Revista de Gastroenterologia de Mexico最新文献

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Respuesta a Teco-Cortes J.A. Primer consenso mexicano de la enfermedad de Crohn. El punto de vista del patólogo 对Teco-Cortes J.A.的回应：关于克罗恩病的第一个墨西哥共识。病理学家的观点

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2025.01.002

J.K. Yamamoto-Furusho

引用次数: 0

Validación de la prueba de denominación de animales para el diagnóstico de la encefalopatía hepática mínima 验证动物命名试验以诊断轻度肝性脑病

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2024.09.003

A.D. Cano-Contreras , J.A. Velarde-Ruiz Velasco , F. Higuera-de-la-Tijera , C.F. Castillo-Diaz , D. Grajales-Velázquez , I. Méndez-Ruiz , V.A. Jiménez-Hernández , R. Aguirre-Lázaro , J.A. Sánchez-Hernández , H.R. Ordaz-Álvarez , J.M. Remes-Troche

Introduction and aim

The diagnosis of minimal hepatic encephalopathy (MHE) is complex in clinical practice, given that its adequate evaluation is time-consuming. The animal naming test (ANT1) has proven to be a useful tool for rapid MHE identification. Our aim was to validate the ANT1 in a cohort of Mexican patients with cirrhosis of the liver.

Material and methods

An observational, cross-sectional, and analytic study was conducted within the time frame of June 2022 and May 2023. MHE diagnosis was made using the psychometric hepatic encephalopathy score (PHES). Patients with overt HE evaluated through the West Haven criteria were excluded. The ANT1 was performed on all participants.

Results

A total of 199 patients with cirrhosis and 31 non-cirrhotic control subjects were analyzed. Women predominated (61.8% and 71%) and mean patient age was 55 ± 10 and 53.6 ± 12 (range 19 to 84 years), respectively. Ninety patients (45.2%) met the MHE criteria determined by the PHES. Using an ANT1 cutoff point of ≤ 15, MHE was identified in 65 (32.7%) patients, along with 75% sensitivity, 72% specificity, 53% positive predictive value, 87% negative predictive value, and 73% diagnostic accuracy. The area under the curve for diagnosing MHE was 0.763 (standard error, 0.081; 95% confidence interval, 0.604-0.923; p ≤ 0.0001).

Conclusions

The ANT1 was shown to be a useful tool for identifying MHE in daily clinical practice. In our population, a cutoff point ≤ 15 animals named could be utilized for rapid screening of patients at high risk for progressing to overt HE, who would then require extensive testing.

简介与目的在临床实践中，诊断轻度肝性脑病（MHE）是复杂的，因为它的充分评估是费时的。动物命名试验（ANT1）已被证明是快速鉴定MHE的有用工具。我们的目的是在一组墨西哥肝硬化患者中验证ANT1。材料和方法在2022年6月至2023年5月期间进行了一项观察性、横断面和分析性研究。MHE诊断采用肝性脑病心理测量评分（PHES）。通过West Haven标准评估的明显HE患者被排除在外。对所有参与者进行ANT1检查。结果共分析199例肝硬化患者和31例非肝硬化对照组。女性占多数（61.8%和71%），患者平均年龄分别为55±10岁和53.6±12岁（范围19至84岁）。90例患者（45.2%）符合PHES确定的MHE标准。采用ANT1截断点≤15,65例（32.7%）患者被诊断出MHE，其敏感性为75%，特异性为72%，阳性预测值为53%，阴性预测值为87%，诊断准确率为73%。诊断MHE的曲线下面积为0.763(标准误差0.081；95%置信区间为0.604-0.923；p≤0.0001)。结论在临床实践中，ANT1是鉴别MHE的有效工具。在我们的人群中，截断点≤15只动物可以用于快速筛选进展为显性HE的高风险患者，然后需要进行广泛的检测。

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引用次数: 0

Mala absorción de ácidos biliares (MAAB): una causa pocas veces sospechada de diarrea crónica. Hacia un diagnóstico eficiente y económico 胆汁酸吸收不良（MAAB）：很少怀疑是慢性腹泻的原因。实现高效、经济的诊断

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2025.01.003

J.M. Remes-Troche

引用次数: 0

Tumor desmoide: análisis clínico y revisión de literatura 脱水肿瘤：临床分析和文献综述

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2024.12.004

M.A. Urbina , O. Melin , P. Galindo , E. Sánchez , J.E. González

引用次数: 0

Características de la alimentación de los pacientes mexicanos con síndrome de intestino irritable. ¿Se distingue de la población general? 墨西哥肠易激综合征患者的饮食特征。它与一般人群有什么不同吗？

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2024.09.010

M. Amieva-Balmori, G.P. Martínez-Pérez, M.R. Francisco, A. Triana-Romero, A.A. Ortiz-Lorenzo, G.A. Hernández-Ramírez, J.A. Martínez-Conejo, G.A. Violante-Hernández, A.D. Cano-Contreras, J.M. Remes-Troche

Introduction

Irritable bowel syndrome (IBS) is a multifactorial condition, in which diet is a main trigger of symptoms. Many patients modify their diet without professional supervision, which can cause nutritional risks or aggravate symptoms. The aim of this study was to evaluate the dietary intake of patients with IBS versus healthy subjects.

Material and methods

An observational, analytic, cross-sectional study was conducted on 108 subjects: 77 (71.3%) diagnosed with IBS (Rome IV criteria) and 31 (28.7%) healthy controls. Patient age was from 18 to 66 years and the woman-to-man ratio was 4.1:1. Both groups completed a 7-day food diary, registering their usual diet that was then analyzed using a nutrition software program.

Results

Macronutrient intake was similar between the two groups but the patients with IBS had a significantly higher intake of vitamins D (P≤.001), B₁ (P≤.001), B₂ (P≤.001), and B₃ (P≤.001). There was greater vitamin B₃ intake in patients with an IBS subtype (P =.005). There were no significant differences in fiber consumption.

Conclusion

The diet of Mexican patients with IBS was slightly different from that of healthy subjects. The IBS patients consumed more fiber and their FODMAP intake was similar to that of the healthy controls. Even though the majority of the IBS patients met the recommendations for macronutrient and micronutrient intake, nutritional guidance in the management of IBS is recommended because dietary adjustments can significantly improve symptoms.

肠易激综合征（IBS）是一种多因素疾病，其中饮食是症状的主要触发因素。许多患者在没有专业监督的情况下改变饮食，这可能导致营养风险或加重症状。本研究的目的是评估肠易激综合征患者与健康受试者的饮食摄入量。材料与方法对108名受试者进行了观察性、分析性、横断面研究：77名（71.3%）诊断为IBS （Rome IV标准），31名（28.7%）健康对照。患者年龄18 ~ 66岁，男女比例4.1:1。两组都完成了为期7天的饮食日记，记录了他们的日常饮食，然后使用营养软件程序进行分析。结果两组患者营养素摄取量相近，但IBS患者维生素D （P≤0.001）、维生素B1 （P≤0.001）、维生素B2 （P≤0.001）、维生素B3 （P≤0.001）的摄取量显著高于IBS患者。IBS亚型患者的维生素B3摄入量更高（P = 0.005）。在纤维摄入量上没有显著差异。结论墨西哥IBS患者的饮食与健康人略有不同。肠易激综合征患者消耗更多的纤维，他们的FODMAP摄入量与健康对照组相似。尽管大多数IBS患者符合宏量营养素和微量营养素摄入量的建议，但仍建议在IBS管理中进行营养指导，因为饮食调整可以显著改善症状。

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引用次数: 0

Eficacia del uso de polvo hemostático para el manejo endoscópico de la hemorragia digestiva alta de origen tumoral 使用止血粉内窥镜管理高肿瘤性消化出血的有效性

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2024.10.004

J.P. Pérez-Macías, M.E. Ramírez- Solís, A.I. Hernández-Guerrero, J.G. Dela Mora- Levy, W.D. Torrecilla- Ramírez, B.A. Sánchez-Jiménez, G.M. Salgado-Castellón

Introduction

Upper gastrointestinal bleeding (UGIB) of neoplastic origin is a rare but life-threatening cause of bleeding. Endoscopic treatment is challenging due to diffuse oozing blood and high rates of rebleeding, despite coagulation and hemoclip use. Hemostatic powders can be an option in those patients. We aimed to determine the initial hemostatic rate and the rebleeding rate at 7 and 30 days, using hemostatic powders in patients with malignant UGIB at a national referral center in Mexico.

Material and methods

A retrospective, observational study was conducted on patients with malignant UGIB treated with hemostatic powder between 2018-2023. Demographic and clinical variables, endoscopic findings, and treatment results were analyzed. A central tendency analysis and the chi-square test were employed.

Results

The study included 54 patients (54.7% were men), with a mean age of 54 years. A total of 40.7% were diagnosed with gastric cancer and presented with an episode of malignant UGIB. Of the endoscopic findings, 52% of patients had active malignant UGIB, most presenting with oozing bleeding (57.4%). EndoClot™ was the main monotherapy employed (81.5%), achieving initial homeostasis in 100% of cases. The rebleeding rate was 22.2% at 7 days and 44.4% at 30 days, with a 30-day accumulated mortality rate of 35.2%.

Conclusions

Malignant UGIB is a potentially life-threatening complication. Hemostatic powder use is highly recommendable due to its efficacy in the immediate control of bleeding. Nevertheless, its effect is temporary, suggesting its use as bridging therapy, facilitating bleeding stabilization and enabling the implementation of definitive hemostatic treatments.

肿瘤源性上消化道出血是一种罕见但危及生命的出血原因。尽管使用了凝血和夹血，但由于弥漫性渗血和高再出血率，内镜治疗是具有挑战性的。止血粉是这些患者的一种选择。我们的目的是确定在7天和30天的初始止血率和再出血率，在墨西哥国家转诊中心使用止血粉治疗恶性UGIB患者。材料与方法对2018-2023年使用止血散治疗的恶性UGIB患者进行回顾性观察研究。分析人口统计学和临床变量、内镜检查结果和治疗结果。采用集中趋势分析和卡方检验。结果54例患者（男性54.7%），平均年龄54岁。共有40.7%的患者被诊断为胃癌，并出现恶性UGIB发作。在内镜检查结果中，52%的患者有活动性恶性UGIB，大多数表现为渗出出血（57.4%）。EndoClot™是采用的主要单药治疗（81.5%），100%的病例实现初始稳态。7天再出血率为22.2%，30天再出血率为44.4%，30天累计死亡率为35.2%。结论恶性UGIB是一种危及生命的并发症。止血粉的使用是非常值得推荐的，因为它能立即控制出血。然而，它的效果是暂时的，建议将其用作桥接治疗，促进出血稳定并使最终止血治疗得以实施。

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引用次数: 0

Recomendaciones de buena práctica clínica para el uso de neuromoduladores en gastroenterología: revisión conjunta de expertos de la Asociación Mexicana de Gastroenterología (AMG) y Asociación Mexicana de Neurogastroenterología y Motilidad (AMNM) 关于在胃肠病学中使用神经调节剂的良好临床实践的建议：墨西哥胃肠病学协会（AMG）和墨西哥神经胃肠病学和运动协会（AMNM）专家的联合审查

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2024.12.001

O. Gómez-Escudero , J.M. Remes-Troche , E. Coss-Adame , K.R. García-Zermeño , J. Aquino-Matus , J. Jiménez-Pavón , L.R. Valdovinos-García , M.A. Vargas-Martínez , M. Amieva-Balmori , J.S. Arenas-Martínez , F.A. Félix-Téllez , P.C. Gómez-Castaños , M. Mejía-Rivas , M.A. Valdovinos-Díaz , G. Vázquez-Elizondo , A.S. Villar-Chávez , C.P. Gyawali

Disorders of gut-brain interaction (DGBI) are characterized by alterations in both central and peripheral gut-brain axis (GBA)-related stimuli, and include esophageal, gastroduodenal, intestinal and anorectal disorders. Despite the fact that several pathophysiologic mechanisms are involved, the mainstay of treatment is neuromodulators, a heterogeneous group of drugs that act on pathways related to central and peripheral pain processing. This expert review by both the AMG (Asociación Mexicana de Gastroenterología) and AMNM (Asociación Mexicana de Neurogastroenterología y Motilidad) summarizes a series of updated clinical recommendations based on an exhaustive review of the literature, regarding the use of neuromodulators for DGBI, and is grouped into six sections: pharmacologic principles, definition, classification, mechanism of action; indications and use in each DGBI subtype; up/downscaling strategies, combination therapy; adverse events; joint use along with psychiatry in the case of comorbidities; and non-pharmacologic neuromodulation. Furthermore, drug selection process tips and dose personalization according to individual groups and sensitivities are provided, and special cases with DGBI-psychiatric comorbidity, as well as overlap with another DGBI, are considered.

肠-脑相互作用紊乱（DGBI）的特征是中央和外周肠-脑轴（GBA）相关刺激的改变，包括食管、胃十二指肠、肠道和肛肠疾病。尽管涉及多种病理生理机制，但主要的治疗方法是神经调节剂，这是一组不同的药物，作用于与中枢和外周疼痛处理相关的途径。AMG （Asociación Mexicana de Gastroenterología）和AMNM （Asociación Mexicana de Neurogastroenterología y Motilidad）的专家综述总结了一系列最新的临床建议，这些建议是基于对文献的详尽回顾，关于使用神经调节剂治疗DGBI，并分为六个部分：药理学原理、定义、分类、作用机制；每种DGBI亚型的适应症和用法；上/下规模策略，联合治疗；不良事件;在有合并症的情况下与精神科联合使用；非药物神经调节。此外，根据个体群体和敏感性提供药物选择过程提示和剂量个性化，并考虑DGBI-精神合并症的特殊情况，以及与另一DGBI重叠的情况。

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引用次数: 0

Síndrome de Boerhaave: reporte de caso de tratamiento conservador exitoso Boerhaave综合征：保守治疗成功病例报告

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2024.11.003

D.C. Calderón-Cabrera , E.J. Cobián-Cerna , C. Zanabria-Caya

引用次数: 0

Trasplante de microbiota fecal mediante colonoscopia para el manejo del síndrome de intestino irritable refractario: resultados preliminares 通过结肠镜移植粪便微生物群以控制肠易激综合征：初步结果

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2025.03.001

C. von Muhlenbrock , P. Núñez , K. Herrera , N. Pacheco , R. Quera

Recent studies have explored the role of the microbiota in disorders of gut-brain interaction, opening pathways for therapies, such as dietary adjustments, probiotics, and fecal microbiota transplantation (FMT). We present herein a pilot study on 4 patients with severe irritable bowel syndrome (IBS), refractory to conventional treatment, in which FMT through colonoscopy showed improvement in pain, bloating, and stool consistency that was maintained during the 6-month follow-up. To establish the broader clinical application of FMT, more research on its efficacy according to instillation site and patient results is needed.

最近的研究探索了微生物群在肠-脑相互作用紊乱中的作用，为治疗开辟了途径，如饮食调整、益生菌和粪便微生物群移植（FMT）。我们在此提出了一项对4例常规治疗难治性严重肠易激综合征（IBS）患者的初步研究，其中通过结肠镜检查的FMT显示疼痛，腹胀和粪便一致性的改善，并在6个月的随访期间保持不变。为了建立FMT更广泛的临床应用，需要根据注射部位和患者结果对其疗效进行更多的研究。

引用次数: 0

Efecto de reunión trimestral y reporte por correo electrónico de TDA, tasa de intubación cecal y tiempo de retirada sobre medidas de calidad personales y de grupo en colonoscopia 季度AD会议和电子邮件报告对结肠镜检查个人和群体质量测量的影响、子宫颈插管率和恢复时间

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Revista de Gastroenterologia de Mexico

Pub Date : 2025-04-01 DOI: 10.1016/j.rgmx.2024.11.011

F.I. Téllez-Ávila , B. Bailey , S. Dehmel , M. Deneke , K. Rude , S. Inamdar , M. García

Introduction

Colonoscopy is the most utilized screening test for colorectal cancer (CRC). The adenoma detection rate (ADR), cecal intubation rate (CIR), and withdrawal time (WT) are established quality indicators (QIs) for colonoscopy. The aim was to measure the effect of individual and group QIs in colonoscopy by providing quarterly meetings and email feedback on ADR, CIR, and WT.

Material and methods

This is a prospective study in two steps. In the initial phase, we aimed to collect the QIs in colonoscopy from our division and in the second step, we aimed to assess the impact of a quarterly report. Pre-Intervention: Using electronic medical records (EMRs), an automated method for calculating the ADR was devised. ADRs from 6 months were obtained. Periodic Feedback: Endoscopists received quarterly feedback during staff meetings and emails for 9 months. Post-Intervention: QIs were recalculated for 8 months, and physicians did not receive reports.

Results

Over 23 months, 1,137 screening colonoscopies were conducted. Seven gastroenterologists participated, distributed into high (n = 6) and low (n = 1) detector groups. The mean patient age was 58.6 ± 9.2 years, with 659 (57.9%) females. Moderate sedation was used in 892 (78.4%) cases. QIs did not show significant improvement during the feedback or post-intervention periods compared with the pre-intervention period. Endoscopists initially categorized as «low detectors» exhibited the most substantial improvement, with the ADR increasing from 23.5% to 61.5% (P < .001).

Conclusion

Quarterly feedback and email reports did not significantly improve colonoscopy quality measures. Regarding the ADR, the intervention's impact was most prominent in «low detectors.»

结肠镜检查是结直肠癌（CRC）最常用的筛查方法。腺瘤检出率（ADR）、盲肠插管率（CIR）和停药时间（WT）是结肠镜检查的既定质量指标（QIs）。目的是通过提供季度会议和关于ADR、CIR和wt的电子邮件反馈来衡量个人和群体QIs在结肠镜检查中的效果。材料和方法这是一项分两步进行的前瞻性研究。在初始阶段，我们的目标是从我们的部门收集结肠镜检查的QIs，在第二步，我们的目标是评估季度报告的影响。干预前：利用电子病历（EMRs），设计了一种自动计算ADR的方法。获得6个月的adr。定期反馈：内镜医师每季度通过员工会议和电子邮件收到反馈，为期9个月。干预后：重新计算QIs 8个月，医生未收到报告。结果在23个月内，共进行了1137次结肠镜筛查。7名胃肠病学家参与，分为高检出率组（n = 6）和低检出率组（n = 1）。患者平均年龄58.6±9.2岁，女性659例（占57.9%）。892例（78.4%）患者使用中度镇静。与干预前相比，在反馈期间或干预后，QIs没有显示出显著的改善。最初被归类为“低检出率”的内窥镜医师表现出最显著的改善，ADR从23.5%增加到61.5% (P <；措施)。结论季度反馈和电子邮件报告并没有显著提高结肠镜检查质量指标。关于ADR，干预的影响在“低检测器”中最为突出

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