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Introducción: A nivel mundial la cirrosis representa una causa importante de morbi-mortalidad. En Guatemala no se cuenta con datos sobre las etiologías de la misma ni su frecuencia. Además, se ha demostrado que los pacientes infectados por virus hepatotropos, progresan más rápido hacia la muerte que los pacientes con enfermedad hepática crónica de otras etiologías. Estos pacientes son el principal interés del estudio, ya que la progresión podría desacelerarse con el tratamiento antiviral adecuado. Objetivos: Evaluar la prevalencia de infección crónica por hepatitis B y C en pacientes cirróticos, las principales causas de la misma, motivos de consulta en la EMA (Emergencia de Medicina de Adultos) y coinfección con VIH. Metodología: Se llevó a cabo un estudio prospectivo de 143 records médicos en la EMA (Emergencia de Adultos) de Gastroenterología del Hospital General San Juan de Dios, en los meses de octubre del 2017 a enero del 2018. Resultados: La ingesta excesiva de alcohol fue la principal causa de cirrosis, mientras que, los VHB y VHC son las principales causas de hepatopatía crónicas en países de primer mundo. Palabras clave: cirrosis, VHB, VHC, virus hepatotropos, progresión
Introduction: Worldwide, liver cirrhosis represents an important cause of morbimortality. There is no available data in Guatemala, regarding its etiologies or frequency and since patients infected with hepatotropic viruses, such as HBV or HCV and cirrhosis, progress faster to death than patients with chronic hepatic disease of different etiologies it is a most to know its prevalence . Objectives: To know the prevalence of HBV and HCV and other causes of chronic hepatic disease as HIV coinfection in patients consulting the ER. Methods: A prospective of study 143 patient files was conducted at the Adult ER and the Gastroenterology Outpatient Clinic at Hospital General San Juan de Dios, from October 2017 to January 2018. Results: Excessive alcohol intake was the main cause of cirrhosis amongst our patients, meanwhile HBV and HCV are the main etiologies of chronic liver disease in first world countries. Key words: cirrhosis, HBV. HCV, hepatotropic viruses, progression
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Background: Barrett´s esophagus (BE) is a disease in which the stratified squamous epithelium of the distal esophagus suffers a change to columnar epithelium. This change is known as intestinal metaplasia. This pathology is related with gastroesophageal reflux disease (GERD), however, lately its presence has been observed in patients without gastroesophageal reflux symptoms, reason why there is an interest in developing some screening method for BE. Objectives: Main purpose for the study was to know de incidence of BE in patients in patients with and without symptoms of GERD from the gastroenterology outpatient service of San Juan de Dios General Hospital. Methods: A retrospective descriptive study to determine the prevalence of BE in patients that underwent an esophageal biopsy during an endoscopy with and without symptoms for GERD. Results: A review of medical records was sampled with a total of 70 patients. Seven (7) were excluded due to a previous diagnosis of esophageal adenocarcinoma. Patients were classified according to their referred symptomatology in previous consultations, in a control group (patients with symptoms of GER, n=32) with a prevalence of 18.75% and an experimental group (patients without symptoms of GER; n=31) with a prevalence of 9.67%. Discussion: The incidence found of near 10% of EB is a statistic significant percentage indicating the need for a screening for Barrett´s esophagus in subjects with no symptoms of GERD with a 95% of reliability
La enfermedad por reflujo gastroesofágico (ERGE) es uno de los desórdenes gastrointestinales con mayor prevalencia. Es la enfermedad gastrointestinal más diagnosticada en Estados Unidos (1) por su alta relación con la obesidad. Existen diferentes factores de riesgo que predisponen a desarrollar la enfermedad, entre ellos: consumo de alimentos que disminuyan la presión del esfínter esofágico inferior, alcoholismo, tabaquismo, hernia hiatal, hipersecreción de ácido gástrico, obesidad y embarazo. El reflujo gastroesofágico (RGE) es el movimiento retrógrado del contenido gástrico hacia el esófago a través del esfínter esofágico inferior, el cual puede ser fisiológico o patológico cuando ya existen síntomas o cambios histopatológicos en el epitelio del esófago. El reflujo gastroesofágico predispone a los pacientes a desarrollar complicaciones: esofagitis, esófago de Barrett, adenocarcinoma de esófago. Las personas pueden presentar diferentes síntomas como: pirosis, regurgitación, saciedad temprana, laringitis, eructos, tos nocturna, erosiones dentales, entre otros. La presencia de estos síntomas orienta al médico para realizar el diagnóstico de ERGE. Aproximadamente un 60% de los adultos en Estados Unidos muestran síntomas ocasionalmente; de este porcentaje, un 7% presentan síntomas todos los días y un 20% mensualmente (2).
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Introducción: La complicación más común de la colangiopancreatografía retrógrada endoscópica (CPRE) es la pancreatitis; la incidencia va de un 5 a 7% en general y este número sube a un 10 a 15% en pacientes de alto riesgo; la Sociedad Americana de Endoscopía Gastrointestinal recomienda la profilaxis medicamentosa para prevenir la pancreatitis post CPRE en centros donde la incidencia supera este número o en pacientes con alto riesgo de padecerla, por lo que es necesario tener la epidemiología en todos los centros donde se realice este procedimiento. Objetivos: Obtener la epidemiología de la pancreatitis post CPRE en procedimientos realizados en el Hospital General San Juan de Dios (HGSD) y determinar los factores de riesgo. Metodología: Se observó a 53 pacientes que fueron sometidos a CPRE en el HGSD por 48 horas. Si los pacientes presentaban dolor abdominal típico de pancreatitis, se les midió niveles de amilasa y lipasa en sangre; si estos estaban elevados más de 5 veces el valor normal superior, se diagnosticó pancreatitis post CPRE (PEP). Se obtuvieron datos tanto del paciente como del procedimiento y así se determinó la incidencia de esta complicación y sus factores de riesgo. Resultados: Se obtuvo datos de 53 pacientes sometidos a CPRE, 38 fueron mujeres y 15 hombres. El promedio de edad fue de 44.86 años (+ 14.98). El factor de riesgo más común fue esfinterotomía en 40 pacientes. Solamente 1 paciente desarrolló PEP (1.88%). La pancreatitis fue leve, sin ninguna complicación adicional. La indicación principal de las CPRE realizadas fue la coledocolitiasis en 24 pacientes. Discusión: Se debe dar profilaxis medicamentosa solamente a pacientes de alto riesgo en el HGSD, debido a que la incidencia de pancreatitis es 1.88%, lo cual está incluso por debajo de los límites aceptados por la Sociedad Americana de Endoscopía Gastrointestinal. Conclusión: La incidencia de pancreatitis post CPRE está dentro de los límites aceptados. Sin embargo se deben hacer estudios más grandes para conocer la incidencia en pacientes de alto riesgo.
Introduction: The most common complication of endoscopic retrograde cholangiopancreatography (ERCP) is pancreatitis, its incidence is 5-7% overall and this number rises to 10 to 15% in high-risk patients. The American Society of Gastrointestinal Endoscopy recommends drug prophylaxis to prevent post-ERCP pancreatitis (PEP) in centers where the incidence exceeds this number or patients at high risk of presenting this complication; therefore, the epidemiology in each center where this procedure is performed needs to be known. Objectives: To ascertain the epidemiology of PEP in procedures performed in the San Juan de Dios General Hospital (HGSD) and identify risk factors. Methodology: Fifty three (53) patients who underwent ERCP in HGSD were followed during 48 hours. Patients who presented typical abdominal pain, serum amylase and lipase were measured; if they showed more than 5 folds the upper normal value, post-ERCP pancreatitis (PEP) was diagnosed. Data from both the patient and the procedure were obtained and therefore the incidence of this complication was assumed, the risk factors was also determined. Results: Data from 53 patients undergoing ERCP was obtained: 38 women and 15 men. The average age was 44.86 years (+ 14.98). The most common risk factor was sphincterotomy in 40 patients. Only one patient developed post-ERCP pancreatitis (1.88%). Pancreatitis was mild without any other complications. The main indication for ERCP was choledocholithiasis in 24 patients. Discussion: Drug prophylaxis should be given only to high-risk patients due to a low risk of incidence of pancreatitis is 1.88%, which is within the limits accepted by the American Society of Gastrointestinal Endoscopy. Conclusion: The incidence of post-ERCP pancreatitis is within acceptable limits but larger studies need to be carried out in order to know the incidence of PEP in high-risk patients.
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OBJECTIVE: To evaluate the success of the treatment with cyanoacrylate in primary hemostasis, rebleeding, and gastric varices eradication. MATERIAL AND METHODS: In this retrospective study 65 patients with gastric varices treated with N-butyl-2-cyanoacrylate (Histoacryl) were included from January 1999 to January 2008. We used a solution of 0,5 mL of cyanoacrylate and 0.9 mL of lipiodol, utilizing an average of 3.46 mL of this mixture per session (range 1 to 6 mL). Sclerosing needles of 21 gauge were used. Patients were sedated. Data were analyzed using a chi-squared test. RESULTS: Sixty-five patients were included, 42 men and 23 women with an average age of 53.8 years (range 18 to 76 years). The etiology of the portal hypertension (PH) was cirrhosis in 52 patients (80%), prehepatic PH in 7 (10.8%), and segmentary PH in 3 (4.6%), and non-classified in 3 (4.6%). Cirrhotic patients were classified as Child A in 21 cases, Child B in 25 and Child C in 6. According to the Sarin classification, 7 patients had gastric-oesophageal varices (GOV) type 1, 32 GOV2, 8 GOV1 and 2, and 8 isolated gastric varices (IGV) type 1. Fifty-six patients (86%) presented active bleeding or stigmata of recent bleeding at time of initial endoscopy. Primary hemostasis was achieved in 50 of them (89%) and the remaining 6 required a second session. Eleven patients presented rebleeding within the following 6 weeks and were again treated with cyanoacrylate. Hemostasis was achieved in 8 of them, 2 were referred for surgical management, and 1 received endovascular treatment. Follow-up was able in 53 patients for an average period of 11 months (range 1 to 81 months). During this period, 7 patients presented an episode ofrebleeding and were treated with cyanoacrylate, achieving hemostasis. Eradication of varices was documented on 21 patients (39.6%). The global rate of rebleeding was 37%. One patient developed splenic vein thrombosis as a major complication of treatment. CONCLUSION: Definitive hemostasis was achieved in 94.6% of patients, with primary hemostasis in 89%. The global rate of rebleeding was 37% and the rate of major complications associated with treatment 0.6%. Eradication of gastric varices was achieved in 35.8% of cases. As these data show, it can be concluded that butyl-cyanoacrylate constitutes an effective method for the treatment of gastric variceal bleeding.
Assuntos
Embucrilato/administração & dosagem , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Soluções Esclerosantes/administração & dosagem , Adolescente , Adulto , Idoso , Varizes Esofágicas e Gástricas/complicações , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
Primary hepatic lymphoma (PHL) is confined to the liver with no evidence of extrahepatic lymphomatosis. Histopathologically, the PHL belongs to the group of non-Hodgkin's lymphomas and the most common subtype is the diffise large B-cell lymphoma. We present a 72-year-old woman, with no relevant antecedents and the following symptoms: early satiety, abdominal discomfort and rapid weight loss. Liver function tests are normal, erythrocyte sedimentation rate is accelerated and LDH progressively increases during the hospitalization. Imaging studies (ultrasound, CT scan, nuclear magnetic resonance) show a multilobued mass of around 12 cm of diameter in the right hepatic lobe. Tumoral and virological markers are negative. The pathology of an echo-guided biopsy informs a massive infiltration by a diffuse large B-cell lymphoma. The immunohistochemical study shows CD20+, CD45+ and negative CD3, CKAE1, AE3, Hepatocyte and HMB45. The citology of pleural liquid is negative for atypia, peripheral blood smear shows no signs of leukemia, bone marrow biopsy is negative for lymphomatous infiltration, and gallium scintigraphy and body CT scan do not reveal extrahepatic lesions. The patient starts chemotherapy with cyclophosphamide and methylprednisolone but worsens and dies two weeks after beginning treatment. We conclude that our patient had a rare disease with an unresectable lesion, poor prognostic factors and high recurrence risk. Chemotherapy is the treatment of choice in these cases.