Imagen de esofagitis en el inmunocompetente: posibilidades diagnósticas / Esophagitis imaging in the immunocompetent: Diagnostic possibilities

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Anomalía congénita portal como causa de hemorragia digestiva alta / Congenital abnormality of the portal vein as cause of upper digestive tract bleeding

La hemorragia digestiva alta (HDA), es aquella cuyo origen se encuentra en segmentos del tracto digestivo situados por encima del ángulo de Treitz. Entre sus posibles causas, destaca por su importancia la hipertensión portal. Presentamos el caso de un paciente de 4 años que debutó con hemorragia digestiva alta, como consecuencia de hipertensión portal prehepática secundaria a anomalía congénita de ramas portales (AU)

Upper gastrointestinal bleeding is the one whose origin is in the digestive tract segments located above the Treitz angle. Among the possible causes, noted for its importance portal hypertension. We report the case of a male 4 year old with upper gastrointestinal bleeding because of prehepatic portal hypertension secondary to congenital anomaly portal branches (AU)

Lesiones polipoideas en la vesícula biliar / Polypoid lesions of the gallbladder

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Manifestaciones gastrointestinales en al púrpura de Schönlein-Henoch / Gastrointestinal manifestations in Henoch-Schönlein purpura

Objetivo: Describir la clínica, el diagnóstico y el tratamiento de la afectación digestiva secundaria a púrpura de Schdnlein-Henoch (PSH). Material y métodos: Se revisaron las historias de los pacientes diagnosticados de púrpura de Schdnlein-Henoch en dos hospitales pediátricos, en los últimos nueve años. Resultados: El número de pacientes con afectación digestiva fue de 40 (56% de un total de 71). La media de edad fue de 6 años y 1 mes (2-13,5). Los síntomas digestivos precedieron a la afectación cutánea en 27 pacientes (67%). Treinta y ocho pacientes padecieron dolor abdominal cólico, 12 tuvieron rectorragia, uno presentó shock hipovolémico secundario a hematemesis, y en un caso hubo enteropatía pierde-proteínas. Se efectuó ecografía abdominal a 5 pacientes, colonoscopia a 2, y esofagogastroscopia a uno. Se administraron corticoides a 7 pacientes (17%), con una dosis media de 1.5 mg/kg/día (intervalo: 1-2 mg/kg/día) y una mediana de duración del tratamiento de 7 días (3-30). La indicación en todos los casos fue la presencia de dolor abdominal refractario. La evolución tras el tratamiento con esteroides fue satisfactoria en 6 de los 7 pacientes. Conclusiones: 1. La afectación digestiva precedió en un 67% de los casos a la afectación cutánea, por lo que estimamos que la PSH debe tenerse en cuenta ante una abdominalgia de etiología no aclarada. 2. Aunque la hemorragia digestiva fue una de sus manifestaciones, ésta fue, generalmente, de escasa cuantía, y sólo se efectuó endoscopia en un 25% de los casos. 3. Los corticoides se mostraron eficaces a la hora de resolver el dolor abdominal intenso

Objective: To describe the signs and symptoms, diagnosis and treatment of gastrointestinal involvement secondary to Henoch-Schönlein purpura. Material and methods: The medical histories of patients diagnosed with Henoch-Schönlein purpura over the last nine years in two pediatric hospitals were reviewed. Results: Forty patients (56% of a total of 71) presented gastrointestinal symptoms. The mean age was 6 years and 1 month (range: 2 to 13.5 years). The gastrointestinal symptoms preceded the cutaneous involvement in 27 patients (67%). Thirty-eight patients complained of colicky abdominal pain, 12 patients presented rectal bleeding, 1 patient experienced hypovolemic shock secondary to hematemesis and there was one case of protein-losing enteropathy. Abdominal ultrasound was performed in five patients, colonoscopy in two and esophagogastroscopy in one. Corticosteroids were administered to seven patients (17%), at a mean dose of 1.5 mg/kg body weight/day (range: 1 to 2 mg/kg/day) for a mean duration of 7 days (range: 3 to 30 days). The indication was the presence of refractory abdominal pain in every case. The outcome after steroid therapy was satisfactory in 6 of the 7 patients. Conclusions: In 67% of the cases, gastrointestinal involvement preceded cutaneous involvement; thus, we consider that Henoch-Schdnlein purpura should be taken into account when dealing with abdominal pain of uncertain etiology. Although gastrointestinal hemorrhage was one of its manifestations, the amount was generally small. and endoscopy was performed in only 25% of the cases. Corticosteroids proved effective in correcting severe abdominal pain

[Therapeutic alternatives in intestinal failure]. / Alternativas terapéuticas en el fracaso intestinal.

BACKGROUND: Long-term parenteral nutrition is effective in the treatment of intestinal failure. Equally, the results of intestinal transplantation (IT) are promising. The choice of one or other form of treatment depends on the balance between the advantages and disadvantages of each. Based on these premises, we analyzed the outcome of home parenteral nutrition (HPN) for intestinal failure in our patients. METHODS: Intestinal failure was considered when parenteral nutrition was required for more than 5 months. In the 14 patients included in the HPN program since 1993, we reviewed the indication of HPN as well as their suitability for IT. RESULTS: Five of the 14 patients received HPN for causes other than intestinal failure. Of the remaining nine patients, four had severe motility disorder, three had short bowel syndrome, and two had protracted diarrhea of infancy. All these patients would be potential candidates for IT. Five patients were weaned off HPN because of intestinal adaptation between 2.5 and 13 months after starting HPN. One patient died because of lack of venous access. Three patients currently continue on HPN. CONCLUSION: Intestinal rehabilitation constitutes the best option for patients with intestinal failure. HPN offers the best interim treatment while waiting for adaptation. IT should be reserved for those patients with severe complications due to HPN. Nevertheless, it may become a real option for those with indefinite HPN. HPN and IT should be considered as complementary treatments.

Alternativas terapéuticas en el fracaso intestinal / Therapeutic alternatives in intestinal failure

Antecedentes: La nutrición parenteral prolongada es eficaz en el tratamiento del fracaso intestinal. Paralelamente asistimos al desarrollo de programas de trasplante intestinal con resultados esperanzadores. El reto de elegir una u otra forma de tratamiento dependerá del balance entre ventajas e inconvenientes de ambas posibilidades. Bajo estas premisas se analiza la evolución de nuestros pacientes con nutrición parenteral domiciliaria (NPD) por fracaso intestinal. Métodos: Consideramos fracaso intestinal cuando se precisó nutrición parenteral más de 5 meses. Se revisó la indicación, la evolución y la idoneidad como candidato a trasplante en los 14 niños incluidos en el programa de NPD desde 1993.Resultados: Cinco de los 14 pacientes recibieron NPD por causas distintas del fracaso intestinal. De los otros nueve, cuatro padecían una grave alteración de la motilidad; tres un síndrome de intestino corto y dos una diarrea intratable del lactante. Todos serían potenciales candidatos para trasplante intestinal. En cinco niños fue posible suspender la nutrición parenteral por conseguir adaptación intestinal entre 2 meses y medio y 13 meses desde el inicio de la NPD. Una paciente falleció por falta de accesos venosos. Tres pacientes continúan actualmente con NPD. Conclusión: La rehabilitación intestinal constituye la mejor opción para pacientes con fracaso intestinal. La NPD constituye el mejor tratamiento provisional en espera de la adaptación intestinal. El trasplante intestinal debería reservarse para aquellos pacientes que presenten complicaciones graves asociadas a la NPD. Sin embargo, podría considerarse como alternativa para quienes dependen indefinidamente de NPD. Ambas técnicas, NPD y trasplante deben considerarse tratamientos complementarios (AU)

Dolor abdominal / Abdominal pain

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[Corn starch in the treatment of patients with glycogenosis type I and III]. / Almidón de maíz crudo en el tratamiento de pacientes con glucogenosis tipo I y III.

RATIONALE: Administering raw corn starch can maintain normoglycemia for long periods after being ingested, thus facilitating control in patients with type I and III glycogenosis. METHODS: The metabolic effects and the effects on the nutritional status of a treatment with fractionated administrations of raw starch are assessed in two patients with type I glycogenosis (ages 18 and 12 years) and one patient with type III glycogenosis (aged 13 years). In the first two cases the response was previously studied after administering a load of raw corn starch in a water suspension, in an amount similar to the estimated rate of endogenous glucose production during the fasting period (5 mg/kg/minute). RESULTS: The results of the overload of starch showed a normoglycemia and an absence of lactoacidosis between 4 and 6 hours after its ingestion. The three patients were given two doses of raw corn starch (2 g/kg/dose) at 1.00 and 5.00 hours during the night. After one year of treatment, all patients showed glycemia levels at 9.00 AM that were greater than 90 mg/dl and lactic acid levels that were lower than 2.4 mmol/l. Moreover, in two of the cases there was an increase in the growth rate. In all cases the amount of the hepatomegaly decreased as did the size of the hepatic adenomas that were present in two of the cases. CONCLUSIONS: In patients with type I and III glycogenosis, raw corn starch can balance the results of the nightly gastric glucose infusion, both with regard to the metabolic control and with regard to the growth.

[Triple-therapy treatment during 1 month versus 2 weeks in gastroduodenal disease due to Helicobacter pylori in children]. / Tratamiento con triple terapia durante un mes versus dos semanas en la enfermedad gastroduodenal por Helicobacter pylori en el niño.

The aim of this study was to assess the clinical outcome of two different durations of triple therapy in children with Helicobacter pylori infection. We established two treatment groups: 1) Short treatment, including 2 week of bismuth subcitrate, amoxycillin and metronidazole treatment (n = 21) and 2) Long treatment, which included the same therapy for two weeks plus bismuth subcitrate alone for two weeks more (n = 26). We found no difference between the short and long treatments. The infection remained in 14% and 19%, respectively. In both groups, we observed children (19%) with persistent abdominal pain in spite of Helicobacter pylori eradication and gastritis healing. We conclude that it is not necessary to prolong triple therapy more than 2 weeks in order to have therapeutic success.

[Biliary lithiasis in childhood]. / Litiasis biliar en la infancia.

We have reported 28 cases of pediatric cholelithiasis in our hospital between 1980 and 1990. We found risk factors in 15 of these cases (53.6%). The most frequent risk factors were hereditary spherocytosis, cholestasis and obesity. A high frequency of non-hemolytic cholelithiasis was noted. Lithiasis was a casual finding in 13 cases (46.4%). The most frequent symptom was nonspecific abdominal pain, which occurred in 8 patients. Diagnosis was made with echography in every case. The range of time in which the patients were followed ranged between 1-5 years. Eight children required surgery. Among the other twenty, twelve were asymptomatic and six improved spontaneously. The mean age at the moment of diagnosis was younger in the children that spontaneously recovered than in children with permanent lithiasis. Therefore, for this reason, we recommend an observation period before surgery in children younger than 3 years of age.

[Secondary carbohydrate intolerance. Evolutive follow-up (author's transl)]. / Intolerancia secundaria a hidratos de carbono. Control evolutivo.

This study reports 70 children suffering from malabsorption and/or carbohydrate intolerance followed for at least twelve months. Mono and dysaccharide overload curves are considered as very valuable tests together with the clinical signs. These must be carefully observed during the tests and after supression of the malabsorbed sugar. Reliability of the overload tests in the follow-up is pointed out. Variations in the normalization time of the curves for each carbohydrate are determined. Finally 90 min. is considered as an advisable end-point for overload tests.