[Comparison of two forms of nasal and pharyngeal topical anestesia for performing esophageal manometry]. / Comparación de dos formas de anestesia tópica nasal y faríngea para la realización de manometría esofágica.

BACKGROUND: The esophageal manometry (EM) is an invasive procedure that causes nasal pain, pharyngeal pain, and nausea. A topical anesthetic may improve tolerance of the examination. OBJECTIVE: To compare the effectiveness of 10% lidocaine with 20% benzocaine as topical anesthetics in order to reduce discomfort during an EM. MATERIALS AND METHODS: 251 patients who had been prescribed an EM received either lidocaine or benzocaine in the nose and pharynx before inserting the catheter An EM was carried out using the usual pull-trough technique and an observer registered the insertion time of the catheter. Patients assessed the intensity of nasal pain and nausea by means of a visual analog scale. Finally, patients were asked whether, if necessary, they would repeat the study. RESULTS: 127 patients were studied in the lidocaine group and 124 in the benzocaine group. The EM was carried out on all patients without complications. Although benzocaine tended to be the preferred anesthetic, no significant differences were found between the groups in relation to nasal pain, nausea, and insertion time. The percentage of patients with moderate or intense discomfort was significantly less in the benzocaine group (nasal pain 10 vs. 33%, p < 0.001; and nausea 24 vs. 36%, p = 0.05). A similar percentage of patients said they would not agree to having another EM (p = NS). CONCLUSIONS: Both lidocaine and benzocaine are topical anesthetics that can reduce discomfort during an EM. Benzocaine seems to achieve a better effect among more patients submitted to this procedure.

[Usefulness of colonoscopy with biopsy for the study of patients with chronic diarrhea]. / La utilidad de la colonoscopia con toma de biopsias en el estudio de pacientes con diarrea crónica.

BACKGROUND: the endoscopic evaluation of the colonic mucosa complemented with biopsy sampling may be very useful in the study of patients with chronic diarrhea. However its value in daily practice has not been extensively explored. OBJECTIVE: to know the utility of colonoscopy with systematic biopsy sampling in the study of the patients with chronic diarrhea. MATERIAL AND METHODS: patients with chronic diarrhea (loose stools and frequent bowel movements for at least four weeks) were examined with colonoscopy and biopsy sampling for systematic histologic examination; even in patients with a normal-appearing mucosa. Patients with the following were excluded: a diagnosis of HIV infection/AIDS, previous colon surgery, known inflammatory bowel disease, gastrointestinal bleeding, anemia or involuntary weight loss. RESULTS: a total of 109 patients were included (63 females, mean age 52 years). Colonoscopy was normal in 53 cases (49%) and abnormal in 56 (51%). The biopsies showed a specific disease in 31 cases (28%), non-specific changes in 58 (53%) and normal mucosa in 20 (18%). Microscopic colitis (lymphocytic or collagenous colitis) was detected in 12 cases (11%) all of them with a normal colonoscopy. Colonoscopy with systematic biopsy sampling allowed making a specific diagnosis in 31 of patients (28%). CONCLUSIONS: colonoscopy with systematic biopsy sampling is very useful in the study of patients with chronic diarrhea, since it established a specific diagnosis in 28% of the patients and 11% with microscopic colitis, all of them with normal mucosa.

[Prevalence of use of alternative and complementary medicine in patients with irritable bowel syndrome, functional dyspepsia and gastroesophageal reflux disease]. / La prevalencia del uso de medicina alternativa y complementaria en pacientes con síndrome de intestino irritable, dispepsia funcional y enfermedad por reflujo gastroesofágico.

INTRODUCTION: The prevalence of use of complementary and alternative medicine (CAM) is high in developed countries and is believed to be even higher in developing countries. There are no data on the use of CAM in patients with gastrointestinal tract disorders in Mexico. OBJECTIVE: To determine the prevalence of CAM use in Mexican patients with gastrointestinal disorders. MATERIAL AND METHODS: A survey was applied to all first-time patients presenting at the gastroenterology service between December 2003 and November 2004. Patients with irritable bowel syndrome (IBS, defined by Rome II), functional dyspepsia (FD, defined by Rome II), and gastroesophageal reflux disease (GERD, defined as erosive esophagitis or abnormal pH intraesophageal monitoring) were included. The use of CAM to relieve gastrointestinal symptoms was examined and the demographic data, the disease history and healthcare use 12 months prior to the study were recorded. RESULTS: The survey was answered by 413 patients (61% IBS, 22% FD y 17% GERD). A total of 181 users of CAM were identified (44% of the total group). The use of CAM was most frequent for IBS (51% IBS, 36% FD, 27% GERD). Herbal medicine was the type of CAM most often used by all groups. The factors associated with CAM use were IBS, history of abdominal surgery, emergency room visits, disabilities and prescription of benzodiazepines, and > or = 3 medical visits for gastrointestinal tract disorders within the previous year. CONCLUSIONS: Prevalence of CAM use is high in general and significantly higher for IBS. Herbal medicine is the most frequently used modality.

[Peritoneal coccidioidomycosis]. / Coccidioidomicosis peritoneal.

BACKGROUND: Peritonitis is a very rare condition that has been found on inmunocompromised patients and patients on peritoneal dialysis. OBJECTIVE: To present one case of a patient with chronic abdominal pain that was found to have coccidioidomycosis. CASE PRESENTATION: 50 year old female with 6 months of intermittent abdominal pain referred to right upper quadrant, nausea and vomiting, without fever or jaundice. On physical exam she had pain localized to right upper quadrant. An US was performed and reported a schleroatrophic and litiasic gallbladder. Exploratory laparoscopy was performed, the findings were diffuse lesions in the peritoneal cavity parietal and visceral, some of them were biopsied. A peritoneal coccidioidomycosis was reported and fluconazol treatment was started. Postoperatory evolution was unremarkable at 3 years. CONCLUSION: Coccidioideal peritonitis is a rare disease, most of the patients are asymptomatic and frequently diagnosed while working up other disease.