arlos Defilippi C

Prevalencia de la resistencia a metrodinazol, claritromicina y tetraciclina en Helicobacter pylori aislado de pacientes de la Región Metropolitana

BACKGROUND Helicobacter pylori is a pathogenic bacterium that infects a significant number of individuals. At present, therapeutic strategies to eradicate this bacterium depend on our knowledge of its resistance to antimicrobials. AIMS To evaluate the primary resistance of H pylori to metronidazole (Mtz), clarithromycin (Cla), and tetracycline (Tet) in symptomatic out-patients. MATERIAL AND METHODS Fifty independent isolates of H pylori were obtained by endoscopy-assisted gastric biopsy from patients attending the University of Chile Clinical Hospital, that previously had not been treated with an eradication regime against this bacterium. The minimal inhibitory concentration of each antimicrobial was determined by agar dilution method. RESULTS Forty five and 27% of the isolates were found to be resistant to Mtz and Tet, respectively; the majority of these resistant isolates were from patients older than 21 years. Twenty percent of isolates were resistant to Cla; these were distributed evenly among different ages. Thirty two percent of the isolates were resistant to two or more of the antimicrobials. CONCLUSIONS The high frequency of naturally occurring, antimicrobial-resistant strains of H pylori poses a national and world-wide problem for public health.

Sobrecrecimiento bacteriano en trastornos funcionales del intestino

BACKGROUND Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders. AIM To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID). MATERIAL AND METHODS Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO. RESULTS We studied 367 patients with a mean age of 50 years (87% females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76% of patients with IBS, 73% of those with functional constipation, 69% of those with functional diarrhea and 68% of those with functional bloating. CONCLUSIONS This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients.

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)

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)

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.

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 ).

Barostato rectal en el síndrome de intestino irritable

Ten healthy subjects and 19 IBSpatients, defined using Rome II criteria (12 with constipation, three with diarrhea and fouralternating between diarrhea and constipation), were studied. Sequential isobaric rectaldistentions, from 2 mmHg up to a maximal pressure of 52 mmHg or when the patients reportedpain, were carried out. Visceral hypersensitivity was defined as a pain threshold under 38mmHg.

Valor de la manometría intestinal en la patología gastrointestinal

Background: Small intestinal manometry is a relatively simple technique. However, its use is usually limited to very few centers and mainly related to research studies. Aim: To report our experience with small intestinal motility studies in a group of normal controls and patients with symptoms suggesting a gastrointestinal motor disorder. Patients and methods: Seventy three studies were performed in 71 subjects: 18 asymptomatic controls and 55 patients presenting with symptoms characterized by abdominal pain, vomiting, bloating, constipation and diarrhea. In 33 patients the same symptoms remained without diagnosis, in spite of extensive laboratory studies. In 10 of these, dilated small intestinal loops were observed and intestinal pseudoobstruction was suspected. Twenty two additional patients with systemic disorders such as scleroderma, diabetes and previous vagotomies, were studied. Motility was assessed by means of perfused catheters connected to external transducers for a mean lapse of 280 min. Results: An abnormal pattern of small intestinal motility suggesting neuropathic, myopathic or a mixed disorder was observed in 76% of all studied patients, with the exception of patients with scleroderma, in whom only myopathic and mixed alterations were observed. In 82% of patients, the results of manometry were useful for the management of the clinical condition. Conclusions: small intestinal manometry is a relatively simple technique that, when used in selected groups of patients, provides useful information for clinical management.