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Gastric cancer is one of the main causes of death in the world. In Venezuela, gastric tumors represent 37% of all malignant tumors of the digestive system, but only 1,6% to 3,1% of these cases are lymphoepithelioma-like carcinoma. Synchronous neoplastic lesions are also rare. The clinical case presented herein, a man with two synchronous tumor lesions, is the first of its kind in this country. Despite their incipient aspect, the histologic study reported two malignant tumors of epithelial origin: well-differentiated adenocarcinoma and lymphoepithelioma-like carcinoma.

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El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

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Los gastrinomas están entre los tumores neuroendocrinos pancreáticos más frecuentes, y el 60 por ciento son malignos. Al momento del diagnóstico el 50 por ciento ya presentan matástasis aunque se trata de lesiones de bajo grado de malignidad, y el 60 por ciento de estas lesiones se originan en lugares extrapancreáticos. Los tres casos que se analizaron demostraron la utilidad de los niveles de gastrina seriados, la ecoendoscopia y la sintigrafía para receptores de somatostatina marcados con Indio 111 en la detección de lesiones metastásicas

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In a large endoscopic population screening study for colo-rectal polyps and cancer among 2,080 average-risk asymptomatic or with minor GI symptoms, adults of both sex, average age 56.2, were submitted to flexible sigmoidoscopy 60 cm as part of a preventive medical checkup. Procedure was very effective: 349 polyps were detected in 276 patients, with a total polyp incidence of 13.3%. In 174, more than 60% of such cases, endoscopic polypectomy was performed: 118 were tubular benign adenomas, 57 hyperplastic, 7 mixed types adenomas, 3 carcinomas in situ Dukes A, 2 villous adenomas one of them malignant, one leiomyoma and one rectal carcinoid. All in situ malignant polyps were removed endoscopically with excellent results. There was a high incidence of polyps (13.04%) in group aged 40-49, therefore changes on criteria for initiating routine flexible sigmoidoscopy must be considered. FOB tests (guaiac) showed a very low specific rate for diagnosis since only 24 out of 276 polyps bearing patients showed positive results, probably due to the fact that most polyps were non-ulcerating and small lesions. One third of the total polyps were out of the reach of the rigid scope and this procedure should be excluded in all screening programs of this type. Endoscopic polypectomy should be always an early procedure. In order to decrease the number of nondetected right side colonic lesions, non accessible to the 60 cm flexible scope, at time of polypectomy a simultaneous colonoscopy should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)

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The authors report a case of gastric epithelial leiomyoma. (Leiomyoblastoma). Macroscopically, such tumors resemble leiomyoma, with a biological behavior between leiomyoma and leiomyosarcoma. A review of the medical literature indicates that gastrointestinal bleeding in the most usual manifestation. The endoscopy biopsy, many times, is unable to confirm the malignant or benign of the tumor. It is emphasized the importance of identifying the potentially malignant tendency of the tumor, indicated, mainly, by histology consist in total gastric resection. Radiology, Ultrasound and Endoscopy are the most frequently used methods to arrive at diagnosis. In our case a patient with a presumed diagnosis of gastric cancer with a severe upper gastrointestinal hemorrhage was operated on as an emergency. A radical extended total gastrectomy was performed. Intraoperative findings included multiple pancreatic, hepatic, splenic, hilium, greater and lesser omental metastases. The patient was released in good condition but died 3 months later.

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The frequency of rectal and colonic polyps was compared in 33 patients with history of cholecystectomy and 37 patients without it. The data were evaluated retrospectively from our medical bank records. We found a major incidence of adenomatous polyps in the group of patients with cholecystectomy, the same in females as in males, with a female prevalence in 2.7:1 ratio in contrast with the group without surgery, where the ratio was 1.5:1 with a male prevalence. We didn't find any association between cholecystectomy and colorectal cancer. All the patients with adenocarcinoma were in the group without cholecystectomy.

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ERCP and cholangiography during surgery (SC) are compared in regard to their usefulness in 100 patients in whom cholecystectomy was performed because of gallstones. The biliary tree was visualized in 73% of patients with ERCP and in 85% with SC 20 patients presented stones in the common bile duct (CBD), of these 19 had previous signs or symptoms clinical history, laboratory, ultrasonography) that suggested this diagnosis, of the rest of the patients (80) without CBD stones only 7 had signs or symptoms that suggested this diagnosis, 4 of these patients had normal cholangiograms and 3 had "odditis". So in 73 patients without symptoms suggestive of CBD stones, preoperative or intraoperative cholangiography was probably not necessary. We consider that it is convenient to perform ERCP only in those patients with gallstones who have clinical findings suggestive of CBD or pancreatic problems (history, laboratory, ultrasonography). Cholangiography during cholecystectomy would be indicated in patients with small gallstones, the finding during operation of a dialted CBD or palpation of stones in the CBD and when ERCP fails in a patient with suggestive symptoms or when there is doubts with the ERCP findings.

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