Recurrencia de infección y diversidad de cepas de Helicobacter pylori en adultos tratados con terapia triple estándar empírica en una población de México / Recurrence of infection and diversity of Helicobacter pylori strains in an adult population in Mexico treated with empirical standard triple therapy

Introducción: posterior al tratamiento erradicador de Helicobacter pylori (H. pylori), podría presentarse recurrencia de infección debido a recrudescencia o reinfección. El objetivo de este estudio fue determinar la recurrencia de infección por H. pylori e identificar cepas virulentas de H. pylori al año posterior de su erradicación con terapia triple estándar. Material y métodos: se realizó un estudio cuasiexperimental. La población estudiada fueron pacientes con enfermedades digestivas asociadas a H. pylori que recibieron terapia triple estándar. Todos los pacientes antes del tratamiento erradicador, y solo aquellos pacientes con prueba de aliento con carbono 14 positivo un año posterior al tratamiento se les realizaron cultivos y reacción en cadena de la polimerasa (PCR) de biopsias gástricas para identificación de cepas. Se realizó análisis estadístico mediante el test t de Student y prueba exacta de Fisher, con un nivel de significancia de 0,05. Resultados: se revisaron 128 pacientes, 51 (39,8%) hombres y 77 (60,2%) mujeres, con una edad promedio de 54,8 (DE 13,8) años. Se halló recurrencia anual de infección por H. pylori en 12 (9,3%) pacientes y reinfección y recrudescencia anual en nueve (7%) y tres (2,3%) pacientes respectivamente. La tasa de recrudescencia en proteína antigénica (cagA) fue de 1/30 (3,3%) pacientes y en citotoxina vacuolizante (vacA) fue de 2/112 (1,8%) pacientes. La tasa de reinfección en cagA fue 3/30 (10%) pacientes y en vacA 6/112 (5,3%) pacientes. Conclusiones: en este estudio la recurrencia de infección fue mayor que en países desarrollados con baja prevalencia de H. pylori y menor que en países en vías de desarrollo con mayor prevalencia de H. pylori. Las cepas cagA o vacA s2/m2 fueron aisladas en reinfección y recrudescencia (AU)

Background. After eradication treatment for Helicobacter pylori, infection could recur due to recrudescence or re-infection. The objective of this study was to determine the recurrence of Helicobacter pylori infection and identify virulent Helicobacter pylori strains one year after eradication with standard triple therapy. Material and methods. A quasi-experimental study was performed that included a patient population with digestive diseases associated with Helicobacter pylori who had received standard triple therapy. Cultures and Polymerase Chain Reaction was performed on gastric biopsies for strain identification in all patients prior to eradication treatment and those with a positive carbon 14 breath test one year after eradication treatment. Statistical analysis was performed using the student T test and Fisher’s exact test, statistical significance was set at 0.05. Results. 128 patients were studied, 51 (39.8%) were male and 77 (60.2%) were female with an average age of 54.8 years (DE 13.8). There was an annual recurrence of Helicobacter pylori infection in 12 (9.3%) patients. An annual re-infection and recrudescence occurred in 9 (7 %) and 3 (2.3%) patients respectively. The recrudescence rate for cagA was 1/30 (3.3%) patients and 2/112 (1.8%) patients for vacA. The re-infection rate for cagA was 3/30 (10%) patients and 6/112 (5.3%) patients for vacA. Conclusions. The recurrence of infection in this study was higher than that recorded in developed countries with a low prevalence of H. pylori and lower than that recorded in developing countries with a higher prevalence of H. pylori. The cagA or vacA s2/m2 strains were isolated after re-infection and recrudescence (AU)

Recurrence of infection and diversity of Helicobacter pylori strains in an adult population in Mexico treated with empirical standard triple therapy.

BACKGROUND: After eradication treatment for Helicobacter pylori, infection could recur due to recrudescence or re-infection. The objective of this study was to determine the recurrence of Helicobacter pylori infection and identify virulent Helicobacter pylori strains one year after eradication with standard triple therapy. MATERIAL AND METHODS: A quasi-experimental study was performed that included a patient population with digestive diseases associated with Helicobacter pylori who had received standard triple therapy. Cultures and Polymerase Chain Reaction was performed on gastric biopsies for strain identification in all patients prior to eradication treatment and those with a positive carbon 14 breath test one year after eradication treatment. Statistical analysis was performed using the student T test and Fisher's exact test, statistical significance was set at 0.05. RESULTS: 128 patients were studied, 51 (39.8%) were male and 77 (60.2%) were female with an average age of 54.8 years (DE 13.8). There was an annual recurrence of Helicobacter pylori infection in 12 (9.3%) patients. An annual re-infection and recrudescence occurred in 9 (7 %) and 3 (2.3%) patients respectively. The recrudescence rate for cagA was 1/30 (3.3%) patients and 2/112 (1.8%) patients for vacA. The re-infection rate for cagA was 3/30 (10%) patients and 6/112 (5.3%) patients for vacA. CONCLUSIONS: The recurrence of infection in this study was higher than that recorded in developed countries with a low prevalence of H. pylori and lower than that recorded in developing countries with a higher prevalence of H. pylori. The cagA or vacA s2/m2 strains were isolated after re-infection and recrudescence.

Calidad de vida relacionada con la salud en adultos con síndrome de intestino irritable en un hospital de especialidades de México. Estudio transversal / Health-related quality of life in adults with irritable bowel syndrome in a Mexican specialist hospital. A cross-sectional study

Introducción: existe evidencia del impacto negativo del síndrome de intestino irritable (SII) en la calidad de vida de los pacientes que lo padecen en comparación con la población general. Objetivo: el objetivo de este estudio fue determinar la calidad de vida relacionada con la salud (CVRS) en adultos con SII en la consulta de un hospital de especialidades de México. Material y métodos: se realizó un diseño transversal y se incluyeron prospectivamente pacientes consecutivos con diagnóstico de SII con criterios de Roma III que acudieron a consulta externa. Se aplicó el cuestionario SF-36 en español versión estándar y sus resultados se compararon con puntuaciones referenciales poblacionales en México. En el análisis estadístico se utilizó t de Student, análisis de varianza y Chi cuadrado, y se consideró una significancia del 0,05%. Resultados: fueron estudiados 154 pacientes, 137 (89%) mujeres y 17 (11%) hombres; la edad media fue de 52,8 (DE 12,6) años. Los subtipos estreñimiento, diarrea y mixto fueron 85 (55,2%), 27 (17,5%) y 42 (27,3%) pacientes respectivamente. La calidad de vida de pacientes con SII vs. puntuaciones referenciales poblacionales en México fueron: subescala salud física 50 vs. 79 y subescala salud mental 59,1 vs. 76,7, respectivamente (p = 0,000). No existió diferencia significativa en la calidad de vida entre los subtipos de SII (p > 0,05). Conclusiones: la CVRS es menor en pacientes con SII en una población al noroeste de México con respecto a datos de un estudio de referencia poblacional realizado en el mismo país, pudiendo realizar inferencia a población de mujeres pero con cautela en los resultados por la muestra pequeña estudiada en hombres. No existió diferencia significativa en la calidad de vida según el subtipo clínico de SII (AU)

Introduction: There are only few reports regarding the use of intragastric-balloons (IGB®) to achieve weight loss and subsequently decrease surgical complications. In this study, we try to assess whether presurgery weight loss using IGB decreases the postsurgical mortality after bariatric surgery. Methods: This is a prospective case-control study. We matched 1:1 by gender, age (± 10 y-o) and type of surgery (sleeve resection [LSG] or gastric bypass [LGBP]), matching cases (A) and controls (H, from a historic cohort). Morbidly obese patients with an indication for bariatric surgery were included in the study. Cases (A) were recruited from an ongoing clinical trial, and the controls (H) came from a historic cohort prior to the start of the clinic trial. The presurgical weight loss in group A was reached by IGB combined with diet, versus only diet in group H. Results: We included 58 patients, 65.5% women, 69% LGBP/31% LSG. The mean age of group A was 42 and 43.4 years old for group H. ASA III of 24.1% group A vs 58.6% group H, p = 0.012. The mean total weight loss (TWL) before surgery was greater in group A (16.2 kg, SD 9.75) than in group H (1.2 kg, SD 6.4), p < 0.0001. The % of EWL before surgery was 23.5 (SD 11.6) in group A vs 2.4 (SD 8) in group H, p < 0.001. Hospital stay was seven days for group A, and eight days for group H, p = 0.285. The rate of unsuccessful IGB treatment to accomplish the scheduled weight loss was 34.5%. The balloon morbidity was 17.2% (6.9% severe). All in all, morbidity (due to bariatric surgery and IGB) was 41% in both groups. Postsurgical morbidity moderate-severe was 20.3% in group A (6.9% severe) and 27.3% in group H (17.2% severe) without statistical significance. One patient died in group H (mortality rate, 3.44%). Conclusion: Preoperative IGB treatment in morbid obesity has not been found to be effective at decreasing postsurgical morbidity LSG and LGBP, despite the fact that it acheives a greater weight loss than diet and exercise (AU)

Health-related quality of life in adults with irritable bowel syndrome in a Mexican specialist hospital. A cross-sectional study.

BACKGROUND: Evidence shows the negative impact of irritable bowel syndrome on the quality of life of patients who suffer from the condition as compared to the general population. OBJECTIVE: The objective of this study was to determine the health-related quality of life in adults with irritable bowel syndrome who are receiving treatment at a specialist hospital. MATERIAL AND METHODS: The study had a cross-sectional prospective design. The study included consecutive patients diagnosed with irritable bowel syndrome under the Rome III criteria and attending outpatient appointments. The SF-36 questionnaire was applied in its standard Spanish version and the results were compared with population reference scores in Mexico. Statistical analysis was performed with the Student's t test, analysis of variance and the Chi-squared test, considering a significance of 0.05%. RESULTS: One hundred and fifty-four patients were included in the study, 137 (89%) women and 17 (11%) men, with an average age of 52.8 (SD 12.6). The constipation, diarrhea and mixed subtypes comprised 85 (55.2%), 27 (17.5%) and 42 (27.3%) patients, respectively. The quality of life of patients with irritable bowel syndrome vs the population reference scores in Mexico were 50 vs 79 for the physical health sub-scale and 59.1 vs 76.7 for the mental health sub-scale, respectively (p = 0.000). No significant difference was found in quality of life among the irritable bowel syndrome subtypes (p > 0.05). CONCLUSIONS: Health-related quality of life is lower in patients with irritable bowel syndrome in a population in the North East of Mexico compared to the data taken from a population reference study undertaken in the same country, enabling an inference in the female population and a cautious one from the results found in the small male sample studied. There was no significant difference found in the quality of life according to the clinical subtype of irritable bowel syndrome.

Regresión de la metaplasia intestinal gástrica tras la erradicación de la infección por Helicobacter pylori en un hospital de México / Regression of gastric intestinal metaplasia after the eradication of Helicobacter pylori infection in a hospital in Mexico

Introducción: la metaplasia intestinal es una lesión precursora del cáncer gástrico. La infección por Helicobacter pylori es la principal causa de metaplasia. Aunque se ha demostrado evidencia de regresión de metaplasia intestinal tras el tratamiento erradicador de esta infección, aún existen controversias al respecto. Objetivo: el objetivo de este estudio fue determinar la frecuencia de la regresión de la metaplasia intestinal gástrica al año de haber erradicado Helicobacter pylori.Métodos: se realizó un diseño prospectivo, longitudinal. La población estudiada fueron pacientes que acudieron a la Unidad de Endoscopia para la realización de una endoscopia digestiva alta por distintas indicaciones, comprobándose metaplasia intestinal asociada a Helicobacter pylori, y que recibieron terapia triple estándar empírica con erradicación de la bacteria. Se realizó una endoscopia digestiva alta con toma de cuatro muestras de biopsias gástricas (dos en antro y dos en cuerpo) antes y después del tratamiento erradicador, estudiándose los hallazgos endoscópicos e histológicos al año de seguimiento. Análisis estadístico con prueba exacta de Fisher y McNemar. Resultados: fueron estudiados 46 pacientes, 20 (43,5%) hombres y 26 (56,5%) mujeres, con edad media de 58,9 (DE 11,2) años. Se encontró metaplasia intestinal en 46 (100%) pacientes antes del tratamiento y en 21 (45,7%) tras la erradicación; metaplasia intestinal completa (tipo I) en 35 pacientes (76,1%) antes del tratamiento y en 11 (23,9%) posterior a la erradicación (p = 0,000); metaplasia intestinal incompleta (tipo II) en 10 (21,7%) pacientes antes del tratamiento y en 10 (21,7%) posterior a la erradicación; y gastritis crónica no atrófica en 35 (76,1%) pacientes antes del tratamiento y en 32 (69,6%) pacientes posterior a la erradicación. Conclusiones: en este estudio la metaplasia intestinal gástrica asociada a la infección por Helicobacter pylori presentó una regresión al año del 54,3% posterior a la erradicación de este microorganismo. Este tratamiento podría modificar la historia natural del desarrollo del cáncer gástrico (AU)

Background: Intestinal metaplasia is a precursor lesion of gastric cancer. Infection by Helicobacter pylori is the principal cause of metaplasia. While evidence of the regression of metaplasia after treatment to eradicate this infection has been demonstrated, controversy remains with regard to this subject. Objective: The objective of this study was to determine the frequency of the regression of gastric intestinal metaplasia one year after the eradication of Helicobacter pylori. Methods: A prospective longitudinal designed study was carried out. The population studied in this research consisted of patients attending the Endoscopy Unit to undergo an upper endoscopy, in whom various symptoms indicated intestinal metaplasia associated with Helicobacter pylori, and who received standard empiric triple therapy to eradicate the bacteria. An upper endoscopy was performed in which four gastric biopsy samples were taken (two from the antrum and two from the body) before and after the eradicating treatment, with the endoscopic and histological findings studied after one year of monitoring. The statistical analysis was conducted using the Fisher’s exact test and the McNemar’s test. Results: Forty-six patients were studied, of whom 20 (43.5%) were men and 26 (56.5%) were women, with an average age of 58.9 (DE 11.2). Intestinal metaplasia was found in 46 (100%) patients before treatment and in 21 (45.7%) patients post-eradication. Complete intestinal metaplasia (type I) was found in 35 patients (76.1%) before treatment and in 11 (23.9%) patients post-eradication (p = 0.000), while incomplete intestinal metaplasia (type II) was found in 10 (21.7%) patients before treatment and in 10 (21.7%) patients post-eradication. Non-atrophic chronic gastritis was found in 35 (76.1%) patients before treatment and in 32 (69.6%) patients post-eradication. Conclusions: In this study, gastric intestinal metaplasia associated with Helicobacter pylori infection showed a regression of 54.3% one year after the eradication of this microorganism. This treatment could modify the natural history of the development of gastric cáncer (AU)

Regression of gastric intestinal metaplasia after the eradication of Helicobacter pylori infection in a hospital in Mexico.

BACKGROUND: Intestinal metaplasia is a precursor lesion of gastric cancer. Infection by Helicobacter pylori is the principal cause of metaplasia. While evidence of the regression of metaplasia after treatment to eradicate this infection has been demonstrated, controversy remains with regard to this subject. OBJECTIVE: The objective of this study was to determine the frequency of the regression of gastric intestinal metaplasia one year after the eradication of Helicobacter pylori. METHODS: A prospective longitudinal designed study was carried out. The population studied in this research consisted of patients attending the Endoscopy Unit to undergo an upper endoscopy, in whom various symptoms indicated intestinal metaplasia associated with Helicobacter pylori, and who received standard empiric triple therapy to eradicate the bacteria. An upper endoscopy was performed in which four gastric biopsy samples were taken (two from the antrum and two from the body) before and after the eradicating treatment, with the endoscopic and histological findings studied after one year of monitoring. The statistical analysis was conducted using the Fisher's exact test and the McNemar's test. RESULTS: Forty-six patients were studied, of whom 20 (43.5%) were men and 26 (56.5%) were women, with an average age of 58.9 (DE 11.2). Intestinal metaplasia was found in 46 (100%) patients before treatment and in 21 (45.7%) patients post-eradication. Complete intestinal metaplasia (type I) was found in 35 patients (76.1%) before treatment and in 11 (23.9%) patients post-eradication (p = 0.000), while incomplete intestinal metaplasia (type II) was found in 10 (21.7%) patients before treatment and in 10 (21.7%) patients post-eradication. Non-atrophic chronic gastritis was found in 35 (76.1%) patients before treatment and in 32 (69.6%) patients post-eradication. CONCLUSIONS: In this study, gastric intestinal metaplasia associated with Helicobacter pylori infection showed a regression of 54.3% one year after the eradication of this microorganism. This treatment could modify the natural history of the development of gastric cancer.

[Concordance among invasive diagnostic procedures for Helicobacter pylori infection in adults]. / Concordancia entre procedimientos diagnósticos invasivos para la infección por Helicobacter pylori en adultos.

OBJECTIVE: Compare the strength of concordance between culture, histology, rapid urease test for diagnosis of Helicobacter pylori infection and histopathological findings relationship and frequency of positivity among such diagnostic procedures. MATERIALS AND METHODS: Diagnostic test study. The study population were subjects with endoscopy and take samples of gastric antral. Rapid urease test (one sample), histology (two samples) and culture (two samples), and histopathological findings of gastric mucosa were performed. Statistical design with Student's t, Fisher exact test, Kappa coefficient. RESULTS: We reviewed 108 subjects, 28 (25.9%) men, 80 (74.1%) women, mean age was 49.1 years (SD 15.1). The Kappa coefficient was 0.729 and 0.377 between culture with histology and rapid urease test, respectively; likewise the Kappa coefficient was 0.565 between histology and rapid urease test. CONCLUSIONS: The strength of concordance was higher between histology with culture and rapid urease test; the most recommended being histology in clinical practice for the detection of Helicobacter pylori infection.

Concordancia entre procedimientos diagnósticos invasivos para la infección por Helicobacter pylori en adultos / Concordance among invasive diagnostic procedures for Helicobacter pylori infection in adults

Objetivo. Comparar la concordancia entre cultivo, histología y prueba rápida de la ureasa para el diagnóstico de infección por Helicobacter pylori, así como la relación de hallazgos histopatológicos y frecuencia de positividad entre dichos procedimientos diagnósticos. Material y métodos. Estudio de pruebas diagnósticas. Población de sujetos con endoscopía digestiva y toma de muestras gástricas antrales en un hospital de especialidades en México. Se realizó prueba rápida de la ureasa (una muestra), histología (dos muestras) y cultivo (dos muestras). Análisis estadístico con coeficiente de Kappa. Resultados. Se estudiaron 108 sujetos: 28 (25.9%) hombres y 80 (74.1%) mujeres; la edad promedio fue 49.1 (DE 15.1) años. El coeficiente de Kappa fue 0.729 y 0.377 entre cultivo con histología y prueba rápida de la ureasa respectivamente; asimismo, el coeficiente de Kappa fue 0.565 entre histología y prueba rápida de la ureasa. Conclusiones. La fuerza de concordancia fue mayor entre histología con cultivo y la prueba rápida de la ureasa, por lo cual la histología es lo más recomendable en la práctica clínica para la detección de la infección por Helicobacter pylori.

Objective. Compare the strength of concordance between culture, histology, rapid urease test for diagnosis of Helicobacter pylori infection and histopathological findings relationship and frequency of positivity among such diagnostic procedures. Materials and methods. Diagnostic test study. The study population were subjects with endoscopy and take samples of gastric antral. Rapid urease test (one sample), histology (two samples) and culture (two samples), and histopathological findings of gastric mucosa were performed. Statistical design with Student's t, Fisher exact test, Kappa coefficient. Results. We reviewed 108 subjects, 28 (25.9%) men, 80 (74.1%) women, mean age was 49.1 years (SD 15.1). The Kappa coefficient was 0.729 and 0.377 between culture with histology and rapid urease test, respectively; likewise the Kappa coefficient was 0.565 between histology and rapid urease test. Conclusions. The strength of concordance was higher between histology with culture and rapid urease test; the most recommended being histology in clinical practice for the detection of Helicobacter pylori infection.

Inadequate prescription of chronic consumption of proton pump inhibitors in a hospital in Mexico. Cross-sectional study.

INTRODUCTION: PPIs have been an enormous therapeutic advance in acid-related diseases. However, it has been detected an abuse in its consumption. The aim of this study was to determine the frequency of inadequate prescription of chronic use of PPIs in outpatients in a speciality hospital. MATERIAL AND METHODS: we performed a cross-sectional descriptive study review. The study population were patients, chronic users of proton pump inhibitors (PPIs), attending outpatient consult in a hospital of government workers. We defined as chronic user of PPIs that patient that takes medication daily for over a year and inappropriate prescription, that one that has not been approved by the clinical guidelines. A simple random sampling was utilized. The following parameters were investigated: diagnosis and prescription of PPIs, time of use, at which level of care PPIs were prescribed (primary care or specialist), self-medication, with or without endoscopy. Forthe statistical analysis, we used Student´s t-test and Chi-square, 95 % confidence intervals and significance 0.05 %. RESULTS: we reviewed 153 patients, 40 (26.1 %) men and 113 (73.9 %) women, mean age 58 ± 11.4 years. The prescription of chronic treatment with PPIs was adequate in 64.7 % of patients and inadequate in 35.3 %. The most common appropriate prescription (31.3 %) of chronic use of PPIs was due to gastroesophageal reflux disease. The most common inadequate prescription was absence of diagnosis (22.2 %), polypharmacy without nonsteroidal anti-inflammatory drugs (16.6 %) and chronic gastritis (16.6 %). History of endoscopy were not statistically significant. CONCLUSIONS: the frequency of inappropriate prescriptions of chronic use of PPIs was high, around 35.3 %, similar to those reported in hospitals in developed countries.

Indicaciones inadecuadas en el consumo crónico de inhibidores de bomba de protones en un hospital de México. Estudio transversal / Inadequate prescription of chronic consumption of proton pump inhibitors in a hospital in Mexico. Cross-sectional study

Introducción: los IBP han sido un avance terapéutico enorme en las enfermedades relacionadas con el ácido. Sin embargo se ha detectado que hay mayoritariamente un abuso en su consumo. El objetivo del estudio fue determinar en nuestro medio la frecuencia de indicación inadecuada en el consumo crónico de IBP en pacientes ambulatorios en un hospital de especialidades. Material y métodos: se realizó un estudio de revisión transversal descriptivo. La población estudiada fueron pacientes de un hospital de trabajadores del Estado, consumidores crónicos de IBP que acudieron a consulta externa. Se definió como consumidor crónico de IBP la toma diaria del medicamento durante más de un año e indicación inadecuada (no aprobada por guías clínicas). El muestreo fue aleatorio simple. Se investigaron los siguientes parámetros: diagnóstico e indicación de los IBP, tiempo de uso, en qué nivel de atención se prescribió (atención primaria o especializada), automedicación, con o sin endoscopia digestiva. Para el análisis estadístico se utilizó t de Student y Chi cuadrado, intervalos de confianza 95 % y significancia 0,05 %. Resultados: se revisaron 153 pacientes, 40 (26,1 %) hombres y 113 (73,9 %) mujeres, edad promedio 58 (DE 11,4) años. La indicación de tratamiento crónico con IBP era adecuada en el 64,7 % de los pacientes e inadecuada en el 35,3 %. La indicación apropiada más frecuente (31,3 %) del consumo crónico de IBP fue la ERGE. La indicación inadecuada más frecuente fue la prescripción sin diagnóstico (22,2 %), polifarmacia sin AINE (16,6 %) y gastritis crónica (16,6 %). Antecedentes de endoscopia no tuvieron significación estadística (p > 0,05). Conclusiones: la frecuencia de indicaciones inadecuadas en el consumo crónico de IBP fue alta y del 35,3%, similar a los publicados en hospitales de países desarrollados(AU)

Introduction: PPIs have been an enormous therapeutic advance in acid-related diseases. However, it has been detected an abuse in its consumption. The aim of this study was to determine the frequency of inadequate prescription of chronic use of PPIs in outpatients in a speciality hospital. Material and methods: we performed a cross-sectional descriptive study review. The study population were patients, chronic users of proton pump inhibitors (PPIs), attending outpatient consult in a hospital of government workers. We defined as chronic user of PPIs that patient that takes medication daily for over a year and inappropriate prescription, that one that has not been approved by the clinical guidelines. A simple random sampling was utilized. The following parameters were investigated: diagnosis and prescription of PPIs, time of use, at which level of care PPIs were prescribed (primary care or specialist), self-medication, with or without endoscopy. For the statistical analysis, we used Student’s t-test and Chi-square, 95% confidence intervals and significance 0.05 %. Results: we reviewed 153 patients, 40 (26.1 %) men and 113 (73.9 %) women, mean age 58 ± 11.4 years. The prescription of chronic treatment with PPIs was adequate in 64.7 % of patients and inadequate in 35.3 %. The most common appropriate prescription (31.3 %) of chronic use of PPIs was due to gastroesophageal reflux disease. The most common inadequate prescription was absence of diagnosis (22.2 %), polypharmacy without nonsteroidal antiinflammatory drugs (16.6 %) and chronic gastritis (16.6 %). History of endoscopy were not statistically significant. Conclusions: the frequency of inappropriate prescriptions of chronic use of PPIs was high, around 35.3 %, similar to those reported in hospitals in developed countries(AU)