Ulcerated submucosal gastric tumor. Could it be a benign condition?

In this article we present the case and images of an infrequent submucosal gastric tumor: an inflammatory fibroid polyp or Vanek´s tumor. When the tumor size exceeds the centimeter, it may be difficult to differentiate from malignant lesions. Endoscopic removal may be feasible and curative.

Tumoración gástrica submucosa ulcerada. ¿Puede ser algo benigno? / Ulcerated submucosal gastric tumor. Could it be a benign condition?

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Metástasis pancreática de carcinoma de células de Merkel diagnosticada mediante biopsia guiada por ecoendoscopia / Pancreatic metastasis from a Merkel cell carcinoma diagnosed by ultrasound-guided biopsy

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Gastric polyps: analysis of endoscopic and histological features in our center.

BACKGROUND AND OBJECTIVE: the prevalence of gastric polyps in esophagogastroduodenoscopies (EGDs) ranges between 0.33 and 6.35%. The relative frequency of histological subspecies varies widely among published series. The objective is to describe the endoscopic and histological characteristics of the polypoid lesions, and to study possible associations. MATERIAL AND METHODS: we retrospectively revised the EGDs done in our center in 2009. Demographic, endoscopic and histological data were gathered. We proceeded to a descriptive analysis and studied possible associations. RESULTS: gastric polypoid lesions were found in 269 of the 6,307 (4.2%) reviewed EGDs, 61% were found in women. Mean age was 64.93 years (SD: ±15.23). A single polyp was found in 186 patients (69.1%), over 10 lesions appeared in 31 (11.5%). An estimated size of ≤ 3 mm was found in 108 lesions (37.2%) and greater than 10 mm in 52 cases (17.9%). Most lesions were sessile (90.8%). The location of 34.8% was the gastric antrum, 39.3% were found in the gastric body and 25.9% were in the fundus. Chronic gastritis was confirmed in 53.5% of the patients and 46.5% had received protom pump inhibitors (PPIs). Histopathological diagnosis was: hyperplastic polyps 50.9%, fundic gland polyps 7.4%, adenomas 3%, adenocarcinomas 1.9% and normal mucosa 29.7%. We found no significant association between the histopathological type of lesions and the use of proton pump inhibitor. CONCLUSIONS: we found polypoid lesions in 4.2% of the EGDs. The most frequent histopathological findings were hyperplastic polyps (50.9%), followed by fundic gland polyps (7.4%), adenomas (3%), and adenocarcinomas (1.9%).

Pólipos gástricos: análisis de características endoscópicas e histológicas en nuestro medio / Gastric polyps: analysis of endoscopic and histological features in our center

Antecedentes y objetivo: la prevalencia de pólipos gástricos en la endoscopia digestiva alta (EDA) oscila entre el 0,33 y el 6,35%. La frecuencia de los subtipos histológicos varía ampliamente entre las series publicadas. El objetivo de nuestro estudio es describir las características endoscópicas e histológicas de los pólipos hallados en las EDA y valorar posibles asociaciones. Material y métodos: revisamos retrospectivamente las EDA realizadas en nuestro centro en 2009. Se recogieron variables demográficas, endoscópicas e histológicas. Se realizó un análisis descriptivo y se estudiaron posibles asociaciones. Resultados: se analizaron 6.307 EDA identificándose lesiones polipoideas en 269 (4,2%), el 61% en mujeres. La edad media fue de 64,93 años (DE: ±15.23). En 186 pacientes (69,1%) se objetivó un solo pólipo y en 31 (11,5%), más de 10. Se estimó un tamaño <= 3 mm en 108 lesiones (37,2%), y mayor de 10 mm en 52 casos (17,9%). La mayoría de los pólipos eran sésiles (90,8%). El 34,8% se ubicaban en antro, el 39,3% en cuerpo y el 25,9% en fundus. El 53,5% de los pacientes presentaba gastritis crónica y el 46,5% había recibido inhibidores de la bomba de protones (IBP). Los hallazgos histológicos principales fueron: pólipos hiperplásicos 50,9%, pólipos de glándulas fúndicas 7,4%, adenomatosos 3% y adenocarcinomas 1,9%. En el 29,7% la biopsia mostró una mucosa normal. No se objetivó asociación entre el tipo histológico y el consumo de IBP. Conclusiones: encontramos lesiones polipoideas en el 4,2% de las EDA. La histología relevante más frecuente fueron pólipos hiperplásicos (50,9%), de glándulas fúndicas (7,4%), adenomas (3%) y adenocarcinomas (1,9%)(AU)

Background and objective: the prevalence of gastric polyps in esophagogastroduodenoscopies (EGDs) ranges between 0.33 and 6.35%. The relative frequency of histological subspecies varies widely among published series. The objective is to describe the endoscopic and histological characteristics of the polypoid lesions, and to study possible associations. Material and methods: we retrospectively revised the EGDs done in our center in 2009. Demographic, endoscopic and histological data were gathered. We proceeded to a descriptive analysis and studied possible associations. Results: gastric polypoid lesions were found in 269 of the 6,307 (4.2%) reviewed EGDs, 61% were found in women. Mean age was 64.93 years (SD: ±15.23). A single polyp was found in 186 patients (69.1%), over 10 lesions appeared in 31 (11.5%). An estimated size of <= 3 mm was found in 108 lesions (37.2%) and greater than 10 mm in 52 cases (17.9%). Most lesions were sessile (90.8%). The location of 34.8% was the gastric antrum, 39.3% were found in the gastric body and 25.9% were in the fundus. Chronic gastritis was confirmed in 53.5% of the patients and 46.5% had received protom pump inhibitors (PPIs). Histopathological diagnosis was: hyperplastic polyps 50.9%, fundic gland polyps 7.4%, adenomas 3%, adenocarcinomas 1.9% and normal mucosa 29.7%. We found no significant association between the histopathological type of lesions and the use of proton pump inhibitor. Conclusions: we found polypoid lesions in 4.2% of the EGDs. The most frequent histopathological findings were hyperplastic polyps (50.9%), followed by fundic gland polyps (7.4%), adenomas (3%), and adenocarcinomas (1.9%)(AU)

[Impact of inflammatory bowel disease on sexual function]. / Impacto de la enfermedad inflamatoria intestinal sobre la función sexual.

Like other chronic diseases, inflammatory bowel disease impairs the quality of life of affected individuals, with an impact on all phases of sexual functioning. The most important factors in this dysfunction are depressed mood, inflammatory activity and concomitant diseases. While the main objective of physicians is to improve the systemic and gastrointestinal symptoms of this disease, other factors are also involved in restoring quality of life. Although sexual problems are a concern to patients, this topic has been insufficiently studied and is not generally taken into account by physicians treating inflammatory bowel disease. If comprehensive care is to be provided to patients with inflammatory bowel disease, sexuality should be approached directly and patients should be referred to appropriate specialists if dysfunction is detected.

Impacto de la enfermedad inflamatoria intestinal sobre la función sexual / Impact of inflammatory bowel disease on sexual function

La enfermedad infl amatoria intestinal, como otras enfermedades crónicas, altera la calidad de vida de los individuos que la padecen, produciéndose un impacto en el funcionamiento sexual que afecta a todas las fases del mismo. El ánimo depresivo, la actividad infl amatoria y las enfermedades concomitantes son los factores más importantes implicados en dicha disfunción. Aunque el objetivo principal de los médicos está dirigido, fundamentalmente, a la mejora de los síntomas sistémicos y digestivos de la enfermedad, éstos no son los únicos factores implicados en el restablecimiento de la calidad de vida. Los problemas de la sexualidad se encuentran dentro de las preocupaciones de estos pacientes; sin embargo, dicho aspecto no ha sido sufi cientemente estudiado y, generalmente, no se tiene en cuenta por parte de los médicos responsables de dicha patología. Si se quiere prestar una atención integral a los pacientes con enfermedad infl amatoria intestinal, se debe abordar la sexualidad de una forma directa y remitir a los especialistas oportunos en caso de detectar una disfunción (AU)

Like other chronic diseases, infl ammatory bowel disease impairs the quality of life of affected individuals, with an impact on all phases of sexual functioning. The most important factors in this dysfunction are depressed mood, infl ammatory activity and concomitant diseases. While the main objective of physicians is to improve the systemic and gastrointestinal symptoms of this disease, other factors are also involved in restoring quality of life. Although sexual problems are a concern to patients, this topic has been insuffi ciently studied and is not generally taken into account by physicians treating infl ammatory bowel disease. If comprehensive care is to be provided to patients with infl ammatory bowel disease, sexuality should be approached directly and patients should be referred to appropriate specialists if dysfunction is detected (AU)

[Ulcerative colitis associated with Vogt-Koyanagi-Harada disease]. / Colitis ulcerosa asociada a enfermedad de Vogt-Koyanagi-Harada.

We report the case of a female patient who was diagnosed with Vogt-Koyanagi-Harada disease at the age of 14 years and who developed myelopathy, resulting in paraparesis. A cerebral magnetic resonance imaging scan revealed the presence of T2-hyperintense lesions in the periventricular white matter, suggesting demyelinization. Twelve years later, ulcerative colitis was diagnosed during workup for abdominal pain associated with bloody diarrhea. The association of these two diseases has previously been reported anecdotically. The management of the ulcerative colitis was complicated by the patient's neurological manifestations. Even though recent reports support the use of anti-TNF drugs in the management of Vogt-Koyanagi-Harada-associated uveitis, because of the lack of experience in patients with neurological symptoms, and the presence of apparently demyelinating lesions in our patient, we did not use these drugs in this case.

Síndrome constitucional asociado a hepatotoxicidad por metformina / Constitutional syndrome associated to metformin induced hepatotoxictyn

La metformina es un antidiabético oral frecuentemente utilizado en el tratamiento de la diabetes mellitus tipo 2. En un 5-20% de los pacientes provoca trastornos gastrointestinales inespecíficos. Son mucho más raros otros efectos secundarios de mayor envergadura, como la acidosis láctica. Se han documentado algunos casos aislados de hepatotoxicidad por este fármaco. Presentamos el caso de un paciente con síndrome constitucional y alteración de la bioquímica hepática atribuible a hepatotoxicidad por metformina, tras descartarse mediante múltiples estudios una etiología tumoral y observarse una resolución completa del cuadro con la suspensión del fármaco

Metformin is an oral antidiabetic agent frequently used to manage type II diabetes. This drug produces nonspecific gastrointestinal symptoms in 5-20% of patients and, more rarely, has also been associated with severe adverse effects such as lactic acidosis. Only a few isolated cases of hepatotoxicity due to this drug have been documented. We report the case of an 83-year-old man with constitutional syndrome and hepatic biochemical alterations, which were attributedto metformin after ruling out an oncologic etiology and observing complete clinical and biochemical resolution after withdrawal of the drug

Una causa infrecuente de obstrucción gástrica: síndrome de Bouveret / An uncommon cause of gastric outlet obstruction: Bouveret's syndrome

El síndrome de Bouveret (SB) es un tipo infrecuente de íleo biliar consistente en una obstrucción gastroduodenal secundaria al paso de cálculos desde la vesícula biliar al duodeno, a través de una fístula colecisto o coledocogastroduodenal. La primera descripción de este síndrome la realizó en 1896 León Bouveret. Desde esta época se han descrito en la literatura médica poco más de 200 casos. Si bien la mortalidad del cuadro se establece en un 25%, el pronóstico viene determinado por la comorbilidad, la edad avanzada y el retraso en el diagnóstico. Para llegar al diagnóstico suelen precisarse tanto técnicas radiológicas (radiografía simple, ecografía, tomografía computarizada o resonancia magnética) como endoscópicas. Se debe intentar siempre el tratamiento endoscópico, aunque es muy frecuente que éste sea fallido y sea preciso recurrir al tratamiento quirúrgico. Presentamos el caso de un paciente que consultó por la aparición de vómitos pospandriales y epigastralgia. A continuación discutimos el manejo diagnóstico y terapéutico de esta infrecuente causa de obstrucción gástrica

Bouveret’s syndrome is a rare type of gallstone ileus inwhich a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, aswell as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopictechniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed (AU)

[Constitutional syndrome associated to metformin induced hepatotoxicity]. / Síndrome constitucional asociado a hepatotoxicidad por metformina.

Metformin is an oral antidiabetic agent frequently used to manage type II diabetes. This drug produces nonspecific gastrointestinal symptoms in 5-20% of patients and, more rarely, has also been associated with severe adverse effects such as lactic acidosis. Only a few isolated cases of hepatotoxicity due to this drug have been documented. We report the case of an 83-year-old man with constitutional syndrome and hepatic biochemical alterations, which were attributed to metformin after ruling out an oncologic etiology and observing complete clinical and biochemical resolution after withdrawal of the drug.

[A rare cause of gastric outlet obstruction: Bouveret's syndrome]. / Una causa infrecuente de obstrucción gástrica: síndrome de Bouveret.

Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.