Apuntes históricos sobre la Gastroenterología en el mundo, Cuba y Matanzas / Historical notes on Gastroenterology. Its development in the World, Cuba and Matanzas

RESUMEN Con el objetivo de resumir algunos aspectos destacados de la historia de la Gastroenterología en el mundo, en Cuba y especialmente en Matanzas, se expusieron cronológicamente hechos relacionados con el tema, y se destacó el aporte y el papel desempeñado por diferentes médicos en la especialidad (AU).

ABSTRACT With the objective of summarizing several significant aspects of the history of Gastroenterology in the world, in Cuba and especially in Matanzas, facts related with the theme were chronologically exposed, and the contribution and role played by different personalities in the specialty were highlighted (AU).

History of Nonalcoholic Fatty Liver Disease.

Based on the assumption that characterizing the history of a disease will help in improving practice while offering a clue to research, this article aims at reviewing the history of nonalcoholic fatty liver disease (NAFLD) in adults and children. To this end, we address the history of NAFLD histopathology, which begins in 1980 with Ludwig's seminal studies, although previous studies date back to the 19th century. Moreover, the principal milestones in the definition of genetic NAFLD are summarized. Next, a specific account is given of the evolution, over time, of our understanding of the association of NAFLD with metabolic syndrome, spanning from the outdated concept of "NAFLD as a manifestation of the Metabolic Syndrome", to the more appropriate consideration that NAFLD has, with metabolic syndrome, a mutual and bi-directional relationship. In addition, we also report on the evolution from first intuitions to more recent studies, supporting NAFLD as an independent risk factor for cardiovascular disease. This association probably has deep roots, going back to ancient Middle Eastern cultures, wherein the liver had a significance similar to that which the heart holds in contemporary society. Conversely, the notions that NAFLD is a forerunner of hepatocellular carcinoma and extra-hepatic cancers is definitely more modern. Interestingly, guidelines issued by hepatological societies have lagged behind the identification of NAFLD by decades. A comparative analysis of these documents defines both shared attitudes (e.g., ultrasonography and lifestyle changes as the first approaches) and diverging key points (e.g., the threshold of alcohol consumption, screening methods, optimal non-invasive assessment of liver fibrosis and drug treatment options). Finally, the principal historical steps in the general, cellular and molecular pathogenesis of NAFLD are reviewed. We conclude that an in-depth understanding of the history of the disease permits us to better comprehend the disease itself, as well as to anticipate the lines of development of future NAFLD research.

Celebrating the career and contributions of Dr Henry T. Lynch (1928-2019).

This article celebrates the career of Dr Henry Lynch and his contributions to cancer genetics through his extensive research, clinical practice and his passion for personalising care by using a patient's genetic profile to determine management and treatment. Dr Lynch's contributions were momentous and continue to have relevance to medical practice, in particular in the fields of clinical genetics, medical oncology and gastroenterology.

Pathology of liver disease: advances in the last 50 years.

Liver disease has been recognized in various forms for centuries. Incredible advances, however, have been made especially in the last 50 years, driven by improvements in histology, the development of immunostains, the development of high resolution imaging methods, improved biopsy and resection methods, and the emergence of the molecular era. With these tools, pathologists and their clinical and basic science colleagues moved from classifying liver disease using an observational, pattern-based approach to a refined classification of disease, one based on etiology for medical disease and tumor classification for neoplastic disease. Examples of liver specific diseases are used to illustrate these exciting advances. These impressive advances of the past provide the foundation for hope in the future, as liver pathology continues to play an important role in improving patient care through disease identification and classification and emerging roles in guiding therapy for cures.

Is Crohn's Disease a Rightly Used Eponym?

In 1932 Burrill B. Crohn, a gastroenterologist at Mount Sinai Hospital in New York City, described, together with two surgical colleagues, a series of 14 patients with an inflammatory condition of the terminal ileum. All patients were operated on by Dr Albert Berg, the Chief Surgeon of the hospital, whose name did not appear on the initial publication. The 'new' disease was called 'regional ileitis', but was rapidly referred to as 'Crohn's disease'. From earlier accounts and publications it has become clear that the condition had already existed for many centuries and was 'discovered' several times before 1932, most notably by Giovanni Morgagni in 1769, Antoni Lesniowski in 1903 and Thomas K. Dalziel in 1913. 'Crohn's disease' might reasonably be known by another eponym. Nevertheless, the 1932 publication of Crohn was pivotal, as were his later contributions to the knowledge of 'his' disease. Therefore the worldwide use of the eponym is rightly to be continued. Present researchers and clinicians with an interest in inflammatory bowel disease [IBD] might learn from the complicated story summarised in this contribution. Apart from an interesting historical overview, there are some lessons for today: the importance of thorough clinical observation and pattern recognition, the need for communication between colleagues and multidisciplinary approaches, and the need for broad access to valuable data, past or present, regardless of the journal or language of publication. It should ultimately bring us some humility, despite great achievements in treating this chronic disease, which defies all our efforts yet to find a cure.

ISDE Presidential Biography: David B. Skinner, MD.

Dr. David Skinner, the 4th President of the ISDE, was a world-renowned surgeon, educator, scholar, and leader. He participated in the formation of the ISDE, hosted two international congresses in 1983 and 1989, and made important advances in the ISDE during his presidential tenure 1992-1995.

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey.

In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic, the content will progress as follows: "lessons learned", "technical considerations" and "future opportunities". Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years. Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as "the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver, pancreas, and part of the duodenum develop". Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease (GERD), achalasia, esophageal diverticula, Barrett's esophagus (BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors. For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy (POEM) which was developed in Japan, has become an alternative to the traditional Heller's myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker's diverticula with improved technique (Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection (ESD) which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies (radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett's and related dysplasia and early cancer can be managed predominantly by endoscopy. Importantly, in regard to early gastric cancer and submucosal tumors (SMTs) of the stomach, ESD and full thickness resection (FTR) can excise these lesions en-bloc and endoscopic suturing is now used to close large defects and perforations. For treatment of patients with malignant gastric outlet obstruction (GOO), endoscopic gastro-jejunostomy is now showing better results than enteral stenting. G-POEM is also emerging as a treatment option for patients with gastroparesis. Obesity has become an epidemic in many western countries and is becoming also prevalent in Asia. Endoscopic sleeve gastroplasty (ESG) is now becoming an established treatment option, especially for obese patients with body mass index between 30 and 35. Data show an average weight loss of 16 kg after ESG with long-term data confirming sustainability. Finally, in respect to endo-hepatology, there are many new endoscopic interventions that have been developed for patients with liver disease. Endoscopic ultrasound (EUS)-guided liver biopsy and EUS-guided portal pressure measurement are exciting new frontiers for the endo-hepatologists.

Chronic pancreatitis. Some important historical aspects. / Pancreatitis crónica. Algunos aspectos históricos relevantes.

Since ancient times the increase of size and hardness sometimes presented by the abdominal structure known as the pancreas has attracted attention. Portal was the first to describe the clinical signs of chronic pancreatitis in 1803. In 1815, Fleischman speculated about the potential role of excessive alcohol consumption. Comfort coined the term "chronic relapsing pancreatitis" in 1946 and described hereditary pancreatitis 6 years later. Zuidema defined tropical pancreatitis in 1959 and 2 years later Sarles described another form of pancreatitis to which Yoshida gave the name autoimmune pancreatitis in 1995. Groove pancreatitis was described by Potet in 1970. Obstructive pancreatitis was defined in 1984 and Ammann identified idiopathic pancreatitis 3 years later. This article gives a historical account of the pioneers who developed the knowledge of how to assess the characteristics that allowed the different forms of chronic pancreatitis to be defined.

La historia y los nuevos retos de la Gastroenterología Pediátrica en Cuba / History and new challenges of Pediatric Gastroenterology in Cuba

El establecimiento de la Gastroenterología Pediátrica como especialidad médica en el ámbito internacional, el proceso de creación en Cuba y contribución en enfermedades digestivas en el infancia y adolescencia, aportes y resultados como subespecialidad pediátrica en el país, son relatados. El objetivo de este trabajo es divulgar la historia de la Gastroenterología Pediátrica en Cuba, trascendencia como subespecialidad desde sus inicios en la década de los años 70 del siglo XX en el Instituto Nacional de Gastroenterología, y generalización en hospitales pediátricos del país. Se exponen los antecedentes internacionales acerca la creación de la Gastroenterología Pediátrica, red de atención de médica en hospitales pediátricos, introducción de la endoscopia digestiva en la infancia, y su papel en ensayos clínicos e investigaciones, reflejando logros científicos. Se reseña la formación de especialistas desde etapa inicial en 1972, así como su consolidación como disciplina emergente en el contexto de la Pediatría de la medicina cubana y su difusión en los países caribeños y latinoamericanos. La participación en la Sociedad Latinoamericana de Gastroenterología Pediátrica, momentos prominentes, publicaciones de libros y en revistas, premios y reconocimientos internacionales, son referidos como exponentes de la labor realizada y dificultades afrontadas. Son descritos el significado de la creación y desarrollo de la Gastroenterología Pediátrica en Cuba como subespecialidad de la Pediatría, los antecedentes internacionales, los resultados y aportes para la Salud Pública nacional, los nuevos retos y el reconocimiento en países caribeños y latinoamericanos; como también, las limitaciones por la política de hostilidad del gobierno de Estados Unidos de América debido al bloqueo económico, comercial y financiero a Cuba desde 1960(AU)

The establishment of Pediatric Gastroenterology as a medical specialty in the international arena, the creation´s process in Cuba and its contribution in the area of digestive diseases during childhood and adolescence; and its contributions and results as a pediatric subspecialty in the country are reported. The objective of this work is to disseminate the history of Pediatric Gastroenterology in Cuba, it significance as a subspecialty from its beginnings in the decade of the 70s of the XXth century in the National Institute of Gastroenterology, and the generalization of it in pediatric hospitals of the country. The international backgrounds are exposed: the creation of Pediatric Gastroenterology, the network of medical attention in pediatric hospitals, the introduction of digestive endoscopy in children, and its role in clinical trials and researches showing scientific achievements. The training of specialists from the initial stage in 1972 is reviewed, as well as its consolidation as an emerging discipline in the context of Cuban medicine´s Pediatrics and its dissemination in the Caribbean and Latin American countries. The participation in the Latin American Society of Pediatric Gastroenterology, prominent moments, publications of books and in journals, awards and international acknowledgments are referred to as exponents of the work done and the difficulties faced. The significance of the creation and development of Pediatric Gastroenterology in Cuba as subspecialty of Pediatrics, the international antecedents, the results and contributions for the National Public Health, the new challenges; and the recognition in Caribbean and Latin American countries are described; as well as the limitations due to the hostile policy of the United States government due to the economic, commercial and financial blockade against Cuba since 1960(AU)