Degree of concordance on the management of patients with gastroesophageal reflux disease. A study among specialists that are members of the Sociedad Latinoamericana de Neurogastroenterología (SLNG).

INTRODUCTION AND AIMS: Due to its different clinical manifestations, gastroesophageal reflux disease (GERD) requires diverse diagnostic and therapeutic interventions. The aim of the study was to evaluate the degree of agreement among Latin American specialists, with respect to the management of GERD. MATERIALS AND METHODS: A cross-sectional study was conducted through a survey with 42 statements (22 related to diagnosis and 20 to treatment) applied to 56 specialists from Latin America. There were 4 possible statement responses: in complete agreement, in partial agreement, in partial disagreement, and in complete disagreement. Reproducibility, level of agreement, and concordance were measured through the Kappa statistic. RESULTS: The response rate was 81% (47/56). General concordance was low, given that there was complete concordance in only 12 statements (28.6%). There was partial concordance in 22 statements (52.4%) and no concordance in 8 (19%). The following themes had the most disagreement: the performance of endoscopy before beginning treatment, the use of proton pump inhibitors (PPIs) in patients with extraesophageal symptoms and with no typical symptoms, and the combined use of PPIs and prokinetics. CONCLUSIONS: In the present study, we found that there was agreement among the Latin American specialists for the diagnosis and management of GERD in less than one-third of the recommendations considered standard. The low concordance could be related to the fact that the availability of diagnostic tools and medications, as well as the prevalence of GERD phenotypes, is different in each country.

Degree of concordance on the management of patients with gastroesophageal reflux disease. A study among specialists that are members of the Sociedad Latinoamericana de Neurogastroenterología (SLNG). / Grado de acuerdo en el manejo de pacientes con enfermedad por reflujo gastroesofágico. Un estudio entre especialistas miembros de la Sociedad Latinoamericana de Neurogastroenterología (SLNG).

INTRODUCTION AND AIMS: Due to its different clinical manifestations, gastroesophageal reflux disease (GERD) requires diverse diagnostic and therapeutic interventions. The aim of the study was to evaluate the degree of concordance among Latin American specialists, with respect to the management of GERD. MATERIALS AND METHODS: A cross-sectional study was conducted through a survey with 42 statements (22 related to diagnosis and 20 to treatment) applied to 56 specialists from Latin America. There were 4 possible statement responses: in complete agreement, in partial agreement, in partial disagreement, and in complete disagreement. Reproducibility, level of agreement, and concordance were measured through the Kappa statistic. RESULTS: The response rate was 81% (47/56). General concordance was low, given that there was complete concordance in only 12 statements (28.6%). There was partial concordance in 22 statements (52.4%) and no concordance in 8 (19%). The following themes had the most disagreement: the performance of endoscopy before beginning treatment, the use of proton pump inhibitors (PPIs) in patients with extraesophageal symptoms and with no typical symptoms, and the combined use of PPIs and prokinetics. CONCLUSIONS: In the present study, we found that there was agreement among the Latin American specialists for the diagnosis and management of GERD in less than one-third of the recommendations considered standard. The low concordance could be related to the fact that the availability of diagnostic tools and medications, as well as the prevalence of GERD phenotypes, are different in each country.

Iron-deficiency anemia as a subclinical celiac disease presentation in an Argentinian population. / La anemia ferropénica como presentación de enfermedad celíaca subclínica en una población argentina.

BACKGROUND: There is a wide heterogeneity in the reports of celiac disease prevalence in iron-deficiency anemia patients. AIM: To determine the prevalence of celiac disease in patients with iron-deficiency anemia. MATERIALS AND METHODS: Adult patients with a diagnosis of iron-deficiency anemia were enrolled for upper endoscopy with duodenal biopsies. Healthy volunteers that underwent upper endoscopy were enrolled as controls. RESULTS: A total of 135 patients with iron-deficiency anemia and 133 controls were enrolled. Celiac disease prevalence was higher in the iron-deficiency anemia group [11.11 vs. 1.51%, OR: 8.18 (1.83-36.55), P=.001). Of the celiac disease patients in the iron-deficiency anemia group, 73.3% had at least one endoscopic sign suggesting villous atrophy, whereas 100% of the celiac disease patients in the control group presented with at least one endoscopic sign. CONCLUSIONS: Patients with iron-deficiency anemia have an increased risk for celiac disease. Up to 25% of these patients may not present any endoscopic sign suggesting villous atrophy.

Small intestinal bacterial overgrowth prevalence in celiac disease patients is similar in healthy subjects and lower in irritable bowel syndrome patients.

BACKGROUND: Untreated celiac disease has traditionally been linked to a greater risk for small intestinal bacterial overgrowth, but the existing evidence is inconclusive. AIMS: To compare the prevalence of small intestinal bacterial overgrowth in subjects with celiac disease compared with control subjects and patients with irritable bowel syndrome. MATERIAL AND METHODS: The study included 15 untreated celiac disease patients, 15 subjects with irritable bowel syndrome, and 15 healthy controls. All enrolled patients underwent a lactulose breath test measuring hydrogen and methane. Small intestinal bacterial overgrowth was defined according to previously published criteria. RESULTS: No differences were found in relation to age or sex. The prevalence of small intestinal bacterial overgrowth was similar between the celiac disease patients and the controls (20 vs. 13.33%, P=NS), whereas it was higher in patients with irritable bowel syndrome (66.66%, P<05). CONCLUSION: There was no difference in the prevalence of small intestinal bacterial overgrowth between the untreated celiac disease patients and healthy controls.

Impact of the endoscopic teaching process on colonic adenoma detection.

BACKGROUND: There has been little reported experience in the Latin American hospital setting in relation to the impact of the endoscopic training process on colonoscopy quality. AIMS: To determine the effect that training in the technique of colonoscopy has on adenoma detection in an Argentinian teaching hospital. MATERIAL AND METHOD: Within the time frame of July 2012 and July 2013, 3 physicians received training in colonoscopy from 4 experienced endoscopists. The colonoscopies performed by the supervised trainees were compared with those carried out by the experienced endoscopists. RESULTS: A total of 318 colonoscopies performed by any one of the 3 supervised trainees and 367 carried out by any one of the experienced endoscopists were included. The univariate analysis showed a non-significant difference in the detection rate of adenomas (30.4 vs. 24.7%, P=.09). In the multivariate analysis, the detection rate of adenomas was significantly higher in the colonoscopies performed by one of the 3 trainees (odds ratio = 1.72 [1.19-2.48]). CONCLUSIONS: The supervised involvement of endoscopic trainees has a positive effect on adenoma detection.

Comparison of abdominal bloating severity between Irritable Bowel Syndrome patients with high and low levels of breath hydrogen excretion in a lactulose breath test.

BACKGROUND: There is growing evidence that gut flora plays a role in the development of Irritable Bowel Syndrome (IBS). Abdominal bloating is a common symptom in these patients and the severity of this symptom could be related to the variations in their fermentative profiles, obtained by measuring the levels of breath hydrogen excretion after lactulose ingestion. AIMS: Our objective was to determine the difference in abdominal bloating severity between IBS patients with high vs low levels of breath hydrogen excretion after lactulose administration. METHODS: Lactulose breath tests were carried out on IBS patients in our institution between July 2009 and August 2010. Patients were requested to fill out a validated questionnaire to assess the severity of their symptoms. Abdominal bloating severity score was compared among patients with high and low breath hydrogen levels. RESULTS: A total of 234 patients were enrolled. There was a statistically significant difference in the abdominal bloating severity score between groups: 7.0 (5.7-8.0) vs 6.5 (5.0-7.5), p=0.001. The comparison among IBS patients with constipation (IBS-C) in both groups also showed a statistically significant difference: 7.5 (6.0-8.5) vs 5.8 (3.5-7.2), p=0.0051. CONCLUSIONS: Those patients with a low level of breath hydrogen excretion after lactulose ingestion presented with significantly greater abdominal bloating than those with a high level of breath hydrogen excretion.

Influencia de la enfermedad periodontal en la evaluación de los trastornos funcionales digestivos / The influence of periodontal disease in the evaluation of functional digestive disorders

Introducción: existe evidencia de una asociación entre las alteraciones de la flora bacteriana intestinal y el síndromde intestino irritable (SII). Dichas alteraciones pueden ser medidas en forma indirecta mediante el test de hidrógeno en aire espirado con lactulosa (THAEL). La flora bacteriana puede verse también alterada en sujetos con enfermedad periodontal (EP). Objetivo: evaluar la influencia de la EP sobre los resultados del THAEL. Materiales y métodos: se incluyeron pacientes con diagnóstico de SII, alo que se les realizó un THAEL. Se evaluó la presencia de EP según la clasificación de la American Dental Association. Se compararon los resultados del THAEL, medidos como área bajo la curva de concentración de hidrógeno/tiempo (ABC) entre aquellos con y sin EP. Resultados: fueron incluidos 51 pacientes, en su mayoría mujeres. El grupo con EP presentó mayor edad. Encontramos un valor basal de hidrógeno significativamente mayor en aquellos con EP que en el grupo sin EP [4 (2-6) vs 1 (1-3.5), p=0.04], pero con el valor de ABC similar entre ambos grupos [2232 (162-5184) vs 2088 (216-6071), p=0.5]. Conclusión: la salud bucal parece ser relevante en el estudio de las alteraciones de la flora bacteriana intestinal, llevando a cambios en los resultados del THAEL.

El incremento del hidrógeno en el aire espirado no predice la intolerancia a la fibra en la dieta en el síndrome del intestino irritable con constipación: estudio piloto / Breath hydrogen levels do not predict fiber intolerance in irritable bowel syndrome with constipation

BACKGROUND: Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. AIM: To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. PATIENTS AND METHODS: 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. RESULTS: Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant deferent. Neither was possible to establish an association between breath H2 and the clinical response to a fiber diet. CONCLUSIONS: In this pilot study we could not detect ary association between breath H2 levels and the clinical response to dietary fiber.

Introducción: Los pacientes con síndrome del intestino irritable (SII) frecuentemente agravan sus síntomas cuando incorporan fibra insoluble en su dieta. Esta intolerancia podría estar relacionada con una incrementada fermentación colónica. El nivel de hidrógeno en el aire espirado es una variable dependiente de la capacidad fermentativa del contenido bacteriano del intestino por lo que podría representar un recurso capaz de predecir el grado de intolerancia a la fibra dietética. Objetivo: El objetivo de este estudio piloto fue investigar si existe una asociación entre los niveles de hidrógeno (H2) en el aire espirado y la respuesta clínica a las dietas con y sin fibra. Pacientes y métodos: En este estudio piloto se incluyeron diez mujeres afectadas de síndrome de intestino irritable con constipación (Criterios Roma II). Siguieron una dieta poco fermentable durante 14 días. En la primera semana las pacientes se sujetaron a la dieta sin ningún agregado, en la segunda semana incorporaron 12 gr diarios de fibra dietaria cruda. Al finalizar ambos períodos las pacientes completaron una escala de Lickert de 7 ítems donde se valoró la respuesta clínica a la dieta administrada y se midió la excreción de H2 en el aire espirado. Resultados: Comparando ambas dietas, se observó que la mediana de las diferencias de los puntajes clínicos (-2,5) indicaba una tendencia favorable a la dieta poco fermentable sin fibra, p=0,048. El incremento de la mediana de la concentración de H2 en el aire espirado fue de 2 ppm para la dieta con fibra, pero el mismo no fue significativo. Tampoco se pudo demostrar una tendencia que permitiera relacionar los valores de H2 con la respuesta clínica a la fibra dietética. Conclusión: Los resultados de este estudio no lograron demostrar una asociación entre los niveles de hidrógeno en el aire espirado y la respuesta clínica a la dieta con fibra.

El incremento del hidrógeno en el aire espirado no predice la intolerancia a la fibra en la dieta en el síndrome del intestino irritable con constipación: estudio piloto / Breath hydrogen levels do not predict fiber intolerance in irritable bowel syndrome with constipation

BACKGROUND: Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. AIM: To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. PATIENTS AND METHODS: 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. RESULTS: Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant deferent. Neither was possible to establish an association between breath H2 and the clinical response to a fiber diet. CONCLUSIONS: In this pilot study we could not detect ary association between breath H2 levels and the clinical response to dietary fiber.(AU)

Introducción: Los pacientes con síndrome del intestino irritable (SII) frecuentemente agravan sus síntomas cuando incorporan fibra insoluble en su dieta. Esta intolerancia podría estar relacionada con una incrementada fermentación colónica. El nivel de hidrógeno en el aire espirado es una variable dependiente de la capacidad fermentativa del contenido bacteriano del intestino por lo que podría representar un recurso capaz de predecir el grado de intolerancia a la fibra dietética. Objetivo: El objetivo de este estudio piloto fue investigar si existe una asociación entre los niveles de hidrógeno (H2) en el aire espirado y la respuesta clínica a las dietas con y sin fibra. Pacientes y métodos: En este estudio piloto se incluyeron diez mujeres afectadas de síndrome de intestino irritable con constipación (Criterios Roma II). Siguieron una dieta poco fermentable durante 14 días. En la primera semana las pacientes se sujetaron a la dieta sin ningún agregado, en la segunda semana incorporaron 12 gr diarios de fibra dietaria cruda. Al finalizar ambos períodos las pacientes completaron una escala de Lickert de 7 ítems donde se valoró la respuesta clínica a la dieta administrada y se midió la excreción de H2 en el aire espirado. Resultados: Comparando ambas dietas, se observó que la mediana de las diferencias de los puntajes clínicos (-2,5) indicaba una tendencia favorable a la dieta poco fermentable sin fibra, p=0,048. El incremento de la mediana de la concentración de H2 en el aire espirado fue de 2 ppm para la dieta con fibra, pero el mismo no fue significativo. Tampoco se pudo demostrar una tendencia que permitiera relacionar los valores de H2 con la respuesta clínica a la fibra dietética. Conclusión: Los resultados de este estudio no lograron demostrar una asociación entre los niveles de hidrógeno en el aire espirado y la respuesta clínica a la dieta con fibra.(AU)

Prevalence, clinical spectrum and atypical symptoms of gastro-oesophageal reflux in Argentina: a nationwide population-based study.

BACKGROUND: Population-based data on gastro-oesophageal reflux in Latin America are lacking. AIM: To assess gastro-oesophageal reflux symptom prevalence, clinical spectrum and association with the atypical symptoms in our country. METHODS: Gastro-oesophageal reflux self-report questionnaires validated at Mayo Clinic, USA, were submitted to a sample of 1000 residents (aged 18-80 years) from 17 representative geographical areas of Argentina. The samples were selected and stratified according to age, gender, geographical areas and size of town of residence provided by the Argentine Bureau of Statistics and Census. RESULTS: The overall prevalence of any typical gastro-oesophageal reflux symptom experienced in the previous year was 61.2% (95% CI, 57.9-64.6), the prevalence of frequent gastro-oesophageal reflux symptoms was 23.0% (95% CI, 20.1-25.9) and the prevalence of gastro-oesophageal reflux disease was 11.9% (95% CI, 9.6-14.1). Frequent gastro-oesophageal reflux symptoms were associated with dysphagia (OR 2.12, 95% CI, 1.27-3.54, P < 0.01), globus (OR 2.22, 95% CI, 1.35-3.66, P < 0.01) and non-cardiac chest pain (OR 1.55, 95% CI, 1.04-2.31, P < 0.05). CONCLUSIONS: In Argentina, typical symptoms of gastro-oesophageal reflux are highly prevalent at the national level, and frequent gastro-oesophageal reflux symptoms are significantly associated with dysphagia, globus and non-cardiac chest pain.

[Multicenter study for the evaluation of the reproducibility in the measurement of rectal sensorial threshold]. / Estudio multicéntrico para la evaluación de la reproducibilidad en la medición del umbral sensorial a la distensión rectal.

A simple way to evaluate the rectal sensorial threshold has been the sloped distention of a rectal balloon, as a way to obtain the required volume to induce desire to defecate (VDE) and pain (VTM). Six medical groups belonging to the Argentine Motility Circle, studied in 14 patients (7M, 7F age 51 +/- 10.1) the VDE and VTM. The measurements were repeated in the same subjects with intervals longer than 24 Hs. The estimate of precision established a coefficient of variation (CV) for VDE of 10.23% (2CV = 20.46%). And so Reproducibility was found to be not acceptable. The CV for VMT was 1.44 (2CV = 2.88%) this could be considered a very good reproducibility. In conclusion, the VTM appears to be a reproducible measurement suitable for clinical and pharmacological studies of the rectal sensorial perception.

Estudio multicentrico para la evaluacion de la reproducibilidad en la medicion del umbral sensorial a la distension rectal / Multicenter study for the evaluation of the reproducibility in the measurement of rectal sensorial threshold

Una forma simple para la evaluación de los umbrales sensoriales del recto ha sido la determinación, mediante la distensión escalonada con un balón intrarrectal, de los volúmenes capaces de generar deseo evacuatorio y dolor. Seis grupos pertenecientes al Círculo de la motilidad, efectuaron en 14 pacientes (7M y 7H edad: 51 DS: 10,1). estudios del volumen de deseo defecatorio (VDE) y del volumen de tolerancia máxima a la distensión rectal (VTM). Los estudios se repitieron con un intervalo no menor de 24 horas en cada uno de los sujetos. El estimado de precisión, estableció un coeficiente de variación (CV) para el VIDE de 10,23 por ciento (2 CV = 20,45 por ciento), lo que no puede ser considerada como una reproducibilidad aceptable. En cambio el CV para el VTM, fue de 1,44 por ciento (2 CV = 2,88 por ciento), lo que s'i puede ser considerada una muy buena reproducibilidad. El VTM es una variable confiable que puede permitir la discriminación sensorial noscioceptiva del recto, pudiendo ser usada para la evaluación clínica y farmacológica

Estudio multicéntrico para la evaluación de la reproducibilidad en la medición del umbral sensorial a la distensión rectal. / [Multicenter study for the evaluation of the reproducibility in the measurement of rectal sensorial threshold]

A simple way to evaluate the rectal sensorial threshold has been the sloped distention of a rectal balloon, as a way to obtain the required volume to induce desire to defecate (VDE) and pain (VTM). Six medical groups belonging to the Argentine Motility Circle, studied in 14 patients (7M, 7F age 51 +/- 10.1) the VDE and VTM. The measurements were repeated in the same subjects with intervals longer than 24 Hs. The estimate of precision established a coefficient of variation (CV) for VDE of 10.23

(2CV = 20.46

). And so Reproducibility was found to be not acceptable. The CV for VMT was 1.44 (2CV = 2.88

) this could be considered a very good reproducibility. In conclusion, the VTM appears to be a reproducible measurement suitable for clinical and pharmacological studies of the rectal sensorial perception.

Estudio multicentrico para la evaluacion de la reproducibilidad en la medicion del umbral sensorial a la distension rectal / Multicenter study for the evaluation of the reproducibility in the measurement of rectal sensorial threshold

Una forma simple para la evaluación de los umbrales sensoriales del recto ha sido la determinación, mediante la distensión escalonada con un balón intrarrectal, de los volúmenes capaces de generar deseo evacuatorio y dolor. Seis grupos pertenecientes al Círculo de la motilidad, efectuaron en 14 pacientes (7M y 7H edad: 51 DS: 10,1). estudios del volumen de deseo defecatorio (VDE) y del volumen de tolerancia máxima a la distensión rectal (VTM). Los estudios se repitieron con un intervalo no menor de 24 horas en cada uno de los sujetos. El estimado de precisión, estableció un coeficiente de variación (CV) para el VIDE de 10,23 por ciento (2 CV = 20,45 por ciento), lo que no puede ser considerada como una reproducibilidad aceptable. En cambio el CV para el VTM, fue de 1,44 por ciento (2 CV = 2,88 por ciento), lo que si puede ser considerada una muy buena reproducibilidad. El VTM es una variable confiable que puede permitir la discriminación sensorial noscioceptiva del recto, pudiendo ser usada para la evaluación clínica y farmacológica (AU)

[Do the physical characteristics of radiopaque markers modify the results of the measurement of colonic transit time?]. / Los caracteres físicos de los Marcadores Radiopacos modifican los resultados de la medición del tiempo de tránsito colónico?

UNLABELLED: This study was performed in 15 healthy control subjects (8 males- age 23-70 and 7 females age 20-74) as a way to compare the total and segmental colonic transit time with two different type of radiopaque markers. One type of markers was 3 mm cut sections of a radiopaque polietilene 14 French Levine tube, with a medium weight of 64.3 mg and a specific gravity (SG) of 1.28. The other type were 7 mm lenticular insoluble barium (lentils) with medium weight of 231 mg and a SG of 1.87. Each subject ingested 20 markers of each type with the breakfast and front and profile plain films of the abdomen were taken 24 and 48 hs after. The total colonic transit time for the polietilene markers was 17.7 hs and 27.3 hs for the barium type (BM) (p < 0.001). The segmental transit time for right colon was 2.4 hs (PM) and 9.7 hs (PM) and 9.7 hs (BM) (p < 0.001) in the left colon 9.5 hs (PM) and 11.3 hs (BM) and in rectoanun 5.9 hs (BM) with no statistical significance. CONCLUSION: the physical characteristics of the radiopaque markers can modify the results of the colonic transit times.

A new method to assess gastric mucosa rewarming time in patients with portal hypertension.

It is possible that the mucosal damage in congestive gastropathy of portal hypertensive patients may have an ischemic basis, since rewarming time in other sites correlates with local blood flow, a method was designed to assess the capacity of the gastric mucosa to rewarm the stomach after a cold challenge, as an index of ischemia. Eleven control subjects and 15 patients with portal hypertension (10 treated with sclerotherapy) were studied with an integrated circuit temperature transducer connected to a digital display. A balloon containing the temperature transducer inside was reversibly fixed 10 cm. proximally to the distal end of a panendoscope. Once upper endoscopy was completed, the balloon placed in the antrum was infused with cooled water (2 degrees C) through a polyethylene tube. The time elapsed for the water to be rewarmed from 20 degrees C to 25 degrees C to 30 degrees C and 20 degrees C to 30 degrees C was measured. Reproducibility of repeated measurements, gave a coefficient of variation of 6%. Total rewarming time was (-mean +/- SD) 178 +/- 51.3 seconds, significantly higher in Portal hypertensive patients as compared to 114 +/- 34.7 seconds in Controls (P < 0.001). (95% Confidence Interval: -X = 63.4 seconds Cl 45.02 to 81.78). 60% of Sensitivity and 100% of Specificity The slower rewarming time in patients with portal hypertension may be the result of mucosal ischaemia, but oedema and cellular infiltration could also affect the heat flow.

Los caracteres fisicos de los marcadores radiopacos modifican los resultados de la medicion del tiempo de transito colonico? / The physical characteristics of radiopaque markers modify the results of the measurement of colonic transit time?

El objetivo de este trabajo es comparar en sujetos controles sanos el tiempo de tránsito colónico total y segmentario con dos tipos de marcadores radiopacos utilizados en nuestro medio. Se estudiaron 16 personas sanas, 8 varones de 23 a 70 años de edad y 7 mujeres de 20 a 74 años con dieta habitual. Un tipo de marcadores corresponde a cilindros huecos de 3 mm de longitud onbtenidos de sondas de Levine 14 French con un peso medio de 64.3 mg y una gravedad específica (GE) de 1.28, el otro tipo de marcadores corresponde a grageas lenticulares indisolubles de bario, de 7 mm de diámetro, 231 mg de peso y GE específica de 1.87. Cada individuo ingirió luego del desayuno 20 marcadores de cada tipo y se obtuvieron radiografías simples de abdomen en decúbito dorsal y lateral izquierdo de pelvis a las 24 hs y 48 hs. El tiempo de tránsito colónico total para marcadores de polietileno fue de 17.7 hs. y para los de bario 27.3 hs. (p < 0.001). En el colon derecho fue respectivamente de 2,4 y 9,7 hs. (p < 0.001) en el izquierdo de 9,5 y 11,3 y en el recto ano de 5,9 y 6,3 (sin significancia estadística). Concluimos que los caracteres físicos de los marcadores radioopacos modifican los resultados del tiempo de tránsito colónico

A new method to asses gastric mucosa rewarming time in patients with portal hypertension

Es posible que el daño mucoso en la gastropatía congestiva de la hipertensión portal puede tener una base de isquemia, desde el tiempo de recalentamiento en otros sitios se correlacione con el flujo sanguíneo local se diseñó un método con el flujo sanguíneo local se diseñó un método para apreciar la capacidad de la mucosa gástrica de volver a calentarse, después de haberla enfriando, como índice de isquemia. Once sujetos control y 15 pacientes con hipertensión portal (10 tratados por escleroterapia) fueron estudiados con un circuito integrado de un transductor de temperatura conectado con una ventana digital. Un balón que contenía al transductor de temperatura fue fijado en forma reversible 10 cm más arriba del extremo de un panendoscopio. Una vez completada la endoscopia se perfundió al balón ubicado en el antro, con agua fría (2ºC) se midió a través de un tubo de polietileno. El tiempo transcurrido para que el agua se recalentara desde 20ºC hasta 25ºC, de 25ºC hasta 30ºC y desde 20ºC hasta 30ºC (fue medido), la reproducibilidad de las mediciones repetidas dio un coeficiente de variación de 6 por ciento. El tiempo total de recalentamiento fue (-X ñ SD) 178 ñ 51,3 segundo, significativamente mayor en los pacientes con hipertensión portal si se lo compara con 114 ñ 34,7 segundos en los controles (95 por ciento de intervalo de confianza:-X 63,4 segundos C1 45,2 a 81,78). Hubo 60 por ciento de sensibilidad y 100 por ciento de especificidad. El recalentamiento más lento en pacientes con hipertensión portal puede ser resultado de la isquemia de la mucosa, pero el edema y la infiltración celular pueden afectar también el flujo sanguíneo (AU)