Acta Gastroenterologica Latinoamericana最新文献

Introduction: Colorectal cancer is one of the most frequent neoplasms and a serious public health concern worldwide. In 2020, in Argentina, 15,605 new cases of colorectal cancer were registered and, in 2022, 7,217 deaths representing 12% of all deaths from malignant tumors. The National Program for the Prevention and Early Detection of Colorectal Cancer recommends that people between 50 and 75 years of age with no personal or family history of colorectal cancer, no history of inflammatory bowel disease, no suggestive symptoms, and no known risk factors should undergo biennial immunological fecal occult blood test. For at-risk groups, specific evaluations are performed based on their specific needs. A positive result of the immunologic fecal occult blood test requires a colonoscopy, the most sensitive test for early detection.

Aim: To assess the rate of TSOMF-I with a positive result. To describe the percentage of patients who undergo VCC after a positive TSOMF-I result. To assess the adenoma detection rate and prevalence of CRC in patients with TSOMF-I-positive.

Materials and methods: A retrospective analysis was perfomedr, in which data were collected from individuals between 50 and 75 years of age with positive immunologic fecal occult blood test and colonoscopies performed at Hospital Pirovano, Ciudad Autónoma de Buenos Aires, from January 1, 2020 to January 1, 2024.

Results: A total of 717 patients were evaluated. A positive result on immunologic fecal occult blood test was observed in 21.6% (n=155) of the cohort, but only 42.6% (n=66) underwent colonoscopy. Findings were identified in 80% of cases, predominantly polyps (36.4%), internal hemorrhoids (34.8%), diverticulosis (18.1%) and angiectasis (4.5%). The prevalence of colorectal cancer was 3%, with an adenoma detection rate of 33.3%.

Conclusion: This study showed a high prevalence of colorectal lesions, including adenomas and colorectal cancer, with figures that resemble those published by other international studies. The results obtained reflect the efficacy of immunological fecal occult blood test screening to identify relevant colorectal lesions. A key finding was that less than half of the patients with positive immunological faecal occult blood test underwent subsequent colonoscopy, which indicates the existence of important barriers to access to this study in our setting and reinforces the need to implement strategies to increase it. These findings are crucial to optimize colorectal cancer screening programs in Argentina, adapting them to the needs of the local population and improving public health outcomes.

Ulcerative colitis is a chronic inflammatory disease that can present with varying degrees of severity. The severe acute form occurs in up to 25% of patients, and its diagnosis is important for timely treatment and detection of complications. To date, clinical practice guidelines suggest first-line treatment with corticosteroids, second-line treatment with infliximab or cyclosporine, and surgical resolution in case of therapeutic failure. We present the clinical case of a 22-year-old female patient with severe acute ulcerative colitis as disease debut, refractory to treatment with corticosteroids and infliximab, who was treated with tofacitinib as rescue therapy.

Introduction: The breath test is currently the most widely used tool for diagnosing small intestinal bacterial overgrowth. The rising prevalence of this condition has led to increased test utilization. However, concerns remain regarding its im plementation, including adherence to international guidelines related to methodology, diagnostic interpretation, and report quality.

Aim: To assess the methodology, report quality, and diagnostic accuracy of breath tests for small intestinal bacterial overgrowth in Argentina, based on international guidelines.

Material and methods: A multicenter observational study included 210 breath test reports from 8 centers across differ ent geographic regions of Argentina. The methodology used for test performance and report quality was evaluated based on 13 predefined criteria. Additionally, the concordance between the diagnoses reported by centers and those determined by an expert based on international guidelines was analyzed.

Results: Significant heterogeneity in methodology and low ad herence to international guidelines were observed. Among the studies, 89% measured only H₂, while 11% included CH₄. Combined sampling intervals were used in 53%, and only 19% reached 180 minutes, with nearly 20% classified as in complete: only 10% specified diagnostic thresholds, and just 4% aligned with current guidelines. Diagnostic concordance was 87% for small intestinal bacterial overgrowth and 73% for intestinal methanogen overgrowth, with an average of 5 out of 13 quality criteria met.

Conclusions: This study underscores the need to standardize breath test methodology and enhance adherence to international guidelines. Efforts should focus on improving report quality, unifying methodology, and increasing diagnostic accuracy for small intestinal bacterial overgrowth in Argentina.

Introduction: Intestinal ganglioneuromatosis is a rare benign neoplastic disease. It is usually described in children, in association with multiple endocrine neoplasia type 2b and neurofibromatosis type 1. Ganglioneuromatosis is rare in adults, where it usually occurs sporadically and in isolation.

Case report: We present a patient with intestinal ganglioneuromatosis in whom the initial clinical and radiographic findings simulated Crohn's disease. A small bowel resection was performed due to endoscopic capsule occlusion. The immunohistochemical study of the resected segment suggested the diagnosis of small bowel ganglioneuroma.

Conclusion: The clinical presentation of intestinal ganglioneuromatosis is variable. The patient may be oligosymptomatic or have an atypical presentation. This diagnosis should be considered when the most common causes of iron deficiency anemia have been excluded. Definitive diagnosis is possible after resection and pathologic analysis of the segment involved.

Gastric cancer is a multifactorial disease, and chronic Helicobacter pylori infection is one of its main causes. It receives little attention in the West, with few preventive policies, especially in countries such as Argentina, which is considered 'low risk.' But both in Argentina and in the United States, the population is heterogeneous, with permanent immigration from countries with high or intermediate risk, with the highest susceptibility in the male population. It is estimated that the incidence will increase due to the aging of the population. In recent years, new evidence for its prevention has emerged. The main strategy for primary prevention is the eradication of Helicobacter pylori, while secondary prevention for heterogeneous countries such as Argentina is based on the identification of risk groups, particularly those with the so-called precursor lesions of gastric cancer. This narrative review explores all these strategies with a 'strong bias' towards the situation in Argentina, Chile and Latin America.

Dysphagia is the sensation of difficulty in the passage of swallowed material from the mouth to the stomac, and is a common symptom in adults. It can indicate a variety of conditions, ranging from severe etiologies to oropharyngeal dysfunctions that carry a risk of aspiration. Esophageal dysphagia is specifically related to disorders affecting the passage of the bolus through the esophagus, which may be caused by structural abnormalities or motility problems. To address esophageal dysphagia, study methods include upper digestive videoendoscopy and esophageal barium transit, the former being the recommended initial study. High-resolution esophageal manometry is essential for evaluating motility disorders, with the Chicago Classification (CCv4.0) used to categorize these disorders. Although high-resolution manometry is the gold standard, additional studies may be required if the results are uncertain. EndoFLIP has recently enabled more precise assessment of the esophageal function and the esophagogastric junction, providing three-dimensional information about the esophageal lumen, measuring areas and distensibility, which is useful for diagnosing disorders such as non-obstructive esophageal dysphagia and assessing the efficacy of treatments in the postoperative period. In the following work, we describe our preliminary experience in the use of this technology through a case series.

Introduction: The use of sedation in digestive endoscopy, particularly in endoscopic retrograde cholangiopancreatography, improves patient tolerance to the procedure and facilitate optimal endoscopic examination conditions, thereby achieving the desired diagnostic and therapeutic effect. Fentanyl and diazepam have been used for years as intravenous medication for upper gastrointestinal endoscopy.

Objective: To evaluate the safety of sedation with diazepam and fentanyl, under the supervision of endoscopists, during endoscopic retrograde cholangiopancreatography.

Material and methods: Descriptive, cross-sectional and prospective study conducted in patients who underwent endoscopic retrograde cholangiopancreatography under sedation with diazepam (5 to 15 mg) and fentanyl (25 to 50 µg) between July 2014 and June 2024. Oxygen saturation, blood pressure and heart rate were monitored to determine the occurrence of adverse events attributable to sedation.

Results: 12,686 patients were studied with an average age of 52.5 years. Hypoxemia was the most frequent complication (85 patients, 0.7%), followed by bradycardia (54 patients,0.4%) and arterial hypotension (41 patients, 0.3%).

Conclusions: Diazepam and fentanyl, administered by trained endoscopist physician and nurse, represent a safe anesthetic alternative for endoscopic retrograde cholangiopancreatography. It allows procedures to be performed outside the operating room, thereby reducing costs.

Introduction: An endoscope is a flexible tube equipped with a camera and a light used for the diagnosis and treatment of digestive pathologies. Although healthcare-associated infections are uncommon, they represent a significant concern. Proper endoscope reprocessing is essential to prevent infections, requiring adherence to established guidelines for cleaning, disinfection, and storage.

Objetive: To compare the effectiveness of manual and automated reprocessing of video gastroscopes and colonoscopes through microbiological monitoring of the following microorganisms: ESBL Escherichia coli, Shigella spp., Salmonella spp., Pseudomonas aeruginosa, Klebsiella pneumoniae carbapenemase (KPC)-producing, and vancomycin-resistant Enterococcus spp.

Materials and methods: A prospective, observational, descriptive study was conducted, in which 207 reprocessing procedures of video gastroscopes and colonoscopes were selected for evaluation. Of these, 103 were manual and 104 were automated. The procedures were evaluated in both the preand post-processing stages. Cultures were performed to isolate ESBL Escherichia coli, Shigella spp., Salmonella spp., Pseudomonas aeruginosa, Klebsiella pneumoniae carbapenemase (KPC)-producing, and vancomycin-resistant Enterococcus spp.

Results: In the pre-reprocessing samples, ESBL Escherichia coli was isolated in 45% of cases, compared to 55% for manual and automated reprocessing, respectively. Similarly, Pseudomonas aeruginosa was isolated in 36% of cases for manual reprocessing and 18% for automated reprocessing. Salmonella spp. was isolated in 18% of cases for both manual and automated reprocessing. Finally, vancomycin-resistant Enterococcus spp. was isolated in 9% of automated reprocessing samples. The results of the manual post-processing demonstrated that 1% of the samples exhibited counts of 1,000-99,999 colony-forming units (CFU)/ ml, while 6% exhibited counts exceeding 100,000 CFU/ml. The automated method demonstrated a 7% prevalence of samples with over 100,000 colony-forming units (CFU) per milliliter. A comparison of the two modalities revealed that pathogens were not identified in seven of the 103 manual samples and six of the 104 automated samples. The only growth observed in the automated samples was that of coagulase-negative Staphylococcus, which is a potential contaminant. However, one automated sample did yield Salmonella spp.

Conclusion: The results obtained were comparable between the two methodologies. The automated reprocessing revealed the presence of an enteropathogen, which will allow for a reassessment of the reprocessing steps in order to enhance the efficacy of the procedures.

Autism spectrum disorders are a group of core neurodevelopmental disorders that include deficits in social interaction and communication, repetitive behaviors, and sensory disorders. There is an increased frequency of gastrointestinal disorders in children with autism spectrum disorders compared to the population of neurotypical children. The factors involved in this increase in frequency are genetic, associated with an imbalance in the intestinal microbiota and dysfunction of the immune system. The most frecuently observed gastrointestinal disorders in these patients are constipation, abdominal pain, nausea and vomiting, food selectivity or allergy problems, abdominal distension, flatulence, aerophagia, diarrhea, fecal incontinence, enuresis and soiling. Children with autism spectrum disorders often have selective and restricted eating habits, resulting in an unbalanced diet that lacks essential nutrients, which contributes to the development of gastrointestinal disorders. In addition, they often have alterations in sensory processing that affect the perception of digestive symptoms or signals. Understanding and treating gastrointestinal disorders in children with autism spectrum disorders can be challenging. These patients require a comprehensive evaluation by a multidisciplinary team that includes pediatricians, gastroenterologists, psychologists, nutritionists, occupational therapists, therapeutic companions, neurologists and teachers. Relief of gastrointestinal symptoms in patients with autism spectrum disorders can improve sleep, appetite and eating patterns, increase energy levels and contribute to an overall sense of well-being. This improves behavior, cognitive function, and educational skills.