Revista Española de Enfermedades Digestivas

Should we prevent colorectal cancer?

Stenosis in laparoscopic gastric bypass: management by endoscopic dilation without fluoroscopic guidance

Objectives: gastric bypass is the surgical procedure that is carried out most frequently in the treatment of morbid obesity. Stenosis of the gastro-jejunal anastomosis is a relatively frequent complication that requires endoscopic management. However, the optimal dilation technique is yet to be determined. The purpose of this study was to evaluate the safety and efficacy of dilation with a hydrostatic balloon (CRE) without radioscopic guidance in morbidly obese patients treated by laparoscopic bypass. Material and methods: retrospective review of the data elicited from 525 patients treated against morbid obesity with laparoscopic gastric bypass from January, 2006 to November, 2010. Results: a total of 22/525 patients (4.1%) developed stenosis of the anastomosis [20 women (91%), 2 men (9%)]. In four patients (18.2%), there was an associated anastomotic ulcer, and in one case, there was a history of bleeding of an ulcer treated with sclerosis one month earlier. The diagnosis of stenosis was done in most patients during the first 90 days after the bypass. All cases were resolved by means of endoscopic dilation without radioscopic guidance, 15 cases (68.1%) required a single session, 6 cases (27.2%) two sessions, and 1 case (4.5%) required four sessions. This last case had an associated anastomotic ulcer. The diameter of the balloons ranged from 12 to 20 mm, generally using diameters of 12-15 mm in the first session, and increasing them in the following sessions according to the previous result. One patient treated with a 20 mm balloon presented with a small tear, without showing any evidence of leak of contrast medium in the radioscopic guidance, and was thus managed conservatively. In the follow-up, no re-stenoses were detected. Conclusions: in our experience, stenosis of the anastomosis in the laparoscopic gastric bypass is an infrequent complication. When it happens, dilation with a hydrostatic balloon is an effective and safe treatment. Radioscopic guidance during dilation is not strictly necessary if norms of progressive dilation are followed.

Omega 3 fatty acids supplementation has an ameliorative effect in experimental ulcerative colitis despite increased colonic neutrophil infiltration

Purpose: omega 3 polyunsaturated fatty acids have anti-inflammatory properties and can be beneficial in the treatment of inflammatory diseases, such as ulcerative colitis. Dextran sodium sulphate (DSS) colitis in rats appears to mimic nearly all of the morphological characteristics and lesion distributions of ulcerative colitis. The purpose of the current study was to investigate the efficacy of omega 3 fatty acids in the treatment of experimental ulcerative colitis. Methods: thirty-six Wistar rats were randomly assigned to group A or group B receiving 5% dextran sulfate sodium (DSS) in their drinking water for eight days. For the next eight days post-DSS, group A animals received tap-water, and group B animals were fed a nutritional solution containing high levels of omega 3 polyunsaturated fatty acids (ProSure®, Abbott Laboratories, Zwolle, Netherlands) once per day, administrated with a orogastric feeding tube. Results: animals fed an omega 3 rich diet exhibited a statistically significant increase in hematocrit and hemoglobin levels, compared to animals drinking tap water, and a trend towards histopathological and clinical improvement, with the administration of omega 3 fatty acids ameliorating epithelial erosion by day 8 post-DSS, but no statistically significant difference was observed between group A and group B animals at 4 or 8 days post-DSS. Also, a statistically significant increase in neutrophil infiltration was observed, as depicted by myelohyperoxidase activity. Conclusion: our findings support a positive role of omega 3 polyunsaturated fatty acids supplementation in an experimental model of ulcerative colitis despite the increased colonic neutrophil infiltration. Further studies are needed in order to investigate the role of increased neutrophils in colonic mucosa.

Effects of changes in dietary habits on colorectal cancer incidence in twenty countries from four continents during the period 1971-2002

Introduction: the incidence of colorectal cancer is one of the highest on a global level. Many epidemiological studies have identified risk and protective factors, many of which have a behavioral component and, therefore, are potentially avoidable or subject to modification. This study investigated the incidence rates of colorectal cancer by gender in twenty different countries, taking into account the dietary habits of the habitants of each country. Material and methods: adjusted incidence rates, according to gender, were obtained for each country from the International Agency for Research on Cancer during the period 1971-2002. Annual per capita consumption data of the different dietary variables were obtained for the period 1961-2007 from the Food and Agriculture Organization of the United Nations. Pearson's correlation coefficients were calculated comparing incidence rates according to gender with different dietary variable using ten-year delay intervals. Results: there is an important variation in trends of colorectal cancer incidence worldwide which were found to be related with the dietary habits of each country. Discussion: based on the trends observed, each country was classified into one of four different situations based on the range of values of their incidence rates and linear trends observed. Due to the potential of primary prevention programs for colorectal cancer and to the delay between changes in the exposure to risk and protective factors and the effects on the incidence of this tumor, the application of legislative and educational measures promoting a healthy diet has become an urgent issue to stop the increasing tendency of colorectal cancer reported worldwide.

Introducción: el cáncer colorrectal es uno de los tumores de mayor incidencia a nivel mundial. Numerosos estudios epidemiológicos han identificado diversos factores de riesgo y protección, muchos de ellos asociados al comportamiento y que, por tanto, son potencialmente evitables o modificables. Este estudio analiza la incidencia de cáncer colorrectal, según género, en veinte países diferentes, teniendo en cuenta los hábitos dietéticos de la población en cada país. Material y métodos: las tasas ajustadas de incidencia, según género, se obtuvieron para cada país de Internacional Agency for Research on Cancer en el periodo 1971-2002. Los datos de consumo anual per cápita de las diferentes variables dietéticas se obtuvieron para el periodo 1961-2007 de Food and Agriculture Organization of United Nations. Los coeficientes de correlación de Pearson se calcularon comparando las tasas de incidencia, según género, con las diferentes variables dietéticas con un retardo de diez años. Resultados: hay importantes variaciones en las tendencias de incidencia de cáncer colorrectal en todo el mundo que pueden estar relacionadas con los hábitos dietéticos de cada país. Discusión: cada uno de los países analizados queda encuadrado en una de cuarto situaciones distintas considerando el rango de valores que toman sus tasas de incidencia y las tendencias lineales de estas en el periodo de estudio. Partiendo del enorme potencial de prevención primaria de este tumor y del desfase temporal para que los cambios en la exposición a los factores de riesgo y protección modifiquen la incidencia del tumor, se deben aplicar, de forma urgente, medidas legislativas y educativas que promuevan dietas saludables que contribuyan a detener la tendencia creciente de la incidencia del cáncer colorrectal a nivel mundial.

Asymptomatic hypertransaminasemia in patients in Primary Care

Introduction and objective: asymptomatic hypertransaminasemia (AH) is a common finding in clinical practice. We propose to determine the prevalence of AH in our environment, its epidemiology and its evolution. Material and methods: we studied a random sample of 1,136 blood tests undertaken in 2006, excluding patients with known hepatic disease or symptoms or signs of liver disease, and following the evolution of the AHs until 2009. Data was analyzed using bivariate and multivariate logistic regression. Results: the percentage of patients found with a AH was 15.24% (95% CI 13.52 to 16.96%). The rates of AST and ALT, were 6.93% (95% CI 5.71 to 8.15%) and 14.31% (95% CI 12.65 to 15.97%) respectively. The percentage of normalization of transaminase values in a second analytical control was a 31.81% (95% CI: 26.21 to 37.4%). An association was found between AH and BMI (OR: 1.129, 95% CI 1.062 to 1.199) and between the persistence of AH and GGT (OR: 1.011, 95% CI 1.003 to 1.018). Fundamental tests such as hepatitis serology or ultrasound were performed on only 50% of patients (with 32% of steatohepatitis). Conclusions: the prevalence found in our study of AH was relatively high (15.24%), being more frequently encountered in obese subjects. Nearly a third of the AHs is normalized in a subsequent blood test. The high GGT is associated with persistence of AH. There is great variability in terms of additional testing in patients with AH and the application of such tests is not protocol.

Introducción y objetivo: la hipertransaminasemia asintomática (HA) es un hallazgo frecuente en la práctica clínica diaria. Nos proponemos conocer la prevalencia de HA en nuestro medio, sus características epidemiológicas y su evolución temporal. Material y métodos: estudiamos una muestra aleatoria de 1.136 analíticas de las realizadas en 2006, excluyendo pacientes con enfermedad hepática conocida o síntomas o signos de enfermedad hepática, y siguiendo evolutivamente las HA hasta el año 2009. Se analizaron los datos a nivel bivariante y multivariante por regresión logística. Resultados: el porcentaje hallado de pacientes con HA fue de un 15,24% (IC 95%: 13,52-16,96%). Los porcentajes de elevación de AST y ALT, fueron de un 6,93% (IC 95%: 5,71-8,15%) y un 14,31% (IC 95%: 12,65-15,97%), respectivamente. El porcentaje de normalización de los valores de transaminasas en un segundo control analítico fue de un 31,81% (IC 95%: 26,21-37,4%). Encontramos asociación entre la HA y el IMC (OR: 1,129; IC 95%: 1,062-1,199) y entre la persistencia de HA y la GGT (OR: 1,011; IC 95%: 1,003-1,018). Pruebas fundamentales como serología de hepatitis o ecografía se realizaron sólo en un 50% de pacientes (con un 32% de esteatohepatitis). Conclusiones: la prevalencia hallada en nuestro estudio de HA fue relativamente elevada (15,24%), presentándose con mayor frecuencia en obesos. Casi un tercio se normalizan en una analítica posterior. La GGT elevada se asocia a persistencia de la HA. Existe gran variabilidad en cuanto a la realización de pruebas complementarias en los pacientes con HA, y la solicitud de dichas pruebas no está protocolizada.

Experimental models for hepatic encephalopathy

Obturator hernia responsible for intestinal obstruction

Atypical endoscopic findings of Crohn's disease

Fitz-Hugh-Curtis syndrome: abdominal pain in women of 26 years old

Fitz-Hugh-Curtis syndrome is an inflammation of the liver capsule as a complication of pelvic inflammatory disease, whose most common etiologic agent is the C. trachomatis. The acute phase of the Fitz-Hugh-Curtis syndrome may present itself with pain in right upper abdomen, commonly confused with other hepatobiliary and gastrointestinal tract diseases. Definitive diagnosis is now possible with non-invasive techniques such as ultrasound, computed tomography, as well as techniques to isolate the responsible germ, available in most centers.

El síndrome de Fitz-Hugh-Curtis es una inflamación de la cápsula hepática, como complicación de una enfermedad inflamatoria pélvica, cuyo agente etiológico más frecuente es la C. trachomatis. La fase aguda del síndrome de Fitz-Hugh-Curtis puede presentarse con dolor en cuadrante superior derecho del abdomen, confundiéndose comúnmente con otras enfermedades hepatobiliares y del tracto gastrointestinal. El diagnóstico definitivo es posible hoy en día por técnicas no invasivas como ecografía, tomografía computarizada, además de técnicas para el aislamiento del germen responsable disponibles en la mayoría de los centros.

Treatment of acute hepatitis C

Subcapsular hepatic hematoma after ERCP (endoscopic retrograde cholangipancreatography)

Association of Wilson disease with neurofibromatosis

Rectal ulcer induced by suppositories

Chagas disease in the differential diagnosis of megacolon

Romiplostim in chronic liver disease with severe thrombocytopenia undergoing an elective invasive procedure

Avascular necrosis of the knees and ulcerative colitis