Hallazgos endoscópicos no relacionados con hipertensión portal en pacientes con cirrosis hepática sometidos a un programa de cribado de varices / Endoscopic findings unrelated to portal hypertension in patients with liver cirrhosis undergoing a varicose vein screening programme

Objetivo: El consenso de Baveno VI para el cribado endoscópico de varices esofagogástricas recomienda evitar la endoscopia en algunos pacientes. Bajo esta estrategia, podrían pasar desapercibidas lesiones no relacionadas con hipertensión portal, algunas de ellas potencialmente graves. El objetivo de este estudio es determinar la prevalencia de dichas lesiones e identificar los factores clínicos asociados a las mismas. Pacientes y métodos: Estudio transversal unicéntrico sobre una cohorte consecutiva de pacientes cirróticos sometidos a endoscopia digestiva alta en el contexto de un programa de cribado de varices esofagogástricas entre noviembre del 2013 y noviembre del 2018. Se analizaron los factores de riesgo para la presencia de lesiones no relacionadas con hipertensión portal mediante regresión logística uni y multivariante. Resultados: Se incluyó a 379 pacientes. La etiología mayoritaria de la cirrosis fue etílica (n=229; 60,4%). La prevalencia de lesiones endoscópicas no relacionadas con hipertensión portal fue del 39,6% (n=150). Entre los 96 pacientes con enfermedad péptica (25,3%) se tomó test de ureasa en 54 (56,2%), siendo positiva en 24 (44,4%). La presencia de lesiones endoscópicas no relacionadas con hipertensión portal no estuvo influida por la edad (p=1), el género (p=0,28), la función hepática (MELD p=0,20, Child-Pugh p=0,77) o la presencia de datos ecográficos de hipertensión portal (p=0,14). Los pacientes fumadores presentaron tendencia a mayor prevalencia de lesiones endoscópicas no relacionadas con la hipertensión portal (43,2% vs. 34,6%; p=0,09), particularmente úlcera péptica (6,4% vs. 0,6%; p=0,05) y duodenitis péptica (17,3% vs. 6,3%; p=0,002). El tabaquismo activo fue el único factor predictivo independiente de ulcus o duodenitis péptica (odds ratio=2,56; intervalo de confianza del 95%: 1,18-5,56; p=0,017).(AU)

Aim: To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis. Patients and methods: Cross-sectional study including a consecutive cohort of patients with liver cirrhosis enrolled in a screening program of oesophageal varices who underwent an upper gastrointestinal endoscopy from November, 2013, to November, 2018. Clinical predictors of endoscopic lesions unrelated to portal hypertension were analyzed by univariate and multivariate logistic regression. Results: A total of 379 patients were included. The most frequent aetiology of liver disease was alcohol consumption (60.4%). The prevalence of endoscopic lesions unrelated with portal hypertension was 39.6% (n=150). Among 96 patients with peptic lesions, urease was obtained in 56.2% of patients (positive in 44.4% of them). The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. Smokers had a trend to increased prevalence of endoscopic lesions unrelated to portal hypertension (43.2% vs. 34.6%; p=0.09), particularly peptic ulcer (6.4% vs. 0.6%; p=0.05) and peptic duodenitis (17.3% vs. 6.3%; p=0.002). Active smoking was the only independent predictor of peptic ulcer or duodenitis (OR=2.56; p=0.017). Conclusion: Active smoking is a risk factor for endoscopic lesions unrelated to portal hypertension. This finding should be further investigated to reassess endoscopic screening programs in cirrhotic smokers.(AU)

Endoscopic findings unrelated to portal hypertension in patients with liver cirrhosis undergoing a varicose vein screening programme. / Hallazgos endoscópicos no relacionados con hipertensión portal en pacientes con cirrosis hepática sometidos a un programa de cribado de varices.

AIM: To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis. PATIENTS AND METHODS: Cross-sectional study including a consecutive cohort of patients with liver cirrhosis enrolled in a screening program of oesophageal varices who underwent an upper gastrointestinal endoscopy from November, 2013, to November, 2018. Clinical predictors of endoscopic lesions unrelated to portal hypertension were analyzed by univariate and multivariate logistic regression. RESULTS: A total of 379 patients were included. The most frequent aetiology of liver disease was alcohol consumption (60.4%). The prevalence of endoscopic lesions unrelated with portal hypertension was 39.6% (n=150). Among 96 patients with peptic lesions, urease was obtained in 56.2% of patients (positive in 44.4% of them). The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. Smokers had a trend to increased prevalence of endoscopic lesions unrelated to portal hypertension (43.2% vs. 34.6%; p=0.09), particularly peptic ulcer (6.4% vs. 0.6%; p=0.05) and peptic duodenitis (17.3% vs. 6.3%; p=0.002). Active smoking was the only independent predictor of peptic ulcer or duodenitis (OR=2.56; p=0.017). CONCLUSION: Active smoking is a risk factor for endoscopic lesions unrelated to portal hypertension. This finding should be further investigated to reassess endoscopic screening programs in cirrhotic smokers.

Perforación de vena yugular por un catéter venoso central de inserción periférica / Jugular vein perforation by a peripherally inserted central catheter

Los catéteres venosos centrales de inserción periférica (PICC) son cada vez más utilizados en pacientes que requieren un acceso intravenoso durante un tiempo prolongado. Presentamos un paciente de 53 años de edad con cáncer de esófago distal avanzado que sufrió una complicación mecánica potencialmente grave tras la inserción de un PICC

Peripherally inserted central catheters (PICC) are increasingly used in patients who require intravenous access for a long time. We present a 53-year-old male patient with an advanced distal esophageal cancer who suffered a potentially serious mechanical complication after insertion of a PICC

[Jugular vein perforation by a peripherally inserted central catheter]. / Perforación de vena yugular por un catéter venoso central de inserción periférica.

INTRODUCTION: Peripherally inserted central catheters (PICC) are increasingly used in patients who require intravenous access for a long time. We present a 53-year-old male patient with an advanced distal esophageal cancer who suffered a potentially serious mechanical complication after insertion of a PICC.

INTRODUCCIÓN: Los catéteres venosos centrales de inserción periférica (PICC) son cada vez más utilizados en pacientes que requieren un acceso intravenoso durante un tiempo prolongado. Presentamos un paciente de 53 años de edad con cáncer de esófago distal avanzado que sufrió una complicación mecánica potencialmente grave tras la inserción de un PICC.

Valoración precoz de la anemia en el paciente con hemorragia digestiva aguda: concordancia entre gasometría venosa y laboratorio convencional / Early evaluation of anaemia in patients with acute gastrointestinal bleeding: venous blood gas analysis compared to conventional laboratory

Fundamento y objetivo: La valoración del paciente con hemorragia digestiva (HD) aguda requiere de una evaluación clínica y analítica precoz. El objetivo de este estudio es valorar la concordancia de la determinación de hemoglobina (Hb) y hematocrito (HTC) precozmente mediante gasometría venosa (GSV) y de forma convencional por el Laboratorio (LAB) de Urgencias. Pacientes y método: Estudio observacional y prospectivo de pacientes ingresados en la Unidad de Hemorragias Digestivas por HD aguda alta y baja. Se recogieron variables demográficas, clínicas y muestras de sangre venosa simultáneas para la determinación de Hb y HTC por GSV y LAB. Se analizó la concordancia de ambos métodos mediante el coeficiente de correlación intraclase (CCI) y el análisis de Bland-Altman. Resultados: Se incluyeron 132 pacientes. Un total de 87 (65,9%) eran varones y la edad media fue de 66,8 años. La GSV sobreestimó la Hb en 0,49 g/dl (intervalo de confianza del 95% 0,21-0,76) respecto al LAB. La concordancia fue muy buena en la Hb (CCI 0,931) y buena en el HTC (CCI 0,899), mostrando las gráficas de Bland-Altman tanto la concordancia como la sobreestimación de la determinación de la Hb por GSV. En 19 pacientes (14,39%) la Hb por GSV superó en más de 1 g/dl la determinación final obtenida por LAB. Conclusiones: La determinación precoz de Hb y HTC en pacientes con HD aguda mediante GSV resulta fiable en la valoración inicial de la anemia. La GSV sobreestima sistemáticamente el valor de Hb en al menos 0,5 g/dl, por lo que la evaluación clínica y hemodinámica del sangrante debe prevalecer sobre el resultado analítico (AU)

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Prevalencia y características de la anemia y ferropenia en pacientes hospitalizados por enfermedades digestivas en España / Prevalence and characteristics of anemia and iron deficiency in patients hospitalized for gastrointestinal diseases in Spain

OBJETIVO: Evaluar la prevalencia y el abordaje terapéutico de la anemia y ferropenia en pacientes hospitalizados por enfermedades gastrointestinales. MÉTODOS: Estudio epidemiológico, multicéntrico, con diseńo mixto (retrospectivo de revisión de historias clínicas aleatorizadas y prospectivo con visita de control) realizado entre febrero de 2010 y marzo de 2011 en 22 servicios de aparato digestivo espańoles. Se consideró anemia grave Hb < 10 g/dl y leve/moderada Hb ≥ 10 g/dl, y ferropenia (ferritina < 30 ng/ml o IST < 16%). RESULTADOS: Se incluyeron 379 pacientes. La edad media ± DE fue de 57 ± 19 ańos y el 47% eran hombres. La prevalencia de anemia al ingreso fue del 60% (IC 95%: 55-65), siendo grave en la mitad de ellos, y la prevalencia del déficit de hierro del 54% (IC 95%: 47-61). El 39% ingresaron por sangrado digestivo, de los cuales el 83% (121/146) tenían anemia. La prevalencia de anemia al alta no cambió (del 60% pasó al 58%) (IC 95%: 53-63): 17% grave y 41% leve/moderada, y la ferropenia se situó en el 41% (IC 95%: 32-50). A los 3-6 meses del ingreso, la prevalencia de anemia fue del 28% (IC 95%: 23-32): 5% grave y 23% leve/moderada; la prevalencia de ferropenia fue del 44% (IC 95%: 39-50). Durante el ingreso, el 50% de los pacientes con anemia no recibió tratamiento, y al alta al 55% de los pacientes que tenían anemia tampoco se les pautó tratamiento. CONCLUSIÓN: La prevalencia de anemia en pacientes hospitalizados por enfermedades gastroenterológicas es muy alta. En la visita de control, en más de la cuarta parte de los pacientes persiste la anemia. Únicamente la mitad de los ingresados recibieron tratamiento para la anemia, aun tratándose de pacientes graves

OBJECTIVE: To determine the prevalence and characteristics of anemia and iron deficiency inpatients hospitalized for gastrointestinal diseases. METHODS: An epidemiological, multicenter, mixed design study (retrospective review of randomized clinical records and prospective visits) conducted between February 2010 and March2011 in 22 Spanish gastroenterology departments. Severe anemia was defined as Hb < 10 g/dL, mild/moderate as Hb≥10 g/dL, and iron deficiency as ferritin < 30 ng/ml or transferrin saturation< 16%.RESULTS: We included 379 patients. The mean ±SD age was 57±19 years and 47% were men.The prevalence of anemia at admission was 60% (95% CI 55 to 65), and anemia was severe (Hb<10 g/dl) in half the patients. The prevalence of iron deficiency was 54% of evaluable patients(95% CI 47 to 61). Gastrointestinal bleeding at admission was found in 39% of the patients, of whom 83% (121/146) were anemic. At discharge, the proportion of anemic patients was unchanged (from 60% at admission to 58% at discharge) (95% CI 53 to 63) and iron deficiency was found in 41% (95% CI 32 to 50): anemia was severe in 17% and mild/moderate in 41%. During follow-up, at 3-6 months after admission, 44% (95% CI 39 to 50) of evaluable patients continued to have iron deficiency and 28% (95% CI 23 to 32) were still anemic: 5% severe and 23% mild/moderate. The prevalence of iron deficiency was 44% (95% CI: 39-50). During admission, 50% of patients with anemia did not receive treatment. At discharge, 55% were untreated. CONCLUSION: The prevalence of anemia in patients hospitalized for gastroenterological diseases was very high. Anemia persisted in over a quarter of patients at the follow-up visit. Only half of hospitalized patients received treatment for anemia, even when the anemia was severe

[Prevalence and characteristics of anemia and iron deficiency in patients hospitalized for gastrointestinal diseases in Spain]. / Prevalencia y características de la anemia y ferropenia en pacientes hospitalizados por enfermedades digestivas en España.

OBJECTIVE: To determine the prevalence and characteristics of anemia and iron deficiency in patients hospitalized for gastrointestinal diseases. METHODS: An epidemiological, multicenter, mixed design study (retrospective review of randomized clinical records and prospective visits) conducted between February 2010 and March 2011 in 22 Spanish gastroenterology departments. Severe anemia was defined as Hb < 10g/dL, mild/moderate as Hb ≥ 10g/dL, and iron deficiency as ferritin < 30ng/ml or transferrin saturation < 16%. RESULTS: We included 379 patients. The mean±SD age was 57±19 years and 47% were men. The prevalence of anemia at admission was 60% (95% CI 55 to 65), and anemia was severe (Hb <10g/dl) in half the patients. The prevalence of iron deficiency was 54% of evaluable patients (95% CI 47 to 61). Gastrointestinal bleeding at admission was found in 39% of the patients, of whom 83% (121/146) were anemic. At discharge, the proportion of anemic patients was unchanged (from 60% at admission to 58% at discharge) (95% CI 53 to 63) and iron deficiency was found in 41% (95% CI 32 to 50): anemia was severe in 17% and mild/moderate in 41%. During follow-up, at 3-6 months after admission, 44% (95% CI 39 to 50) of evaluable patients continued to have iron deficiency and 28% (95% CI 23 to 32) were still anemic: 5% severe and 23% mild/moderate. The prevalence of iron deficiency was 44% (95% CI: 39-50). During admission, 50% of patients with anemia did not receive treatment. At discharge, 55% were untreated. CONCLUSION: The prevalence of anemia in patients hospitalized for gastroenterological diseases was very high. Anemia persisted in over a quarter of patients at the follow-up visit. Only half of hospitalized patients received treatment for anemia, even when the anemia was severe.

[Early evaluation of anaemia in patients with acute gastrointestinal bleeding: venous blood gas analysis compared to conventional laboratory]. / Valoración precoz de la anemia en el paciente con hemorragia digestiva aguda: concordancia entre gasometría venosa y laboratorio convencional.

BACKGROUND AND OBJECTIVE: Evaluation of patients with acute gastrointestinal bleeding (AGB) requires early clinical evaluation and analysis. The aim of this study is to evaluate early concordance of hemoglobin (Hb) and hematocrit (HTC) levels determined by conventional venous blood gas analysis (VBG) and by conventional Laboratory in Emergencies (LAB). PATIENTS AND METHODS: Observational and prospective study of patients admitted in the Gastrointestinal Haemorrhage Unit with both high and low AGB. Demographic and clinical variables and simultaneous venous blood samples were obtained to determine Hb and HTC by VBG and LAB. Concordance in both methods was analysed by intra-class correlation coefficient (ICC) and Bland-Altman analysis. RESULTS: One hundred and thirty-two patients were included: 87 (65.9%) males, average age 66.8 years. VBG overestimated Hb in 0.49 g/dl (95% confidence interval: 0.21-0.76) with respect to LAB. Concordance was very high in Hb (ICC 0.931) and high in HTC (0.899), with the Bland-Altman graphs showing both concordance and overestimation of Hb levels determined by VBG. In 19 patients (14.39%), Hb by VBG exceeded in more than 1g/dL the final determination obtained by LAB. CONCLUSIONS: Early determination of Hb and HTC in patients with AGB by VBG provides reliable results in the initial evaluation of anaemia. VBG systematically overestimates Hb values by less than 0.5 g/dl, and therefore clinical and hemodynamic evaluation of the bleeding patient should prevail over analytical results.

Situación actual del manejo de la hemorragia digestiva alta no varicosa en España / Current management of nonvariceal upper gastrointestinal bleeding in Spain

Introducción La mortalidad en la hemorragia digestiva alta no varicosa (HDA-NV) no ha variado. Se necesita conocer más información para mejorar las estrategias de tratamiento. Los objetivos de este estudio fueron: a) describir el perfil de presentación de los episodios de HDA-NV; b) el manejo clínico según práctica clínica habitual, y c) establecer cuáles son los resultados clínicos asociados a los tratamientos endoscópicos y médicos en España. Métodos ENERGIB fue un estudio retrospectivo de cohortes que recogió información del manejo y forma de presentación de HDA-NV en Europa. Presentamos los datos relativos a España. Los pacientes se trataron según la práctica clínica habitual. Para las variables cuantitativas se calculó la media y la desviación estándar y para las categóricas se calcularon frecuencias absolutas y relativas. Resultados Los pacientes (n = 403) fueron hombres (71%), con edad media 65 años, asociaron comorbilidad (62,5%). Los equipos encargados de su manejo fueron gastroenterólogos (57,1%) o médicos internistas (25,1%). Los inhibidores de la bomba de protones se usaron de forma empírica preendoscopia en un 80% de los casos. El 6,4% presentó persistencia y el 6,7% resangrado después de la endoscopia. La tasa de mortalidad en los 30 días posteriores fue del 3,5%.ConclusionesEste estudio permite conocer el perfil de presentación de los episodios de HDA-NV en España y el manejo en práctica clínica habitual. Este se ajusta a los estándares propuestos por las recientes guías de práctica clínica. Entre otros datos destaca que los pacientes con hemorragia son cada vez de edad más avanzada y presentan un mayor número de enfermedades asociadas, lo que podría explicar que la mortalidad se haya mantenido estable a pesar de los evidentes avances en el manejo de esta entidad (AU)

Background Mortality related to nonvariceal upper gastrointestinal bleeding (NVUGIB) has not changed. More information is needed to improve the management of this entity. The aims of this study were: a) to determine the characteristics of bleeding episodes, b) to describe the clinical approaches routinely used in NVUGIB, and c) to identify adverse outcomes related to endoscopic or medical treatments in Spain. Methods The European survey of nonvariceal upper GI bleeding (ENERGiB) was an observational, retrospective cohort study on NVUGIB with endoscopic evaluation carried out across Europe. The present study focused on Spanish patients in the ENERGiB study. The patients were managed according to routine care. The mean and standard deviation were calculated for quantitative variables and absolute and relative frequencies were calculated for categorical variables. Results Patients (n=403) were mostly men (71%), with a mean age of 65 years, and co-morbidities (62.5%). Most of the patients were managed by gastroenterologists (57.1%) or internal medicine teams (25.1%). A proton pump inhibitor was used empirically in 80% before endoscopy. Bleeding persistence occurred in 6.4% and recurrence in 6.7%. The mortality rate at 30 days was 3.5%.ConclusionsThis study contributes to the characterization of Spanish patients and NVUGIB episodes in a real clinical setting and identifies the routine management of this entity, which is in line with the standards proposed by recent clinical practice guidelines. A notable finding was that age and the number of comorbidities in NVUGIB patients were increasing. These factors could explain the persistent mortality rate, despite the evident advances in the management of this entity (AU)

[Current management of nonvariceal upper gastrointestinal bleeding in Spain]. / Situación actual del manejo de la hemorragia digestiva alta no varicosa en España.

BACKGROUND: Mortality related to nonvariceal upper gastrointestinal bleeding (NVUGIB) has not changed. More information is needed to improve the management of this entity. The aims of this study were: a) to determine the characteristics of bleeding episodes, b) to describe the clinical approaches routinely used in NVUGIB, and c) to identify adverse outcomes related to endoscopic or medical treatments in Spain. METHODS: The European survey of nonvariceal upper GI bleeding (ENERGiB) was an observational, retrospective cohort study on NVUGIB with endoscopic evaluation carried out across Europe. The present study focused on Spanish patients in the ENERGiB study. The patients were managed according to routine care. The mean and standard deviation were calculated for quantitative variables and absolute and relative frequencies were calculated for categorical variables. RESULTS: Patients (n=403) were mostly men (71%), with a mean age of 65 years, and co-morbidities (62.5%). Most of the patients were managed by gastroenterologists (57.1%) or internal medicine teams (25.1%). A proton pump inhibitor was used empirically in 80% before endoscopy. Bleeding persistence occurred in 6.4% and recurrence in 6.7%. The mortality rate at 30 days was 3.5%. CONCLUSIONS: This study contributes to the characterization of Spanish patients and NVUGIB episodes in a real clinical setting and identifies the routine management of this entity, which is in line with the standards proposed by recent clinical practice guidelines. A notable finding was that age and the number of comorbidities in NVUGIB patients were increasing. These factors could explain the persistent mortality rate, despite the evident advances in the management of this entity.

Perforación esofágica tras biopsia en paciente con esofagitis eosinofílica / Esophageal perforation following a biopsy in a patient with eosinophilic esophagitis

La esofagitis eosinofílica (EE) es una enfermedad infradiagnosticada que hay que sospechar ante todo paciente con disfagia e impactación alimentaria. Aunque estos son los síntomas guía, el espectro clínico y endoscópico es muy variable. Es obligatorio tomar conciencia sobre las posibles complicaciones derivadas de las maniobras diagnósticas y terapéuticas en la EE. Un manejo cuidadoso de los procedimientos endoscópicos conseguirá extremar las precauciones necesarias para evitar iatrogenia. Presentamos el caso de un varón joven con disfagia y estenosis esofágica que en el curso de su diagnóstico sufre como complicación una perforación esofágica (AU)

Eosinophilic esophagitis is an underdiagnosed disease that should be suspected in all patients with dysphagia and food impaction. Although these are the leading symptoms, the clinical and endoscopic spectrum is highly varied. Clinicians should be aware of the risk of endoscopy-related complications in this disorder. Precautions should be maximized in endoscopic examinations to avoid iatrogenic damage. We describe the case of a young patient with esophageal stricture and dysphagia who suffered a perforation following a biopsy (AU)

[Esophageal perforation following a biopsy in a patient with eosinophilic esophagitis]. / Perforación esofágica tras biopsia en paciente con esofagitis eosinofílica.

Eosinophilic esophagitis is an underdiagnosed disease that should be suspected in all patients with dysphagia and food impaction. Although these are the leading symptoms, the clinical and endoscopic spectrum is highly varied. Clinicians should be aware of the risk of endoscopy-related complications in this disorder. Precautions should be maximized in endoscopic examinations to avoid iatrogenic damage. We describe the case of a young patient with esophageal stricture and dysphagia who suffered a perforation following a biopsy.

Does fecal calprotectin predict relapse in patients with Crohn's disease and ulcerative colitis?

BACKGROUND AND AIMS: An evaluation is made of the utility of fecal calprotectin in predicting relapse in patients with inflammatory bowel disease (IBD). The possible differences in its predictive capacity in Crohn's disease (CD) versus ulcerative colitis (UC), and the different phenotypes, are also examined. METHODS: This is a prospective study with 135 patients diagnosed with IBD in clinical remission for at least 3 months. The patients submitted a stool sample within 24 hours after the baseline visit, for the measurement of fecal calprotectin. All patients were followed-up on for one year. RESULTS: Sixty-six patients had CD and 69 UC. Thirty-nine (30%) suffered from relapse. The fecal calprotectin concentration was higher among the patients with relapse than in those that remained in remission: 444 µg/g (95% CI 34-983) versus 112 µg/g (95% CI 22-996); p<0.01. Patients with CD and calprotectin>200 µg/g relapsed 4 times more often than those with lower marker concentrations. In UC, calprotectin>120 µg/g was associated with a 6-fold increase in the probability of disease activity outbreak. The predictive value was similar in UC and CD with colon involvement and inflammatory pattern. In this group, calprotectin>120 µg/g predicted relapse risk with a sensitivity of 80% and a specificity of 60%. Relapse predictive capacity was lower in patients with ileal disease. CONCLUSIONS: Fecal calprotectin may be a useful marker for predicting relapse in patients with IBD. Its predictive value is greater in UC and CD with colon involvement and inflammatory pattern, compared with ileal CD.

[Fulminant ischemic gastropathy: the final stage of a difficult-to-diagnose disease]. / Isquemia gástrica fulminante: el estadio final de una enfermedad poco expresiva.

Ischemic gastropathy is highly infrequent in daily medical practice. In the last few years, the number of reported cases has increased. Although the guiding symptom is usually abdominal pain, the clinical spectrum of the disease is highly variable. Early diagnosis and treatment are essential to change the natural history of the disease. We present the case of a 75-year-old man with chronic abdominal pain who developed a fulminant form of necrotizing gastric ischemia and died within less than 24h.

Hemorragia por varices gástricas como manifestación inicial de linfoma pancreático primario / Bleeding from gastric varices as the initial manifestation of primary pancreatic lymphoma

Los síntomas que con mayor frecuencia aparecen en el cáncer de páncreas son el dolor abdominal, la pérdida de peso o la ictericia. La hemorragia digestiva alta por rotura de varices gástricas es una entidad mucho menos prevalente en estos pacientes. Este hallazgo requiere descartar siempre la presencia de trombosis de la vena esplénica. Presentamos el caso de un varón joven que acude a urgencias por hematemesis en el que las pruebas diagnósticas acabaron dilucidando un linfoma pancreático primario (LPP) que provocó trombosis de la vena esplénica, circulación colateral y varices gástricas aisladas sangrantes. Hasta hoy no hemos encontrado en la literatura médica ningún LPP que se exprese inicialmente de este modo. Finalmente realizamos una revisión de la literatura médica e incidimos en la importancia de descartar la trombosis de la vena esplénica en pacientes con varices gástricas aisladas y unas nociones acerca del diagnóstico y tratamiento del LPP (AU)

In patients with pancreatic cancer, the most frequent symptoms are abdominal pain, weight loss and jaundice. Upper gastrointestinal bleeding produced by gastric varices is a rare entity in these patients and requires the presence of splenic vein thrombosis (SVT) to be excluded. We describe the case of a young man who presented to the emergency department with hematemesis. Diagnostic tests revealed primary pancreatic lymphoma (PPL), which provoked splenic vein thrombosis, collateral circulation and the formation of isolated bleeding gastric varices. To date, we have found no reports in the literature of PPL with this form of presentation. Finally, we review the literature, with emphasis on the importance of excluding splenic vein thrombosis in patients with isolated gastric varices, and discuss certain features of the diagnosis and treatment of PPL (AU)

[Bleeding from gastric varices as the initial manifestation of primary pancreatic lymphoma]. / Hemorragia por varices gástricas como manifestación inicial de linfoma pancreático primario.

In patients with pancreatic cancer, the most frequent symptoms are abdominal pain, weight loss and jaundice. Upper gastrointestinal bleeding produced by gastric varices is a rare entity in these patients and requires the presence of splenic vein thrombosis (SVT) to be excluded. We describe the case of a young man who presented to the emergency department with hematemesis. Diagnostic tests revealed primary pancreatic lymphoma (PPL), which provoked splenic vein thrombosis, collateral circulation and the formation of isolated bleeding gastric varices. To date, we have found no reports in the literature of PPL with this form of presentation. Finally, we review the literature, with emphasis on the importance of excluding splenic vein thrombosis in patients with isolated gastric varices, and discuss certain features of the diagnosis and treatment of PPL.

Isquemia gástrica fulminante: el estadio final de una enfermedad poco expresiva / Fulminant ischemic gastropathy: the final stage of a difficult-to-diagnose disease

La gastropatía isquémica es un cuadro que se presenta de forma muy poco frecuente en la práctica médica diaria habiéndose observado en los últimos años un aumento de los casos reportados. Aunque el síntoma guía suele ser el dolor abdominal, el espectro clínico de la enfermedad es muy variable, siendo el diagnóstico y tratamiento precoz fundamentales para cambiar la historia natural de la enfermedad. Presentamos el caso de un varón de 75 años con dolor abdominal crónico que desarrolló una forma fulminante de isquemia gástrica necrotizante falleciendo en menos de veinticuatro horas (AU)

Ischemic gastropathy is highly infrequent in daily medical practice. In the last few years, the number of reported cases has increased. Although the guiding symptom is usually abdominal pain, the clinical spectrum of the disease is highly variable. Early diagnosis and treatment are essential to change the natural history of the disease. We present the case of a 75-year-old man with chronic abdominal pain who developed a fulminant form of necrotizing gastric ischemia and died within less than 24h (AU)