[Approach to thoracic pain from the gastroenterologist's point of view]. / Aproximación al dolor torácico desde el punto de vista del digestólogo.

Chest pain is common in medical consultations. One of the most frequent and serious causes is acute ischemic heart disease, which must be ruled out. The gold standard is coronary angiography. Noncardiac recurrent chest pain has a favorable prognosis. The most frequent cause is esophageal disease, with a prevalence of between 20% and 50%. The most frequent form is gastroesophageal reflux disease followed by esophageal motor disorders. Empirical treatment with high-dose proton pump inhibitors should be considered as a diagnostic-therapeutic test before performing exhaustive complementary investigations of esophageal function. Among complementary tests, manometry combined with 24-hour pH-metry has the highest diagnostic yield. Antidepressants are an acceptable therapeutic option in patients with esophageal visceral hyperalgesia.

Aproximación al dolor torácico desde el punto de vista del digestólogo / Approach to thoracic pain from the gastroenterologist’s point of view

El dolor torácico es un síntoma muy frecuente de consulta médica. La cardiopatía isquémica aguda es una de las causas más frecuentes y de mayor trascendencia, por lo que es prioritario descartarla; para ello, el método de referencia es la coronariografía. El dolor torácico recurrente de etiología no cardíaca tiene un pronóstico muy favorable. Las causas más frecuentes son las enfermedades esofágicas, con una prevalencia de entre el 20 y el 50%, y entre ellas, la más frecuente es la enfermedad por reflujo gastroesofágico, seguida de los trastornos motores del esófago. Un tratamiento empírico con inhibidores de la bomba de protones en dosis altas debería considerarse como prueba diagnosticoterapéutica antes de iniciar un estudio exhaustivo de la función esofágica con exploraciones complementarias, entre las cuales la que mejor rendimiento diagnóstico tiene es la manometría combinada con la pH-metría de 24 h. Los antidepresivos son una aceptable opción terapéutica en pacientes con hiperalgesia visceral esofágica

Chest pain is common in medical consultations. One of the most frequent and serious causes is acute ischemic heart disease, which must be ruled out. The gold standard is coronary angiography. Noncardiac recurrent chest pain has a favorable prognosis. The most frequent cause is esophageal disease, with a prevalence of between 20% and 50%. The most frequent form is gastroesophageal reflux disease followed by esophageal motor disorders. Empirical treatment with high-dose proton pump inhibitors should be considered as a diagnostic-therapeutic test before performing exhaustive complementary investigations of esophageal function. Among complementary tests, manometry combined with 24-hour pH-metry has the highest diagnostic yield. Antidepressants are an acceptable therapeutic option in patients with esophageal visceral hyperalgesia

Hepatitis por hierbas chinas / Hepatitis due to Chinese herbs

No disponible

Perspectivas actuales y futuras del tratamiento del síndrome del intestino irritable* / Current and future prospects of the treatment of the irritable

No disponible

Tos crónica / Chronic cough

No disponible

[Esophageal achalasia with apparently normal relaxation of the lower sphincter: clinical significance and therapeutic response to pneumatic dilatation]. / Acalasia esofágica con relajación aparentemente normal del esfínter inferior: significado clínico y respuesta terapéutica a la dilatación neumática.

OBJECTIVE: To evaluate if the clinical presentation and the response to pneumatic dilation is different in patients with achalasia with an apparent normal lower esophageal sphincter relaxation. DESIGN: Prospective study to compare clinical, radiographic and manometric characteristics and the response to pneumatic dilation according to the ability of the lower esophageal sphincter to relax normally. PATIENTS: One hundred and fifty seven consecutive patients with achalasia were included. Relaxation of the lower esophageal sphincter was abnormal in 130 patients and apparently normal in 27. The response to pneumatic dilation was evaluated in 116 patients, 94 with abnormal function of the lower esophageal sphincter and 22 with normal function. RESULTS: Clinical findings, esophageal diameter and basal pressure of the lower esophageal sphincter were similar in both groups. The efficacy of the dilation, the number of dilations and the rate of complications were also similar. CONCLUSIONS: Patients with achalasia and an apparent normal lower esophageal sphincter relaxation are not different from patients with typical achalasia and present a similar response to pneumatic dilation.

[Are there clinical differences between typical and vigorous achalasia and response to pneumatic dilatation?]. / Existen diferencias clínicas y en la respuesta a la dilatación neumática entre la acalasia típica y la vigorosa?

The aim of this study was to analyze whether the vigorous character of esophageal contraction conditions differences in the clinical characteristics or in response to pneumatic dilatation treatment in patients with achalasia. To do so, a prospective protocol study was designed in which the clinical, radiological, and manometric characteristics of the patients and the response to pneumatic dilatation were compared on the basis of the presence or absence of severe contraction of the esophageal body. One hundred fifty-seven consecutive patients diagnosed with achalasia were included on presentation of a compatible clinical picture and absence of peristalsis in the esophageal body. Out of these patients, 120 presented a manometric pattern of typical achalasia and 37 had vigorous achalasia. Response to pneumatic dilatation was analyzed in 116 patients, 90 with typical achalasia and 26 with vigorous achalasia. Significant differences were only found between the two groups with respect to the greater response tone of the lower esophageal sphincter observed in the patients with vigorous achalasia. There were no differences in the remaining clinical, radiologic or manometric variables compared. Neither were any differences observed in regard to therapeutic response to pneumatic dilatation in the two groups of patients. It may be concluded that differentiation between typical and vigorous achalasia has no clinical or therapeutic significance.

[Computer-assisted analysis of the prognosis in patients with upper gastrointestinal hemorrhage]. / Análisis asistido por ordenador del juicio pronóstico en pacientes con hemorragia digestiva alta.

The prognosis of 189 patients with upper gastrointestinal bleeding was studied with the assistance of a computer. The safety of the prognosis given by the doctor was partially improved with the computer. However, when both judgements were simultaneously considered, the best results were obtained. A scoring-system constructed with simple clinical data proved useful to obtain prognostic judgements with high sensitivity and specificity. It is concluded that the reliability of the prognosis given in patients with upper gastrointestinal bleeding can be improved with objective methods. The improvement is maximal if objective information is evaluated together with clinical information.

Antacids in the treatment of peptic ulcer disease.

In peptic ulcer disease, antacids present a therapeutic effect by neutralizing gastric acid and reducing acid delivery to the duodenum. Furthermore, they reduce the activity of pepsin and have the capacity to bind bile acids. Despite the opinion of most clinicians, the effect of antacids relieving pain in patients with peptic ulcer has not been definitely demonstrated. Furthermore, antacids do not seem to improve the healing rate of gastric ulcer. Earlier studies showed that antacids could hasten the healing of duodenal ulcer when administered at a very high dose. However, recent papers demonstrate that this therapeutic effect is also achieved with a dose with very low neutralizing capacity. Severe side effects are rare, although they can occur in high-risk patients. However, minor problems, such as changes in bowel habits, are more frequent.

Do the stigmata of recent haemorrhage have additional prognostic value in patients with bleeding duodenal ulcer?

To assess the additional prognostic value of endoscopic stigmata of recent haemorrhage (SRH) in addition to clinical data, a pilot study was conducted on 207 duodenal ulcer patients from the OMGE survey. The incidence of SRH was compared in 145 patients who settled and 62 who re-bled. Only active bleeding emerged as significantly commoner in the latter group. Two computer-assisted predictions of further bleeding (before and after addition of the stigmata to a clinical database) were compared with the final outcome. Little improvement, in terms of prognosis for further bleeding, was obtained when SRH data were added. Similar findings were observed in a smaller series from Marburg, FRG.