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1.
Rev Esp Med Nucl Imagen Mol ; 36(1): 37-47, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27765536

RESUMO

Chronic diarrhoea is a common entity in daily clinical practice and it leads to a loss in these patients quality of life. It may be the main symptom of multiple ethiologies including bile acid malabsorption (BAM) which has a comparable prevalence to celiac disease. The BAM results from imbalances in the homeostasis of bile acids in the enterohepatic circulation. It can be a consequence of ileal disease or ileal dysfunction (BAM type i), it can be considered idiopathic or primary (BAM type ii) or associated with other gastrointestinal entities (BAM type iii). Among the different diagnostic methods available, 75SeHCAT study is the primary current method due to its sensitivity, specificity, safety and low cost. The main disadvantage is that it's not available in all countries, so other diagnostic methods have appeared, such as serum measurement of FGF19 and C4, however they are significantly more complex and costly. The first-line treatment of bile acid diarrhoea is bile acid sequestrant, such as cholestyramine, which can be difficult to administer due to its poor tolerability and gastrointestinal side effects. These are less prominent with newer agents such as colesevelam. In summary, the BAM is a common entity underdiagnosed and undertreated, so it is essential to establish a diagnosis algorithm of chronic diarrhoea in which the 75SeHCAT study would be first or second line in the differential diagnosis of these patients.


Assuntos
Ácidos e Sais Biliares/metabolismo , Diarreia/diagnóstico por imagem , Íleo/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Radioisótopos de Selênio/farmacocinética , Esteatorreia/diagnóstico por imagem , Ácido Taurocólico/farmacocinética , Algoritmos , Ácidos e Sais Biliares/classificação , Biomarcadores , Resina de Colestiramina/uso terapêutico , Doença Crônica , Cloridrato de Colesevelam/uso terapêutico , Colestipol/uso terapêutico , Diarreia/classificação , Diarreia/complicações , Diarreia/tratamento farmacológico , Diarreia/etiologia , Circulação Êntero-Hepática , Jejum , Fezes/química , Fatores de Crescimento de Fibroblastos/sangue , Humanos , Íleo/metabolismo , Absorção Intestinal , Sensibilidade e Especificidade , Esteatorreia/classificação , Esteatorreia/complicações , Esteatorreia/tratamento farmacológico , Imagem Corporal Total
2.
Gastroenterol Hepatol ; 29(2): 74-6, 2006 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-16448608

RESUMO

We present the case of a 79-year-old woman who had received a diagnosis of Crohn's disease 3 years previously and who developed a mucosa-associated lymphoid tissue (MALT) lymphoma of the right colon while undergoing treatment with mesalazine. The patient had not received immunosuppressive drugs or infliximab. The possible association between Crohn's disease and the development of intestinal lymphomas is analyzed. The incidence, pathogenic mechanisms, diagnostic strategy, treatment and prognosis of these neoplasms are described, mainly with reference to MALT lymphomas of the colon.


Assuntos
Neoplasias do Colo/complicações , Doença de Crohn/complicações , Linfoma de Zona Marginal Tipo Células B/complicações , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Neoplasias do Colo/diagnóstico , Doença de Crohn/tratamento farmacológico , Feminino , Humanos , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Mesalamina/uso terapêutico
3.
Gastroenterol Hepatol ; 29(5): 294-6, 2006 May.
Artigo em Espanhol | MEDLINE | ID: mdl-16733035

RESUMO

Spontaneous intramural dissection of the esophagus (SIDE) is an unusual clinical entity. It is a benign disease that, despite its alarming endoscopic appearance, usually responds well to conservative management and has an excellent prognosis. Nevertheless, some situations require emergency surgical treatment. These situations include esophageal perforation with mediastinitis, massive bleeding, and abscess, among others. Upper gastrointestinal endoscopy is a useful diagnostic test when radiological examinations (hydrosoluble contrast esophagogram, computed tomography, or magnetic resonance imaging) have excluded perforation. We present the case of a 42-year-old woman who was admitted to our hospital complaining of acute chest pain, dysphagia, and odynophagia. Because of the persistence of symptoms and diagnostic uncertainty (SIDE versus complicated esophageal duplication cyst) surgery was performed. The definitive diagnosis was SIDE.


Assuntos
Perfuração Esofágica/cirurgia , Adulto , Dor no Peito/etiologia , Anormalidades Congênitas/diagnóstico , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Cisto Esofágico/diagnóstico , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/diagnóstico por imagem , Esofagectomia , Esofagoscopia , Esôfago/anormalidades , Feminino , Humanos , Tomografia Computadorizada por Raios X
4.
Rev Esp Enferm Dig ; 95(10): 700-6, 692-9, 2003 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-14588064

RESUMO

OBJECTIVES: to evaluate the efficacy of endoscopic treatment in patients with upper gastrointestinal (UGIH) due to duodenal ulcer with high risk of persistent or recurrent bleeding and to determine the associated failure factors of this procedure. PATIENTS AND METHOD: three hundred and thirty-six patients with UGIH due to duodenal ulcer requiring endoscopic treatment were analyzed between January 1992 and December 2001. The patients were classified according to the endoscopic findings: a) patients with limited bleeding; and b) patients with persistent and/or recurrent bleeding due to therapeutic failure. The clinical guidelines followed in patients with endoscopic treatment failure were previously established in the internal protocol. The variables that obtained statistical significance in the univariate analysis were included in the logistic regression model to identify those with an independent predictive value for failure of the endoscopic treatment. RESULTS: mean age of the patients was 60 +/- 17 years, 271 (81%) were male. Bleeding with severe hemodynamic affectation was detected in 82 patients (24%). The most common location of the duodenal ulcer was on the anterosuperior part of the duodenal bulb (227 patients, 68%). In 43 patients (13%) the ulcer was larger than 2 cm. The bleeding stigmata were classified as: Forrest I in 125 (38%) and Forrest II in 211 (62%). It was initially reached in 297 patients (88%). Twenty-two patients required emergency surgery (6,5%) and the global mortality rate was 3%. Severe hemodynamic affectation at admission (OR 11.8, p>0.001), ulcers exceeding 2 cm (OR 6.95, p = 0.019) and the presence of active bleeding during endoscopy (Forrest I) (OR 3.55, p = 0.08) were the variables included in the multivariate analysis independently associated to endoscopic therapy failure. CONCLUSION: endoscopic therapy is an efficient treatment of upper gastrointestinal bleeding due to duodenal ulcer. By means of a clinical variable, the hemodynamic status and two endoscopies, bleeding stigmata and the size of the ulcer, a group of patients with high risk of endoscopic treatment failure can be selected.


Assuntos
Úlcera Duodenal/terapia , Gastroscopia , Técnicas Hemostáticas , Úlcera Péptica Hemorrágica/terapia , Úlcera Duodenal/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/cirurgia , Recidiva , Estudos Retrospectivos , Falha de Tratamento
5.
Rev Esp Enferm Dig ; 96(5): 305-14, 2004 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-15180442

RESUMO

OBJECTIVES: to analyse survival and quality of life of patients with malignant obstructive jaundice after palliative treatment, comparing endoscopic stent insertion and palliative surgical (palliative resection and bypass surgical). PATIENTS AND METHOD: eighty and seven patients were included in a trial. They were distributed to endoscopic stent (50) and palliative surgical (37). It analysed survival, quality of life and comfort index of jaundiced patients. The good quality of life was defined by absence of jaundice, pruritus and cholangitis after the initial treatment. RESULTS: the median survival of the patients treated to endoscopic stent was 9,6 months whereas the patients to surgical treatment survived a median of 17 months. The time free of disease was 4 months in stented patients and 10,5 months in surgical patients. There was no significant difference in comfort index between the two groups (stented 34%, surgical 42,5%) Neither was there significant difference in survival and quality of life between palliative resection and bypass surgery. CONCLUSIONS: despite the survival and time free of disease being better in surgical patients, there was no significant difference in overall quality of life between the two groups. The survival and quality of life are the same after palliative resection as after bypass surgery, for this should not be performed routinely or to justify resection as a debulking procedure.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Desvio Biliopancreático , Icterícia Obstrutiva/cirurgia , Cuidados Paliativos , Neoplasias Pancreáticas/cirurgia , Qualidade de Vida , Stents , Idoso , Neoplasias dos Ductos Biliares/complicações , Endoscopia do Sistema Digestório , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Estudos Retrospectivos , Análise de Sobrevida
6.
Gastroenterol Hepatol ; 25(6): 392-4, 2002.
Artigo em Espanhol | MEDLINE | ID: mdl-12069701

RESUMO

Amiodarone is a widely used and effective long-term antiarrhythmic drug but with known adverse effects. Prolonged oral administration of this drug has been implicated in numerous hepatic lesions, ranging from isolated, asymptomatic transaminase elevation to fulminant, fatal liver failure. Few cases of acute hepatotoxicity due to intravenous administration have been reported. We present a 69-year-old woman with atrial fibrillation who developed acute hepatitis within 24 hours of amiodarone infusion at the recommended dosage. The drug was withdrawn and laboratory findings progressively returned to normal over the following days. We analyze a possible mechanism of action for hepatotoxicity and highlight the importance of monitoring liver function in patients receiving this drug.


Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Idoso , Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Fatores de Tempo
7.
Gastroenterol Hepatol ; 26(3): 147-51, 2003 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-12586007

RESUMO

OBJECTIVE: To evaluate the results of endoscopic dilatation in caustic esophageal strictures and to analyze the factors associated with a favorable response. PATIENTS AND METHOD: We performed a retrospective study of 33 patients who underwent dilatation with Savary bougie between 1989 and 2001. Response to initial dilatation and outcome during follow-up were analyzed. RESULTS: The mean age was 50 years (8-83) and 58% were women. Intake was accidental in 29 (88%). In all patients, the caustic substance ingested was alkali. Dilatation was started in the acute phase in 12 patients (36%) and 13 presented inflammatory phenomena adjacent to the stenosis. During initial dilatation, 2 1.6 sessions (2-18) were performed and a favorable response was obtained in 18 patients (54%). At the end of follow-up, 68% of the patients presented satisfactory health status. The comparative study revealed that statistically significant variables for a favorable response to treatment were: accidental alkali intake, instauration of treatment in the chronic phase, absence of inflammatory phenomena, and a small number of initial dilatation sessions. CONCLUSIONS: In our series, more than half the patients with esophageal stenosis due to intake of corrosive alkalis showed a favorable initial response. In these patients with acute-phase stenosis who required a greater number of initial dilatation sessions, endoscopic therapy was less effective.


Assuntos
Álcalis/efeitos adversos , Queimaduras Químicas/terapia , Cateterismo/métodos , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/terapia , Esofagoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras Químicas/etiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Gastroenterol Hepatol ; 26(4): 227-33, 2003 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-12681115

RESUMO

INTRODUCTION: Endoscopic therapy is an effective technique in the control of bleeding due to peptic ulcer. However, bleeding persists or recurs in as many as 10-30% of patients. Gastric and duodenal ulcers present different clinical and endoscopic features and consequently the efficacy of endoscopic therapy and the factors associated with its failure should be studied separately. OBJECTIVES: To analyze the efficacy of endoscopic therapy in patients at high risk of persistent or recurrent bleeding due to gastric ulcer and to identify the factors associated with the failure of this technique. PATIENTS AND METHODS: We performed a retrospective study based on a clinical intervention protocol. Two hundred eight patients admitted for bleeding secondary to gastric ulcer with active bleeding or stigmas of recent bleeding who received endoscopic therapy between January 1992 and December 2001 were analyzed. Clinical, laboratory and endoscopic variables on admission, as well as the medical treatment and endoscopic procedure applied, were registered. Endoscopy was performed within 12 hours of admission. Patients were classified according to their response to endoscopic therapy: a) patients with limited bleeding, and b) patients with persistent or recurrent bleeding due to therapeutic failure. Intervention in patients with therapeutic failure was performed according to a previously established protocol. Variables that were statistically significant in the univariate analysis were included in a logistic regression model to identify those with an independent predictive value for failure of endoscopic therapy. RESULTS: Definitive hemostasis was achieved after initial therapy in 181 patients (87%). The efficacy of a second procedure increased the percentage of hemostasis to 91% of the patients. In the logistic regression model, the only variables that were independently associated with initial therapeutic failure were: hemodynamic status on admission (p = 0.016; OR = 3.99), the need for transfusion of blood products prior to endoscopy (p = 0.025; OR = 3.48), upper localization of the gastric ulcer (p = 0.050; OR = 3.08) and unsatisfactory endoscopic therapy (p = 0.009; OR = 17.39). CONCLUSION: These variables could contribute to the early identification of a subgroup of patients, which would enable us to increase medical-surgical surveillance and offer them other therapeutic alternatives.


Assuntos
Gastroscopia , Técnicas Hemostáticas , Úlcera Péptica Hemorrágica/terapia , Úlcera Gástrica/terapia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Terapia Combinada , Comorbidade , Emergências , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Feminino , Hemodinâmica , Humanos , Hepatopatias Alcoólicas/complicações , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/cirurgia , Recidiva , Estudos Retrospectivos , Risco , Úlcera Gástrica/complicações , Falha de Tratamento , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico
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