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.

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.

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.

[Manometric effects of pinaverium bromide in irritable bowel syndrome]. / Efectos manométricos del bromuro de pinaverio en el síndrome de intestino irritable.

The effects of pinaverium bromide on colonic motility were investigated in a controlled, controlled, cross-over study in 32 patients with irritable bowel syndrome. Constipation was clearly predominant in one group of 16 patients, and diarrhea in the other group of 16. Manometric measurements were taken of the colonic motor response generated by distention of a balloon inserted to the rectosigmoid junction. Measurements were taken before and one hour after ingestion of two tablets containing placebo or two tablets each containing 50 mg of pinaverium bromide. Following intake of placebo the motility index increased from the basal value in patients with constipation, and resistance to distention decreased in the diarrhea group. These changes were attributable to repetition of the mechanical stimulus within a relatively brief time lapse, or more probably to the ingestion of liquid which accompanied intake of tablets. Compared with placebo, pinaverium bromide induced inhibition of both effects. From the therapeutic point of view, the decrease in motility index seen in patients with irritable bowel syndrome and constipation is particularly interesting.

[Fiberendoscopic sclerotherapy of esophageal varices: relationship of varices size, quantity of sclerosing agent used and number of sessions]. / Escleroterapia fibroendoscópica de várices esofágicas: relación entre el tamaño de las várices, cantidad de esclerosante empleado y número de sesiones.

By means of fiberendoscopic injection sclerotherapy, it was possible to achieve eradication of esophageal varices in 18 patients. At the onset of treatment 9 patients had small varices (grade II) and other 9 had big varices (grade III). It was found in the big varices group there was needed more courses (p less than 0.01) and a greater amount of sclerosing agent (p less than 0.001) than in the group with small varices. Since those patients with big varices required more courses and more volume of sclerosing agent, and in fact they have more risk to rebleed during the pre-eradication period. It is proposed as a solution during this period, the use of a B receptor blocking agent (Propranolol) simultaneously with sclerotherapy.

[Fiberendoscopic sclerotherapy of esophageal varices (description of a technic)]. / Escleroterapia fibroendoscópica de várices esofágaicas (descripción de una técnica).

We describe a technique used for fiberendoscopic sclerosis of esophageal varices. The addition of a balloon around the endoscope is advocated for three uses: 1) ingurgitation of varices allows better visualization, 2) the methods avoid the quick clearing of the sclerosing agent, 3) it can be used as hemostatic agent in case of necessity. The sclerosant agent used is an association of ethanolamine oleate, hypertonic glucose solution (50%) and natural conjugated strogens.

[Evaluation of the involvement of the internal anal sphincter by the measurement of the amplitude and duration of the ano-rectal inhibitory reflex]. / Evaluación del compromiso del esfinter anal interno mediante la medición de la intensidad y duración del reflejo ano-rectal inhibitorio.

The aim of this study was the evaluation of a possible correlation between the resting tone of the anal canal (RT) and amplitude and duration of the recto anal inhibitory reflex (RAIR). 94 subjects, 72 women and 22 men, aged 9-91 years (mean 53 years) were studied. Manometric testing was performed on all subjects with a three balloon system. The maximal anal canal resting tone, the amplitude and duration of the RAIR, were measured. According with the RT, subjects were divided on three groups: GROUP I: RT up to 79 mmHg GROUP II: 80 to 120 mmHg and GROUP III: with RT more than 121 mmHg. The amplitude of RAIR was for GROUP I: mean = 7.09 SD:4.93, GROUP II: mean-10.5 SD:7.3, GROUP III: mean 15.14 DS: 8.19. p less than 0.001 between GROUPS I and III. The duration (d/s) of RAIR was for GROUP I: mean = 180 DS:70, GROUP II: 175.6 DS: 68, GROUP III mean: 201.6 DS 86.4. No differences were found between GROUPS I and II (p less than 0.13), I and III (p less than 0.17), and II and III (p less than 0,33). Positive Sperman correlation (p less than 0,001) was found between RT and amplitude of RAIR. The observation of a positive correlation between RT and RAIR amplitude suggest that the functional integrity of the internal sphincter could be also evaluated by the amplitude but not duration of the RAIR.

[Effects of medicinal fiber on colonic transit in patients with irritable colon syndrome]. / Efectos de la fibra medicinal sobre el tránsito colónico en pacientes con síndrome del colon irritable.

Twenty patients suffering from irritable bowel syndrome, 14 patients with pain and constipation and 6 patients with pain and diarrhoea, were studied in order to: a) Evaluate the symptomatic response to a Plantago Ovatae fiber medicine. b) Study with radio-opaque markers the colonic transit modifications that could explain the therapeutic responses. There were observed the following results: 1) Pain decreased or disappeared in 80% of the patients. 2) Constipation decreased or disappeared in 78.6% of the patients. 3) Diarrhoea decreased or disappeared in 5 of the 6 patients that were studied. 4) There was a significative increase of the feces weight without changes of the dry residue. 5) Taking all the patients as a whole the number of the retained radio-opaque markers was the same before and after the active treatment. If we evaluate the patients with constipation and the patients with diarrhoea separately the first group shows an acceleration of the colonic transit (fewer retained markers) and the second group shows a decrease of the colonic transit (more retained markers). We draw the conclusion that the Plantago Ovatae fiber regulates or moderates the colon motility and enables a physiological balance of the colonic transit.

[Chronic constipation. Clinical forms and therapeutic responses]. / Constipación crónica. Formas clínicas y respuestas terapéuticas.

Fifteen patients suffering from different types of constipation were studied by means of radiopaque markers in order to know: a) If there is a correlation between the clinical state and the physiopathological motor variables of idiopatic constipation. b) The efficacy of a compound that combines its bulk action to its stimulation of the intestinal wall. Based on the results it is concluded that: The methodology is not useful in order to differentiate the colon motor behaviours in idiopatic constipation if these differences really exist. The evacuative effect of the compound was easily and objectively demonstrated by the acceleration of the radiopaque markers along the right colon. There was a good correlation between the subjective assessment done by the physician, and the patient and the objective results.

[pH-metric variables in gastroesophageal reflux in asthmatic patients]. / Variables pH-métricas en el reflujo gastro-esofágico del paciente asmático.

As there is an increased incidence of gastroesophageal reflux (GER) in asthmatic patients compared with the normal population, in the present trial we have tried to establish the following: 1) Possible differences in pH-metric variables between patients with GER and asthma, and asthmatic patients with or without GER 2) The usefulness of simultaneous evaluation and correlation of reflux episodes with the respiratory peak flow (EPF) in asthmatic patients. 31 patients divided in four groups were compared. A) 16 patients with typical symptoms of GER without respiratory symptoms. B) 10 asthmatic patients with GER symptoms. C) 5 asthmatic patients without GER symptoms. D) 15 asthmatic patients who represents the sum of B and C. In all patients ambulatory computerized, four hours pH recordings were obtained after standard meal. The study was divided in two equal periods (upright and recumbent). The EPF was measured before starting the study and every 20 min during the recumbent period. From de following pH-metrics variables: total number of reflux episodes, percentage of recording time when intra-oesophageal pH < 4 in the upright position or recumbent position and for the total period, duration of longest reflux episode, number of episodes longer than five minutes, and correlation between reflux episodes and patients symptoms. Only differences were seen when the time of the longer period with GER and the number of patients with more than five minutes episodes were compared between groups A and D. From the results we conclude that the GER in asthmatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

[Somatostatin in the emergency treatment of upper digestive hemorrhage in patients with portal hypertension]. / Somatostatina en el tratamiento de emergencia de la hemorragia digestiva alta en hipertensos portales.

During a 2-yr period 15 patients (17 episodes) with variceal bleeding (VB) and 7 with cirrhosis and acute gastroduodenal haemorrhage (GDH) received intravenous somatostatin (250 mcg per hr after a bolus of 250 mcg). Initial control of bleeding was achieved in 13 (76%) with VB and in all with GDH. Three of the 4 patients with VB and 2 with GDH who rebled during treatment were controlled increasing the infusion to 500 mcg/hr. Patients with VB received somatostatin for 24 hrs, time selected for initiating injection sclerotherapy, and those with GDH for 48-72 hrs. At 24 hrs 71% of patients with VB and all with GDH were free of bleeding. Combining different therapies VB was controlled in 16 of the 17 episodes (94%) with only one death. No complications were observed in any of the 22 patients treated.

[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.

[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.