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

Diphyllobothrium spp. is a parasite with global distribution. Diphyllobothriasis is the human infestation by this parasite. Symptoms usually occur a few weeks after infection and include nausea, diarrhea, and abdominal pain; less frequently, prolonged or severe infections can lead to anemia. The endoscopic finding of the tapeworm is an incidental finding. The inflammation associated with diphyllobothriasis can be considered in the differential diagnosis of ileal ulcers. We present the case of a woman in whom a tapeworm and one ileal ulcer were found, histology suggested lymphoid proliferation; however, the clonality study showed that these inflammatory changes were secondary to diphyllobothriasis.

Telemedicine has grown during the COVID-19 pandemic. Gastroenterology at Clínica Universidad de los Andes has continued it post-pandemic. Usability is the measure by which users evaluate the effectiveness, efficiency, and satisfaction in telemedicine. The usability of this type of consultation in Chile is unknown.

Objective: To evaluate the level of usability among patients attended through teleconsultations in Gastroenterology at Clínica Universidad de los Andes (March-August 2023).

Materials and methods: A cross-sectional descriptive study on the level of usability using the adapted and modified Telehealth Usability Questionnaire. It consists of 12 items (score range 12-84) and comprises 2 factors: effectiveness and ease of use. Sociodemographic characteristics were also evaluated.

Results: A total of 150 questionnaires were analyzed. A high level of usability was observed (median: 81; range 54-84), with high scores in effectiveness (median: 28; range 20-28) and ease of use (median: 53; range 30-56), without significant differences according to sex, age, educational level, geographic location, and health insurance. Of the respondents, 76.7% were aged 30 to 64 years. 36% resided in the metropolitan region, 61% were women, and 80% were from the private health system. 29% consulted for abdominal pain, 20% for inflammatory bowel disease, and 17% for abnormal liver function tests. For 53.3%, it was their first consultation, and 46.7% were in follow-up via this method.

Conclusion: In this cohort, telemedicine is perceived as an effective and easy-to-use tool, with a high level of usability regardless of the patients' sociodemographic characteristics. Therefore, in gastroenterology, telemedicine appears to be a form of healthcare accepted by patients.

Colonic polyp refers to lesions that exhibit a protrusion of the mucosa, regardless of histology. The most recent WHO classification is based on a better understanding of these lesions; however, its application in daily practice could be subject to interobserver variability biases that could have clinical implications.

Objectives: To determine the interobserver variability in the histopathological reporting and grading of dysplasia of samples obtained from elevated colon lesions in a private laboratory in the city of Lima.

Materials and methods: Observational, descriptive, and prospective study: Case series type. All biopsies of elevated colon lesions received over a period of 3 months were evaluated by two observers without clinical information of the cases, to diagnose the lesions according to the WHO classification. In cases of diagnostic differences, the cases were evaluated together to reach a consensus.

Results: A Kappa coefficient value of 0.458 was obtained in the diagnostic classification of elevated colon lesions, while a Kappa value of 0.416 in the evaluation of dysplasia; indicating moderate agreement.

Conclusions: Despite achieving moderate agreement between evaluators, this work demonstrates the importance of not only relying on morphological criteria for diagnostic classification, but also including criteria of location and size of these lesions to increase diagnostic accuracy.

Oesophageal cancer corresponds to a malignant neoplasm with a poor prognosis. Neuroendocrine tumors of the esophagus are very rare, accounting for less than 2%. When clinically manifested by permanent, progressive dysphagia and general impact, they usually correspond to locally advanced tumors with a poor prognosis. We present the case of a 45-year-old man who attended medical attention for persistent and progressive dysphagia, who was diagnosed with neuroendocrine carcinoma of the oesophagus. The diagnosis was reached through endoscopy, revealing an extensive, vegetative and stenosing lesion occupying three-quarters of the oesophageal circumference. Histology confirmed the diagnosis of poorly differentiated small cell malignancy with positive immunohistochemistry for chromogranin A and synaptophysin. In light of the diagnosis of small cell neuroendocrine carcinoma of the oesophagus with locaregional extension, stage IV, palliative treatment with chemotherapy, radiotherapy and percutaneous endoscopic gastronomy was proposed, with a survival of only 6 months.

The endoscopic placement of a biliary stent presents adverse events, including proximal migration in the bile duct, a situation that can be so challenging to resolve that surgery must sometimes be resorted to. We present the case of a 83-year-old patient who underwent endoscopic retrograde cholangio pancreatography (ERCP) for acute cholangitis and a plastic biliary stent was placed for stenosis in the distal common bile duct. Four months later, proximal migration of the stent was evident; conventional extraction techniques were performed without success. Due to not having a cholangioscope, a novel method was designed in which a forceps is slid along a hydrophilic guide and guided to the distal portion of the stent in order to successfully trap and extract it. It is concluded that the "zipline" technique is an effective method that could be used safely in patients with proximal migration of a biliary stent in which its adherence to the biliary wall does not allow it to be linked with common methods, especially in situations where direct cholangioscopy is not available.

Background: One of the pathways involved in liver regeneration processes is TWEAK/Fn14 (tumor necrosis factor-related weak inducer of apoptosis/fibroblast growth factor-inducible 14), which has been proposed to act directly and selectively on hepatic progenitor cells; however, its role in the regeneration of steatotic liver metabolic dysfunction associated fatty liver disease has not been fully elucidated.

Objective: To evaluate the behavior of Fn14 and its ligand TWEAK, as well as cellular stress signals as biochemical cues for possible liver regeneration in MAFLD.

Materials and methods: A prospective study was carried out where the behavior of Fn14 and its ligand TWEAK, as well as cellular stress signals were observed as biochemical indications of a possible liver regeneration in a condition of tissue damage caused by excessive lipid accumulation. The expression of TWEAK, Fn14 and heat shock proteins in hepatic steatosis of non-alcoholic origin was assessed using immunohistochemistry and western blotting.

Results: The histological classification of the tissues under study corresponded to microvesicular steatosis. We report a high level of expression of heat shock proteins in the cytoplasm. The expression of TWEAK and Fn14 in liver tissue affected by lipid accumulation was localized in the cytoplasm of hepatocytes, showing a higher intensity of reactivity for Fn14 compared to its ligand TWEAK.

Conclusion: The expression of TWEAK/Fn14 axis was positive suggesting reactivity of the signaling pathway in metabolic dysfunction associated fatty liver disease.

Typhoid fever (enteric fever), caused by Salmonella enterica subsp. enterica serovar Typhi (S. Typhi), is a public health problem especially in South Asia and sub-Saharan African countries, while incidence remains low in most other parts of the world, where the disease is primary related to recent travel to endemic countries or contact with chronic carriers. The diagnosis of typhoid fever is challenging in endemic countries, often also low- and middle- income countries (LMIC), due to the poor sensitivity/specificity of available serologic tests and lack of adequate infrastructure for blood cultures. We report the case of an 18-year-old male patient with a 21-day history of right-sided abdominal pain, malaise, headache, intermittent fever and watery diarrhea. Contrast-enhanced abdominal computed tomography (CT) exhibits thickening of the terminal ileum, cecum and ascending colon with mesenteric lymphadenopathy. Laboratory findings indicate elevated transaminases, positive blood culture to S. Typhi and a positive Widal test to S. Paratyphi A, B and S. Typhi H (flagellar) antigens. A diagnosis of complicated typhoid fever was made. Following a 13-day regimen of ceftriaxone, all symptoms resolved. Few reports have been made about CT manifestations in patients with typhoid fever. While CT can aid in diagnosis, it is particularly important for identifying complications of typhoid fever such as perforation, bleeding and abscess formation.

Introduction: Conventional management of small intestinal bacterial overgrowth (SIBO) involves intraluminal-action antibiotics. Controversially, probiotics are used to optimize outcomes, but this therapeutic intervention is understudied.

Objective: To evaluate the efficacy of probiotics in the treatment of small intestinal bacterial overgrowth. Materials and methos: A search was conducted using relevant terms guided by a documentalist in CENTRAL, MEDLINE, and EMBASE, LILACS, conference proceedings, the International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov, in English or Spanish, up to January 2023. The search aimed to identify studies evaluating the effectiveness of probiotics in small intestinal bacterial overgrowth. Controlled trials of probiotics compared to placebo or other interventions (antibiotics) for symptom control and normalization of hydrogen breath test in adult patients with small intestinal bacterial overgrowth were included. Two authors independently assessed and extracted data. Information on methods, participants, interventions, and outcomes (resolution of SIBO by hydrogen breath test, symptom control) was collected. When appropriate, risk ratios (OR) with 95% confidence intervals (CI) were calculated. Study quality was evaluated using the Cochrane Risk of Bias Assessment Tool.

Results: A total of 18 clinical trials were found, including one case-control study, two crossover trials, and one single-arm clinical trial. Out of these, 14 clinical trials had a control group, of which 9 were randomized, collecting information from 496 patients treated with probiotics and 480 controls. Among them, 6 clinical trials compared probiotics (n=122) against placebo (n=104). Due to lack of uniformity in outcome reporting, only 3 of these studies were included in the meta-analysis, revealing a favorable effect of probiotics in resolving SIBO by hydrogen breath test (OR=0.3, 95% CI, 0.3-1.0). The studies showed high heterogeneity and a high risk of bias.

Conclusions: Using the GRADE methodology, we found low-quality clinical evidence in favor of using probiotics compared to placebo for the resolution of SIBO.

Background: Management of anastomotic dehiscences following colorectal surgery is a topic of debate. In this context, endoluminal vacuum therapy offers promising results.

Objective: To analyze the efficacy and feasibility of endoluminal vacuum therapy in distal anastomotic dehiscences after colorectal surgery.

Materials and methods: This study is a descriptive case series that evaluates patients with anastomotic dehiscences over a period of 18 months. All patients were treated with Endo-sponge® (Braun Medical, Hessen, Germany).

Results: Fourteen patients were included in the final analysis. The indications for endoluminal vacuum therapy were Hartmann's stump insufficiency (n=6), anastomotic leakage after laparoscopic total mesorectal excision (n=4), and anastomotic dehiscence after transanal total mesorectal excision (n=4). A total of 204 sponges were placed per patient (median 12.5, range 1-33). Complete resolution was achieved in 9 patients (57.1%) in a mean time of 108 days (range 15-160 days). In the sub-analysis, patients with acute dehiscence (<3 months) achieved complete resolution in 80% (8/10), whereas no patient with chronic defects reached resolution (0/4). A low complication rate (7%) was recorded.

Conclusion: Endoluminal vacuum therapy appears to be a feasible and safe treatment with a high success rate in patients with large acute colorectal anastomotic defects.