[Caustics injuries in the upper gastrointestinal tract: clinical and endoscopic features]

OBJECTIVE

To describe the clinical and endoscopic features of caustics injuries in the upper gastrointestinal tract in patients of the National Hospital Daniel Alcides Carrión.

MATERIALS AND METHODS

A descriptive study was conducted; the study populations were patients diagnosed with caustic ingestion who were admitted into the Gastroenterology service of the HNDAC to perform an upper endoscopy during the period of January 2009 to December 2012. We documented the type of caustic substance ingested, cause of intake, amount ingested, intake mode, signs or symptoms present, endoscopic findings as classified by Zargar, presence of complications and treatment performed. Analysis was performed comparing them based on the ingested caustic type: acid or alkali.

RESULTS

We obtained 91 patients; the average age was 30.6±16.3 years. Caustic substances ingested were: bleach (sodium hypochlorite) in 71 (78%) patients, muriatic acid (hydrochloric acid) in 18 (20%) patients, caustic soda in 2 (2%) patients. The average intake was 136ml (30-500 ml). The most frequent signs and symptoms were vomiting, abdominal pain, nausea and sore throat. The 46% of patients had injuries. 100% of patients who ingested acid and 33% who ingested alkali had lesions. Five (5%) patients had oropharyngeal lesions, 24 (26%) in the esophagus, 36 (40%) in the stomach and 12 (13%) in the duodenum. Grade I lesions were found in 10 (11%) patients, 16 (18%) patients with grade II lesions and 15 (16%) of patients with grade III, 12 patients who toke acid had lesions of grade III. Esophageal stricture was found in 2 (2%) patients, gastric stenosis in 7 (8%) patients and esophageal and gastric stenosis in 3 (3%) patients. Two patients required pneumatic dilation and 10 surgical treatments.

CONCLUSION

Most injuries were found in the stomach. Acidic injuries occur more frequently and with greater severity than alkaline. Acidic substances produce esophageal or gastric stenosis more frequently than alkaline.

Distribución de los Grupos Sanguíneos ABO en los Pacientes con Úlcera Péptica

OBJETIVO: Determinar la distribución de los grupos sanguíneos ABO en los pacientes con úlcera péptica. MÉTODOS: Trabajo descriptivo y retrospectivo. Se revisaron historias clínicas de pacientes con diagnóstico endoscópico de úlcera péptica y tipificación del grupo sanguíneo ABO entre junio de 1994 y noviembre de 1996. Se tomó como control los pacientes y donantes del banco de sangre atendidos entre julio y agosto de 1996. El método estadístico utilizado fue el chi-cuadrado. RESULTADOS: Se estudiaron 100 pacientes. En el control, 73% tuvieron el grupo sanguíneo O, en los pacientes con úlcera péptica 78%. De los ulcerosos duodenales, 85% presentaron grupo sanguíneo O y de éstos, los menores de 40 años, 94% tenía grupo O. CONCLUSIONES: 1) La distribución de grupos sanguíneos en los pacientes con úlcera péptica es similar al control. 2) La distribución de grupos ABO en pacientes con úlcera duodenal muestra una diferencia estadísticamente significativa respecto al control con predominio del grupo O, particularmente en los pacientes menores de 40 años.

[Rectal mucosal prolapse syndrome: study of cases. Hospital Daniel A Carrion, Lima, Peru, 2010-2013]

OBJECTIVE

to describe the clinical, endoscopic, and histological characteristics of rectal mucosal prolapse syndrome, formerly known as Solitary rectal ulcer, in patients from a general hospital.

MATERIAL AND METHODS

All patient diagnosed as rectal mucosal prolapse syndrome during 2010-2013 was selected; the medical history war reviewed and the histological slides were reevaluated by two pathologists.

RESULTS

17 cases of rectal mucosal prolapse syndrome were selected, the majority were males under 50 years, the most common clinical findings were rectal bleeding (82%) and constipation (65%), the endocopic findings were heterogeneous,: erythema (41%), ulcers (35%) and elevated lesions (29%). All cases presented fibromuscularhyperplasia in lamina propia and crypt distortion in the microscopic evaluation.

CONCLUSION

In our study of rectal mucosal prolapse syndrome. The most common clinical findings were rectal bleeding and constipation. Erythematous mucosa was the most common endoscopic finding.

[Diagnostic of ascites due to portal hypertension: accuracy of the serum-ascites albumin gradient and protein analises in ascitic fluid]

OBJECTIVE

To evaluate the diagnostic accuracy of the Serum-Ascites Albumin Gradient (GASA), Protein Concentration in the Ascitic Fluid (PTLA), Albumin Concentration in the ascitic fluid (CAA) and the Protein Ascites/Serum Ratio (IPAS) for the diagnosis of ascites due to portal hypertension.

MATERIALS AND METHODS

it was an observational and retrospective study of validation of diagnostic tests. The study population was patients from a National Public Health Hospital Daniel Alcides Carrion of Callao, Peru, during the period January to December of 2012, patients over 15 years old with a diagnosis of ascites which samples were taken for study by paracentesis with an standard technique, it was analyzed total protein and albumin, as well as study of total protein and albumin in blood. We obtained the diagnostic accuracy, sensitivity, specificity, PPV and NPV of the Serum-Ascites Albumin Gradient (GASA), Protein Concentration in the Ascitic Fluid (PTLA), Albumin Concentration in the ascitic fluid (CAA) and the Protein Ascites/Serum Ratio (IPAS) for the diagnosis of ascites due to portal hypertension. To determine ascites by HTP as diagnostic tests we took into account: GASA >= 1.1, PTLA <2.5, CAA <1.1 or IPAS< 0.5.

RESULTS

There were 126 patients diagnosed with ascites, 10 patients was excluded for having incomplete data. Of the 116 patients, the average age was 53.03 +/- 15.73 years old, male 65 (56%) and female 51 (44%). 61 (52%) had ascites due to portal hypertension from liver cirrhosis, and 55 (48%) of ascites due to NO HTP. The sensitivity and specificity for GASA was 93% and 47% respectively, for PTLA was 80% and 89% respectively, for CAA was 85% and 87% respectively and for the IPAS was 83% and 80% respectively. The área under the ROC curve for GASA was 0.70, ATPL was 0.84, IPAS was 0.81 and CAA was 0.86, we found statistically significant differences between GASA compared to the other three parameters (p<0.01 ).

CONCLUSION

The diagnostic accuracy of CAA, ATPL and IPAS is higher than the GASA to discriminate between ascites due to HTP or NO HTP, so that they could be used in clinical practice alone or together to achieve a diagnostic approach more successful.

[Bisap-O: obesity included in score BISAP to improve prediction of severity in acute pancreatitis]

INTRODUCTION

Most patients with acute pancreatitis exhibits a self-limiting clinical course and relatively free of major complications. Several scores have been created with the intention of achieving adequate and early predict the severity of pancreatitis in order to reduce this mortality. BISAP score was validated in 2008 as a predictor of mortality for acute pancreatitis, obesity is an independent risk factor that increases the risk of severity in patients with acute pancreatitis.The aim of this study is to determine whether obesity BISAP added a score improves prediction of severity in patients with acute pancreatitis.

MATERIAL AND METHODS

This study was conducted in Daniel Alcides Carrión Hospital, Lima, Peru. The patient data were collected in the Emergency Service, it was a cross-sectional retrospective study, between January 2009 and June 2010.

RESULTS

We evaluated a total of 99 patients with acute pancreatitis. Etiology of the 99 were biliary pancreatitis. Only 2 ended in death (2%). Most cases occurred in female patients 77/22 (77.8%). Sixteen of the 99 patients (16%) were considered severe acute pancreatitis. 90% (89/99) had a BISAP <3, 10% a BISAP ≥ 3, fifteen of the 99 patients had a BISAP-O> 3, of them 12 were actually considered a severe pancreatitis. Of 16 patients with severe pancreatitis, 14 patients had a BMI>25. (P = 0.03, OR = 4.39). BISAP-O has a sensitivity, specificity, PPV and NPV of 75%, 96.4%, 80% and 95.2% respectively, with an accuracy of 92.3%. The area under the curve for BISAP-O was 0.94 (95% CI 0.89 to 0.99). There was no difference when compared with the other studied scores (p = 0.45).

CONCLUSIONS

BISAP The score is a simple method that can be used to predict the severity of acute pancreatitis. Obesity associated BISAP (BISAP-O) provides higher sensitivity and diagnostic accuracy to score BISAP and can serve as a parameter to help predict severity in patients with acute pancreatitis. It was not possible to assess the BISAP-O score as a predictor of mortality for patients with acute pancreatitis, due to the low mortality rate in the present study. Further studies are required to validate the score BISAP associated with obesity in predicting severity.

[Characteristics of gastroduodenal ulcers in patients with negative biopsies for Helicobacter pylori]

OBJECTIVES

To evaluate the clinical, epidemiological and endoscopic characteristics of the Helicobacter pylori (Hp) negative peptic ulcer disease.

METHODS

In this cross sectional study we included 651 patients diagnosed of peptic ulcer disease between January 2000 and December 2005. The diagnosis of Hp infection was established by histology. Clinical and epidemiological characteristics of patients with and without Hp infection were compared.

RESULTS

Males prevailed (69%). Hp negative ulcers were older (57.73 +/- 19.44 years old vs 50.26 +/- 18, 64 years old, P < 0.001). Clinical characteristics did not differ among both groups. Duodenal ulcer prevailed in Hp positive patients (56.5%) and gastric ulcer in Hp negative patients (53.5%). Multiple ulcers and intestinal metaplasia were more frequently found in Hp negative cases [9.3% vs 4.5% (P = 0.015) and 34.5% vs 22.1% (P = 0.001), respectively]. CONCLUSION. Hp negative peptic ulcer disease is found in older patients, with a higher frequency of gastric ulcers, multiple lesions and intestinal metaplasia.

[Sub-hepatic bilioma: report of a case and review of literature]

Biliomas are encapsulated collections of bile outside the biliary tree, caused mainly by trauma to the liver or bile ducts, or by acute obstruction of them, and not infrequently without an apparent cause. We present an 86 y.o. female patient who comes to the ER with right upper quadrant abdominal pain, fever and jaundice. Gallbladder had been removed previously but she had a dilated bile duct consistent with choledocolithiasis. Surgery was performed when she developed peritonitis and a sub-hepatic bilioma was found.

[Epidemiological changes in peptic ulcer and their relation with Helicobacter pylori. Hospital Daniel A Carrion 2000-2005]

INTRODUCTION

Peptic ulcer disease is a frequent pathological condition. In the last few years there have been reports describing changes in its epidemiology and its association with Helicobacter pylori infection.

AIMS

To describe epidemiological characteristics of peptic ulcers during the study period from January 2000 through December 2005 in Hospital Daniel Carrion.

METHODS

Cross sectional analitical study. All patients with an endoscopic diagnosis of peptic ulcer were included. Patients with gastric cancer or previous surgery were excluded. Data were processed using the SPSS 9.0 software.

RESULTS

We reviewed 10,819 endoscopy reports with 899 peptic ulcer cases diagnosed during the study period. 67.8% were male, age average 54 years. Age was higher in females (59.8 y), as was in those with gastric and pyloric ulcers (68.7 y). Most frequent endoscopic indications were upper gastrointestinal bleeding (53.3%) and dyspepsia (43.8%). Duodenal location was the most frequent (49.5%) although in recent years gastric ulcers have become more prevalent. Gastric ulcers were more commonly located in the antrum lesser curvature, while duodenal ulcers were located in the anterior wall of the duodenal bulb. Gastric ulcers were larger in size and more in number than duodenal ones. Helicobacter pylori was present in 65.3% of all ulcers, 74.3% for duodenal and 55.4% for gastric ulcers.

CONCLUSIONS

Prevalence of peptic ulcers during the study period was 83.09 cases per 1,000 endoscopies. Duodenal ulcers were the most frequent although there is a decline in the last years. There is also a decrease in the frequency of Helicobacter pylori infection as compared to what is usually described.

[Seasonal variation in upper gastrointestinal bleeding associated with portal hypertension]

OBJECTIVE

To determine if there is a seasonal pattern in the occurrence of upper gastrointestinal bleeding in patients with portal hypertension.

MATERIALS AND METHODS

All reports on upper gastrointestinal endoscopies at the department of gastroenterology carried out between July 1996 and June 2001 (N=9264) were revised. All cases of upper gastrointestinal bleeding studied by endoscopy were included. The group studied included adults and children considering data on age, sex and reported endoscopic diagnoses. The data was collected and grouped monthly and then regrouped by seasons. The data was processed with Epi Info version 6.0 and analyzed by the chi-square test.

RESULTS

Out of all the endoscopies carried out, 11.1% were for upper gastrointestinal bleeding episodes. In total, 114 cases of bleeding associated with portal hypertension were found, these represent 11% of the total number of cases of upper gastrointestinal bleeding. The greatest frequency of upper gastrointestinal bleeding associated with portal hypertension was registered between April and June, which are the autumn months. However, there was no significant difference in comparison with the other seasons of the year.

CONCLUSIONS

No seasonal pattern of upper gastrointestinal bleeding associated with portal hypertension was detected.

[The physician's attitude towards infection by Helicobacter pylori in clinical practice]

AIM

To study the attitude of general practitioners and internists towards the infection with helicobacter pylori.

METHODS USED

Interviews were conducted among 170 physicians. Proportions were compared using the Z test.

RESULTS

Out of 170 interviewed, 152 questionnaires were completed correctly: 80.9% were general practitioners and 19% internists. All of the GPs and 84.6% of internists chose the oral-fecal as the route of transmission. Gastric ulcer was thought to be associated by 60.8% of GPs and 72.4% of internists. The least well known association was with MALT lymphoma (8.1%). Biopsy was reported as the best way to make diagnosis (54 and 72.4%). GPs reported they would treat recurring ulcers as Helicobacter pylori, while internists would treat them since the first episode. Sixty point 2 percent (60.2%) of GPs and 69% of internists are using inadequate schemes for treating Hp infections. The combination of omeprazol, amoxicillin, bismuth salts or clarithromycin was the most frequently used.

CONCLUSIONS

Current knowledge regarding Helicobacter pylori infection among GPs and internists is not sufficiently understood.

[ABO BLOOD GROUPS AS RISK FACTOR IN HELICOBACTER PYLORI INFECTION]

TITLE: ABO blood groups as risk factor in Helicobacter pylori infection.OBJECTIVE: To asses the relation between ABO blood groups and Helicobacter pylori (Hp) infection. METHODS: The present is a case and control study. A study population of dyspeptic patients who underwent upper gastrointestinal endoscopy was selected. Four biopsies were taken from the antrum and the body of the stomach and blood group was typified. Patients with gastrectomy, gastric cancer, treated for Hp infection in the previous six months or without blood group typification were excluded. The population sample was found using EPIINFO 5.1 program. We called case to every patient with Hp (+) biopsy and control all with Hp (-) biopsy. The risk of the infection was calculated with the OR (Odds ratio) and the study sample was compared with the blood bank control group using the Chi-square test (p<0.005).RESULTS: 367 patients were included (202 female). Age average was 45,06 years. 276 (75,2%) were Hp (+). There were not statistically significant differences in the distribution of ABO blood groups between the study population and the blood bank control. When we compared the ABO blood distribution between patients Hp (+) and Hp (-) we found significant differences for blood group O (p=0.004) and blood group A (p=0.03). Statistical analysis revealed an OR=2,22 for the blood group O and OR=0,5 for the blood group A.CONCLUSIONS: 1) The ABO blood group distribution is different in patients with Hp infection compared with those without Hp infection. 2) Blood group O would be a moderate risk factor for infection by Helicobacter pylori.