Esophageal motor disorders in subjects with incidentally discovered Chagas disease: a study using high-resolution manometry and the Chicago classification.

In patients with chronic indeterminate Chagas disease, conventional manometry has shown that 25-48% had esophageal motor disorders. Recently, esophageal high-resolution manometry (HRM) has revolutionized the assessment of esophageal motor function. In this study, we performed esophageal HRM in a group of subjects with incidentally positive serological findings for Trypanosoma cruzi. In this prospective observational study, we evaluated subjects who had positive serological tests for Chagas disease detected during a screening evaluation for blood donation. All subjects underwent symptomatic evaluation and esophageal HRM with a 36 solid-state catheter. Esophageal abnormalities were classified using the Chicago classification. Forty-two healthy subjects (38 males) aged 18-61 years (mean age, 40.7 years) were included. When specific symptoms questionnaire was applied, 14 (33%) subjects had esophageal symptoms. Esophageal high-resolution manometry revealed that 28 (66%) of the subjects had an esophageal motility disorder according to the Chicago classification. Most common findings were hypocontractile disorders in 18 subjects (43%) and esophagogastric junction (EGJ) outflow obstruction in 6 (15%). Esophageal high-resolution manometry reveals that up to two thirds of the subjects with an incidental diagnosis of Chagas disease have esophageal abnormalities. This technology increases the detection and allows a more complete assessment of esophageal motor function in subjects infected with T. cruzi even in the early stages of the disease.

[Comparative analysis between breath test, serological immunoassay and rapid-urease test for detection of Helicobacter pylori infection in Mexican patients with non-investigated dyspepsia]. / Un análisis comparativo entre prueba de aliento, serología y prueba de ureasa rápida para la detección de infección por Helicobacter pylori en pacientes mexicanos con dispepsia no investigada.

INTRODUCTION: There are multiple Helicobacter pylori (Hp) detection tests, some are invasive and other noninvasive. The diagnostic accuracy of these methods varies according to the prevalence of the disease. OBJECTIVE: To determine the diagnostic accuracy of the breath test, serology and rapid urease test, considering gastric biopsy with Giemsa stain as the gold standard in Hp-infected subjects with uninvestigated dyspepsia. METHODS: Eighty four subjects (64 women, mean age 45 years) who were referred for dyspeptic symptoms were evaluated. Also, 20 healthy volunteers (12 men, average age 38 years) were evaluated. All the subjects underwent hystological analysis with Giemsa stain, breath test (Heliprobe®), rapid urease test (CLOtest®) and serological immunoassay (Hexagon®). RESULTS: Overall, Hp infection was diagnosed by histological analysis in 59 subjects (49 patients and 10 healthy subjects). Positivity to breath test, rapid urease test and serology were 56%, 46% and 44% respectively. Agreement with the histological analysis was 0.902 for the breath test, 0.620 for rapid urease test and 0.45 for serology. The area under the curve for the breath test was 0.95, for the rapid urease test was 0.82 and for serological test was 0.74. CONCLUSIONS: In our population, the breath test shown to have a diagnostic accuracy equivalent to histological analysis by Giemsa in subjects with uninvestigated dyspepsia.

[What people mean by constipation? A general population based-study.]. / ¿Qué se entiende por estreñimiento? Un estudio en población abierta.

INTRODUCTION: The word "constipation" is used by people to refer multiple symptoms such as infrequent stools, hard stools, excessive straining and feeling of incomplete evacuation. This variability is a confounding factor and may induce discrepancies between doctors and patients. AIM: to evaluate among the general population of 6 different cities of Mexico, what is meant by constipation. MATERIAL AND METHODS: A cross-sectional study was performed in the cities of Veracruz, Tampico, Tuxtepec, Colima, Puebla and San Luis Potosi (representing 4 geographical areas of Mexico). All subjects answer a questionnaire that assesses self-perception of constipation with the question: Do you consider yourself constipated? Frequency and stool form (Bristol), symptoms and associated factors to constipation were also evaluated. Rome III criteria for functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) were applied. RESULTS: One thousand and forty one subjects were evaluated (mean age 35 +/- 15 years), 657 (63%) women. In our study, 87% (n = 907) had a bowel movement at least every 48 hours and most of them (67%) have stools type 3-4. Thirty four percent (n = 356) of subjects considered to have constipation, of whom 73 (21%) met criteria for FC, 65 (18%) for IBS-C and 218 subjects (61%) did not meet diagnostic criteria. The symptom that best defines constipation was straining (47%). Correlation and concordance between self-perception and the Rome criteria was 0.14 (p = 0.61). CONCLUSIONS: In our population, 61% of subjects who perceived symptoms of constipation are not really constipated according to the criteria of Rome.