Pólipos adenomatosos en familiares de primer grado de pacientes con cáncer del colon

Introducción: El cáncer colorectal constituye en la actualidad la segunda neoplasia maligna más frecuente. La mayoría son esporádicos, otra pequeña proporción corresponde a formas hereditarias. Sin embargo, se estima que en un 15 % a 20 % de casos pueden existir un componente hereditario asociado. Los familiares de primer grado de pacientes con cáncer colorrectal, constituyen un universo de mayor riesgo que la población general de padecer esta enfermedad, por lo que se recomienda el cribado en estos individuos. Objetivo: Determinar la frecuencia de pólipos adenomatosos en individuos con familiares de primer grado diagnosticados con cáncer de colon. Métodos: Se realizó un estudio descriptivo, de corte transversal, que incluyó a 126 adultos con familiares de primer grado de consanguinidad con cáncer de colon, a los que se les realizó colonoscopia en el Instituto de Gastroenterología entre diciembre de 2019 y diciembre 2021. Se describen las características de los pólipos adenomatosos encontrados. Resultados: La media para la edad fue de 55,9 ± 10,6, predominaron las mujeres. Se encontraron pólipos adenomatosos; 27 eran sésiles y 12 pediculados; en 26 (66,7 %), el tamaño era menor de 10 mm. La mayoría de los pólipos, fueron del tipo tubular. Se observó diversidad en cuanto a la localización de las lesiones, sin que existiera un predominio en ningún segmento anatómico. Conclusiones: Lesiones precursoras del cáncer colorrectal, como los pólipos adenomatosos, son frecuentes en individuos asintomáticos con familiares de primer grado de consanguinidad que padecieron esta neoplasia maligna.

Introduction : Colorectal cancer is currently the second most frequent neoplasm. Most of them are sporadic, another small proportion corresponds to hereditary forms. However, it is estimated that in 15-20% of cases there may be an associated hereditary component. First-degree relatives of patients with colorectal cancer constitute a universe with a higher risk of developing this disease than that of the general population, so screening is recommended in these individuals. Objective : To determine the frequency of adenomatous polyps in individuals with first-degree relatives diagnosed with colon cancer. Methods : A descriptive, cross-sectional study was carried out, including 126 adult relatives with first-degree blood relatives with colon cancer, who underwent colonoscopy at the Institute of Gastroenterology between December 2019 and December 2021. The characteristics of the adenomatous polyps found are described. Results : The mean for age was 55.9 ± 10.6, women predominated: 94 (74.6 %). Thirty-nine (30.9 %) adenomatous polyps were found; 27 (69.2 %) were sessile and 12 (30.7 %) pedunculated; in 26 (66.7 %) the size was less than 10 mm. The majority, 37 (94.8 %), were of the tubular type. Diversity was observed as to the location of the lesions, with no predominance in any anatomical segment. Conclusions : Precursor lesions of colorectal cancer, such as adenomatous polyps, are common in asymptomatic individuals with first-degree relatives who have had this malignancy.

Hipertransaminasemia, astenia, artralgias e hiperpigmentación cutánea / Hypertransaminasemia, asthenia, arthralgia and skin hyperpigmentation

RESUMEN La hemocromatosis hereditaria es una enfermedad metabólica infrecuente que afecta primariamente al hígado, y que se caracteriza por un incremento de la absorción intestinal de hierro. Se presentó un paciente de 49 años de edad, evaluado en consulta externa, desde alrededor de dos años atrás, por: astenia, anorexia, artralgias e hiperpigmentación cutánea, asociada a hipertransaminasemia y seronegatividad para virus B y C. Los niveles de saturación de transferrina y ferritina evidenciaron la sobrecarga de hierro, y el estado homocigoto para la mutación C282Y confirmó la sospecha diagnóstica; se descartaron otras condiciones como: hepatitis crónica por virus B y C, esteatohepatitis no alcohólica, anemia hemolítica crónica, anemia sideroblástica, talasemia mayor, u otras enfermedades metabólicas que afectan al hígado. La biopsia hepática mostró hallazgos típicos de esta condición. Las flebotomías semanales fueron bien toleradas y se logró una mejoría clínica del paciente y de los parámetros de laboratorio.

ABSTRACT Hereditary hemochromatosis is an uncommon metabolic disease, primarily affecting the liver in which increased intestinal absorption of iron is seen. We presented a 49- year -old patient who was evaluated in an outpatient clinic for suffering from asthenia, anorexia, arthralgia and skin hyperpigmentation associated with hypertransaminasemia and negative serology for B and C viruses from about two years ago. Serum ferritin, and transferrin saturation levels evidenced iron overload and homozygosity for the C282Y mutation confirmed the suspected diagnosis; other conditions were ruled out such as chronic hepatitis due to B and C viruses, non-alcoholic steatohepatitis, chronic hemolytic anemia, sideroblastic anemia, thalassemia major or some other metabolic diseases affecting the liver. Liver biopsy showed typical findings related to this condition. Weekly phlebotomies were well tolerated, as well as clinical improvement of the patient and laboratory parameters were achieved.

Autoimmune Hepatitis in Cuban Patients: A Retrospective Analysis of Clinical and Histological Profiles, Treatments, and Outcomes.

BACKGROUND: Population-based studies on the clinical course and prognosis of autoimmune hepatitis (AIH) from Caribbean countries are limited. OBJECTIVE: The aim of this study was to provide information regarding the clinical and laboratory findings, histological profile, treatments, and outcomes of patients with AIH with long-term follow-up in a tertiary referral center. METHODS: A retrospective study was performed at the National Institute of Gastroenterology in Havana, Cuba, by enrolling 82 patients with a well-documented, long-term clinical course of AIH. Clinical and laboratory findings, histological profiles, treatments, and outcomes were analyzed. RESULTS: At diagnosis, 73 (89%) patients had AIH type 1, 84.1% were women, and their median age was 46.5 years (range, 17-79 years). The median follow-up period was 84 months (interquartile range, 12-276 months). Clinical onset was mild or subclinical in 72% of patients and asymptomatic in 12.2%. At diagnosis, the Hennes's median score was 6 (range, 3-8). Complications were seen in 44 (53.6%) patients, 42 (51.2%) with liver-related complications and 9 (10.9%) without liver-related complications. Cirrhosis was present at diagnosis in 32 (39%) patients. Cirrhosis was subsequently diagnosed in the other 28 patients who were not cirrhotic at diagnosis, over a median follow-up of 12 (IQR, 2-84) months. During follow-up, 6 patients died (7.3%). Cumulative survival at 5 and 10 years was 98.4% and 89%, respectively. A complete biochemical response was achieved in 79% of patients in a mean (SD) of 11.7 (11.6) months. Side effects due to treatment were reported in 76 (92.7%) patients, and no pretreatment factors were found to predict treatment response. CONCLUSIONS: These Cuban patients with AIH had acceptable disease remission rate and a prompt treatment response. Although most patients had advanced-stage liver disease at diagnosis or developed during follow-up, the cumulative survival rate was high when patients were receiving and complying with treatment.

Seudohipoparatiroidismo 1b / Pseudohypoparathyroidism 1b

RESUMEN El seudohipoparatiroidismo 1b se caracteriza por resistencia aislada a la parathormona, en ausencia de las manifestaciones típicas de la osteodisfrofia hereditaria de Albright; debido a alteraciones epigenéticas del locus GNAS. Puede presentarse de forma esporádica, o heredado de manera autosómico dominante por vía materna. Se presenta paciente masculino de 31 años, con antecedentes de tumores óseos y calcificaciones cerebrales diagnosticados a los 14 años; que se consulta por presentar mareo intenso, rigidez del cuello y la boca, dificultad para hablar y tragar, desorientación y trastornos de percepción; con fenotipo y somatometría normales, y signos de tetania latente (Chvostek y Trouseau positivos). Los estudios realizados mostraron: hipocalcemia, hiperfosfatemia, aumento de niveles de parathormona y múltiples calcificaciones en cerebro y cerebelo. Con tales hallazgos se emite el diagnóstico de seudohipoparatiroidismo 1b, el cual se confirma mediante pruebas moleculares con alteración en el patrón de metilación en el locus GNAS. No presentó alteraciones en el estudio de secuenciación de los 13 exones codificantes del GNAS. Se concluyó como un caso esporádico ante la ausencia de historia familiar de hipocalcemia, combinado con amplia pérdida de metilación del gen GNAS y la no evidencia de deleciones. Se presenta el primer reporte de esta enfermedad en Cuba con estudio molecular(AU)

ABSTRACT Pseudohypoparathyroidism 1b is characterized by isolated resistance to parathormone, in the absence of the typical manifestations of hereditary Albright osteodysphrophy; due to epigenetic alterations of the GNAS locus. It can occur sporadically, or inherited in an autosomal dominant way through the mother. We report the case of a 31-year-old male patient, with history of bone tumors and cerebral calcifications diagnosed at age 14. She came to consultation due to severe dizziness, stiff neck and mouth, difficulty speaking and swallowing, disorientation and perception disorders; he showed normal phenotype and somatometry, and signs of latent tetany (positive Chvostek and Trouseau). Studies have shown hypocalcaemia, hyperphosphatemia, increased levels of parathormone and multiple calcifications in the brain and cerebellum. These findings, pseudohypoparathyroidism 1b is diagnosed confirmed by molecular tests showing alteration in the methylation pattern in the GNAS locus. There were no alterations in the sequencing study of the 13 exons coding for GNAS. It was concluded as a sporadic case in the absence of a family history of hypocalcemia, combined with extensive loss of GNAS gene methylation and no evidence of deletions. This is the first report this disease with molecular study in Cuba(AU)

Hiperplasia linfoide ileo-colónica en pacientes pediátricos / Ileo-colonic lymphoid hyperplasia in pediatric patients

Introducción: La Hiperplasia nodular linfoide gastrointestinal constituye una entidad infrecuente con manifestaciones clínicas diversas y con mayor frecuencia en la edad pediátrica. Objetivo: Caracterizar clínica, endoscópica e histológicamente a los pacientes pediátricos con hiperplasia linfoide de colon e íleon terminal diagnosticados en el Instituto de Gastroenterología. Material y Métodos: Se realizó un estudio descriptivo, transversal, en el periodo comprendido entre 2014 y 2016 en el Instituto de Gastroenterología. La muestra estuvo constituida por 50 pacientes, quienes cumplieron los criterios de inclusión y exclusión. Se evaluaron variables demográficas, clínicas, endoscópicas e histológicas, así como el comportamiento de la comorbilidad con enfermedades malignas, enfermedades inflamatorias intestinales, giardiosis, trastornos de la respuesta inmunohumoral y alergias alimentarias. Resultados: El sexo masculino, entre 7-10 años y el color de la piel blanca fueron los más frecuentes. El sangrado rectal fue el síntoma principal (62 por ciento) y la localización a nivel del íleon terminal en 69 por ciento, no se relacionó con enfermedad maligna, hubo tres pacientes con diagnóstico de hiperplasia linfoide de íleon terminal y colitis ulcerosa. El 74 por ciento presentó aspecto nodular por histología y 60 por ciento se le diagnosticó Giardia lamblia, en la evaluación inmunohumoral predominó los pacientes sin inmunocompromiso (78 por ciento), el Prick Test fue positivo en 60 por ciento, sobre todo, a la leche de vaca. Conclusiones: La manifestación clínica que predominó fue el sangrado rectal, endoscópicamente la localización en íleon y la forma nodular por histología. No encontramos comorbilidades con enfermedades malignas y fueron más frecuentes los trastornos alérgicos y parasitarios que las alteraciones inmunológicas(AU)

Introduction: Lymphoid nodular hyperplasia of the gastrointestinal tract is an uncommon entity with diverse clinical manifestations, which is more frequent in the pediatric age. Objective: To characterize clinically, endoscopically, and histologically, those pediatric patients with lymphoid hyperplasia of the colon and terminal ileum diagnosed in the Institute of Gastroenterology. Material and Methods: A descriptive, cross-sectional study was carried out during the period between 2014 and 2016 in the Institute of Gastroenterology. The sample consisted of 50 patients who met the inclusion and exclusion criteria. Demographic, clinical, endoscopic and histological variables were evaluated, as well as the behavior of comorbidity with malignant diseases, inflammatory bowel diseases, giardiasis, disorders of the humoral immune response and food allergies. Results: The male sex, the age group between 7-10 years, and the white skin color were the most frequent. Rectal bleeding was the main symptom (62 percent), and the location of the lesions in the terminal ileum was observed in 69 percent of the patients. There was no relationship between lymphoid hyperplasia and malignant disease, but three patients were diagnosed with lymphoid hyperplasia of the terminal ileum, and ulcerative colitis. 74 percent of the biopsies presented a nodular variety, and 60 percent of the patients were diagnosed with Giardia lamblia; the cases that were not immunocompromised prevailed in the evaluation of humoral immune response (78 percent); the Prick Test was positive in 60 percent of children, especially to cow's milk. Conclusions: The predominant clinical manifestation was rectal bleeding; the localization was in the ileum, which was seen by endoscopic procedure; and the nodular form was demonstrated by histology. We did not find comorbidities with malignant diseases, and allergic and parasitic disorders were more frequently diagnosed than immunological alterations(AU)

Fibrosis Severity as a Determinant of Cause-Specific Mortality in Patients With Advanced Nonalcoholic Fatty Liver Disease: A Multi-National Cohort Study.

BACKGROUND & AIMS: Little is known about the natural course of nonalcoholic fatty liver disease (NAFLD) with advanced fibrosis. We describe long-term outcomes and evaluate the effects of clinical and histologic parameters on disease progression in patients with advanced NAFLD. METHODS: We conducted a multi-national study of 458 patients with biopsy-confirmed NAFLD with bridging fibrosis (F3, n = 159) or compensated cirrhosis (222 patients with Child-Turcotte-Pugh scores of A5 and 77 patients with scores of A6), evaluated from April 1995 through November 2013 and followed until December 2016, death, or liver transplantation at hepatology centers in Spain, Australia, Hong Kong, and Cuba. Biopsies were re-evaluated and scored; demographic, clinical, laboratory, and pathology data for each patient were collected from the time of liver biopsy collection. Cox proportional and competing risk models were used to estimate rates of transplantation-free survival and major clinical events and to identify factors associated with outcomes. RESULTS: During a mean follow-up time of 5.5 years (range, 2.7-8.2 years), 37 patients died, 37 received liver transplants, 88 had initial hepatic decompensation events, 41 developed hepatocellular carcinoma, 14 had vascular events, and 30 developed nonhepatic cancers. A higher proportion of patients with F3 fibrosis survived transplantation-free for 10 years (94%; 95% confidence interval [CI], 86%-99%) than of patients with cirrhosis and Child-Turcotte-Pugh A5 (74%; 95% CI, 61%-89%) or Child-Turcotte-Pugh A6 (17%; 95% CI, 6%-29%). Patients with cirrhosis were more likely than patients with F3 fibrosis to have hepatic decompensation (44%; 95% CI, 32%-60% vs 6%, 95% CI, 2%-13%) or hepatocellular carcinoma (17%; 95% CI, 8%-31% vs 2.3%, 95% CI, 1%-12%). The cumulative incidence of vascular events was higher in patients with F3 fibrosis (7%; 95% CI, 3%-18%) than cirrhosis (2%; 95% CI, 0%-6%). The cumulative incidence of nonhepatic malignancies was higher in patients with F3 fibrosis (14%; 95% CI, 7%-23%) than cirrhosis (6%; 95% CI, 2%-15%). Death or transplantation, decompensation, and hepatocellular carcinoma were independently associated with baseline cirrhosis and mild (<33%) steatosis, whereas moderate alcohol consumption was associated with these outcomes only in patients with cirrhosis. CONCLUSIONS: Patients with NAFLD cirrhosis have predominantly liver-related events, whereas those with bridging fibrosis have predominantly nonhepatic cancers and vascular events.

Tumores neuroendocrinos del tracto gastroenteropancreático. Estudio multicéntrico / Neuroendocrine tumors of the gastroenteropancreatic tract. A multicentric study

Introducción: Los tumores neuroendocrinos del tracto gastroenteropancreático constituyen un grupo infrecuente de neoplasias, de diagnóstico tardío y tratamiento complejo. Objetivo: Caracterizar clínica, macroscópica e histopatológicamente los tumores neuroendocrinos del tracto gastro enteropancreático. Material y Método: Se realizó un estudio observacional descriptivo de corte transversal, con 54 pacientes con diagnóstico histopatológico de estas neoplasias, confirmados por inmunohistoquímica, diagnosticados en el Instituto de Gastroenterología, Instituto Nacional de Oncología y Radiobiología y el Hospital Clínico-Quirúrgico Hermanos Ameijeiras, en el período 2008-2014. Resultados: El sexo femenino (66,7 por ciento y el grupo de edad de 50-69 años (48,1 por ciento), fueron los más frecuentes. La manifestación clínica más reportada fue el dolor abdominal (87 por ciento), seguido de las diarreas (16.7 por ciento), y del íctero (14.8 por ciento). Los tumores fueron más frecuentes en intestino delgado (31,5 por ciento) y páncreas (27,8 por ciento). La lesión endoscópica polipoidea se observó en 88,9% de los pacientes. La mayoría de los tumores midieron menos de 2 cm. Los tumores grado 1 y 2 tuvieron igual comportamiento en cuanto a frecuencia (40.7 por ciento). No hubo asociación estadísticamente significativa entre la localización del tumor, el tamaño y el grado histológico. Conclusiones: Predominó el sexo femenino y el grupo de edad de 50-69 años, el síntoma clínico más frecuente fue el dolor abdominal, las lesiones se localizaron con mayor frecuencia en intestino delgado y páncreas, con un predominio de la forma polipoide como patrón endoscópico y menores de 2 cm. No hubo asociación entre la localización anatómica, el tamaño de la lesión y la clasificación histopatológica(AU)

Diagnosis and Treatment of Autoimmune Liver Diseases in a Tertiary Referral Center in Cuba.

BACKGROUND: Autoimmune liver diseases (AILD) comprise a set of entities characterized by tissue damage as a result of the loss of self-tolerance. There are few reports of AILD from Caribbean countries. OBJECTIVES: The aim of our study was to investigate the clinical patterns, laboratory findings, and immunologic features, treatment responses, and prognoses of AILD in adult patients at a Cuban tertiary referral center. METHODS: A prospective study was conducted at the National Institute of Gastroenterology in Havana, Cuba, from May 2012 to April 2016. Clinical, immunologic, and histologic features of autoimmune hepatitis (AIH), primary biliary cirrhosis, AIH/primary biliary cirrhosis overlap syndrome, autoimmune cholangiopathy, and primary sclerosing cholangitis were recorded. Response to therapy was assessed by serum alanine aminotransferase and bilirubin levels at 3, 6, 12, and 24 months after treatment initiation. RESULTS: Of the 106 patients included in the study, 85.5% were women. The median age at presentation was 47 years. AIH was the most common AILD and was diagnosed in 60 patients (56.6%), 55 of whom had type 1 AIH. Primary biliary cirrhosis was diagnosed in 22 patients (20.7%), overlap syndrome in 16 patients (15%), autoimmune cholangiopathy in 5 patients (4.71%), and PSC in 3 patients (2.8%). Most patients were symptomatic; 48 patients (45.2%) presented with liver cirrhosis, 14.5% of whom had decompensated cirrhosis. Follow-up of treatment was between 6 and 24 months. Prednisone monotherapy was used in 22 AIH patients (36.6%) and a combination of prednisone and azathioprine was used in 28 (46.6%) AIH patients. Response to treatment was seen in 41 AIH patients (68.3%), 33 of whom (55%) had a complete response and 8 of whom (24.2%) relapsed after 12 months of maintenance therapy. No or incomplete response to treatment was seen in 18 patients (30%). In 46 patients with autoimmune cholestasis, ursodeoxycholic acid was used as monotherapy in 25 patients (54.3%). CONCLUSIONS: The clinical profile of AILD in a sample of the Cuban population is similar to that reported in South areas (Developing countries). AIH was more frequent than PBC, and usually presented with advanced liver disease that responded poorly to treatment.

Sarcoma de Kaposi gástrico como causa inusual de sangrado digestivo / Gastric Kaposi’s sarcoma as an unusual cause of digestive bleeding

Fundamento: el sarcoma de Kaposi es un tumor de origen vascular asociado a pacientes con infección por Virus de Inmunodeficiencia Humana. Objetivo: presentar el caso de un paciente con sarcoma de Kaposi gástrico que debuta con cuadro de hemorragia digestiva. Caso Clínico: paciente masculino de 29 años que presenta cuadro de sangrado digestivo alto a forma de melena asociado a dolor abdominal en epigastrio, astenia, anorexia y pérdida de peso. Se realiza estudios complementarios que concluyen sarcoma de Kaposi gástrico en paciente HIV positivo. Conclusiones: el Sarcoma de Kaposi gástrico es una causa inusual de sangrado digestivo por lo cual constituye un hallazgo endoscópico infrecuente en pacientes sin historia personal de infección por HIV.

Background: Kaposi’s sarcoma is a vascular tumor associated with HIV infection (Human Immunodeficiency Virus). Objective: to present the case of a patient with gastric Kaposi's sarcoma who debuted with digestive hemorrhage. Clinical case: a 29-year-old male patient with upper gastrointestinal bleeding associated with abdominal pain in the epigastrium, asthenia, anorexia, and weight loss. Complementary studies were conducted which concluded Gastric Kaposi ’s sarcoma in an HIV-positive patient. Conclusions: gastric Kaposi's sarcoma is an unusual cause of digestive bleeding, making it an uncommon endoscopic finding in patients with no history of HIV infection.

Sarcoma de Kaposi gástrico como causa inusual de sangrado digestivo / Gastric Kaposis sarcoma as an unusual cause of digestive bleeding

Fundamento: el sarcoma de Kaposi es un tumor de origen vascular asociado a pacientes con infección por Virus de Inmunodeficiencia Humana.Objetivo: presentar el caso de un paciente con sarcoma de Kaposi gástrico que debuta con cuadro de hemorragia digestiva.Caso Clínico: paciente masculino de 29 años que presenta cuadro de sangrado digestivo alto a forma de melena asociado a dolor abdominal en epigastrio, astenia, anorexia y pérdida de peso. Se realiza estudios complementarios que concluyen sarcoma de Kaposi gástrico en paciente HIV positivo.Conclusiones: el Sarcoma de Kaposi gástrico es una causa inusual de sangrado digestivo por lo cual constituye un hallazgo endoscópico infrecuente en pacientes sin historia personal de infección por HIV(AU)

Background: Kaposis sarcoma is a vascular tumor associated with HIV infection (Human Immunodeficiency Virus).Objective: to present the case of a patient with gastric Kaposi's sarcoma who debuted with digestive hemorrhage.Clinical case: a 29-year-old male patient with upper gastrointestinal bleeding associated with abdominal pain in the epigastrium, asthenia, anorexia, and weight loss. Complementary studies were conducted which concluded Gastric Kaposi s sarcoma in an HIV-positive patient.Conclusions: gastric Kaposi's sarcoma is an unusual cause of digestive bleeding, making it an uncommon endoscopic finding in patients with no history of HIV infection(AU)

Serum biomarkers can predict a change in liver fibrosis 1 year after lifestyle intervention for biopsy-proven NASH.

BACKGROUND & AIMS: The dynamic response of serum fibrosis biomarkers to histological changes within the liver following lifestyle intervention (LI) is unknown. We explored relationships between changes in serum biomarkers and liver fibrosis in NASH patients undergoing LI. METHODS: Paired liver biopsies were performed in 261 NASH patients to assess fibrosis change after 1 year of LI. We explored the utility of serum fibrosis markers to predict changes in hepatic fibrosis and developed and internally validated a model for predicting fibrosis improvement in patients with baseline fibrosis. RESULTS: Regression, stabilization and worsening of fibrosis occurred in 51 (20%), 165 (63%) and 45 (17%) patients respectively. By multivariable analysis, change in HbA1c (OR, 0.39, P<.01), platelets (OR, 1.22, P<.01) and NFS (OR, 0.27, P<.01), as well as ALT normalization (OR, 9.7, P<.01) were independently associated with fibrosis improvement, whereas change in platelets (OR, 0.96, P<.01), and NFS (OR, 1.8, P<.01) as well as ALT normalization (OR, 0.21, P<.01) were linked to fibrosis progression. A model, including change in HbA1c, platelet and ALT normalization, was significantly more accurate (AUC of 0.96, 95% CI, l0.94-0.99) than NFS, FIB-4 and APRI for predicting fibrosis improvement. Using a threshold of ≥0.497, positive and negative predictive values were 94% (95% CI, 84-98) and 91% (95% CI, 81-96) respectively. CONCLUSIONS: Change in NFS, platelets and ALT normalization are associated with change in liver fibrosis after 1 year of LI. A model including change in HbA1c, platelet and ALT normalization discriminated patients with fibrosis improvement significantly better than other biomarkers.

Poliposis linfomatosa múltiple gastrointestinal / Gastrointestinal multiple lymphomatosus polyposis

La poliposis linfomatosa es una forma poco frecuente de linfoma gastrointestinal primario que ocurre sobre todo en pacientes de la tercera edad. Se reporta un caso de un paciente masculino de 74 años que presenta diarreas de 2 meses de evolución asociado a dolor abdominal, astenia, anorexia y pérdida de peso. Se realiza estudios complementarios que concluyen Poliposis linfomatosa intestinal. (Linfoma de las células del Manto)(AU)

Lymphomatous polyposis is a rare form of primary gastrointestinal that occurs mainly in older adults. This is the case of a male patient aged 74 years who had diarrheas for 2 months associated to abdominal pain, asthenia, anorexia and weight loss. Supplementary studies were performed to finally diagnose intestinal lymphomatous polyposis (Mantle cell lymphoma)(AU)

Poliposis linfomatosa múltiple gastrointestinal / Gastrointestinal multiple lymphomatosus polyposis

La poliposis linfomatosa es una forma poco frecuente de linfoma gastrointestinal primario que ocurre sobre todo en pacientes de la tercera edad. Se reporta un caso de un paciente masculino de 74 años que presenta diarreas de 2 meses de evolución asociado a dolor abdominal, astenia, anorexia y pérdida de peso. Se realiza estudios complementarios que concluyen Poliposis linfomatosa intestinal. (Linfoma de las células del Manto).

Lymphomatous polyposis is a rare form of primary gastrointestinal that occurs mainly in older adults. This is the case of a male patient aged 74 years who had diarrheas for 2 months associated to abdominal pain, asthenia, anorexia and weight loss. Supplementary studies were performed to finally diagnose intestinal lymphomatous polyposis (Mantle cell lymphoma).

Respuesta inmunitaria humoral en pacientes con Colitis Ulcerosa / Introduction: Ulcerative colitis is an inflammatory bowel disease. Little is known about its causes, but genetic, environmental, immunological and bacterial factors have been suggested. Objective: Describe the humoral immune response of patients with ulcerative colitis cared for at the Institute of Gastroenterology from January 2014 to April 2015. Methods: A descriptive cross-sectional prospective study was conducted at the Institute of Gastroenterology from January 2014 to April 2015 which included all the patients diagnosed with ulcerative colitis. An evaluation was performed of clinical, endoscopic and histological variables as well as the results of immunological studies. Results: A predominance was found of the female gender, the over-49 age group and white skin. There was also a predominance of alterations in complement components C3 and C4 and immunoglobulin G. Dependence and isolated correlation was observed between the results of immunological variables and the post-diagnosis time of evolution, the Truelove and Witts clinical scale, the degree of colonoscopic and histological activity, and the degree of dysplasia for p < 0.05. Conclusions: Immune response is a predictive factor for good evolution of the disease, but it does not allow to draw an inference about colonoscopic and histological activity. Immune response, on the other hand, is not related to the clinical evaluation scale of Truelove and Witts, the degree of dysplasia, clinical extraintestinal manifestations or post-diagnosis time of evolution

Introducción: la colitis ulcerosa es una enfermedad inflamatoria intestinal de causa aún poco conocida. Se postulan muchos mecanismos de producción de tipo genético, ambiental, inmunológico, bacteriano.Objetivo : describir la respuesta inmunitaria humoral en pacientes con colitis ulcerosa atendidos en el Instituto de Gastroenterología en el período enero 2014- abril 2015.Métodos: se realizó un estudio descriptivo prospectivo de corte transversal en el Instituto de Gastroenterología, en el período de enero de 2014 a abril de 2015, donde se incluyeron todos los pacientes con diagnóstico de colitis ulcerosa. Se evaluaron variables clínicas, endoscópicas, histológicas y resultado de los estudios inmunológicos.Resultados: predominó el sexo femenino, edad superior a 49 años y blancos; también hubo predominio de alteraciones de complemento C3 y C4 e inmunoglobulina G. Se halló dependencia y correlación aislada entre el resultado de las variables inmunológicas y el tiempo de evolución posdiagnóstico, la escala clínica de Truelove y Witts, el grado de actividad colonoscópica e histológica, así como el grado de displasia para p < 0,05.Conclusiones : la respuesta inmunitaria es un factor predictivo de buena evolución de la enfermedad aunque no permite realizar inferencia sobre la actividad colonoscópica e histológica; además no se encuentra relacionado con la escala de evaluación clínica de Truelove y Witts, el grado de displasia, las manifestaciones clínicas extraintestinales y el tiempo de evolución posdiagnóstico(AU)

Introduction: Ulcerative colitis is an inflammatory bowel disease. Little is known about its causes, but genetic, environmental, immunological and bacterial factors have been suggested.Objective: Describe the humoral immune response of patients with ulcerative colitis cared for at the Institute of Gastroenterology from January 2014 to April 2015.Methods: A descriptive cross-sectional prospective study was conducted at the Institute of Gastroenterology from January 2014 to April 2015 which included all the patients diagnosed with ulcerative colitis. An evaluation was performed of clinical, endoscopic and histological variables as well as the results of immunological studies.Results: A predominance was found of the female gender, the over-49 age group and white skin. There was also a predominance of alterations in complement components C3 and C4 and immunoglobulin G. Dependence and isolated correlation was observed between the results of immunological variables and the post-diagnosis time of evolution, the Truelove and Witts clinical scale, the degree of colonoscopic and histological activity, and the degree of dysplasia for p < 0.05.Conclusions: Immune response is a predictive factor for good evolution of the disease, but it does not allow to draw an inference about colonoscopic and histological activity. Immune response, on the other hand, is not related to the clinical evaluation scale of Truelove and Witts, the degree of dysplasia, clinical extraintestinal manifestations or post-diagnosis time of evolution(AU)

Caracterización de pacientes con colitis ulcerosa atendidos en centro de nivel terciario / Characterization of patients with ulcerative colitis treated at tertiary center

Introducción: la colitis ulcerosa es una afección de la sociedad moderna y su frecuencia en los países desarrollados ha ido en aumento desde mediados del siglo XX. Objetivo: caracterizar a pacientes con colitis ulcerosa. Métodos: se realizó un estudio descriptivo de corte transversal a 176 pacientes, con una edad media de 41,1 ± 14,5 años y colitis ulcerosa, atendidos en el Instituto de Gastroenterología desde enero 2011 hasta diciembre 2012. Resultados: se halló predominio del sexo femenino y el color de la piel blanca, mayor número de pacientes no fumadores y localización de la colitis hacia zona más distal del colon. Los síntomas más frecuentes fueron las diarreas con flemas y el sangrado rectal; mientras que las estenosis y el cáncer, al nivel de colon, y las alteraciones articulares y hepatobiliares, al nivel extracolónico, resultaron las complicaciones predominantes. El tratamiento medicamentoso más utilizado fue azulfidina, mesalazina y prednisona, por vía oral. Las causas más frecuentes de tratamiento quirúrgico fueron la estenosis y el cáncer colorrectal; las de muerte, el cáncer colorrectal y el colangiocarcinoma. Conclusiones: la colitis ulcerosa requiere especial atención por un equipo multidisciplinario y la familia, a partir del conocimiento de la enfermedad y sus complicaciones(AU)

Introduction: ulcerative colitis is a pathology of the modern society, and its frequency in developed countries has been growing since the middle of twenty century. Objective: characterize patients with ulcerative colitis. Methods: a transversal study was conducted in 176 patients with ulcerative colitis who are treated at Gastroenterology Institute from January 2011 to December 2012. Results: predominance of females and white skin color subjects was found, as well as higher number of nonsmoking subjects, the most frequent location of colitis was toward the distal colon area. The most common symptoms were diarrhea with mucus and rectal bleeding; but stenosis and cancer at colon level, joint disorders and hepatobiliary at extracolonic level were the predominant complications. The most widely used drug treatment was Azulfidine, mesalazine and prednisone orally. The most common causes of surgical treatment were stenosis and colorectal cancer. The most common cause death were colorectal cancer and cholangiocarcinoma. Conclusions: ulcerative colitis require special care by a multidisciplinary team and family, from knowledge of the disease and its complications(AU)

Comportamiento clínico, epidemiológico, endoscópico e histológico del cáncer gástrico de tipo epitelial / Clinical, epidemiological, endoscopic and histological behavior of epithelial gastric cancer

Introducción: el cáncer gástrico constituye un grave problema de salud mundial por ser una de las enfermedades de más difícil control. Objetivo: describir las principales características clínicas, epidemiológicas, endoscópicas e histológicas del cáncer gástrico de tipo epitelial. Métodos: estudio observacional de casos y controles, en el Instituto de Gastroenterología, entre septiembre de 2012 y agosto de 2014. Se incluyeron 27 casos y 54 controles. Resultados: predominaron las mujeres (59,3 por ciento, n= 27), fue más frecuente entre 70 a 79 años, edad media de 63,9 años. La epigastralgia fue el síntoma más frecuente en ambos grupos [85,2 por ciento (casos) vs 81,5 por ciento (controles)], su asociación con náuseas, vómitos, astenia, anorexia y pérdida de peso fue más frecuente en los casos, se mostró diferencias estadísticamente significativas (P= 0,008, IC= 1,39-25,31). El signo físico más frecuente fue la palidez cutáneo-mucosa. Fueron más frecuentes las lesiones mayores de 2 cm, en los dos tercios distales del estómago, así como el tipo III (clasificación de Paris). El carcinoma de células en anillo de sello predominó (48,1 por ciento). Conclusiones: la epigastralgia asociada a la astenia, la pérdida de peso y la anorexia constituyen la sintomatología clínica más frecuente en los pacientes con cáncer gástrico de tipo epitelial. El tipo histológico más frecuente fue el carcinoma de células en anillo de sello(AU)

Introduction: Gastric cancer is a serious health problem due to the complexity of its control. Objective: Describe the main clinical, epidemiological, endoscopic and histological characteristics of epithelial gastric cancer. Methods: An observational case-control study was conducted at the Institute of Gastroenterology from September 2012 to August 2014. The study sample consisted of 27 cases and 54 controls. Results: There was a predominance of the female gender (59.3 percent, n= 27) and the 70-79 age group, with a mean age of 63.9 years. Epigastralgia was the most common symptom in both groups [85.2 percent (cases) vs. 81.5 percent (controls)]. Its association with nausea, vomiting, asthenia, anorexia and weight loss was more frequent in cases, with statistically significant differences (P= 0.008, CI= 1.39-25.31). The most common physical sign was skin and mucous pallor. The most frequent lesions were those larger than 2 cm, located in the two distal thirds of the stomach, and type III of the Paris classification. Signet ring cell carcinoma predominated (48.1 percent). Conclusions: Epigastralgia associated to asthenia, weight loss and anorexia are the most common clinical symptoms in patients with epithelial gastric cancer. The most frequent histological type is signet ring cell carcinoma(AU)

Caracterización de pacientes con colitis ulcerosa atendidos en centro de nivel terciario / Characterization of patients with ulcerative colitis treated at tertiary center

Introducción: la colitis ulcerosa es una afección de la sociedad moderna y su frecuencia en los países desarrollados ha ido en aumento desde mediados del siglo XX.Objetivo: caracterizar a pacientes con colitis ulcerosa.Métodos: se realizó un estudio descriptivo de corte transversal a 176 pacientes, con una edad media de 41,1 ± 14,5 años y colitis ulcerosa, atendidos en el Instituto de Gastroenterología desde enero 2011 hasta diciembre 2012.Resultados: se halló predominio del sexo femenino y el color de la piel blanca, mayor número de pacientes no fumadores y localización de la colitis hacia zona más distal del colon. Los síntomas más frecuentes fueron las diarreas con flemas y el sangrado rectal; mientras que las estenosis y el cáncer, al nivel de colon, y las alteraciones articulares y hepatobiliares, al nivel extracolónico, resultaron las complicaciones predominantes. El tratamiento medicamentoso más utilizado fue azulfidina, mesalazina y prednisona, por vía oral. Las causas más frecuentes de tratamiento quirúrgico fueron la estenosis y el cáncer colorrectal; las de muerte, el cáncer colorrectal y el colangiocarcinoma.Conclusiones: la colitis ulcerosa requiere especial atención por un equipo multidisciplinario y la familia, a partir del conocimiento de la enfermedad y sus complicaciones(AU)

Comportamiento clínico, epidemiológico, endoscópico e histológico del cáncer gástrico de tipo epitelial / Clinical, epidemiological, endoscopic and histological behavior of epithelial gastric cancer

INTRODUCCIÓN: el cáncer gástrico constituye un grave problema de salud mundial por ser una de las enfermedades de más difícil control. OBJETIVO: describir las principales características clínicas, epidemiológicas, endoscópicas e histológicas del cáncer gástrico de tipo epitelial. MÉTODOS: estudio observacional de casos y controles, en el Instituto de Gastroenterología, entre septiembre de 2012 y agosto de 2014. Se incluyeron 27 casos y 54 controles. RESULTADOS: predominaron las mujeres (59,3 %, n= 27), fue más frecuente entre 70 a 79 años, edad media de 63,9 años. La epigastralgia fue el síntoma más frecuente en ambos grupos [85,2 % (casos) vs 81,5 % (controles)], su asociación con náuseas, vómitos, astenia, anorexia y pérdida de peso fue más frecuente en los casos, se mostró diferencias estadísticamente significativas (P= 0,008, IC= 1,39-25,31). El signo físico más frecuente fue la palidez cutáneo-mucosa. Fueron más frecuentes las lesiones mayores de 2 cm, en los dos tercios distales del estómago, así como el tipo III (clasificación de Paris). El carcinoma de células en anillo de sello predominó (48,1 %). CONCLUSIONES: la epigastralgia asociada a la astenia, la pérdida de peso y la anorexia constituyen la sintomatología clínica más frecuente en los pacientes con cáncer gástrico de tipo epitelial. El tipo histológico más frecuente fue el carcinoma de células en anillo de sello.

INTRODUCTION: Gastric cancer is a serious health problem due to the complexity of its control. OBJECTIVE: Describe the main clinical, epidemiological, endoscopic and histological characteristics of epithelial gastric cancer. METHODS: An observational case-control study was conducted at the Institute of Gastroenterology from September 2012 to August 2014. The study sample consisted of 27 cases and 54 controls. RESULTS: There was a predominance of the female gender (59.3 %, n= 27) and the 70-79 age group, with a mean age of 63.9 years. Epigastralgia was the most common symptom in both groups [85.2 % (cases) vs. 81.5 % (controls)]. Its association with nausea, vomiting, asthenia, anorexia and weight loss was more frequent in cases, with statistically significant differences (P= 0.008, CI= 1.39-25.31). The most common physical sign was skin and mucous pallor. The most frequent lesions were those larger than 2 cm, located in the two distal thirds of the stomach, and type III of the Paris classification. Signet ring cell carcinoma predominated (48.1 %). CONCLUSIONS: Epigastralgia associated to asthenia, weight loss and anorexia are the most common clinical symptoms in patients with epithelial gastric cancer. The most frequent histological type is signet ring cell carcinoma.

Development and validation of a noninvasive prediction model for nonalcoholic steatohepatitis resolution after lifestyle intervention.

UNLABELLED: Liver biopsy is the gold standard method to assess nonalcoholic steatohepatitis (NASH) resolution after therapeutic interventions. We developed and validated a simple and noninvasive scoring system to predict NASH resolution without fibrosis worsening after 1 year of lifestyle intervention. This was a prospective cohort study conducted in 261 patients with histologically proven NASH who were treated with lifestyle changes for 52 weeks and underwent a second liver biopsy to confirm NASH resolution. We divided the data into development (140 subjects) and validation (121 individuals) sets. NASH resolution occurred in 28% (derivation group) and 27% (validation group). At the multivariable analysis, weight loss (odds ratio [OR] = 2.75, 95% confidence interval [CI] 1.65-4.58; P < 0.01), type 2 diabetes (OR = 0.04, 95% CI 0.005-0.49; P = 0.01), normal levels of alanine aminotransferase at the end of intervention (OR = 9.84, 95% CI 2.21-44.1; P < 0.01), age (OR = 0.89, 95% CI 0.83-0.97; P = 0.01), and a nonalcoholic fatty liver activity score ≥5 (OR = 0.08, 95% CI 0.01-0.43; P < 0.01) were independent predictors of NASH resolution. The area under the receiver operating characteristic curve of the selected model was 0.956 and 0.945 in the derivation and validation cohorts, respectively. Using a score threshold of ≤46.15, negative predictive values were 92% in the derivation and validation groups, respectively. By applying a cutoff ≥69.72, positive predictive values were 92% and 89% in the derivation and validation groups, respectively. Using both cutoffs, a liver biopsy would have been avoided in 229 (88%) of 261 patients, with a correct prediction in 209 (91%) CONCLUSIONS: A noninvasive prediction model including weight loss, type 2 diabetes, alanine aminotransferase normalization, age, and a nonalcoholic fatty liver activity score ≥5 may be useful to identify NASH resolution in patients under lifestyle intervention. (Hepatology 2016;63:1875-1887).