and laparoscopic fundoplication in achalasia. A retrospective experience.

BACKGROUND: Laparoscopic myotomy associated with fundoplication is a useful therapeutic resource for the treatment of achalasia. The aim of the study was to analyze the outcomes of the surgical treatment of achalasia in a group of patients treated at the Hospital Naval de la Secretaría de Marina and at the Hospital Español in Veracruz during a 6-year period. METHODS: Eleven patients were submitted to myotomy and fundoplication. Variables analyzed were age, gender, symptom duration, surgical complications, surgical time, day/stay, and postoperative morbidity. RESULTS: Mean age was 41.7 years ± 7.69 years; 63.64% of the patients were male and 36.36% were female. Average time from symptom onset was 2.5 ± 1.38 years. All patients had received previous unsuccessful medical and endoscopic treatment. Diagnosis was confirmed by esophagogram, endoscopy and manometry. All patients underwent Heller myotomy and fundoplication. Operative time was 140.4 ± 26.2 min. Average days/stay was 3.7 ± 1.4 days. Postoperative course was satisfactory in all patients and there was no perioperative mortality. Average follow-up was 3.8 ± 2.3 years. CONCLUSIONS: In our group, laparoscopic myotomy with fundoplication was a safe procedure offering excellent results comparable with those published in the literature. There is controversy about the type of fundoplication; therefore, the choice is at the discretion of the surgeon.

Enfermedad diverticular complicada: Manejo quirúrgico en el Hospital Español de Veracruz / Complicated diverticular disease: Surgical management at the Hospital Español de Veracruz

Objetivo: Evaluar los resultados del tratamiento quirúrgico de pacientes con enfermedad diverticular complicada en un periodo de 9 años. Sede: Hospital Español de Veracruz (tercer nivel de atención). Diseño: Observacional, descriptivo, transversal, retrospectivo. Análisis estadístico: Medidas de frecuencia relativa y tendencia central. Pacientes y métodos: Estudio de 41 pacientes operados por enfermedad diverticular del colon complicada. Variables analizadas: Características sociodemográficas, factores de riesgo, indicaciones quirúrgicas, técnica quirúrgica empleada, complicaciones y evolución postoperatoria. Resultados: La edad promedio fue 66 ± 12.3 años, con predominio del género femenino (51.22%). Las principales indicaciones quirúrgicas fueron: perforación (43.90%), diverticulitis de repetición (21.95%), hemorragia (19.51%), fístula de colon a vejiga y vagina (9.76%) y obstrucción (4.88%). La obesidad fue el factor de riesgo más frecuente (24.39%). En el 56.10% de los casos la cirugía fue electiva. En el 92.69% se efectuó resección primaria con anastomosis y en 7.31% procedimiento de Hartmann. La evolución de los pacientes fue satisfactoria en el 78.05%. La mortalidad del grupo fue de 2.44%. Conclusiones: La experiencia de nuestro grupo en el manejo de la enfermedad diverticular complicada revela una elevada morbilidad, con mortalidad similar a la reportada en la literatura mundial. Es recomendable que el manejo sea realizado por cirujanos expertos y en hospitales de concentración.

Objective: To assess the results of surgical treatment of patients with complicated diverticular disease in a 9-year period. Setting: Hospital Español de Veracruz (third level health care). Design: Observational, descriptive, cross-sectional, retrospective study. Statistical analysis: Relative frequency and central tendency measures. Patients and methods: We studied 41 patients with complicated colonic diverticular disease. Analyzed variables were: sociodemographic characteristics, risk factors, surgical indications, surgical technique used, complications, and postoperative evolution. Results: Average age was of 66 ± 12.3 years, predominating women (51.22%). The main surgical indications were: perforation (43.90%), recurring diverticulitis (21.95%), hemorrhage (19.51%), colon fistula toward the bladder and vagina (9.76%), and obstruction (4.88%). Obesity was the most frequent risk factor (24.39%). Surgery was elective in 56.10% cases. Primary resection with anastomoses was performed in 92.69% of the cases and Hartman's procedure in 7.31%. Evolution of patients was satisfactory in 78.05%, and mortality in the group was of 2.44%. Conclusions: Our experience in the management of complicated diverticular disease reveals a high morbidity, with mortality similar to that reported in the worldwide literature. It is advisable that management be performed by experienced surgeons and at concentration hospitals.

Routine liver biopsy to screen for nonalcoholic fatty liver disease (NAFLD) during cholecystectomy for gallstone disease: is it justified?

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) share common risk factors. There are no firm recommendations regarding screening of NAFLD in patients at risk. Our aim was to assess the prevalence of and factors associated with NAFLD in a cohort of patients operated for symptomatic GD and evaluate the usefulness of routine liver biopsy. METHODS: Ninety-five consecutive patients underwent a liver biopsy at the end of a standard laparoscopic cholecystectomy for symptomatic GD. Clinical, biochemical, demographic, and anthropometric variables were obtained prospectively. RESULTS: Fifty-two patients (55%) had biopsies compatible with NAFLD. These patients were classified according to the system proposed by Brunt et al. as follows: grade I, n = 27 (52%); grade II, n = 15 (29%); grade III, n = 10 (19%). Two grade III patients had zone III focal perisinusoidal fibrosis and three had overt cirrhosis. Only 13% of subjects had a suspected diagnosis of NAFLD preoperatively. In multivariate logistic regression, only obesity was significantly associated with NAFLD. There were no complications or mortality. DISCUSSION: Fifty-five percent of patients with GD have associated NAFLD. Awareness of this association may result in an earlier diagnosis. The high prevalence of NAFLD in patients with GD may justify routine liver biopsy during cholecystectomy to establish the diagnosis, stage, and possible direct therapy.

[Frequency and clinical, biochemical and histological characteristics of nonalcoholic fatty liver disease in patients with gallstone disease]. / Frecuencia y características clínicas, bioquímicas e histológicas del hígado graso no alcohólico en pacientes con enfermedad litiásica vesicular.

BACKGROUND: In 1980, nonalcoholic fatty liver disease (NALFD) was described. It is related to the genesis of gallstones and is considered as a manifestation of the metabolic syndrome. In order to determine the frequency, anatomoclinical characteristics and biochemical and histological alterations in NAFLD, patients underwent cholecystectomy (GD). For this reason, we considered carrying out this study. METHODS: This was a prospective and observational study. The study population was comprised of patients with gallstone disease who were treated at the "Hospital Español" in Veracruz, Mexico from January 1, 2005 to November 30, 2006 and underwent cholecystectomy and liver biopsy. Analyzed variables were anthropometric characteristics and risk factors, and in each patient biochemical tests, abdominal ultrasound (US) and histological liver study were performed. RESULTS: In 95 patients, according to liver biopsy diagnoses, we found a frequency of 54.74% of NAFLD associated with gallstones. Females were more affected (71.15%) and the average age was 55.6 +/- 17.87 years. Risk factors were obesity (67.3%), diabetes mellitus (17.3%), and dyslipidemia (76.92%). Patients with NAFLD had elevated levels of glucose, glycosylated hemoglobin, cholesterol, triglycerides and HDLcholesterol, and aminotransferases. Abdominal US did not show sufficient specificity and sensitivity to detect NAFLD. Histological findings showed stage I steatosis in 51.93%, stage II in 28.84% and stage III in 19.23%. Cirrhosis was found in 3.15%. DISCUSSION: Results of our study confirm the high frequency of NAFLD in association with gallstone disease. We consider this the first work to analyze and describe the primary clinical, biochemical and morphological characteristics.

Frecuencia y características clínicas, bioquímicas e histológicas del hígado graso no alcohólico en pacientes con enfermedad litiásica vesicular / Frequency and clinical, biochemical and histological characteristics of nonalcoholic fatty liver disease in patients with gallstone disease

BACKGROUND: In 1980, nonalcoholic fatty liver disease (NALFD) was described. It is related to the genesis of gallstones and is considered as a manifestation of the metabolic syndrome. In order to determine the frequency, anatomoclinical characteristics and biochemical and histological alterations in NAFLD, patients underwent cholecystectomy (GD). For this reason, we considered carrying out this study. METHODS: This was a prospective and observational study. The study population was comprised of patients with gallstone disease who were treated at the [quot ]Hospital Español[quot ] in Veracruz, Mexico from January 1, 2005 to November 30, 2006 and underwent cholecystectomy and liver biopsy. Analyzed variables were anthropometric characteristics and risk factors, and in each patient biochemical tests, abdominal ultrasound (US) and histological liver study were performed. RESULTS: In 95 patients, according to liver biopsy diagnoses, we found a frequency of 54.74% of NAFLD associated with gallstones. Females were more affected (71.15%) and the average age was 55.6 +/- 17.87 years. Risk factors were obesity (67.3%), diabetes mellitus (17.3%), and dyslipidemia (76.92%). Patients with NAFLD had elevated levels of glucose, glycosylated hemoglobin, cholesterol, triglycerides and HDLcholesterol, and aminotransferases. Abdominal US did not show sufficient specificity and sensitivity to detect NAFLD. Histological findings showed stage I steatosis in 51.93%, stage II in 28.84% and stage III in 19.23%. Cirrhosis was found in 3.15%. DISCUSSION: Results of our study confirm the high frequency of NAFLD in association with gallstone disease. We consider this the first work to analyze and describe the primary clinical, biochemical and morphological characteristics.