[Esophageal tuberculosis in an immunocompetent patient]. / Tuberculosis esofágica en paciente inmunocompetente.

We present the case of a 68-year-old man who presented dysphagia and weight loss over the previous three months. Esophageal transit showed extreme stenosis suspicious for neoplasia but which was revealed to be a granulomatous inflammatory lesion. Culture of the lesion revealed Mycobacterium tuberculosis. Chest x-ray showed pulmonary tuberculosis. Esophageal tuberculosis should be considered in patients with dysphagia and pulmonary tuberculosis.

Tonsillectomy and inflammatory bowel disease location.

OBJECTIVE: Epidemiological studies have found an increased frequency of childhood infections and tonsillectomies in patients with inflammatory bowel disease (IBD). The aim of our study was to test whether particular clinical patterns of IBD could be associated with previous tonsillectomy. METHODS: Two hundred and twenty consecutive IBD patients (100 with Crohn's disease (CD) and 120 with ulcerative colitis (UC)) were prospectively assessed and classified into groups according to disease location. In those with a positive history of tonsillectomy, an ear, nose and throat (ENT) examination was carried out to confirm the diagnosis. RESULTS: Eighty-two IBD patients (37%) underwent tonsillectomy in childhood: 47 out of 100 CD patients (47%), and 35 out of 120 UC patients (29%). Disease location in CD patients affected the ileum in 28, and 21 of them were tonsillectomized (tonsillectomy rate of 75%). Thirty-six patients had an ileocolonic location, and 14 of them had had a tonsillectomy (39%). With disease confined to the colon, only 9 out of 29 patients (31%) had undergone previous tonsillectomy. The higher prevalence of tonsillectomy in patients with CD ileitis was statistically significant (P = 0.0034). No significant differences between groups of UC patients according to the extent of the disease were found. CONCLUSION: The ileum is the most prevalent location of disease in CD patients with previous tonsillectomy.

Effect of fiber supplements on internal bleeding hemorrhoids.

BACKGROUND/AIMS: The aim of this study is to assess prospectively the effect of fiber additions on internal bleeding hemorrhoids. MATERIALS AND METHODS: Fifty patients with bleeding internal hemorrhoids are studied and randomized in two groups. Patients in the study group were treated with a commercially available preparation of Plantago Ovata and those in the control group were treated with a placebo. Endoscopy was performed on every patient before and after treatment to establish: a) the degree of hemorrhoidal prolapse, b) the number of congested hemorrhoidal cushions and c) contact bleeding hemorrhoids. RESULTS: During the 15 days of treatment, the average number of bleeding episodes was 4.8 +/- 3.8 for the study group versus 6.4 +/- 3 for the control group (n.s.). During the following 15 days, it decreased to 3.1 +/- 2.7 in the study group versus 5.5 +/- 3.2 (p < 0.05) in the control group and in the last 10 days of treatment a further reduction to 1.1 +/- 1.4 was found in the study group versus 5.5 +/- 2.9 (p < 0.001). The number of congested hemorrhoidal cushions diminished from 2.6 +/- 1 to 1.6 +/- 2.2 after fiber treatment (p < 0.01) and no differences were found in the control group. In the fiber group, hemorrhoids bled on contact in 5 out of 22 patients before treatment and in none after treatment; no differences were found in the control group. No modification of the degree of prolapse was observed after treatment. CONCLUSION: Addition of dietary fiber may improve internal bleeding hemorrhoids although with no immediate effect. Fiber addition should be ensured in patients who refuse invasive treatment, waiting for a more defined form of treatment, or with contraindications.

Antimicrobial therapy for Helicobacter pylori infection versus long-term maintenance antisecretion treatment in the prevention of recurrent hemorrhage from peptic ulcer: prospective nonrandomized trial on 125 patients.

OBJECTIVE: Our objective was to assess the effectiveness of therapy for Helicobacter pylori (HP) on the prevention of recurrent bleeding in patients with recent upper gastrointestinal hemorrhage from peptic ulcers. METHODS: We performed a prospective follow-up study without randomization on 125 consecutive patients (83 males and 42 females) who had presented with their first major episode of upper gastrointestinal hemorrhage from peptic ulcer (22 gastric and 103 duodenal ulcers). All 125 patients were HP-positive. During the acute phase of bleeding, all patients were treated with standard supportive measures. After the acute bleeding phase, patients were allocated to two treatment groups: 1) antimicrobial therapy-84 patients received one of the following three regimens: 1) amoxicillin 500 mg t.i.d. for 10 days + omeprazole 20 mg b.i.d. for 30 days; 2) clarythromycin 500 mg t.i.d. for 12 days + omeprazole 20 mg b.i.d. for 30 days; or 3) amoxicillin 500 mg t.i.d. for 10 days + metronidazole 500 mg t.i.d. for 10 days + colloidal bismuth subcitrate 240 mg b.i.d. for 30 days. For long-term antisecretion maintenance treatment, 41 patients were allocated to either omeprazole 20 mg once a day or ranitidine 150 mg once a day, for 1 yr. RESULTS: During the follow-up period, peptic ulcers recurred in six patients in the antibiotic group (7.14%) and 13 patients in the maintenance group (31.7%) (p < 0.001). The fraction of patients without recurrent bleeding was greater in the antibiotic group than in the maintenance group. Two patients in the antibiotic group (2.3%) and five in the maintenance group (12.1%) had recurrent hemorrhages (p < 0.1). CONCLUSION: Cure of HP infection reduces the recurrence of peptic ulcer and of rebleeding from ulcer disease more effectively than does long-term maintenance therapy.

[Crohn's disease of the duodenum complicated by sclerosing cholangitis and pancreatitis]. / Enfermedad de Crohn duodenal complicada con colangitis esclerosante y pancreatitis.

We describe the case of a 27 year-old man with Crohn's Disease of the duodenum associated with pancreatitis and cholestatic syndrome secondary to sclerosing cholangitis. Pancreatitis resolved along with the clinical improvement of Crohn's Disease. This case supports the concept of an association between duodenal Crohn's Disease, sclerosing cholangitis and pancreatitis.

Endoscopic anal dilatation for fissure-in-ano: a new outpatient treatment modality.

We describe a new therapeutic procedure for fissure-in-ano, endoscopic anal dilatation. Anal dilatation is performed with a two-valved anoscope under local anesthesia in an ambulatory setting. We report our results using this technique in 62 patients after a mean follow-up of 19 months (range: 12-24 months). Thirty days after the procedure, 55 patients (93%) were symptom-free, whereas 3 of them (4.8%) failed to improve. After nineteen months, one patient out of 47 in follow-up had a recurrence. No bleeding, discharge or defects of continence, either transient or permanent, were noted. The results of endoscopic anal dilatation are comparable with those of lateral sphincterotomy, can be achieved at a lower complication rate, with only minor and temporary complications, and performed by physicians with no specific surgical training.