Helicobacter pylori in recently-diagnosed versus chronic duodenal ulcer.

Helicobacter pylori is one of the main causes of type B gastritis and is frequently found in the gastric antrum or in areas of gastric metaplasia in duodenal ulcer patients. The aim of this study was to evaluate Helicobacter pylori and gastric metaplasia prevalence in duodenal ulcer patients within their first diagnosed episode compared to those with chronic ulcer disease. Eighty three patients were prospectively studied in a 2-year period, they were divided into 3 groups: Group I, control, included 29 patients; Group II, 17 patients, included patients with first diagnosed duodenal ulcer episode; and Group III, 37 patients, with chronic ulcer disease. Helicobacter pylori prevalence in duodenum was significatively lower in Group II versus Group III and controls (67.5%, 0% and 3.2% respectively) (p < 0.001). In the antrum Hp prevalence was also lower in Group II compared to Group III and I (41%, 78.3% and 24.1%) with a significative difference (p < 0.001). Gastric metaplasia was significantly higher in Group III versus Group II and controls. These results suggest that Helicobacter pylori plays an important but not exclusive role in the pathogenesis of these disease together with other factors.

[Colonic ulcer in HIV (+) patients]. / Ulceras colónicas en pacientes HIV (+).

UNLABELLED: A characteristic rectocolonic endoscopic finding is the presence of ulcers, which may correspond to different diagnosis. Between January, 1989 and May, 1993, we performed 28 colonoscopies and 12 rectoscopies in patients with HIV (+). In all cases, histologic, parasitologic, bacteriologic, virologic, and micrologic studies were practised on tissue biopsies. Eighteen of them presented rectocolonic ulcers (we are not including anal and terminal ileum ulcers). The studies involved 16 males and 2 females, with an average age of 31, 21 years old (20-47), 14 of which were male homosexuals, 2 intravenous drug abusers, 1 hemophilic and an heterosexual female. Symptoms were as follows: 15 with hematochezia, 7 with proctorrhagia, 6 with enterorrhagia and 2 with both manifestations. All the rest, presented chronic diarrhea, loss of weight, anal secretion, asthenia, fever, constipation and anemia in isolated cases. Diagnosis were 6 rectocolonic cytomegalovirus (all occurred during the current year). Other related opportunistic pathogens included an intestinal TBC, a rectal Herpes and a Burkitt's lymphoma. Related etiological agents were not found in 9 patients, in spite of systematic quest. Opportunistics found in three of the cases revealed AIDS in those patients. COMMENTS: 1-The indexes of male homosexuals are strikingly higher than the rest of our HIV endoscopy statistics. 2-We observed prevailing idiopathic lesions. 3-The relationship between "CU like" pictures, already described, and the immunocomponents of the idiopathic CU is unknown. 4-All our CMV cases are recent. 5-Hematochezia was the most frequent symptom. 6- Herpetic ulcers correspond to HSV type 1. 7-Diffuse ulcers may correspond to lymphoma.

[Esophageal pathology in patients with the AIDS virus. Etiology and diagnosis]. / Patología esofágica en pacientes con virus del SIDA. Etiología y diagnóstico.

From 180 patients infected with human immunodeficiency virus (HIV) and followed-up for one year, 17 cases (9.44%) were referred to detect oesophageal pathology. They were prospectively analyzed through fibroscopy, radiology, biopsies for histopathology, virology and mycology and brush cytology. Most frequent symptoms were dysphagia. Odynophagia and retrosternal pain, usually associated, and not providing an accurate diagnostic clue. The most common causes of symptoms were oesophageal candidiasis (47.70%), and herpetic ulcers (23.52%) caused by herpes simplex virus (HSV) type 2. Reflux pathology was also found (11.76%). Cytomegalovirus, other opportunistic infections and tumors were not detected. Seven (64%) of the eleven patients with oesophageal candidiasis also had oral involvement. Four (66%) of six oesophageal ulcers were herpetic; two of them (50%) showed oral ulcers too, and one (25%) had perioral herpetic blisters. Almost in every case endoscopic features allowed diagnosis. Endoscopy in candidiasis showed isolated or confluent white plaques of variable grade. Herpetic ulcers, alone or multiple, were deep with slightly elevated borders. Radiology yielded a poor diagnostic profit (50%), specially in case of multiple lesions. Cytology was highly specific and sensitive (both 90.9%) and suggested viral etiology in 100% of HSV patients. Histopathology was less sensitive than endoscopy and cytology (73% in candida and one HSV non-ulcer case). Both, cytology and histopathology showed koilocytosis in herpetic virus infected patients. The studies performed allowed to change the HIV disease stage in ten patients (62.5%) and to diagnose AIDS in seven (43.75%). In every case medical behavior was oriented or changed by these studies.

PIP: 16 HIV seropositive patients among the 180 treated at the Hospital Muniz and the Hospital Posadas in Buenos Aires between December 1988 and December 1989 were referred to the Hospital Posadas Endoscopy Service for esophageal studies. The 16 patients were prospectively studies by means of fiberoscopy, radiology, biopsies, virology, mycology, and brush cytology. Early treatment is of utmost importance because opportunistic infections may aggravate the general condition, increase immune system effects, and probably permit greater replication of HIV, in addition to producing symptoms. 14 patients were male and 2 female. Ages ranged from 18 to 41 and averaged 32 years. 10 were male homo- or bisexuals and the other 6 were intravenous drug users. 14 of the patients consulted because of specifically esophageal symptoms. 12 reported dysphagia, 8 odynophagia, and 6 retrosternal pain. 9 patients presented various symptoms. 15 of the 16 symptomatic patients had some pathology related to HIV. The remaining case presented a small submucus tumor and gastroesophageal reflux. The symptoms had appeared between 10 days and 1 year prior to study. Symptoms did not provide accurate diagnostic clues. 11 cases of esophageal candidiasis were diagnosed endoscopically by isolated or confluent white plaques. 3 patients classified as grade 1 or 2 on the basis of the intensity and density of plaques had mild symptoms, and 8 classified as grade 3 or 4 had more severe symptoms. 7 of the 11 patients also had oral candidiasis. 4 of 6 patients presenting ulcerative pathology were diagnosed virologically with herpes simplex virus type 2. Herpetic ulcers were single or multiple and were deep with slightly raised edges. No ulcers attributable to cytomegalovirus were diagnosed. 4 of the 11 patients with candidiasis also had ulcers, in 2 cases herpetic. The studies indicated a change in the stage of HIV infection following Centers for Disease Control criteria in 10 cases. AIDS was diagnosed in 7 cases based on esophageal findings. Endoscopic study and the samples obtained guided treatment in the 16 patients. In 1 case a repeat endoscopy led to a change in treatment. It is recommended that endoscopy be performed in all patients with esophageal symptoms. Radiology was relatively ineffective, with 50% of diagnoses in error. Histopathology required multiple biopsies and was less sensitive than endoscopy and cytology. Cytology was highly specific and sensitive.

[Acute and chronic diarrhea in AIDS: study of 435 (HIV+) patients, in Buenos Aires]. / Diarrea aguda y crónica en SIDA: estudio de 435 pacientes HIV(+), en Buenos Aires.

OBJECTIVE: Assessment of the rate of Diarrhoea in an infected HIV population of our medium. Assessment of its etiology, risk factors and response to treatment in both presentation of disease (Acute and chronic). DESIGN: This is a retrospective analysis of HIV and/or AIDS patients and diarrhea. The analytic points were: the clinical pattern of diarrhea (acute or chronic), risk factors, age, sex, etiology, stage of the disease, and response rate to treatment. PLACE: Hospital Prof. A. Posadas, that is situated in the greater Buenos Aires, and that functions as a referral centre for AIDS patients. PATIENTS AND METHODS: 435 case records that were followed up through June 1987/ March 1994 were reviewed; 109 of the total number suffered from diarrhea. RESULTS: The rate of diarrhoea in the studied population was 25% (109/435). This represented the first symptom of HIV infection in 18.3% of the patients (20/109), 49% had acute diarrhea and 51% had chronic diarrhea. An etiologic agent was established in 52.3% of the chronic diarrhoeas and in the 17.7% of the acute ones, with a 35.4% of a global isolation when basic stool test were made. Sixty three percent of the patients with chronic diarrhoea were in stage IV of HIV infection. The 78.3% of the acute diarrhoeas and 46% of the chronic ones were responsive to specific or symptomatic treatment. CONCLUSIONS: HIV antibodies determinations should be included in the study protocol of diarrhea, especially in young patients. Chronic diarrhea could be related to final stages of the disease, with lower response to treatment. Endoscopy studies should be useful when the stool tests are negative, specially in the Cytomegalovirus (CMV) and Mycobacterium complex avium intracellulare (MAI) search.

[Emergency endoscopy in upper digestive tract hemorrhage]. / Endoscopía de urgencia en hemorragia digestiva alta (H.D.A.).

The experience in upper G.I. tract hemorrhage accumulated during the first 30 months in the Emergency Hemorrhage Unit at the Hospital Posadas is here reported over a total of 428 endoscopies, we found 518 lesions. Ninety one (21%) presented with active bleeding, and 317 (76%) were considered as the probable cause of the bleeding. In 37 cases (8.6%) the site of bleeding was detected, but the diagnosis wasn't done. The most frequent lesions were erosive gastritis (21.2%), gastric ulcer (20%), erosive duodenitis (12.6%), duodenal ulcer (12.15%) and esophageal varices (12.12%) the diagnosis was normal 14.7% of the cases. One hundred and sixty one patients were admitted to the hospital; on 143 (88.82%) patients the original diagnosis was confirmed but it was modified in 18 patients (11.18%) by surgery or repeated endoscopy. During the last 20 months of the period the accuracy diagnostic of the endoscopy increased 95%. When compared with the first 10 months (76%) this fact shows, the importance of the experience acquired by the endoscopist. Most of the patients received medical treatment with a mortality of 9.02% and 25 patients received surgical treatment with a mortality of 28%.

Prevalence and etiology of gastroduodenal ulcer in HIV-positive patients: a comparative study of 497 symptomatic subjects evaluated by endoscopy.

OBJECTIVE: In 497 HIV-positive (+) patients with upper digestive tract symptoms, 23 (5%) had gastroduodenal ulcers (GDU) at upper endoscopy. METHODS: To establish the causes of GDU in this setting, 16 of these patients who had had comprehensive histological evaluation (group I) were compared with 20 HIV+ subjects with upper gastrointestinal symptoms but without ulcer (group II), and with 16 seronegative patients with GDU (group III). Eighty-one percent of group I subjects and 90% of group II patients had C3 AIDS. The presence of gastritis and Helicobacter pylori, fungi, mycobacteria, viruses (especially cytomegalovirus [CMV] and herpes simplex [HSV]), and parasites was determined in all three groups by histopathological and microbiological studies. RESULTS: The prevalence of chronic active gastritis was 13/16 (81%) in group I, 12/20 (60%) in group II, and 15/16 (94%) in group III. It was associated with H. pylori in group III, and with opportunistic pathogens in groups I and II and with none in group III. H. pylori was detected in 5/16 patients (31%) in group I, in 12/20 (60%) in group II, and 11/16 (69%) in group III. Cytomegalovirus was histologically diagnosed in 8/16 patients (50%) in group I and in 1/20 (5%) in group II. This virus was the only factor shown to be significantly associated with GDU in these cases (p = 0.0046). Cryptosporidium was found in 2/16 (12.5%) patients in group I, in 1/20 (5%) in group II, and in none in group III. Differences between groups I and II were not statistically significant. No other organisms were observed in the three groups. CONCLUSIONS: Gastroduodenal ulcers were infrequent in HIV+ subjects with upper digestive tract symptoms and CMV was the only organism significantly associated with GDU in HIV+ patients. Among HIV+ patients, H. pylori was an uncommon cause of ulcer. Among HIV+ subjects with ulcer, chronic active gastritis was more common than H. pylori and it was associated with other pathogens. Finally, HIV+ patients with GDU should have endoscopic biopsies to detect opportunistic infections, especially CMV, because H. pylori infection is uncommon.

Soporte nutricional domiciliario con gastrostomia endoscópica percutánea / Home nutritional support with percutaneous endoscopic gastrostomy

La Gastrostomía Endoscópica Percutánea (PEG) es un método rápido y seguro de acceso a la alimentación enteral en pacientes de alto riesgo para ser sometidos a una gastrostomía abierta y que requieran de nutrición enteral prolongada con el fin de lograr un adecuado soporte nutricional. El objetivo de este estudio fue evaluar la tolerancia en el uso de la PEG, medir las complicaciones inmediatas y tardías y evaluar el estado nutricional de los pacientes a los seis meses de inicio del soporte nutricional. Material y métodos: se confeccionó un formulario con datos personales, enfermedad de base, enfermedad actual, laboratorio al ingreso y a los seis meses, complicaciones inmediatas y tardías. Se implementó el soporte nutricional domiciliario a trav{es de una fórmula artesanal. El método de administración fue en bolos y con jeringa. El seguimiento se realizó a través de contactos telefónicos y visitas periódicas al hospital para la evaluación clínica y nutricional. Resultados: se evaluaron un total de dieciseis pacientes (once hombres, cinco mujeres)...(AU)

Soporte nutricional domiciliario con gastrostomia endoscópica percutánea / Home nutritional support with percutaneous endoscopic gastrostomy

La Gastrostomía Endoscópica Percutánea (PEG) es un método rápido y seguro de acceso a la alimentación enteral en pacientes de alto riesgo para ser sometidos a una gastrostomía abierta y que requieran de nutrición enteral prolongada con el fin de lograr un adecuado soporte nutricional. El objetivo de este estudio fue evaluar la tolerancia en el uso de la PEG, medir las complicaciones inmediatas y tardías y evaluar el estado nutricional de los pacientes a los seis meses de inicio del soporte nutricional. Material y métodos: se confeccionó un formulario con datos personales, enfermedad de base, enfermedad actual, laboratorio al ingreso y a los seis meses, complicaciones inmediatas y tardías. Se implementó el soporte nutricional domiciliario a trav{es de una fórmula artesanal. El método de administración fue en bolos y con jeringa. El seguimiento se realizó a través de contactos telefónicos y visitas periódicas al hospital para la evaluación clínica y nutricional. Resultados: se evaluaron un total de dieciseis pacientes (once hombres, cinco mujeres)...

Helicobacter pylori in recently-diagnosed versus Chronic duodenal ulcer

Helicobacter pylori is one of the main causes of type B gastritis and is frequently found in the gastric antrum or in areas of gastric metaplasia in duodenal ulcer patients. The aim of this study was to evaluate Helicobacter pylori and gastric metaplasia prevalence in duodenal ulcer patients within their first diagnosed episode compared to those with chronic ulcer disease. Eighty three patients were prospectively studied in a 2- year period. they were divided into 3 groups: Group I, control, included 29 patients; Group II, 17 patients, included patients with first diagnosed duodenal ulcer episode; and Group III, 37 patients, with chronic ulcer disease. Helicobacter pylori prevalence in duodenum was significatively lower in Group II versus Group III and controls (67.5 percent; 0 percent and 3.2 percent respectively) p<0.001). In the antrum Hp prevalnce was also lower in Group II compared to Group III and I (41 percent, 78,3 percent and 24.1 percent) with a significative difference (p<0.001). Gastric metaplasia was significantly higher in Group III versus Group II and controls. These results suggest that Helicobacter pylori plays an important but not exclusive role in the pathogenesis of these disease together with other factors. (AU)

Helicobacter pylori in recently-diagnosed versus Chronic duodenal ulcer

Helicobacter pylori is one of the main causes of type B gastritis and is frequently found in the gastric antrum or in areas of gastric metaplasia in duodenal ulcer patients. The aim of this study was to evaluate Helicobacter pylori and gastric metaplasia prevalence in duodenal ulcer patients within their first diagnosed episode compared to those with chronic ulcer disease. Eighty three patients were prospectively studied in a 2- year period. they were divided into 3 groups: Group I, control, included 29 patients; Group II, 17 patients, included patients with first diagnosed duodenal ulcer episode; and Group III, 37 patients, with chronic ulcer disease. Helicobacter pylori prevalence in duodenum was significatively lower in Group II versus Group III and controls (67.5 percent; 0 percent and 3.2 percent respectively) p<0.001). In the antrum Hp prevalnce was also lower in Group II compared to Group III and I (41 percent, 78,3 percent and 24.1 percent) with a significative difference (p<0.001). Gastric metaplasia was significantly higher in Group III versus Group II and controls. These results suggest that Helicobacter pylori plays an important but not exclusive role in the pathogenesis of these disease together with other factors.

Ulceras colónicas en pacientes HIV (+) / Colonic ulcers in HIV (+) patients

Uno de los hallazgos endoscópicos rectocolónicos característicos es la presencia de úlceras colónicas, que pueden corresponder a diferentes diagnósticos. Entre enero de 1989 y mayo de 1993, practicamos 28 colonoscopías y 42 rectocospías en pacientes HIV +. En todos los casos se practiron estudios histológicos, parasitológicos, bacteriológicos, virológicos y micológicos en tejido biopsiado. En 18 de ellas (26 por ciento) encontramos úlceras rectocolónicas (excluimos aquí las úlceras anales y las de ileon terminal). Se trató de 16 hombres y 2 mujeres, con edad promedio de 31, 21 años (20-47), de los cuales 14 eran hombres homosexuales, 2 adictos endovenosos, 1 hemofílico y una mujer heterosexual. Los síntomas fueron hematoquezia en 15, 7 con proctorragia, 6 con enterorragia, y 2 con ambas manifestaciones. Los restantes presentaban todos diarrea crónica, pérdida de peso, secreción anal, astenia, fiebre, constipación y anemia en casos aislados. Los diagnósticos fueron: 6 citomegalovirus rectocolónicos (todos en el presente año). Otros patógenos oportunistas asociados fueron: una TBC intestinal, un herpes rectal y un linfoma tipo Burkitt. En 9 pacientes no se halló agente etiológico asociado pese a la búsqueda sistemática de los mismos. En tres casos los oportunistas hallados fueron marcadores de SIDA en esos pacientes. (AU)

Ulceras colónicas en pacientes HIV (+) / Colonic ulcers in HIV (+) patients

Uno de los hallazgos endoscópicos rectocolónicos característicos es la presencia de úlceras colónicas, que pueden corresponder a diferentes diagnósticos. Entre enero de 1989 y mayo de 1993, practicamos 28 colonoscopías y 42 rectocospías en pacientes HIV +. En todos los casos se practiron estudios histológicos, parasitológicos, bacteriológicos, virológicos y micológicos en tejido biopsiado. En 18 de ellas (26 por ciento) encontramos úlceras rectocolónicas (excluimos aquí las úlceras anales y las de ileon terminal). Se trató de 16 hombres y 2 mujeres, con edad promedio de 31, 21 años (20-47), de los cuales 14 eran hombres homosexuales, 2 adictos endovenosos, 1 hemofílico y una mujer heterosexual. Los síntomas fueron hematoquezia en 15, 7 con proctorragia, 6 con enterorragia, y 2 con ambas manifestaciones. Los restantes presentaban todos diarrea crónica, pérdida de peso, secreción anal, astenia, fiebre, constipación y anemia en casos aislados. Los diagnósticos fueron: 6 citomegalovirus rectocolónicos (todos en el presente año). Otros patógenos oportunistas asociados fueron: una TBC intestinal, un herpes rectal y un linfoma tipo Burkitt. En 9 pacientes no se halló agente etiológico asociado pese a la búsqueda sistemática de los mismos. En tres casos los oportunistas hallados fueron marcadores de SIDA en esos pacientes.