Inflammatory map of the gastroduodenal mucosa in patients with upper gastrointestinal symptoms. The role of H. pylori infection.

INTRODUCTION AND AIM: The gastric mucosa has been studied since the pre-Helicobacter pylori (H. pylori) era, but the complete descriptions of the stomach and duodenum have been anecdotal, and those of the distal duodenum, exceptional. Our aim was to evaluate the different epidemiologic characteristics and the gastroduodenal inflammatory status in patients with upper gastrointestinal symptoms. MATERIALS AND METHODS: We studied 138 patients divided into: the non-ulcer group (functional dyspepsia [n = 77] and GERD [n = 27]) and the ulcer group (peptic ulcer [n = 13] and duodenal ulcer [n = 21]). Ten biopsy samples (2 from the corpus, 3 from the antrum, 3 from the proximal duodenum, and 2 from the distal duodenum) were taken in each patient for histologic and/or microbiologic study. RESULTS: The prevalence of dyspepsia, functional dyspepsia, and H. pylori was 80.4%, 69.4%, and 82.6%, respectively. The frequency of superficial chronic gastritis in the corpus was significantly higher in the ulcer group vs. the non-ulcer group, whereas there was more chronic atrophic gastritis in the antrum in the ulcer group (P < 0.05). Duodenitis was significantly more frequent in the ulcer group vs. the non-ulcer group, in both the proximal and distal duodenum. Pangastroduodenitis was a significant finding in the ulcer group. In both groups, chronic gastritis (corpus and antrum) and duodenitis (proximal and distal) were significantly related to the presence of H. pylori. Proximal duodenitis is not an uncommon finding in functional dyspepsia (37.7%) and is twice as frequent as distal duodenitis (16.9%). CONCLUSIONS: The ulcer group presented with a gastroduodenal inflammatory map different from that of the non-ulcer group and was characterized by a higher frequency of superficial chronic gastritis in the corpus, chronic atrophic gastritis in the antrum, and a very high frequency of proximal duodenitis.

Irritable bowel syndrome in patients with dyspepsia: a community-based study in southern Europe.

OBJECTIVES: Dyspepsia and irritable bowel syndrome (IBS) share aetiopathogenic factors, and may therefore be part of a single disorder. This study was intended to determine their prevalence in the general population, and the degree of overlap between these two digestive disorders. DESIGN: Descriptive study. METHODS: A sample of 264 subjects chosen randomly from the population census of a city in Spain, and considered representative of the general population in this city, was surveyed by questionnaire. RESULTS: The prevalence of dyspepsia was 23.9%, and that of IBS was 13.6%. Of the subjects with dyspepsia, 31.6% had IBS, and of the subjects with IBS, 55.6% reported symptoms of dyspepsia. The prevalence of IBS was higher among subjects with dyspepsia (31.7%) than among those who reported no symptoms of dyspepsia (7.9%; P < 0.05). Moreover, the prevalence of IBS was similar in three subgroups identified according to the type of dyspepsia described (ulcer-like, reflux-like or dysmotility-like). When we compared subjects with both dyspepsia and IBS and those with dyspepsia alone, we found no significant differences in clinical characteristics except for abdominal pain and fear of cancer, which were more frequent in the former. Of the entire sample, 27.7% of the subjects sought medical attention for IBS and 17% missed work because of IBS. CONCLUSION: Our findings suggest that functional dyspepsia and IBS are two manifestations of a single, more extensive digestive system disorder.

[Epidemiology of primary biliary cirrhosis in the South area of Granada]. / Epidemiología de la cirrosis biliar primaria en el área sur de Granada.

BACKGROUND: The epidemiology of primary biliary cirrhosis (PBC) in Spain is still poorly known. In fact, remarkable differences between areas have been found. METHODS: The epidemiology of PBC was investigated in the South area of the city and the province of Granada from 1976 through 1989. Several clinical and epidemiological data were collected from 25 patients who met the criteria for PBC and the yearly incidence and prevalence were calculated. RESULTS: The ages of patients which PBC ranged from 31 to 74 years (mean age 50 +/- 10.5); 88% were females and 28% were diagnosed in the asymptomatic phase of the disease. The incidence for the study period was variable, with a maximum of 6.8 cases/million and an overall yearly incidence rate of 4.1 +/- 2.3 cases/million (7.1 +/- 4.3 cases/million for females). When the risk population was considered (people over 25 years) the respective values were 11.5 and 6.9 +/- 3.7 cases/million (12.1 +/- 7.2 cases/million for females). The prevalence showed a progressive increase, being 36.4 cases/million at the end of the study; for the "risk" population it was 61.5/million (100 cases/million for females). CONCLUSIONS: Incidence and prevalence of PBC in the area of study are within medium and medium-high values for Spain and Europe. As in other studies, personal environmental or social factors with epidemiological significance were not identified.

Epidemiology of dyspepsia in a random mediterranean population. Prevalence of Helicobacter pylori infection.

AIM: The prevalence of dyspepsia in the community is poorly known, because most studies have used samples that were not representative of the general population. This study was intended to determine the prevalence of dyspepsia in a random sample of the general population, and its epidemiologic and sociodemographic characteristics. METHODS: In this descriptive study we used a questionnaire administered during a personal interview to survey a random sample of 264 subjects in a Mediterranean population. RESULTS: The prevalence of dyspepsia was 24%; we found no relation between prevalence and demographic characteristics, smoking and drinking, or type of dyspepsia. Forty subjects with dyspepsia were examined and the specific diagnosis was found in 18 (45%) of them. The subgroup with reflux-like dyspepsia was the largest (60%), although there was considerable overlap between subgroups with reflux-like, ulcer-like and dysmotility-like dyspepsia. Anti-Helicobacter pylori antibodies (IgG) were found in 52% of the subjects, but bacterial infection was not related with dyspepsia. CONCLUSIONS: Up to one-fourth of the general population in the city where the subjects reside may have dyspepsia. This disorder was associated with irritable bowel syndrome in half of the cases, but was not associated with H. pylori infection.

[Endoscopic, histologic and morphometric evaluation of the gastric mucosa in patients with osteoarthritis treated with piroxicam and zinc acexamate]. / Evaluación endoscópica, histológica y morfométrica de la mucosa gástrica en pacientes con osteoartritis tratados con piroxicam y acexamato de cinc.

Zinc acexamate (ZAM) is an antiulcer agent with antisecretory and gastroprotective properties. The aim of this study was to evaluate endoscopically and morphometrically the efficacy of ZAM in the prophylaxis of gastroduodenal lesions induced by pyroxicam. Thirty nine patients from 30 to 70 years of age diagnosed with osteoarthritis without lesions in the upper digestive tract on basal endoscopy were studied. A randomized, double blind study was designed in which the patients received 20 mg/day of pyroxicam together with 300 mg/day of ZAM or placebo for 4 weeks. Clinical controls were undertaken on days 0, 14, 28 and endoscopic and histologic controls performed on days 0 and 28. The two groups were homogeneous regarding basal parameters. Endoscopic grading of the gastroduodenal lesions at the end of the study was lower in the group treated with ZAM (p < 0.001). Ulcers were found in only 2 patients (one antral and one duodenal) both of whom were in the placebo group (10.5%). Histologic scoring following treatment demonstrated higher values in the placebo group (p < 0.001) and scarce alterations with respect to base values in the group treated with ZAM. Morphometric quantification showed lower cell densities in both groups at the body level (p < 0.001). However, these did not vary in the antrum in the group treated with ZAM but increased in the placebo group (p < 0.001) as an expression of proliferative cell response to mucosal damage. At a single nightly dosis of 300 mg ZAM is effective in the prophylaxis of gastric and duodenal lesions induced by pyroxicam.

[Asymptomatic chronic intrahepatic cholestasis and multiple hypodense nodules in the liver and the spleen: manifestations of a case of sarcoidosis]. / Colestasis intrahepática crónica asintomática y múltiples nódulos hipodensos en hígado y bazo: manifestaciones de un caso de sarcoidosis.

Sarcoidosis is a systemic granulomatous disease of unknown etiology which may present multiple clinical manifestations. Liver involvement is observed among 21-79% of the cases. Nonetheless, hepatic sarcoidosis is usually asymptomatic and the finding of cholestasis is an infrequent complication. In the last few years, the presence of multiple hypodense nodules in the liver and spleen has been described in 5-15% of these patients following the application of dynamic intravenous techniques in abdominal CT scan. Although the histopathologic study of these nodules suggests that their formation is due to the coalescence of the microscopic granulomas, the cause of this aggregation remains unknown. A case of hepatic sarcoidosis presenting chronic cholestasis and whose abdominal tomographic study with intravenous contrast demonstrated the existence of hypodense lesions in the liver and spleen suggesting malignant disseminated disease is reported.

[Acute pseudo-obstruction of the colon, a problem of old age. A study of 5 cases treated medically]. / La pseudobstrucción aguda del colon, un problema de la tercera edad. Estudio de cinco casos tratados médicamente.

Acute partial obstruction of the colon is a frequent complaint among elderly patients, this being the reason for the increase in incidence. 5 cases which were medically treated successfully are presented. The proper terminology is briefly discussed, describing the typical clinical features and the associated diseases which appear in 80-90% of cases. The diagnosis is basically clinical and plain abdominal X-Ray, barium enema and/or colonoscopy are the most helpful tests to make a differential diagnosis between mechanical and nonmechanical obstruction. An in-depth view on colonoscopy as a diagnostic and therapeutic method is presented.

[Acute pancreatitis: an infrequent complication of cystic fibrosis (mucoviscidosis)]. / Pancreatitis aguda: una complicación poco frecuente de la fibrosis quística (mucoviscidosis).

We comment the case of a 25-year-old woman, diagnosed since the age of 7 as cystic fibrosis, who presented acute pancreatitis, an exceptional complication of the underlying disease. In the ultrasonographic exploration and endoscopic retrograde cholangiopancreatography was appreciated dilation of the pancreatic ducts, with mobile echoes and filling defects, respectively, compatible with mucus plugs. The etiopathogenesis of this type of acute pancreatitis and the procedure for reaching an etiological diagnosis are discussed. Although the patient presented moderate grade pancreatic failure, there is presently no agreement as to whether pancreatitis secondary to cystic fibrosis can be considered as chronic pancreatitis.

Altered gastric emptying in patients with irritable bowel syndrome.

Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut.