Persistent and De Novo GERD After Sleeve Gastrectomy: Manometric and pH-Impedance Study Findings.

PURPOSE: One concerning disadvantage of sleeve gastrectomy (SG) technique as a treatment for obesity is the risk of developing gastroesophageal reflux disease (GERD) or worsening its symptoms after surgery. The purpose of this study is to describe the changes in manometry and 24-h pHmetry with impedance in bariatric patients after SG. MATERIALS AND METHODS: Retrospective analysis of 225 patients who underwent SG and were subjected to manometry, 24-h phmetry, and 24-h impedance between 2006 and 2016. Patients were subdivided into groups based on the test performed: 66 patients with manometry, 60 with 24-h pHmetry and 53 with 24-h impedance. Descriptive and analytical statistics were used for analysis. RESULTS: Manometry results showed a decrease in LES pressure from 12.26 ± 6.87 to 8.88 ± 6.28 mmHg in patients after surgery, de novo LES incompetence in 53.33%, worsening of symptoms in 71.4%, increase of inverted gastroesophageal gradient from 6.06% to 48.48% (p<0.05), and a rise in esophageal dysmotility from 18.19% to 37.87%. 24-h pHmetry showed an increase of DeMeester score from 16.71 ± 12.78 to 42.88 ± 32.08 after SG and 79.48% of de novo GERD. Ambulatory 24-h impedance showed an increase of pathological reflux from 47.17% to 88.67% postoperatively. CONCLUSIONS: Laparoscopic SG is associated with a higher proportion of abnormal DeMeester score and greater incompetence of the LES in post-SG esophageal tests. Hence, SG may predispose the development of gastroesophageal reflux in the postoperative period.

[Evaluation of a carbon 13 breath test for the diagnosis of Helicobacter pylori]. / Evaluación de un test del aliento con carbono 13 para el diagnóstico de Helicobacter pylori.

OBJECTIVE: To evaluate a Chinese-made carbon-13 breath test as a non-invasive diagnostic method for Hp infection in the Peruvian population through the determination of sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, and diagnostic utility. MATERIALS AND METHODS: A cross-sectional and descriptive study was carried out on a secondary database of the Gastroenterology Service of the Cayetano Heredia Hospital and Cayetano Heredia Clinic from November 2017 to August 2018. Patients over 18 years of age who underwent endoscopy were included upper digestive. RESULTS: A sensitivity of 90.3% (95% CI 0.81-0.96), a specificity of 82.5% (95% CI 0.67-0.93), a positive predictive value was found and negative of 90.3% and 82.5%, and positive and negative likelihood ratio of 5.16 and 0.12, respectively. The area under the ROC curve was 0.88 (95% CI: 0.80-0.96). CONCLUSIONS: The carbon 13 breath test is a non-invasive and simple test that provides results quickly. However, it is not possible to recommend the routine use of this test due to the discrepancy between the international and local results obtained. Studies with larger sample sizes, standardized protocols and different manufacturers are suggested to evaluate their performance and characteristics.

Evaluación de un test del aliento con carbono 13 para el diagnóstico de Helicobacter pylori / Evaluation of a carbon 13 breath test for the diagnosis of Helicobacter pylori

RESUMEN Objetivo: Evaluar un test del aliento con carbono 13 de fabricación China como método diagnóstico no invasivo para la infección por Hp en población peruana a través de la determinación de sensibilidad, especificidad, valor predictivo positivo y negativo, likelihood ratio positivo y negativo y utilidad diagnóstica. Materiales y métodos: Se realizó un estudio transversal y descriptivo sobre una base de datos secundaria del Servicio de Gastroenterología del Hospital Cayetano Heredia y Clínica Cayetano Heredia de noviembre de 2017 a agosto de 2018. Se incluyó a pacientes mayores de 18 años sometidos a una endoscopía digestiva alta. Resultados: Se halló una sensibilidad de 90,3% (IC 95% 0,81-0,96), especificidad de 82,5% (IC 95% 0,67-0,93), valor predictivo positivo y negativo de 90,3% y 82,5%, y likelihood ratio positivo y negativo de 5,16 y 0,12, respectivamente. El área bajo la curva ROC fue 0,88 (IC 95%: 0,80-0,96). Conclusiones: El test del aliento con carbono 13 es una prueba no invasiva y sencilla que proporciona resultados de forma rápida. Sin embargo, no es posible recomendar el uso rutinario de esta prueba debido a la discrepancia entre los resultados internacionales y locales obtenidos. Se sugiere realizar estudios con mayores tamaños muestrales, protocolos estandarizados y de diferentes fabricantes para evaluar su rendimiento y características.

ABSTRACT Objective: To evaluate a Chinese-made carbon-13 breath test as a non-invasive diagnostic method for Hp infection in the Peruvian population through the determination of sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, and diagnostic utility. Materials and methods: A cross-sectional and descriptive study was carried out on a secondary database of the Gastroenterology Service of the Cayetano Heredia Hospital and Cayetano Heredia Clinic from November 2017 to August 2018. Patients over 18 years of age who underwent endoscopy were included upper digestive. Results: A sensitivity of 90.3% (95% CI 0.81-0.96), a specificity of 82.5% (95% CI 0.67-0.93), a positive predictive value was found and negative of 90.3% and 82.5%, and positive and negative likelihood ratio of 5.16 and 0.12, respectively. The area under the ROC curve was 0.88 (95% CI: 0.80-0.96). Conclusions: The carbon 13 breath test is a non-invasive and simple test that provides results quickly. However, it is not possible to recommend the routine use of this test due to the discrepancy between the international and local results obtained. Studies with larger sample sizes, standardized protocols and different manufacturers are suggested to evaluate their performance and characteristics.