Transición en las enfermedades crónicas gastrointestinales. Del cuidado pediátrico al del adulto / Transition in chronic gastrointestinal diseases. From pediatric to adult care

Los avances tecnológicos y del conocimiento hicieron que un mayor número de pacientes con enfermedad crónica gastrointestinal pasen de ser atendidos por el pediatra al control por los médicos de adultos durante una de las etapas más vulnerables de la vida: la adolescencia. El Grupo de Trabajo de Transición del Comité de Gastroenterología de la Sociedad Argentina de Pediatría realizó una búsqueda de literatura exhaustiva y convocó a especialistas referentes del país, con el objeto de unificar los criterios basados en la evidencia y la experiencia. De esta manera, se proponen una serie de recomendaciones para todo el equipo de salud (pediatra, gastroenterólogo infantil, nutricionista, gastroenterólogo de adultos, psicólogo, enfermería), incluso para pacientes y familias, que faciliten el proceso de transición y optimicen el seguimiento, el control, la prevención de complicaciones y la calidad de vida de los pacientes con enfermedades crónicas gastrointestinales

Technological advances and the globalization of knowledge have led to a considerable increase in the number of patients with chronic gastrointestinal disease who transition from pediatric to adult care during one of the most vulnerable life stages: adolescence. The Transition Working Group of the Gastroenterology Committee of the Sociedad Argentina de Pediatría conducted an exhaustive literature search and summoned leading specialists in the most frequent chronic pathologies from all over the country to unify criteria based on evidence and experience. As a result, a series of recommendations are proposed for the whole health team (pediatrician, pediatric gastroenterologist, nutritionist, adult gastroenterologist, psychologist, and nurse) including patients and families, to facilitate the transition process, optimize follow-up, prevent complications, and improve the quality of life of patients with chronic gastrointestinal diseases.

[Transition in chronic gastrointestinal diseases. From pediatric to adult care]. / Transición en las enfermedades crónicas gastrointestinales. Del cuidado pediátrico al del adulto.

Technological advances and the globalization of knowledge have led to a considerable increase in the number of patients with chronic gastrointestinal disease who transition from pediatric to adult care during one of the most vulnerable life stages: adolescence. The Transition Working Group of the Gastroenterology Committee of the Sociedad Argentina de Pediatría conducted an exhaustive literature search and summoned leading specialists in the most frequent chronic pathologies from all over the country to unify criteria based on evidence and experience. As a result, a series of recommendations are proposed for the whole health team (pediatrician, pediatric gastroenterologist, nutritionist, adult gastroenterologist, psychologist, and nurse) including patients and families, to facilitate the transition process, optimize follow-up, prevent complications, and improve the quality of life of patients with chronic gastrointestinal diseases.

Los avances tecnológicos y del conocimiento hicieron que un mayor número de pacientes con enfermedad crónica gastrointestinal pasen de ser atendidos por el pediatra al control por los médicos de adultos durante una de las etapas más vulnerables de la vida: la adolescencia. El Grupo de Trabajo de Transición del Comité de Gastroenterología de la Sociedad Argentina de Pediatría realizó una búsqueda de literatura exhaustiva y convocó a especialistas referentes del país, con el objeto de unificar los criterios basados en la evidencia y la experiencia. De esta manera, se proponen una serie de recomendaciones para todo el equipo de salud (pediatra, gastroenterólogo infantil, nutricionista, gastroenterólogo de adultos, psicólogo, enfermería), incluso para pacientes y familias, que faciliten el proceso de transición y optimicen el seguimiento, el control, la prevención de complicaciones y la calidad de vida de los pacientes con enfermedades crónicas gastrointestinales.

Mutación DGAT1 en dos hermanas con falla de medro: reporte de caso / DGAT1 mutation in two sisters with failure to thrive: a case report

Las diarreas y enteropatías congénitas (CODE por su sigla en inglés) son un grupo de trastornos monogénicos que se han descrito en los últimos años. Dentro de las CODE, la mutación del gen de la diacilglicerol o-aciltransferasa 1 (DGAT1) es un trastorno enzimático poco común asociado con diarrea crónica grave de aparición temprana. El objetivo es presentar a dos hermanas que consultaron por diarrea crónica, retraso en el crecimiento, vómitos e hipoalbuminemia en la primera infancia. En ambas pacientes se encontró un compuesto heterocigota de la mutación del DGAT1. Esta mutación se describió previamente en la población asiática; sin embargo, estas son las dos primeras pacientes en tener esta mutación en la población latinoamericana. Estos dos casos pueden ampliar nuestro conocimiento sobre las diarreas congénitas en general y las características clínicas de los pacientes con mutaciones en DGAT1 en particular.

Congenital diarrhea and enteropathies (CODEs) are a group of monogenic disorders that have been described in recent years. Within the CODEs, the mutation in the diacylglycerol O-acyltransferase 1 (DGAT1) gene is a rare enzyme disorder associated with severe, early-onset chronic diarrhea. Our objective is to describe the case of 2 sisters who consulted for chronic diarrhea, growth retardation, vomiting, and hypoalbuminemia in early childhood. A compound heterozygous DGAT1 mutation was found in both patients. This mutation was previously described in the Asian population; however, these are the first 2 patients to show this mutation in the Latin American population. These 2 cases may expand our knowledge about congenital diarrhea in general and the clinical characteristics of patients with DGAT1 mutations in particular.

DGAT1 mutation in two sisters with failure to thrive: a case report. / Mutación DGAT1 en dos hermanas con falla de medro: reporte de caso.

Congenital diarrhea and enteropathies (CODEs) are a group of monogenic disorders that have been described in recent years. Within the CODEs, the mutation in the diacylglycerol O-acyltransferase 1 (DGAT1) gene is a rare enzyme disorder associated with severe, early-onset chronic diarrhea. Our objective is to describe the case of 2 sisters who consulted for chronic diarrhea, growth retardation, vomiting, and hypoalbuminemia in early childhood. A compound heterozygous DGAT1 mutation was found in both patients. This mutation was previously described in the Asian population; however, these are the first 2 patients to show this mutation in the Latin American population. These 2 cases may expand our knowledge about congenital diarrhea in general and the clinical characteristics of patients with DGAT1 mutations in particular.

Las diarreas y enteropatías congénitas (CODE por su sigla en inglés) son un grupo de trastornos monogénicos que se han descrito en los últimos años. Dentro de las CODE, la mutación del gen de la diacilglicerol o-aciltransferasa 1 (DGAT1) es un trastorno enzimático poco común asociado con diarrea crónica grave de aparición temprana. El objetivo es presentar a dos hermanas que consultaron por diarrea crónica, retraso en el crecimiento, vómitos e hipoalbuminemia en la primera infancia. En ambas pacientes se encontró un compuesto heterocigota de la mutación del DGAT1. Esta mutación se describió previamente en la población asiática; sin embargo, estas son las dos primeras pacientes en tener esta mutación en la población latinoamericana. Estos dos casos pueden ampliar nuestro conocimiento sobre las diarreas congénitas en general y las características clínicas de los pacientes con mutaciones en DGAT1 en particular.

Pediatric Inflammatory Bowel Disease: A Multicenter Study of Changing Trends in Argentina Over the Past 30 Years.

Purpose: To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the past three decades in Argentina and determine if there are differences between the first two decades and the past decade. Methods: We conducted a retrospective multicenter analytical study in children with IBD between 0 and 18 years of age diagnosed between 1987 and 2017 in three tertiary health centers in Argentina. The evaluation included clinical characterization, endoscopy, histology, and imaging data together with therapeutic strategies. The patients were divided into two groups: Group 1, diagnosed between 1987 and 2007, and Group 2, diagnosed between 2008 and 2017. Results: Of the 756 patients included, 409 (54%) had ulcerative colitis (UC), 250 (33%) had Crohn's disease (CD), and 97 (13%) had IBD-unclassified (IBD-U). The positive family history was 3.8%, which was more frequent among children under two years of age (6.7%). There were no significant differences in clinical presentation and extraintestinal manifestations between periods, with hepatic manifestations being the most frequent. In the last decade, we found an upward trend in CD, a downward trend in UC/IBD-U, even after adjustment for socioeconomic status, and a decrease of 50% in surgical treatments coinciding with the advent of biological therapy. Conclusion: This is the first multicenter cohort study in a Latin American country to describe clinical, endoscopic, and therapeutic data across the past 30-year period. Although CD was responsible for the overall increase in incidence, UC was still prevalent in this region.

Enfoque integral en el diagnóstico del patrón esquelético maxilomandibular, la postura corporal y cráneo-cervical / A comprehensive approach to the diagnosis of the maxillomandibular skeletal pattern, body posture and craniocervical position

Introducción: Los principios biomecánicos de cabeza y cuello cobran un interés especial en el campo de la ortodoncia y la ortopedia dentomaxilofacial. Cualquier anomalía debe ser analizada y tratada dentro del sistema cráneo-cérvico-mandibular con un enfoque integral. Objetivo: Describir la relación entre el patrón esquelético maxilomandibular sagital, la postura corporal y la posición cráneo-cervical en adolescentes. Métodos: Estudio descriptivo, transversal, desarrollado entre marzo del 2018 a junio del 2019. La muestra estuvo conformada por 105 adolescentes del séptimo grado de la ESBU "Eduardo Anoceto Rega", de Santa Clara. Se determinó el patrón esquelético maxilomandibular de clase I, II y III midiendo la convexidad facial del cefalogramas de Ricketts; la posición cráneo-cervical de extensión, normoinclinación y flexión con el cefalograma de Rocabado; el tipo de postura con el método de Bricot. Se siguieron las normas éticas y fueron aplicados los estadígrafos chi cuadrado, F de Fisher y estadístico de Welch. Resultados: La postura D (espalda plana y plano escapular anterior) predominó en todas las clases esqueléticas 64,76 por ciento de los adolescentes, seguido de la postura C (plano escapular posterior). En la clase II, después de la postura D siguió la postura B (plano escapular y glúteo alineados con aumento de las curvas anteriores) con un 6,22 por ciento. Predominó la normoinclinación cráneo-cervical 46,67 por ciento y la flexión 42,86 por ciento. En la clase III predominó la flexión y el ángulo posteroinferior de Rocabado mayor respecto a las otras clases esqueléticas de 107º. Conclusiones: La posición del cráneo respecto a las estructuras cervicales, asociada a las características de cada clase esquelética, puede ser un indicador importante en el diagnóstico morfológico. A pesar de las muchas investigaciones en este campo, aún no se puede hablar de consenso en cuanto al grado de relación entre la postura craneocervical y las maloclusiones(AU)

Introduction: Head and neck biomechanical principles are particularly relevant in the fields of orthodontics and dentomaxillofacial orthopedics. Any anomaly should be analyzed and treated within the cranio-cervical-mandibular system applying a comprehensive approach. Objective: Describe the relationship between the sagittal maxillomandibular skeletal pattern, body posture and craniocervical position in adolescents. Methods: A descriptive cross-sectional study was conducted from March 2018 to June 2019. The study sample was 105 adolescents attending seventh grade at Eduardo Anoceto Rega junior high school in Santa Clara. Determination was made of maxillomandibular skeletal patterns Classes I, II and III, measuring the facial convexity in Ricketts' cephalograms, craniocervical extension, normal inclination and flexion positions with Rocabado's cephalogram, and posture type with Bricot's method. Ethical standards were complied with. Use was made of the statistical tests chi-square, Fisher's F and Welch's. Results: Posture D (flat back and anterior scapular plane) prevailed in all skeletal classes: 64.76 percent of the adolescents, followed by posture C (posterior scapular plane). In Class II, posture D was followed by posture B (scapular and gluteal plane aligned with increased anterior curves): 6.22 percent. A predominance was observed of craniocervical normal inclination: 46.67 percent and flexion: 42.86 percent. In Class III, Rocabado's flexion and posteroinferior angle were more common than the remaining 107º skeletal classes. Conclusions: Cranial position with respect to cervical structures, according to the characteristics of each skeletal class, may be an important indicator in morphological diagnosis. Despite the large number of studies conducted in this field, consensus has not been achieved about the degree of relationship between craniocervical posture and malocclusions(AU)

[Ibero-latinamerican clinical practical guidelines on pediatric caustic esophagitis: Physiopathology and clinical-endoscopic diagnosis (1st Part)]. / Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: Fisiopatología y diagnóstico clínico-endoscópico (1a Parte).

Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

[Ibero-Latinamerican Clinical Practical Guidelines on pediatric caustic esophagitis: Therapeutical aspects (Part 2)]. / Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: Aspectos terapéuticos (2a. Parte).

Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: aspectos terapéuticos (2a. Parte) / Ibero-Latinamerican Clinical Practical Guidelines on pediatric caustic esophagitis: therapeutical aspects (Part 2)

Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: fisiopatología y diagnóstico clínico-endoscópico (1a Parte) / Ibero-latinamerican clinical practical guidelines on pediatric caustic esophagitis: physiopathology and clinical-endoscopic diagnosis (1st Part)

Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Real-time PCR detection of a 16S rRNA single mutation of Helicobacter pylori isolates associated with reduced susceptibility and resistance to tetracycline in the gastroesophageal mucosa of individual hosts.

The molecular mechanism of Helicobacter pylori resistance to tetracycline involves mutations in the primary binding site of the ribosome. A resistance or reduced susceptibility to tetracycline could be the result of single, double or triple mutations in the 16S rRNA gene of H. pylori. We investigated if the genotype was correlated to tetracycline resistance as determined phenotypically in vitro for 96 H. pylori isolates in the gastroesophageal mucosa of Venezuelan individual hosts. E-test for antimicrobial susceptibility test and real-time PCR for the detection of 16S rRNA gene mutations were performed in 96 H. pylori isolates (48 obtained from antrum, and 48 from oesophagus) from eight dyspeptic patients. In the gastric mucosa, 38 isolates were identified sensitive and 10 resistant to tetracycline by E-test, whereas 44 sensitive and 4 resistant isolates were found in the oesophagus. Real-time PCR detection of the 16S rRNA gene exhibited mutants with a single base-pair substitution (AGA926GGA) in six antrum isolates and seven oesophagus isolates, whereas only three harboured a low level of tetracycline resistance in vitro. Our results indicate that real-time PCR detection of 16S rRNA is a reliable method to classify among tetracycline-resistant genotypes and useful in patients who have experienced a first-line treatment failure with triple therapy.

Comparative prevalence of Oxalobacter formigenes in three human populations.

There has been increasing interest in the human anaerobic colonic bacterium Oxalobacter formigenes because of its ability to metabolize oxalate, and its potential contribution to protection from calcium oxalate kidney stones. Prior studies examining the prevalence of this organism have focused on subjects in developed countries and on adults. Now using O. formigenes-specific PCR, we have compared the prevalence of these organisms among subjects in two remote areas in which modern medical practices have hardly been present with a USA group of mothers and their infants for the first three years of life. Among the Amerindians of the Yanomami-Sanema and Yekwana ethnic groups in Venezuela and the Hadza in Tanzania, O. formigenes was detected in 60-80% of the adult subjects, higher than found in adults from USA in this and prior studies. In young children, the prevalence was much lower in USA than in either tribal village. These data extend our understanding of the epidemiology of O. formigenes carriage, and are consistent with the hypothesis that the rising incidence of kidney stones is associated with the progressive loss of O. formigenes colonization in populations that have been highly impacted by modern medical practices.

Complex virome in feces from Amerindian children in isolated Amazonian villages.

The number of viruses circulating in small isolated human populations may be reduced by viral extinctions and rare introductions. Here we used viral metagenomics to characterize the eukaryotic virome in feces from healthy children from a large urban center and from three Amerindian villages with minimal outside contact. Numerous human enteric viruses, mainly from the Picornaviridae and Caliciviridae families, were sequenced from each of the sites. Multiple children from the same villages shed closely related viruses reflecting frequent transmission clusters. Feces of isolated villagers also contained multiple viral genomes of unknown cellular origin from the Picornavirales order and CRESS-DNA group and higher levels of nematode and protozoan DNA. Despite cultural and geographic isolation, the diversity of enteric human viruses was therefore not reduced in these Amazonian villages. Frequent viral introductions and/or increased susceptibility to enteric infections may account for the complex fecal virome of Amerindian children in isolated villages.

Oral and Cloacal Helicobacter Detection in Wild and Captive Orinoco Crocodiles (Crocodylus intermedius) in Venezuela.

Helicobacter species can colonize digestive tract of animals and humans and have been associated with gastrointestinal diseases; however, this genus has not been studied in crocodiles. Our objective was to detect by PCR Helicobacter genus and Helicobacter pylori in oral and cloacal swabs from Orinoco crocodiles of two wild (Cojedes River System and Capanaparo River) and two captive breeding centers (CBCs; Masaguaral Ranch and UNELLEZ) populations. Bacterial DNA was found in 100% of oral samples (10 wild and 10 captives), and in the 95% of cloacal samples (10 wild and 9 captives). In wild populations, Helicobacter spp. was not detected, whereas in CBCs, Helicobacter was detected in 10% of the oral samples, and 66.7% of cloacal samples. H. pylori was detected in two Orinoco crocodiles. Two cloacal non-pylori Helicobacter amplicons were sequenced, showing low similarity (≤97%) to Helicobacter sequences reported. This is the first report of Helicobacter species, including H. pylori in Crocodylus intermedius from CBCs.

[Gallstone ileus, surgical management review]. / Íleo biliar, revisión del manejo quirúrgico.

BACKGROUND: Gallstone ileus (GI) represents a rare cause of mechanical intestinal occlusion, which is caused by the impaction of a gallstones at the gastrointestinal tract, being most frequently the terminal ileum; its etiology is due to the passage of a calculum through a biliary-enteric fistula. Due to its low incidence, diagnostic suspicion and adequate initial surgical treatment are essential for an adequate clinical evolution. OBJECTIVE: A bibliographic review on the current surgical management of GI was carried out and exemplified by the presentation a clinical case. CLINICAL CASE: 78-year-old male with bowel obstruction, upon undergoing a CT scan, a gallstone at the level of distal ileum is displayed, therefore, an exploratory laparotomy (ex lap) is performed with enterotomy and extraction of the calculus. The patient bestowed adequate postoperative clinical evolution, and the presence of a cholecystoduodenal fistula is documented by an upper endoscopy. DISCUSSION: GI represents an uncommon pathology, however, there is discrepancy in the literature regarding the initial surgical management, especially in whether or not a biliary procedure should be associated with emergency enterolithotomy. CONCLUSION: GI is associated with complications secondary to diagnostic delay and its late surgical resolution, although the initial treatment is aimed at resolving the intestinal obstruction through enterotomy and gallstone extraction, there is controversy regarding the preferred time for cholecystectomy and repair of biliary-enteric fistula, being the two-stage surgery the surgical procedure of choice, especially in patients with a high risk of complications.

ANTECEDENTES: El íleo biliar (IB) es una causa poco frecuente de oclusión intestinal mecánica, causado por la impactación de un cálculo biliar en el tubo digestivo, siendo la localización más frecuente el íleon terminal; se debe al paso de un cálculo a través de una fístula bilioentérica. Debido a su baja incidencia, la sospecha diagnóstica y el tratamiento quirúrgico inicial adecuado son de gran importancia para la evolución clínica. OBJETIVO: Realizar una revisión bibliográfica sobre el manejo quirúrgico actual del IB y ejemplificarlo mediante la presentación de un caso clínico. CASO CLÍNICO: Varón de 78 años con cuadro de oclusión intestinal, con presencia de cálculo biliar en el íleon distal por tomografía. Se realiza laparotomía exploradora con enterotomía y extracción del cálculo. Cursa con adecuada evolución posquirúrgica, documentándose fístula colecistoduodenal por panendoscopia. DISCUSIÓN: El IB es una patología poco común, por lo cual existe discrepancia en cuanto al tipo de manejo quirúrgico ideal, sobre todo en si se debe o no asociar un procedimiento biliar a la enterolitotomía de urgencia. CONCLUSIÓN: El IB se asocia a complicaciones secundarias al retraso diagnóstico y a una mala elección de la técnica quirúrgica inicial. Si bien el tratamiento está encaminado a resolver la obstrucción intestinal mediante enterotomía y extracción del cálculo biliar, existe controversia en cuanto al tiempo preferido para realizar la colecistectomía y la reparación de la fístula bilioentérica, siendo la cirugía en dos tiempos el procedimiento quirúrgico de elección, sobre todo en pacientes con alto riesgo de complicaciones.

Comparison of gizzard and intestinal microbiota of wild neotropical birds.

Gut bacterial communities have been shown to be influenced by diet, host phylogeny and anatomy, but most of these studies have been done in captive animals. Here we compare the bacterial communities in the digestive tract of wild birds. We characterized the gizzard and intestinal microbiota among 8 wild Neotropical bird species, granivorous or frugivorous species of the orders Columbiformes and Passeriformes. We sequenced the V4 region of the 16S rRNA gene in 94 collected samples from 32 wild birds from 5 localities, and compared bacterial communities by foraging guild, organ, locality and bird taxonomy. 16S rRNA gene-based sequencing data were examined using QIIME with linear discriminant analysis effect size (LEfSe) and metabolic pathways were predicted using PICRUSt algorism. We identified 8 bacterial phyla, dominated by Firmicutes, Actinobacteria and Proteobacteria. Beta diversity analyses indicated significant separation of gut communities by bird orders (Columbiformes vs. Passerifomes) and between bird species (p<0.01). In lower intestine, PICRUSt shows a predominance of carbohydrate metabolism in granivorous birds and xenobiotics biodegradation pathways in frugivorous birds. Gizzard microbiota was significantly richer in granivorous, in relation to frugivorous birds (Chao 1; non-parametric t-test, p<0.05), suggesting a microbial gizzard function, beyond grinding food. The results suggest that the most important factor separating the bacterial community structure was bird taxonomy, followed by foraging guild. However, variation between localities is also likely to be important, but this could not been assessed with our study design.

Point Mutations at gyrA and gyrB Genes of Levofloxacin-Resistant Helicobacter pylori Isolates in the Esophageal Mucosa from a Venezuelan Population.

The treatment of Helicobacter pylori infection is complicated by antibiotic resistance. A high levofloxacin (LVX) resistance rate was previously demonstrated in H. pylori isolates from gastric mucosa (40%) and esophagus (19%) in individual hosts of a Venezuelan population. We aimed to assess the molecular mechanisms of LVX resistance and susceptibility in isolates from the gastroesophageal mucosa, by studying point mutations in the quinolone resistance-determining region of gyrA and gyrB genes. Sequencing of gyrA and gyrB genes (N = 120) helped to identify point mutations in 60 isolates (30 from antrum and 30 from esophagus) of five dyspeptic patients. Double (Asn87Thr and Asp91Asn) and single (Asn87Ile or Asn87Thr) mutations in the gyrA gene were identified in the esophageal mucosa. These mutations have been commonly found in the stomach. Occurrence of a single (Asn87Ile) mutation was associated with high resistance (minimum inhibitory concentration ≥ 32 µg/mL) to LVX. Only a single (Ser479Gly) mutation was found in the gyrB gene in both mucosae. One patient presented isolates with no mutations in the two genes studied. Isolates with the same mutation pattern in individual hosts revealed identical genetic profiles for these genes, confirming that isolates identified in the esophageal mucosa come from isolates colonizing the stomach. Helicobacter pylori resistance to LVX in the esophagus is related to double- and single-point mutations in gyrA and gyrB genes, such as those found in the stomach. Levofloxacin should be applied with caution, because its antibiotic effect on H. pylori is decreasing in Latin America, perhaps owing to high prescription rates.

Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina / One-year prospective registry of inflammatory bowel disease in the Argentine pediatric population

Introducción. La enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Su diagnóstico es cada vez más frecuente en pediatría y la incidencia es desconocida en Argentina. El objetivo de este trabajo fue determinar la incidencia anual de EII en menores de 18 años de nuestro país, los aspectos epidemiológicos y las formas clínicas de presentación. Población y métodos. Estudio prospectivo, multicéntrico y observacional que abarcó todo el territorio nacional. Se incluyeron menores de 18 años con diagnóstico de EII de centros públicos y privados entre el 1/6/2012 y el 31/5/2013, a través de protocolo en la web. Resultados. Participaron 17 centros, y se registraron 50 pacientes en 10 centros. La incidencia fue 0, 4/100 000 < 18 años; EC, 20; CU, 25; y EII no clasificable, 5. Distribución según sexo: 26 varones y 24 mujeres. La edad media al momento del diagnóstico fue de 9, 7 años y la demora diagnóstica, de 16, 5 meses. Los síntomas y signos más frecuentes fueron diarrea crónica con sangre y/o moco, dolor abdominal y adelgazamiento. El retraso del crecimiento fue menor de lo esperado. Las manifestaciones extraintestinales se presentaron en el 24% en CU y en el 25% en EC. La localización más frecuente en EC fue ileocolónica, y, en CU, pancolónica. No se observó CU con formas graves. Conclusiones. La incidencia fue menor que la reportada por otros registros. Se considera conveniente la creación de un registro permanente, que no solo permita conocer la incidencia, sino también servir de apoyo a los centros referentes que diagnostican y tratan esta patología.

Introduction. Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). IBD diagnosis has become increasingly common in pediatrics but its incidence is unknown in Argentina. The objective of this study was to determine the annual incidence of IBD in children and adolescents younger than 18 years in Argentina, its epidemiological aspects, and clinical presentations. Population and methods. Prospective, observational, multicenter study conducted in Argentina. Children and adolescents younger than 18 years from public and private facilities, diagnosed with IBD between June 1st, 2012 and May 31st, 2013 were included via a web protocol. Results. Seventeen sites participated in the study; 50 patients were recruited from 10 sites. IBD incidence was 0.4/100 000 among individuals <18 years; CD, 20; UC, 25; and idiopathic IBD, 5. Distribution by sex: 26 boys and 24 girls. Patients' mean age at diagnosis was 9.7 years, and delay in the diagnosis was 16.5 months. The most common symptoms and signs were chronic diarrhea with blood and/or mucus, abdominal pain, and weight loss. Growth retardation was less common than expected. Extraintestinal manifestations were observed in 24% of UC cases and in 25% of CD cases. The most common location of CD was the ileum and colon, and of UC was the entire colon (pancolonic). There were no cases with severe UC. Conclusions. The incidence was lower than that reported in other registries. We recommend the development of an ongoing registry, to establish the incidence of IBD, but also to serve as backup for referring facilities where this disease is diagnosed and treated.

One-year prospective registry of inflammatory bowel disease in the Argentine pediatric population. / Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina.

INTRODUCTION: Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). IBD diagnosis has become increasingly common in pediatrics but its incidence is unknown in Argentina. The objective of this study was to determine the annual incidence of IBD in children and adolescents younger than 18 years in Argentina, its epidemiological aspects, and clinical presentations. POPULATION AND METHODS: Prospective, observational, multicenter study conducted in Argentina. Children and adolescents younger than 18 years from public and private facilities, diagnosed with IBD between June 1st, 2012 and May 31st, 2013 were included via a web protocol. RESULTS: Seventeen sites participated in the study; 50 patients were recruited from 10 sites. IBD incidence was 0.4/100 000 among individuals <18 years; CD, 20; UC, 25; and idiopathic IBD, 5. Distribution by sex: 26 boys and 24 girls. Patients' mean age at diagnosis was 9.7 years, and delay in the diagnosis was 16.5 months. The most common symptoms and signs were chronic diarrhea with blood and/or mucus, abdominal pain, and weight loss. Growth retardation was less common than expected. Extraintestinal manifestations were observed in 24% of UC cases and in 25% of CD cases. The most common location of CD was the ileum and colon, and of UC was the entire colon (pancolonic). There were no cases with severe UC. CONCLUSIONS: The incidence was lower than that reported in other registries. We recommend the development of an ongoing registry, to establish the incidence of IBD, but also to serve as backup for referring facilities where this disease is diagnosed and treated.

INTRODUCCIÓN: La enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Su diagnóstico es cada vez más frecuente en pediatría y la incidencia es desconocida en Argentina. El objetivo de este trabajo fue determinar la incidencia anual de EII en menores de 18 años de nuestro país, los aspectos epidemiológicos y las formas clínicas de presentación. POBLACIÓN Y MÉTODOS: Estudio prospectivo, multicéntrico y observacional que abarcó todo el territorio nacional. Se incluyeron menores de 18 años con diagnóstico de EII de centros públicos y privados entre el 1/6/2012 y el 31/5/2013, a través de protocolo en la web. RESULTADOS: Participaron 17 centros, y se registraron 50 pacientes en 10 centros. La incidencia fue 0,4/100 000 < 18 años; EC, 20; CU, 25; y EII no clasificable, 5. Distribución según sexo: 26 varones y 24 mujeres. La edad media al momento del diagnóstico fue de 9,7 años y la demora diagnóstica, de 16,5 meses. Los síntomas y signos más frecuentes fueron diarrea crónica con sangre y/o moco, dolor abdominal y adelgazamiento. El retraso del crecimiento fue menor de lo esperado. Las manifestaciones extraintestinales se presentaron en el 24% en CU y en el 25% en EC. La localización más frecuente en EC fue ileocolónica, y, en CU, pancolónica. No se observó CU con formas graves. CONCLUSIONES: La incidencia fue menor que la reportada por otros registros. Se considera conveniente la creación de un registro permanente, que no solo permita conocer la incidencia, sino también servir de apoyo a los centros referentes que diagnostican y tratan esta patología.