Esofagitis y gastritis cáustica / Esophagitis and caustic gastritis

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Colitis ulcerosa grave, con megacolon tóxico, resuelta con infliximab / Severe ulcerative colitis and toxic megacolon resolved with infliximab therapy

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Expression of bcl-2 in ductular proliferation is related to periportal hepatic stellate cell activation and fibrosis progression in patients with autoimmune cholestasis.

AIM: To study bcl-2 expression in ductular proliferation cholangiocytes and hepatic stellate cell activation in liver biopsies from patients with autoimmune cholangitis and primary biliary cirrhosis. MATERIALS AND METHODS: Twenty-four primary biliary cirrhosis patients and 11 autoimmune cholangitis patients were included. Thirty-four females, average age: 52.5+/-12.6 years. We studied the presence of ductular proliferation, cholestasis, florid ductal lesion, granulomata, ductopenia and histologic stage. Patients were classified in primary biliary cirrhosis or autoimmune cholangitis according to antimitochondrial antibodies, antinuclear antibodies, smooth muscle antibody, antiGP210 and antiSP100 autoantibodies. We studied the presence of bcl-2 by monoclonal antibcl-2 antibody (clon 100, BioGenex). The presence of activated (specific antialpha-actin antibodies) and independent lobular, periportal and portal hepatic stellate cell was assessed using a semiquantitative scale. RESULTS: Interlobular ducts bcl-2 was seen in 18 (51.4%) patients. Activated periportal hepatic stellate cell correlated with Ludwig's stage (r=0.43; n=35; p=0.01). Ten out of 15 (66.6%) patients with ductular proliferation showed positive interlobular ducts bcl-2 while bcl-2 was negative in 8 out of 20 (40%) patients without ductular proliferation; p<0.05. Bcl-2 positive patients in ductular proliferation showed a more advanced Ludwig's stage (2.33+/-0.77 versus 1.26+/-1.05; p<0.05) and a higher periportal hepatic stellate cell activation index (0.83+/-0.78 versus 0.23+/-0.43; p=0.009). No relationship was found among periportal hepatic stellate cell activation and the presence of florid ductal lesion, cholestasis, granulomata or biliary erosive necrosis. Hepatic stellate cell activation was similar in patients with either autoimmune cholangitis or primary biliary cirrhosis. CONCLUSIONS: Periportal hepatic stellate cell activation seems to play a main role in fibrosis progression in patients with autoimmune cholestasis. Bcl-2 expression in ductular proliferation may promote hepatic stellate cell activation and fibrosis.

[Influence of nonsteroidal antiinflammatory drugs in gastrointestinal bleeding due to gastroduodenal ulcers or erosions in patients with liver cirrhosis]. / Influencia de los antiinflamatorios no esteroideos en la hemorragia digestiva por úlceras o erosiones gastroduodenales en pacientes con cirrosis hepática.

INTRODUCTION: Peptic ulcer disease, with or without complications, is more common in patients with liver cirrhosis than in the general population. Factors associated with portal hypertension are involved in its pathogenesis. The prevalence of Helicobacter pylori infection in patients with liver cirrhosis and the general population is similar. The aim of the present study was to determine the influence of nonsteroidal antiinflammatory drugs (NSAIDs) in the etiology of bleeding peptic ulcer disease in patients with liver cirrhosis. PATIENTS AND METHODS: We studied 35 patients with liver cirrhosis and gastrointestinal bleeding due to gastroduodenal ulcers or erosions (group A), 125 noncirrhotic patients with gastrointestinal bleeding due to gastroduodenal ulcers or erosions (group B), and 70 patients with liver cirrhosis who were admitted to hospital without gastrointestinal bleeding (group C). All patients were questioned about NSAID consumption, including aspirin, during the week prior to hospital admission. RESULTS: NSAID consumption was reported by 15 patients (42.8%) in group A, 102 patients (58.2%) in group B, and 6 patients (8.5%) in group C. Statistically significant differences were obtained when the results for group A were compared with those for group C. CONCLUSIONS: NSAID consumption in patients with liver cirrhosis without gastrointestinal bleeding was low (8.5%) and was much lower than that observed in patients with cirrhosis admitted to hospital for bleeding due to gastroduodenal ulcers or erosions (42.8%). As occurs in the general population, NSAIDs play a significant role in the pathogenesis of bleeding due to peptic ulcer disease in patients with liver cirrhosis and portal hypertension.

Influencia de los antiinflamatorios no esteroideos en la hemorragia digestiva por úlceras o erosiones gastroduodenales en pacientes con cirrosis hepática / Influence of nonsteroidal antiinflammatory drugs in gastrointestinal bleeding due to gastroduodenal ulcers or erosions in patients with liver cirrhosis

Introducción: La enfermedad péptica gastroduodenal, con o sin complicaciones, es más frecuente en los pacientes con cirrosis hepática que en la población general y en su patogenia influirían factores dependientes de la hipertensión portal. La prevalencia de la infección por Helicobacter pylori en la población con cirrosis hepática es similar a la existente en la población general. Se objetiva conocer la influencia de los antiinflamatorios no esteroideos (AINE) en la etiología de la patología péptica gastroduodenal con hemorragia digestiva de los pacientes con cirrosis hepática. Pacientes y métodos: Se incluyó a 35 pacientes con cirrosis hepática con hemorragia digestiva por úlceras o erosiones gastroduodenales (grupo A), 125 pacientes no cirróticos, con hemorragia digestiva por úlceras o erosiones gastroduodenales (grupo B) y 70 pacientes con cirrosis hepática que ingresan sin hemorragia digestiva (grupo C). En todos los pacientes, mediante encuesta dirigida, se investiga el consumo de AINE, incluido ácido acetilsalicílico (AAS), en la semana previa al ingreso hospitalario. Resultados: Referían consumo de AINE 15 pacientes (42,8%) del grupo A, 102 pacientes (58,2%) del grupo B y 6 pacientes (8,5%) del grupo C. Se obtuvieron diferencias significativas al comparar los resultados del grupo A con el grupo C. Conclusiones: El consumo de AINE en los pacientes con cirrosis hepática sin hemorragia digestiva es bajo (8,5%), muy inferior al observado en los pacientes con cirrosis que ingresan con hemorragia por úlceras o erosiones gastroduodenales (42,8%). Se puede considerar que los AINE, como sucede en la población general, desempeñarían un importante papel en la patogenia de la hemorragia digestiva por patología péptica en la población con cirrosis hepática e hipertensión portal

Introduction: Peptic ulcer disease, with or without complications, is more common in patients with liver cirrhosis than in the general population. Factors associated with portal hypertension are involved in its pathogenesis. The prevalence of Helicobacter pylori infection in patients with liver cirrhosis and the general population is similar. The aim of the present study was to determine the influence of nonsteroidal antiinflammatory drugs (NSAIDs) in the etiology of bleeding peptic ulcer disease in patients with liver cirrhosis. Patients and methods: We studied 35 patients with liver cirrhosis and gastrointestinal bleeding due to gastroduodenal ulcers or erosions (group A), 125 noncirrhotic patients with gastrointestinal bleeding due to gastroduodenal ulcers or erosions (group B), and 70 patients with liver cirrhosis who were admitted to hospital without gastrointestinal bleeding (group C). All patients were questioned about NSAID consumption, including aspirin, during the week prior to hospital admission. Results: NSAID consumption was reported by 15 patients (42.8%) in group A, 102 patients (58.2%) in group B, and 6 patients (8.5%) in group C. Statistically significant differences were obtained when the results for group A were compared with those for group C. Conclusions: NSAID consumption in patients with liver cirrhosis without gastrointestinal bleeding was low (8.5%) and was much lower than that observed in patients with cirrhosis admitted to hospital for bleeding due to gastroduodenal ulcers or erosions (42.8%). As occurs in the general population, NSAIDs play a significant role in the pathogenesis of bleeding due to peptic ulcer disease in patients with liver cirrhosis and portal hypertension

Influencia de los antiinflamatorios no esteroideos en la hemorragia digestiva por úlceras o erosiones gastroduodenales en pacientes con cirrosis hepática / Influence of nonsteroidal antiinflammatory drugs in gastrointestinal bleeding due to gastroduodenal ulcers or erosions in patients with liver cirrhosis

Introducción: La enfermedad péptica gastroduodenal, con o sin complicaciones, es más frecuente en los pacientes con cirrosis hepática que en la población general y en su patogenia influirían factores dependientes de la hipertensión portal. La prevalencia de la infección por Helicobacter pylori en la población con cirrosis hepática es similar a la existente en la población general. Se objetiva conocer la influencia de los antiinflamatorios no esteroideos (AINE) en la etiología de la patología péptica gastroduodenal con hemorragia digestiva de los pacientes con cirrosis hepática. Pacientes y métodos: Se incluyó a 35 pacientes con cirrosis hepática con hemorragia digestiva por úlceras o erosiones gastroduodenales (grupo A), 125 pacientes no cirróticos, con hemorragia digestiva por úlceras o erosiones gastroduodenales (grupo B) y 70 pacientes con cirrosis hepática que ingresan sin hemorragia digestiva (grupo C). En todos los pacientes, mediante encuesta dirigida, se investiga el consumo de AINE, incluido ácido acetilsalicílico (AAS), en la semana previa al ingreso hospitalario. Resultados: Referían consumo de AINE 15 pacientes (42,8%) del grupo A, 102 pacientes (58,2%) del grupo B y 6 pacientes (8,5%) del grupo C. Se obtuvieron diferencias significativas al comparar los resultados del grupo A con el grupo C. Conclusiones: El consumo de AINE en los pacientes con cirrosis hepática sin hemorragia digestiva es bajo (8,5%), muy inferior al observado en los pacientes con cirrosis que ingresan con hemorragia por úlceras o erosiones gastroduodenales (42,8%). Se puede considerar que los AINE, como sucede en la población general, desempeñarían un importante papel en la patogenia de la hemorragia digestiva por patología péptica en la población con cirrosis hepática e hipertensión portal

Introduction: Peptic ulcer disease, with or without complications, is more common in patients with liver cirrhosis than in the general population. Factors associated with portal hypertension are involved in its pathogenesis. The prevalence of Helicobacter pylori infection in patients with liver cirrhosis and the general population is similar. The aim of the present study was to determine the influence of nonsteroidal antiinflammatory drugs (NSAIDs) in the etiology of bleeding peptic ulcer disease in patients with liver cirrhosis. Patients and methods: We studied 35 patients with liver cirrhosis and gastrointestinal bleeding due to gastroduodenal ulcers or erosions (group A), 125 noncirrhotic patients with gastrointestinal bleeding due to gastroduodenal ulcers or erosions (group B), and 70 patients with liver cirrhosis who were admitted to hospital without gastrointestinal bleeding (group C). All patients were questioned about NSAID consumption, including aspirin, during the week prior to hospital admission. Results: NSAID consumption was reported by 15 patients (42.8%) in group A, 102 patients (58.2%) in group B, and 6 patients (8.5%) in group C. Statistically significant differences were obtained when the results for group A were compared with those for group C. Conclusions: NSAID consumption in patients with liver cirrhosis without gastrointestinal bleeding was low (8.5%) and was much lower than that observed in patients with cirrhosis admitted to hospital for bleeding due to gastroduodenal ulcers or erosions (42.8%). As occurs in the general population, NSAIDs play a significant role in the pathogenesis of bleeding due to peptic ulcer disease in patients with liver cirrhosis and portal hypertension

Gestación a término en paciente con enfermedad de Crohn en tratamiento con adalimumab / Term pregnancy in a patient with Crohn’s disease under treatment with adalimumab

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Pneumocystis carinii diseminado en paciente tratado con inmunosupresores / Disseminated Pneumocystis carinii in a patient treated with immunosuppressive drugs

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Diagnosis of Helicobacter pylori infection using urease rapid test in patients with bleeding duodenal ulcer: influence of endoscopic signs and simultaneous corporal and antral biopsies.

INTRODUCTION: The sensitivity of invasive diagnostic methods for Helicobacter pylori (H. pylori) infection, particularly of urease rapid test, is decreased in cases of gastroduodenal ulcer and upper gastrointestinal bleeding. OBJECTIVES: To assess the influence of blood in the stomach or recent bleeding endoscopic signs in the diagnostic sensitivity of urease rapid test among patients with bleeding duodenal ulcer, as well as the influence of simultaneously collecting corporal and antral biopsy samples. PATIENTS AND METHODS: 120 patients, 85 male and 35 female, with an average age of 62 (18-88) years, who were admitted to our Hospital due to bleeding duodenal ulcer and who received an endoscopic diagnosis within 24 hours of admission were included. None of the patients had been under treatment with non-steroideal antiinflammatory drugs, proton-pump inhibitors or antimicrobial drugs in the two weeks prior to the bleeding event, and none had received eradicating therapy for H. pylori. In this group of selected patients an H. pylori infection rate nearing 100% was assumed. H. pylori infection was ruled out using antral biopsy (69 cases) or both antral and fundic biopsies (51 cases) for urease rapid testing (Jatrox-H.p.-Test). Patients were classified in three groups according to their endoscopic bleeding signs: a) presence of blood in the stomach or recent bleeding ulcer (21 cases); b) ulcer showing non-recent bleeding signs (38 cases); and c) ulcer without bleeding signs (61 cases). The sensitivity of the urease rapid test was compared between patient groups. Similarly, urease test results with an antral biopsy sample were compared in 100 patients with non-bleeding duodenal ulcer. RESULTS: Urease test was positive in 93% of patients with non-bleeding duodenal ulcer, and in 83% of patients with upper gastrointestinal bleeding, which reached statistical significance (p = 0.019). This test was positive in 82.6% of patients with an antral biopsy, and in 82.3% of patients with combined antral and fundic biopsies. In group A, urease test was positive in 90.5% of patients; in group B, it was positive in 89.5% of patients, and in group C, the test turned positive in 75.4% of patients. Statistical differences were only reached when patients in group C were compared to patients in groups A and B together (p = 0.037). CONCLUSIONS: 1. The presence of either blood in the stomach or recent bleeding endoscopic signs appeared not to be the conditioning factor for the decreased sensitivity of urease test among patients with bleeding duodenal ulcer. 2. The decreased sensitivity of this test in patients with upper gastrointestinal bleeding is more evident during the resolution stage, and it does not seem to occur because of H. pylori migration from the antrum to the corporal gastric region.

Diagnosis of Helicobacter pylori infection in patients with bleeding ulcer disease: rapid urease test and histology.

INTRODUCTION: The endoscopic diagnosis of Helicobacter pylori infection in patients with bleeding peptic ulcer is limited by a decreased sensitivity in standard invasive tests, rapid urease test and histology. There is controversy about the convenience of using one, neither, or both diagnostic tests. AIMS: To evaluate the results of simultaneously performed rapid urease test and histology in the diagnosis of Helicobacter pylori infection (H. pylori) in patients with bleeding peptic ulcer. PATIENTS AND METHODS: We included 173 patients, 98 male and 75 female, with an average age of 62 years (18-88), with upper gastrointestinal bleeding secondary to duodenal ulcer (115) or gastric ulcer (58), diagnosed within 24 hours after hospital admission. None of the patients had received treatment for H. pylori, proton pump inhibitors or antibiotics in the two weeks prior to the upper gastrointestinal bleeding episode. H. pylori infection was investigated in all patients by two antral biopsy samples for histological study (hematoxilin-eosin) and one or two antral biopsies for rapid urease test (Jatrox-H.p.-test). In cases with a negative urease test and histology, a 13C urea breath test was performed. Infection was considered present when at least one invasive test or the breath test was positive, whereas both invasive tests and the breath test had to be negative to establish an absent infection. RESULTS: 152 patients (88%) showed H. pylori infection, 104 patients (90%) with duodenal ulcer and 48 patients (83%) with gastric ulcer. In all 119 cases (78%) were diagnosed by the urease test and 112 cases (74%) by histology. Both methods were used to diagnose 134 of 152 cases (88%) (p < 0.05), these being positive in 97 cases and negative in 39 cases. In 18 of these 39 cases, the breath test was positive. CONCLUSIONS: Histology and urease test have similar diagnostic values for the identification of H. pylori in patients with bleeding peptic ulcer. Due to its rapid results, the urease test should be the method of choice. However, additional biopsies should be performed, and, when negative, a histological study should be carried out, since a combination of both methods allows a more precise diagnosis.

[Carcinoid tumor of the ileum and self-limited colitis]. / Tumor carcinoide ileal y colitis autolimitada.

Carcinoid tumors of the ileum represent the most frequent localization of this type of tumor in the gastrointestinal tract. The association of this tumor with the presence of inflammatory bowel disease is well characterized. Self-limiting colitis is an entity that poses serious difficulties when performing a differential diagnosed by other causes of colitis. We present the case of a patient who was diagnosed with carcinoid tumor of the ileum. Clinical and histological findings of self-limiting colitis were also observed.