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1.
Gut ; 73(10): 1607-1617, 2024 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-39122364

RESUMEN

OBJECTIVE: During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research. DESIGN: We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM. RESULTS: From 426 manuscripts identified, 16 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory Helicobacter pylori infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend H. pylori eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence. CONCLUSION: Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as H. pylori eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from H. pylori eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist.


Asunto(s)
Mucosa Gástrica , Guías de Práctica Clínica como Asunto , Lesiones Precancerosas , Neoplasias Gástricas , Humanos , Gastroscopía/métodos , Gastroscopía/normas , Infecciones por Helicobacter/patología , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori , Metaplasia/diagnóstico , Metaplasia/patología , Metaplasia/terapia , Lesiones Precancerosas/patología , Lesiones Precancerosas/terapia , Lesiones Precancerosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patología , Neoplasias Gástricas/prevención & control , Mucosa Gástrica/patología
2.
Rev Esp Enferm Dig ; 2024 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-39297601

RESUMEN

We report a case of a 48-year-old male with HIV and poor adherence to antiretroviral therapy, presenting with two months of abdominal pain and diarrhea. His latest CD4 count was 11/µL. Imaging and biopsy confirmed CMV enteritis with ulcerated lesions in the distal ileum. Despite prolonged antiviral therapy with ganciclovir and foscarnet, the patient's condition remained refractory, necessitating ileocaecal resection and ileostomy, followed by further resection and anastomosis. Post-surgery, the patient recovered well and was discharged. This case underscores the potential benefit of surgical intervention in CMV enteritis unresponsive to medical treatment in HIV patients.

3.
Gastroenterol Hepatol ; 46(6): 411-418, 2023.
Artículo en Inglés, Español | MEDLINE | ID: mdl-35580739

RESUMEN

BACKGROUND: Adenocarcinoma is preceded by chronic atrophic gastritis, gastric intestinal metaplasia and dysplasia. Trefoil factor 3 (TFF3) is a peptide secreted by goblet cells, which is abundantly present in intestinal metaplasia. AIM: To evaluate the utility of serum TFF3 as a non-invasive biomarker for the diagnosis of intestinal metaplasia and gastric cancer. METHODS: Single-center, cross-sectional study of 274 patients who consecutively underwent upper gastrointestinal endoscopy with gastric biopsies (updated Sydney system). TFF3 levels were measured in serum by a commercial ELISA kit. Patients with normal histology or chronic atrophic gastritis without intestinal metaplasia comprised the control group. In addition, 14 patients with invasive gastric cancer were included as a reference group. The association between TFF3 levels and intestinal metaplasia was assessed by logistic regression. RESULTS: Patients with intestinal metaplasia (n=110) had a higher median TFF3 level as compared to controls (n=164), 13.1 vs. 11.9ng/mL, respectively (p=0.024). Multivariable logistic regression showed a no significant association between TFF3 levels and intestinal metaplasia (OR=1.20; 95%CI: 0.87-1.65; p-trend=0.273). The gastric cancer group had a median TFF3 level of 20.5ng/mL, and a significant association was found (OR=3.26; 95%CI: 1.29-8.27; p-trend=0.013). CONCLUSION: Serum levels of TFF3 do not discriminate intestinal metaplasia in this high-risk Latin American population. Nevertheless, we confirmed an association between TFF3 levels and invasive gastric cancer.


Asunto(s)
Gastritis Atrófica , Helicobacter pylori , Lesiones Precancerosas , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/patología , Factor Trefoil-3 , Estudios Transversales , Biomarcadores , Metaplasia/patología , Mucosa Gástrica , Lesiones Precancerosas/patología
4.
Gastroenterol Hepatol ; 45(7): 515-523, 2022.
Artículo en Inglés, Español | MEDLINE | ID: mdl-34890721

RESUMEN

INTRODUCTION: Helicobacter pylori infection affects approximately 70% of the Chilean population. It is a public health problem whose eradication treatment is part of the explicit health guarantees in Chile. OBJECTIVES: Characterize the most widely used H. pylori first-line eradication therapies in our environment and evaluate their efficacy. METHODS: A retrospective observational study was carried out where, in patients with certified H. pylori infection, the eradication therapy indicated by the treating physician, its efficacy, adherence and adverse effects, in addition to the eradication certification method used, were evaluated. RESULTS: 242 patients and 4 main therapies were analyzed: standard triple therapy, dual therapy, concomitant therapy, and bismuth quadruple therapy. Eradication rates of 81.9% (95% CI 74.44-87.63), 88.5% (95% CI 73.13-95.67), 93.7% (95% CI 78.07-98.44) and 97.6% (95% CI 84.81-99.67) were observed respectively, with concomitant therapy (RR: 1.14; 95% CI 1.01-1.29; p=.028) and quadruple therapy with bismuth (RR: 1.19; 95% CI 1.09-1.31; p<.001) being significantly more effective than standard triple therapy. Regarding the rate of reported adverse effects, it was 58.5% (95% CI 50.66-65.92), 35.4% (95% CI 24.6-48.11), 22.9% (95% CI 81-37.14) and 63.4% (95% CI 47.8-76.64), having the dual and concomitant therapy significantly fewer adverse effects compared with standard therapy. CONCLUSIONS: Quadruple therapies are superior to standard triple therapy and should be considered as first-line treatment in Chile. Dual therapy is promising. More studies will be required to determine which therapies are most cost-effective.


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapéutico , Antibacterianos/efectos adversos , Bismuto/uso terapéutico , Chile , Quimioterapia Combinada , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Inhibidores de la Bomba de Protones/uso terapéutico
5.
Rev Med Chil ; 147(11): 1382-1389, 2019 Nov.
Artículo en Español | MEDLINE | ID: mdl-32186598

RESUMEN

Background Chile has one of the highest mortality rates by gastric cancer (GC) worldwide. Primary prevention of GC and detection of pre-neoplastic and early neoplastic lesions should be a national priority. Aim To assess the impact of the protocolization of endoscopy referral and the use of H. pylori stool antigen test (HPSA) in the management of dyspepsia to decrease the waiting list for endoscopy and increase the detection of gastric pre-neoplastic and early neoplastic lesions. Material and Methods We included all patients referred to the Endoscopy Unit of a regional hospital, from January 2015 to December 2017. We also included patients with known pre-neoplastic lesions and all those with first degree relatives with GC. We implemented protocols for referral of patients with dyspepsia considering the use of HPSA test, prioritizing to endoscopy those with a higher risk of GC. Results A total of 4,641 endoscopies and 2,631 HPSA tests were carried out. After the adoption of these protocols, we observed a 52% decrease in the waiting time for endoscopy. The GC detection rate in this period was 1.8 to 3.1 cases per 100 endoscopies. After the adoption of the protocols, we observed a significant increase in early GC detection rate (from none in 2015 to 13% in 2017, p = 0.03). Conclusions The protocolization of the referral for endoscopy associated with widespread use of HPSA test in the management of patients with dyspepsia, are successful strategies to decrease waiting lists for endoscopy and optimize the detection rate of pre-neoplastic lesions and early GC.


Asunto(s)
Antígenos Bacterianos/análisis , Dispepsia/diagnóstico , Heces/microbiología , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/aislamiento & purificación , Lesiones Precancerosas/diagnóstico , Listas de Espera , Dispepsia/microbiología , Diagnóstico Precoz , Endoscopía/estadística & datos numéricos , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/microbiología , Humanos , Lesiones Precancerosas/microbiología , Atención Primaria de Salud , Derivación y Consulta , Sensibilidad y Especificidad
6.
Rev Med Chil ; 147(8): 1059-1066, 2019 Aug.
Artículo en Español | MEDLINE | ID: mdl-31859972

RESUMEN

BACKGROUND: Continuing education is essential for health professions and online courses can be a good way for professional development. AIM: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. MATERIAL AND METHODS: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. RESULTS: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. CONCLUSIONS: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.


Asunto(s)
Educación a Distancia/métodos , Educación Médica Continua/métodos , Gastroenterología/educación , Chile , Evaluación Educacional , Femenino , Geografía , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Reproducibilidad de los Resultados , Sociedades Médicas , Factores de Tiempo
8.
Rev Med Chil ; 142(9): 1181-92, 2014 Sep.
Artículo en Español | MEDLINE | ID: mdl-25517059

RESUMEN

An expert panel analyzed the available evidence and reached a consensus to release 24 recommendations for primary and secondary prevention of gastric cancer (CG) in symptomatic patients, with indication for upper GI endoscopy. The main recommendations include (1) Search for and eradicate H. pylori infection in all cases. (2) Systematic gastric biopsies (Sydney protocol) in all patients over 40 years of age or first grade relatives of patient with CG, to detect gastric atrophy, intestinal metaplasia or dysplasia. (3) Incorporate the OLGA system (Operative Link on Gastritis Assessment) to the pathological report, to categorize the individual risk of CG. (4) Schedule endoscopic follow-up according to the estimated risk of CG, namely annual for OLGA III- IV, every 3 years for OLGA I- II or persistent H. pylori infection, every 5 years for CG relatives without other risk factors and no follow-up for OLGA 0, H. pylori (-). (4) Establish basic human and material resources for endoscopic follow-up programs, including some essential administrative processes, and (5) Suggest the early CG/total CG diagnosis ratio of each institution and the proportion of systematic recording of endoscopic images, as quality indicators. These measures are applicable using currently available resources, they can complement any future screening programs for asymptomatic population and may contribute to improve the prognosis of CG in high-risk populations.


Asunto(s)
Detección Precoz del Cáncer/métodos , Endoscopía Gastrointestinal , Lesiones Precancerosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Chile , Humanos , Factores de Riesgo , Sociedades Médicas
9.
Artículo en Inglés | MEDLINE | ID: mdl-39090833

RESUMEN

INTRODUCTION: Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations. OBJECTIVE: To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America. METHODS: A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms. RESULTS: 772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success. CONCLUSIONS: Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.

10.
Rev Med Chil ; 140(9): 1101-8, 2012 Sep.
Artículo en Español | MEDLINE | ID: mdl-23354630

RESUMEN

BACKGROUND: Genetically programmed adult-type hypolactasia affects 56% of Chilean population. Ideally, diagnosis should be confirmed. AIM: To compare diagnostic yield of genetic test, hydrogen (H2) expiratory test and a validated symptomatic structured survey (SS). MATERIAL AND METHODS: Patients submitted to H2 test answered a historic (anamnestic) and current SS (after the ingestion of 25 g of lactose). A blood sample was obtained for determination of genetic polymorphisms C/T_13910, C/G_13907 and G/A_22018 by polymerase chain reaction. The gold standard for diagnosis of lactose intolerance (LI) was the agreement of at least two of three tests. RESULTS: Sixty-one participants aged 39 ± 12 years (21 males), were studied. Anamnestic SS was diagnostic of LI in all cases (score > 7), while current SS detected LI in 27/61 (46%). H2 test (an increase > 15 ppm after ingestion of 25 g of lactose) showed LI in 31/61 (51%). The locus C/G_13907 showed no polymorphism and locus G/A_22018 was in complete linkage disequilibrium with C/T_13910. Genotype C/C_13910, associated to hypolactasia, was present in 30/58 (52%). According to the gold-standard, 32/61 (52.5%) patients were diagnosed as LI. Sensitivity and specificity were, respectively, 79% and 69% for current SS, 93% and 93% for H2 test and 97% and 93% for the genetic test. The last two showed a positive likelihood ratio (LR) > 10 and a negative LR < 0.1, figures within the range considered clinically useful. CONCLUSIONS: Genotype C/C_13910 is responsible for hypolactasia in this population. Anamnestic report of symptoms after milk ingestion and symptoms after lactose ingestion, are not accurate enough. H2 and genetic tests are simple and similarly accurate to diagnose lactose intolerance in adults.


Asunto(s)
Intolerancia a la Lactosa/diagnóstico , Adulto , Anciano , Femenino , Genotipo , Humanos , Lactasa/genética , Intolerancia a la Lactosa/genética , Prueba de Tolerancia a la Lactosa , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Polimorfismo Genético , Polimorfismo de Nucleótido Simple , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Adulto Joven
11.
DEN Open ; 2(1): e97, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35873520

RESUMEN

The World Endoscopy Organization Stomach and Duodenal Diseases Committee extracted minimum elements for screening and diagnosis of gastric cancer (GC) in aim to support countries that do not have national guidelines on screening and diagnosis of GC. Current national or international guidelines were collected worldwide and recommendations were classified according to the quality of evidence and were finalized through a modified Delphi method. The minimum elements consist of seven categories: [1] Extraction of high-risk patients of GC before esophagogastroduodenoscopy (EGD), [2] Patients who need surveillance of GC, [3] Method to ensure quality of EGD for detection of GC, [4] Individual GC risk assessment by EGD, [5] Extraction of high-risk patients of GC after EGD [6] Qualitative or differential diagnosis of GC by EGD, and [7] Endoscopic assessment to choose the therapeutic strategy for GC. These minimum elements will be a guide to promote the elimination of GC among countries with a high incidence of GC who lack national guidelines or screening programs.

12.
Ann Hepatol ; 9(1): 15-22, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20308718

RESUMEN

BACKGROUND: Gastroesophageal variceal bleeding is a common complication of portal hypertension. Current guidelines recommend thorn-blockers for primary prophylaxis. However, evidence suggests that endoscopic variceal ligation (EVL) reduce bleeding episodes. AIMS: To compare endoscopic EVL with propranolol (PPL) for primary prophylaxis of variceal bleeding. METHODS: We conducted a randomized controlled trial. Over a 9-year period, 75 patients with cirrhosis and high-risk esophageal varices (HREV) were recruited and allocated to EVL (n=39) or PPL (n=36). Primary outcome was variceal bleeding. Secondary outcomes were survival, source of bleeding and serious adverse events. Analyses were made by intention-to-treat. RESULTS: Baseline characteristics were similar. Medium follow-up was 1647+/-1096 days. complete follow-up was achieved in 85% of patients. Variceal bleeding occurred in 12% of EVL and in 25% of PPL group (p=0.17). The actuarial risks of bleeding after 2 years were similar in both groups. Overall mortality was 51% in EVL and 33% in PPL group (p=0.17). Patients in the EVL group showed a lower rate of esophageal variceal bleeding (5.1% v/s 25%, p=0.027) and a higher rate of subcardial variceal bleeding compared with PPL group (7.7% v/s 0%, p=0.027). Serious adverse events related to EVL occurred in 2 patients, including 1 death. CONCLUSIONS: The present study supports that PPL should be considered the first choice in primary prophylaxis of variceal bleeding offering similar effects and lower severe adverse events compared with EVL.


Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Endoscopía/métodos , Várices Esofágicas y Gástricas/prevención & control , Hemorragia Gastrointestinal/prevención & control , Propranolol/uso terapéutico , Anciano , Várices Esofágicas y Gástricas/epidemiología , Femenino , Hemorragia Gastrointestinal/epidemiología , Humanos , Estimación de Kaplan-Meier , Ligadura/métodos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento
13.
Gastroenterology ; 134(2): 491-9, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18242215

RESUMEN

BACKGROUND & AIMS: Helicobacter pylori infection in children infrequently causes gastroduodenal mucosal ulceration. Because H pylori induces T-cell dependent gastric inflammation in adults and T regulatory (Treg) cells suppress T-cell-dependent pathology, we evaluated gastric histopathology and Treg cell responses in H pylori-infected children and adults. METHODS: Gastric tissue from 36 children and 79 adults with abdominal symptoms in Santiago, Chile, was evaluated prospectively for H pylori bacteria and histopathology using the Sydney classification and Treg responses using immunoassay, immunohistochemistry, and real-time polymerase chain reaction. RESULTS: Eighteen (50%) of the children and 51 (65%) of the adults were infected with H pylori. Children and adults were colonized with similar levels of H pylori. However, the level of gastritis in the children was reduced substantially compared with that of the adults (P < .05). Coincident with reduced gastric inflammation, the number of Treg cells and levels of Treg cytokines (transforming growth factor [TGF]-beta1 and interleukin-10) were increased markedly in the gastric mucosa of H pylori-infected children compared with that of infected adults (P < .03 and < .05, respectively). Also, H pylori infection in the children was associated with markedly increased levels of gastric TGF-beta1 and interleukin-10 messenger RNA. Importantly, gastric TGF-beta1 in H pylori-infected children localized predominantly to mucosal CD25(+) and Foxp3(+) cells, indicating a Treg source for the TGF-beta1. CONCLUSIONS: Gastric pathology is reduced and local Treg cell responses are increased in H pylori-infected children compared with infected adults, suggesting that gastric Treg cell responses down-regulate the inflammation and ulceration induced by H pylori in children.


Asunto(s)
Gastritis/inmunología , Gastritis/virología , Infecciones por Helicobacter/inmunología , Helicobacter pylori/patogenicidad , Linfocitos T Reguladores/patología , Linfocitos T Reguladores/fisiología , Adolescente , Adulto , Envejecimiento/patología , Proliferación Celular , Niño , Chile , Regulación hacia Abajo , Femenino , Factores de Transcripción Forkhead/metabolismo , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Mucosa Gástrica/virología , Gastritis/etiología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/patología , Humanos , Interleucina-10/metabolismo , Subunidad alfa del Receptor de Interleucina-2/metabolismo , Masculino , Estudios Prospectivos , ARN Mensajero/metabolismo , Linfocitos T Reguladores/virología , Factor de Crecimiento Transformador beta1/metabolismo
14.
J Pediatr Gastroenterol Nutr ; 47(5): 612-7, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18979584

RESUMEN

BACKGROUND: Helicobacter pylori infection results in a systemic immune response characterized by the initial rise of immunoglobulin (Ig) M followed by the elevation of IgG- and IgA-specific antibody levels in serum. Age and regional considerations may modify the accuracy of serological tests. OBJECTIVES: To determine the accuracy of specific IgG, IgA, and IgM in H pylori infection determination in different age groups. PATIENTS AND METHODS: We enrolled 179 patients referred for endoscopy. Patients were considered infected if they had positive histological or urease test results for H pylori. Titers of IgG, IgA, and IgM were determined in serum by enzyme-linked immunosorbent assay. Through receiver operator characteristic curves, cutoff, sensitivity, and specificity values were obtained. Agreement and correlation between immunoglobulin titers and inflammation markers were explored. RESULTS: Infection with H pylori was present in 58% of adults, 62% of adolescents, and 25% of children. Sensitivity and specificity were higher in children younger than 12 years old for IgG and IgA. All diagnostic performance values were lower for IgM. Agreement measures were approximately 0.5 in adults and reached values of approximately 0.7 for adolescents and children. IgM had negative agreement with other methods. There was a correlation between inflammation markers, H pylori load, and immunoglobulin titers for IgG and IgA. These associations decreased with age and were not observed for IgM. CONCLUSIONS: IgG and IgA serological tests reached high performance values, particularly in children younger than 12 years old, indicating that they are reasonable screening methods once cutoff values are adjusted to local population and age. IgM does not present an additional contribution.


Asunto(s)
Biomarcadores/sangre , Infecciones por Helicobacter/inmunología , Helicobacter pylori , Inmunoglobulina M/sangre , Adolescente , Adulto , Niño , Endoscopía , Infecciones por Helicobacter/sangre , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto Joven
15.
Microbes Infect ; 9(4): 428-34, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17336120

RESUMEN

Helicobacter pylori infection is highly prevalent in Chile (73%). Usually a minority of infected patients develops complications such as ulcers and gastric cancer that have been associated with the presence of virulence factors (cagA, vacA) and host T helper response (Th1/Th2). Our aim was to evaluate the relationship between strain virulence and host immune response, using a multiple regression approach for the development of a model based on data collected from H. pylori infected patients in Chile. We analyzed levels of selected cytokines determined by ELISA (interleukin (IL)-12, IL-10, interferon (IFN)-gamma and IL-4) and the presence of cagA and vacA alleles polymorphisms determined by PCR in antral biopsies of 41 patients referred to endoscopy. By multiple regression analysis we established a correlation between bacterial and host factors using clinical outcome (gastritis and duodenal ulcer) as dependent variables. The selected model was described by: clinical outcome=0.867491 (cagA)+0.0131847 (IL-12/IL-10)+0.0103503 (IFN-gamma/IL-4) and it was able to explain over 90% of clinical outcomes observations (R(2)=96.4). This model considers that clinical outcomes are better explained by the interaction of host immune factors and strain virulence as a complex and interdependent mechanism.


Asunto(s)
Citocinas/inmunología , Infecciones por Helicobacter/inmunología , Infecciones por Helicobacter/virología , Helicobacter pylori/inmunología , Helicobacter pylori/patogenicidad , Factores de Virulencia/genética , Adolescente , Adulto , Alelos , Antígenos Bacterianos/genética , Proteínas Bacterianas/genética , Niño , Preescolar , Úlcera Duodenal/inmunología , Úlcera Duodenal/virología , Femenino , Gastritis/inmunología , Gastritis/virología , Helicobacter pylori/genética , Humanos , Masculino , Persona de Mediana Edad , Células TH1/inmunología , Células Th2/inmunología
16.
Cancer Epidemiol Biomarkers Prev ; 16(4): 662-7, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17416755

RESUMEN

BACKGROUND AND AIMS: Chile ranks fifth in the world among countries with the highest incidence of gastric cancer. The aim was to quantify the association between Helicobacter pylori infection and gastric cancer mortality at the county of residence. METHODS: A cross-sectional household survey, a probability sample of the Chilean adult population, provided 2,615 participants in whom serum H. pylori IgG antibodies were measured (ELISA). The spatial pattern of 48,367 deaths due to gastric cancer which occurred from 1985 to 2002 was analyzed using a hierarchical Poisson regression model; 333 counties were categorized as low, medium, and high gastric cancer mortality with median gastric cancer death rates of 11.4, 19.1, and 26.0 per 100,000 inhabitants, respectively. The association between H. pylori positivity and gastric cancer mortality in the county of residence was assessed by multivariate Poisson regression for complex samples. RESULTS: H. pylori prevalence was 73.0% [95% confidence intervals (CI), 70.0-76.0], higher in men [prevalence rate ratio (PRR), 1.1 (95% CI, 1.01-1.20)], peaked at ages 45 to 64, and dropped after age 65. It was higher among residents in counties with high gastric cancer mortality (79.7%; 95% CI, 76.4-82.6) compared to counties with low gastric cancer mortality (62.3%; 95% CI, 53.8-70.2; corresponding PRR, 1.3; 95% CI, 1.1-1.5); under age 24, H. pylori infection was 79.7% (95% CI, 72.2-85.6) versus 39.8% (95% CI, 19.6-64.2) among residents in counties with high and low gastric cancer mortalities, respectively (PRR, 2.0; 95% CI, 1.1-3.7). CONCLUSIONS: The high prevalence of H. pylori at younger ages was associated with high gastric cancer mortality in the base population.


Asunto(s)
Infecciones por Helicobacter/epidemiología , Helicobacter pylori , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/mortalidad , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Chile/epidemiología , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Helicobacter pylori/inmunología , Humanos , Masculino , Persona de Mediana Edad , Distribución de Poisson , Prevalencia , Sensibilidad y Especificidad
17.
World J Gastroenterol ; 13(21): 2967-72, 2007 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-17589948

RESUMEN

AIM: To compare the efficacy of 7-d versus 14-d triple therapy for the treatment of H pylori infection in Chile, with a prevalence of 73% in general population. METHODS: H pylori-infected patients diagnosed by rapid urease test, with non-ulcer dyspepsia or peptic ulcer disease were randomized to receive omeprazole 20 mg bid, amoxicillin 1 g bid, and clarithromycin 500 mg bid for 7 (OAC7) or 14 (OAC14) d. Primary outcome was eradication rate 6 wk after the treatment. Subgroup analysis was carried out considering the eradication rate among patients with or without peptic ulcer disease and eradication rate among smokers or non-smokers. RESULTS: One hundred and thirty-one patients were randomized to OAC7 (n = 69) or OAC14 (n = 62). The overall eradication rate (intention-to-treat) was 78.3% in OAC7 and 85.5% in OAC14 groups, without a significant difference (P =0.37). No significant difference in the eradication rate was found among the patients with peptic ulcer disease (n = 31) between the OAC7 group (85.7%) and OAC14 group (87.5%). However, smokers had an obviously lower eradication rate compared to non-smokers, particularly in the OAC7 group (57.1% in smokers vs 83.6% in non-smokers; P = 0.06). Adverse effects rate were similar between both groups. CONCLUSION: Short-term efficacy of triple therapy with OAC for 7 d is comparable to 14 d in this high-prevalence population. Longer follow-up, and studies focused to some subgroups of patients (smokers and non-ulcer patients) are necessary to support widespread use of 7-d instead of 10-14-d triple therapy in a developing country like Chile.


Asunto(s)
Amoxicilina/administración & dosificación , Antibacterianos/administración & dosificación , Claritromicina/administración & dosificación , Infecciones por Helicobacter/tratamiento farmacológico , Omeprazol/administración & dosificación , Adulto , Chile/epidemiología , Esquema de Medicación , Quimioterapia Combinada , Femenino , Infecciones por Helicobacter/epidemiología , Helicobacter pylori/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Resultado del Tratamiento
18.
World J Gastroenterol ; 12(44): 7172-8, 2006 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-17131482

RESUMEN

AIM: To validate a non-invasive method to detect gastric mucosal atrophy in a Chilean population with high prevalence of gastric cancer and a poor survival rate. METHODS: We first determined the optimal cut-off level of serum pepsinogen (PG)-1, PG-1/PG-2 ratio and 17-gastrin in 31 voluntary symptomatic patients (mean age: 66.1 years), of them 61% had histologically confirmed gastric atrophy. Then, in a population-based sample of 536 healthy individuals (209 residents in counties with higher relative risk and 327 residents in counties with lower relative risk for gastric cancer), we measured serum anti-H pylori antibodies, PG and 17-gastrin and estimated their risk of gastric cancer. RESULTS: We found that serum PG-1 < 61.5 microg/L, PG-1/PG-2 ratio < 2.2 and 17-gastrin > 13.3 pmol/L had a high specificity (91%-100%) and a fair sensitivity (56%-78%) to detect corpus-predominant atrophy. Based on low serum PG-1 and PG-1/PG-2 ratio together as diagnostic criteria, 12.5% of the asymptomatic subjects had corpus-predominant atrophy (0% of those under 25 years and 20.2% over 65 years old). The frequency of gastric atrophy was similar (12% vs 13%) but H pylori infection rate was slightly higher (77% vs 71%) in the high-risk compared to the low-risk counties. Based on their estimated gastric cancer risk, individuals were classified as: low-risk group (no H pylori infection and no atrophy; n = 115; 21.4%); moderate-risk group (H pylori infection but no atrophy; n = 354, 66.0%); and high-risk group (gastric atrophy, with or without H pylori infection; n = 67, 12.5%). The high-risk group was significantly older (mean age: 61.9+/-13.3 years), more frequently men and less educated as compared with the low-risk group. CONCLUSION: We propose to concentrate on an upper gastrointestinal endoscopy for detection of early gastric cancer in the high-risk group. This intervention model could improve the poor prognosis of gastric cancer in Chile.


Asunto(s)
Atrofia/diagnóstico , Mucosa Gástrica/patología , Adulto , Anciano , Anciano de 80 o más Años , Atrofia/epidemiología , Chile/epidemiología , Femenino , Gastrinas/sangre , Humanos , Masculino , Persona de Mediana Edad , Pepsinógeno A/sangre , Pepsinógeno C/sangre , Valores de Referencia , Factores de Riesgo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiología
19.
Rev. méd. Chile ; 147(11): 1382-1389, nov. 2019. tab, graf
Artículo en Español | LILACS | ID: biblio-1094167

RESUMEN

Background Chile has one of the highest mortality rates by gastric cancer (GC) worldwide. Primary prevention of GC and detection of pre-neoplastic and early neoplastic lesions should be a national priority. Aim To assess the impact of the protocolization of endoscopy referral and the use of H. pylori stool antigen test (HPSA) in the management of dyspepsia to decrease the waiting list for endoscopy and increase the detection of gastric pre-neoplastic and early neoplastic lesions. Material and Methods We included all patients referred to the Endoscopy Unit of a regional hospital, from January 2015 to December 2017. We also included patients with known pre-neoplastic lesions and all those with first degree relatives with GC. We implemented protocols for referral of patients with dyspepsia considering the use of HPSA test, prioritizing to endoscopy those with a higher risk of GC. Results A total of 4,641 endoscopies and 2,631 HPSA tests were carried out. After the adoption of these protocols, we observed a 52% decrease in the waiting time for endoscopy. The GC detection rate in this period was 1.8 to 3.1 cases per 100 endoscopies. After the adoption of the protocols, we observed a significant increase in early GC detection rate (from none in 2015 to 13% in 2017, p = 0.03). Conclusions The protocolization of the referral for endoscopy associated with widespread use of HPSA test in the management of patients with dyspepsia, are successful strategies to decrease waiting lists for endoscopy and optimize the detection rate of pre-neoplastic lesions and early GC.


Asunto(s)
Humanos , Lesiones Precancerosas/diagnóstico , Listas de Espera , Helicobacter pylori/aislamiento & purificación , Infecciones por Helicobacter/diagnóstico , Dispepsia/diagnóstico , Heces/microbiología , Antígenos Bacterianos/análisis , Lesiones Precancerosas/microbiología , Atención Primaria de Salud , Derivación y Consulta , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/microbiología , Sensibilidad y Especificidad , Diagnóstico Precoz , Dispepsia/microbiología , Endoscopía/estadística & datos numéricos
20.
World J Gastroenterol ; 20(31): 10969-83, 2014 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-25152601

RESUMEN

AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature. METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria. RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing. CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.


Asunto(s)
Antibacterianos/uso terapéutico , Técnica Delphi , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Inhibidores de la Bomba de Protones/uso terapéutico , Técnicas Bacteriológicas , Consenso , Progresión de la Enfermedad , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/aislamiento & purificación , Humanos , América Latina/epidemiología , Úlcera Péptica/epidemiología , Úlcera Péptica/microbiología , Úlcera Péptica/prevención & control , Guías de Práctica Clínica como Asunto , Lesiones Precancerosas/tratamiento farmacológico , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/microbiología , Valor Predictivo de las Pruebas , Recurrencia , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/prevención & control , Factores de Tiempo , Resultado del Tratamiento
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