Recurrence of Helicobacter pylori infection after several eradication therapies: long-term follow-up of 1000 patients.

AIM: To study the incidence of Helicobacter pylori recurrence, its chronological aspects, and the variables that might influence it. METHODS: A total of 1000 patients in whom H. pylori had been eradicated were prospectively studied. Therapies were classified as low and high efficacy regimens. Four to eight weeks after completion of therapy, 13C-urea-breath-test was performed, and it was repeated yearly up to 5 years. In some patients, endoscopy with biopsies was also performed to confirm H. pylori eradication. RESULTS: A total of 1000 patients were included, giving 2744 patient-years of follow-up. Seventy-one H. pylori recurrences were observed (2.6% per patient-year). Probability of being H. pylori-negative at 1 year was 94.7%, and at 5 years 90.7%. In the multivariate analysis, low age (OR: 1.84; 95% CI: 1.04-3.26) and low efficacy therapies (OR: 2.5; 1.23-5.04) correlated with 1-year H. pylori recurrence. Differences were observed when Kaplan-Meier curves were compared depending on age and therapy regimen. CONCLUSION: Risk of posteradication H. pylori recurrence is higher during the first year, which suggests that most recurrences during this period are recrudescence and not true reinfections. H. pylori recurrence is more frequent in younger patients and in those treated with low efficacy therapies, but is exceptional if high efficacy therapies are used, in which case post-therapy eradication can be safely confirmed at 4 weeks with 13C-urea-breath-test.

Metástasis hepáticas de melanoma uveal / Liver metastases from uveal melanoma

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Mujer joven con colestasis y ductopenia / No disponible

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Safe endoscopic resection of gangliocytic paraganglioma of the major duodenal papilla.

A case of gangliocytic paraganglioma of the papilla of Vater in a 76-year-old man with a history of recurrent obstructive jaundice is presented. This is the first case of gangliocytic paraganglioma of the major papilla successfully resected by endoscopic ampullectomy.

Autoimmune cholangitis, nosological location.

Autoimmune cholangitis is an entity with a controversial nosological location. It has been defined as a setting of autoimmune chronic cholestasis, clinically, biochemically and histologically resembling primary biliary cirrhosis, although with a different immunological profile. It lacks antimitochondrial antibodies and instead usually presents other autoimmunity features, basically positivity to antinuclear antibodies. In this article, we discuss its nosological location based on descriptions published on this entity and comparisons with primary biliary cirrhosis.

Poliposis de glándulas fúndicas: dos situaciones clínicas diferentes para una sola clase de pólipos / Fundic gland polyposis: two clinical settings for only one type of polyps

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Assessment of the usefulness of endoscopic signs in Helicobacter pylori associated gastritis.

OBJECTIVE: To determine whether endoscopic signs exist to establish the presence of Helicobacter pylori, which may be used markers of infection in the absence of gastroduodenal peptic lesions. METHODS: A prospective study was carried out in 150 consecutive patients, all symptomatic, who presented endoscopic evidence of gastritis and in whom the absence or presence of H. pylori was undetermined at the time of the study. A quantitative assessment was made of the three types of lesions previously associated with the presence of H. pylori on endoscopy: nodules, erosions, and red patches in the antrum. Biopsy samples were taken for the microbiological and histological studies; a positive result in either study was considered to indicate infection by H. pylori. RESULTS: Of the 150 patients studied, 115 (76%) presented H. pylori infection. No significant differences existed with respect to the clinical findings or the distribution according to sex. The mean age of infected patients was 49 years, being lower in the nodular group (p = 0.008) and higher in the group presenting erosions (p < 0.05); this fact suggests that the endoscopic findings may differ depending on the moment of infection. Evidence of antral nodules was observed in 15 patients, 11 of whom (73%) showed positively for H. pylori; the sensitivity was 9.5% and the positive predictive value was 0.73. Of the 17 patients presenting erosions, 16 were positive for H. pylori (93.8%); the sensitivity was 13% and the positive predictive value was 0.94. Red patches were detected in 63 patients, 48 of whom (76%) were positive for H. pylori; the sensitivity was 48% and the positive predictive value was 0.76. These three patterns did not coincide in any of the patients, for an overall sensitivity and specificity of 70.5% and 80.6%, respectively (p < 0.05). CONCLUSION: The sensitivity and specificity of the set of lesions assessed were high as no two overlapped; when the lesions were dealt with individually, however, the sensitivity was low, showing a low negative predictive value, making it necessary the use of standard detection measures, although in the presence of nodules and/ or erosions the existence of H. pylori infection is practically the norm.

[Eosinophilic cholecystitis: an infrequent cause of cholecystectomy]. / Colecistitis eosinofílica: una causa poco frecuente de colecistectomía.

Eosinophilic cholecystitis is a rare form of cholecystitis. Histologically, it is characterized by a dense, transmural leukocyte infiltrate composed of more than 90% eosinophils. The etiology remains obscure, although it had been associated with allergies, parasites, hypereosinophilic syndromes, eosinophilic gastroenteritis, cholelithiasis, and acalculous cholecystitis. Here we report an eosinophilic cholecystitis gallstone-associated case, the only one with this histopathologic diagnosis among 5,537 cholecystectomies made in our hospital in the last years.

[Direct percutaneous endoscopic jejunostomy, variation of the technique of gastrostomy]. / Yeyunostomía endoscópica percutánea directa, variación de la técnica de gastrostomía.

Percutaneous endoscopic gastrojejunostomy is a percutaneous endoscopic gastrostomy derived technique, that is widely employed. However it has a high incidence of mechanic complications. Percutaneous endoscopic jejunostomy direct access, improves these problems and allows to apply this technique in patients with previous gastric resection or with other gastric diseases that contraindicate percutaneous endoscopic gastrostomy. We describe, for the first time in our country, a direct percutaneous endoscopic jejunostomy placement.

Antimitochondrial antibody-negative chronic nonsuppurative destructive cholangitis. Atypical primary biliary cirrhosis or autoimmune cholangitis?

We investigated whether autoimmune cholangitis (AC) has specific features that constitute an entity other than primary biliary cirrhosis (PBC). We compared clinical, laboratory, and liver biopsy features; response to treatment; and the follow-up of two groups of patients. The first group comprised seven patients with AC criteria-PBC with negative antimitochondrial antibodies (AMAs) and positive antinuclear antibodies (ANAs)-termed the PBC AMA-negative group; the second was made up of another seven PBC patients with positive AMA, labeled the PBC AMA-positive group. We found that the PBC AMA-negative group had, besides negative AMAs and positive ANAs, a significantly higher incidence of asthenia, a higher and earlier incidence of liver failure, and higher ANA titers and serum immunoglobulin G levels than the PBC AMA-positive group. There were no significant differences in the other laboratory tests, although the PBC AMA-negative group showed higher serum bilirubin and aminotransferase and lower serum alkaline phosphatase and immunoglobulin M levels. Liver histological data were similar in both groups. Patients in the PBC AMA-negative group, with more markedly abnormal liver tests, responded to immunosuppressive therapy. We concluded that patients with criteria for PBC but with negative AMAs and positive ANAs have a few specific features that fall between PBC and autoimmune chronic hepatitis. This finding suggests that these patients have a different disease, for which autoimmune cholangitis seems to be an appropriate name.

[Systemic amyloidosis associated with common variable hypogammaglobulinemia and intestinal lymphoid nodular hyperplasia]. / Amiloidosis sistémica asociada a hipogammaglobulinemia común variable e hiperplasia nodular linfoide intestinal.

Common variable hypogammaglobulinemia syndrome with lymphoid nodular hyperplasia of the intestine forms part of the so-called hypogammaglobulinemic enteropathies. It is characterized by decreased serum immunoglobulins, recurrent respiratory tract infections and chronic diarrhea. The development of systemic amyloidosis is infrequent, but it can be explained by the multiple infections in this setting. The case of a 47-years old woman with hypogammaglobulinemic enteropathy, who developed systemic amyloidosis is presented. It was manifested as a nephrotic syndrome. The previously published reports include 12 cases of common variable hypogammaglobulinemia with systemic amyloidosis. Half of them presented nephrotic syndrome as a manifestation of their amyloidosis. It is important to keep in mind this complication in these patients' follow-up in order to increase the doses of gammaglobulin. That is the way to compensate their additional losses because of the nephrotic syndrome that they usually develop.