Prevalence of Helicobacter pylori infection in medical professionals in Spain.

OBJECTIVE: The epidemiology of Helicobacter pylori infection is still under investigation, and the exact source of infection and its mode of transmission are still unknown. The purpose of this prospective study was to determine whether medical professionals in Spain, especially gastroenterologists and gastrointestinal endoscopists, have a higher prevalence of H. pylori infection. METHODS: Two hundred and twenty four medical professionals attending the annual gastroenterology meeting in Spain (176 men, 48 women; mean age, 41.8 +/- 11.4 years; range, 25-73 years) and a control group of 189 persons of similar age were investigated for the prevalence of H. pylori infection by using the 13C-urea breath test. All medical professionals completed a questionnaire regarding medical specialty and regular performing of gastrointestinal endoscopy procedures. RESULTS: The overall prevalence of H. pylori infection in total medical professionals was 52.7%, compared with 51.9% in the control group (P > 0.05). When specialty was considered, the prevalence of H. pylori infection among gastroenterologists was 53.3%, also not significantly higher than 50.0% among non-gastroenterologists (P > 0.05). There were no statistical differences of H. pylori prevalence among endoscopists and non-endoscopists. CONCLUSIONS: Medical practice and, more specifically, gastroenterology and the regular performance of gastrointestinal endoscopy pose no additional risk for H. pylori infection in Spain.

[Diagnosis of Campylobacter pylori infection of the gastric mucosa: histologic and microbiologic aspects]. / Diagnóstico de la infección por Campylobacter pylori en la mucosa gástrica: aspectos histológicos y microbiológicos.

The usefulness of culturing gastric biopsies obtained by endoscopic visualization, Gram stain, immediate and late urease test, and histologic observation of Campylobacter pylori in the diagnosis of gastric mucosa infection by Campylobacter pylori was assessed in 75 patients. Four antral biopsies were obtained in 75 patients, 35 with duodenal ulcer and 40 with nonulcerous dyspepsia and all specimens were subjected to the above procedures. Positive criteria for infection were either a positive culture or the concurrence of positive Gram stain, positive urease test before 24 hours and observation of the Campylobacter pylori at the histologic preparations. The sensitivity and specificity of every test was calculated. The most useful tests were the biopsy culture and the early urease reaction. It should be pointed out that the ureasa test is rapidly done, has a low cost, and possess a high degree of reliability. Therefore it is very useful to the clinician and to the endoscopist.

[Nadolol as an adjuvant to sclerotherapy of esophageal varices for prevention of recurrent hemorrhaging]. / Nadolol como coadyuvante a la escleroterapia de varices esofágicas en la profilaxis de recidiva hemorrágica.

AIM: to assess whether nadolol could improve the results of sclerotherapy in the prevention of varices rebleeding. EXPERIMENTAL DESIGN: prospective study in which patients with cirrhosis and Child-Pugh's class A or B and with their first hemorrhage from esophageal varices, diagnosed by emergency endoscopy, were included. After initial control of bleeding with emergency sclerotherapy, the patients were randomized into two groups to receive long-term variceal sclerotherapy either alone (group 1) or plus nadolol (group 2). Sclerotherapy was performed by intravariceal injection of 5% ethanolamine at days 0, 4 10, 30 and then monthly until eradication of varices. Nadolol was administered during the whole follow-up in a dose to reduce resting pulse rate by 25% (mean final dose: 82 +/- 31 mg/d). PATIENTS: During a two year period (1989-1991), 40 patients with cirrhosis (from alcohol abuse in 48%), were included. 18 patients were allocated in group 1 and 22 in group 2. RESULTS: Both groups were well-matched for clinical, biological and endoscopic data. Follow-up was similar in both (24.3 +/- 10.6 months in group 1 vs 27.3 +/- 9.8 in group 2). Nine patients in group 1 (50%) and 13 in group 2 (59%) rebled during the follow-up, with a total number of 14 and 22 rebleeding episodes respectively (p = NS). There were no differences between the two groups when considering rebleeding index, transfusional requirements per rebleeding episode and the cumulative percentage of patients free from rebleeding. Severe complications attributable to treatment were observed in 22% of patients in group 1 and in 27% in group 2 (p = NS). Two patients died in each group. CONCLUSIONS: In patients undergoing long-term sclerotherapy for prevention of variceal rebleeding, nadolol confers no additional benefit.

[Gastric metastasis of breast carcinoma]. / Metástasis gástrica de carcinoma de mama.

Although distal dissemination from breast cancer is commonly found in bones, lungs, liver and brain, others less common sites have been occasionally reported. A 60 year-old woman with long standing disseminated breast cancer disease was admitted to our hospital with upper gastrointestinal bleeding. At endoscopy, an abnormal area was seen in the lesser curvature of the stomach. Invasion of the gastric wall by metastases from carcinoma of the breast was diagnosed in the biopsy. No further treatment was warranted and the patient died soon thereafter. Gastric metastases are primarily located in the submucosa and muscular layers of the stomach. Lack of mucosal involvement suggests a blood-borne spread. Although our patient had no progesterone receptors in the primary breast tumor, previous studies have suggested that the presence of receptors may facilitate gastrointestinal spread. Gastric metastases from extraintestinal cancers may be asymptomatic, and are usually late events in the progression of the disease.

[Spontaneous bacterial peritonitis: a comparative study of 2 methods of ascitic fluid culture]. / Peritonitis bacteriana espontánea: estudio comparativo de dos métodos de cultivo del líquido ascítico.

The sensitivity in the diagnosis of spontaneous bacterial peritonitis of ascitic fluid inoculation in blood culture bottles has been compared with the conventional method. We have analyzed 74 positive ascitic fluid cultures from 64 patients, the samples being processed by both techniques simultaneously. While all the ascitic fluid cultures performed by inoculation in blood culture bottles were positive, in only 42 from the 74 conventional cultures (56, 75%) bacterial growth was detected (p less than 0.001). Nineteen bacterascites were diagnosed by inoculation in blood culture bottles and 10 by the conventional method (p = NS). Gram stain was only positive in 3 spontaneous bacterial peritonitis (6%). We conclude that ascitic fluid inoculation in blood culture bottles improves significantly the sensitivity of the microbiological diagnosis of spontaneous bacterial peritonitis, without increasing the diagnosis of bacterascites.

[Usefulness of laparoscopy as a second-look method in neoplasms of the ovary]. / Utilidad de la laparoscopia como método de "second-look" en las neoplasias de ovario.

The usefulness of second-look laparoscopy in the follow-up of ovarian cancer is evaluated. This procedure has been included in the protocol for the treatment of these tumors. During the period 1980-1987 a total of 3038 laparoscopies were performed; 205 (7%) were for ovarian cancer. We present the results of 72 explorations in 52 patients; after surgery and chemotherapy all of them were in complete remission. 44 explorations were second-look laparoscopy and 28 third-look laparoscopy. All the examinations were done under local anesthesia. There were two failures due to the presence of adhesions secondary to the previous surgery which prevented the pneumoperitoneum. In 35 (48.6%) explorations a neoplasia was found and a laparotomy was avoided. There were 31% (4/13) false negative in second-look laparotomy post-laparoscopy. The correlation between gross and microscopic findings was excellent. There were no complications in spite of the previous abdominal surgery. We recommend second-look laparoscopy in patients under treatment of ovarian cancer which in our experience avoided laparotomy almost in half of the cases; no complications were observed and the procedure was well-tolerated.

[Is the omeprazole and amoxicillin combination useful in the treatment eradicating Helicobacter pylori in Spain?]. / Es útil la asociación de omeprazol y amoxicilina en el tratamiento erradicador de Helicobacter pylori en España?

AIM: To evaluate the efficiency of omeprazole (20 mg/12 h) plus amoxycillin (1 gr/12 h) in eradicating Helicobacter pylori in duodenal ulcer patients studied in four hospitals in our country. METHODS: One-hundred and four patients (mean age: 49 +/- 16 years, 67% males) attended at four general hospitals in Spain, who had a duodenal ulcer demonstrated by endoscopy. These patients were infected with H. pylori demonstrated by urease test and histologic methods, and in 32 by a breath test and 18 by culture. Omeprazole 20 mg b.i.d. plus amoxycillin 1 gr b.i.d. was administered for 2 weeks. Endoscopy was repeated 1 month after completing therapy, and the aforementioned diagnostic methods were performed again. RESULTS: Eradication was achieved in 29% of cases (n = 30). In multiple logistic regression analysis, duration of ulcer disease was the only variable which correlated with success in H. pylori eradication (chi(2) = 7.2; p = 0.02). Additional variables (age, sex, smoking, pre-treatment with omeprazole, AINEs or H2 antagonist, ulcer size, and antral histologic gastritis) were not correlated with H. pylori eradication. Ulcer healing was demonstrated in 80% of patients (n = 83), and the healing rate was higher when eradication was achieved (97%) than in H. pylori-positive patients (73%) (p < 0.01). Compliance was good in all cases. No adverse effects were observed. CONCLUSION: [corrected] Disappointing results were obtained with omeprazole (20 mg b.i.d.) plus amoxycillin (1 gr b.i.d.) on H. pylori eradication. This combination cannot be recommended in our country at the doses employed in this study.

[Pseudoachalasia: a diagnosis to consider in the assessment of dysphagia]. / Seudoacalasia: un diagnóstico a considerar en la evaluación de la disfagia.

The diagnosis of achalasia is based on the patient's symptoms and on manometric studies although other diseases present similar symptomatology. To present an elderly woman clinically and manometrically diagnosed with achalasia of the cardia who was treated by dilatation. When the patient relapsed and was surgically treated she was found to have and esophageal adenocarcinoma. When considering a diagnosis of achalasia, alternative diagnoses (especially neoplasias) should be borne in mind, especially in unusual situations, such as rapid onset or in the elderly.

[Consequences of the bilateral vagus nerve section at a cervical level]. / Consecuencias de la sección bilateral del vago a nivel cervical.

We present the consequences corresponding to a bilateral section of the main trunk of vagus nerve at cervical level in a patient with an oropharyngeal carcinoma with bilateral neck nodes. As a consequence of the bilateral resection of both vagus nerves during neck dissections, as well as motor and sensitive damage of the larynx and pharynx, we could observe affection of the normal tone of the oesophagus, stomach and duodenum which forced to enteral nutrition by direct jejunal access, and a disorder of the cardiac rhythm due to loss of the parasympathetic innervation appeared.

Abortion research in Latin America.

Surveys dealing with abortion in Latin America have provided useful information despite problems in the collection and use of the data. Considerations that should be taken into account in designing abortion surveys and using the resultant information have been discussed here. Special attention has been paid to the need for a broad definition of "abortion" in order to overcome difficulties in gathering information about abortion in Latin America. Surveys have shown increasing incidence of abortion throughout Latin America in the recent past. In examining changes over time it is crucial to interpret clearly and carefully the summary measures of proportion of pregnancies ending in abortion and abortion rates per 1,000 women. It is also important to realize that the level and direction of change of the abortion rate depends on both the rate at which women are becoming pregnant and the proportion of pregnancies ending in abortion. Better survey design and techniques and more careful use of the resulting information will aid in the planning and evaluation of programs aimed at reducing abortion in Latin America.

PIP: Surveys dealing with abortion in Latin America have provided useful information despite difficulties in the collection and the use of the data. Comparisons of different studies and interpretations of the findings are complicated by differences in definitions, criteria, and methodology used and by misunderstandings of what the data represent. Focus is on considerations that should be taken into account in designing abortion surveys and using the resultant information. Special attention has been given to the need for a broad definition of "abortion" in order to overcome difficulties in gathering information about abortion in Latin America. Survey findings show that in the past few years the incidence of abortion has been increasing in Latin America, particularly in urban areas. In all cases where comparison across time could be made for similar groups of women, the proportion of pregnancies ending in abortion increased, as did the rate of abortion/1000 women. Comparative studies of the effect of family planning on abortion assist in the planning and evaluation of family planning programs aimed at reducing the practice of abortion. 1 way to do this using data from abortion surveys is to examine changes in proportions of pregnancies ending in abortion and in rates of abortion/1000 women in comparison with changes in the pregnancy rate.

Influence of the menstrual cycle and of menopause on the gastric emptying rate of solids in female volunteers.

The aim of this study was to assess the influence of the normal menstrual cycle and of menopause on the gastric emptying rate of solids. Gastric emptying was studied in 15 premenopausal and ten postmenopausal women with an isotopic technique after the ingestion of a radiolabelled test meal. Premenopausal women were studied twice: within 1 week prior to menses and again 1 week after onset of menses. Postmenopausal women were studied only once. The emptying curves of the solid component of the meal fitted a linear model. The half-emptying time was 78 +/- 5 min during the follicular phase, 75 +/- 7 min during the luteal phase and 76 +/- 6 min in postmenopausal women (differences not statistically significant). The mean percentages of the meal retained in the stomach at different time intervals were also similar in the three groups. These results suggest that the menstrual cycle does not influence the gastric emptying rate of solids, which remains unchanged in relation to the follicular phase or after menopause.

Omeprazole versus ranitidine as adjunct therapy to endoscopic injection in actively bleeding ulcers: a prospective and randomized study.

BACKGROUND AND STUDY AIMS: Although high rates of initial hemostasis can be achieved with endoscopic injection therapy in actively bleeding ulcers, the incidence of rebleeding is not negligible. Optimal conditions for clotting may require achieving deep and sustained acid inhibition to avoid the deleterious effect of acid and pepsin secretions on the hemostatic process. The aim of this study was to assess whether omeprazole could improve the efficacy of ranitidine as an adjunct treatment in endoscopic injection therapy to avoid rebleeding. PATIENTS AND METHODS: Eighty-six patients with active arterial bleeding from a peptic ulcer disclosed at emergency endoscopy were included in this prospective trial. All patients received injections of 1:10,000 adrenaline. Subsequently, they were randomized to receive either intravenous omeprazole (n = 45), with an initial dose of 80 mg followed by 40 mg every eight hours for four days and thereafter with oral administration; or ranitidine (n = 41), 50 mg every six hours for 12 to 24 hours and thereafter with oral administration. RESULTS: The two groups were well matched in terms of clinical and endoscopic data. There were no statistically significant differences between the groups with regard to: further bleeding (29% in both groups), need for emergency surgery (20% in the omeprazole group vs. 22% in the ranitidine group), transfusion requirements (2.4 +/- 2.2 vs. 2.2 +/- 2.1 units), length of hospital stay (14.1 +/- 13.9 vs. 15.3 +/- 15.4 days), or mortality (7% vs. 2%). CONCLUSIONS: Our results suggest that omeprazole does not improve the efficacy of ranitidine after endoscopic injection therapy in patients with an active arterial bleeding ulcer.

Value of second-look endoscopy after injection therapy for bleeding peptic ulcer: a prospective and randomized trial.

A prospective and randomized trial involving 104 patients was performed to assess whether second-look endoscopy could improve the efficacy of injection therapy for bleeding ulcers. The inclusion criteria were the presence of active arterial bleeding or a non-bleeding visible vessel at emergency endoscopy. All the patients received emergency injection of 1:10,000 adrenaline and were subsequently randomized (52 patients in each group) according to whether or not they would receive a second elective endoscopy within the first 24 hours with repeated injection if a visible vessel was still identified. Both groups were well matched for clinical and endoscopic data. A tendency towards better results was noted in the group that received a second-look endoscopy; the two groups were compared in regard to further bleeding (21% versus 29%, 95% confidence interval of the difference = -24.3 to 8.5), need for emergency surgery (8% versus 15%, 95% confidence interval of the difference = -19.9 to 4.5), transfusion requirements (1.7 +/- 1.9 versus 2.5 +/- 2.5 units, 95% confidence interval of the difference = -1.6 to 0.07), length of hospital stay (9.3 +/- 8.6 versus 11.8 +/- 10.8 days, 95% confidence interval of the difference = -6.2 to 1.4), and mortality rate (2% versus 4%). Although these trends did not achieve statistical significance, a type II error cannot be ruled out. However, according to our results, several hundred patients would be required to demonstrate statistically these relatively small differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastric emptying of two radiolabelled antacids with simultaneous monitoring of gastric pH.

The aim of this study was to assess the gastric emptying rate of two antacids using an scintigraphic technique and simultaneous monitoring of gastric pH in 16 healthy male volunteers. Ten ml of Talcid (hydrotalcite 1 g) and Maalox (Mg-Al-hydroxide), with a similar neutralization capacity, were labelled with technetium-99m using a pyrophosphate bridge. Labelled antacids were given on separate days (within 2 weeks), 1 h after a standard meal. Intragastric pH was measured for at least 4 h, using ambulatory pH-metry with a dual-crystant antimony catheter. Continuous monitoring was started 1 h prior to the meal (baseline) and lasted 3 h (post-prandial, post-antacid and final periods). The antacid capacity of labelled and unlabelled antacids was similar. The mean percentages of antacids retained in the stomach fitted a linear model. The mean half-emptying time of Talcid was 63.9 +/- 27.9 min, while that of Maalox was 57.3 +/- 23.9 min (P = NS). The recordings of gastric pH (mean values of pH for each period) showed a similar profile for both antacids. The mean pH (Maalox vs Talcid) was 1.69 vs 2.07 in the baseline period, 1.95 vs 1.93 in the post-prandial period, 1.79 vs 1.15 in the post-antacid period (P = NS) and 0.4 vs 0.52 in the final period (P < 0.05 vs prior periods). In conclusion, the gastric emptying of Talcid and Maalox was similar and pH profiles were parallel and remained unchanged for the two antacids within the first hour of intake. A significant decrease in pH was observed 1 h after intake of the antacids, suggesting a possible rebound effect.

Endoscopic injection therapy of bleeding ulcer: a prospective and randomized comparison of adrenaline alone or with polidocanol.

In a prospective randomized trial involving 63 patients with bleeding peptic ulcer, we assessed whether the addition of 1% polidocanol improved the results achieved by 1/10(4) adrenaline alone for injection therapy. The inclusion criterion was the presence of active arterial bleeding or a nonbleeding visible vessel at emergency endoscopy. Thirty patients were treated with 1/10(4) adrenaline (group A) and 33 with adrenaline plus 1% polidocanol (group B). Initial hemostasis was achieved in 97% of cases in both groups and permanent hemostasis in 87% patients in group A and in 76% in group B (p = NS). Mortality was 6% in group A and 3% in group B. There were no differences between the two groups regarding requirements for emergency surgery, the number of transfusions, or the length of hospital stay. One patient in group B had a perforation. No other relevant complications were noted. In conclusion, combined therapy does not improve the results achieved with adrenaline alone.

Prediction of therapeutic failure in patients with bleeding peptic ulcer treated with endoscopic injection.

Endoscopic injection therapy was performed in a consecutive series of 233 patients admitted for a bleeding peptic ulcer with active arterial hemorrhage or a nonbleeding visible vessel disclosed at emergency endoscopy. Further bleeding occurred in 57 cases (24.5%). The present study was conducted to evaluate whether any clinical or endoscopic features could identify the patients at high risk of therapeutic failure. Multiple logistic regression analysis showed that failure was significantly related to: (1) the ulcer location on the posterior wall (P = 0.004) or superior wall (P = 0.003) of the duodenal bulb, (2) the ulcer size (P = 0.011), and (3) the existence of associated diseases (P = 0.012). The validity of the prediction rule based on these factors was evaluated by receiver-operating characteristic curves and was confirmed and prospectively validated in an independent sample of 81 patients with a bleeding peptic ulcer treated by endoscopic injection. We conclude that once the initial control of bleeding has been achieved by injection therapy, the present prediction rule can be used to identify candidates for alternative treatment.

Endoscopic hemostasis by local injection of epinephrine and polidocanol in bleeding ulcer. A prospective randomized trial.

The present prospective randomized trial has been carried out to assess the efficacy of the endoscopic injection of epinephrine plus polidocanol, in the prompt treatment of upper gastrointestinal bleeding due to peptic lesions. Over a period of one year, 72 patients were admitted to the study. Thirty-six of these underwent endoscopic treatment (group A), while the others received medical treatment (group B). Definitive hemostasis was achieved in 29 patients in group A, and in 21 in group B (p less than 0.05). Seven patients in group A and 12 in group B underwent emergency surgery for persistent or recurrent bleeding (p = NS). Three patients from group B received endoscopic treatment owing to relative surgical contraindications. It was successful in all of them. Patients from group A needed a significantly lower number of units of packed red cells (p less than 0.05). Our results show that it is justified to employ endoscopic injection as the first therapeutic step in upper GI bleeding due to peptic gastroduodenal lesions.