RESUMEN
Background: Seronegative celiac disease (CD) poses a diagnostic challenge. Aims: Characterize and identify differences between seronegative and seropositive CD. Patients and methods: Retrospective cohort study examining adult patients diagnosed with CD (1980-2017). Clinical, analytical, histological, genetic and immunophenotypic data were compiled. Seronegative CD was defined as a anti-tissue transglutaminase type 2 IgA and endomysial antibodies (EMA) negative and HLA-DQ2 and/or DQ8 positive, showing clinical signs of CD plus an abnormal duodenal biopsy, and responding to a gluten-free diet (GFD). Factors associated with seronegative CD were identified through binomial logistic regression. Results: Of 315 CD patients, 289 were seropositive (91.7%) and 26 seronegative (8.3%). Among the seronegative patients, higher prevalence was observed for autoimmune thyroiditis (26.9% vs. 9.7%, p = .016), HLA-DQ8 heterozygosity (23.1% vs. 2.5%, p Ë .001) and Marsh I lesion (34.6% vs. 3.7%, p Ë .001). The two groups showed similar flow cytometry-determined duodenal immunophenotypes and rates of refractory CD. Conclusions: Seronegative CD differs mostly in genetic (more HLA-DQ8) and histologic (milder atrophy) features as compared with seropositive. Intestinal intraepithelial immunophenotype by flow cytometry, similar in both modalities, is a useful tool to diagnose seronegative CD.
Asunto(s)
Enfermedad Celíaca/genética , Enfermedad Celíaca/patología , Duodeno/patología , Linfocitos/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atrofia , Autoanticuerpos/sangre , Biopsia , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/dietoterapia , Dieta Sin Gluten , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/genética , Enfermedades Duodenales/patología , Femenino , Citometría de Flujo , Proteínas de Unión al GTP/sangre , Antígenos HLA-DQ/genética , Humanos , Inmunoglobulina A/inmunología , Mucosa Intestinal/patología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Proteína Glutamina Gamma Glutamiltransferasa 2 , Estudios Retrospectivos , Transglutaminasas/sangre , Adulto JovenRESUMEN
BACKGROUND: Endoscopic sleeve gastroplasty is a safe and feasible treatment for obesity. This study is focused on our technique modification which suggests a different suturing pattern in order to distribute suture tension more evenly. METHODS: A retrospective study of 148 patients (121 women) who underwent this procedure and were monitored for 12 months was conducted. The average age was 41.53 ± 10 years. The average BMI was 35.11 ± 5.5 kg/m2 with the average initial weight being 98.7 ± 17 kg. A subgroup of the first 72 patients (60 women) were monitored for 18 months. A new running "Z" stitch pattern was used to provide gastric cavity reduction by means of 4 parallel suture rows. The stitch pattern was intended to provide a homogenous distribution of the disruptive force on the suture among all stitch points. RESULTS: %TWL was 17.53 ± 7.57 in 12 months and 18.5 ± 9% in 18 months indicating durability of the procedure. Patients with a BMI < 35 benefited most from an endoscopic gastroplasty. Leptin did not predict a response to endoscopic gastroplasty and decreased in all patients. In just one case there was a mild bleeding (0.67%) at the insertion point of the helix, which was resolved by sclerotherapy. CONCLUSIONS: Endoscopic gastroplasty offers a real choice for obese patients. This single-center experience with a modified suturing pattern provides a successful technique for weight loss.
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Endoscopía/métodos , Gastroplastia/métodos , Obesidad/cirugía , Técnicas de Sutura , Adulto , Índice de Masa Corporal , Femenino , Humanos , Leptina/sangre , Masculino , Estudios Retrospectivos , Pérdida de PesoRESUMEN
Ménétrier disease is a rare condition of an unknown origin, with a wide spectrum of clinical signs and symptoms at presentation. Diagnosis is made through the combination of clinical, analytical, endoscopic and histological data. Surgery is the classical treatment. However, new medical approaches have emerged.
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Anemia Ferropénica/etiología , Gastritis Hipertrófica/complicaciones , Anemia Ferropénica/diagnóstico , Gastrectomía , Gastritis Hipertrófica/diagnóstico , Gastritis Hipertrófica/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal tract with no obvious cause after assessment with upper and lower gastrointestinal endoscopy. In these cases, the source is suspected to be in the small bowel. Obscure bleeding can be occult or overt. The aim of this study was to analyze the clinical and analytical characteristics and findings on capsule endoscopy in patients with OGIB and to determine the factors related to the detection of lesions in both forms of presentation. METHODS: We performed a retrospective study of capsule endoscopies carried out between November 2009 and November 2012 for OGIB. RESULTS: We analyzed 284 capsule endoscopies in 272 patients. Initially, 12 procedures could not be evaluated and were repeated. A total of 272 procedures were finally included in the analysis. The results of 114 (41.9%) capsule endoscopies were normal. Compared with patients with occult OGIB, those with overt OGIB were significantly older (70.2 vs. 67.5 years; p = 0.04), consumed more NSAID (24.2% vs. 11.9%; p = 0.01), had higher hemoglobin levels (9.3 vs. 10.4; p < 0,001) and more frequently required transfusion (64.5% vs 32.2%; p < 0.001). No differences were found between the two forms of presentation in the detection of canker sores-ulcers and polyps-masses. Vascular lesions were more frequently detected in overt than in occult OGIB (40.3% vs. 25.7%, respectively), (p < 0.05). When the total number of diagnoses carried out by capsule endoscopy was analyzed, no differences were found in diagnostic yield between overt OGIB (57%) and occult OGIB (54%), (p = 0.6). In overt OGIB, multivariate analysis showed that the variables that significantly predicted the detection of lesions on capsule endoscopy were consumption of medication NSAID (OR 2.75; p = 0.01), antiplatelets and anticoagulants (OR 2.64; p = 0.03) and analytical data hemoglobin (OR 3.23; p < 0.001) and INR (OR 1.8; p = 0.02). In occult OGIB, multivariate analysis showed that the factors significantly related to the detection of lesions on endoscopy were age (OR 1.9; p = 0.04) and NSAID consumption (OR 2.1; p = 0.01). CONCLUSIONS: Capsule endoscopy is essential in the assessment of OGIB. Although the diagnostic yield was similar in both forms of presentation, vascular lesions were more frequently detected in overt OGIB. The diagnostic yield of capsule endoscopy could be optimized by taking into account the form of presentation (overt vs. occult) and certain clinical and analytic data (age, drug consumption, hemoglobin).
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Endoscopía Capsular , Hemorragia Gastrointestinal/diagnóstico por imagen , Anciano , Angiodisplasia/complicaciones , Angiodisplasia/diagnóstico por imagen , Antiinflamatorios no Esteroideos/efectos adversos , Anticoagulantes/efectos adversos , Transfusión Sanguínea , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Hemoglobinas/análisis , Humanos , Relación Normalizada Internacional , Masculino , Inhibidores de Agregación Plaquetaria/efectos adversos , Hemorragia Posoperatoria/diagnóstico por imagen , Hemorragia Posoperatoria/etiología , Estudios RetrospectivosAsunto(s)
Drenaje/efectos adversos , Endosonografía/efectos adversos , Hemorragia Gastrointestinal/etiología , Ultrasonografía Intervencional/efectos adversos , Anciano de 80 o más Años , Carcinoma Hepatocelular/complicaciones , Colecistitis Aguda/complicaciones , Colecistitis Aguda/cirugía , Colecistostomía , Colelitiasis/complicaciones , Colelitiasis/cirugía , Drenaje/métodos , Úlcera Duodenal/complicaciones , Embolización Terapéutica , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Humanos , Neoplasias Hepáticas/complicaciones , Masculino , Cuidados Paliativos , Úlcera Péptica Hemorrágica/etiología , Úlcera Péptica Hemorrágica/terapia , Soluciones Esclerosantes/uso terapéutico , Escleroterapia , Choque/etiología , Choque Séptico/etiología , Stents , Ultrasonografía Intervencional/métodosAsunto(s)
Quiste Epidérmico/patología , Síndromes Neoplásicos Hereditarios/diagnóstico , Enfermedades de la Piel/patología , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Apendicectomía , Neoplasias del Apéndice/diagnóstico , Neoplasias del Apéndice/genética , Neoplasias del Apéndice/terapia , Enfermedades Asintomáticas , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/genética , Tumor Carcinoide/terapia , Quimioterapia Adyuvante , Terapia Combinada , Diagnóstico Diferencial , Endoscopía del Sistema Digestivo , Quiste Epidérmico/genética , Quiste Epidérmico/cirugía , Fluorouracilo/administración & dosificación , Síndrome de Gardner/diagnóstico , Síndrome de Gardner/genética , Cabeza , Hepatectomía , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Masculino , Terapia Neoadyuvante , Síndromes Neoplásicos Hereditarios/patología , Oxaliplatino/administración & dosificación , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/genética , Neoplasias del Recto/cirugía , Enfermedades de la Piel/genética , Enfermedades de la Piel/cirugíaRESUMEN
Collagenous sprue is a rare disease of the small bowel characterized by mucosal atrophy and excessive subepithelial collagen deposition. The etiology remains unclear and the diagnosis is based upon patient´s clinical picture and anatomopathological findings. Clinically, collagenous sprue is characterized by persistent diarrhoea, severe malabsorption, multiple nutrient deficiencies and progressive weight loss. Differential diagnosis includes celiac disease, which is mandatory to rule out because of their frequent association. Glutenfree diet is the first therapeutic step, but it usually is not effective. However, recent studies show high success rates with immunomodulators, mainly corticosteroids. We report the case of a patient presenting with chronic diarrhea and severe malabsorption who was diagnosed with collagenous sprue, with no response to gluten free diet, but with excellent response to budesonida.
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Esprue Colágeno/diagnóstico , Anciano de 80 o más Años , Enfermedad Crónica , Esprue Colágeno/complicaciones , Tejido Conectivo , Diarrea/etiología , Humanos , MasculinoAsunto(s)
Arterias/anomalías , Esófago/irrigación sanguínea , Hemorragia Gastrointestinal/etiología , Escleroterapia , Terapia Combinada , Epinefrina/administración & dosificación , Epinefrina/uso terapéutico , Esofagoscopía , Gangrena de Fournier/complicaciones , Hemorragia Gastrointestinal/terapia , Hemostasis Quirúrgica/instrumentación , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Soluciones Esclerosantes/administración & dosificación , Soluciones Esclerosantes/uso terapéuticoAsunto(s)
Enfermedad Celíaca/complicaciones , Perforación Intestinal/etiología , Enfermedades del Yeyuno/etiología , Linfoma de Células B Grandes Difuso/complicaciones , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedad Celíaca/dietoterapia , Colectomía , Terapia Combinada , Ciclofosfamida/administración & dosificación , Dieta Sin Gluten , Susceptibilidad a Enfermedades , Síndrome de Down/complicaciones , Doxorrubicina/administración & dosificación , Humanos , Perforación Intestinal/cirugía , Enfermedades del Yeyuno/cirugía , Neoplasias del Yeyuno/complicaciones , Neoplasias del Yeyuno/tratamiento farmacológico , Neoplasias del Yeyuno/prevención & control , Neoplasias del Yeyuno/cirugía , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/prevención & control , Linfoma de Células B Grandes Difuso/cirugía , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones , Prednisona/administración & dosificación , Rituximab/administración & dosificación , Tomografía Computarizada por Rayos X , Vincristina/administración & dosificaciónRESUMEN
Diagnosis of refractory celiac disease (CD) is based on exclusion of other disorders, persistence of malabsorptive symptoms and villous atrophy, despite a strict gluten-free diet for at least 6-12 months. Detection of alterations in the intraepithelial lymphocyte population is crucial for diagnosis. A subgroup of patients with refractory CD may develop severe complications such as enteropathy-associated T cell lymphoma (EATL). We present the case of a patient with longstanding silent CD who developed EALT, highlighting the challenge posed by the diagnosis and treatment of this entity.
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Linfoma de Células T Asociado a Enteropatía/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The safety and health effects for celiac people of a novel beverage (SOFB) developed from sprouted oat flour by fermentation with Lactobacillus plantarum was explored. In vitro reactivity against anti-gliadin antibodies (AGA) and antioxidant/anti-inflammatory potential of SOFB in RAW 264.7 macrophages and Caco-2 cells were evaluated. Immunoreactivity against AGA and antioxidant activity were not detected in SOFB, but it exhibited significant anti-inflammatory activity. The tolerability and impact of SOFB consumption for 6 months on nutritional status and intestinal microbiota composition were investigated in 10 celiac adults (five treated and five control). SOFB consumption did not adversely affect duodenal mucosa nor the total IgA or anti-tissue transglutaminase antibody (IgA-tTG) levels in celiac participants, but it significantly decreased total cholesterol levels at all sampling times and folic acid levels at the end of the study compared to the placebo beverage. SOFB administration also shifted gut microbiota, leading to a higher relative abundance of some beneficial bacteria including the genera Subdoligranulum, Ruminococcus and Lactobacillus in the SOFB group. This study provides supporting evidence of the safety of health benefits of a novel functional beverage produced from sprouted oat.
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Avena , Enfermedad Celíaca/dietoterapia , Alimentos Fermentados , Plantones , Animales , Antiinflamatorios , Anticuerpos/inmunología , Antioxidantes , Avena/inmunología , Células CACO-2 , Alimentos Funcionales , Microbioma Gastrointestinal , Gliadina/inmunología , Glútenes/análisis , Humanos , Inmunoglobulina A/análisis , Inmunoglobulina A/inmunología , Lactobacillus plantarum/metabolismo , Ratones , Estado Nutricional , Células RAW 264.7Asunto(s)
Ataxia/etiología , Enfermedad Celíaca/complicaciones , Dieta Sin Gluten , Leucoencefalopatías/etiología , Trastornos Mentales/etiología , Biopsia , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/psicología , Reacciones Cruzadas , Duodeno/patología , Femenino , Deficiencia de Ácido Fólico/complicaciones , Deficiencia de Ácido Fólico/tratamiento farmacológico , Lóbulo Frontal/fisiopatología , Humanos , Deficiencia de IgA/complicaciones , Hierro/uso terapéutico , Deficiencias de Hierro , Leucoencefalopatías/diagnóstico por imagen , Leucoencefalopatías/fisiopatología , Leucoencefalopatías/psicología , Imagen por Resonancia Magnética , Trastornos Mentales/fisiopatología , Células de Purkinje/inmunología , Temblor/etiología , Adulto JovenRESUMEN
Anticonvulsant hypersensitivity syndrome is an unpredictable, potentially fatal drug reaction to aromatic anticonvulsants such as carbamazepine, phenytoin and phenobarbital. The hallmark features include fever, eosinophilia, rash and involvement of one or more internal organs. Clearly established diagnostic criteria and treatment guidelines are lacking. A high index of suspicion is required to identify this syndrome, allowing early withdrawal of the drug and avoiding re-exposure. We report an illustrative case of anticonvulsant hypersensitivity syndrome and review the published literature.
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Anemia Hemolítica/inducido químicamente , Anticonvulsivantes/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Erupciones por Medicamentos/etiología , Epilepsia Parcial Compleja/tratamiento farmacológico , Epilepsia del Lóbulo Temporal/tratamiento farmacológico , Enfermedades Linfáticas/inducido químicamente , Fenitoína/efectos adversos , Adolescente , Aminas/uso terapéutico , Anticonvulsivantes/uso terapéutico , Astrocitoma/complicaciones , Astrocitoma/diagnóstico , Astrocitoma/cirugía , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Carbamazepina/administración & dosificación , Carbamazepina/uso terapéutico , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Errores Diagnósticos , Quimioterapia Combinada , Epilepsia Parcial Compleja/etiología , Epilepsia del Lóbulo Temporal/etiología , Femenino , Gabapentina , Ganglioneuroma/diagnóstico , Humanos , Giro Parahipocampal/cirugía , Fenitoína/administración & dosificación , Fenitoína/uso terapéutico , Radiocirugia , Ácido gamma-Aminobutírico/uso terapéuticoAsunto(s)
Endoscopía Capsular , Hemorragia Gastrointestinal/patología , Hemangioma/patología , Neoplasias del Yeyuno/patología , Anciano de 80 o más Años , Hemorragia Gastrointestinal/etiología , Hemangioma/complicaciones , Humanos , Neoplasias del Yeyuno/complicaciones , Masculino , Índice de Severidad de la EnfermedadRESUMEN
Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.