The fourth Mexican consensus on Helicobacter pylori. / IV consenso mexicano sobre Helicobacter pylori.

Important advances have been made since the last Mexican consensus on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection was published in 2007. Therefore, the Asociación Mexicana de Gastroenterología summoned 20 experts to produce "The Fourth Mexican Consensus on Helicobacter pylori". From February to June 2017, 4 working groups were organized, a literature review was performed, and 3 voting rounds were carried out, resulting in the formulation of 32 statements for discussion and consensus. From the ensuing recommendations, it was striking that Mexico is a country with an intermediate-to-low risk for gastric cancer, despite having a high prevalence of H. pylori infection. It was also corroborated that peptic ulcer disease, premalignant lesions, and histories of gastric cancer and mucosa-associated lymphoid tissue lymphoma should be considered clear indications for eradication. The relation of H. pylori to dyspeptic symptoms continues to be controversial. Eradication triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor should no longer be considered first-line treatment, with the following 2 options proposed to take its place: quadruple therapy with bismuth (proton pump inhibitor, bismuth subcitrate, tetracycline, and metronidazole) and quadruple therapy without bismuth (proton pump inhibitor, amoxicillin, clarithromycin, and metronidazole). The need for antimicrobial sensitivity testing when 2 eradication treatments have failed was also established. Finally, the promotion of educational campaigns on the diagnosis and treatment of H. pylori for both primary care physicians and the general population were proposed.

Efficacy of narrow-band imaging for detecting intestinal metaplasia in adult patients with symptoms of dyspepsia. / La eficacia de la imagen de banda estrecha para la detección de metaplasia intestinal en pacientes adultos con síntomas de dispepsia.

INTRODUCTION AND OBJECTIVE: Atrophy and intestinal metaplasia are early phenotypic markers in gastric carcinogenesis. White light endoscopy does not allow direct biopsy of intestinal metaplasia due to a lack of contrast of the mucosa. Narrow-band imaging is known to enhance the visibility of intestinal metaplasia, to reduce sampling error, and to increase the diagnostic yield of endoscopy for intestinal metaplasia in Asian patients. The aim of our study was to validate the diagnostic performance of narrow-band imaging using 1.5× electronic zoom endoscopy (with no high magnification) to diagnose intestinal metaplasia in Mexican patients. MATERIALS AND METHODS: A retrospective cohort study was conducted on consecutive patients with dyspeptic symptoms at a private endoscopy center within the time frame of January 2015 to December 2016. RESULTS: A total of 338 patients (63±8.4 years of age, 40% women) were enrolled. The prevalence of H. pylori infection was 10.9% and the incidence of intestinal metaplasia in the gastric antrum and corpus was 23.9 and 5.9%, respectively. Among the patients with intestinal metaplasia, 65.3% had the incomplete type, 42.7% had multifocal disease, and one third had extension to the gastric corpus. Two patients had low-grade dysplasia. The sensitivity of white light endoscopy was 71.2%, with a false negative rate of 9.9%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of narrow-band imaging (with a positive light blue crest) were 85, 98, 86.8, 97.7, and 87.2%, respectively. CONCLUSION: The prevalence of H. pylori infection and intestinal metaplasia in dyspeptic Mexican patients was not high. Through the assessment of the microsurface structure and light blue crest sign, non-optical zoom narrow-band imaging had high predictive values for detecting intestinal metaplasia in patients from a general Western setting.

[Treatment of non-variceal hemorrhage of the upper digestive tract]. / Tratamiento de la hemorragia no variceal del tubo digestivo alto.

High digestive tract hemorrhage (HDTH) represents on average 35% of the indications for endoscopy. It shows as a complication in different digestive pathologies or secondary to coagulopathies. Endoscopic management of non-variceal HDTH includes a gamut of procedures that when grouped together, have shown to be effective and safe in its control with an important diminishing in morbidity-mortality, transfusion requirements, days of hospital stay, and the need for surgery. The most frequently employed methods are substance injections, multipolar coagulation, and thermic catheter, which achieve an average 90% hemostasis, but still inform high percentages of relapse. Approximately 25% of the patients with non-variceal hemorrhage may bleed again after endoscopic management. New procedures such as hemoclips and the combination of endoscopic methods have been used to diminish relapse. Endoscopic treatment should be carried out when we find bleeding lesions with Forrest Ia, Ib and IIa classifications, fundamentally because the risk of hemorrhagic relapse is very high among these groups. The treatment for the eradication of Helicobacter pylori in patients with bleeding peptic ulcers diminishes, in an important manner, the risk of the recurrence of hemorrhage.

[A comparative study of 2 methods of preparation for colonoscopic procedure]. / Estudio comparativo de dos esquemas de preparación para procedimiento colonoscópico.

BACKGROUND: Although ingestion of polyethylene glycol solution has become the standard preparation for colonoscopy since 1980, there is investigation of new safe, comfortable and cheap methods. OBJECTIVE: We carried out a prospective study in order to compare the utility and tolerance related to the preparation of the colon for colonoscopy, using a dioctyl sodium sulfosuccinate enema (SD) versus our conventional preparation. METHOD: Group A was prepared the day previous to the study with liquid diet, oral laxative and application of an SD, prior to the endoscopy received another SD. Group B was prepared three days with liquid diet, the day previous to the colonoscopy they ingested oral laxative and used a water enema (W(e)), and they used another W(e) the day of the procedure. The patients' tolerance in each case was compared using a scale assigned as good, fair and poor. The cleaning obtained in the colon was also evaluated in a scale of good, regular and bad, considering three colon segments. RESULTS: Forty-four patients had been studied, 19 men and 25 women; each group with 22 patients. In group A: the preparation tolerance was good in 14 cases (63.6%), fair in seven (31.8%) and poor in one (4.5%); also, the obtained cleaning up to the cecum was good in nine cases (40.9%) and fair in 13 (59%). In group B: the tolerance was good in five cases (22.7%) fair in 12 (54.5%) and poor in five (22.7%); the obtained cleaning in this group up to the cecum was good in two cases (9%), fair in 19 (86.3%) and poor in one (4.5%). CONCLUSIONS: The SD preparation was better tolerated and more effective in order to achieve the cleaning of the colon than the conventional one.

[Gastric leiomyosarcomas and leiomyoblastomas]. / Leiomiosarcomas y leiomioblastomas gástricos.

The authors review the cases with smooth muscle tumors of the stomach (SMTS), excluding the leiomyomas, at the Mexico's General Hospital in a period of 5 years. They found 8 cases in women and 3 in men, with 51.3 years average. The average of evolution of symptoms was 5 months, prevailing: anaemia, digestive bleeding and abdominal pain. Barium radiology and endoscopy guided to the diagnosis. The tumors were located 7 at the fundus, 3 at the body and one at the gastric antrum. The size oscillated between 1.5-28 cm., average 8 cm. Endoscopic specimens were positive in 2/7 cases and cytologic samples were negative in all cases. Eight tumors were leiomyosarcomas (LMS) and 3 were leiomyoblastomas (LMB); the histologic criteria in order to differentiate them was based on the number of mitosis for 50 fields (50 csf), the size and their hypercellularity. A patient died before being operated. Two cases were subjected to emergency surgery, and died after that. In the cases treated with elective surgery the authors performed subtotal gastrectomy with major omentectomy in 4 and surgical resection of the tumor in the remaining 4 patients. The mortality rate for surgery was 27.2%.