[Eosinophilic enteritis causing intestinal obstruction]. / Enteritis eosinofílica como causa de obstrucción intestinal.

Eosinophilic enteritis is an uncommon disorder of unknown etiology in which the digestive symptoms are associated with eosinophilic infiltration of the different layers of the intestinal wall. Clinical symptoms depend on the layers involved and are usually characterized by peripheral eosinophilia. Radiological findings depend on the layers involved. Definitive diagnosis is based on clinical and histopathological findings. Treatment of choice is currently with corticoids and prognosis is benign with relapses. The pathogenesis remains unclear. We report a patient who presented with intestinal obstruction and describe the follow-up.

[Primary intestinal T lymphoma with massive eosinophilia]. / Linfoma T primario de intestino asociado a intensa eosinofilia.

Primary intestinal T lymphoma with eosinophilia is an infrequent tumour. Its rarity account for the paucity of similar cases recorded in the literature. It affects predominantly middle-aged men and may be associated with ulceration, fistula formation and intestinal perforation with an abdominal mass. Lesions of the intestine with massive tissue eosinophilia may be a difficult diagnostic problem, but this entity displays distinctive histological features. The presence of intense tissue eosinophilia is a T-cell dependent lymphomas response. We describe a case of T lymphoma involving small intestine with massive eosinophilia.

[Eosinophilic gastroenteritis]. / Gastroenteritis eosinofílica.

Eosinophilic gastroenteritis is a rare clinicopathogenic entity of an unknown aetiology in which a variety of digestive symptoms are associated to the eosinophilic infiltration in the intestinal wall. The clinical features depend on the site of eosinophilic infiltration, and the association with peripheral eosinophilia is very frequent. The radiologic findings were not specific and the diagnostic is based on the endoscopic and/or peroral gastrointestinal biopsy. The response to steroid therapy is spectacular. The etiology is unknown but we review the recent literature.

Anisakis, anisakiasis and IgE-mediated immunity to Anisakis simplex.

Anisakis simplex is a common parasite in fish and cephalopods and is not only capable of causing anisakiasis in humans through visceral invasion of the third-stage larvae but can also cause anaphylactic reactions, as has recently been demonstrated. We present the clinical case of a 56-year-old man who initially presented anaphylactic reactions related to eating fish. Shortly afterwards, he began to experience self-limiting recurrences of very intense epigastric pain, nausea and vomiting. Skin tests for immediate hypersensitivity (prick tests) with a commercial extract as well as the determination of specific IgE in the patient's serum were clearly positive for A. simplex. The hemogram did not show eosinophilia. Copro-cultures and parasites in the patient's feces were repeatedly negative. Gastroscopy was normal. The intestinal tract showed contrast flocculation and dilation of ansas in the distal duodenum and proximal jejunum. Biopsy samples of gastric and distal duodenum mucous showed an active process of chronic inflammation with a predominance of eosinophils in the lamina propria. After subjecting the patient to a fish and cephalopod-free diet and treating him with thiabendazole 350 mg every 12 hours for 6 days, he showed no sign of symptoms while awaiting new tests. Even though the diagnosis of IgE-mediated allergy caused by A. simplex offers no room for doubt, we are unable to present a firm diagnosis of anisakiasis as no larva has been seen. Nevertheless, the clinical pattern, the image of the intestinal tract, the eosinophilic infiltrate in the biopsies and the good response to thiabendazole all lead to the suspected existence of anisakiasis in this patient coexisting with IgE-mediated allergy to this parasite.

[Refractory peptic ulcer: the pathogenic mechanisms]. / Ulcera péptica refractaria: mecanismos patogénicos.

The vast majority of peptic ulcers heal after treatment with either H2 receptor antagonists or omeprazole at standard doses. However, it is also recognized that a 5-10% of peptic ulcers will not heal. The possibility of identifying the factors associated with refractory ulcers would have important repercussions. Several retrospective and prospective studies have pointed out a number of clinical, environmental or intrinsic factors. In recent years 2 factors have emerged as the main cause of peptic ulcer. Helicobacter pylori infection and NSAID use, and these two factors might be involved in the pathogenesis of refractory ulcer.