Federico Roesch-Dietlen

Routine liver biopsy to screen for nonalcoholic fatty liver disease (NAFLD) during cholecystectomy for gallstone disease: is it justified?

BackgroundNonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) share common risk factors. There are no firm recommendations regarding screening of NAFLD in patients at risk. Our aim was to assess the prevalence of and factors associated with NAFLD in a cohort of patients operated for symptomatic GD and evaluate the usefulness of routine liver biopsy.MethodsNinety-five consecutive patients underwent a liver biopsy at the end of a standard laparoscopic cholecystectomy for symptomatic GD. Clinical, biochemical, demographic, and anthropometric variables were obtained prospectively.ResultsFifty-two patients (55%) had biopsies compatible with NAFLD. These patients were classified according to the system proposed by Brunt et al. as follows: grade I, n = 27 (52%); grade II, n = 15 (29%); grade III, n = 10 (19%). Two grade III patients had zone III focal perisinusoidal fibrosis and three had overt cirrhosis. Only 13% of subjects had a suspected diagnosis of NAFLD preoperatively. In multivariate logistic regression, only obesity was significantly associated with NAFLD. There were no complications or mortality.DiscussionFifty-five percent of patients with GD have associated NAFLD. Awareness of this association may result in an earlier diagnosis. The high prevalence of NAFLD in patients with GD may justify routine liver biopsy during cholecystectomy to establish the diagnosis, stage, and possible direct therapy.

Validation and Diagnostic Usefulness of Gastroesophageal Reflux Disease Questionnaire in a Primary Care Level in Mexico

Background/Aims Different non-invasive diagnostics strategies have been used to assess patients with gastroesophageal reflux. Gastroesophageal reflux disease (GERD) questionnaire (GerdQ) is a 6-item, easy to use questionnaire that was developed primarily as a diagnostic tool for GERD in primary care. Our aim was to validate and assess diagnostic utility of GerdQ questionnaire in Mexican patients in the primary care setting. Methods The study was performed in 3 phases: (1) a questionnaire translation and comprehension study (n = 20), (2) are a reproducibility and validation study (50 patients and 50 controls) and (3) a study to assess the clinical utility in 252 subjects with GERD symptoms. Diagnostic accuracy was calculated using endoscopy and/or pH-metry as the gold standard. Results Internal consistency measured by the Cronbach’s α coefficient was 0.81 for patients and 0.90 for healthy controls, with a mixed coefficient of 0.93. Reproducibility for GerdQ was very good and its discriminating validity was 88%. Most of the patients with erosive reflux and non-erosive reflux with abnormal pH-metry had scores > 8, meanwhile most of the patients with functional heartburn and hypersensitive esophagus had < 8. Sensitivity, specificity and positive predictive value of GerdQ com -pared to the gold standard were 72%, 72% and 87%, respectively. Conclusions In Mexico, the GerdQ questionnaire Spanish validated version is useful for GERD diagnosis in the primary care setting.

Prevalence of celiac disease and related antibodies in patients diagnosed with irritable bowel syndrome according to the Rome III criteria. A case–control study

The cost‐effectiveness for screening for celiac disease (CD) in patients with irritable bowel syndrome (IBS), specifically in the diarrhea (IBS‐D) subtype, is beneficial if the prevalence is >1%. However, recent studies have shown controversial results. In this large case–control study, our aim was to determine the prevalence of CD and a panel of related antibodies in patients diagnosed with IBS.

Application of colon capsule endoscopy (CCE) to evaluate the whole gastrointestinal tract: a comparative study of single-camera and dual-camera analysis.

Background and study aims Colon capsule endoscopy (CCE) was developed for the evaluation of colorectal pathology. In this study, our aim was to assess if a dual-camera analysis using CCE allows better evaluation of the whole gastrointestinal (GI) tract compared to a single-camera analysis. Patients and methods We included 21 patients (12 males, mean age 56.20 years) submitted for a CCE examination. After standard colon preparation, the colon capsule endoscope (PillCam Colon™) was swallowed after reinitiation from its “sleep” mode. Four physicians performed the analysis: two reviewed both video streams at the same time (dual-camera analysis); one analyzed images from one side of the device (“camera 1”); and the other reviewed the opposite side (“camera 2”). We compared numbers of findings from different parts of the entire GI tract and level of agreement among reviewers. Results A complete evaluation of the GI tract was possible in all patients. Dual-camera analysis provided 16% and 5% more findings compared to camera 1 and camera 2 analysis, respectively. Overall agreement was 62.7% (kappa = 0.44, 95% CI: 0.373–0.510). Esophageal (kappa = 0.611) and colorectal (kappa = 0.595) findings had a good level of agreement, while small bowel (kappa = 0.405) showed moderate agreement. Conclusion The use of dual-camera analysis with CCE for the evaluation of the GI tract is feasible and detects more abnormalities when compared with single-camera analysis.

Consenso mexicano sobre el síndrome de intestino irritable

BACKGROUND Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociación Mexicana de Gastroenterología (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. AIMS To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. METHODS The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. RESULTS Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. CONCLUSIONS We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included.

Prevalence of irritable bowel syndrome in caregivers of patients with chronic diseases

Caregivers are an at‐risk population for psychic and physical diseases such as irritable bowel syndrome (IBS). However, it is not known whether providing care for the chronically ill patient can be considered a risk factor for developing IBS. In this study, our aim was to evaluate the prevalence of IBS according to the Rome II criteria in a group of caregivers.

Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease: the experience of a center for digestive physiology in Southeastern Mexico

BACKGROUND Dental erosion (DE) is the loss of the hard tissues of the tooth produced by the action of gastric juice, pepsin and acid on the dental enamel, its frequency ranges from 5 to 53.41 %. In Mexico there are no reports on the frequency and possible association. OBJECTIVE To establish the prevalence of dental erosion and its relationship to GERD. PATIENTS AND METHODS Prospective, observational, descriptive and comparative study was conducted in 60 patients diagnosed with GERD and 60 healthy patients at the Institute of Medical and Biological Research of the Universidad Veracruzana in Veracruz city. Anthropometric characteristics, dietary habits, oral hygiene, alcohol consumption, smoking, ED index and Index of decayed/missing dental pieces/sealed and correlation between severity of ED and GERD were analyzed. RESULTS 78.67 % of patients with GERD had ED, 23.33 % corresponded to grade 0, 41.67 % to N1, N2 and 23.33 % to 11.67 % to N3. Predominance of females (2,3:1). The mean age was 50.92 +/- 13.52 years. The severity of dental erosion was significantly related to the severity of reflux, halitosis, CPO index and poor eating habits. There was no statistically significant difference in the other variables analyzed. CONCLUSIONS Dental erosion has a high frequency in patients with GERD and reflux characteristics are directly related to their severity and therefore should be considered as a manifestation of GERD extraesophageal.

Frecuencia de infección por virus del papiloma humano en pacientes con cáncer del aparato digestivo

INTRODUCTION AND AIM Cancer is the result of the interaction of genetic and environmental factors. It has recently been related to viral infections, one of which is human papillomavirus. The aim of the present study was to describe the frequency of human papillomavirus infection in patients with digestive system cancers. MATERIALS AND METHODS A prospective, multicenter, observational study was conducted on patients with gastrointestinal cancer at 2public healthcare institutes in Veracruz. Two tumor samples were taken, one for histologic study and the other for DNA determination of human papillomavirus and its genotypes. Anthropometric variables, risk factors, sexual habits, tumor location, and histologic type of the cancer were analyzed. Absolute and relative frequencies were determined using the SPSS version 24.0 program. RESULTS Fifty-three patients were studied. They had gastrointestinal cancer located in: the colon (62.26%), stomach (18.87%), esophagus (7.55%), rectum (7.55%), and small bowel (3.77%). Human papillomavirus was identified in 11.32% of the patients, 66.7% of which corresponded to squamous cell carcinoma and 33.3% to adenocarcinoma. Only genotype 18 was identified. Mean patient age was 61.8±15.2 years, 56.60% of the patients were men, and 43.40% were women. A total of 15.8% of the patients had a family history of cancer and 31.6% had a personal history of the disease, 38.6% were tobacco smokers, and 61.4% consumed alcohol. Regarding sex, 5.3% of the patients said they were homosexual, 3.5% were bisexual, 29.8% engaged in oral sex, and 24.6% in anal sex. CONCLUSIONS Our study showed that human papillomavirus infection was a risk factor for the development of gastrointestinal cancer, especially of squamous cell origin.

El abordaje, las actitudes y el conocimiento acerca de Helicobacter pylori en médicos generales es deficiente. ¡Hay mucho que mejorar!

BACKGROUND Helicobacter pylori (Hp) infection is one of the most common infections in humans. Due to its worldwide prevalence, a series of guidelines and recommendations has been developed for the appropriate screening, diagnosis, and management of patients with Hp infection. AIM To evaluate the approach, attitudes, and knowledge of a group of Mexican general practitioners in relation to Hp. MATERIALS AND METHODS A cross-sectional study was conducted that evaluated the knowledge of Hp diagnosis and treatment through the application of a questionnaire. RESULTS From the total of 430 questionnaires delivered, information was obtained from 411 (95% response rate). The most frequent indications for eradication treatment were peptic ulcer (48.4%), gastroesophageal reflux disease (41.8%), and dyspepsia (39.2%). Thirty-one percent of the physicians surveyed used more than one test to look for Hp, and serology was the most commonly employed method. The most widely used antibiotic regimen was clarithromycin plus amoxicillin (63.8%), followed by metronidazole plus tetracycline (16%). Ninety-two percent of the physicians confirmed eradication through endoscopy for the histologic analysis and only 23% utilized the breath test. CONCLUSIONS Our results show the lack of knowledge about the established diagnostic and treatment recommendations for Hp infection. The implementation of workshops, courses, and conferences, or the formulation of practical guidelines should be directed at primary care physicians to strengthen the practice of medicine based on scientific evidence.