Prevalence of anal intraepithelial neoplasia in women with genital neoplasia.

BACKGROUND: Anal intraepithelial neoplasia is believed to be a precursor of anal cancer, and it appears to be related to high-risk human papillomavirus. Women with genital neoplasia have been shown to be at increased risk for anal cancer. OBJECTIVE: The aim of this study is to determine the prevalence of anal intraepithelial neoplasia in women with genital neoplasia. DESIGN: This is a cross-sectional study. SETTING: This study took place at Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, from May 2008 to April 2010. PATIENTS: Included in the study were 106 immunocompetent women with a histopathological diagnosis of genital neoplasia and 74 women without gynecologic neoplasia. MAIN OUTCOME MEASURE: All women underwent high-resolution anoscopy with biopsies of acetowhite areas or abnormal vascular features such as punctation and mosaics for histopathological diagnosis of anal intraepithelial neoplasia. RESULTS: : The overall prevalence of anal intraepithelial neoplasia was 6.6%. In women with genital neoplasia, the prevalence was 10.4% (95% CI, 5.6%-17.3%), whereas the prevalence was 1.4% (95% CI, 0.07%-6.5%) in women without genital neoplasia (P = .016). The prevalence ratio was 7.68 (95% CI, 1.01-58.21). LIMITATION: Women with normal results on high-resolution anoscopy were not submitted to random biopsies for ethical reasons. Small lesions could be missed, and thus our findings might be underestimated. CONCLUSION: The prevalence of anal intraepithelial neoplasia is higher in women with genital neoplasia.

Urinary Concentrations of Polycyclic Aromatic Hydrocarbon Metabolites in Maté Drinkers in Rio Grande do Sul, Brazil.

Background: Consumption of maté, an infusion of the herb Ilex paraguariensis (yerba maté), is associated with increased risk of esophageal squamous cell carcinoma (ESCC), but the carcinogenic mechanism is unclear. Commercial brands of yerba maté contain high levels of carcinogenic polycyclic aromatic hydrocarbons (PAHs), which are acquired during the traditional drying process. The purpose of this study was to characterize exposure to PAHs in maté drinkers over a wide range of maté consumption.Methods: We recruited 244 adults who answered a questionnaire and collected a fasting spot urine specimen. We quantified urinary concentrations of seven PAH metabolites and assessed associations between self-reported recent maté consumption and urinary PAH metabolites by multivariate regression.Results: Recent maté consumption showed a significant dose-response association with 6 of 7 PAH metabolites in unadjusted models (Ptrend < 0.05). After adjustment for creatinine and potential confounders, concentrations of 2-naphthol, 1-hydroxyphenanthrene, and the sum of 2- and 3-hydroxyphenanthrene remained significantly associated with recent maté intake. The sum of the urinary concentrations of the phenanthrene metabolites was similar or higher among maté drinkers who did not smoke than among smokers who did not drink matéConclusions: Urinary concentrations of PAH metabolites were significantly associated with self-reported amounts of recent maté intake, and drinking maté increased urinary concentrations of some PAH metabolites as much as smoking cigarettes.Impact: Drinking maté is a source of exposure to potentially carcinogenic PAHs, consistent with the hypothesis that the PAH content of maté may contribute to the increased risk of ESCC in maté drinkers. Cancer Epidemiol Biomarkers Prev; 27(3); 331-7. ©2017 AACR.

[Prevalence of Helicobacter pylori infection and gastric cancer precursor lesions in patients with dyspepsia]. / Prevalência da infecção por Helicobacter pylori e das lesões precusoras do câncer gástrico em pacientes dispéticos.

BACKGROUND: Helicobacter pylori infection has been considered to play significant role in gastric carcinogenesis, but only a minority of people who harbor this organism will develop gastric cancer. H. pylori infection first causes chronic non atrophic gastritis. Chronic non atrophic gastritis may evolve to atrophic gastritis and intestinal metaplasia and finally to dysplasia and adenocarcinoma. AIMS: To estimate the prevalence of H. pylori infection and the precancerous gastric lesions and their relationship, in patients with dyspeptic symptoms who underwent upper gastrointestinal endoscopy at a reference center in the central region of Rio Grande do Sul state, Brazil. METHODS: We analyzed gastric biopsies taken from corpus and antrum of patients who underwent upper gastrointestinal endoscopy for H. pylori detection, between 1994 and 2003. According to Sydney system, chronic non atrophic gastritis, atrophic gastritis and intestinal metaplasia were diagnosed by histological examination (H-E stain). The histological diagnoses were related to H. pylori infection status. RESULTS: Biopsies from 2,019 patients were included in the study. Patients mean age was 52 (+/-15) and 59% were female. Seventy six percent had H. pylori infection. Normal mucosa, chronic non atrophic gastritis, atrophic gastritis and intestinal metaplasia were diagnosed in 5%, 77%, 3% and 15%, respectively. The OR for any degree of gastric mucosa lesion in infected patients was 10 (CI95% 6.50 - 17%). The OR for infected patients had chronic non atrophic gastritis was 3 (CI95% 2,2 - 3,4). The OR for infected patients had atrophic gastritis or intestinal metaplasia was less than 1. CONCLUSIONS: The prevalence of H. pylori infection in this population was high (76%) and infected individuals had the probability 10 folds greater than non infected individuals to have any lesion of gastric mucosa. The prevalence of precancerous lesions was 77% for non atrophic chronic gastritis, 3% for atrophic gastritis and 15% for intestinal metaplasia. Infected patients had risk 3 folds greater than non-infected for the occurrence of non atrophic chronic gastritis. H. pylori infection did not show risk for occurrence of atrophic gastritis and intestinal metaplasia, suggesting that other risk factors should be involved in the carcinogenesis process.

LOW PREVALENCE OF BARRETT'S ESOPHAGUS IN A RISK AREA FOR ESOPHAGEAL CANCER IN SOUTH OF BRAZIL.

BACKGROUND: Barrett's esophagus a complication of gastroesophageal reflux disease (GERD) is a precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has been increasing in most Western countries. Rio Grande do Sul (RS), the Southernmost state of Brazil has the highest rates of esophageal cancer with low prevalence of esophageal adenocarcinoma. OBJECTIVE: To investigate the prevalence of Barrett's esophagus among patients underwent to upper gastrointestinal endoscopy in the last 5 years. METHODS: The records of patients underwent upper gastrointestinal endoscopy between 2011 and 2015 were analyzed. Demographic data, GERD symptoms, endoscopic findings, extension and histological diagnosis of columnar epithelia of the esophagus were recorded. Significance among the variables was accessed by chi-square test and Fisher's exact test with 95% CI. RESULTS: A total of 5996 patients underwent to upper gastrointestinal endoscopy in the period were included. A total of 1769 (30%) patients with GERD symptoms or esophagitis and 107 (1.8%) with columnar lined esophagus were identified. Except for eight patients, the others with columnar lined esophagus had GERD symptoms or esophagitis. Barrett's esophagus defined by the presence of intestinal metaplasia occurred in 47 patients; 20 (43%) with segments over 3 cm and 27 (57%) with segments shorter than 3 cm. The global prevalence of Barrett's esophagus was 0.7% and in GERD patients 2.7%. The odds ratio for the occurrence of columnar lined esophagus in patients with GERD was 30 (95%CI=15.37-63.34). The odds ratio for the presence of intestinal metaplasia in long segments was 8 (95%CI=2.83-23.21). CONCLUSION: GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett's esophagus than short segments. Barrett's esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett's esophagus represented globally 0.3% and 1.1% in GERD patients.

IS THE IMMUNOCROMATOGRAPHIC FECAL ANTIGEN TEST EFFECTIVE FOR PRIMARY DIAGNOSIS OF HELICOBACTER PYLORI INFECTION IN DYSPEPTIC PATIENTS?

BACKGROUND: The diagnosis of H. pylori infection can be performed by non-invasive and invasive methods.The identification through a fecal antigen test is a non-invasive, simple, and relatively inexpensive test. OBJECTIVE: To determine the diagnostic performance of fecal antigen test in the identification of H. pylori infection. METHODS: H. pylori antigens were identified in the stools of dyspeptic patients undergoing upper gastrointestinal endoscopy. For the identification of H. pylori antigen, we use ImmunoCard STAT! HpSA with immunochromatography technique. Histopathology plus urease test were the gold standard. RESULTS: We studied 163 patients, 51% male, mean age of 56.7± 8.5years. H. pylori infection was present in 49%. Fecal test presented: sensitivity 67.5% (CI95% 60.6-72.9); specificity 85.5% (CI95% 78.9-90.7); positive predictive value 81.8% (CI95% 73.4-88.4) and negative predictive value 73,2% (CI95% 67.5-77.6); Positive likelihood ratio was 4.7 (CI95% 2.9-7.9) and Negative Likelihood Ratio 0.4 (CI95% 0.3-0.5). The prevalence odds ratio for a positive test was 12.3 (CI95% 5.7-26.3).The index kappa between FAT and histology/urease test was 0.53 (CI95% 0.39-0.64). CONCLUSION: Immunochromatographic FAT is less expensive than the other methods and readily accepted by the patients but its diagnostic performance does not recommend its use in the primary diagnosis, when the patient may have an active infection.

Peptic ulcer frequency differences related to h. Pylori or aines.

BACKGROUND: Peptic ulcer etiology has been changing because of H. pylori decline. OBJECTIVES: To estimate peptic ulcer prevalence in 10 years-interval and compare the association with H. pylori and use of non-steroidal anti-inflammatory drugs. Methods Records assessment in two periods: A (1997-2000) and B (2007-2010), searching for peptic ulcer, H. pylori infection and non-steroidal anti-inflammatory drugs use. RESULTS: Peptic ulcer occurred in 30.35% in A and in 20.19% in B. H. pylori infection occurred in 73.3% cases in A and in 46.4% in B. Non-steroidal anti-inflammatory drugs use was 3.5% in A and 13.3% in B. Neither condition occurred in 10.4% and 20.5% in A and B respectively. Comparing both periods, we observed reduction of peptic ulcer associated to H. pylori (P=0.000), increase of peptic ulcer related to non-steroidal anti-inflammatory drugs (P=0.000) and idiopathic peptic ulcer (P=0.002). The concurrent association of H. pylori and non-steroidal anti-inflammatory drugs was also higher in B (P=0.002). Rates of gastric ulcer were higher and duodenal ulcer lower in the second period. CONCLUSIONS: After 10 years, the prevalence of peptic ulcer decreased, as well as ulcers related to H. pylori whereas ulcers associated to non-steroidal anti-inflammatory drugs increased. There was an inversion in the pattern of gastric and duodenal ulcer and a rise of idiopathic peptic ulcer.

Immunohistochemical expression of HER2 in adenocarcinoma of the stomach.

BACKGROUND: Worldwide, gastric cancer is the fourth cancer in incidence and the second most common cause of cancer death. Gastric cancer is asymptomatic in the early stages and very often diagnosed at advanced stages, determining a dismal prognosis. Expression of the HER2 gene has been identified in about 20% of gastric cancer cases, and its hyper-expression is associated with poor prognosis. OBJECTIVE: To investigate HER2 immunohistochemical expression in gastric adenocarcinoma and its relationship to the histological type and anatomic location. METHODS: A cross-sectional retrospective study analyzed the immunohistochemical expression of HER2 in a sample of 48 specimens of gastric cancer. Immunohistochemical analysis were performed using avidin-biotin-peroxidase method with C-erb B2 (clone EP1045Y), as a primary antibody (Biocare Medical, USA). Standardized gastric adenocarcinoma's HER2 expression criteria has been used in the analysis of samples. RESULTS: There were seven cases with reactivity for HER2. Five were of intestinal-type while two cases were of mixed-type in which the expression occurred in the intestinal component. It was identified a significant association of HER2 expression in the intestinal subtype of gastric adenocarcinoma (P=0.003). Regarding the anatomical site, HER2 was positive in only one (16.6%) of the six proximal cases and six (14.28%) of the 42 distal cases (P=0.88). CONCLUSION: HER2 immunoexpression was identified in 14.6% of the samples, and the expression was significantly associated to Lauren's intestinal subtype.

No evidence of HPV DNA in esophageal squamous cell carcinoma in a population of Southern Brazil.

AIM: To investigate the association between human papillomavirus (HPV) and esophageal squamous cell carcinoma (ESCC) in southern Brazil. METHODS: We studied 189 esophageal samples from 125 patients from three different groups: (1) 102 biopsies from 51 patients with ESCC, with one sample from the tumor and another from normal esophageal mucosa distant from the tumor; (2) 50 esophageal biopsies from 37 patients with a previous diagnosis of head and neck squamous cell carcinoma (HNSCC); and (3) 37 biopsies from esophageal mucosa with normal appearance from 37 dyspeptic patients, not exposed to smoking or alcohol consumption. Nested-polymerase chain reaction (PCR) with the MY09/11 and GP5/6 L1 primers was used to detect HPV L1 in samples fixed in formalin and stored in paraffin blocks. All PCR reactions were performed with a positive control (cervicovaginal samples), with a negative control (Human Genomic DNA) and with a blank reaction containing all reagents except DNA. We took extreme care to prevent DNA contamination in sample collection, processing, and testing. RESULTS: The histological biopsies confirmed the diagnosis of ESCC in 52 samples (51 from ESCC group and 1 from the HNSCC group) and classified as well differentiated (12/52, 23.1%), moderately differentiated (27/52, 51.9%) or poorly differentiated (7/52, 13.5%). One hundred twenty-eight esophageal biopsies were considered normal (51 from the ESCC group, 42 from the HNSCC group and 35 from dyspeptic patients). Nine had esophagitis (7 from the HNSCC and 2 from dyspeptic patients). Of a total of 189 samples, only 6 samples had insufficient material for PCR analysis: 1 from mucosa distant from the tumor in a patient with ESCC, 3 from patients with HNSCC and 2 from patients without cancer. In 183 samples (96.8%) GAPDH, G3PDH and/or ß-globin were amplified, thus indicating the adequacy of the DNA in those samples. HPV DNA was negative in all the 183 samples tested: 52 with ESCC, 9 with esophagitis and 122 with normal esophageal mucosa. CONCLUSION: There was no evidence of HPV infection in different ESCC from southern Brazil.

Esophageal squamous cell carcinoma - precursor lesions and early diagnosis.

Squamous cell carcinoma of the esophagus (SCCE) carries a poor prognosis due to late diagnosis. Early detection is highly desirable, since surgical and endoscopic resection offers the only possible cure for esophageal cancer. Population screening should be undertaken in high risk areas, and in low or moderate risk areas for people with risk factors (alcoholics, smokers, mate drinkers, history of head and neck cancer, achalasia and lye stricture of the esophagus). Esophageal balloon cytology is an easy and inexpensive sampling technique, but the current methods are insufficient for primary screening due to sampling errors. Conventional endoscopy with biopsy remains the standard procedure for the identification of pre-malignant and early malignant changes in esophageal mucosa and endoscopic detection. It may be enhanced by several techniques such as dye and optic chromoendoscopy, magnifying endoscopy, and optical-based spectroscopic and imaging modalities. Since more than 80% of SCCE deaths occur in developing countries, where expensive techniques such as narrow band imaging (NBI) and autofluorescence imaging are unavailable, the most cost-effective tool for targeting biopsies may be Lugol dye chromoendoscopy, since it is easy, accurate, inexpensive and available worldwide. In ideal conditions, or in developed countries, is it reasonable to think that optimal detection will require a combination of techniques, such as the combination of Lugol's chromoendoscopy and NBI to identify esophageal areas that require further characterization by a high resolution technique. The efficacy and cost-effectiveness will determine whether these modalities will become part of standard endoscopy practice.

Baixa prevalência de esôfago de Barrett em área de risco para câncer esofágico no Sul do Brasil / Low prevalence of barrett's esophagus in a risk area for esophageal cancer in south of brazil

ABSTRACT BACKGROUND: Barrett's esophagus a complication of gastroesophageal reflux disease (GERD) is a precursor of esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has been increasing in most Western countries. Rio Grande do Sul (RS), the Southernmost state of Brazil has the highest rates of esophageal cancer with low prevalence of esophageal adenocarcinoma. OBJECTIVE: To investigate the prevalence of Barrett's esophagus among patients underwent to upper gastrointestinal endoscopy in the last 5 years. METHODS: The records of patients underwent upper gastrointestinal endoscopy between 2011 and 2015 were analyzed. Demographic data, GERD symptoms, endoscopic findings, extension and histological diagnosis of columnar epithelia of the esophagus were recorded. Significance among the variables was accessed by chi-square test and Fisher's exact test with 95% CI. RESULTS: A total of 5996 patients underwent to upper gastrointestinal endoscopy in the period were included. A total of 1769 (30%) patients with GERD symptoms or esophagitis and 107 (1.8%) with columnar lined esophagus were identified. Except for eight patients, the others with columnar lined esophagus had GERD symptoms or esophagitis. Barrett's esophagus defined by the presence of intestinal metaplasia occurred in 47 patients; 20 (43%) with segments over 3 cm and 27 (57%) with segments shorter than 3 cm. The global prevalence of Barrett's esophagus was 0.7% and in GERD patients 2.7%. The odds ratio for the occurrence of columnar lined esophagus in patients with GERD was 30 (95%CI=15.37-63.34). The odds ratio for the presence of intestinal metaplasia in long segments was 8 (95%CI=2.83-23.21). CONCLUSION: GERD patients had a risk 30-folds greater to present columnar lined esophagus than patients without GERD symptoms. Long segments of columnar lined esophagus, had a risk eight-folds higher to have Barrett's esophagus than short segments. Barrett's esophagus overall prevalence was 0.7%. In GERD patients, the prevalence was 2.7%. Long Barrett's esophagus represented globally 0.3% and 1.1% in GERD patients.

RESUMO CONTEXTO: Esôfago de Barrett, complicação da doença do refluxo gastroesofágico (DRGE), é lesão precursora do adenocarcinoma esofágico. O adenocarcinoma esofágico apresenta incidência crescente principalmente no ocidente. O estado do Rio Grande do Sul apresenta as taxas mais altas de câncer esofágico no Brasil, porém com baixa prevalência de adenocarcinoma. OBJETIVO: Investigar a prevalência de esôfago de Barrett em pacientes submetidos a endoscopia digestiva alta nos últimos 5 anos. MÉTODOS: Revisão de prontuários dos pacientes submetidos a endoscopia digestiva alta entre 2011 e 2015. Registrados dados demográficos, sintomas de DRGE, achados endoscópicos, extensão e diagnóstico histológico de epitelização colunar do esôfago. A significância entre as variáveis foi acessada pelos testes do qui-quadrado e exato de Fisher com IC95%. RESULTADOS: Foram incluídos 5996 pacientes. Identificamos 1769 (30%) com sintomas de DRGE ou esofagite e 107 (1,8%) com epitelização colunar. À exceção de oito pacientes com epitelização colunar, os demais apresentavam sintomas de DRGE ou esofagite. Esôfago de Barrett definido pela presença de metaplasia intestinal ocorreu em 47 pacientes; 20 (43%) com segmentos acima de 3 cm e em 27 (57%) com segmentos menores. A prevalência global de esôfago de Barrett foi 0,7% e em pacientes com DRGE foi 2,7%. A razão de chances para a ocorrência de epitelização colunar em pacientes com DRGE foi 30 (IC95%=15,37-63,34) e para a ocorrência de metaplasia intestinal em segmentos longos foi 8 (IC95%=2,83-23,21). CONCLUSÃO: Pacientes com DRGE apresentaram risco 30 vezes maior que pacientes sem DRGE para a ocorrência de epitelização colunar. O risco de ocorrência de esôfago de Barrett em segmentos longos foi oito vezes maior. A prevalência global de esôfago de Barrett foi 0,7%. Em pacientes com DRGE a prevalência foi 2,7%. Segmentos longos de esôfago de Barrett representaram globalmente 0,3% e em pacientes com DRGE 1,1%.

Reduced quality of life in patients with non-erosive gastroesophageal reflux disease

Introduction: Gastroesophageal reflux disease (GERD) is a highly prevalent condition in the Western world. It is a frequent cause of medical appointments and has a high impact on quality of life (QOL). This study aimed to assess health-related quality of life (HQ-QOL) of patients with non-erosive gastroesophageal disease (NERD) and compare their scores with the scores of patients with GERD symptoms and non-pathological acid reflux (non-NERD). Methods: We studied 42 patients with GERD symptoms­21 with positive pHmetry for acid reflux (NERD group) and 21 with negative pHmetry for acid reflux (non-NERD group). We enrolled patients matched by age and gender. Patient inclusion criteria were based on clinical and endoscopic findings and pHmetry. All other major diseases having an impact on QOL were excluded as well as patients in regular use of proton pump inhibitors, prokinetics, histamine-2 receptor antagonists and anti-depressants. All subjects were asked to fill in a validated translation of the SF-36 questionnaire. We described scores trough median and interquartile range (IQR) and assessed the significance of the comparisons through Mann-Whitney test and chi-square test or Student's t-test when appropriate. Results: We found no significant differences in the eight domains of SF-36 between the two groups. Conclusion: QOL of patients with GERD symptoms was equivalent, regardless of acid reflux at pHmetry (AU)

Percutaneous endoscopic gastrostomy and peristomal infection: an avoidable complication with the use of a minimum skin incision.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a fast and simple method. Although considered safe, PEG is associated with many potential complications. Peristomal infection is the complication most frequently reported. OBJECTIVE: To analyze patients who underwent PEG and the association of peristomal infection with the extent of skin incision (SI) and usage of prophylactic antibiotics (PA). METHODS: A retrospective review of the records of 120 patients who underwent PEG was carried out. Patients were divided into 3 subgroups: (1) Patients with SI 10 mm/without PA, (2) Patients with SI up to 5 mm/without PA, and (3) Patients with SI up to 5 mm/with PA. RESULTS: Peristomal infection occurred in 12.8% of patients from subgroup 1, and in 2.2% of patients from subgroup 2. There was no infection in subgroup 3. Peristomal infection was associated with the SI extent (P=0.01) and there was no association with PA (P=0.3). SI >5 mm presented an odds ratio of 10.5 (95% confidence interval, 1.58-68.42) for the occurrence of peristomal infection. CONCLUSIONS: The use of PA did not seem to reduce peristomal infection rates. However, minimal SI was significantly associated with reduction of this complication.

Is the immunocromatographic fecal antigen test effective for primary diagnosis of helicobacter pylori infection in dyspeptic patients? / Teste imunocromatográfico do antígeno fecal: efetivo no diagnóstico primário da infecção por Helicobacter pylori em pacientes dispépticos?

ABSTRACT Background The diagnosis of H. pylori infection can be performed by non-invasive and invasive methods.The identification through a fecal antigen test is a non-invasive, simple, and relatively inexpensive test. Objective To determine the diagnostic performance of fecal antigen test in the identification of H. pylori infection. Methods H. pylori antigens were identified in the stools of dyspeptic patients undergoing upper gastrointestinal endoscopy. For the identification of H. pylori antigen, we use ImmunoCard STAT! HpSA with immunochromatography technique. Histopathology plus urease test were the gold standard. Results We studied 163 patients, 51% male, mean age of 56.7± 8.5years. H. pylori infection was present in 49%. Fecal test presented: sensitivity 67.5% (CI95% 60.6-72.9); specificity 85.5% (CI95% 78.9-90.7); positive predictive value 81.8% (CI95% 73.4-88.4) and negative predictive value 73,2% (CI95% 67.5-77.6); Positive likelihood ratio was 4.7 (CI95% 2.9-7.9) and Negative Likelihood Ratio 0.4 (CI95% 0.3-0.5). The prevalence odds ratio for a positive test was 12.3 (CI95% 5.7-26.3).The index kappa between FAT and histology/urease test was 0.53 (CI95% 0.39-0.64). Conclusion Immunochromatographic FAT is less expensive than the other methods and readily accepted by the patients but its diagnostic performance does not recommend its use in the primary diagnosis, when the patient may have an active infection.

RESUMO Contexto O diagnóstico da infecção por Helicobacter pylori (H. pylori) pode ser realizado por métodos invasivos e não invasivos. A identificação através do teste do antígeno fecal é um método não invasivo, simples, fácil e relativamente barato. Objetivo Determinar o desempenho diagnóstico do teste fecal imunocromatográfico na identificação da infecção pelo H. pylori. Métodos A pesquisa de antígenos fecais do H. pylori foi realizada através do ImmunoCard STAT! HpSA em pacientes dispépticos submetidos à endoscopia digestiva alta com coleta de biópsias para histopatologia e teste da urease, utilizados como padrão ouro. Resultados Foram estudados 163 pacientes, 51% do sexo masculino, com idade média de 56,7± 8,5 anos. A infecção por H. pylori esteve presente em 49%. O teste fecal apresentou o seguinte desempenho diagnóstico: sensibilidade 67,5% (IC95% 60,6-72,9), especificidade 85,5% (IC95% 78,9-90,7), valor preditivo positivo 81,8% (IC95% 73,4-88,4) e valor preditivo negativo 73,2% (IC95% 67,5-77,6). A razão de probabilidade positiva foi 4,7 (IC95% 2,9-7,9) e a razão de probabilidade negativa foi 0,4 (IC95% 0,3-0,5). A razão de chances de prevalência para teste fecal positivo foi 12,3 (IC95% 5,7-26,3). O índice kappa para a concordância do teste fecal com histologia/teste da urease foi 0,53 (IC95% 0,39-0,64) Conclusão O teste fecal imunocromatográfico apresenta baixo custo e é facilmente aceito pelos pacientes, no entanto seu desempenho diagnóstico não o recomenda para diagnóstico primário.

Peptic ulcer frqquency differences related to h. pylori or aines / Diferentes frequências da úlcera péptica relacionadas com H. pylori ou AINES

Background Peptic ulcer etiology has been changing because of H. pylori decline. Objectives To estimate peptic ulcer prevalence in 10 years-interval and compare the association with H. pylori and use of non-steroidal anti-inflammatory drugs. Methods Records assessment in two periods: A (1997-2000) and B (2007-2010), searching for peptic ulcer, H. pylori infection and non-steroidal anti-inflammatory drugs use. Results Peptic ulcer occurred in 30.35% in A and in 20.19% in B. H. pylori infection occurred in 73.3% cases in A and in 46.4% in B. Non-steroidal anti-inflammatory drugs use was 3.5% in A and 13.3% in B. Neither condition occurred in 10.4% and 20.5% in A and B respectively. Comparing both periods, we observed reduction of peptic ulcer associated to H. pylori (P=0.000), increase of peptic ulcer related to non-steroidal anti-inflammatory drugs (P=0.000) and idiopathic peptic ulcer (P=0.002). The concurrent association of H. pylori and non-steroidal anti-inflammatory drugs was also higher in B (P=0.002). Rates of gastric ulcer were higher and duodenal ulcer lower in the second period. Conclusions After 10 years, the prevalence of peptic ulcer decreased, as well as ulcers related to H. pylori whereas ulcers associated to non-steroidal anti-inflammatory drugs increased. There was an inversion in the pattern of gastric and duodenal ulcer and a rise of idiopathic peptic ulcer. .

Contexto A etiologia da úcera péptica vem apresentando mudanças devido à redução da infecção pelo H. pylori. Objetivos Estimar a prevalência da úlcera péptica em dois períodos com intervalo de 10 anos e comparar a associação com a infecção pelo H. pylori com o uso de anti-inflamatórios não esteroides. Métodos Revisão de prontuários em dois períodos: A (1997-2000) e B (2007-2010), com busca por úlcera péptica, H. pylori e uso de anti-inflamatórios não esteroides (AINE). Resultados Úcera péptica apresentou frequência de 30,35% em A e 20,19% em B. Infecção por H. pylori ocorreu em 73,3% em A e em 46,4% em B. Uso de anti-inflamatórios não esteroides ocorreu em 3,5% em A e em 13,3% em B. Nenhuma dessas condições esteve associada em 10,4% e 20,5% das úlceras em A e B, respectivamente. Comparando os dois períodos, houve redução da úlcera péptica associada à H. pylori (P=0,000), aumento das úlceras associadas ao uso de anti-inflamatórios não esteroides (P=0,000) e aumento de úlceras idiopáticas (P=0,002). A associação concomitante de H. pylori e anti-inflamatórios não esteroides foi também mais alta em B (P=0,002). Úlceras gástricas aumentaram e úlceras duodenais diminuíram em B. Conclusões No intervalo de 10 anos, a prevalência de úlcera péptica diminuiu assim como as úlceras relacionadas com H. pylori e houve um aumento das úlceras associadas ao uso de anti-inflamatórios não esteroides. Houve inversão na frequência das lesões gástricas e duodenais e aumento da prevalência da úlcera idiopática. .

Immunohistochemccal expression of her2 in adenocarcinoma of the stomcch / Expressão imunoistoquímica do HER2 no adenocarcinoma de estômago

Background Worldwide, gastric cancer is the fourth cancer in incidence and the second most common cause of cancer death. Gastric cancer is asymptomatic in the early stages and very often diagnosed at advanced stages, determining a dismal prognosis. Expression of the HER2 gene has been identified in about 20% of gastric cancer cases, and its hyper-expression is associated with poor prognosis. Objective To investigate HER2 immunohistochemical expression in gastric adenocarcinoma and its relationship to the histological type and anatomic location. Methods A cross-sectional retrospective study analyzed the immunohistochemical expression of HER2 in a sample of 48 specimens of gastric cancer. Immunohistochemical analysis were performed using avidin-biotin-peroxidase method with C-erb B2 (clone EP1045Y), as a primary antibody (Biocare Medical, USA). Standardized gastric adenocarcinoma‘s HER2 expression criteria has been used in the analysis of samples. Results There were seven cases with reactivity for HER2. Five were of intestinal-type while two cases were of mixed-type in which the expression occurred in the intestinal component. It was identified a significant association of HER2 expression in the intestinal subtype of gastric adenocarcinoma (P=0.003). Regarding the anatomical site, HER2 was positive in only one (16.6%) of the six proximal cases and six (14.28%) of the 42 distal cases (P=0.88). Conclusion HER2 immunoexpression was identified in 14.6% of the samples, and the expression was significantly associated to Lauren’s intestinal subtype. .

Contexto O câncer gástrico ocupa o quarto lugar em incidência no mundo e é a segunda causa de óbito por neoplasia maligna. Por ser assintomático nas fases iniciais, na maioria das vezes, é diagnosticado em fases avançadas. A expressão do gene HER2 tem sido identificada em cerca de 20% dos casos de câncer gástrico e, sua hiper-expressão está associada a um pior prognóstico nestes pacientes. Objetivo Investigar a expressão imunoistoquímica do HER2 em espécimes de adenocarcinoma gástrico e sua relação com a classificação histológica e localização anatômica. Métodos Estudo transversal, retrospectivo, no qual foi analisada a expressão imunoistoquímica para o HER2, em uma amostra de 48 espécimes de câncer gástrico, através da técnica de imunoistoquímica, pelo método avidina-biotina-peroxidase utilizando anticorpo primário C-erb B2, clone EP1045Y (Biocare Medical, USA). Resultados Foram encontrados sete casos reativos para o HER2; destes, cinco eram casos de adenocarcinoma do tipo intestinal e dois eram casos do tipo misto, porém, nestes, a expressão ocorreu no componente intestinal, o que determinou uma associação significante da expressão de HER2 com o componente intestinal do adenocarcinoma gástrico (P=0,003). Em relação ao local anatômico, HER2 foi reativo em apenas um (16,6%) de seis casos proximais e seis (14,28%) dos 42 casos distais (P=0,88). Conclusão A expressão de HER2 ocorreu em 14,6% da amostra, associada significativamente ao subtipo intestinal de Lauren. .

Immunoreactivity of cytokeratins 7 and 20 in goblet cells and columnar blue cells in patients with endoscopic evidence of Barrett's esophagus.

CONTEXT: Barrett's esophagus is characterized by the presence of goblet cells. However, when alcian-blue is utilized, another type of cells, called columnar blue cells, is frequently present in the distal esophagus of patients with endoscopic evidence of Barrett's esophagus. Cytokeratin 7 and 20 immunoreactivity has been previously studied in areas of intestinal metaplasia at the esophagogastric junction. However, the expression of these cytokeratins in columnar blue cells has not been characterized. OBJECTIVE: To compare the expression of cytokeratin 7 and 20 in goblet cells and columnar blue cells in patients with endoscopic evidence of Barrett's esophagus. METHODS: Biopsies from 86 patients with endoscopic evidence of Barrett's esophagus were evaluated. The biopsies were stained for cytokeratin 7 and 20. RESULTS: Goblet cells were present in 75 cases and columnar blue cells in 50 cases. Overall, cytokeratin 7 expression was similar in goblet cells and columnar blue cells (P = 0.25), while cytokeratin 20 was more common in goblet cells (P <0.001). In individuals with both cell types, however, cytokeratin 7 staining was the same in goblet and columnar blue cells in 95% of the cases, and cytokeratin 20 staining was the same in 77%. CONCLUSION: Goblet cells and columnar blue cells have similar immunohistochemical staining patterns for cytokeratins 7 and 20 in patients with endoscopic evidence of Barrett's esophagus.

Simple and complicated rectal diverticula: endoscopic analysis of a case series from Brazil

INTRODUCTION: Diverticular disease of the colon is a very common condition, present in most of the elderly population. However, the occurrence of rectal diverticula is extremely unusual. It is typically an incidental finding at colonoscopy. OBJECTIVE: Describe epidemiological, clinical, surgical and endoscopic characteristics of a case series of rectal diverticula in Brazil. METHODS: Four patients with rectal diverticula were analyzed in terms of symptomatology, associated conditions and colonoscopy findings. Endoscopic findings were discussed individually. RESULTS: The prevalence of rectal diverticula at our endoscopy unit was 0.15% of all colonoscopies, affecting 0.74% of patients with colonic diverticulosis. The endoscopic analysis showed the diverticulum ostium with mean size of 2.3 cm, depth of 2.8 cm and anal margin distance of 6.8 cm. Colonoscopy also demonstrated simple rectal diverticulum in all patients. Diverticula were located in the anterior, right lateral and posterior walls of the rectum. One patient developed diverticulitis as complication and underwent to diverticulectomy. CONCLUSIONS: Rectal diverticulum is an incidental finding at colonoscopy and associated with diverticulosis. Its rarity and specific colonoscopic characteristics make it a unique entity. Asymptomatic in most cases, it rarely needs intervention. Surgery is reserved for complicated cases. (AU)

INTRODUÇÃO: Diverticulose é uma condição muito comum, presente em grande parte da população idosa. Divertículo retal, entretanto, é condição rara. Geralmente é um achado incidental em colonoscopias. OBJETIVO: Descrever as características epidemiológicas, clínicas, cirúrgicas e, especialmente, endoscópicas de uma série de casos de divertículos retais no Brasil. MÉTODOS: Quatro pacientes com divertículos retais são analisados em relação a sintomatologia, condições associadas e colonoscopias. Os achados endoscópicos são discutidos especificamente. RESULTADOS: Em nosso Serviço de Endoscopia, a prevalência de divertículos retais foi de 0,15% de todas as colonoscopias realizadas e de 0,74% em pacientes portadores de diverticulose. Análise endoscópica revelou tamanho médio do óstio do divertículo de 2,3 cm, profundidade de 2,8 cm e distância da margem anal de 6,8 cm. Colonoscopia demonstrou presença de divertículo retal único em todos pacientes, os quais se localizaram nas paredes anterior, lateral-direita e posterior do reto. Um dos pacientes apresentou diverticulite como complicação, sendo submetido à cirurgia de diverticulectomia. CONCLUSÕES: Divertículo retal é um achado incidental em colonoscopias, estando associado à diverticulose. Sua raridade e seus aspectos endoscópicos específicos tornam importante o reconhecimento como uma entidade única. Assintomático na maioria dos casos, raramente necessita intervenção. Cirurgia está reservada para os casos em que ocorrem complicações. (AU)

Pyoderma gangrenosum as a initial manifestation of ulcerative proctocolitis

Pyoderma gangrenosum is a rare inflammatory skin condition characterized by progressive and recurrent skin ulceration of destructive course. It is usually associated with rheumatoid arthritis, paraproteinemia, myeloproliferative diseases and inflammatory bowel diseases, especially non-specific ulcerative proctocolitis. In these situations, skin lesions are described as concurrent with the intestinal condition. However, reports on pyoderma gangrenosum preceding intestinal findings are less frequent. The authors describe a case of a woman with febrile condition associated with skin lesions diagnosed by biopsy as pyoderma gangrenosum. Two weeks later, she developed diarrhea, arthralgia and sepsis, being diagnosed as ulcerative proctocolitis. After the administration of the treatment for ulcerative proctocolitis, she showed improvements in sepsis care, remission of diarrhea and regression of skin lesions. This case highlights the importance of considering pyoderma gangrenosum as a manifestation associated with inflammatory bowel disease, regardless of its timing in relation to intestinal symptoms. (AU)

Pioderma gangrenoso é uma forma de inflamação cutânea, caracterizada por ulceração progressiva e recorrente da pele, com curso destrutivo. Geralmente é associada à artrite reumatoide, paraproteinemia, doenças mieloproliferativas e doença inflamatória intestinal, em especial retocolite ulcerativa inespecífica. Em tais casos, as lesões cutâneas são descritas concomitantes ao quadro intestinal, porém, relatos com descrição de pioderma gangrenoso precedendo achados intestinais são menos frequentes. Os autores relatam caso de mulher com quadro febril associado a lesões cutâneas diagnosticadas por biópsia como pioderma gangrenoso. Duas semanas depois, apresentou diarreia, artralgia e sepse sendo diagnosticada retocolite ulcerativa. Com o tratamento para retocolite ulcerativa apresentou melhora do quadro séptico, remissão da diarreia e regressão das lesões cutâneas. Este caso enfatiza a importância em considerar o pioderma gangrenoso como manifestação associada à doença inflamatória intestinal, independente de sua temporalidade em relação aos sintomas intestinais. (AU)

O comitê de ética em pesquisa na Universidade Federal de Santa Maria: um breve histórico / The research ethics committee at Universidade Federal de Santa Maria: a brief historical review

A análise da validade ética das pesquisas se concretiza nos Comitês de Ética em Pesquisa (CEP) das instituições. Este trabalho apresenta o histórico de organização e implementação do Comitê de Ética em Pesquisa na Universidade Federal de Santa Maria (UFSM), a demanda de análise de projetos e divulga a sua importância na universidade. Os dados foram obtidos através de um levantamento histórico realizado pela análise de arquivos internos do CEP. Foi pesquisado o número de projetos submetidos à avaliação pelo CEP desde sua fundação até dezembro de 2009, assim como de seu local de origem.

The analysis of the ethical validity of research materializes in the Research Ethics Committee (CEP) of institutions. The objective of the present article was to briefly present the history of the organization and implementation of the Research Ethics Committee at Universidade Federal de Santa Maria (UFSM), as well as the trends in demand for project analysis, in addition to disclosing its importance to the institution. Data were collected by means of a historical research based on the analysis of internal files of the CEP. We investigated the number of projects submitted for review by the CEP from its implementation to December 2009.

Immunoreactivity of cytokeratins 7 and 20 in goblet cells and columnar blue cells in patients with endoscopic evidence of Barrett's esophagus / Imunoreatividade das citoqueratinas 7 e 20 nas células caliciformes e células colunares azuis em pacientes com evidência endoscópica de esôfago de Barrett

CONTEXT: Barrett's esophagus is characterized by the presence of goblet cells. However, when alcian-blue is utilized, another type of cells, called columnar blue cells, is frequently present in the distal esophagus of patients with endoscopic evidence of Barrett's esophagus. Cytokeratin 7 and 20 immunoreactivity has been previously studied in areas of intestinal metaplasia at the esophagogastric junction. However, the expression of these cytokeratins in columnar blue cells has not been characterized. OBJECTIVE: To compare the expression of cytokeratin 7 and 20 in goblet cells and columnar blue cells in patients with endoscopic evidence of Barrett's esophagus. METHODS: Biopsies from 86 patients with endoscopic evidence of Barrett's esophagus were evaluated. The biopsies were stained for cytokeratin 7 and 20. RESULTS: Goblet cells were present in 75 cases and columnar blue cells in 50 cases. Overall, cytokeratin 7 expression was similar in goblet cells and columnar blue cells (P = 0.25), while cytokeratin 20 was more common in goblet cells (P <0.001). In individuals with both cell types, however, cytokeratin 7 staining was the same in goblet and columnar blue cells in 95 percent of the cases, and cytokeratin 20 staining was the same in 77 percent. CONCLUSION: Goblet cells and columnar blue cells have similar immunohistochemical staining patterns for cytokeratins 7 and 20 in patients with endoscopic evidence of Barrett's esophagus.

CONTEXTO: Esôfago de Barrett é caracterizado pela presença de células caliciformes. Entretanto, quando "alcian blue" é utilizado, outro tipo de células, chamadas células colunares azuis, estão frequentemente presentes no esôfago distal de pacientes com evidência endoscópica de esôfago de Barrett. A imunoreatividade das citoqueratinas 7 e 20 tem sido estudada previamente em áreas de metaplasia intestinal na junção esôfago-gástrica. Entretanto, a expressão destas citoqueratinas nas células colunares azuis não foi caracterizada. OBJETIVO: Comparar a expressão das citoqueratinas 7 e 20 nas células caliciformes e células colunares azuis em pacientes com evidência endoscópica de esôfago de Barrett. MÉTODOS: Biopsias de 86 pacientes com evidência endoscópica de esôfago de Barrett foram avaliadas. Estas foram coradas com citoqueratinas 7 e 20. RESULTADOS: Células caliciformes estavam presentes em 75 casos e células colunares azuis em 50 casos. Ao todo, a expressão da citoqueratina 7 foi similar nas células caliciformes e células colunares azuis (P = 0,25), enquanto que a da citoqueratina 20 foi mais comum nas células caliciformes (P<0,001). Por outro lado, em indivíduos apresentando ambos os tipos de células, a coloração da citoqueratina 7 foi a mesma nas células caliciformes e células colunares azuis em 95 por cento dos casos, e a coloração da citoqueratina 20 foi a mesma em 77 por cento. CONCLUSÃO: As células caliciformes e as células colunares azuis têm padrões similares de coloração imunoistoquímica para citoqueratina 7 e 20 em pacientes com evidência endoscópica de esôfago de Barrett.