Acta Gastroenterologica Latinoamericana最新文献

Introduction: The response to proton pump inhibitor treatment in functional dyspepsia varies among patients. A decision tool that identifies the probability of response based on clinical data could optimize management in these patients.

Objective: To develop and internally validate an easy-to-use predictive model that enables clinicians to establish the probability of response to proton pump inhibitors in patients with functional dyspepsia.

Material and methods: We conducted a cross-sectional study on adults with functional dyspepsia. A pilot study identified variables related to response to proton pump inhibitors. Internal validation was performed by split-sample method, with 70% for model development and 30% for validation. We developed the model using multivariable logistic regression, and selected variables based on the best subset method. The final model was subsequently transformed into a scoring rule. Predictive ability was assessed using the area under the curve (AUC) and Hosmer-Lemeshow statistic.

Results: A total of 192 patients were included. The best subset identified 4 variables with the best performance. The logistic model showed good calibration and discrimination with an AUC of 0.89 and a Hosmer-Lemeshow chi-square test with p = 1. The scoring rule assigned the following values: anxiety symptoms (3 points), fibromyalgia (2 points), depression (1 point), and female sex (- 1 point). A total score of 4 points or less was associated with a good response to proton pump inhibitor treatment, with a sensitivity of 96.5% and specificity of 56.6%.

Conclusions: We present a novel tool that facilitates the early identification of patients with a better therapeutic response to the management of functional dyspepsia.

Colorectal anastomotic dehiscence is a serious post-surgical complication that significantly increases morbidity, mortality, length of hospital stay and medical care costs. Its frequency ranges from 4 to 26%. Risk factors include advanced age, malignancy, prolonged surgical time, preoperative radiation therapy, and perioperative blood loss or transfusion requeriments. Clinical manifestations can be varied, including the presence of abdominal pain or distension, leukocytosis, presence of pus, meteorism, fecal leakage through drains or the surgical incision, and in the most severe cases, peritonitis and sepsis with multi-organ failure. Early diagnosis is essentialand timely treatment will depend on its clinical repercussion. Rarely, they do not require active therapeutic intervention, but may delay ostomy closure. Most patients require antibiotic treatment, percutaneous or endoscopic drainage and, in cases of peritonitis and systemic inflammatory response syndrome, surgical intervention. Endoluminal vacuum therapy is a minimally invasive endoscopic technique that allows drainage and obliteration of the peri-anastomotic spaces with a success rate that varies from 75 to 97%, depending on early diagnosis. We describe the case of a 76-year-old female patient with a history of obesity and adenocarcinoma of the rectum who underwent a low colorectal anastomosis and creation of a protective ileostomy, which evolved with a symptomatic anastomotic leak that was successfully treated with endoscopic vacuum therapy.

Celiac disease is the most common cause of intestinal villous atrophy. It may present with a clinical course characterized by chronic diarrhea, malabsorption, and weight loss. Diagnosis is based on the presence of positive specific antibodies in serum, characteristic enteropathy, and the clinical and histological response to a gluten-free diet. However, in some cases, patients with villous atrophy who do not respond to the exclusion of gluten from the diet present a diagnostic and therapeutic challenge. It is essential to perform a differential diagnosis, as there are different pathologies that can mimic celiac disease. The association of celiac disease with other immune-mediated diseases is well known, including inflammatory bowel disease. It is also frequently associated with microscopic colitis, which may be a potential cause of persistent or recurrent symptoms. The clinical course of celiac disease may be complicated by the development of additional conditions such as microscopic colitis, refractory celiac disease or collagenous sprue. Collagenous sprue is a rare enteropathy affecting the small intestine, characterized by the presence of villous atrophy and a thick band of subepithelial collagen. It may be associated with gastritis and lymphocytic and/or collagenous colitis. The literature describes its association with other autoimmune diseases. Complications may include ulceration, perforation, and the development of intestinal lymphoma. Consequently, it has high morbidity and mortality, and a poor prognosis. Knowledge about the natural history, pathogenesis and clinical evolution of collagenous sprue is limited. Some recent publications describe a benign course with a good response to treatment with immunosuppressants. However, the coexistence of celiac disease, inflammatory bowel disease and collagenous sprue is rare, and is presented as isolated case reports.

Case report: We present the case of a 52-year-old male patient diagnosed with collagenous gastroenteritis associated with inflammatory bowel disease, with unfavorable evolution despite treatment.

Conclusion: The report of additional cases of association between collagenous sprue and inflammatory bowel disease could help improve the clinical management of these patients.

Ulcerative colitis is a type of inflammatory bowel disease, characterized by chronic mucosal inflammation that begins distally at the level of the rectum and extends proximally continuously. It is considered a high-risk condition for the development of colorectal cancer; therefore, surveillance colonoscopy is mandatory. We present the case of an 80-year-old patient with a diagnosis of extensive ulcerative colitis of 35 years of evolution. In surveillance colonoscopy, a non-granular pseudo-depressed lateral growth lesion measuring 30 mm in diameter, located in the middle rectum. Whence, an endoscopic submucosal dissection was performed to remove the lesion. The procedure was completed without complications. Endoscopic submucosal dissection is an advanced endoscopic technique, which allows complete and bloc resection of lesions at risk of superficial submucosal invasion, even in those with a high probability of submucosal fibrosis.

Anal pathologies represent a common reason for consultation in general and specialized medical practice, often misinterpreted by patients as hemorrhoids. This review article focuses on providing a guide for the initial diagnosis and management of major anal pathologies, aiming to assist general practitioners and gastroenterologists in their daily practice. The differential diagnoses of the most prevalent syndromes, including anal tumor syndrome, prolapse syndrome, and painful syndrome are explored. The importance of a detailed anamnesis and a directed physical examination is emphasized. The article also describes in detail the clinical characteristics and management of conditions such as skin tags, condylomas, hemorrhoids, and anal abscesses. Therapeutic options are briefly discussed. This review provides practical tools to improve diagnostic accuracy and treatment effectiveness.

Objective: Although the causes of colorectal adenoma have been well characterized in other populations, this study is the first to investigate the risk factors for colorectal adenoma in a Peruvian population.

Materials and methods: This is an observational, retrospective, case-control study of patients who underwent colonoscopy at the gastroenterology service of a large hospital in northern Peru between 2015 and 2020. Two groups of 138 patients were selected based on colorectal adenoma diagnosis. Gender, age, and the presence of non-alcoholic fatty liver disease, diabetes, obesity, hypertension and dyslipidemia were compared between groups to calculate risk factors for colorectal adenoma. These are known risk factors in other populations.

Results: Among the measured factors, non-alcoholic fatty liver disease and male sex were found to be associated with colorectal adenoma (OR 3.3, 95% CI Interval 1.8-6.1 for non-alcoholic fatty liver disease, and OR 2.2 95% CI 1.3-3.6 for male sex). Other socio-medical characteristics did not reach statistical significance. Furthermore, no significant differences in location, number, size, endoscopic classification, histology or presence of advanced adenoma were observed when comparing patients diagnosed with non-alcoholic fatty liver disease with patients without this condition.

Conclusion: This study suggests that non-alcoholic fatty liver disease and male sex are positively associated with the diagnosis of colorectal adenoma in Peruvians. This suggests the need for more careful screening of these demographics.

Heterotopic pancreas in the gallbladder is a rare and asymptomatic lesion, which has been identified in patients with cholelithiasis or other diseases of the biliary tract, being an incidental diagnosis so far reported by histopathological diagnosis. Forty-one cases have been reported in the world literature, so it would correspond to the number 42; described for the first time since 1916 by Otschkin the fourth at a national level and the first reported at the state level.We present a female patient in the fourth decade of life. With biliary colic secondary to acute chronic cholecystitis by clinical and ultrasound, the histopathological diagnosis was ectopic pancreas in the gallbladder wall, acute chronic cholecystitis, and pure cholesterol lithiasis.

Introduction: Treatment with over the scope clips is useful for perforations, fistulas, and bleeding in the digestive tract. Operated by expert endoscopists, it is an effective method for the management of ulcer rebleeding, and there is recent evidence that its use may be superior to standard combination therapy as first-line treatment of non-variceal upper gastrointestinal bleeding in selected patients.

Aim: To describe the results of the use of over the scope clips in patients at high risk of rebleeding, as a first-line treatment, performed by endoscopists in training at a third-level center.

Materials and methods: A cross-sectional study included patients undergoing endoscopy for non-variceal upper gastrointestinal bleeding treated with over the scope clips as first-line endoscopic therapy. Operators were simulation-trained gastroenterology residents. Before placing the over the scope clip, 0.01% diluted adrenaline was injected. Successful hemostasis was defined as the absence of persistent or recurrent bleeding. Subsequent complications were analyzed: new endoscopy, need for surgery and/or death.

Results: Eleven cases were included with a median age of 65. Of the total causes of bleeding, 8 were ulcers, predominantly duodenal. Hemostasis was achieved in 100% of cases, with no persistent bleeding. Subsequent transfusion support was required in 6 of the 11 patients. A new endoscopy was performed in 4 of the patients, and none had evidence of rebleeding associated with the lesion initially treated with an over the scope clip. However, after 72 hours, one of the patients presented with melena and hemodynamic instability requiring emergency surgery, where an atypical gastrectomy was performed. The surgical specimen showed the presence of a vascular lesion in the periphery of the over the scope clip. No mortality related to gastrointestinal bleeding within the first 30 days was detected in any of the cases.

Conclusion: The scope clip system could be considered for use by endoscopists in training for the treatment of non-variceal upper gastrointestinal bleeding, under supervision and with prior training on simulation models, performing an appropriate selection of patients.

Intestinal tuberculosis is an infrequent pathology. Although it has a low incidence, it is on the rise due to the increase in the number of cases of HIV infection, resistance to anti-tuberculosis drugs, and migratory changes. Sometimes diagnosis is difficult for physicians given its clinical heterogeneity. It can mimic other intestinal diseases, and therefore its detection and start of treatment are often late. For this reason, the diagnosis is usually made in advanced or severe stages. We present the case of a 53-year-old immunocompetent woman with fever, general repercussions, respiratory symptoms and diarrhea of 3 months' evolution. Video colonoscopy showed lesions in the cecum with biopsies confirming Mycobacterium tuberculosis, also present in respiratory samples. Despite initiating anti-tuberculosis treatment, the patient presented intestinal perforation with poor evolution and death.