Primer consenso venezolanode enfermedad por reflujo gastroesofágico / Venezuelan consensus on gastroesophageal reflux diseases

El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

Use of multiwavelength emission from hollow cathode lamp for measurement of state resolved atom density of metal vapor produced by electron beam evaporation.

State resolved atom population of metal vapor having low-lying metastable states departs from equilibrium value. It needs to be experimentally investigated. This paper reports the use of hollow cathode lamp based atomic absorption spectroscopy technique to measure online the state resolved atom density (ground and metastable) of metal vapor in an atomic beam produced by a high power electron gun. In particular, the advantage of availability of multiwavelength emission in hollow cathode lamp is used to determine the atom density in different states. Here, several transitions pertaining to a given state have also been invoked to obtain the mean value of atom density thereby providing an opportunity for in situ averaging. It is observed that at higher source temperatures the atoms from metastable state relax to the ground state. This is ascribed to competing processes of atom-atom and electron-atom collisions. The formation of collision induced virtual source is inferred from measurement of atom density distribution profile along the width of the atomic beam. The total line-of-sight average atom density measured by absorption technique using hollow cathode lamp is compared to that measured by atomic vapor deposition method. The presence of collisions is further supported by determination of beaming exponent by numerically fitting the data.

Comparison of PCR and common clinical tests for the diagnosis of H. pylori in dyspeptic patients.

Helicobacter pylori has been recognized as a major gastric pathogen. The objective of this study was to assess the diagnostic value of common clinical tests to detect H. pylori infection, by comparison with PCR. Serum and gastric biopsy specimens from 106 dyspeptic patients were examined. Serology was performed with Pyloriset Dry test, and biopsies were examined histologically, for rapid urease activity and PCR amplification of an ureA gene segment of H. pylori. PCR primers were specific for H. pylori and required at least 1.47 pg of H. pylori DNA, corresponding to about 800 bacterial cells. According to serology, histology, rapid urease, and PCR, positive results were respectively found in 56%, 86%, 64%, and 85% of dyspeptic patients, primarily with gastritis. Relative to PCR, the sensitivity (and specificity) was 55% (38%) for serology, 86% (13%) for histology, 70% (69%) for urease. When combining histology and urease, Bayesian analysis of data indicated no advantage of using combined methods over rapid urease test alone. Histology should not any longer be considered a gold standard test for Helicobacter pylori. Urea breath test still seems the first option for non invasive diagnostic. If an invasive diagnostic is justified, highly specific and sensitive molecular methods should be used to examine specimens.

PCR detection of Helicobacter pylori in string-absorbed gastric juice.

Molecular methods for detection of Helicobacter pylori infection have been shown to be highly sensitive in gastric biopsies and cultures. The objective of this work was to compare PCR detection of H. pylori DNA in string-absorbed gastric juice and in gastric biopsies. The study was performed in 47 dyspeptic adult patients undergoing endoscopy, and infection was detected by amplification of a segment of H. pylori ureA gene. Of the 29 patients positive in biopsy analysis, 23 (79%) were also positive in the gastric string. PCR analysis of gastric strings is a sensitive and safe procedure to detect H. pylori when endoscopy is not indicated, and may be of great clinical and epidemiological usefulness in determining effectiveness of eradication therapies, typing virulence genes and detecting antibiotic resistance mutations.

Utilidad clínica del ultrasonido endoscópico en la evaluación de patologías benignas gastrointestinales: reporte preliminar / Clinical utility of endoscopic ultrasound in the gastrontestinal bening pathology evaluation: preliminar report

La Ecoendoscopia es una herramienta diagnóstica importante en la evaluación de lesiones gastrointestinales benignas, sin embargo la utilidad clínica es incierta. Objetivo: Determinar la utilidad del Ultrasonido Endoscópico en las lesiones gastrointestinales benignas. Métodos: Estudiamos retrospectivamente 59 pacientes consecutivos sometidos a Ultrasonido Endoscópico. Se obtuvo información completa en 53 pacientes (15 hombres, 38 mujeres) con edad promedio de 44 años. El diagnóstico final fue confirmado por cirugía convencional o endoscópica (n= 10), colangiopancreatografía endoscópica retrógrada con o sin esfinterotomía (n= 18), histología (n= 4) y seguimiento médico (n= 21) con una media de 4,6 meses, 35 pacientes tenían diagnóstico inicial dudoso: lesión submocosal (n= 10), lesión pancreática (n= 16), lesión biliar (n= 7) y otras lesiones (n= 2), 18 pacintes tenían diagnóstico inicial sindromático: colestasis extrahepática (n= 10), pancreatitis aguda o recurrente (n= 5), hemobilia (n= 1), dolor abdominal (n= 1) e hipoglicemia severa (n= 1). Resultados: Los hallazgos endosonográficos fueron: 1 papiloma esofágico, 4 lesiones gástricas, 21 lesiones pancreáticas, 13 lesiones biliares, 12 estudios normales y 2 no concluyentes. Hubo 3 falsos negativos y 5 falsos positivos. La Ecoendoscopia fue de ayuda en 85 por ciento (45/53) de los casos porque aportó diagnóstico etiológico en 9, recomendó terapia curativa en 16 evitó estudios sucesivos en 20. En 11 por ciento de casos no mejoró el diagnóstico preliminar y en 4 por ciento de casos se consideró equivocado con un error y una terapia quirúrgica no curativa