Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru最新文献

Introduction: The diagnosis and treatment of gastric cancer may have been affected during the COVID-19 pandemic, ultimately influencing mortality from this disease.

Objective: To evaluate changes in gastric cancer mortality during the COVID-19 pandemic years.

Materials and methods: An interrupted time series analysis was conducted to assess changes in gastric cancer mortality. Data were obtained from the National Death Information System. Three periods were compared: pre-pandemic (2017-2019), pandemic (2020-2021), and post-pandemic (2022-2023). Segmented regression models were used.

Results: Before the pandemic, an average of 2,107 deaths per year was recorded. During 2020 and 2021, mortality increased by 39% and 118%, respectively. The highest peaks occurred between April and July 2020. An additional rise was observed during the early months of 2021. Although mortality progressively declined in 2023, pre-pandemic levels were not restored. The analysis showed that observed deaths consistently exceeded expected projections through late 2022.

Conclusions: The COVID-19 pandemic generated a temporary but significant increase in gastric cancer-related mortality in Peru.

Introduction: Advanced age is associated with a greater prevalence of oesophageal motor disorders due to increased lower oesophageal sphincter (LES) pressure and decreased peristaltic vigour. Secondary peristalsis is particularly affected by age, which may be related to increased oesophageal dysmotility in older adults.

Objectives: To describe the most common oesophageal disorders in older adults undergoing high-resolution oesophageal manometry (HREM) according to the Chicago Classification V4.0.

Materials and methods: An observational, descriptive, retrospective, cross-sectional study was conducted at San Ignacio University Hospital. Patients over 65 years of age who underwent HREM for various reasons between 2020 and 2025 were included.

Results: Total number of patients included, age and age range. A total of 177 patients aged 65 years or older, with an age range of 68-76 years, were included. The main indication for HREM was dysphagia, present in 49.7% of patients, followed by reflux symptoms in 39%. The most frequent pathological manometric diagnosis was inconclusive outlet obstruction (14.1%), followed by ineffective oesophageal motility (9.6%) and achalasia (5.1%). A manometric diagnosis of ineffective oesophageal motility was made in 17.1% of patients with erosive gastro-oesophageal reflux disease (GERD).

Conclusion: Older adults are more likely to have esophageal dysmotility, and outflow tract obstruction disorders are the most frequently identified in this population.

Primary anal melanoma accounts for less than 2% of all melanomas and anal tumors. It is highly aggressive, and its nonspecific clinical presentation can delay diagnosis. Despite advances in immunotherapy, surgical resection remains the only curative treatment in early stages. We report a case of a patient presenting with rectal bleeding and an anal mass, without involvement of the skin, eyes, or gastrointestinal tract. Immunohistochemistry was positive for S-100 and Melan-A. Hepatic and pulmonary metastases were identified, and the clinical course was unfavorable.

Achalasia is a primary esophageal motility disorder characterized by the absence of peristalsis and failure of relaxation of the lower esophageal sphincter (LES). Its etiology remains uncertain, with proposed mechanisms including autoimmune, infectious, and genetic factors. To review recent advances in the diagnosis and management of achalasia, with emphasis on functional classification, the role of emerging technologies, and the most effective therapeutic strategies. A narrative review of the literature in English and Spanish was conducted, including scientific articles, clinical practice guidelines, and recent international consensus statements (AGA 2024, ESGE 2025). The Chicago Classification v4.0 has improved the diagnostic accuracy of esophageal motility disorders through high-resolution esophageal manometry (HRM), facilitating more precise therapeutic decision-making. The peroral endoscopic myotomy (POEM) has demonstrated high clinical efficacy, particularly in type III achalasia. The laparoscopic Heller myotomy remains a valid option, especially when combined with fundoplication, while pneumatic dilation should be reserved for selected cases. Emerging technologies such as the EndoFLIP (Endoluminal Functional Lumen Imaging Probe) allow for dynamic assessment of the LES during diagnostic and therapeutic procedures, optimizing surgical planning and treatment individualization, while reducing complications and improving clinical outcomes. The modern management of achalasia requires an individualized approach. Treatment selection should consider the functional subtype, institutional expertise, and patient preferences.

Olmesartan is a widely prescribed antihypertensive agent. While the most frequent adverse reactions include headache, influenza-like symptoms, and dizziness, sprue-like enteropathy-characterized by chronic diarrhea and intestinal villous atrophy that does not improve with a gluten-free diet-has also been documented. Hepatic involvement attributable to olmesartan is far less well known: clinical trials reported mild aminotransferase elevations in fewer than 2% of participants, a rate comparable to placebo. Nevertheless, in recent years several cases of severe acute hepatitis with variable latency periods have been published. The simultaneous occurrence of both potentially serious adverse effects is exceptionally uncommon, with only two patients described in the literature to date. We report the case of a 66-year-old woman receiving long-term therapy with a fixed combination of olmesartan medoxomil, amlodipine, and hydrochlorothiazide. More than two years after treatment initiation she developed chronic diarrhea (4-6 bowel movements per day). Months later, during an exacerbation of the diarrhea that produced hydro-electrolyte disturbances requiring hospitalization, she experienced jaundice and profound liver function test abnormalities, prompting an exhaustive investigation of both clinical pictures. After an extensive work-up, concomitant olmesartan-induced enteropathy and hepatotoxicity was suspected. Cessation of the drug led to complete resolution of symptoms and normalization of all laboratory parameters.

We describe the case of a pediatric patient with eosinophilic gastroduodenitis secondary to visceral toxocariasis, presenting with clinical, endoscopic, and histological features suggestive of gastric lymphoma. The patient, from a rural area, exhibited severe gastrointestinal symptoms, persistent hypereosinophilia, deep ulcerative lesions in the stomach and duodenum, as well as systemic involvement. After an extensive immunological, hematological, and infectious disease evaluation, the diagnosis was confirmed by positive serology for Toxocara canis. The patient showed favorable clinical evolution with antiparasitic therapy, immunomodulation, and intensive nutritional support. This case highlights the importance of considering infectious etiologies in the differential diagnosis of eosinophilic gastroduodenal disorders, particularly in pediatric patients with systemic involvement and a presentation mimicking malignant disease.

Anomalous biliopancreatic junction is a very rare condition, with very low incidences in Asia, 1:1000 inhabitants and even lower in the West, up to 1:100,000. Endoscopic retrograde cholangiopancreatography is the diagnostic imaging technique of choice. This condition involves the junction of the biliary and pancreatic ducts outside the duodenal wall, predisposing patients to reflux of bile and pancreatic juice, which increases the risk of recurrent acute pancreatitis. Therefore, timely diagnosis and appropriate treatment are crucial.

At the conclusion of an endoscopic procedure, we must prepare a report of the observed findings. However, the generated report is not only intended to describe and list what was detected during the endoscopy. The endoscopy report should serve as a relevant tool that not only improves communication among medical staff, but also supports subsequent clinical decision-making through a clear diagnosis. This objective can be achieved by systematizing our reports through the routine use of validated classifications and scales. Nevertheless, their use is often complex and not regularly applied, particularly among endoscopists in training. For this reason, we present the following narrative review, aimed at providing gastroenterologists in training with the most important classifications, explained in a simple manner and accompanied by updated references.

Introduction: Magnetic Resonance Enterography (MRE) is a valuable imaging modality for the evaluation and follow-up of patients with inflammatory bowel disease (IBD), particularly Crohn's disease (CD). This study describes MRE findings in patients with suspected or confirmed CD at a national reference center for IBD in Colombia.

Materials and methods: A descriptive observational study was conducted in patients evaluated with MRE at a specialized IBD center.

Results: Of the 20 patients evaluated, 18 (90%) underwent MRE due to clinical or endoscopic suspicion of Crohn's disease, while 2 patients (10%) had a previously confirmed diagnosis and were assessed for follow-up evaluation. Overall, 40% of the cohort showed findings compatible with acute inflammatory activity. Overall, 40% of the cohort showed findings compatible with acute inflammatory activity. Intestinal involvement was most frequent in the terminal ileum (40%), followed by the sigmoid colon (15%), and the descending, transverse, and cecum colon (10% each). The average ileal segment length was 37 mm, with mean parietal thickening of 5.7 mm. Mesenteric fat signal alteration was observed in 55% of patients, mesenteric lymphadenopathy in 35%, and vascular changes in 10%. Chronic fibrostenotic changes were found in 15%, and 20% showed subocclusive-type obstructions. Findings not related to IBD were noted in 35% of cases. Based on the simplified Magnetic Resonance Index of Activity (MaRIA) score, 50% had a score of 0-1, 5% scored 2, 40% scored 3, and 5% scored 5.

Conclusions: The MAGNETIC study confirms MRE's role in identifying active inflammation, chronic sequelae, and complications in Crohn's disease. It supports the use of the MaRIA score for objective disease assessment, enhancing clinical decision-making in specialized IBD centers.