Revista Española de Enfermedades Digestivas

Lung transplantation and esophageal dysfunction

Guidelines for reviewers of The Spanish Journal of Gastroenterology (REED)

Esophageal motor disorders are frequent during pre and post lung transplantation. Can they influence lung rejection?

ABSTRACT Background: lung transplantation (LTx) is a viable option for most patients with end-stage lung diseases. Esophageal motor disorders (EMD) are frequent in candidates for LTx, but there is very little data about changes in esophageal motility post-LTx. Aim: the aim of our study was to assess esophageal motor disorders by high resolution manometry (HRM) both pre-LTx and six months post-LTx in patients with and without organ rejection. Study: HRM (Manoscan(r)) was performed in 57 patients both pre-LTx and six months post-LTx. HRM plots were analyzed according to the Chicago classification 3.0. Results: EMD were found in 33.3% and in 49.1% of patients pre-LTx and post-LTx, respectively, and abnormal peristalsis was more frequently found post-LTx (p = 0.018). Hypercontractile esophagus was frequently found post-LTx (1.8% and 19.3% pre-LTx and post-LTx, respectively). Esophagogastric junction (EGJ) morphology changed significantly pre-LTx and post-LTx; type I (normal) was more frequent post-LTx (63-2% and 82.5% respectively, p = 0.007). EMD were more frequent post-LTx in both the non-rejection and rejection group, although particularly in the rejection group (43.2% and 69.2% respectively, p = 0.09). EMD such as distal spasm, hypercontractile esophagus and EGJ outflow obstruction were also observed more frequently post-LTx in the rejection group. Conclusion: significant changes in esophageal motility were observed pre-LTx and particularly post-LTx; hypercontractile esophagus was a frequent EMD found post-LTx. EMD were more frequent in the group of patients that experienced organ rejection compared to the non-rejection group. EMD leading to an impaired esophageal clearance should be considered as an additional factor that contributes to LTx failure.

Continuous esomeprazole infusion versus bolus administration and second look endoscopy for the prevention of rebleeding in children with a peptic ulcer

ABSTRACT Introduction: the majority of studies of acute gastrointestinal bleeding in children are retrospective, focusing on therapeutic endoscopy. Previous studies performed in adult patients have demonstrated that both scheduled second look endoscopy and high dose continuous omeprazole infusion are effective in the prevention of peptic ulcer rebleeding. The aim of this study was to compare the efficacy of these two strategies using esomeprazole for the prevention of rebleeding following primary endoscopic hemostasis in children with peptic ulcers. The main outcome was to assess the rebleeding rate within 30 days after the initial hemostasis. Methods: consecutive pediatric cases who underwent endoscopic treatment for bleeding peptic ulcers were randomized into two treatment groups following hemostasis. The first group received esomeprazole as an intravenous bolus every 12 hours for 72 hours and a routine second look endoscopy within 12-24 hours with endotherapy retreatment in the case of a persistent stigmata of bleeding. The second group received a continuous high dose esomeprazole infusion for 72 hours without endoscopic reassessment unless required due to rebleeding. Results: a total of 63 children were randomized to the second look endoscopy group and 64 to the esomeprazole infusion group. Rebleeding occurred within 30 days in four patients (6.3%) in the first group and in three patients (4.6%) in the second group (p = 0.7). Conclusions: a pharmaceutical approach using a high dose continuous esomeprazole infusion in children after an initial endoscopic hemostasis has a similar efficacy compared to second look endoscopy and bolus esomeprazole administration for the prevention of peptic ulcer rebleeding. Thus, the discomfort of a second endoscopy in children can be avoided and is only recommended for selected high risk cases.

Gastrointestinal stromal tumors: 16 years' experience within a university hospital

ABSTRACT Aim: the aim was to convey our 16-year experience regarding gastrointestinal stromal tumors within in a high volume university hospital. Factors that may impact on patient survival were evaluated. Material and methods: all patients diagnosed with gastrointestinal stromal tumors in our clinic over a 16-year period were retrospectively evaluated. All patients included in the study had their tumors surgically resected. Survival analyses were performed using the Kaplan-Meier method. Survival time comparisons between groups were performed using the log-rank test. The effect of continuous variables on survival times were evaluated via a Cox-regression analysis with a backward conditional method. Results: one hundred and thirty-five patients (76 males and 59 females) were included into the study and the mean age was 62.8 ± 13.3 years. Overall survival time was 121.3 ± 7.0 months and the 5-year survival rate was 66.6 ± 4.2%. Patients with colorectal tumors had significantly lower survival times than patients with tumors located in the stomach (p = 0.001) and small intestine (p = 0.033). Patients with moderate risk scores had a significantly longer survival compared to patients with high risk scores (p = 0.003) and patients with tumor recurrence had a significantly shorter survival (p < 0.001). There was no significant relationship between survival and factors such as gender and tumor size (p > 0.05). However, age, Ki-67 and the mitotic index were poor prognostic factors and C-kit was considered as a good prognostic factor. Conclusion: some of the findings in this study are consistent with published data. However, our data significantly differs from previous studies such as the common finding of the effect of gender and tumor size on survival.

A prospective, controlled assessment of the technical characteristics of a novel forward-viewing echoendoscope

RESUMEN Introducción: la ultrasonografía endoscópica (USE) es una técnica de gran utilidad en el diagnóstico y tratamiento de distintas patologías del tracto digestivo. Objetivo: evaluar de forma prospectiva la utilidad clínica de un nuevo ecoendoscopio de visión frontal (FV-CLA). Métodos: estudio observacional transversal. Todos los pacientes sometidos a una USE durante un periodo de dos meses fueron evaluados para su inclusión en el estudio. Se analizaron de forma sistemática todas las estaciones mediastínicas, perigástricas y periduodenales (evaluando la facilidad de obtener los cortes ultrasonográficos y la calidad de los mismos) y se realizó punción de las lesiones indicadas clínicamente. Resultados: se incluyeron un total de 45 pacientes. La exploración ecoendoscópica pudo ser completada en el 100% de los pacientes, registrándose dos complicaciones menores. La manejabilidad del ecoendoscopio fue catalogada como sobresaliente; la visibilidad global del plano USE, como notable; y tan solo la visualización USE de las estaciones 4L y 5 fue puntuada como insuficiente. La visualización del páncreas y del resto de las estaciones USE fue puntuada como sobresaliente o notable. La facilidad de realizar punción, incluso desde la segunda porción duodenal, fue puntuada como notable o sobresaliente. Conclusión: el FV-CLA permite realizar una exploración completa y de calidad en el tracto digestivo superior, incluyendo punciones. Existen algunas estaciones mediastínicas que parecen poco accesibles para este nuevo aparato. Sería interesante validar la utilidad del FV-CLA en la terapéutica guiada por USE.

ABSTRACT Introduction: endoscopic ultrasound (EUS) is a highly useful technique for the diagnosis and management of different gastrointestinal (GI) tract conditions. Objective: to prospectively assess the clinical usefulness of a novel forward-viewing echoendoscope (FV-CLA). Methods: this was a cross-sectional observational study. All patients that underwent EUS over a two-month period were considered for the study. All mediastinal, perigastric and periduodenal stations were consistently assessed with a rating from 0 to 10 points with regard to the ease to obtain ultrasonographic sections and the quality of ultrasound images. The identified lesions were punctured when clinically indicated. Results: a total of 45 patients were included. EUS was completed in 100% of patients, with two minor complications recorded. Echoendoscope maneuverability was graded as "A" (9-10 points), overall plane visibility was graded as "B" (7-8 points) and only stations 4L and 5 visualization were graded as "D" (< 7 points). Visualization of the pancreas and the rest of the EUS stations were rated as excellent or very good. The feasibility to perform EUS-FNA, even from the second portion of the duodenum, was graded excellent or very good. Conclusion: the FV-CLA allows a complete, high-quality examination of the upper GI tract, including EUS-FNA punctures. Some mediastinal stations are hardly accessible with this new device. A formal validation of the FV-CLA for EUS-guided therapy would be of interest.

Risk factors associated with gastric cancer in Mexico: education, breakfast and chili

ABSTRACT Background and aim: the aim of the study was to use a validated questionnaire to identify factors associated with the development of gastric cancer (GC) in the Mexican population. Methods: the study included cases and controls that were paired by sex and ± 10 years of age at diagnosis. In relation to cases, 46 patients with a confirmed histopathological diagnosis of adenocarcinoma-type GC, as reported in the hospital records, were selected, and 46 blood bank donors from the same hospital were included as controls. The previously validated Questionnaire to Find Factors Associated with Gastric Cancer (QUFA-GC(c)) was used to collect data. Odds ratio (OR) and 95% confidence interval (IC) were estimated via univariate analysis (paired OR). Multivariate analysis was performed by logistic regression. A decision tree was constructed using the J48 algorithm. Results: an association was found by univariate analysis between GC risk and a lack of formal education, having smoked for ≥ 10 years, eating rapidly, consuming very hot food and drinks, a non-suitable breakfast within two hours of waking, pickled food and capsaicin. In contrast, a protective association against GC was found with taking recreational exercise and consuming fresh fruit and vegetables. No association was found between the development of GC and having an income that reflected poverty, using a refrigerator, perception of the omission of breakfast and time period of alcoholism. In the final multivariate analysis model, having no formal education (OR = 17.47, 95% CI = 5.17-76.69), consuming a non-suitable breakfast within two hours of waking (OR = 8.99, 95% CI = 2.85-35.50) and the consumption of capsaicin ˃ 29.9 mg capsaicin per day (OR = 3.77, 95% CI = 1.21-13.11) were factors associated with GC. Conclusions: an association was found by multivariate analysis between the presence of GC and education, type of breakfast and the consumption of capsaicin. These variables are susceptible to intervention and can be identified via the QUFA-GC(c).

Outbreak of acute hepatitis A in the health area served by the Hospital Universitario Virgen de la Victoria (HUVV): a change in epidemiology

RESUMEN En el año 2016 se detectó en la provincia de Málaga un brote de hepatitis A en pacientes con características epidemiológicas especiales, con un predominio de sujetos del sexo masculino. Presentamos 51 casos de hepatitis A aguda con una media de edad de 35,7 años, el 90% varones, con un 55% de casos que reconocían haber mantenido relaciones sexuales con otros hombres en los últimos dos meses. La mitad de ellos requirieron ingreso hospitalario por coagulopatía significativa en el momento del diagnóstico, sin evolución a fallo fulminante, ni encefalopatía en ningún caso. Cuatro casos presentaban ascitis al diagnóstico. Este brote se suma a otros dos publicados en Reino Unido y Holanda con un número de casos similar y epidemiológicamente muy parecidos, lo cual refuerza la importancia de la vigilancia epidemiológica y la necesidad de vacunación en esta población de riesgo, así como de campañas informativas a la población para prevenir la enfermedad.

ABSTRACT In 2016, an outbreak of hepatitis A was identified in the Malaga province among patients with specific epidemiological characteristics, which were predominantly males. This is a report of 51 subjects with acute hepatitis A and a mean age of 35.7 years, 90% were male and 55% of cases were men who had had sex with other men within the last two months. Half of them required hospitalization for significant coagulopathy at diagnosis and no cases progressed to fulminant failure or encephalopathy. Four patients had ascites at the time of diagnosis. This outbreak adds to those reported in the United Kingdom and the Netherlands with a similar number of cases and epidemiology. These studies highlight the importance of epidemiological surveillance, the need for vaccination in this particular at risk population and the need for informative campaigns in order to prevent this disease.

Spanish Consensus Document on Bariatric Endoscopy. Part 1. General considerations

RESUMEN La obesidad es una enfermedad crónica multifactorial, incurable, recurrente y progresiva, asociada a importantes complicaciones físicas y psicológicas y con considerable morbimortalidad. Por este motivo, deben individualizarse la evaluación, el tratamiento y el seguimiento del paciente obeso dentro de una unidad multidisciplinar que disponga de unos adecuados recursos humanos y estructurales. Su tratamiento médico mediante medidas higiénicas-dietéticas, aunque imprescindible, puede resultar insuficiente y la opción quirúrgica, reservada a obesidades severas o mórbidas, no está exenta de complicaciones ni es del agrado de muchos pacientes. En este contexto, pueden considerarse tres situaciones en las que el tratamiento endoscópico, como estrategia complementaria y con escasas complicaciones, contribuye al beneficio del paciente obeso: en primer lugar, aquel subgrupo de pacientes con sobrepeso grado II u obesidad no mórbida en el que el tratamiento médico aislado haya fracasado o como complemento al mismo; en segundo lugar, en aquellos pacientes con obesidad mórbida que rechacen la cirugía o a los cuales esta les resulte contraindicada o de riesgo excesivo; y finalmente, en aquellos pacientes afectos de superobesidad que necesitan perder peso previo a la cirugía bariátrica para disminuir la morbimortalidad de la misma. En este sentido, el Grupo Español de Endoscopia Bariátrica (Grupo Español de Trabajo para el Tratamiento Endoscópico del Metabolismo y la Obesidad [GETTEMO]) ha elaborado este Documento de Consenso para que sirva de orientación práctica a todos los profesionales implicados en la endoscopia de la obesidad y permita establecer los requisitos mínimos necesarios para el correcto funcionamiento de una Unidad de Endoscopia Bariátrica.

ABSTRACT Obesity is a chronic multifactorial, incurable, recurrent, and progressive disease associated with significant physical and psychological complications, and considerable morbidity and mortality. For this reason, the assessment, management, and follow-up of obese patients should take place in the setting of a multidisciplinary unit equipped with adequate human and structural resources. Medical treatment using hygienic-dietary measures, while indispensable, may be insufficient, and surgery, which is reserved for severe or morbid obesity, is not exempt from complications neither is to the liking of many patients. In this context three situations may be considered where endoscopic treatment, used as a supplementary strategy with few complications, contributes to benefit obese patients: first, in a subgroup of patients with grade-II overweight or non-morbid obesity where medical therapy alone failed or needs supplementation. Second, in patients with morbid obesity when surgery is rejected, is contraindicated, or entails excessive risk. Finally, in patients with superobesity who need to lose weight before bariatric surgery in order to reduce surgery-related morbidity and mortality. In this regard, the Spanish Task Force on Bariatric Endoscopy (Grupo Español de Trabajo para el Tratamiento Endoscópico del Metabolismo y la Obesidad, GETTEMO) have developed this Consensus Document to serve as practical guidance for all professionals involved in the endoscopic management of obesity, and to facilitate establishing a minimum set of requirements for the proper functioning of a bariatric endoscopy unit.

Hepatic encephalopathy secondary to a splenorenal shunt that manifested a long time after a liver transplantation

Hepatitis E virus in neurological disorders: a case of Parsonage-Turner syndrome

RESUMEN La infección por el virus de la hepatitis E (VHE) es una patología emergente en países industrializados y con un amplio espectro clínico. La hepatitis aguda, en ausencia de inmunocompromiso y embarazo, es una entidad leve y paucisintomática en la mayoría de los pacientes. No obstante, las manifestaciones extrahepáticas, entre ellas las neurológicas, son frecuentes y en ocasiones conllevan secuelas neurológicas permanentes. Reportamos el caso de un paciente inmunocompetente que ingresa por cuadro de parestesias y debilidad en ambas extremidades superiores asociado a elevación anictérica de transaminasas. El diagnóstico, mediante electromiograma y serologías, fue de síndrome de Parsonage-Turner (neuralgia amiotrófica) secundario a VHE. La neuralgia amiotrófica (NA) es una patología axonal desmielinizante que afecta al plexo braquial y se asocia al VHE hasta en un 10% de los casos. Recalcamos la importancia de solicitar serologías del VHE en pacientes con patología neurológica, especialmente con afectación del sistema nervioso periférico. El papel de la ribavirina en estos escenarios está pendiente de esclarecer; no obstante, el diagnóstico y tratamiento precoz podría suponer una mejoría pronóstica, minimizando las secuelas neurológicas.

ABSTRACT Hepatitis E virus (HEV) infection is an emerging disease in developed countries with a broad clinical spectrum. In the absence of immunodeficiency or pregnancy, it is a mild and almost asymptomatic condition in most cases. However, extrahepatic manifestations, including neurological conditions, are common and may occasionally lead to permanent neurological sequelae. Herein, we report the case of an immunocompetent patient who was admitted to our hospital with paresthesia and weakness in both the upper extremities associated with anicteric-elevated transaminases. The diagnosis was Parsonage-Turner syndrome (neuralgic amyotrophy) secondary to HEV infection. The diagnosis was reached via electromyography and serology tests. Neuralgic amyotrophy (NA) is a demyelinating axonal disease that affects the brachial plexus and is associated with HEV infection in up to 10% of cases. We also emphasize the importance of requesting HEV serology in patients with neurological disease, especially with the involvement of the peripheral nervous system. Although the role of ribavirin remains to be fully determined, early diagnosis and treatment may result in an improved prognosis, thereby minimizing neurological sequelae.

Magnesium poisoning, multi-organ failure and ischemic colitis secondary to chronic ingestion of a parapharmacy product

RESUMEN En el artículo se describe el caso clínico de una paciente con fallo multiorgánico y colitis isquémica secundario a intoxicación por magnesio, debido a la ingesta crónica de un producto de parafarmacia, utilizado para el tratamiento del estreñimiento crónico. Se describe el caso clínico y se realiza una revisión de la literatura.

ABSTRACT The article describes the clinical case of a patient with multi-organ failure and ischemic colitis secondary to magnesium poisoning, due to the chronic intake of a parapharmacy product, used for the treatment of chronic constipation. The clinical case is described and a review of the literature is made.

Update of the SEPD position statement on the use of biosimilars for inflammatory bowel disease

Systemic sclerosis and sarcoidosis: a rare case of chronic intestinal pseudo-obstruction

Idiopathic portal hypertension with regard to thiopurine treatment

Proctitis and perirectal abscesses: is there anything else to think about?

Focal pneumatosis cystoides intestinalis: optic colonoscopy and virtual colonoscopy features

Listeriosis during the period 2003-2016