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Ruiz-Manriquez J, León-Lara X, Campos-Murguía A, Solis-Ortega A, Pérez-González B, Uscanga L, Peláez-Luna M. Knowledge of Latin American gastroenterologists and endoscopists regarding SARS-CoV-2 infection. Revista de Gastroenterología de México (English Edition) 2020. [PMCID: PMC7261444 DOI: 10.1016/j.rgmxen.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ruiz-Manriquez J, León-Lara X, Campos-Murguía A, Solis-Ortega AA, Pérez-González B, Uscanga LF, Peláez-Luna M. Knowledge of Latin American gastroenterologists and endoscopists regarding SARS-CoV-2 infection. Rev Gastroenterol Mex (Engl Ed) 2020; 85:288-294. [PMID: 32466830 PMCID: PMC7198154 DOI: 10.1016/j.rgmx.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION After the World Health Organization declared the COVID-19 outbreak a pandemic, the number of patients with confirmed SARS-CoV-2 infection (COVID-19) has increased exponentially, and gastroenterologists and other specialists most likely will be involved in the care of those patients. AIM To evaluate the knowledge Latin American gastroenterologists and endoscopists (staff physicians and residents) have about the characteristics of COVID-19, as well as the prevention measures to be taken during endoscopic procedures. MATERIALS AND METHODS We conducted a cross-sectional study that included gastroenterologists and endoscopists from 9 Latin American countries. An electronic questionnaire was applied that was designed to evaluate the knowledge of symptoms, risk groups for severe disease, prevention measures, and the reprocessing of endoscopes utilized in patients with COVID-19. RESULTS Information was obtained from 133 physicians. Ninety-five percent of them correctly identified the most frequent symptoms of the virus, and 60% identified the 3 risk groups for severe disease. Sixty-six percent of those surveyed did not consider it necessary to use standard precautions during endoscopic procedures, and 30% did not consider contact precautions necessary. Forty-eight percent of the participants surveyed were not familiar with the protocol for reprocessing the endoscopes utilized in patients with COVID-19. CONCLUSION The majority of the gastroenterologists and endoscopists surveyed were familiar with the signs and symptoms of COVID-19 and the populations at risk for complications. There was a lack of knowledge about prevention measures (during clinical care and endoscopic procedures) and the reprocessing of endoscopic equipment by 70% and 48%, respectively, of those surveyed. Dissemination and teaching strategies that increase the knowledge of specific biosafety measures must be carried out.
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Affiliation(s)
- J Ruiz-Manriquez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"
| | - X León-Lara
- Laboratorio de investigación en inmunodeficiencias, Instituto Nacional de Pediatría
| | - A Campos-Murguía
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"
| | - A A Solis-Ortega
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"
| | - B Pérez-González
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"
| | - L F Uscanga
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"
| | - M Peláez-Luna
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"; División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México.
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Keil-Ríos D, Angulo-Molina D, Peláez-Luna M, Farca-Belsaguy A, Estradas-Trujillo J. Capsule endoscopy for the study of small bowel disorders: Experience at a private institution in Mexico. Revista de Gastroenterología de México (English Edition) 2020. [DOI: 10.1016/j.rgmxen.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Miranda-Zazueta G, González-Regueiro JA, García-Juárez I, Moctezuma-Velázquez C, López-Díaz FJ, Pérez-González B, Uscanga-Domínguez LF, Peláez-Luna M. Pharmacologic management of patients with hepatic and pancreatic diseases that involve immunosuppressive therapies. Position statement within the framework of the SARS-CoV-2 (COVID-19) pandemic. Rev Gastroenterol Mex (Engl Ed) 2020; 85:312-320. [PMID: 32620315 PMCID: PMC7298481 DOI: 10.1016/j.rgmx.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
La enfermedad por coronavirus 2019 (COVID-19) es causada por el virus del síndrome respiratorio agudo grave-coronavirus 2 (SARS-CoV-2). La COVID-19 ha afectado a unos 6 millones de personas en todo el mundo en menos de 4 meses posterior al reporte de los primeros casos en China en diciembre de 2019. La relación que guarda la enfermedad por SARS-CoV-2 con el tratamiento inmunosupresor utilizado en diversos trastornos gastrointestinales es incierta, y esto genera el debate sobre suspender el tratamiento inmunosupresor para mejorar el pronóstico de la infección, lo cual incluye el riesgo inherente de rechazo de injerto o agudización de enfermedades autoinmunes que potencialmente pudieran agravar el curso de la infección. En base a la evidencia disponible se logra establecer una postura de tratamiento en pacientes con enfermedades gastrointestinales que requieren terapia inmunosupresora.
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Affiliation(s)
- G Miranda-Zazueta
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - J A González-Regueiro
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - I García-Juárez
- Departamento de Gastroenterología, Unidad de Hepatología y Trasplante Hepático, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - C Moctezuma-Velázquez
- Departamento de Gastroenterología, Unidad de Hepatología y Trasplante Hepático, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - F J López-Díaz
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - B Pérez-González
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - L F Uscanga-Domínguez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - M Peláez-Luna
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México.
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Keil-Ríos D, Angulo-Molina D, Peláez-Luna M, Farca-Belsaguy A, Estradas-Trujillo J. Capsule endoscopy for the study of small bowel disorders: Experience at a private institution in Mexico. Rev Gastroenterol Mex (Engl Ed) 2019; 85:240-245. [PMID: 31582187 DOI: 10.1016/j.rgmx.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/06/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Capsule endoscopy has revolutionized the study of small bowel disorders. Its diagnostic yield, reasons for referral, and frequency of significant endoscopic findings at our institution are unknown. The aims of our study were to describe the reasons for referral, the frequency of significant endoscopic findings, and the diagnostic yield of capsule endoscopy in patients that underwent the procedure for the study of small bowel disorders. MATERIAL AND METHODS A retrospective study was conducted that included all patients that underwent capsule endoscopy for small bowel disorder evaluation at our institution. The diagnostic yield for significant endoscopic findings, the frequency of significant endoscopic findings, and the reasons for referral for capsule endoscopy were determined. RESULTS A total of 134 patients were included in the study and 143 capsule endoscopies were performed. Women made up 48.5% of the sample and the mean patient age was 63 years (18.7 standard deviation). The main reasons for referral were suspicion of overt small bowel bleeding (55.9%) and suspicion of occult small bowel bleeding (28.6%). The overall diagnostic yield was 66.4%. The most common significant findings were small bowel angioectasias (52.6%) and small bowel ulcers (38.9%). There were two adverse events (1.3%): one capsule retention that required enteroscopic removal and one asymptomatic bronchoaspiration of the capsule that resolved spontaneously. CONCLUSIONS The frequency of significant endoscopic findings with capsule endoscopy at our institution was different from that reported in other Mexican studies, but the reasons for referral and the diagnostic yield were similar.
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Affiliation(s)
- D Keil-Ríos
- Unidad de Endoscopia Avanzada, Centro Médico ABC, Ciudad de México, México.
| | - D Angulo-Molina
- Unidad de Endoscopia Avanzada, Centro Médico ABC, Ciudad de México, México
| | - M Peláez-Luna
- Unidad de Endoscopia Avanzada, Centro Médico ABC, Ciudad de México, México
| | - A Farca-Belsaguy
- Unidad de Endoscopia Avanzada, Centro Médico ABC, Ciudad de México, México
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Remes-Troche JM, Uscanga-Domínguez LF, Aceves-Tavares RG, Calderón de la Barca AM, Carmona-Sánchez RI, Cerda-Contreras E, Coss-Adame E, Icaza-Chávez ME, Lopéz-Colombo A, Milke-García MP, Morales-Arámbula M, Peláez-Luna M, Ramos Martínez P, Sánchez-Sosa S, Treviño-Mejía MC, Vázquez-Frías R, Worona-Dibner LB, Zamora-Nava LE, Rubio-Tapia A. Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico. Rev Gastroenterol Mex (Engl Ed) 2018; 83:434-450. [PMID: 30197183 DOI: 10.1016/j.rgmx.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/12/2018] [Accepted: 05/24/2018] [Indexed: 12/17/2022]
Abstract
Celiac disease, celiac sprue, or gluten-sensitive enteropathy, is a generalized autoimmune disease characterized by chronic inflammation and atrophy of the small bowel mucosa. It is caused by dietary exposure to gluten and affects genetically predisposed individuals. In Mexico, at least 800,000 are estimated to possibly have the disease, prompting the Asociación Mexicana de Gastroenterología to summon a multidisciplinary group of experts to develop the "Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico" and establish recommendations for the medical community, its patients, and the general population. The participating medical professionals were divided into three working groups and were given the selected bibliographic material by the coordinators (ART, LUD, JMRT), who proposed the statements that were discussed and voted upon in three sessions: two voting rounds were carried out electronically and one at a face-to-face meeting. Thirty-nine statements were accepted, and once approved, were developed and revised by the coordinators, and their final version was approved by all the participants. It was emphasized in the document that epidemiology and risk factors associated with celiac disease (first-degree relatives, autoimmune diseases, high-risk populations) in Mexico are similar to those described in other parts of the world. Standards for diagnosing the disease and its appropriate treatment in the Mexican patient were established. The guidelines also highlighted the fact that a strict gluten-free diet is essential only in persons with confirmed celiac disease, and that the role of gluten is still a subject of debate in relation to nonceliac, gluten-sensitive patients.
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Affiliation(s)
- J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, México.
| | - L F Uscanga-Domínguez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - R G Aceves-Tavares
- Servicio de Gastroenterología, Hospital General del Estado Dr. Ernesto Ramos, Bours, Hermosillo, Sonora, México
| | | | | | - E Cerda-Contreras
- ITESM. Medicina Interna y Gastroenterología Fundación Clínica Médica Sur, Ciudad de México, México
| | - E Coss-Adame
- Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Ciudad de México, México
| | - M E Icaza-Chávez
- Hospital Star Médica de Mérida, Gastroenterología de la UNIMAYAB, , Mérida, Yucatán, México
| | - A Lopéz-Colombo
- Dirección de Educación e Investigación en Salud, UMAE Hospital de Especialidades del Centro Médico Nacional Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - M P Milke-García
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Ciudad de México, México
| | - M Morales-Arámbula
- Servicio de Gastroenterología y Endoscopía Gastrointestinal, Hospital Country 2000, Guadalajara, Jalisco, México
| | - M Peláez-Luna
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - S Sánchez-Sosa
- Jefe de Patología, Hospital Ángeles de Puebla, Universidad de Las Américas Puebla (UDLAP), Puebla, México
| | - M C Treviño-Mejía
- Universidad Iberoamericana, Universidad Xochicalco, Tijuana, Baja California, México
| | - R Vázquez-Frías
- Universidad Iberoamericana, Universidad Xochicalco, Tijuana, Baja California, México
| | - L B Worona-Dibner
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - L E Zamora-Nava
- Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - A Rubio-Tapia
- División de Gastroenterología y Hepatología, Mayo Clinic, Rochester, Minnesota, Estados Unidos de América
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Valdovinos M, Montijo E, Abreu A, Heller S, González-Garay A, Bacarreza D, Bielsa-Fernández M, Bojórquez-Ramos M, Bosques-Padilla F, Burguete-García A, Carmona-Sánchez R, Consuelo-Sánchez A, Coss-Adame E, Chávez-Barrera J, de Ariño M, Flores-Calderón J, Gómez-Escudero O, González-Huezo M, Icaza-Chávez M, Larrosa-Haro A, Morales-Arámbula M, Murata C, Ramírez-Mayans J, Remes-Troche J, Rizo-Robles T, Peláez-Luna M, Toro-Monjaraz E, Torre A, Urquidi-Rivera M, Vázquez R, Yamamoto-Furusho J, Guarner F. The Mexican consensus on probiotics in gastroenterology. Revista de Gastroenterología de México (English Edition) 2017. [DOI: 10.1016/j.rgmxen.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Valdovinos MA, Montijo E, Abreu AT, Heller S, González-Garay A, Bacarreza D, Bielsa-Fernández M, Bojórquez-Ramos MC, Bosques-Padilla F, Burguete-García AI, Carmona-Sánchez R, Consuelo-Sánchez A, Coss-Adame E, Chávez-Barrera JA, de Ariño M, Flores-Calderón J, Gómez-Escudero O, González-Huezo MS, Icaza-Chávez ME, Larrosa-Haro A, Morales-Arámbula M, Murata C, Ramírez-Mayans JA, Remes-Troche JM, Rizo-Robles T, Peláez-Luna M, Toro-Monjaraz EM, Torre A, Urquidi-Rivera ME, Vázquez R, Yamamoto-Furusho JK, Guarner F. The Mexican consensus on probiotics in gastroenterology. Rev Gastroenterol Mex 2017; 82:156-178. [PMID: 28104319 DOI: 10.1016/j.rgmx.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/17/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.
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Affiliation(s)
- M A Valdovinos
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
| | - E Montijo
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - A T Abreu
- Servicio de Gastroendoscopia, Hospital Regional n.(o) 2 con Unidad de Medicina de Atención Ambulatoria, IMSS, Ciudad de México, México
| | - S Heller
- Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
| | - A González-Garay
- Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México
| | - D Bacarreza
- Hospital Infantil de las Californias, Tijuana, BC, México
| | - M Bielsa-Fernández
- Unidad de Pacientes en Estudio, Universidad Autónoma de Guadalajara, Zapopan, Jalisco, México
| | - M C Bojórquez-Ramos
- UMAE Hospital de Pediatría, Centro Médico Nacional de Occidente, IMSS, , Guadalajara, Jalisco, México
| | - F Bosques-Padilla
- Departamento de Medicina Interna, División de Gastroenterología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - A I Burguete-García
- Departamento de Epidemiología Genética e Infecciones, CISEI, INSP, Cuernavaca, Mor., México
| | | | - A Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - E Coss-Adame
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J A Chávez-Barrera
- Departamento de Gastroenterología Pediátrica, UMAE Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, IMSS, Ciudad de México, México
| | - M de Ariño
- Servicio de Gastroenterología, Hospital Español, Ciudad de México, México
| | - J Flores-Calderón
- Departamento de Gastroenterología y Endoscopia, UMAE Hospital de Pediatría Dr. Silvestre Frenk Freund, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia Digestiva y Motilidad Gastrointestinal, Hospital Ángeles Puebla, Puebla, México
| | - M S González-Huezo
- Departamento de Gastroenterología, Centro Médico Issemym, Metepec, Estado de México, México
| | | | - A Larrosa-Haro
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | | | - C Murata
- Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, México
| | - J A Ramírez-Mayans
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - J M Remes-Troche
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana (UV), Veracruz, México
| | - T Rizo-Robles
- Servicio de Gastroenterología, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Ciudad de México, México
| | - M Peláez-Luna
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - E M Toro-Monjaraz
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - A Torre
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - M E Urquidi-Rivera
- Servicio de Gastroenterología Pediátrica y Endoscopia, Hospital Regional ISSSTE, Monterrey, N.L., México
| | - R Vázquez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - J K Yamamoto-Furusho
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - F Guarner
- Servicio de Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
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Schmulson M, Bielsa MV, Carmona-Sánchez R, Hernández A, López-Colombo A, López Vidal Y, Peláez-Luna M, Remes-Troche JM, Tamayo JL, Valdovinos MA. [Gastrointestinal microbiota and irritable bowel syndrome; response to García-Mazcorro]. Rev Gastroenterol Mex 2014; 79:215-6. [PMID: 25216998 DOI: 10.1016/j.rgmx.2014.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/19/2014] [Indexed: 12/19/2022]
Affiliation(s)
- M Schmulson
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México, México DF, México.
| | - M V Bielsa
- Departamento de Gastroenterología, Facultad de Medicina, Universidad Autónoma de Guadalajara, Guadalajara, Jalisco, México
| | - R Carmona-Sánchez
- Servicio de Gastroenterología, Servicio de Medicina Interna, Hospital Ángeles-CMP, San Luis Potosí, México
| | - A Hernández
- Servicio de Endoscopia, Instituto Nacional de Cancerología, México DF, México
| | - A López-Colombo
- Coordinación Delegacional de Investigación en Salud, Instituto Mexicano del Seguro Social, Puebla, México
| | - Y López Vidal
- Programa de Inmunología Molecular Microbiana, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México DF, México
| | - M Peláez-Luna
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México, México DF, México
| | - J M Remes-Troche
- Programa de Inmunología Molecular Microbiana, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México DF, México; Investigador Titular de Tiempo Completo, Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Medico-Biológicas, Universidad Veracruzana, Veracruz, Facultad de Medicina Miguel Alemán Valdés, Veracruz, México
| | - J L Tamayo
- Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, México
| | - M A Valdovinos
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México
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Schmulson M, Bielsa M, Carmona-Sánchez R, Hernández A, López-Colombo A, López Vidal Y, Peláez-Luna M, Remes-Troche J, Tamayo J, Valdovinos M. Gastrointestinal microbiota and irritable bowel syndrome; response to García-Mazcorro. Revista de Gastroenterología de México (English Edition) 2014. [DOI: 10.1016/j.rgmxen.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schmulson M, Bielsa MV, Carmona-Sánchez R, Hernández A, López-Colombo A, López Vidal Y, Peláez-Luna M, Remes-Troche JM, Tamayo JL, Valdovinos MA. Microbiota, gastrointestinal infections, low-grade inflammation, and antibiotic therapy in irritable bowel syndrome: an evidence-based review. Rev Gastroenterol Mex 2014; 79:96-134. [PMID: 24857420 DOI: 10.1016/j.rgmx.2014.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Post-infectious irritable bowel syndrome (PI-IBS) prevalence, small intestinal bacterial overgrowth (SIBO), altered microbiota, low-grade inflammation, and antibiotic therapy in IBS are all controversial issues. AIMS To conduct an evidence-based review of these factors. METHODS A review of the literature was carried out up to July 2012, with the inclusion of additional articles as far as August 2013, all of which were analyzed through the Oxford Centre for Evidence-Based Medicine (OCEBM) system. RESULTS 1.There is greater SIBO probability in IBS when breath tests are performed, but prevalence varies widely (2-84%). 2.The gut microbiota in individuals with IBS is different from that in healthy subjects, but a common characteristic present in all the patients has not been established. 3.The incidence and prevalence of PI-IBS varies from 9-10% and 3-17%, respectively, and the latter decreases over time. Bacterial etiology is the most frequent but post-viral and parasitic cases have been reported. 4.A sub-group of patients has increased enterochromaffin cells, intraepithelial lymphocytes, and mast cells in the intestinal mucosa, but no differences between PI-IBS and non-PI-IBS have been determined. 5.Methanogenic microbiota has been associated with IBS with constipation. 6.Rifaximin at doses of 400mg TID/10days or 550mg TID/14days is effective treatment for the majority of overall symptoms and abdominal bloating in IBS. Retreatment effectiveness appears to be similar to that of the first cycle. CONCLUSIONS Further studies are required to determine the nature of the gut microbiota in IBS and the differences in low-grade inflammation between PI-IBS and non-PI-IBS. Rifaximin has shown itself to be effective treatment for IBS, regardless of prior factors.
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Affiliation(s)
- M Schmulson
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México, México DF, México.
| | - M V Bielsa
- Departamento de Gastroenterología, Facultad de Medicina, Universidad Autónoma de Guadalajara, Guadalajara, Jalisco, México
| | - R Carmona-Sánchez
- Servicio de Gastroenterología, Servicio de Medicina Interna, Hospital Ángeles-CMP, San Luis Potosí, San Luis Potosí, México
| | - A Hernández
- Servicio de Endoscopia, Instituto Nacional de Cancerología, México DF, México
| | - A López-Colombo
- Coordinación Delegacional de Investigación en Salud, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
| | - Y López Vidal
- Programa de Inmunología Molecular Microbiana, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México DF, México
| | - M Peláez-Luna
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Departamento de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México, México DF, México
| | - J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Veracruz, México; Facultad de Medicina «Miguel Alemán Valdés», Universidad Veracruzana, Veracruz, Veracruz, México
| | - J L Tamayo
- Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, México
| | - M A Valdovinos
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México
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Peláez-Luna M, Romero F. [Usefulness of endoscopic ultrasound elastography in evaluating and differentiating pancreatic lesions]. Rev Gastroenterol Mex 2014; 79:62-64. [PMID: 24642399 DOI: 10.1016/j.rgmx.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 06/03/2023]
Affiliation(s)
- M Peláez-Luna
- Laboratorio HIPAM, Unidad de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, México DF, México; Unidad de Endoscopia, Clínica Lomas Altas, México DF, México; Unidad Avanzada de Endoscopia, Centro Médico ABC, México DF, México.
| | - F Romero
- Unidad Avanzada de Endoscopia, Centro Médico ABC, México DF, México
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Peláez-Luna M, Romero F. Usefulness of endoscopic ultrasound elastography in evaluating and differentiating pancreatic lesions. Revista de Gastroenterología de México (English Edition) 2014. [DOI: 10.1016/j.rgmxen.2014.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Peláez-Luna M, Borbolla-Arizti JP, Herrera-Lozano A, Baquera-Heredia J. [Frequency of visualization of celiac ganglia by endoscopic ultrasound and its potential in assessing neural invasion in patients with pancreatic lesions]. Rev Gastroenterol Mex 2013; 78:251-4. [PMID: 24290318 DOI: 10.1016/j.rgmx.2013.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/27/2013] [Accepted: 09/02/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Celiac ganglia (CG) can be seen by endoscopic ultrasound; they play an important role in pain management and are a potential site for extrapancreatic tumor neural invasion. AIMS To evaluate the frequency of CG visualization during endoscopic ultrasound examination and to evaluate the feasibility of this technique to identify extrapancreatic tumor neural invasion in patients with pancreatic lesions. METHODS We retrospectively reviewed all endoscopic ultrasound studies performed between November 2007 and June 2010. Images of the celiac region were presented to an endosonographer, who reported the presence or absence of CG. RESULTS We included 31 cases. CG were identified in 14 (45%) cases. Average size was 10mm (range 4-25mm) by±1mm (range 1-7mm). In 2 cases, fine needle aspiration biopsy was performed and reported nerve cell bodies; in one case malignant cells were seen. CONCLUSIONS CG were identified in 45% of the cases. Fine needle aspiration biopsy can detect unanticipated extrapancreatic tumor neural invasion in pancreatic malignancies.
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Affiliation(s)
- M Peláez-Luna
- Unidad de Endoscopia Avanzada, Centro Médico ABC, México D.F., México; Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), México D.F., México.
| | | | - A Herrera-Lozano
- Unidad de Endoscopia Avanzada, Centro Médico ABC, México D.F., México
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Peláez-Luna M. [Chronic pancreatitis and autoimmune pancreatitis]. Rev Gastroenterol Mex 2013; 78 Suppl 1:42-4. [PMID: 24041055 DOI: 10.1016/j.rgmx.2013.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M Peláez-Luna
- Profesor Asociado de Medicina. Laboratorio de Hígado, Páncreas y Motilidad (HIPAM). Unidad de Medicina Experimental Facultad de Medicina. Universidad Nacional Autónoma de México (UNAM).
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Peláez-Luna M. Evidence-based medicine?!... What for? Rev Gastroenterol Mex 2012; 77:157-8. [PMID: 23140763 DOI: 10.1016/j.rgmx.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 09/20/2012] [Accepted: 09/27/2012] [Indexed: 11/16/2022]
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Gutiérrez-Salmeán G, Peláez-Luna M. [Nutritional therapy in acute pancreatitis: a practical guide for the initial enteral nutritional support.]. Rev Gastroenterol Mex 2010; 75:67-76. [PMID: 20423783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Nutritional support is a cornerstone in acute pancreatitis (AP) treatment, which is a catabolic state that can result in patient's nutritional depletion. First step in the management of AP is to asses its severity. Despite mild AP cases usually do not require nutritional support severe cases benefit from its early initiation. Total enteral nutrition (TEN) decreases the frequency of complications and is the preferred nutrition modality in AP. Availability of nutrition specialists is often limited and usually the primary care physician decides when and how to start nutritional support in AP. AIM To perform a systematic review about nutritional support in AP and create a TEN guide to aid the non nutrition specialist involved in the treatment of AP patients. MATERIAL AND METHODS The search for eligible studies was carried out using the Pub Med and the National Library of Medicine electronic data bases. Controlled clinical trials, treatment guidelines and systematic review articles were selected. RESULTS It is recommended to initiate nutritional support in AP cases that will be without oral intake longer than a week and TEN is the election modality. We created a TEN guide explaining how to choose and initiate TEN in AP. CONCLUSIONS Early TEN improves AP prognosis and is the nutritional modality of choice in every AP patients that will remain without oral intake longer than a week.
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Lozoya-González D, Farca-Belsaguy A, Peláez-Luna M, Vázquez-Ballesteros E, González-Galeote E, Salceda-Otero JC. [Endoscopic resection of ampullary adenoma.]. Rev Gastroenterol Mex 2010; 75:89-92. [PMID: 20423788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Ampullary adenomas can occur sporadically or as part of familial adenomatous polyposis syndrome. Most of them are asymptomatic. Current standard of management is complete surgical or endoscopic resection, depending on depth of invasion and/or biliary tract involvement. The last can be established by endoscopic ultrasound or endoscopic retrograde colangiopancreatography. Surgical resection has high morbidity (25% to 65%) and mortality (10%) in unexperienced hands compared to endoscopic therapy (12% and 1%, respectively). Complications of endoscopic therapy ranges from 7% to 10%. Recurrence of adenomatous lesions treated endoscopically is 30%. Endoscopic surveillance after resection is mandatory. We present the case of a patient with an ampulla of Vater s adenoma successfully resected endoscopically previous assessment of the lesion by endoscopic ultrasound.
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Salceda-Otero JC, Vázquez-Ballesteros E, Peláez-Luna M, Lozoya-González D, González-Galeote E, Farca-Belsaguy A. Endoscopic biliary large-balloon dilation after endoscopic sphincterotomy for the treatment of large common bile duct stones. Case report. Rev Gastroenterol Mex 2010; 75:339-343. [PMID: 20959188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Common bile duct (CBD) stones extraction is usually performed by endoscopic sphincterotomy followed by removal by either a Dormia basket or extraction balloon catheter. However, some stones due to their size are not amenable to these procedures and extracorporeal or mechanical lithotripsy devices need to be used. Mechanical lithotripsy involves usage of a basket that will be inevitably destroyed which increases cost to the patient and endoscopy unit. The use of extracorporeal wave shock lithotripsy is an alternative; however it is not available widely. Reports about the use of hydrostatic large caliber balloon dilator (HLCBD) aiding in the extraction of large caliber CBD stones have concluded that is a safe and feasible therapeutic alternative. We present the case of a 25 mm x 30 mm CBD stone that could not be extracted using conventional methods. CBD dilation using HLCBD was performed after endoscopic sphincterotomy in an attempt to avoid mechanical lithotripsy.
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Affiliation(s)
- J C Salceda-Otero
- Advanced Endoscopy Unit ABC Medical Center, Universidad Nacional Autónoma de México (UNAM), Mexico
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Lozoya-González D, Farca-Belsaguy A, Peláez-Luna M, Vázquez-Ballesteros E, González-Galeote E, Salceda-Otero JC. [Endoscopic mucosal resection due to adenocarcinoma of the esophagus caused by Barrett's esophagus.]. Rev Gastroenterol Mex 2009; 74:383-386. [PMID: 20423774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The endoscopic therapy has been used in the treatment of early stage neoplastic esophageal lesions with great success. The endoscopic ultrasound is a useful tool for the correct staging of these lesions. The staging accuracy of esophageal cancer with endoscopic ultrasound reaches 80% for T stage and 77% for N stage. The endoscopic approach provides complete resection of lesions confined to the mucosal layer, is a safety procedure with complications reported to occur from 3% to 13%. The morbidity and mortality rates after an endoscopic mucosal resection have been reported to be less than those posterior to esophagectomy. We present a case of a patient with high surgical risk, who underwent an upper endoscopy because of long history of gastroesophageal reflux disease and uncontrollable hiccup with successful endoscopic mucosal resection with plastic cap and polipectomy loop of an early stage esophageal adenocarcinoma derived of Barrett s esophagus.
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Gutiérrez-Salmeán G, Peláez-Luna M, González-Galeote E, Lozoya-González D, Fuchs-Tarlovsky V, Farca-Belsaguy A. Outcomes of temporary self-expanding plastic stents (SEPS) use for gastrointestinal leaks. A case series. Rev Gastroenterol Mex 2009; 74:181-186. [PMID: 19858005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Gastrointestinal fistulas can develop as a complication of any gastrointestinal surgery, trauma, malignant disease, radiotherapy or because of iatrogenic procedures. The use of self expandable metallic stents (SEMS) has been reported as a feasible and effective therapeutic method. Self expandable plastic stents (SEPS) have been successfully used to treat esophageal malignancies, perforations and leaks but information regarding outcomes of SEPS in gastrointestinal leaks is scarce. OBJECTIVE To report the outcomes and complications of endotherapy using SEPS in upper gastrointestinal tract fistulas following gastrointestinal surgery. MATERIAL AND METHODS Retrospective review of 5 cases of upper gastrointestinal leaks treated with SEPS. Medical records were reviewed to obtained patients demographics, procedure success, complications and follow up. RESULTS We described 2 women and 3 men with an age ranged between 29 and 65 years old. SEPS were left in place for a median period of 90 days (range: 30-279 days). There were no complications related to SEPS placement, replacement or withdrawal. Fistulas closed in 60% of the cases where SEPS were the only therapeutic maneuver and in more than 80% when other therapy (cyanoacrilate, fibrin) was used. CONCLUSIONS Endotherapy with SEPS appears as a feasible, safe and effective option for sealing gastrointestinal fistulas.
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Affiliation(s)
- G Gutiérrez-Salmeán
- Advanced Endoscopy Unit, ABC Medical Center, Oncology Ward, Hospital General de Mexico
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Peláez-Luna M, Martinez-Salgado J, Olivera-Martinez MA. Utility of the MAYO End-Stage Liver Disease score, King's College Criteria, and a new in-hospital mortality score in the prognosis of in-hospital mortality in acute liver failure. Transplant Proc 2006; 38:927-9. [PMID: 16647512 DOI: 10.1016/j.transproceed.2006.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Several prognostic scores attempt to aid in the selection of patients with acute liver failure (ALF) to be treated either medically or by liver transplantation; however, their lack of fulfillment does not predict spontaneous survival in ALF and refined prognostic criteria are needed to improve such selection. Our aim was to evaluate and compare a new ALF in-hospital mortality prediction score versus King's College Criteria (KCC) and model for End-Stage Disease (MELD) score. METHODS First-time ALF-diagnosed individuals admitted to our institution (n = 58) were grouped according their final outcome as "alive" or "death," and those significantly different variables between groups entered into a logistic regression and lineal regression models. An ALF in-hospital mortality score (ALFIHMS) was produced and its sensitivity, specificity, and area under receiver operator characteristics were compared with those of KCC and MELD scores. RESULTS Since no significant differences (P = .81) in mortality rates between fulminant and subfulminant hepatic failure were found, no further analysis according to ALF's classification was performed. After obtaining and comparing ALFIHMS with KCC and MELD, we found that ALFIHMS prediction accuracy is higher than that of KCC and MELD score and that an ALFIHMS cutoff point >15 points is associated with an in-hospital mortality probability >50%. CONCLUSIONS ALFIHMS has higher prognostic accuracy than KCC and MELD scores in ALF.
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Affiliation(s)
- M Peláez-Luna
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Suazo-Baráhona J, Carmona-Sánchez R, Robles-Díaz G, Milke-García P, Vargas-Vorácková F, Uscanga-Domínguez L, Peláez-Luna M. Obesity: a risk factor for severe acute biliary and alcoholic pancreatitis. Am J Gastroenterol 1998; 93:1324-8. [PMID: 9707059 DOI: 10.1111/j.1572-0241.1998.442_l.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In this study we evaluate the association between obesity and complication development in patients with a first-attack acute pancreatitis (AP), and investigate the influence of comorbid factors on this association. METHODS Medical records of 150 patients with AP were reviewed. General data, AP etiology, admission AP prognostic criteria, and occurrence of complications were recorded. Patients were classified according to body mass index (BMI) as obese (BMI > 25 kg/m2) and nonobese (BMI < or = 25 kg/m2). RESULTS Prevalence of obesity was 57%. Thirty-eight percent of the obese patients developed complications as compared with 21% of the nonobese (RR=1.74; 95% CI, 1-2.9). The risk for severe AP increased according to the degree of obesity. Pancreatic and peripancreatic necrosis was more common in obese patients (17.6% vs 6%), as was the incidence of infectious complications. The risk for severe AP was highest in obese patients with either alcoholic (RR=5.3; 95% CI, 1.2-23) or biliary etiology (RR=5.2, 95% CI, 1-26). CONCLUSION Obesity may predispose to a complicated course of AP, especially if it is secondary to alcohol or gallstones. Further studies are needed to establish the precise prognostic value of obesity in AP, as well as the pathogenic mechanisms involved in the process.
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Affiliation(s)
- J Suazo-Baráhona
- Department of Gastroenterology, Instituto Nacional de la Nutrición Salvador Zubirán, México City, México
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