Acta Gastroenterologica Latinoamericana最新文献

Introduction: . Obesity is a risk factor for gastrointestinal diseases such as gastroesophageal reflux disease, erosive esophagitis, and hiatal hernia, among others. The presence of some of these diseases during the preoperative bariatric study may condition the surgical technique to be performed.

Materials and methods: . We conducted a retrospective, descriptive, cross-sectional study from a prospectively collected database of patients with obesity treated with bariatric surgery between January 2016 and June 2022 who systematically underwent preoperative upper gastrointestinal endoscopy.

Results: . We evaluated 704 patients who were candidates for bariatric surgery. The mean age of the patients was 40 years, predominantly female (71.6%). The most frequent endoscopic findings were gastropathies, which appeared in 98.9% (n: 696) of the patients, followed by esophageal disorders in 11.6% (n: 82). The prevalence of erosive esophagitis was 9.8% (n: 69). In adittion, 19.7% of the endoscopic findings required preoperative medical treatment and in 4% of the patients the surgical decision was determined by the endoscopic finding.

Conclusion: . Given the high relationship between obesity and diseases of the upper digestive tract, and the interference that these diseases can have in the postoperative evolution of a bariatric patient, we consider that upper gastrointestinal endoscopy should be routinely included in the preparation of the patient who is a candidate for bariatric surgery.

Introduction: . In this report, the experience using tofacitinib in two pediatric patients diagnosed with ulcerative colitis at the International Hospital of Colombia is described. A review of the current state of the art is also carried out.

Cases: . Both patients had already undergone conventional management without an adequate response for almost two years. In case 1, clinical remission was achieved one month after initiating sustained treatment with tofacitinib. In case 2, clinical and endoscopic remissions were achieved two months after initiating treatment.

Discussion: . Studies have demonstrated its efficacy as induction and maintenance therapy for moderate to severe active ulcerative colitis, with an acceptable safety profile. However, information about the use of tofacitinib within the treatment arsenal is limited in the pediatric age group.

Conclusion: . Tofacitinib is a promising alternative for the treatment of ulcerative colitis with no response or loss of response to conventional treatment. We present the experience of two adolescent patients in whom clinical remission of the disease was achieved earlier than expected, also documenting endoscopic and histologic remission in one of them.

Introduction: . Von Meyenburg complexes or biliary hamartomas are a rare benign congenital anomaly of the intrahepatic bile ducts. They are usually asymptomatic and incidentally found on imaging studies but can cause jaundice, abdominal pain, and cholangitis.

Case report: . An 80-year-old male patient was admitted to the emergency department due to progressive jaundice associated with pruritus, with an altered hepatogram and a cholestasis pattern. Imaging studies were performed in which there were no alterations in the liver parenchyma or bile ducts. A liver biopsy was performed, which revealed perivenular canalicular cholestasis and the presence of von Meyenburg complexes. The patient was treated with ursodeoxycholic acid with normalization of cholestasis at outpatient follow-up.

Conclusion: . The diagnosis of biliary hamartomas should be considered in patients with intrahepatic cholestasis in whom the etiology is not identified by initial studies. They represent a diagnostic challenge as they are not always seen in imaging studies.

Introduction: Upper gastrointestinal bleeding constitutes a primary emergency for emergency services world wide. It has varied etiology and broadther apeutics, so the use of prognostic scalesis necessary to establish the patient's risk.

Objectives: . Determine which of the four scales studied has a greater capacity to discriminate between cases of low and high risk for rebleeding, need for blood transfusion and death.

Materials and methods: . A retrospective cohort study was carried out using the data base of the Guasmo Sur General Hospital from 2020 to 2022, comparing scores obtained by applying the scales to patients diagnosed with upper gastrointestinal bleeding and the irevolution to know their potential prognosis.

Results: . In predicting mortality, the following had better AUC: pre-endoscopic Rockall and AIMS65 with 0.701 and 0.689, respectively; the most useful are Rockall and pre-endoscopic Rockall with sensitivity 95% and NPV 98.3%, with cut-off points of 4 and 3, respectively. In predicting rebleeding, the score with the best AUC was GBS with 0.700, at a cut-off point of 9, it had a sensitivity of 92.3% and a NPV of 95.1%. In predicting the need for transfusion, the one with the best AUC was GBS with 0.766, and a cut-off point of 5, it is the most useful with sensitivity 97.1% and NPV 82.6%.

Conclusion: . The most useful scales for the different outcomes measured were Rockall, pre-endoscopic Rockall and GBS.

Introduction. Breath tests have been widely used for the diagnosis of small intestinal microbial overgrowth. Some of the equipment currently used for gas measurement tends to have limitations; the simplest portable equipment measures only hydrogen, while the most complete ones allow the simultaneous measurement of hydrogen, methane, CO2, and recently hydrogen sulfide. The presence of elevated methane values usually coincides with decreased hydrogen excretion and, therefore, by measuring only exhaled hydrogen levels, the study is reported erroneously as normal.

Aim: . To analyze the comparative diagnostic yield between the isolated measurement of hydrogen and the simultaneous measurement of hydrogen and methane.

Material and methods: . An observational study was carried out by analyzing hydrogen and methane concentrations in exhaled air, using lactulose as substrate. The study included 353 patients (78% women), with an age range of 18/75, who presented one or more of the following symptoms: abdominal pain, bloating, flatulence and chronic defecatory problems. Values ≥ 20 ppm for hydrogen within 90 minutes lactulose of ingestion were considered positive, and for methane, values ≥ 10 ppm at any time during the study. The diagnostic yield was calculated using the formula: number of positive studies divided by the total number of studies performed. Based on the normal reference values, the number and percentage of diagnoses of small intestinal bacterial overgrowth, intestinal methanogenic overgrowth and mixed microbial overgrowth were calculated.

Results: . Out of a total of 353 patients, 111 (31.44%) were LBT positive; 78 (22.09%) had mixed flora (SIBO + IMO); 54 (15.29%) had methanogenic overgrowth; 55 (15.62%) had small intestine bacterial overgrowth, (accepted as a positive hydrogenic response exclusively) and 55 (15.62%) were negative. Fifty-four (15.29%) had a flat curve. The diagnostic yield varies if we consider only positive SIBO by exclusive hydrogen measurement, in such cases it was 0.16 (95% CI 0.12-0.19). However, when considering mixed cases (partial diagnosis) the diagnostic yield was 0.47 (95% CI 0.41-0.52). On the other hand, the simultaneous measurement of hydrogen and methane added was positive for those with methanogenic overgrowth (111+55+78/353) and the diagnostic yield is 0.69 (CI 0.64-0.73). Conclusion. The simultaneous measurement of H2 and CH4 would improve the diagnostic yield compared to the isolated measurement of hydrogen.

Introduction: . Cow's milk protein allergy can have multiple clinical manifestations. Some cases present with inflammation of the rectosigmoid colon with secondary colonic dysmotility similar to Hirschsprung's disease. Previous studies have shown that the proportion of cow's milk protein allergy in newborns presenting with Hirschsprung's disease-like symptoms is high.

Aim: . To describe the clinical case of a patient with cow's milk protein allergy, with symptoms and barium enema imaging suggestive of Hirschsprung's disease.

Clinical case: . A term infant, previously healthy, with episodes of regurgitation since two weeks of life and worsening of symptoms with vomiting and irritability at three months of age. Physical examination revealed findings compatible with cow's milk protein allergy. She was exclusively breastfed and instructed to continue on a cow's milk exclusion diet. Three days after the onset of symptoms, her condition worsened with vomiting and the imaging studies were expanded with findings that could have been related to Hirschsprung's Disease. An endorectal biopsy was performed and Hirschsprung's disease was ruled out. It was indicated to discontinue breastfeeding and continue with the amino acid-based formula, with adequate tolerance, weight and height progression, resolution of xeroderma and abdominal distension.

Conclusion: . In patients with severe abdominal distension or findings simulating Hirschsprung's disease, cow's milk protein allergy should be considered as an increasingly common entity in the differential diagnosis, and appropriate diagnostic tests should be performed to establish the diagnosis. Endorectal biopsy is indicated to confirm the definitive diagnosis of Hirschsprung's disease.

A review of the different treatments for fecal incontinence is presented, with special emphasis on the results of surgical procedures for this condition. It addresses a comprehensive and personalized approach to the management of patients with fecal incontinence, which is of capital importance, where the results of the different therapeutic options must be weighed in their relationship to the quality of life of the patients. Finally, a treatment algorithm for said condition is suggested.

Introduction: . Biliary atresia is an inflammatory, obstructive, and idiopathic process affecting the bile ducts that leads to biliary cirrhosis. Early diagnosis and Kasai surgery offer patients the possibility of survival without requiring a liver transplant.

Main: . To describe the implementation of a novel method of screening for biliary atresia using a quick response (QR) code at a fourth-level care hospital.

Materials and methods: . An observational, descriptive and prospective study was carried out at the Hospital Público Materno Infantil, Salta, Argentina, between September 2022 and September 2023. During this period, the screening for biliary atresia was carried out through a survey accessible via a QR code. This survey had to be completed between 15-30 days of life of the newborn´s, comparing the color of stools with a numbered colorimetric chart. The responses were categorized as "normal" and "abnormal". Patients with abnormally colored stools were contacted by phone and scheduled for a medical consultation.

Results: . A total of 6,113 live newborns were registered. 1,294 surveys were analyzed. The response rate was 21%. 57.3% of respondents completed the survey between 15 and 30 days after birth. Among the 1,294 patients surveyed, 17 recorded abnormal responses, of which one had biliary atresia and two had secondary cholestasis. The screening presented a false-positive rate of 1.1% (14/1,294). The estimated percentage of true positives from the screening was 0.2% (3/1,294). The prevalence of biliary atresia was 0.1% (1/1,294).

Conclusion: . The response rate to screening for biliary atresia using the QR code during the evaluated period was lower than that reported using colorimetric cards. Adherence increased in the last months of the program´s implementation, which requires more time for execution and dissemination. We believe that this technological innovation applied to screening could represent a progress in the early detection of biliary atresia.