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

Drug-induced esophageal ulcers constitute an acquired chemical injury to the esophageal mucosa, most frequently associated with tetracyclines, particularly doxycycline. We report a case of "kissing ulcers" diagnosed through esophagogastroduodenoscopy in a young woman undergoing doxycycline treatment for rosacea. The pathogenesis is linked to drug-specific factors, such as caustic effects, hyperosmolar properties, and prolonged mucosal contact with the medication, in addition to patient-specific risks, including esophageal motility disorders, reduced saliva production, and mid-esophageal anatomical compression. Clinically, patients commonly present with abrupt-onset chest pain, dysphagia, and odynophagia, while endoscopic findings often reveal mucosal erythema, erosions, and specular distribution esophageal ulcers (referred to as "kissing ulcers"). Management involves discontinuation of the causative drug, initiation of proton pump inhibitors or sucralfate, and implementation of preventive measures, such as ensuring adequate hydration during medication intake. This condition is generally self-limiting, with symptoms resolving within two weeks, underscoring the importance of prompt diagnosis and treatment to avoid potential complications.

Objective: To determine the sociodemographic, anthropometric, biochemical-metabolic risk factors, and presence of comorbidities associated with metabolic hepatic steatosis with high suspicion of advanced fibrosis in thin patients compared to overweight or obese patients, treated at the Hospital Nacional Dos de Mayo 2012-2022.

Materials and methods: The sample included 160 patients, 80 cases and 80 controls from the medical records of patients treated in the Endocrinology Office. The research was quantitative, observational and analytical of cases and controls. It evaluated socio-demographic, clinical, biochemical variables and comorbidities. Descriptive analysis was used. Chi-square tests, calculation of OR, and confidence interval were applied, and logistic regression analysis was performed to evaluate confounding variables.

Results: Sociodemographic: 77.5% female and 36.3% over 60 years of age p<.05. Anthropometric: 52.5% had abnormal abdominal circumference. Biochemical: 83.8% HDL low p<0.05 OR 10.6; 68.8% hypercholesterolemia <0.05; 72.5% hypertriglyceridemia p<0.05 OR 1.78; 61.3% elevated HbA1c p=0.48; 86.3% elevated LDL p>0.05 and 93.8% Increased ferritin p<0.05 OR 11.8.

Clinical: Metabolic syndrome p<0.05 1.22 (0.9-1.44) and within the comorbidities 62.5% had diabetes mellitus p=0.26. After logistic regression analysis: Ferritin, decreased HDL and hypertriglyceridemia with a value of p<0.05.

Conclusions: Increased ferritin, decreased HDL, and hypertriglyceridemia influence the risk of developing metabolic dysfunction associated with steatohepatitis with advanced fibrosis in lean patients treated at the Hospital Nacional Dos de Mayo 2012-2022.

Introduction: Chronic abdominal pain (CAP) is a challenge in daily consultation. The most frequent cause is anterior cutaneous nerve entrapment syndrome (ACNES), which is diagnosed when the Carnett sign is positive. There are two ways to identify the Carnett sign: elevating the head and trunk or elevating the lower extremities. To date, these two ways of looking for the Carnett sign have not been compared.

Objective: To compare the effectiveness of the two maneuvers to identify the Carnett sign, evaluate the effectiveness of infiltration of the tender points with 2% lidocaine, and estimate the cost of examinations before diagnosis.

Material and methods: Randomized controlled study.

Results: 1320 patients were included and 660 patients were randomly assigned to group A: elevation of the head and trunk and 660 to group B: elevation of the lower extremities. Both maneuvers were similarly effective in identifying the Carnett sign. Infiltration of the points produced immediate relief in most patients. The costs of different studies before definitive diagnosis were approximately US$ 861 000 (dollars) versus US$ 66.00, which would be equivalent to 7.6% of the expenses incurred for tests performed before diagnosis.

Conclusion: The two ways of exploring the Carnett sign have similar efficacy. Infiltration with 2% lidocaine produced rapid and significant improvement of pain with minimal side effects. Not knowing the Carnett sign increases health costs.

The stercoral colitis is an inflammatory caused by fecal impactation. The etiology is poorly managed chronic constipation in specific risk groups. Patients usually present with abdominal pain, abdominal distension, and fever; in severe cases, peritoneal signs, shock or multiorgan failure may occur. It is important to have a high index of suspicion and request an abdominal CT scan with contrast. Treatment is conservative in the absence of peritoneal signs or hemodynamic instability; otherwise, management is surgical. We present the case of an 86-year-old male with a history of ischemic stroke, dysmobility and chronic constipation that presented with hematochezia. The imaging study showed thickening of the wall of the distal sigmoid colon and rectum, as well as feces inside. The endoscopic study revealed ulcers in the rectum and the recto-sigmoid junction. Conservative treatment with enemas and laxatives was indicated, with favorable clinical evolution.

Endoscopic ultrasound-guided anterograde cholangiopancreatography (EUS-guided APC) allow us to address pathologies of the bile duct that are not treatable by endoscopic retrograde cholangiography (ERCP), such as: post-surgical benign strictures in altered anatomy, hepatolithiasis, gastric outlet obstruction, among others. Previously, when ERCP was not effective, surgical interventions such as Hepaticojejunostomy (HJ) or percutaneous transperietohepatic drainage (PTHD) were resorted to. However, EUS-guided APC has been shown to have greater clinical success, be less invasive and have a lower incidence of complications. We present the case of a 61-years-old patient with a history of HJ bypass surgery who presented abdominal pain due to hepatholitiasis and post-anastomosis benign biliary stricture, in whom the antegrade technique was performed by endoscopic ultrasound through the proximal stomach, called hepaticogastrostomy (HG) with good results.

This case report describes an ERCP performed on a patient with situs inversus totalis and choledocholithiasis, highlighting the technical adaptations implemented and those described in the literature to overcome anatomical challenges and achieve a successful intervention. The experience presented in this case underscores the importance of technical and the expertise of the endoscopist in managing complex procedures in patients with unusual anatomical variations.

Introduction: This article summarizes the clinical practice guide (CPG) for management of patients with hepatocellular carcinoma (HCC) in the Social Security of Peru (EsSalud).

Objective: To provide evidence-based clinical recommendations for management of patients with HCC in EsSalud.

Materials and methods: A guideline development group (GDG) was formed, which included specialist physicians and methodologists, who formulated clinical questions. Systematic searches of systematic reviews were conducted and - when deemed relevant - primary studies in PubMed during 2024. Evidence was selected to answer each of the proposed clinical questions. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic working meetings, the GDG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution No. 53-IETSI-ESSALUD-2024.

Results: The CPG addressed 8 clinical questions regarding management of patients with HCC. Based on these questions, 9 recommendations were formulated (8 conditional, 1 based on a Preliminary Health Technology Assessment Opinion), 12 points of good clinical practice, and 1 flow chart.

Conclusion: Evidence-based recommendations were statement for the management of patients with HCC.

Endoscopic biliary plastic stent placement is standard therapy for biliary obstruction secondary to benign and malignant diseases. Complications associated with its placement are low, but potentially dangerous for the patient, especially those associated with proximal migration of the stent in the bile duct, which requires additional manipulations of the bile duct for its extraction using standard methods through endoscopic retrograde cholangiopancreatography in most patients. We present the clinical case of a patient with proximal migration and impaction of a plastic biliary stent, which required the use of advanced endoscopic techniques through cholangioscopy for its extraction.

Helicobacter pylori (H. pylori) is the primary etiological agent of gastric adenocarcinoma, which affects over 60% of the global population, with a significant prevalence in Latin America. Given its impact on the affected population, it is crucial to understand the diagnostic tools available for detecting this infection. While clarithromycin-based therapies are still widely used, the high rates of resistance to this antibiotic in the region needs the establishment of alternative, more effective treatments as the standard of care, such as bismuth-based quadruple therapy or high-dose dual therapy with amoxicillin. In cases of refractory infection, local data registries are valuable for informed decision-making.

Objective: This review aims to evaluate the efficacy and safety of premedication comprising mucolytics and/or defoaming agents to improve the quality of visualization during elective upper digestive endoscopy (elective upper GI endoscopy) procedure.

Materials and methods: A systematic review of the literature contained in electronic databases (Medline/Pubmed, Embase, and Lilacs) was performed to identify randomized controlled trials and systematic reviews that assessed patients undergoing upper gastrointestinal endoscopy (elective upper GI Endoscopy) under sedation, after being premedicated with mucolytics and/or defoaming agents for mucous clearance. A meta-analysis was conducted to determine the relative efficacy and safety profile of such premedication.

Results: In patients undergoing an elective procedure, premedication with defoaming and/or mucolytic agents improved the visibility score of the gastric antrum during upper GI endoscopy. The use of combined agents such as simethicone vs. water and N-acetyl cysteine (NAC) vs. water showed significant differences in favor of the active substance; however, no significant differences were found between the use of simethicone alone vs. simethicone + NAC. The use of pronase and dimethylpolysiloxane, among others, produced no significant difference (additive effect) in the visualization score. This is associated with the limited number of studies that performed similar comparisons and the heterogeneity of the outcomes. No major adverse effects were reported in the studies that were included regarding safety outcomes (i.e., volume of fluids required for clearance, risk of bronchoaspiration, and disinfection of equipment).

Conclusions: The results of this review evidence that premedication with simethicone (a drug registered in Colombia for use against functional gastrointestinal disorders; ATC group A03A) is safe and effective for improving the quality of visualization during elective upper GI endoscopy procedures. However, no significant differences were observed in the visualization quality with the use or addition of other agents. The use simethicone should be set as off-label use and should be implemented at the prescriber's discretion. The use of simethicone as a premedication is recommended to improve the endoscopic visualization score in elective procedures.