[Chronic diarrhea post cholecystectomy]. / Diarrea crónica postcolecistectomía.

In the present article presents the high frequency of previous cholecystectomy as determinant factor of chronic diarrhea and its control with cholestyramine.

[Constipation syndrome: methods for measuring the speed of intestinal transit]. / Síndrome estreñimiento: métodos para medir la velocidad de tránsito intestinal.

In the present article, I remind what I presented, in a symposium performed in our Society on the constipation syndrome, in relation with the definition and the determinant factors of this syndrome, and, in addition, with the methods we have created to determine physiologically the velocity of the intestinal transit, specially colonic.

[Forty-four years of advances in pathogenesis, diagnosis and treatment of flatulence syndrome]. / 44 años de avances en etiopatogenia, diagnóstico y tratamiento del síndrome flatulencia.

In the present paper, the author reminds investigations performed, since forty-four years ago, to clarify the etiopathogenesis and to improve the diagnosis and treatment of the flatulence syndrome.

Helicobacter pylori-associated chronic atrophic gastritis involving the gastric body and severe disease by Vibrio cholerae.

Evidence has associated chronic infection by Helicobacter pylori with chronic gastritis, low gastric acid production and an increased risk of life-threatening cholera. However, the relationship of specific patterns of histological damage in the gastric mucosa associated with H. pylori infection and the occurrence of cholera has not been described. The purpose of this study was to compare the gastric pH and histopathological findings in gastric biopsies taken from patients with severe diarrhoeal disease due to Vibrio cholerae with those taken from a control (cholera-negative) population. Thirty-five H. pylori-positive patients who had severe dehydration from culture-confirmed cholera (cases) and 40 patients with H. pylori but with no history of cholera (controls) were recruited. Gastric pH was measured and multiple biopsies were taken from the gastric antrum and body for histopathological examination. The results revealed that patients with severe cholera had a significantly higher prevalence of hypochlorhydria at endoscopy compared with controls. Furthermore, cases had significantly more chronic atrophic gastritis (45.7% vs. 12.5%; P=0.002) and intestinal metaplasia (37.1% vs. 2.5%; P<0.01) in the gastric body than controls. Our findings suggest that the nature and location of these gastric lesions may predispose a subset of H. pylori-infected individuals to severe disease by V. cholerae.

Environmental temperature, cholera, and acute diarrhoea in adults in Lima, Peru.

The effects of environmental temperature, presence and severity of El Niño, presence of cholera in the community, and interactions among these variables on the number of adult diarrhoeal patients attending the Hospital Nacional Cayetano Heredia in Lima, Peru, during 1991-1998, were evaluated. During 1991-1996, an increased number of visits to the hospital due to acute diarrhoea in the warmer months was observed. This periodic pattern was altered in 1997, when rising of the environmental temperature was observed in Lima secondarily associated with a strong El Niño event. A multivariate model was built in which environmental temperature and interaction between environmental temperature and presence of cholera predicted the number of adult patients with acute diarrhoea attending the Hospital Nacional Cayetano Heredia. Monitoring of environmental temperature and presence of cholera may be used as a warning system to predict epidemics of diarrhoea in adults, which may have a tremendous impact on healthcare strategies and management of health services in general.

[HELICOBACTER PYLORI INFECTION ERRADICATION IN DISPEPTIC PATIENTS WITH AND WITHOUT PEPTIC ULCER] / Erradicacón de la infección por Helicobacter pylori utilizando Tetraciclina, Furazolidona y Bismuto en pacientes dispépticos con y sin úlcera péptica.

BACKGROUND: Helicobacter pylori (HP) infection is very prevalent worldwide, and has been associated with the presence of duodenal ulcer, gastric ulcer and chronic active gastritis. It is also speculated that HP may have a role in gastric cancer development. Triple drug schemes have been shown to be the most effective approach to erradicate HP infection. Nevetheless, high rates of resistance against some antibiotics as well as high costs affect the effectiveness of these therapies. The goal of the present study is to assess the effectiveness of the combination of tetracycline, furazolidone and bismuth in erradicating HP, as well as the changes in the histology.METHODS: Patients with diagnosis of HP infection, found in their antral gastric biopsies (hematoxylin and eosin staining (H-E)), were included. They received the following scheme for 10 days: tetracycline 500 mg qid., furazolidone 100 mg qid., and colloidal bismuth subcitrate 120 mg qid. Patients were instructed to come back for follow-up 6 to 8 weeks after starting the therapy. At that time a control upper endoscopy was performed and 3 antral biopsies were taken. Biopsies were stained with H-E and read by experienced pathologists. In both, the biopsy before treatment and the control biopsy, the following parameters were looked for: presence and density of HP; presence, depth and grade of chronic gastritis (lymphoplasmocytic infiltrate); presence and grade of inflammatory activity (polymorphonuclear inflitrate); presence of glandular atrophy; presence, grade (partial or total) and extent (focal or multifocal) of mucinous damage (epithelial damage); presence of intestinal metaplasia; and presence of lymphoid follicles.RESULTS: Fifty-nine patients (30 men and 29 women) completed per protocol. Mean age was 43 +/- 18 (range: 14-73). HP erradication was achieved in 54 patients (91.5%). Control biopsies showed improvement in the following parameters: presence and density of HP (p<0.001); presence, depth and grade of chronic gastritis (p<0.001); presence and grade of inflammatory activity (p<0.001); presence, grade and extent of mucinous damage (p<0.001); and presence of lymphoid follicles (p<0.001). Neither the presence of glandular atrophy nor the presence of intestinal metaplasia showed any significant change. Patients who did not erradicate HP showed no significant difference in any of the parameters.CONCLUSIONS: The triple drug scheme including tetracycline, furazolidone and bismuth is effective in HP erradication. Erradication of HP is followed by an improvement in the following histologic parameters: presence, depth and grade of chronic gastritis (LMN infiltrate); presence and grade of inflammatory activity (PMN infiltrate); presence, grade and extent of mucinous damage; and presence of lymphoid follicles. This scheme is a cost-effective alternative for the therapy of HP infection in low income populations with a high prevalence of infection with this bacteria.

[HELICOBACTER PYLORI, CHRONIC GASTRITIS, GASTRIC ANDDUODENAL ULCER: STUDY OF 1638 PATIENTS] / Helicobacter pylori, Gastritis Crónica, UlceraGástrica y Ulcera Duodenal: Estudio de 1638 pacientes.

We anaylize in patients from high socio economic level the histologic findings of biopsies from the gastric mucosa taken endoscopically. Patients with upper gastrointestinal symptoms were examined with esophagogastroduodenoscopy. In the histologic study we considered: presence of Helicobacter pylori, mucinous damage, displasia, atrophy and intestinal metaplasia. Patients were divided in two groups: those who endoscocopically did not present gastric or duodenal active ulcer, gastric neoplasia or were not gastrectomized or vagotomized and those in which active gastric or duodenal ulcer was found. The first group was comprised of 1406 patients (647 women and 769 men). 57.33% (806) showed presence of Helicobacter pylori in the histologic study. Males presented higher prevalence of the bacteria (57.32% vs 42.68%, p=0.021873). Atrophys was found in 8.25% and was more frequent in patients with H. pylori (78.45% vs 21.55% p=0.0000026) / Intestinal metaplasla was found in 11.24% being related more with the presence of H.pylori (74.68% vs 25.32%, p=0.0000043). In the second group comprised of 232 patients: 192 males (82.7%) 82.75% showed presence of the bacteria. There was not a statistical difference by comparing sex and age vs presence of ulcer.

[CONTRIBUTION STUDY TO THE EPIDEMIOLOGY OF HELICOBACTERPYLORI IN PERU: ANALYSIS OF 3005 CASES] / Contribución al estudio de laepidemiología del Helicobacter pylori en el Perú.Análisis de 3005 casos.

Compiling our observations from the last 15 years in regard to the epidemiology of Helicobacter pylori in Perú, we have analized 3005 cases. Studying and comparing the rates of infection among japanese inmigrants living in Perú for more than 10 years, niseis, japanese visitors and peruvians, we found similar rates. According to these results it seems that at least in japaneses there is not any genetic predisposition to acquire the infection. Studying peruvians of different socioeconomic levels, we observed similar rates of infection with the exception of women of high socioeconomic level. It seems that the last group of people is not exposed to the different mechanisms of infection. We found similar rates of infection in patients of low socioeconomic level living in the coast, sierra and jungle. Our studies in children showed that the infection is acquired during early childhood. Therefore in Perú we have not observed an ascending rate of infection according to age as has been described in industrialized countries. Analizing water from 48 sources we found Helicobacter pylori in 24 samples, 20 of them were taken from the municipal source of water. Water seems to be an important vehicle of infection, according to our studies, in children drinking water from different sources.

[Comments on irritable bowel syndrome]. / Comentarios Sobre el Síndrome de Intestino Irritable.

UNLABELLED: The Author comments about the inadequacy of the organic and functional terminology in the description of digestive problems categorized as Irritable Bowel Syndrome (IBS), also the adjective irritable and wrong is ambiguous and equivocal and the consideration in the definition of the Rome I, II , and III criteria for IBS since 3 months of discomfort is subject to great debate. KEYWORDS: Irritable Bowel Syndrome, Rome criteria, functional diseases.

[Gastrointestinal syndromes (3): flatulence (2)]. / Grandes síndromes gastrointestinales (3): flatulencia (2).

The second part of the article on flatulence reviewed aspects of the pathogenesis, diagnosis and treatment of this syndrome.

[Gastrointestinal syndromes (3): flatulence (1)]. / Grandes síndromes gastrointestinales (3): flatulencia (1).

Now we expose important data on definition and cardinal symptoms of the flatulence syndrome and, besides, on accumulated knowledge in relation to digestive tract gases.

Diarrea crónica postcolecistectomía / Chronic diarrhea post cholecistectomy

En el presente artículo se trata sobre la alta frecuencia del antecedente de colecistectomía como factor determinante de diarrea crónica y su control con colestiramina.

In the present article presents the high frequency of previous cholecystectomy as determinant factor of chronic diarrhea and its control with cholestyramine.

Recopilación de observaciones e investigaciones sobre factores psicológicos en las enfermedades / Compilation of observations and research about psychological factors in diseases

En septiembre de 2011, un artículo de revisión recogió las observaciones e investigaciones llevadas a cabo por elautor a lo largo de casi 45 años de trabajo en relación a factores psicológicos en las enfermedades. El objetivo de tal publicación fue la esperanza de que tales hallazgos pudieran ser útiles para colegas médicos, profesores, residentes yestudiantes de medicina en su práctica clínica. Con algunas modificaciones, se presentan nuevamente a fin de captarvaliosas opiniones y comentarios de colegas psiquiatras sobre el tema.

In September 2011, a review article of observations and investigations conducted by this author over a period of almost 45 years, related to psychological factors in diseases was published. Its objective was basically the hope that such findings could be useful for the clinical practice of physicians, teachers, residents and medical students. The material is presented again, with some modifications, to stimulate valuable opinions and comments of psychiatrist colleagues about the topic.

[Common gastrointestinal syndromes (2): dyspepsia or upper digestive tract syndrome related to food (I)]. / Grandes síndromes gastrointestinales (2): dispepsia o síndrome del aparato digestivo alto relacionado con alimentos (I).

We expose, this time, our ideas and findings on the definition, the classification and the cardinal symptoms of the dyspeptic syndrome.

[Major gastrointestinal syndromes (2): dyspepsia or syndrome of the upper digestive system related with food (2)]. / Grandes síndromes gastrointestinales (2): dispepsia o síndrome del aparato digestivo alto relacionado con alimentos (2).

We expose, this time, our ideas and findings on the etiopathogenesis, diagnosis and treatment of the dyspeptic syndrome.

Síndrome estreñimiento: métodos para medir la velocidad de tránsito intestinal / Constipation syndrome: methods for measuring the rate of intestinal transit

En el presente artículo, recuerdo lo que presenté, en un simposio llevado a cabo en nuestra Sociedad sobre el síndrome estreñimiento, en relación con la definición y los factores determinantes de este síndrome, y, además, con los métodos que hemos creado para medir en forma fisiológica la velocidad del tránsito intestinal, especialmente colónico.

In the present article, I remind what I presented, in a symposium performed in our Society on the constipation syndrome, in relation with the definition and the determinant factores of this syndrome, and, in addition, with the methods we have created to determine physiologically the velocity of the intestinal transit, specially colonic.

[Major gastrointestinal syndromes (1): general remarks]. / Grandes síndromes gastrointestinales (1): generalidades.

We will review concepts of the maladies of the people, focusing the problems as "great" syndromes, that are those that include the greater number of gastrointestinal symptoms. We begin this series of articles, reviewing aspects of the multifactorial genesis of the diseases, the real core of the diagnosis and the classification of the organic and "functional" gastrointestinal disorders.

[The high fermentative capacity of colonic bacteria in the origin of flatulence and its sensibility to bismuth subsalicylate]. / Alta capacidad fermentativa de las bacterias colónicas en la génesis de la flatulencia, y su sensibilidad al subsalicilato de bismuto.

Using a previously described technique, "in vitro" determinations were carried out for faecal fermentation (FF): basal faecal fermentation (BFF), i.e, only with faeces, with faeces and lactulose (LFF) and with faeces, lactulose and bismuth subsalicylate (BiLFF) in 34 patients with flatulence. The media+d.s. of the difference between the LFFand BFF levels (LFF-BFF) in patients with flatulence was significant and markedly higher than the respective media +d.s. in 30 normal control patients previously studied (9.1+4.7 vs. 3.9+3.2 ml gas/24 hrs; p<0.000001 respectively). And, although FF was reduced by adding bismuth salicylate in only 24% (70.6%) of the patients with flatulence but not in the remaining 10 (29.4%), in total the media+d.s. of the differences between the levels BiLFF and BFF (BiLFFBFF) was significantly lower that the media+d.s. of the differences between the LFF and BFF levels (LFF-BFF) (6.0+4.2 vs 9.1+4.7 ml gas/24 hrs; p<0.01 respectively). These results confirm that: 1) The fermentative capacity of the colonic bacteriae is most likely to be abnormally intense in peoples with flatulence and 2) Bismuth subsalicylate can be useful in the control of excessive colonic fermentation and flatulence; they raise, furthermore, the interesting possibility that we may have found the way to predict when the use of bismuth subsalicylate could be effective in the treatment of a patient with flatulence.

Propuesta para mejorar la nomenclatura, la clasificación y el diagnóstico de las enfermedades, teniendo en cuenta sus síntomas, signos y síndromes, y los factores determinantes / Proposal to improve the nomenclature, classification and diagnosis of diseases, taking into account their symptoms and signs, syndromes and determinant factors

El desorden que se ha ido produciendo a través del tiempo, en la nomenclatura y la clasificación de las enfermedades es considerado, a nivel internacional, un problema crónico que debería resolverse. De otro lado, diagnosticar no consiste solamente en dar un nombre convencional a la enfermedad que afecta a un paciente, y tampoco solamente en diferenciarla de otras similares. En este artículo, se presenta una propuesta para mejorar la nomenclatura, la clasificación y el diagnóstico de las enfermedades, teniendo en cuenta sus síntomas y signos, síndromes, y factores determinantes.

The disorder that has been produced, through time, in the nomenclature and classification of diseases is considered, at international level, a clinical problem that should be solved. On the other hand, to diagnose does not only consist in giving a conventional name to the disease that affects a patient, and also not only in differentiating it from similar ones. In this paper, we present a proposal to improve the nomenclature, classification and diagnosis of diseases, taking into account their symptoms and syndromes, signs, and determinant factors.