[Systematic review: Epidemiology of gastroesophageal reflux disease in Latin America]. / Revisión sistemática: Epidemiología de la enfermedad por reflujo gastroesofágico en Latinoamérica.

The prevalence of gastroesophageal reflux disease (GERD) is 10% to 20% in Europe and North America, and about 5% in Asia. This systematic review aimed to quantify the prevalence and incidence of GERD in Latin America, and to determine the potential risk factors and co-morbidities. Systematic literature searches were conducted in PubMed, Embase and the Scientific Electronic Library On-line. No language restrictions were imposed. Eight studies were identified that reported on the prevalence of heartburn and/or regurgitation in Latin America. The prevalence of heartburn and/or regurgitation was 11.9% to 31.3% in the five studies that reported on at least weekly symptoms, and 25% to 35% in the three studies that did not report on symptom frequency. GERD symptoms were associated with obesity and respiratory diseases. No population-based studies on the incidence of GERD or the prevalence of reflux esophagitis were identified. However, four studies investigated the prevalence of reflux esophagitis in patients referred for upper gastrointestinal endoscopy, reporting it to be 35% to 47% in patients referred because of GERD symptoms and 13% in patients referred for any indication. The reported prevalence of GERD in Latin America is similar to estimates obtained in previous studies from Europe and North America, and higher than those obtained from Asia. The association of GERD symptoms with specific comorbidities warrants further investigation and should inform patient management.

Esophageal stenosis: three-dimensional multidetector CT and virtual endoscopy.

The improvement in spatial, temporal, and contrast resolutions with the newest multidetector computed tomographic (MDCT) scanners opens the opportunity to explore other applications of the virtual endoscopy technique besides the colon and stomach evaluation. As a non-invasive technique, virtual esophagoscopy represents an alternative to conventional endoscopy for the assessment of esophageal stenosis. The procedure and diagnostic performance are reviewed. Findings of this modality are illustrated.

An international primary care survey of GERD terminology and guidelines.

BACKGROUND: Terminology used to describe upper gastrointestinal disorders differs by country and language. However, the extent of variation in physician understanding of GERD and associated conditions and symptoms is not known. AIM: To determine the knowledge of primary care physicians with regard to: terminology related to GERD, their understanding of related complications and extra-esophageal symptoms/conditions, and their use of guidelines relating to GERD. METHODS: Gastroenterologists from 17 countries asked primary care physician colleagues to complete a one-page online survey on GERD. RESULTS: 352 primary care physicians, (77% community-based, 23% hospital-based) completed the questionnaire. Gastroesophageal reflux disease/GERD (84%) or reflux/reflux disease (47%) were the terms mostly often used to record a diagnosis for patients with reflux-related symptoms or clinical manifestations; dyspepsia (15%), epigastric pain (10%), and gastritis (9%) were infrequently used. Erosive esophagitis, Barrett's esophagus, stricture, and esophageal adenocarcinoma were recognized as being associated with GERD by 88, 71, 61 and 51% of physicians, respectively. Extra-esophageal problems of cough, sleep-related disorders, laryngitis and asthma were recognized to be associated with GERD by 74, 50, 48 and 47% of respondents. Thirty-nine percent of physicians stated that they did not use a specific definition of GERD; 33% used an international and 14% used a national guideline in managing patients. CONCLUSIONS: (1) GERD is well recognized, but its related terminology is variable throughout the world. (2) There was variable and incomplete recognition of extra-esophageal manifestations GERD. (3) Recognition of extra-esophageal diseases caused by GERD is variable. (4) Current GERD guidelines are infrequently used by primary care physicians.

Uninvestigated dyspepsia in Latin America: a population-based study.

We sought to assess the prevalence, severity of symptoms, and risk factors of uninvestigated dyspepsia in a population-based study in Argentina. Eight hundred thirty-nine valid questionnaires were evaluated. Dyspepsia was present in 367 subjects (43.2%; 95% confidence interval [CI], 39.8-46.6); 110 (13.6%) had overlap with gastroesophageal reflux disease (GERD). The group with dyspepsia without GERD consisted of 257 subjects (29.6%; 95% CI, 26.5-32.7), 183 (71.1%) had ulcer-like dyspepsia, and 74 (28.9%) had dysmotility-like dyspepsia. Symptoms were considered very severe in 1.9%, severe in 14.0%, moderate in 59.5%, and mild in 24.5% of the subjects. Dyspepsia was associated with a score >14 on the psychosomatic symptom scale (PSC) (OR, 2.52; 95% CI, 1.75-3.61), a family history of diseases of the esophagus or stomach (OR, 1.73; 95% CI, 1.19-2.52) and an educational level >12 years (OR, 1.55; 95% CI, 1.05-2.29). Dyspepsia is especially prevalent in Argentina. In a significant proportion of dyspeptic subjects, the severity of symptoms interferes with daily activities. A higher PSC, positive family history, and a higher educational level are risk factors for dyspepsia.

An evidence-based, Latin-American consensus on gastro-oesophageal reflux disease.

In recognition of the high prevalence of gastro-oesophageal reflux disease (GORD) and its importance in Latin America, the InterAmerican Association of Gastroenterology and the InterAmerican Society of Digestive Endoscopy organized a Latin-American Consensus on GORD in Cancun, Mexico in September 2004. The main objectives of the consensus meeting were to provide evidence-based guidance with respect to the diagnosis and treatment of GORD, relevant to all countries in the region. The methodology, results and recommendations of the consensus are described in detail.

Peptic esophageal stricture: a report from Argentina.

Peptic esophageal stricture (PES) is a major complication of gastroesophageal reflux disease. The aims of this paper were to determine the characteristics of these patients with regard to demography, morphology, functional status and results of therapy. The charts of the patients treated at our service who underwent esophageal dilatation for PES between 1971 and 1998 were reviewed. Statistical analyses were performed by means of chi2, Mann-Whitney and Student's t-tests. One hundred and thirty-five patients with PES were dilated by various means. The mean age was 61.1 +/- 16.3 years, the ratio of men to women was 2.75/1 and mean duration of symptoms was 44.4 +/- 74.6 months. Their symptoms were dysphagia in 100%, pyrosis in 70%, and regurgitation in 40% of the cases. There was an average weight loss of 3.3 +/- 6 kg. The upper gastro-intestinal series showed pre- and post-dilatation diameters at the stricture of 8 +/- 2.5 mm and 15.9 +/- 1.2 mm, respectively. The stricture was located at the lower third of the esophagus in 97% and at the middle third in 3% of the cases. We found PES endoscopically in all instances, with different degrees of erosions in 64%, ulcers in 20% and Barrett's esophagus in 16% of the cases. The biopsy samples showed intestinal metaplasia in 16% and esophagitis in 75.5%, being normal in the remaining 8.5%. Brush cytology was negative for malignancy in 100% of the cases. Esophageal manometry showed peristaltic wave amplitude of 40 +/- 3 mmHg and presence of peristaltic waves of 62 +/- 38.6%. LES pressure was 8.6 +/- 6.3 mmHg (NV 24.2 +/- 6.3 mmHg). Measurement of pH showed 15% of patients had pH < 4. Patients needed a mean of 4.7 +/- 1.6 dilations per case, with successful results in 87.2% of cases. The perforation rate was 0.1% of the total number of procedures and 0.7%, of patients. The mortality rate was 0.7% (one case). We observed PES relapse in 32% of the cases. There was no correlation between relapse, age, duration of the stenosis or pharmacological treatment with H2 blockers or proton pump inhibitors. We conclude that in Argentina, demography, morphology, functional status and results of dilatation of PES patients are similar to those reported in the Western world, with the exception of the different behavior seen after treatment with H2 blockers or proton pump inhibitors.

Endoscopía virtual esofágica: experiencia preliminar / Esophagic virtual endoscopy: preliminary experience

Propósito: determinar la utilidad de la endoscopía virtual (EVE) en el diagnóstico de la estenosis esofágica comparándola con la endoscopía convencional. Material y método: se evaluaron dieciseis pacientes con sospecha de estenosis. Las EVE se realizaron con un Tomógrafo Multislice con cortes de 2,5 mm cada 1,3 mm. Se realizó una adquisición previa distensión con material efervescente y otra con contraste baritado. En los pacientes con atresia esofágica se distendieron ambos cabos con efervescente. Resultados: hubo 5 estenosis congénitas y 7 adquiridas (2 benignas y 5 malignas). La EVE visualizó las estenosis, determinó su longitud, espesor de pared y orientó si era benigna o maligna. En estos últimos hubo pérdida del plano graso entre el esófago y las estructuras adyacentes. De los 4 pacientes restantes, 3 presentaron hernia hiatal y uno ulceraciones. Conclusión: la EVE es un método rápido, no invasivo, útil para el estudio de las estenosis orgánicas. La evaluación bidimensional-tridimensional permite un diagnóstico de extensión de la estructura y de su etiología probable. En el caso de lesiones malignas posibilita una estratificación tumoral

Epitelio de Barrett: revisión clínica / Barrett's epithelium: clinical review

In this paper we review the literature about regarding etiology, natural history, methods of study and treatment of Barrett's esophagus. Likewise we review our personal experience as well as the one at national leve.

Enfermedad pro reflujo gastroesofagico refractaria al tratamiento medico ¿Que conducta adoptar: la pildora o el bisturi? / Gastroesophageal reflux disease refractory to mdical treatment. What to do: the pill or the knife?

En la presente revisión se analiza la literatura moderna referida a la epidemiologia, clínica, fisiopatología y tratamiento de la enfermedad por reflujo gastroesofágico. Se pone énfasis en un pequeño grupo de pacientes que se caracteriza por tendencia a la recidiva, analizándose entonces las posibilidades que ofrecen tanto el tratamiento farmacológico como el quirúrgico. Finalmente, se proyecta la información obtenida de la bibliografia, traz ndose un panorama de la realidad de nuestro país.

Esophageal perforation after pneumatic dilatation for achalasia: why?

A retropective study was perfomed to asses risk factors in patients with esophageal echalasia undergoing pneumatic dilatation. Of 140 patients who underwent 159 dilatations, 7 sustained esophageal perforation (4.4 percent). They were matched with a group of 52 non perforated, dilated achalasia patients. History of prior pneumatic dilatation and small esophageal diameter were found to be risk factors by chi square and ANOVA. Conclusions: 1) Pneumatic dilatation for esophageal achalasia is a procedure with 4.4 percent risk of perforation and 0.6 percent mortality rate. 2) The risk of developping an esophageal perforation is increased by previous pneumatic dilatation and small esophageal diameter. Another risk factor such as a possible anatomical weakness of the esophageal wall (and the likelihood of it being evaluated by ultrasonography) at the site of perforation is suggested.

Esophageal perforation after pneumatic dilatation for achalasia: why?

UNLABELLED: A retrospective study was performed to asses risk factors in patients with esophageal achalasia undergoing pneumatic dilatation. Of 140 patients who underwent 159 dilatations, 7 sustained esophageal perforation (4.4%). They were matched with a group of 52 non perforated, dilated achalasia patients. History of prior pneumatic dilatation and small esophageal diameter were found to be risk factors by chi square and ANOVA. CONCLUSIONS: 1) Pneumatic dilatation for esophageal achalasia is a procedure with 4.4% risk of perforation and 0.6% mortality rate. 2) The risk of developing an esophageal perforation is increased by previous pneumatic dilatation and small esophageal diameter. Another risk factor such as a possible anatomical weakness of the esophageal wall (and the likelihood of it being evaluated by ultrasonography) at the site of perforation is suggested.

Acalasia del esofago: que hacer, en balon o el bisturi? / Esophageal achalasia: what to do, the ballon or the knife?

In this paper we review the different options published in the world literature regarding the treatment of achalasia of the esophagus. It is concluded that pneumatic dilatation and Heller's operation are the only valid possibilities for primary treatment of the disease. The specific indications for each procedure are also being set. The cost analysis in our country is determined, arriving to the conclusion that pneumatic dilation has a direct cost of A$968 (expectant cost up to A$1.144); and laparoscopic Heller's operation A$2.250. Our personal experience on 120 pneumatic dilatations is analyzed and compared with that of the literature, arriving to the conclusion that our results are similar to the ones of the main available papers.