Risk of hyperamylasemia and acute pancreatitis after double-balloon enteroscopy: a prospective study.

BACKGROUND AND STUDY AIMS: There have been reports, mainly retrospective, of pancreatitis and hyperamylasemia after anterograde double-balloon enteroscopy (DBE). Our aim was to report the incidence of pancreatitis and hyperamylasemia after DBE and investigate possible risk factors associated with its occurrence. PATIENTS AND METHODS: In this single-center prospective cohort study, serum samples were taken for amylase and lipase before and 3 hours after anterograde DBE in consecutive patients. Multiple variables were recorded, including total procedure time, insertion depth, and number of passes. Patients were evaluated to 24 hours later for signs of pancreatitis. The main outcome measures were the occurrence of hyperamylasemia and pancreatitis. RESULTS: 92 patients were included in the analysis (58 women, 34 men; mean age 54 years, range 18-89). The mean total procedure time was 62 minutes (range 30-120). The mean post-procedure amylase and lipase levels were significantly higher in comparison with the baseline levels (165 U/L vs. 69 U/L and 144 U/L vs. 28 U/L respectively, P<.05); 36 patients (39%) showed hyperamylasemia after the procedure and three patients developed acute mild pancreatitis. Hyperamylasemia was associated more frequently with procedure duration greater than 60 minutes ( P<.001) and insertion depth greater than 25 cm ( P<.013). CONCLUSIONS: The incidence of hyperamylasemia after anterograde DBE is common and particularly associated with longer procedure time and insertion depth. The cumulative incidence of pancreatitis was 3%. We recommend the avoidance of both unnecessarily lengthy procedures and deep insertion distances in patients who undergo anterograde DBE.

Capsaicin induction of esophageal symptoms in different phenotypes of gastroesophageal reflux disease.

BACKGROUND: Type 1 vanilloid receptors (TRPV1) have been described on esophageal afferent sensitive neurons. Stimulation of TRPV1 receptors with capsaicin may induce heartburn. Capsaicin is the pungent component of chili and the most extensively studied TRPV1 agonist. OBJECTIVES: To investigate the effect of esophageal stimulation with intraesophageal capsaicin administration on induction of esophageal symptoms and on esophageal chemo-sensitization to acid in different gastroesophageal reflux disease (GERD) phenotypes. METHODS: Healthy volunteers and patients with GERD (non-erosive [NERD], erosive GERD [EE] and Barrett's esophagus [BE]) were prospectively studied. All subjects were randomized to receive either intraesophageal perfusion capsaicin or saline 0.9%. Thirty minutes after saline or capsaicin infusion an acid perfusion test of HCl was performed. A week later, a crossover phase with capsaicin versus saline was performed. Five symptoms were evaluated every 5 min during the first 30 minutes after capsaicin, saline, and acid perfusion: chest burning, chest pain, heartburn, epigastric burning, and epigastric pain. RESULTS: 17 healthy subjects and 31 GERD patients (10 NERD, 11 EE, and 10 BE) were included. Twenty- eight (90%) of GERD and 6 (35%) of healthy subjects had esophageal symptoms after capsaicin perfusion. Mean for the 5 evaluated symptoms induced by capsaicin was significantly higher in the GERD group compared to the control group. The highest symptom severity was in the erosive subgroup. Capsaicin decreased the 5 symptoms induced by acid perfusion in both healthy volunteers and GERD patients. Total score of esophageal symptom severity (produced by acid perfusion) was significantly reduced by capsaicin infusion in the BE group. CONCLUSIONS: Capsaicin induces esophageal and gastric symptoms in healthy volunteers and GERD patients. Capsaicin reduces esophageal chemosensitivity to acid, especially in patients with BE.

Serum erythropoietin levels in kidney donors after renal transplantation.

BACKGROUND: Renal transplantation is the treatment of choice for many patients with end-stage renal disease. In the donor, renal excretory function is not affected after nephrectomy; however, little is known about other functions such as erythropoietin production. We studied the erythropoietin production in renal donors after nephrectomy. METHODS: We included healthy individuals fulfilling the criteria for kidney donation. Blood samples were collected before and monthly from 1 to 6 months after nephrectomy. Complete blood cell counts and erythropoietin were assayed. RESULTS: Eight kidney donors were studied. A significant increase in erythropoietin levels was observed during the first 3 months, but no difference was observed by the 4th month as compared with basal values. CONCLUSIONS: Erythropoietin production rose during the first 3 months after nephrectomy. However, erythropoietin was normal by the 4th month. Unchanged hemoglobin levels may suggest that the compensatory production of erythropoietin could participate in the preservation of an adequate physiological status of the donor after nephrectomy.

Hemophagocytic syndrome associated with hematological neoplasias.

Hemophagocytic syndrome (HPS) is a reactive process that complicates several diseases including hematological neoplasias (HN). It has been suggested that HPS may be a negative prognosis factor for neoplastic diseases. In this retrospective analysis, 13 cases with HPS associated to HN were compared with two age, sex, diagnosis, disease stage and treatment matched controls in order to determine the impact of this syndrome on the survival. Cases with HPS were adult patients with a male:female ratio of 1:1 and their clinical picture was characterized by fever, lymphadenopathy, hepatosplenomegaly, and pancytopenia. Median survival since HN diagnosis was 7 and 48 months for the HPS and control groups, respectively (P = 0.0001). In ten patients who died, median survival after HPS presentation was 1 month. These results suggest that the presence of HPS is a negative prognosis factor in patients with HN. Due to its high mortality rate, an individualized, early, and intensive chemotherapeutic regimen may be required for HN complicated with this syndrome.

Potential harmful effect of iodinated intravenous contrast medium on the clinical course of mild acute pancreatitis.

HYPOTHESIS: A worse clinical outcome might be expected in patients with acute pancreatitis (AP) who receive intravenous contrast medium for a nondynamic contrast-enhanced computed tomographic (CECT) study early during hospital admission. DESIGN: Cohort analytic study. SETTING: Tertiary care center. PATIENTS: Of 126 patients with mild AP, 52 patients underwent CECT to establish AP diagnosis (group 1), and the remaining 74 did not (group 2). MAIN OUTCOME MEASURES: Survival and development of local or systemic complications during the hospital stay. Potential confounders were demographic, clinical, and biochemical data, as well as therapeutic measures. The Atlanta classification was used to define local and systemic complications. RESULTS: Mean age, etiology of AP, prognostic score on admission, and pharmacologic treatment were similar between groups. Local and systemic complications were more frequently observed in patients who underwent CECT (odds ratio, 11.4; 95% confidence interval, 2.0-64.8; P =.008). Six patients, all in group 1, developed a pancreatic abscess (odds ratio, 20.8; P =.004). In 5 of them, a second CECT showed more severe AP changes. The association between CECT and abscess development was more apparent in patients with a body mass index of 25 or more and/or nasogastric suction. Six patients in group 1 and 1 in group 2 had systemic complications (odds ratio, 9. 5; P =.01). There were no deaths. CONCLUSIONS: The observed increased incidence of local and systemic complications in patients with mild AP who undergo CECT, particularly in those with a body mass index of 25 or more, suggests a potentially harmful effect of intravenous contrast medium. Until this issue is clarified, it seems reasonable to restrict the use of dynamic CECT to patients with severe AP, protracted clinical course, or suspected local septic complication.

Comparison of ceftibuten vs. amoxicillin/clavulanic acid as antibiotic prophylaxis in cholecystectomy and/or biliary tract surgery.

A randomized, comparative, prospective clinical trial was carried out at a tertiary care center to compare the efficacy of two antibiotic regimens in the prophylaxis of postoperative infection in patients undergoing biliary tract surgery. One hundred patients undergoing cholecystectomy or biliary tract exploration were randomly allocated to one of the following antibiotic regimens: the standard regimen of three doses of amoxicillin/clavulanic acid (1000/200 mg) given by intravenous infusion, or a single dose of ceftibuten (400 mg) given orally. Patients were monitored during their stay in the hospital and over a 2 week period as outpatients. Fifty adult patients were included in each group. Mean age was 49 years, and sex distribution was 82 women and 18 men. The groups were comparable in terms of demographic characteristics and comorbidity. There were no cases of postoperative infection in the ceftibuten group, but five cases of infection occurred in the amoxicillin/clavulanic acid group (P < 0.05). No adverse effects were observed with either antibiotic. The treatment cost per patient was significantly lower for ceftibuten. The results indicate that ceftibuten is well tolerated and more effective than amoxicillin/clavulanic acid for prophylaxis following gallbladder and biliary tract surgery. In addition, ceftibuten has the advantage of being more cost-effective and easier to administer than amoxicillin/clavulanic acid so it could be considered as an alternative for antibiotic prophylaxis in these types of surgical procedures.

Cytokines, growth factors, and oxidative stress in HepG2 cells treated with ethanol, acetaldehyde, and LPS.

Inflammatory mediators, including cytokines, growth factors, and reactive oxygen species, are associated with the pathology of chronic liver disease. In the liver, cytokine and growth factor secretion are usually associated with nonparenchymal cells, particularly Kupffer cells. In the present studies, the effect of 24 and 72 h administration of ethanol (50 mM). acetaldehyde (175 microM), and LPS (1 microg/ml) were studied on the expression and secretion of TNF-alpha, IL-1beta, IL-6, and TGF-beta3, lipid peroxidation damage and glutathion content in HepG2 cell cultures. A 24 h exposure to ethanol induced the expression of TNF-alpha and TGF-beta1, and the secretion of IL-1beta and TGF-beta1. With the same period of treatment, acetaldehyde markedly increased TNF-alpha expression, and stimulated IL-1beta secretion, while LPS exposure induced the expression of TNF-alpha, IL-6, and TGF-beta1, and the secretion of IL-1beta, IL-6, and TGF-beta1. A reduced in TNF-alpha response and TGF-beta1 expression were observed after 72 h exposure to ethanol. A 72 h acetaldehyde exposure decreased markedly TNF-alpha expression and stimulated a previously absent TGF-beta1 response. With the same time of exposure, LPS reduced slightly TGF-beta1 expression, and decreased its secretion. IL-1beta and IL-6 were not detected under 72 h exposure conditions. Lipid peroxidation damage was increased in all treatments, but higher values were found in 72 h treatments. Glutathion content diminished in all treatments. These findings suggest that HepG2 cells, independent of other cells such as Kupffer or macrophages, participate in a differential cytokine, growth factor and oxidative stress response, which differs according to the toxic agent and the time of exposure.

Portal-systemic encephalopathy and gastrointestinal bleeding after cardioselective beta-blocker (metoprolol) administration to patients with portal hypertension.

The use of the non-selective beta-blocker propranolol has been widely recommended to prevent gastrointestinal bleeding in patients with portal hypertension. We conducted a prospective, randomized controlled trial of metoprolol, a selective beta-blocker for prevention of gastrointestinal bleeding from portal hypertension in 29 non-selected patients with liver disease and previous gastrointestinal bleeding. Fifteen patients received placebo treatment for 40 +/- 18 months and 14 patients received metoprolol for 31 +/- 17 months. A sustained reduction in resting pulse was observed in those patients treated with metoprolol. There was no significant difference in acute re-bleeding episodes between the two groups. Of the 14 patients treated with metoprolol, three (21%) re-bled, all three requiring blood transfusion. Four (26.5%) of the 15 patients treated with the placebo re-bled, two cases with acute bleeding and the remaining two cases presented a positive stool guaiac test. All cases who bled during the metoprolol therapy required exclusion from the trial, and surgical procedures or sclerotherapy as well. After both metoprolol or placebo treatments, similar deterioration of standard liver function tests was observed. Further, at the end of the trial, 11 patients on metoprolol (78%) and four of the patients treated with the placebo (27%) required treatment for clinical portal-systemic encephalopathy (p < 0.01). The risk of poor sympathomimetic response after cardioselective beta 1-blocker during acute bleeding episodes and the appearance of hepatic encephalopathy deserve further investigation. The selective beta-blocker metoprolol seems to be an inadequate choice to prevent gastrointestinal re-bleeding in patients with portal hypertension.

Laparoscopic versus open splenectomy for immune thrombocytopenic purpura.

BACKGROUND: Laparoscopic splenectomy (LS) has been proposed as a substitute to open splenectomy (OS) in the treatment of immune thrombocytopenic purpura (ITP). The aim of this study was to compare two cohorts of patients with ITP who underwent OS or LS. PATIENTS AND METHODS: From February 1990 to January 1997, 27 patients underwent OS and 22 LS. Perioperative characteristics, outcomes, and complications were comparatively analyzed. RESULTS: Mean age was 38 years (+/- 16) in the OS group, and 39 (+/- 16) in the LS group; the male: female ratio was 1:2 in both groups. Median preoperative platelet count was 16 x 10(9)/L (range 2 to 186 x 10(9)/L) in the OS group, and 50 x 10(9)/L (2 to 241 x 10(9)/L) in the LS group. Mean operative time was 2.7 hours (+/- 0.7) for OS, and 4.5 hours (+/- 1) for LS (P <0.0001). Two conversions to laparotomy occurred in the LS group. A total of 14 complications occurred in 10 patients of the OS group; 8 complications occurred in 6 patients of the LS group. Two patients died in the OS group and 1 in the LS group. Mean postoperative discharge was 6 days (3 to 44) in the OS group and 4 days (2 to 11) in the LS group (P <0.02). Response rates were similar in both groups. CONCLUSIONS: Laparoscopic splenectomy is comparable to OS in terms of efficacy and safety, and it is associated with a shorter hospital stay.

Histologic diagnosis of primary hyperparathyroidism: a concordance analysis between three pathologists.

Primary hyperparathyroidism (HPT) is caused by a parathyroid adenoma, hyperplasia or carcinoma. Difficulties for the histologic diagnosis of abnormal parathyroid tissue are widely recognized. The aim of the study was to evaluate the reproducibility of the morphologic criteria through a concordance study among three pathologists. Representative slides of 40 patients with biochemically primary HPT stained with hematoxylin and eosin were blindly reviewed by three pathologists. Each pathologist established the diagnosis of adenoma or hyperplasia and assessed the presence of fat cells, a rim of normal tissue, a fibrous capsule, the number of cellular types, the lobular pattern, and the characteristics of the blood vessel's wall. A concordance analysis was then performed. Mean age of the group was 55 +/- 14 yr, 7 were males and 33 females. The concordance analysis among the three pathologists for the differential diagnosis between adenoma and hyperplasia, showed a Kappa index of 0.5. Kappa index for the presence of fat cells was 0.56, for the presence of a rim of normal tissue 0.47, and for the number of cellular types 0.29. The concordance for the differential diagnosis between parathyroid adenoma and hyperplasia in this study was low.

Preservation of a digital osteotendinous structure with an omental flap.

Taking into account the angiogenic properties of the omentum to revascularize ischemic tissues, this experimental, longitudinal, prospective, double-blind study in rabbits was designed to revascularize and preserve the mobility of a digital osteotendinous structure surgically devascularized in advance and to compare such omental angiogenic ability with that of the muscle and the panniculus carnosus. Thirty New Zealand rabbits were used. Three toes from the hind feet were surgically amputated from each rabbit. The skin was removed, exposing the bones, tendons, ligaments, and joints, to form what we termed the osteotendinous structure. Through a median laparotomy, the first part of each rabbit's own osteotendinous structure was placed inside the panniculus carnosus (group I), the second under the rectus abdominis muscle (group II), and the third was wrapped in a pediculate omental flap (group III). Three weeks later, each structure was assessed clinically for mobility and fibrosis and microscopically for fibrosis, newly formed vessels, viability, and tissue regeneration. Clinically, the group I structures showed a greater amount of fibrosis. The structures in groups II and III showed minimal fibrosis in all but four cases, which showed moderate fibrosis. Differences in joint mobility were assessed with the Kruskal-Wallis test. There was a statistically significant difference in mobility for the structures from group III, which was higher, followed by those from groups II and I. The exception was the proximal interphalangeal joints in groups II and III, for which the differences had no statistical significance. Microscopically, fibrosis and tissue necrosis were intense in the structures in group I, moderate in the group II structures, and mild in the group III structures. Conversely, vessel neoformation and tissue regeneration were intense in the structures in group III, moderate in group II, and were nil in group I. This study confirms with statistical significance that, in the rabbit, the omentum has a higher ability to revascularize degloved tissues than do the muscle and the panniculus carnosus, thus preserving a higher joint and tendon mobility. Consequently, it is suggested that a free omental flap be used in the treatment of ring avulsion injuries that lead to degloving of the digits.

[Present and future of trial design]. / Presente y futuro de los estudios clínicos.

Nowadays, clinical researchers can choose from a large variety of designs. These can be classified as observational or experimental, descriptive or comparative, longitudinal or cross-sectional, prospective or retrospective, "blind" or "unblind", prolective or retrolective. The randomized double-blind trial is still the most controlled design and, therefore, the least susceptible to bias. However, ethical, economical and generalizability reasons limit their use. Current tendencies are towards the use of poorly controlled studies that can provide weak evidence and could, ultimately, do more harm than good to our patients and our economy. There is, therefore, the need for designs that could I) provide high quality evidence, II) substitute an experiment when it cannot be done, and III) overcome the limitations of randomized clinical trials.

[Diagnostic utility of serum beta-carotenes in intestinal malabsorption syndrome]. / Utilidad diagnóstica de los beta-carotenos séricos en el síndrome de absorción intestinal deficiente.

In order to determine the reference values of serum beta-carotene and its usefulness in the diagnosis of steatorrhea, 140 healthy subjects and 120 patients with suspected malabsorption syndrome were studied. The reference values, established in terms of the percentiles 2.5 and 97.5, were 85-270 micrograms/dL for men and 112-385 micrograms/dL for women. The beta-carotene diagnostic usefulness was determined by comparison with stool fat levels. According to ROC curves, steatorrhea was diagnosed at beta-carotene values of less than 89 micrograms/dL and 103 micrograms/dL for men and women respectively with a 78% sensitivity, 82% specificity, 76% positive and 84% negative predictive values and 80% accuracy. The steatorrhea prevalence (stool fat > 5 g/day) in our patients was 42%. Due to the implicit technical difficulties of the stool fat determinations and the results of this study, we propose the serum quantification of beta-carotene as an useful screening test in patients with chronic diarrhea and malabsorption syndromes.

[Reference values for protein C activity in healthy adults in Mexico]. / Valores de referencia de la activadad de proteína C en adultos sanos en México.

Protein C (pC) is a natural-occurring anticoagulant and its acquired or hereditary deficiency has been associated with thrombosis. For its screening, technics that appraise both its plasmatic concentration and biological activity are used. The quantitative deficiency is important, but some characteristics of pC activity (pCA) suggest an essential role of the functional deficiency. Because reference levels have not been previously described in Mexico, we report here the results of a pCA assessed by a chromogenic assay in 88 adult healthy mexican people between 15 and 69 years of age. The pCA values at the 2.5 and 97.5% percentiles in our population were 75 and 137% in normal plasma. Functional disorders of this protein have been described in the presence of normal pC quantitative levels and, therefore, there are individuals with low pC concentrations and a normal pCA without thrombosis. These data suggest that the pCA could be a more important screening test than the quantitative determination as the first step in the study of a possible deficiency state of protein C.

[The international normalization ratio in the monitoring of oral anticoagulant therapy]. / El cociente de normalización internacional en la vigilancia de la terapia anticoagulante oral.

Oral anticoagulants are employed very frequently in the prophylaxis and treatment of several diseases. For their optimal effectiveness, many vigilance schedules have been proposed but none has proved to be 100% effective. The international normalization ratio (INR) can be a safer way to monitor oral anticoagulation, and our objective was to determine its clinical usefulness. A prothrombin time test (PT) was carried out by means of either a chromogenic or a coagulometric method, and an INR was obtained using the ratio of the PT patient/PT control elevated to an exponential given by the international sensitivity index (ISI) of our thromboplastin. Our objective was to maintain our patients in a therapeutical INR range between two and three. We present our experience with 77 patients and 810 results during an 18 months period. We observed 26 cases of hemorrhage and three of thrombosis. In all these cases, the INR was out of the desired therapeutical range. No deaths occurred in our patients. Our analysis showed a significative disagreement between the INR and the prothrombin time ratio (PTR) but a better correlation with hemorrhage and thrombosis was seen with the INR than with the PTR. Our experience supports the use of INR in the clinical vigilance of oral anticoagulation as a useful method.

[What patients think of the services of the Instituto Nacional de la Nutrición "Salvador Zubirán"]. / Lo que opinan los pacientes de los servicios del Instituto Nacional de la Nutrición "Salvador Zubirán" (INNSZ).

The quality of care has always been a subject of interest to the Instituto Nacional de la Nutrición "Salvador Zubirán", in order to improve its services. This interest led to the present survey which aims to evaluate the patient's global satisfaction and to identify specific problems susceptible of improvement. One hundred and seventy-one patients or relatives attending eight different services of the Institute were interviewed. Opinions about the following aspects were explored by means of service-specific questionnaires: sociodemographic characteristics, satisfaction with care, waiting periods, patient-personnel relationship, hospital environment, food quality, drug availability and costs. Results of the survey show a high level of satisfaction with the services provided, i.e. 33% of the patients considered it good, and 64% excellent. However, and in agreement with other reports, this high level of satisfaction does not necessarily reflect an absence of problems, i.e. long waiting periods, insufficient restrooms, failures in getting information about their health status, and occasional absence of drugs in the pharmacy were identified. Continuation of this kind of surveys in our setting leads not only to the identification of problems, but also to the evaluation of the impact that resulting measures may have on the patient's satisfaction.

Asymptomatic gallstones and duration of cyclosporine use in kidney transplant recipients.

BACKGROUND: Cyclosporine (CsA) use has been associated to the development of cholelithiasis in transplant recipients. We herein explored the role of time under CsA on this association in asymptomatic adult kidney transplant recipients (KTR). METHODS: A cross-sectional study was conducted in 140 KTR with variable post-transplant follow-up (PTFU), and without history of symptomatic biliary disease. Upper abdominal ultrasound was performed in all patients. According to the immunosuppressive schedule, patients were classified in three groups: Azathioprine + prednisone (group 1, n = 37), azathioprine + prednisone < 24 months CsA (group 2, n = 58), or azathioprine + prednisone > or = 24 months CsA (group 3, n = 45). Age at time of ultrasound performance, gender, PTFU, chronic viral liver disease, parity, oral contraceptives, serum lipids, diabetes and body mass index were analyzed concomitantly. RESULTS: Median age was 38, 31, and 36 years in groups 1, 2, and 3, respectively. The male:female ratio in the same groups was 1.5:1, 1:1, and 2:1. Mean PTFU was 130, 48, and 53 months, respectively (p = 0.0001). Gallstones were found in three (8%) group 1 KTR, in nine (16%) group 2 KTR, and in 10 (22%) group 3 KTR (p = 0.214). Adjusting for PTFU, the association between length of CsA and prevalence of lithiasis was significantly stronger among those with longer use of CsA (odds ratio = 6.1, p = 0.046). No significant differences were found among groups in the other variables. CONCLUSIONS: KTR receiving CsA for more than two years show increased prevalence of gallstones.

[Prospective evaluation of gastroesophageal reflux in patients with achalasia treated with pneumatic dilatation, thoracic or abdominal myotomy]. / Evaluación prospectiva de reflujo gastroesofágico en pacientes con acalasia tratados con dilatación neumática, miotomía torácica o abdominal.

INTRODUCTION: Symptomatic gastroesophageal reflux (GER) occurs in 0-20% of patients treated with pneumatic dilation and in 5-30% with cardiomyotomy. However, the prevalence of GER evaluated with esophageal pH-monitoring is unknown. AIM: To investigate the frequency of GER in achalasia patients treated with pneumatic dilation or myotomy. MATERIAL AND METHODS: Patients with achalasia were evaluated prospectively and classified in 4 groups: group A = treated with pneumatic dilation; group B = treated with open abdominal myotomy; group C = transthoracic myotomy; and group D = submitted to laparoscopic abdominal myotomy with antireflux procedure. Esophageal manometry and 24 h pH-monitoring were performed in all patients. GER was defined as a pH < 4 in more than 4% of the total time. RESULTS: Thirty-one patients, 22 women and 9 men, with a mean age of 44.7 years were evaluated. Nine patients had GER symptoms and 22 were asymptomatic. GER was detected with pH-metry in 42% of the total group: 33% for group A, 75% for group B, 44% for group C and none for group D. CONCLUSIONS: Prevalence of GER in achalasia patients treated with pneumatic dilation and surgical myotomy was high. We suggest the inclusion of 24 hr esophageal pH-metry in the follow-up due to the significant prevalence of asymptomatic GER. Minimal hiatus dissection and antireflux procedure were surgical factors related with a lower frequency of GER after achalasia myotomy.

[Optimization of the tagged urea test for the detection of H. pylori in patients with dyspepsia]. / Optimización de la prueba de la urea marcada para la detección de H. pylori en pacientes con dispepsia.

Helicobacter pylori (Hp) has been associated to gastritis, peptic ulcer, gastric cancer, and other gastrointestinal disorders. The 14C-urea breath test (UBT) has been proposed as a simple and noninvasive method for its detection, and has recently been implemented in our institution. To optimize our resources, we performed a sensitivity analysis to determine the minimal sampling and duration of testing required, and to establish objective criteria for its interpretation. With this purpose, endoscopy, antral biopsy and UBT were performed in 104 dyspeptic patients. For the UBT, a basal breath sample was taken before the administration of 10 microCi of 14C-urea and followed by sequential breath sampling at 5, 15, 30 and 60 minutes. Considering histologic findings as the gold standard, receiver operating characteristic (ROC) curves were constructed for the following three 14CO2 excretion strategies: excretion by sample, maximum excretion, and cumulative excretion. Hp was detected in 74 (71%) of the patients, and its presence coincided with significantly higher 14CO2 excretion than in the Hp negative (p < 0.001). The three excretion strategies were comparable in terms of diagnostic accuracy, but the most efficient results were given by the 15 minute sample. With a cut-off point of > or = 1.7%, the sensitivity and specificity of this sample was > or = 83%, the positive and negative predictive values were 93% and 68%, and the accuracy was 84%. We conclude that UBT can be completed with a single breath sampling at 15 min, and its results objectively interpreted as positive if the 14CO2 excretion is > or = 1.7%.

[Incidence of peptic ulcer at the Instituto Nacional de la Nutrición "Salvador Zubirán": study of localization, associated factors and temporal trends]. / Frecuencia de la ulcera péptica en el Instituto Nacional de la Nutrición "Salvador Zubirán"; estudio de localización, factores asociados y tendencias temporales.

OBJECTIVE: To know the frequency, trends and associated factors of peptic ulcer disease in our Institute. BACKGROUND: Peptic ulcer is an important disease; about 5-10% of the population can expect to develop this disease during lifetime. MATERIAL AND METHODS: We reviewed 1,123 patients with peptic ulcer in five years. Sex, age, habits (tobacco and alcohol consumption), non-steroidal anti-inflammatory drugs use, ulcer location and complications were analyzed. To evaluate temporal trends, our results were compared with previous studies made in our Institute. RESULTS: The male-female ratio was 1:1, with a mean age of 52.2 years. Forty percent of the patients had duodenal ulcer, 42% had gastric ulcer, and 19% had esophageal, anastomotic or multiple ulcers. The most common complication was bleeding, which occurred more frequently in gastric (37%) than duodenal ulcer (24%) (P < 0.005). Gastric ulcer occurred in older patients when compared to duodenal ulcer (P < 0.02). Non-steroidal anti-inflammatory drugs consumption was more frequent in patients with gastric (14%) than duodenal ulcer (10%) (P < 0.04). The frequency of tobacco and alcohol consumption was higher in multiple ulcers. CONCLUSIONS: A tendency toward a decreased frequency of duodenal ulcer and increased frequency of gastric ulcer was observed in our Institute during the last 30 years. In the same period, bleeding has been the leading complication, suggesting a higher referral of complicated peptic ulcer.