Eduardo Monge

Baja frecuencia de positividad serológica en pacientes con biopsias histológicamente compatibles con enfermedad celiaca en Perú

Objective: to study the frequency of positive serology for celiac disease (CD) in patients with duodenal biopsies suggestive of this disease. Material and methods: cross sectional study. We included patients with duodenal biopsies histologically compatible with CD and antigliadin, antiendomysial and IgA antitransglutaminase antibodies. We defined a “case” of CD if there was a positive biopsy and either antiendomisial or antitransglutaminase positive antibodies. Results: thirty one patients were included in our study. Six were antiendomysial positive and 5 antitransglutaminase positive while the antigliadin was positive in 14 cases. Therefore, out of 31 patients only 10 had a serology compatible with CD and only one had positive both antibodies, antiendomysial and antitransglutaminase. Conclusions: a) we have found that most of the duodenal biopsies compatible with CD are not diagnosed with positive serology; and b) we found a low correlation between serological diagnostic tests.

COLONIC TAENIOSIS: LETTERS, TECHNIQUES AND IMAGES

Dear Editor, Tapeworms are parasites that inhabit human intestines. Beef tapeworms (Taenia saginata) range in size from 4 to 10 m, whereas pork tapeworms (Taenia solium) may reach 2 to 4 m. Colonization occurs by eating raw or undercooked meat. Tapeworms usually cause no symptoms and may surprise an endoscopist who finds the unsuspected jejunal inhabitant. We report a 39-year-old man with no prior medical history. He presented with moderate, intermittent abdominal pain, unrelated to food ingestion. Pain consisted of general discomfort, cephalea, and intermittent rectorrhagia. Bowel movements were scarce and not painful. Physical examination showed normal heart rate and blood pressure with a non-distended abdomen, epigastric tenderness and no organomegaly. The rest of the physical examination was basically normal. Laboratory tests showed hemoglobin 15.3 g/dL, white blood cell count 7450 cell/mm, hypereosinophilia 550 cells/ mm (7.4%), whereas serum amylase, lipase, and liver function tests were normal. Ova and parasites were negative. Abdominal ultrasound showed splenomegaly.A colonoscopy was carried out and a white mobile tapeworm was found in the left colon. (Fig. 1). The tapeworm was entirely extracted with a polypectomy snare, and its length was approximately 1 m long (Fig. 2). Taeniasis is now recognized as a major public health problem in most developing countries because of its association with seizures. In the human, the scolex attaches to jejunal mucosa and develops into an adult tapeworm. Tapeworms are diagnosed by identifying eggs or proglottids in stool. Eggs of both species are indistinguishable. Proglottids of T. saginata are 2 cm long and have more than 12 uterine branches, those of T. solium measure 1.2 cm and have fewer than 10 branches Treatment of choice in intestinal taeniasis is praziquantel. Alternative treatment is albendazole which our patient received. Taenia or its proglottids may be accidentally found during colonoscopy and the endoscopist can successfully extract the parasite using a polypectomy snare.

Successful Endoscopic Band Ligation of Duodenal Dieulafoy's Lesion

Dieulafoy’s lesion (DL) is an abnormal arterial lesion in the digestive tract. We report a 21-year-old male, without any relevant his past medical and familiar history. He admitted to the ER with a history of hematemesis and melena. An upper endoscopy showed a protruding vessel without surrounding venous dilatation, active bleeding or mucosal defect. This vascular lesion was located in the anterior wall of duodenal bulb. Endoscopic ligation subsequently performed with two bands and a successful haemostasis achieved.