A comparative analysis of response to vs. ORS + gelatin tannate pediatric patients with acute diarrhea.

AIM: The study aims to observe the response to treatment with ORS only or ORS + gelatin tannate in two cohorts of pediatric patients with acute diarrhea, with the primary efficacy endpoint being the number of stools at 12 hours from baseline. METHODS: Children aged 3 months to 12 years were included in the study. Only children with acute diarrhea, more than 3 liquid stools, and duration inferior to 72 h were included. Number of stools was recorded as absolute number, categorized as or= 4 stools over 12 hours, and as a stool decrease index (SDI). Other clinical variables were recorded, including weight, fever, vomiting, stool characteristics, and signs of peritonitis/sepsis. RESULTS: Baseline characteristics for the two populations included a mean age of 2.3 years in the ORS group and 2.6 years in the ORS + gelatin tannate group. Children younger than 2 years represented 59.8 and 54.3% in the ORS and ORS + gelatin tannate groups, respectively. Clinical variables such as vomiting, dehydration, weight, and stool decrease index were used to compare the two groups. We found a statistical significant difference between the two groups (p < 0.0001) -- SDI for the ORS group was -0.1894; for the ORS + gelatin tannate group was -0.6023. CONCLUSIONS: We observed a significant decrease in the number of stools and an improvement in the consistency of stools in the ORS + gelatin tannate group. Other clinical variables such as vomiting, dehydration, weight, bloody stools, and peritonitis/sepsis signs showed no statistical differences between the two groups, but did show a general trend toward improvement. The Stool Decrease Index (SDI) showed a 18% decrease in the number of stools for the ORS group and 60% for the ORS + gelatin tannate group. The use of ORS + gelatin tannate was associated with a greater decrease in SDI. Gelatin tannate decreased the number of stools at twelve hours in children.

Análisis comparativo de dos cohortes de pacientes pediátricos con diarrea aguda y respuesta a la solución de rehidratación oral (SRO) frente a SRO + tanato de gelatina / A comparative analysis of response to ORS (oral rehydration solution) vs. ORS + gelatin tannate in two cohorts of pediatric patients with acute diarrhea

Objetivo: el estudio tiene como objetivo observar la respuestaal tratamiento con SRO o SRO + tanato de gelatina en dos cohortesde pacientes pediátricos que presentan diarrea aguda, siendoel número de deposiciones a las 12 horas desde el tratamientoinicial el criterio principal de valoración de la eficacia.Métodos: en el estudio se incluyeron niños de entre 3 meses y12 años de edad. Únicamente se incluyeron niños con diarreaaguda, con más de 3 deposiciones líquidas y menos de 72 horasde evolución. Se registró la variable principal del número de deposicionesy de análisis como número absoluto, categorizado como<= 3 y >= 4 deposiciones en 12 horas y como un índice de disminuciónde deposiciones (IDD). Se registraron otras variables clínicascomo peso, fiebre, vómitos, características de las deposiciones ysignos de peritonitis/sepsis.Resultados: las características principales para las dos poblacionesfueron una edad media de 2,3 años en el grupo de SRO yde 2,6 años en el grupo de SRO + tanato de gelatina. Los niñosmenores de 2 años representaban el 59,8% de los integrantes delgrupo de SRO y el 54,3% de los del grupo de SRO + tanato degelatina. Se registraron variables clínicas como vómitos, deshidratación,peso, fiebre, vómitos, características de las deposiciones ysignos de peritonitis/sepsis. Se creó un índice de disminución delas deposiciones (IDD = final [12 h] - deposiciones iniciales/deposicióninicial) para comparar los dos grupos. Encontramos una diferenciaestadísticamente significativa entre los dos grupos (p <0,0001), el SDI del grupo de SRO fue de -0,1894 y el del grupode SRO + tanato de gelatina fue -0,6023.Conclusiones: observamos una disminución significativa enel número de deposiciones y una mejora en la consistencia de lasdeposiciones en el grupo de SRO + tanato de gelatina...(AU)

Aim: the study aims to observe the response to treatment with ORS only or ORS + gelatin tannate in two cohorts of pediatric patients with acute diarrhea, with the primary efficacy endpoint being the number of stools at 12 hours from baseline. Methods: children aged 3 months to 12 years were included in the study. Only children with acute diarrhea, more than 3 liquid stools, and duration inferior to 72 h were included. Number of stools was recorded as absolute number, categorized as <= 3 and >= 4 stools over 12 hours, and as a stool decrease index (SDI). Other clinical variables were recorded, including weight, fever, vomiting, stool characteristics, and signs of peritonitis/sepsis. Results: baseline characteristics for the two populations included a mean age of 2.3 years in the ORS group and 2.6 years in the ORS + gelatin tannate group. Children younger than 2 years represented 59.8 and 54.3% in the ORS and ORS + gelatin tannate groups, respectively. Clinical variables such as vomiting, dehydration, weigth, and stool decrease index were used to compare the two groups. We found a statistical significant difference between the two groups (p < 0.0001) -- SDI for the ORS group was -0.1894; for the ORS + gelatin tannate group was -0.6023. Conclusions: we observed a significant decrease in the number of stools and an improvement in the consistency of stools in the ORS + gelatin tannate group. Other clinical variables such as vomiting, dehydration, weight, bloody stools, and peritonitis/sepsis signs showed no statistical differences between the two groups, but did show a general trend toward improvement. The Stool Decrease Index (SDI) showed a 18% decrease in the number of stools for the ORS group and 60% for the ORS + gelatin tannate group. The use of ORS + gelatin tannate was associated with a greater decrease in SDI. Gelatin tannate decreased the number of stools at twelve hours in children(AU)

Polipectomía de alto riesgo: cómo prevenir las complicaciones / High-risk polypectomy: how to prevent major complications

No disponible

Hemorragia digestiva por hemangiomatosis difusa de intestino delgado en el anciano / Gastrointestinal hemorrhage caused by a difuse hemangiomatosis of the small bowel in an elderly patient

No disponible

Pathogenic implications of interleukin-8 activity and bacterial phenotype in antral gastritis associated with Helicobacter pylori.

OBJECTIVE: Helicobacter pylori (Hp) infection is characterized by an intense inflammatory infiltrate in the gastric mucosa, which is chemoattracted by different cytokines. Interleukin-8 (IL-8) seems to play an important role in the recruitment of circulating neutrophils, and modulation of IL-8 secretion seems to be a strain marker. This study was designed to examine IL-8 concentrations in the gastric mucosa and their relationship with H. pylori phenotype and histologic findings. METHODS: Gastric biopsies were obtained from the antrum and corpus in 106 patients (69 Hp-positive and 37 Hp-negative). IL-8 levels in the gastric mucosa were analyzed by ELISA and Hp phenotype was determined with a western blot test. RESULTS: 75% of H. pylori strains were CagA+ and 54.2% were VacA+. The Houston classification was used for histologic findings. No association between gastric atrophy or intestinal metaplasia and Hp phenotype was found. The highest IL-8 levels were found in CagA+ infected gastric mucosa, but the difference with respect to infection by a VacA+ strain was not statistically significant. IL-8 levels were highest when neutrophils were the predominant cell in the gastric inflammatory infiltrate (p < 0.05). IL-8 levels were higher in patients with atrophic gastritis than in patients with nonatrophic gastritis (p < 0.05). CONCLUSIONS: In patients with H. pylori infection, IL-8 levels are higher than in Hp-negative patients regardless of Hp phenotype. There is an association between IL-8 and a neutrophilic infiltrate. Perpetuation of a chronic infiltrate could lead to more severe lesions such as atrophic gastritis or intestinal metaplasia, as deduced from the IL-8 levels found in these types of lesion.

Clinical relevance of Helicobacter pylori CagA-positive strains: gastroduodenal peptic lesions marker.

OBJECTIVES: peptic ulcer is characterized by its recurrent nature, which necessitates maintenance treatment in most patients. But this natural history can be changed in patients with peptic ulcer associated to Helicobacter pylori, as shown by the low rates of recurrence and decreased hemorrhagic recidivism associated with this infection. Whether CagA or VacA strains are associated with a greater risk of peptic ulcer is controversial. This study was designed to examine endoscopic findings and their relation with H. pylori phenotype (CagA or VacA). METHODS: 106 selected dyspeptic patients underwent upper gastrointestinal tract endoscopic examination between September 1996 and May 1997 [69 with H. pylori (Hp) and 37 without this infection]. Endoscopic findings were classified as gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), duodenitis (Du), chronic gastritis (CG) and normal mucosa (NM). Hp phenotype was analyzed with a western blot test. RESULTS: 75% of H. pylori strains were CagA-positive and 54.2% were VacA-positive. 82.4% of the cases of DU were associated with a CagA+ phenotype, but the association was not statistically significant. Otherwise 100% of gastric ulcers were associated with CagA+ strains (p < 0.005). VacA phenotype was not associated with any particular endoscopic finding. Peptic ulcer (DU or GU) was also associated with the CagA+ phenotype (p < 0.05). CONCLUSIONS: the CagA+ H. pylori phenotype seems to be a peptic lesion marker, but was more frequently related with GU than with DU in our sample of Spanish patients.

Relevancia clínica de las cepas de Helicobacter pylori CagA positivo: marcador de lesiones pépticas gastroduodenales / Clinical relevance of Helicobacter pylori CagA-positive strains: gastroduodenal peptic lesions marker

INTRODUCCIÓN: la historia natural de la úlcera péptica se puede cambiar en aquellos sujetos en los que ésta se asocia a Helicobacter pylori, como se comprueba en las escasas tasas de recurrencia y en la disminución de las recidivas hemorrágicas por úlcera que se producen en los casos en que se erradica la bacteria. Existe cierta controversia en si la expresión de CagA o VacA por parte de la bacteria se asocia o no a un mayor riesgo de padecer úlcera péptica. OBJETIVO: analizar los hallazgos endoscópicos de una serie de pacientes y su relación con la expresión de CagA o VacA. MATERIAL Y MÉTODO: hemos estudiado 106 pacientes [(69 con infección por Hp (Hp+) y 37 controles (Hp-)] que se sometieron a una endoscopia alta entre Septiembre de 1996 a Mayo de 1997. Los hallazgos endoscópicos se clasificaron en úlcera gástrica (UG), úlcera duodenal (UD), erosiones gástricas (EG), duodenitis (D), gastritis endoscópica (GE) o mucosa normal (MN). El fenotipo se determinó por técnica de Western Blot a partir de una muestra de sangre. RESULTADOS: el 75 por ciento de las cepas de nuestra serie son CagA+ y el 54,2 por ciento VacA+. A pesar de que el 82,4 por ciento de las úlceras duodenales (UD) se asociaron al fenotipo CagA+ esta asociación no es estadísticamente significativa, en cambio encontramos que el 100 por ciento de las UG se asociaron al fenotipo CagA+ (p < 0,05). En relación al fenotipo VacA, no se encontró relación estadísticamente significativa con ninguno de los hallazgos endoscópicos. Así mismo al agrupar a los pacientes con UD o UG (úlcera péptica), comprobamos también que éstas se asociaron en un 88 por ciento de los casos con el fenotipo CagA+ (p < 0,05). CONCLUSIONES: en nuestro entorno el fenotipo CagA+ parece comportarse como marcador de lesiones pépticas, estando más relacionado con la UG que con la UD (AU)

Are there changes in gastric emptying during the menstrual cycle?

BACKGROUND: The questions of whether gastric emptying of solids and liquids differs in men and women and whether emptying is influenced by the action of sex hormones on gastric smooth muscle remain unresolved. METHODS: We analysed the gastric emptying of digestible solids (GES), liquids (GEL), and radiopaque indigestible solids (GER) in three groups of healthy volunteers: 50 women in the follicular phase of the menstrual cycle, 50 women in the luteal phase, and 100 men. [99mTc]-labelled diethylenetriamine pentaacetic acid (DTPA) was used as the radioactive marker for digestible solids, and [111In]DTPA was used as the marker for liquids, to time gastric motility after a solid and a liquid meal. GER was evaluated on a different day in abdominal roentgenograms. RESULTS: GES and GEL were slower in women than in men (P < 0.05), but GER was similar in the two sexes. However, there were no significant differences in GES, GEL, or GER between women in the follicular and those in the luteal phase, between plasma concentrations of oestradiol and progesterone and the variables used to characterize gastric emptying. CONCLUSIONS: Evidence of postprandial 'physiologic gastroparesis' was found in women, although no differences were found between men and women in gastric motility during fasting. The rate of emptying was not related to changes in plasma concentrations of sex hormones during the menstrual cycle.

Altered gastric emptying in patients with irritable bowel syndrome.

Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut.

[Segmental portal hypertension due to a retroperitoneal abscess of tuberculous etiology]. / Hipertensión portal segmentaria debida a absceso retroperitoneal de etiología tuberculosa.

We report a patient with segmental portal hypertension secondary to a retroperitoneal tuberculous abscess. The patient was admitted to the hospital because of upper gastrointestinal bleeding. Gastric varices were the only lesion found at endoscopy. At laparotomy a retroperitoneal abscess was found as the etiology of splenic vein thrombosis. We emphasize the low frequency of this finding and its resolution after splenectomy and antituberculous drugs.