Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico. / Guía clínica para diagnóstico y tratamiento de la enfermedad celíaca en México.

Celiac disease, celiac sprue, or gluten-sensitive enteropathy, is a generalized autoimmune disease characterized by chronic inflammation and atrophy of the small bowel mucosa. It is caused by dietary exposure to gluten and affects genetically predisposed individuals. In Mexico, at least 800,000 are estimated to possibly have the disease, prompting the Asociación Mexicana de Gastroenterología to summon a multidisciplinary group of experts to develop the "Clinical guidelines on the diagnosis and treatment of celiac disease in Mexico" and establish recommendations for the medical community, its patients, and the general population. The participating medical professionals were divided into three working groups and were given the selected bibliographic material by the coordinators (ART, LUD, JMRT), who proposed the statements that were discussed and voted upon in three sessions: two voting rounds were carried out electronically and one at a face-to-face meeting. Thirty-nine statements were accepted, and once approved, were developed and revised by the coordinators, and their final version was approved by all the participants. It was emphasized in the document that epidemiology and risk factors associated with celiac disease (first-degree relatives, autoimmune diseases, high-risk populations) in Mexico are similar to those described in other parts of the world. Standards for diagnosing the disease and its appropriate treatment in the Mexican patient were established. The guidelines also highlighted the fact that a strict gluten-free diet is essential only in persons with confirmed celiac disease, and that the role of gluten is still a subject of debate in relation to nonceliac, gluten-sensitive patients.

Indications for and diagnostic yield of capsule endoscopy in the elderly. / Indicaciones y rendimiento diagnóstico de la cápsula endoscópica en el anciano.

INTRODUCTION AND AIMS: The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients. MATERIALS AND METHODS: All consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed. RESULTS: Of 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001). CONCLUSIONS: Capsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield.

[Indications for corticosteroids in gastroenterology]. / Indicaciones de corticoesteroides en gastroenterología.

Since the discovery of anti- inflammatory and immunosuppressive properties of glucocorticoids in the late 40's, these drugs have been a cornerstone in the treatment of a variety of autoimmune and inflammatory diseases, being one of the most prescribed drugs in spite of their side effects occurring in up to 80% of patients treated. In Gastroenterology, as in other medical specialties, glucocorticoids are a widely used tool for the treatment of various diseases affecting the gastrointestinal tract, liver, bile ducts and pancreas, making it necessary to establish when and in which patients are indicated, as well as the glucocorticoid type, dose, route of administration and duration of treatment, taking into account that the long-term use without adequate control produces complications that may outweigh their beneficial effects.

[Thickening of the colon and terminal ileum documented with computer tomography and its correlation with colonoscopic findings at a third-level hospital]. / Engrosamiento colónico y de íleon terminal documentado por tomografía computarizada y su correlación con hallazgos colonoscópicos en un hospital de tercer nivel.

BACKGROUND: Tomographic finding of thickening of colon and terminal ileum and its correlation with colonoscopic findings has been poorly studied. Various radiographic patterns of intestinal thickening suggestive of benign disease have been described, but they cannot completely rule out malignancy. OBJECTIVE: To determine if a relationship exists between colonic wall or terminal ileum thickening documented by computed tomography with abnormal colonoscopic findings and colon cancer. METHODS: Retrospective study of radiology database of a tertiary hospital identifying patients with report of thickening of terminal ileum or colon and have colonoscopy performed. It was investigated the performance of endoscopic biopsies and histopathological outcome. RESULTS: We included 24 patients. The main site of colonic thickening on CT was sigmoid in 8 (33.3%) cases. The most common colonoscopic finding was colorectal tumor probably malignant in 7 (29.2%) patients, but adenocarcinoma was reported in 8 (33.3%) patients. There was a statistically significant relationship between colonic thickening and colorectal cancer (p < 0.001) but no statistically significant association was found between thickening and sigmoid colon cancer. There was statistical significant correlation between weight loss, melena, anemia, constipation, diarrhea, and hematochezia with diagnosis of cancer (p < 0.01). CONCLUSIONS: The finding of thickening of colon documented by computed tomography is significantly associated with the presence of colorectal carcinoma. Additional colonoscopy must always be performed in an attempt to elucidate the origin of this thickening.