Acta Gastroenterologica Latinoamericana最新文献

Introduction: The prevalence of chronic atrophic gastritis and intestinal metaplasia based on samples from third-level hospitals, may overestimate their frequency.

Objetive: To estimate the frequency of premalignant histological lesions of the stomach in a second-level hospital.

Material and methods: Observational, retrospective, descriptive, cross-sectional, epidemiological study. It was conducted with patients who had already undergone diagnostic upper digestive endoscopy, regardless of the clinical reason. Patients with gastrointestinal bleeding, tumors or without biopsy were excluded.

Results: A total of 4454 cases were reviewed, of which 115 (2.6%, CI 2.2 - 3.1) had chronic atrophic gastritis. Compared to non-atrophic gastritis, the presence of chronic atrophic gastritis was more frequent in older adults (43.5% vs. 24.9%; p < 001) and in those with dyspepsia symptoms (35.7% vs. 19.9%; p < 0.001); and less frequent in economically active population (47.8% vs. 64.9%; p < 0.001). Among patients with chronic atrophic gastritis, nearly twice as many tested positive for Helicobacter pylori (47.8% vs. 25.6%; p < 0.001). Helicobacter pylori infection nearly tripled the risk of developing chronic atrophic gastritis (Odds Ratio 2.65; p < 0.001).

Conclusion: In a second-level hospital, the prevalence of premalignant histological lesions is significantly lower than that reported by local studies conducted in third-level hospitals. The presence of chronic atrophic gastritis was associated with older age, indication for upper digestive endoscopy for dyspepsia, and Helicobacter pylori infection; while the indication for regurgitation was associated with its absence.

Introduction: Annular pancreas is a rare congenital anomaly detected after the development of complications or as an incidental finding. Its diagnosis and treatment are controversial.

Case presentation: A 44-year-old woman with chronic episodes of mild epigastric pain, nausea and emesis, with increasing frequency over the past two months. An abdominal ultrasound showed a distended gallbladder without stones, and dilated extrahepatic bile ducts. An endoscopic retrograde cholangiopancreatography was performed, revealing a circumferential pancreatic duct in the head of the pancreas surrounding the second part of the duodenum. By injecting contrast medium through the major papilla, its drainage was observed through a second, adjacent pore. Suspecting annular pancreas, magnetic resonance cholangiopancreatography was performed, showing a complete annular pancreatic duct. In the presence of recurrent symptoms of abdominal pain, the patient was referred to hepatobiliary surgery for definitive surgical management.

Conclusions: Annular pancreas is a diagnosis to be considered in adults in case of epigastric pain associated with non-specific symptoms. Advances in imaging methods make its diagnosis timely. Despite the lack of guidelines on treatment, this must be individualized on a case-by-case basis.

The use of gastric emptying scintigraphy is the gold standard in clinical practice for evaluating gastric motility and confirming the diagnosis of gastroparesis. It provides physiologic information, allows quantification of findings, and is a non-invasive method. In addition, it can be repeated over time to assess therapeutic response. In the same way, the esophagus, small intestine and colon can be evaluated by nuclear medicine.

Introduction: Dyssynergic defecation is a functional disorder characterized by a lack of coordination between abdominal contractions and the relaxation of the anal sphincter, leading to chronic constipation. The main symptoms include a sensation of incomplete evacuation and excessive defecatory effort. Diagnosis requires excluding organic causes and evaluating alarm symptoms through digital rectal examination, high-resolution anorectal manometry, and balloon expulsion tests. Dyssynergic defecation is classified into four subtypes based on the manometric mechanisms involved.

Objective: To describe the clinical and manometric characteristics of patients suspected of having dyssynergic defecation and estimate the proportions of the different subtypes.

Materials and methods: Observational, descriptive, and retrospective study of 170 patients over 18 years of age diagnosed with dyssynergic defecation, evaluated at Hospital de Clínicas José de San Martín. High-resolution anorectal manometry was performed with a 12- circumferentially-oriented pressure sensors catheter and a balloon expulsion test. Manometric patterns were classified into four subtypes based on defecatory effort and sphincter relaxation.

Results: The average age was 59.3 years (SD 15.7), and 80.6% of the patients were women. The distribution of the subtypes was as follows: type I (31.2%), type II (17%), type III (22.9%), and type IV (28.8%). No significant differences were found in age distribution (p = 0.558). Type IV dyssynergia had the highest proportion of women (95.9%, p = 0.015). The presence of symptoms such as incomplete evacuation, defecatory effort, and digitations varied between subtypes, but no statistically significant differences were found.

Conclusion: The study confirms the clinical and manometric heterogeneity of patients with dyssynergic defecation. While some subtypes show a higher association with certain symptoms, the lack of significant differences suggests that other factors might influence the clinical presentation. High-resolution anorectal manometry remains key in the evaluation and classification of dyssynergic defecation.

Congenital anomalies of the pancreas result from failure of proper migration and/or fusion during embryologic development. They are usually diagnosed in adulthood, incidentally in imaging studies performed for other reasons. Some patients may develop symptoms such as abdominal pain or even relevant clinical conditions including gastric outflow tract obstruction, acute and recurrent pancreatitis. In this article we will review the imaging features of the most important congenital pancreatic anomalies, with emphasis on magnetic resonance cholangiopancreatography.

Intestinal malrotation is a rare congenital anomaly that occurs in approximately one in 500 to 6,000 live births and is characterized by abnormal rotation of the intestine during fetal development. Intestinal malrotation in adults is rare, occurring in only 0.17% of CT scans performed in this age group. The occurrence of colon cancer in a patient with intestinal malrotation raises important difficulties and technical factors to consider when diagnosing and treating colon cancer.