Ana María Madrid S

Sobrecrecimiento bacteriano intestinal en pacientes con pancreatitis crónica

Small intestine bacterial overgrowth in patients with chronic pancreatitis Background: Previous reports describe 30-40% of small intestine bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP), SIBO is a cause of persistent symptoms in this group of patients even when they are treated with pancreatic enzymes. Aim: To asses the frequency of SIBO in patients with CP. Patients and methods: We studied 14 patients with CP using an hydrogen breath test with lactulose to detect SIBO, a nonabsorbable carbohydrate, whose results are not influenced by the presence of exocrine insufficiency. Main symptoms and signs were bloating in 9 (64%), recurrent abdominal pain in 8 (57%), intermittent diarrhea in 5 (36%) and steatorrhea in 5 (36%). At the same time we studied a healthy control group paired by age and sex. Results: SIBO was present in 13 of 14 patients with CP (92%) and in 1 of 14 controls (p<0.001). The only patient with CP and without SIBO was recently diagnosed and had minimal morphologic alterations in computed tomography and endoscopic pancreatography. Conclusions: SIBO is common in CP and may be responsible for persistent symptoms. Proper diagnosis and treatment could alleviate symptoms and improve quality of life (Rev Med Chile 2008; 136: 976-80). (Key words: Gastrointestinal contents; Malabsorption syndrome; Pancreatitis, chronic)

Producción endógena de alcohol en pacientes con cirrosis hepática, alteración motora y sobrecrecimiento bacteriano

Background: Small intestinal bacterial overgrowth generates endogenous ethanol production both in experimental animals and humans. Patients with cirrhosis have small intestinal bacterial overgrowth, but endogenous ethanol production has not been studied in them. Aim: To investigate endogenou ethanol production in patients with cirrhosis, altered intestinal motility and small intestinal bacterial overgrowth. Patients and methods: Eight patients with cirrhosis of different etiologies and altered gastrointestinal motility, consisting in changes in the migrating motor complex, were studied. All had also small intestinal bacterial overgrowth, measured by means of the H2 breath test with lactulose. Plasma ethanol levels were measured by gas liquid chromatography in fasting conditions and 120 min after a carbohydrate rich meal. Results: In fasting conditions, no patient had endogenous ethanol production. Alter the meal, ethanol in concentrations of 11.3 and 8.2 mg/del were detected in two patients. Negligible amounts of ethanol were detected in 4 patients and two patients had undetectable alcohol levels. Conclusions: A low endogenous production of ethanol was demonstrated in six of eight patients with cirrhosis (Rev Med Chile 2002; 130: 1329-34)

Sobrecrecimiento bacteriano intestinal: An update

Small intestinal bacterial overgrowth (SIBO) is characterized by nutrient malabsorption, associated with an excessive number of bacteria in the proximal small intestine. Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. SIBO occurs when there are alterations in intestinal anatomy, gastrointestinal motility, or a lack of gastric acid secretion. The true association between SIBO and irritable bowel syndrome and celiac disease remains uncertain. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, nutritional support and when it is possible, the correction of underlying predisposing conditions.Small intestinal bacterial overgrowth (SIBO) is characterized by nutrient malabsorption, associated with an excessive number of bacteria in the proximal small intestine. Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. SIBO occurs when there are alterations in intestinal anatomy, gastrointestinal motility, or a lack of gastric acid secretion. The true association between SIBO and irritable bowel syndrome and celiac disease remains uncertain. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, nutritional support and when it is possible, the correction of underlying predisposing conditions

Candidiasis esofágica en pacientes inmunocompetentes: Estudio clínico e inmunológico

Background: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials. Aim: To report the features of 10 immunocompetent patients with esophageal candidiasis. Patients and methods: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, Iymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured. Results: Six patients had a low CD4 Iymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all. Conclusions: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated (Rev Med Chile 2004; 132: 1389-94). (Key Words: Candidiasis, esophageal; Immunity, cellular; Immunocompetence)

Enfermedad Celíaca del adulto: Experiencia clínica

Thirty seven patients (28 women), were studied. Median ageat diagnosis was 41 years (range 15-69). Main symptoms and signs were diarrhea (78%), weightloss (38%) and abdominal pain (38%). Anemia was found in 49%, elevation of ESR in 57%,elevation of alkaline phosphatases in 54%, elevation of aspartate aminotransferase in 38% and arise in alanine aminotransferase in 27%. Antiendomysial antibodies were positive in 17/22(77%) and antitransglutaminase in 19/22 (86%) patients. Endoscopic findings were suggestive ofCD in 47% of cases and duodenal biopsy showed intestinal villi atrophy in 34 (92%) patients.The three patients with normal histology had positive serology and a good response to gluten freediet.

Gastrointestinal motility disturbances in Chagas disease

Serum antibodies against Trypanosoma Cruzi have been observedin 19% of the Chilean population. Marked differences in organ involvement have been reported inpatients with Chagas disease. Chagas disease is rarely an aetiological factor for achalasia inChile, which is different from reports in other countries of South America. In contrast, a high inci-dence of megacolon among these patients have been reported.

Daño hepático por fármacos: características clínicas e histológicas en 33 casos

Background: Drug induced liver disease (DILD) is common and of difficult diagnosis. Aim: To report the clinical, laboratory and pathological findings in 33 patients with DILD. Patients and methods: We revised 1,164 liver biopsies and 57 were selected as suspicious of DILD. In these, the scale proposed by Maria et al was applied to assess the possibility of hepatotoxicity reactions and 33 were selected. Results: The 33 cases had a mean age of 48±18 years and 14 were male. Forty eight medications were involved, with an average of 1.4 drugs per patient. The main drugs were antimicrobials, antineoplastics-immunosuppresives and non-steroidal antiinflammatory drugs. The clinical presentations in order of frequency were cholestasis, hepatitis, asymptomatic, fulminant hepatitis and cirrhosis. The laboratory alterations observed in cases with hepatitis were 20 fold transaminase and bilirubin elevation. In cholestasis, moderate elevations of alkaline phosphatases and gamma glytamyl transferase were observed. Pathology showed hepatocellular damage, cholestasis and mixed damage, but also submassive necrosis and cirrhosis in one case. Conclusions: The present study confirms that DILD is frequently unpredictable and that it can cause a wide variety of clinical and pathological presentations, that can even evolve to chronicity (Rev Med Chile 2003; 131: 1128-34). (Key Words: Drug hypersensitivity; Drug toxicity)

Existe en la constipación idiopática severa un trastorno difuso de la motilidad intestinal

BACKGROUND Studies in patients with chronic severe constipation, suggest the presence of a diffuse motor disorder of the gastrointestinal tract. AIM To investigate small bowel motor activity in a group of patients with severe constipation. MATERIAL AND METHODS Forty three patients (age range 13 to 70 years, 40 women) with severe constipation referred to our motility laboratory, where studied. Ten had a previous colectomy. Radiological examinations showed a megacolon in 30 and dilatation of small intestinal loops in nine; the remaining X rays studies were normal. Small intestinal motility was studied using perfused catheters and external transducers. RESULTS Ten patients had normal motor recordings. Eight patients showed a neuropathic disorder characterized by a continuous irregular pattern of contractions of normal amplitude, with absence of phase III of the migrating motor complex (MMC). Sixteen presented a normal MMC associated to a decreased amplitude of contractions (Miopatic disorder). Nine showed both types of motor disorders (Mixed pattern). Normal radiological findings were more commonly associated to normal manometric recordings. By contrast, an altered motor activity, mainly of myopathic and mixed type motor disorder, was observed in all patients with dilated small intestinal and colonic loops. CONCLUSIONS The presence of small intestinal motor disorders was a frequent finding in this selected group of patients with chronic constipation.

Electrogastrografía de superficie: una nueva técnica para el estudio de la motilidad gástrica en nuestro medio

Background: Gastric electrical activity can be accurately recorded and analyzed by cutaneous electrogastrography. Different types of abnormalities have been described in a variety of disorders. Aim: To analyze a group of asymptomatic subjects and assess the prevalence and patterns of dysrrhythmias in patients with type 1 and 2 diabetes and patients with functional dyspepsia. Patients and methods: One hundred subjects were studied (32 male, mean age 45 years old, 10 asymptomatic, 11 type 1 diabetics, 22 type 2 diabetics and 57 subjects with functional gastrointestinal disturbances). Gastric myoelectrical activity was recorded using surface electrogastrography for 1 hour in the fasting state and 1 hour after a test meal (350 kcal). Results: The electrogastrogram was normal in 90% of asymptomatic controls. It was abnormal in 64% of type 1 diabetic patients, in 55.5% of type 2 diabetic patients and in 61% of patients with functional dyspepsia. Different types of dysrrhythmias were observed in each group. Conclusions: Electrogastrography might define a subgroup of patients with electrical rhythm disturbances, that may have a different approach to treatment than patients with normal gastric electrical activity (Rev Med Chile 2002; 130: 1209-16 ).

Prueba de Elisa en deposición para detectar infección por Helicobacter pylori

Background: Infection with Helicobacter pylori is frequent in Chile, and a good test for its diagnosis ideally should be non-invasive, fast, easy and inexpensive. Aim: To report the use of an immunoassay test, that detects antigens of Helicobacter pylori in stools. Material and methods: One hundred and four patients that required an upper gastrointestinal endoscopy were studied. Stool samples were analyzed using an enzymatic immunoassay. These results were compared with those obtained with the urease test and microscopic examination of smears taken from biopsies obtained during the diagnostic endoscopy. Results: In 81 of 83 patients considered to have the infection according to the endoscopic tests, the antigen was also present in the stools. The test was negative in 16 of 21 patients considered to be without the infection. The resulting sensitivity and specificity for the immunoassay was thus 97.6 and 76.2% respectively, with positive and negative predictive values of 92.4 and 88.9%, respectively. Conclusions: These results are in agreement with those reported in the literature. Further studies are needed to define its usefulness in massive screening, follow up after antibiotic treatments or the detection of coccoid forms of Helicobacter pylori (Rev Med Chile 2002; 130: 61-65)