Predictors of dental erosions in patients evaluated with upper digestive endoscopy: a cross-sectional study.

The most studied medical condition related with dental erosions is gastroesophageal reflux disease (GERD). The aim of this study was to assess other predictors of dental erosions besides GERD in outpatients referred for upper digestive endoscopy. In a cross-sectional study, we prospectively evaluated 235 patients who underwent upper digestive endoscopy. Patients were interviewed and examined by a trained dentist before the endoscopies, addressing dental health as well as clinical information and food intake. Dental erosion was classified using Basic Erosive Wear Examination score. Potential predictors for dental erosions were: gender, age, chronic use of antidepressants and proton pump inhibitors (PPI), diabetes mellitus, body mass index, heartburn and acid regurgitation scores, chocolate intake, reflux esophagitis and hiatal hernia. Overall prevalence of dental erosions was 23.4%. The most parsimonious Poisson regression model for dental erosions considered age, chocolate intake and acid regurgitation as predictors. Dental erosions were associated with acid regurgitation in patients younger than 50 years [adjusted prevalence ratio (PR) = 1.8 (95% CI 1.1-2.9)] and with chocolate intake in patients older than 50 years [PR = 2.1 (95% CI 1.2-3.9]. The surfaces most eroded were palatine/lingual (n = 25) and occlusal (n = 25), followed by vestibular (n = 5). In outpatients evaluated with upper digestive endoscopy, the variables associated with dental erosions were age younger than 50 years, acid regurgitation and chocolate intake. Referral for dental evaluation should be considered for young patients with GERD and frequent acid regurgitation.

Comfort, safety and quality of upper gastrointestinal endoscopy after 2 hours fasting: a randomized controlled trial.

BACKGROUND: Upper gastrointestinal endoscopy has been performed after fasting 8 or more hours, which can be harmful to the patients. We assessed comfort, safety and quality of endoscopy under moderate sedation after 2 hours fasting for clear liquids. METHODS: In this clinical trial, patients referred for elective endoscopy were randomly assigned to a fasting period of 8 hours (F8) or a shorter fasting (F2), in which 200 ml of clear liquids were ingested 2 hours before the procedure. Endoscopists blinded to patients fasting status carried out the endoscopies. Comfort was rated by the patients, whereas safety and quality were determined by the endoscopists. RESULTS: Ninety-eight patients were studied (aging 48.5 ± 16.5 years, 60% women): 50 patients (51%) in F2 and 48 in F8. Comfort was higher in F2 than F8 in regard to anxiety (8% vs. 25%; P = 0.029), general discomfort (18% vs. 42%; P = 0.010), hunger (44% vs. 67%; P = 0.024), and weakness (22% vs. 42%; P = 0.034). Regurgitation of gastric contents into the esophagus after endoscopic intubation did not differ between F2 and F8 (26% vs. 19%; P = 0.471). There was no case of pulmonary aspiration. Gastric mucosal visibility was normal in most patients either in F2 or F8 (96% vs. 98%; P = 0.999). CONCLUSIONS: Elective upper GI endoscopy after 2 hours fasting for clear liquids was more comfortable and equally safe compared to conventional fasting. This preparation might be cautiously applied for patients in regular clinical conditions referred for elective endoscopy. TRIAL REGISTRATION: SAMMPRIS ClinicalTrial.gov number, NCT01492296.

Gastric metastases of a malignant melanoma

Malignant melanoma accounts for around 5% of all malignant skin tumors. It is considered one of the most aggressive neoplasms due to its high metastasizing capacity. The most common sites of metastasis are peri-tumor lymph nodes, lung, brain and liver. The digestive tract is not a common site of metastasis. When involved, the small intestine is the organ most commonly affected. The stomach is a rare site of metastasis, found in only 7% percent of the cases. We report a case of a 72-year-old patient with a history of malignant melanoma who presented with acute epigastric pain. Enterotomography, upper endoscopy and additional biopsies confirmed the diagnosis of gastric metastases. (AU)

Prevalência de pólipos com displasia de alto grau em pacientes com idade inferior a 50 anos / Prevalence of polyps with high degree dysplasia in patients with less than 50 years of age

O câncer colorretal é uma doença freqüente e passível de diagnóstico precoce. Objetiva-se avaliar uma idade ideal para o início do rastreio dessa doença. Avaliaram-se 2.068 colonoscopias em estudo transversal; 411 mostravam pólipos e em 270 obteve-se resultado histopatológico. Verificou-se idade média de 61 anos, sendo 52 (141) do sexo feminino; 61 (161) eram pólipos neoplásicos; desses, 15 (25) continham displasia de alto grau; 28 (7) das displasias de alto grau concentravam-se na população com idade inferior a 50 anos.

Manifestaçöes de comprometimento hepático na angiostrongilíase abdominal e diagnóstico pelo encontro dos ovos do parasita / Clinical manifestations of hepatic involvement in abdominal angiostrongyliasis diagnosed by the finding of the parasite's eggs

Manifestaçöes clínicas de comprometimento hepático na angiostrongilíase abdominal e diagnóstico pelo encontro de ovos do parasita nos cortes histológicos, raramente säo referidos na literatura. Os autores descrevem um caso onde o quadro clínico inicial era sugestivo de lesäo tumoral na regiäo ileocecal. A presença de ovos do parasita nas lesöes anatômicas habituais desta parasitose auxiliou a estabelecer o diagnóstico. Este relato serve para alertar médicos e patologistas para apresentaçöes aparentemente pouco usuais da angiostrongilíase abdominal