RESUMEN
Cyclosporin (CsA) has been proposed in the management of patients with acute ulcerative colitis (UC) in whom standard therapy failed and who were candidates for colectomy. Seven academic hospitals contributed to this retrospective study that included 29 patients (median age: 33 y. (15-74 y.); 12 females and 17 males). The median duration of the disease was 4 y. (0.3 to 33 y.). Before initiating CsA, patients were unresponsive to treatment including i.v. corticosteroids (n = 29), 5-ASA or salazopyrine (n = 19), azathioprine (n = 3), antibiotics (n = 14). The i.v. mean dose was 4 mg/kg/day and was adapted to blood level. Concomitant treatment included corticosteroids (n = 27). The median duration of i.v. CsA administration was 10 days (4 to 41 days). At the end of CsA administration, a global improvement was described in 20 patients while a surgery had to be performed immediately in 8 patients because of exacerbation of symptoms (n = 7) or perforation (n = 1). One other patient (74 y.) died because of Pneumocystis carinii infection. For the responders, maintenance therapy included: tapering dose of steroids (n = 12), azathioprine (n = 12), 5-ASA or salazopyrine (n = 10), methotrexate (n = 1) or oral CsA (n = II). The median duration of follow-up was 12 months (4 to 48 months). Among the 20 responders, 7 were subsequently referred for colectomy either electively (n = 3) or because of recurrence of the disease (n = 4). Among the 12 patients treated by azathioprine as a maintenance therapy, only 3 had to be referred for surgery (25%). Among the 8 patients who did not receive azathioprine, 4 were subsequently referred for a colectomy (50%) (NS). In patients with acute refractory UC who received CsA, the short-term efficacy (avoidance of immediate colectomy) was obtained in 20 out of 29 patients (69%). However, after a median follow-up of 12 months, only 13 patients were colectomy free (45%).
Asunto(s)
Colitis Ulcerosa/tratamiento farmacológico , Ciclosporina/uso terapéutico , Inmunosupresores/uso terapéutico , Enfermedad Aguda , Adolescente , Adulto , Anciano , Bélgica , Colitis Ulcerosa/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
A prospective epidemiological study on inflammatory bowel diseases (IBD) patients was performed in Brussels' area from April 1st, 1992 to 30th March, 1993. The mean annual incidence for Crohn's diseases (CD) was 4.1/10(5) inhabitants/year among native Belgian people and 6.4/10(5) inhabitants/year for subjects issued from Moroccan families. For ulcerative colitis, the incidence was 3.7/10(5) inhabitants/year for native Belgian people and only 1.2/10(5) inhabitants/year for Moroccan subjects. The male/female sex ratio was 0.4 for CD and 1.9 for UC. At the time of diagnosis, the mean age was 34 years for CD and 38 years for UC. For both diseases, the age peak was between 20 and 29 years. Cigarette smoking was significantly higher in CD (48%) than in UC patients (12%). Family history was about 10% for both diseases.
Asunto(s)
Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Adulto , Bélgica/epidemiología , Métodos Epidemiológicos , Humanos , Incidencia , Estudios Prospectivos , Fumar/epidemiologíaRESUMEN
Two patients who developed gastric giardiasis after 2 weeks of treatment with omeprazole 20 mg b.i.d. followed by omeprazole 20 mg per day for 2-6 weeks are described. In one patient, gastric giardiasis occurred in the presence of only mild intestinal metaplasia. In the other patient, Giardia lamblia infection had resolved 4 weeks after the cessation of omeprazole treatment, which, to our knowledge, is the first case reported in the literature. It is tempting to speculate that gastric giardiasis can develop in the absence of mucosal abnormalities during hypochlorhydria induced by treatment with a high dose of a proton-pump inhibitor. Specific treatment may not be required if the drug can be stopped and no other gastric disease causing hypochlorhydria is present.
Asunto(s)
Antiulcerosos/efectos adversos , Giardiasis/inducido químicamente , Omeprazol/efectos adversos , Inhibidores de la Bomba de Protones , Gastropatías/inducido químicamente , Gastropatías/parasitología , Anciano , Amoxicilina/uso terapéutico , Animales , Antiulcerosos/uso terapéutico , Quimioterapia Combinada , Úlcera Duodenal/tratamiento farmacológico , Úlcera Duodenal/microbiología , Mucosa Gástrica/parasitología , Giardia lamblia/aislamiento & purificación , Giardiasis/diagnóstico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Humanos , Masculino , Persona de Mediana Edad , Omeprazol/uso terapéutico , Penicilinas/uso terapéutico , Úlcera Gástrica/tratamiento farmacológico , Factores de TiempoRESUMEN
OBJECTIVES: To compare the healing rates of acute duodenal ulcer in patients receiving pantoprazole 40 mg or omeprazole 20 mg once daily and to assess drug tolerance. DESIGN: Randomized, double-blind study evaluating patients with healed duodenal ulcer on endoscopy after 2 weeks of treatment and patients unhealed at 2 and after 4 weeks of treatment. SETTING: Hospital or private gastroenterology practice outpatients. PATIENTS: Men or women, aged at least 18 years, with one or two duodenal ulcers. Patients with ulcer complications or with other significant acid-related disease were excluded. A total of 270 patients entered the study, of whom 255 were included in the per-protocol analysis. RESULTS: The primary measure of efficacy was the healing rates of duodenal ulcers. Complete healing of ulcers was observed in 88 (71%) of the 124 patients in the pantoprazole group and in 85 (65%) of the 131 patients in the omeprazole group after 2 weeks of treatment. The cumulative healing rates after 4 weeks were 118 (95%) out of 124 and 117 (89%) out of 131 patients, respectively. There was no significant difference between treatment groups with respect to either healing rates or freedom from ulcer pain at 2 weeks. Both treatments were well tolerated: only 10 and 11 patients in the pantoprazole and omeprazole groups, respectively, reported adverse events. Diarrhoea was reported by two patients in each group. CONCLUSIONS: Pantoprazole 40 mg daily and omeprazole 20 mg daily are equally effective in inducing ulcer healing.
Asunto(s)
Antiulcerosos/uso terapéutico , Bencimidazoles/uso terapéutico , Úlcera Duodenal/tratamiento farmacológico , Omeprazol/uso terapéutico , Sulfóxidos/uso terapéutico , 2-Piridinilmetilsulfinilbencimidazoles , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiulcerosos/administración & dosificación , Antiulcerosos/efectos adversos , Bencimidazoles/administración & dosificación , Bencimidazoles/efectos adversos , Diarrea/inducido químicamente , Método Doble Ciego , Tolerancia a Medicamentos , Duodenoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Omeprazol/administración & dosificación , Omeprazol/efectos adversos , Pantoprazol , Sulfóxidos/administración & dosificación , Sulfóxidos/efectos adversos , Cicatrización de HeridasRESUMEN
We report three cases of severe hepatotoxicity related to benzarone, a benzofuran derivative. Our cases include a 35-year-old woman with (sub)fulminant hepatitis, a 67-year-old woman with macronodular cirrhosis, and a 68-year-old man with severe chronic active hepatitis and cirrhosis, with positivity of anti-smooth muscle antibodies. Two patients died. We stress the potential of benzarone to cause hepatotoxicity, which usually resembles severe chronic active hepatitis. Our cases constitute the most severe cases of benzarone hepatotoxicity reported so far, and comprise the first cases of (sub)fulminant hepatitis and cirrhosis related to benzarone.
Asunto(s)
Benzbromarona/análogos & derivados , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Fibrinolíticos/efectos adversos , Encefalopatía Hepática/inducido químicamente , Adulto , Anciano , Benzbromarona/administración & dosificación , Benzbromarona/efectos adversos , Biopsia , Enfermedad Hepática Crónica Inducida por Sustancias y Drogas , Resultado Fatal , Femenino , Fibrinolíticos/administración & dosificación , Encefalopatía Hepática/patología , Hepatitis Crónica/patología , Humanos , Hígado/efectos de los fármacos , Hígado/patología , Cirrosis Hepática/inducido químicamente , Cirrosis Hepática/patología , Masculino , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/patología , Insuficiencia Venosa/tratamiento farmacológico , Insuficiencia Venosa/patologíaRESUMEN
We studied the pharmacokinetics of a single 0.5-mg i.v. dose of chlordesmethyldiazepam in 8 patients with liver disease and in 12 age-matched healthy controls. The kinetics were also studied of a single 1-mg oral dose in the patients with liver disease. After i.v. administration the kinetics of total chlordesmethyldiazepam in patients with liver disease differed from those in controls: elimination half-life was almost twice that in controls (395 and 204 h), as a consequence of a marked reduction in total clearance (0.13 and 0.25 ng.ml-1.h-1), whereas the apparent volume of distribution was similar in patients and controls (4.7 and 3.9 l/kg-1). The free fraction of the drug in patients was higher (5.5%) than in controls (2.9%). Correction for differences in protein binding revealed clearance in the patients was one-fifth (1.8 and 10.5 ng ml-1.kg-1) and volume of distribution one-half (65.0 and 118.4 l.kg-1) that in controls. The systemic availability of oral chlordesmethyldiazepam was high (110%) in spite of a relatively slow absorption rate. These results indicate a need for caution in the administration of chlordesmethyldiazepam to patients with liver disease.
Asunto(s)
Administración Oral , Ansiolíticos , Anticonvulsivantes/farmacocinética , Anticonvulsivantes/uso terapéutico , Benzodiazepinas , Inyecciones Intravenosas , Hepatopatías/tratamiento farmacológico , Nordazepam/análogos & derivados , Femenino , Fibrosis/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Nordazepam/farmacocinética , Nordazepam/uso terapéutico , FarmacocinéticaRESUMEN
The endoscopist examining a patient with a history of gastric surgery is expected to know details of the history, the present physical condition, and relevant laboratory results. Familiarity with the appropriateness or limitations of different types of fiberscopes in relation to the individual case, and knowledge of how to overcome common difficulties, is important. The preparation must address the particular characteristics of the case, and the endoscopist must be aware of contraindications, complications, and recommendations to be observed in special circumstances. Based on situations confronted in daily practice, the authors suggest a systematic approach to the examination of patients with a history of gastric surgery, and point to the importance of observing the following steps: measurement of the length of the greater curvature in the gastric stump, verification of artifacts and anatomic modifications and their repercussions, removal of symptomatic suture line or staples, dilatation of strictures, fragmentation of bezoars, exeresis of polypoid lesions, collection of tissue samples, and regular follow up of the patients.
Asunto(s)
Gastroscopía , Estómago/patología , Estudios de Seguimiento , Gastrectomía , Muñón Gástrico/patología , Gastroscopios , Gastroscopía/métodos , Humanos , Anamnesis , Examen Físico , Cuidados Posoperatorios , Estómago/cirugíaRESUMEN
We report a successful endoscopic obliteration of a large recurrent tracheoesophageal fistula (diameter 0.6 cm, length 2.0 cm) in a 12-year-old girl, using a combination of Histoacryl (n-butyl-z-cyanoacrylate) and Aethoxysclerol injected through a polyethylene catheter. The severe pulmonary infection, which rendered surgery potentially life threatening, disappeared after the endoscopic closure. Since the obliteration, now over 12 months ago, the girl is asymptomatic. Endoscopic obliteration is a worthwhile technique and should be considered as an alternative to surgery in patients presenting with a complicated recurrent tracheoesophageal fistula.
Asunto(s)
Esofagoscopía , Complicaciones Posoperatorias/terapia , Fístula Traqueoesofágica/terapia , Anestesia General , Niño , Enbucrilato/administración & dosificación , Atresia Esofágica/complicaciones , Atresia Esofágica/cirugía , Esofagoscopía/métodos , Femenino , Humanos , Polidocanol , Polietilenglicoles/administración & dosificación , Complicaciones Posoperatorias/etiología , Recurrencia , Adhesivos Tisulares/uso terapéutico , Fístula Traqueoesofágica/etiologíaRESUMEN
We report a 12-year-old boy presenting with smooth muscle antibody-positive auto-immune chronic active hepatitis. Suspicion of the diagnosis arose after a routine blood test which revealed abnormal liver function tests. In spite of the presence of cirrhosis and patchy necrosis on liver biopsy, our patient never showed any clinical feature of impaired liver function. This observation demonstrates that auto-immune hepatitis may exist for a long time before clinical symptoms appear and probably explains why some cases of auto-immune hepatitis finally present as fulminant liver failure.
Asunto(s)
Enfermedades Autoinmunes/diagnóstico , Hepatitis Crónica/inmunología , Niño , Hepatitis Crónica/diagnóstico , Humanos , Pruebas de Función Hepática , MasculinoRESUMEN
The brown bowel syndrome is a rare disorder caused by vitamin E deficiency occurring in malabsorption syndromes. In patients with celiac sprue and chronic pancreatitis, the death rate from malignancy is high. We believe that vitamin E deficiency is responsible for the development of the brown bowel syndrome and may be partially responsible for the high incidence of malignancy in patients with celiac sprue and chronic pancreatitis. We report such a patient, and review the literature.
Asunto(s)
Adenocarcinoma/etiología , Enfermedad Celíaca/complicaciones , Neoplasias del Colon/etiología , Enfermedades Intestinales/etiología , Pancreatitis/complicaciones , Deficiencia de Vitamina E/complicaciones , Anciano , Enfermedad Crónica , Humanos , Enfermedades Intestinales/patología , Masculino , SíndromeRESUMEN
A 21-year-old woman with Crohn's disease of the colon developed a skin rash after 3 weeks of treatment with sulfasalazine. Administration of sulfasalazine was discontinued. When mesalazine was instituted 1 week later, she developed a severe hypersensitivity reaction characterized by fever, diarrhea, skin rash with subsequent desquamation, marked atypical lymphocytosis, and severe hepatotoxicity. Recovery was complete. The clinical and biological features as well as liver pathology of this case bear a striking resemblance to earlier reports of hypersensitivity reaction with severe hepatotoxicity to sulfasalazine. The authors urge caution when mesalazine is given to a patient with known hypersensitivity to sulfasalazine.
Asunto(s)
Ácidos Aminosalicílicos/efectos adversos , Hipersensibilidad a las Drogas/etiología , Hígado/efectos de los fármacos , Sulfasalazina/efectos adversos , Adulto , Femenino , Humanos , Hígado/patología , MesalaminaRESUMEN
We report a patient with a jejunal leiomyosarcoma who presented with fever of unknown origin. Resection of the tumour resulted in resolution of his symptoms.
Asunto(s)
Fiebre de Origen Desconocido/etiología , Neoplasias del Yeyuno/complicaciones , Leiomiosarcoma/complicaciones , Humanos , Neoplasias del Yeyuno/patología , Leiomiosarcoma/patología , Masculino , Persona de Mediana EdadRESUMEN
Altogether, 138 patients were included in a study aimed at evaluating the effect of cisapride on healing and relapse of oesophagitis shown endoscopically. In the first phase of the study cisapride was given in an open fashion at 10 mg four times a day for 8 to 16 weeks, and healing was obtained in 69% of patients. Healing occurred later in patients with grades II to IV oesophagitis. The total score for reflux symptoms decreased by 67%. Eighty of the healed patients were included in the second phase. They were randomly assigned to double blind treatment with either cisapride 10 mg (n = 37) or placebo (n = 43) twice a day. Control endoscopy was performed when symptoms recurred or at the end of the six month trial. The cumulative percentage of patients in remission was higher (p = 0.06, survival analysis) in the cisapride group than in the placebo group, the relapse rates being 20% and 39%. The duration of remission tended to be longer in patients with a lower initial degree of oesophagitis. Adverse effects were no more frequent with cisapride than with placebo. In conclusion, cisapride is efficacious in healing oesophagitis, and, unlike other gastrointestinal prokinetic drugs or low dose cimetidine (400-800 mg daily) or ranitidine (150 mg daily), it may prevent relapse of oesophagitis.
Asunto(s)
Esofagitis Péptica/tratamiento farmacológico , Piperidinas/uso terapéutico , Adolescente , Adulto , Anciano , Cisaprida , Método Doble Ciego , Esofagitis Péptica/patología , Esofagitis Péptica/prevención & control , Esófago/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Piperidinas/efectos adversos , Estudios Prospectivos , Recurrencia , Inducción de RemisiónRESUMEN
Endoscopic ultrasonography (EUS), performed by means of an endoscope equipped with an ultrasound transducer, has been used in the imaging, staging, and follow-up of esophageal cancer for a decade. Although at first considered as a more or less experimental procedure, it emerged in the last six years as a valuable and precise tool for the assessment of various upper GI disorders. It is now well established that EUS can provide more accurate staging information on upper GI pathology than other imaging techniques such as conventional radiology, conventional ultrasound, CT, MRI and endoscopy. However, it remains complementary to other imaging methods, and is not suited for routine screening purposes. The instrumentation, technique, limitations, pitfalls, accuracy, and possible future of EUS are discussed, particularly concerning esophageal cancer.
Asunto(s)
Neoplasias Esofágicas/diagnóstico por imagen , Esofagoscopía , Neoplasias Esofágicas/patología , Humanos , Estadificación de Neoplasias , Transductores , Ultrasonografía/métodosRESUMEN
Mastocytosis is a chronic disease accompanied by specific infiltration of mast cells into the skin and other tissues. In 90% of cases only the skin is involved. In systemic mastocytosis there is an abnormal proliferation of mast cells in various organs including the gastrointestinal tract and liver. Release of various mediators and infiltrative growth of the mast cells lead to the symptoms of the disease. Therefore, many patients present with abdominal symptoms. The clinical manifestations are reviewed with special focus on the gastrointestinal and hepatic involvement. The prognosis of the disease is variable but most often benign. The treatment is based on H1 and H2-blockers and disodium cromoglycate.
Asunto(s)
Enfermedades Gastrointestinales/etiología , Mastocitosis/complicaciones , Enfermedades Gastrointestinales/tratamiento farmacológico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Antagonistas de los Receptores H2 de la Histamina/uso terapéutico , Humanos , Hepatopatías/etiología , Mastocitosis/diagnóstico , Mastocitosis/terapiaRESUMEN
The authors review and describe the technique of laser in the management of lower gastrointestinal tract tumors.