Primer consenso venezolanode enfermedad por reflujo gastroesofágico / Venezuelan consensus on gastroesophageal reflux diseases

El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

[Rectal biopsies from HIV-infected patients]. / Biopsias rectales en pacientes con infección por el virus de inmunodeficiencia humana.

Rectosigmoidoscopy and rectal biopsies specimens were taken from thirty six HIV infected patients in the Vargas Hospital of Caracas. There were thirty three males and three females. the mean age was thirty two years. Seventy three per cent were homosexuals. The sexual behaviour was the most important risk factor for the infection with the HIV. Forty four per cent of the rectosigmoidoscopies were abnormal, presenting hiperemic or petechiae mucosas. Alterations in rectal biopsies were reported on all specimens, twenty six with inespecific chronic rectitis. Two bipsies reported Kaposi's Sarcoma and eight bipsies demonstrated opportunistic agents.

[Effectiveness and innocuousness of the association of calcium dobesilate, dexamethasone acetate and lidocaine versus prednisolone capronate with dibucaine clorohydrate in the treatment of hemorrhoids-]. / Effectividad e inocuidad de la asociacion de dobesilato de calcio con acetato de dexametasona y lidocaina con capronato de prednisolona con clorhidrato de dibucaina, en el tratamiento de las hemorroides.

The objective of the present study was to compare properties of two associations in the topical treatment of hemorrhoids. They were included 40 patient with diagnosis of internal hemorrhoids grade 1 or 2, which was indicated topic treatment after the realization of an interrogatory and anoscopy. The treatment received according to a randomized and double blind design: A = dobesilate of calcium with acetato of dexamethasone and lidocaine or B = Capronato of Prednisolone with Clorhidrato of dibucaina, applied twice a day. They were carried out controls every 7 days. In each control was carried out interrogatory and respective anoscopy. There was a prevalence of the females, and the age corresponded to the 5t decade of the life. Patients of the treatment. A presented greater number of predisponents factors, but minor percentage of previous treatments. As for the evaluation of the punctuation of symptoms and of the grade of Hemorrhoids, comparing beginning and final, they didn't show significant difference interproduct confirming the effectiveness and similar inocuity. In both products was observed a important improvement concerning to the symptoms and grade of hemorrhoids but the patients of the treatment A precipitated the greater speed. As for the evaluation made by the phisicians, the treatment A (88%) and B (85.7%) the got successful outputs. The opinion of the patients was a 100% of marked goods or moderated beneficial. Both treatments were successful so much in effectiveness like in inocuity although the treatment A were always got the best efectiveness outputs.

[Portal hypertensive gastropathy: histologic and endoscopic correlation]. / Gastropatía portal hipertensiva: correlación endoscópico histológica.

Portal Hypertensive Gastropathy (PHG) diagnosed in 42 patients by upper gastrointestinal endoscopy and was correlated with histological findings of gastric biopsies taken from fundus-body and antrum and observed blinded by the pathologist. We found that in the fundus PHG was observed in 97.14% and of these 77.14% were mosaic pattern. Submucosal vessel dilatation was observed in 65.71%, congestion in 60% and chronic gastritis in 62.85%. Histologic and endoscopic correlation was possible in 85.71%. Our results show a histologic and endoscopic correlation.

[Gastric mucosa injuries in portal hypertension]. / Lesiones de la mucosa gástrica en hipertensión portal.

Portal Hypertension (PH) was diagnosed in 114/4145 patients (p) evaluated by upper gastrointestinal endoscopy during 1991-92 (2.75%). Portal hypertensive gastropathy (PHG) was found in 39.47% p. Mild PHG was observed in 82.22% and esophageal varices grade was directly correlated to PHG presence. This is a new entity to be considered because of its bleeding possibility in PH patients.

Specific digestive deficiency of phagocytes in paracoccidioidomycosis. Its absence in peripheral blood neutrophils of members of the nuclear family of patients. An initial report.

Paracoccidioidomycosis (PARA) affects only a minority of individuals, who have presumably been exposed to the causative fungus (Paracoccidioides brasiliensis). Neutrophils (PMNs) from patients with PARA show a significant and specific digestive deficiency phagocytosed P. brasiliensis in vitro. It is not known whether the defect is acquired after contact with the fungus, or precedes it. We studied the spouses and offspring of three patients with PARA. Individuals studied stayed in the same house as their husband or father. None of the relatives had evidence of PARA, and their PMNs showed no defect in their ability to digest or kill the fungus. Relatives showed no indication of sensitization against P. brasiliensis. These results are compatible with the view that effective contact with P. brasiliensis may occur only under restricted conditions and that the defect in digestive ability is an infrequent and specific occurrence.

[Budd-Chiari syndrome, pulmonary thromboembolism, and deep venous thrombosis associated with "lupus anticoagulant" and recent use of oral contraceptives]. / Síndrome de Budd-Chiari, tromboembolismo pulmonar y trombosis venosa profunda, asociado con "anticoagulante lúpico" y uso reciente de anticonceptivos orales.

The Budd-Chiari syndrome is the clinical manifestation of the total or partial obstruction of the hepatic veins and/or inferior vena cava. It is an infrequent cause of portal hypertension. The chronic presentation is the most frequent and is characterized by right upper quadrant pain, hepatomegaly, and ascites of slow onset. We report a case of a 26 year old woman affected by this disorder associated to a recent use of oral contraceptive and a "Lupus Anticoagulant". She subsequently developed deep venous thrombosis and pulmonary embolism. She died almost 6 years after the onset of symptoms.

PIP: A 26-year-old woman sought medical care in April 1983 because she had been experiencing pain in the right upper quadrant for 2 months, as well as an enlarged abdomen and postprandial fullness accompanied by nausea and vomiting. She had used oral contraceptives (OCs) for a period of 11 months up to 4 months before the inception of the symptoms. Examination showed normal vital functions but painful hepatomegaly. Hepatic biopsy showed dilatation of the central vein of the lobe; ultrasound of the liver showed hepatomegaly, the dilatation of hepatic veins, and suprahepatic veins; and echos of the inside were suggestive of thrombosis. The Doppler instrument revealed inversion of the hepatic flow towards the spleen and the presence of multiple collateral veins. Venocavography confirmed almost total obstruction of the inferior vena cava in its retrohepatic trajectory. Percutaneous transhepatic splenoportography demonstrated evidence of slow suprahepatic drainage with obstruction of the contrast medium in the area of the cava. The pressure in the suprahepatic vein was 43 cm of H2O. As the illness progressed, profound venous thrombosis of the left lower extremity developed, which was treated with heparin and managed with fenindione for 4 years. 5 years later, multiple pulmonary thromboembolism was confirmed by pulmonary gammagram of perfusion and digital arteriography. She received medical treatment based on low sodium and diuretic diet. Her hepatic function progressively deteriorated with increased ascites and collateral venous network. She died in December 1988.

[Phagocytic function of polymorphonuclear leukocytes and lymphocyte subpopulations in patients with amebiasis]. / Función fagocitaria de leucocitos polimorfonucleares y subpoblaciones linfocitarias en pacientes con amibiasis.

We initiated a pilot study to evaluate the functions of polymorphonuclear leukocytes and also to analyze the behavior of lymphocyte subpopulations in patients with different clinical forms of amoebiasis. We found significant differences in many aspects as NBT reduction, Candida digestion, CD4/CD8 relation, Ia expression. We suggest a wider investigation of the mechanism of cell mediated immunity in patients with amoebiasis.

[Percutaneous liver biopsy in outpatients]. / Biopsia hepática percutánea en pacientes ambulatorios.

We studied prospectively 44 patients with diffuse liver disease. We performed percutaneous liver biopsy in these outpatients. They were required to be in absolute response during the following 4-6 hours after the biopsy was completed. After that period, they could go home and have a relative rest for the remnant day. These patients were followed by clinical evaluation and by real time abdominal ultrasound. We found some complications: Transitory arterial hypotension, pain in the site of puncture, hepatic hematomas. Only one of the patients with hematomas required hospitalization during 24 hours. The mortality was 0%. According to our experience, the hepatic biopsy is a procedure that can be performed in outpatients with a wide margin of security. An important point of view to consider is the economic advantage since it means a decrease in costs by each hepatic biopsy accomplished considering the cost/day of hospitalization.