Squamous cell carcinoma of the oesophagus in a patient with Klippel-Trenaunay syndrome

The Klippel-Trenaunay syndrome (KTS) is a rare disorder characterized by a triad of port-wine stains, varicose veins, and bony or soft tissue hypertrophy of one extremity. Digestive bleeding is the most commonly observed gastrointestinal manifestation. In rare cases, the syndrome is associated with malignancies. We report the case of a 38-year-old woman with KTS and dysphagia caused by an oesophageal squamous cell carcinoma.

Effectiveness of Helicobacter pylori Treatments According to Antibiotic Resistance

INTRODUCTION

Antibiotic resistance is one of the main factors that determine the efficacy of treatments to eradicate Helicobacter pylori infection. Our aim was to evaluate the effectiveness of first-line and rescue treatments against H. pylori in Europe according to antibiotics resistance.

METHODS

Prospective, multicenter, international registry on the management of H. pylori (European Registry on H. pylori Management). All infected and culture-diagnosed adult patients registered in the Spanish Association of Gastroenterology-Research Electronic Data Capture from 2013 to 2021 were included.

RESULTS

A total of 2,852 naive patients with culture results were analyzed. Resistance to clarithromycin, metronidazole, and quinolones was 22%, 27%, and 18%, respectively. The most effective treatment, regardless of resistance, were the 3-in-1 single capsule with bismuth, metronidazole, and tetracycline (91%) and the quadruple with bismuth, offering optimal cure rates even in the presence of bacterial resistance to clarithromycin or metronidazole. The concomitant regimen with tinidazole achieved an eradication rate of 99% (90/91) vs 84% (90/107) with metronidazole. Triple schedules, sequential, or concomitant regimen with metronidazole did not achieve optimal results. A total of 1,118 non-naive patients were analyzed. Resistance to clarithromycin, metronidazole, and quinolones was 49%, 41%, and 24%, respectively. The 3-in-1 single capsule (87%) and the triple therapy with levofloxacin (85%) were the only ones that provided encouraging results.

DISCUSSION

In regions where the antibiotic resistance rate of H. pylori is high, eradication treatment with the 3-in-1 single capsule, the quadruple with bismuth, and concomitant with tinidazole are the best options in naive patients. In non-naive patients, the 3-in-1 single capsule and the triple therapy with levofloxacin provided encouraging results.

[Follow-up of chronic hepatitis B carriers. Serological course and risk of reactivation]

AIM

To investigate serologic changes and risk of reactivation in hepatitis B chronic carriers.

PATIENTS AND METHODS

Two hundred chronic HBs-Ag positive patients were included (follow-up greater than 18 months). According to the HBeAg/Anti-HBe status at the moment of inclusion they were classified in 3 groups: I: 40 patients HBeAg positive, II: 158 anti-HBe positive and III: 2 HBeAg/Anti-HBe negatives. All patients were screened in the follow-up for biochemical test, hepatitis B, C and D virus serology, DNA.HBV by hybridization, alpha fetoprotein and abdominal ultrasound.

RESULTS

Mean age was 35 +/- 12 years (14-61), and mean follow-up 71 +/- 35.1 months (18-252). In the follow-up 28 patients in group I seroconverted HBeAg/Anti-HBe, 18 spontaneously (annual rate 10%). In group II four patients out off 158 were DNA HBV positive. Only 3 chronic HBV carriers lost HBsAg and developed Anti-HBs (annual rate 0,25%). Reactivation of viral activity was detected in 13 patients Anti-HBe positive, DNA.HBV negative. HBeAg appeared during reactivation in six, both HBeAg/Anti-HBe were negative in one, and six were unchanged. Reactivation was significantly more frequent in chronic carriers with high GPT activity (13 out off 75, 17.3%) than in patients with normal GPT (0 out off 107, 0%) (p < 0.0005).

CONCLUSIONS

Reactivation of HBV activity is frequent in HBsAg chronic carriers Anti-HBe positive, DNA.HBV negative and who are abnormal GPT levels; these patients should be considered at risk of reactivation. The control in the follow-up of HBV chronic carriers with persistently normal GPT, without advanced liver disease, may not be so frequent. The increased infectiousness during reactivation of HBV activity must be taken account for prophylaxis of HBV infection in chronic carriers contacts.

[Chronic anemia and intestinal pseudoobstruction as presentation form of hamartomatous polyp of the Vater's ampulla]

We report the case of a 70-year-old female with chronic anemia and intestinal pseudoobstruction from a large hamartomatous polyp of the ampulla of Vater. The patient had been operated by obstructive jaundice of possible biliary etiology and a cholecystojejunostomy was performed. Later, due to cholangytis of unknown etiology cholecystectomy and choledochoduodenostomy were done. The polyp was resected by surgery.

[Gastric adenocarcinoma in hamartomatous polyp in Peutz-Jeghers syndrome]

The Peutz-Jeghers syndrome is characterized by gastrointestinal polyposis and mucocutaneous melanin pigmentation. Between the complications are the appearance of gastrointestinal neoplasms. There is an increasing evidence suggesting the hamartoma-adenoma-carcinoma sequence in Peutz-Jeghers syndrome. We present a 32-years-old man with Peutz-Jeghers syndrome who developed an adenocarcinoma arising in a gastric hamartomatous polyp. We discuss the risk to develop gastrointestinal neoplasms and the necessity for periodic surveillance.

[Massive hemorrhage due to esophageal varices as a form of presentation of autoimmune hepatitis]

Autoimmune hepatitis is a necro-inflammatory disease of unknown etiology. An acute or fulminant presentation is rare. We report a 18-year-old man presented with acute variceal hemorrhage. The patient was treated with endoscopic sclerotherapy, somatostatin, balloon tamponade and TIPS. The patient died within a week of massive bleeding and hepatic failure. This patient's history strongly suggests that autoimmune hepatitis can be presented as fulminant hemorrhage. The importance of diagnosis and treatment is emphasized to improve prognosis.

[Gastrointestinal disorders in Guatemala and their relationship with parasitic infections]

BACKGROUND

To determine the frequency of symptoms suggestive of functional gastrointestinal disorders and their relation to parasite infections in a developing nation.

MATERIAL AND METHODS

174 consecutive patients was seen in a gastroenterology clinic in Solola (Guatemala).

RESULTS

Symptoms suggestive of irritable bowel syndrome was diagnosed in 37 patients (21%), irritable bowel syndrome with dyspeptic syndrome in 26 (15%) and dyspeptic syndrome in 24 (14%). Forty-two patients (24%) had been diagnosed of parasitation in the past. Such patients had a higher risk of suffering symptoms suggestives with functional gastrointestinal disorder (OR 6,335 CI 95% 2.72-14-75). Fifty-nine patients (34%) were subjected to parasite examination in stools; of these, 13 proved positive. In this same group of patients the risk of functional gastrointestinal problems was likewise higher among the subjects with parasite infection (p < 0.05). In turn, 41 patients (49%) with symptoms suggestives of gastrointestinal functional disorders were or had previously been diagnosed of parasite infection.

CONCLUSIONS

Symptoms suggestives of functional gastrointestinal disorders are frequent in developing regions and its was in relation to intestinal parasites.

[Massive fecal impaction in a patient with osteogenesis imperfecta]

The case of a 22 year old male with massive faecal impaction and anorectal mechanical stenosis caused by multiples bone fractures and pelvic deformities secondary to imperfect osteogenesis is reported. The patient was treated with subtotal colectomy and permanent colostomy.

[Gastrointestinal disorders in Guatemala and their relation with parasitic infections]

BACKGROUND

To determine the frequency of symptoms sugestive of functional gastrointestinal disorders and their relation to parasite infections in a developing nation.

MATERIAL AND METHODS

174 consecutive patients was seen in a gastroenterology clinic in Solola (Guatemala).

RESULTS

Symptoms suggestive of irritable bowel syndrome was diagnosed in 37 patients (21%), irritable bowel syndrome with dyspeptic syndrome in 26 (15%) and dyspeptic syndrome in 24 (14%). Forty-two patients (24%) had been diagnosed of parasitation in the past. Such patients had a higher risk of suffering symptoms suggestives with functional gastrointestinal disorder (OR 6,335 CI 95% 2.72-14-75). Fifty-nine patients (34%) were subjected to parasite examination in stools; of these, 13 proved positive. In this same group of patients the risk of functional gastrointestinal problems was likewise higher among the subjects with parasite infection (p < 0.05). In turn, 41 patients (49%) with symptoms suggestives of gastrointestinal functional disorders were or had previously been diagnosed of parasite infection.

CONCLUSIONS

Symptoms suggestives of functional gastrointestinal disorders are frequent in developing regions and its was in relation to intestinal parasites.

[Comparative study of the eradication of Helicobacter pylori: ranitidine bismuth citrate versus omeprazole plus two antibiotics for seven days]

AIMS

To compare the efficacy of ranitidine bismuth citrate (RB) combined with two antibiotics during seven days in comparison with OCA-7 for treatment of Helicobacter pylori.

METHODS

In a randomized clinical trial 200, consecutive patients infected by Helicobacter pylori were studied prospectively. One of two regimens was given for 7 days; OCA-7 (omeprazole 20 mg b.i.d., amoxycillin 1 gr b.i.d., clarithromycin 500 mg b.i.d.) or RBCA (RB 400 b.i.d., amoxicillin 1 gr b.i.d., clarithromycin 500 mg b.i.d.). Eradication was defined as a negative breath test one month after therapy.

RESULTS

112 male and 88 female with a mean age of 48 years (range 18-82). 100 patients were randomized to OCA-7 and 100 patients to RBCA-7. Overall 186 patients completed the treatment. Intention to-treat eradication was in the group OCA-7 of 72% and 73% in group RBCA-7. Per-protocol eradication was in the group OCA-7 of 78% and 77% in group RBCA-7 (p = 0.3). Five patients in the group OCA-7 and nine in the group RBCA-7, had side effects, three of these patients did not complete therapy by diarrhea.

CONCLUSIONS

RB with two antibiotics is as effective and safe as OCA-7 for the eradication of Helicobacter pylori.

[The gastrointestinal changes in dystrophia myotonica]

Myotonic dystrophy is a multisystemic disorder inherited as an autosomal dominant trait. The secondary gastrointestinal disturbances are not well recognized. Two cases of myotonic dystrophy in a 51-year-old and 39-year-old woman with gastrointestinal symptoms disturbances are reported. One patient presented motor dysfunction in the colon and esophagus, organoaxial gastric volvulus and cholestasis. The second patient developed an acute colonic pseudo-obstruction. The patient improved with cisapride. The digestive manifestations of myotonic dystrophy and the treatment are reviewed.

Spontaneous rupture of the liver in amyloidosis

Hepatic rupture is an unusual complication of hepatic amyloidosis. We report the case of a 59-yr-old man with a subcapsular hematoma of the liver with hepatic rupture secondary to amyloidosis. The patient died during the surgery. The etiology, pathology, diagnosis, and treatment of this complication are discussed. Previously reported cases of subcapsular hematoma of the liver secondary to amyloidosis are reviewed. This knowledge and an awareness of the possible diagnosis will help to decrease the high mortality rate associated with this complication.

[Irritable bowel syndrome in patients under age 55 with dyspeptic syndrome]

The presence of IBS was studied in 289 patients under 55 years of age with dyspeptic syndrome. The subjects were divided into two groups: group I (240 patients with DS) and group II (49 patients with DS and IBS). The mean duration of follow%shy;up was 10.8 years (130 months). IBS was diagnosed in 49 patients (17%). Females accounted for 64% and 77% of groups I and II, respectively (p < 0.05). There were no differences in mean age or the type of FDS. The patients in group II consulted more often and earlier (92% returned for consultation, and took 27 months in doing so) than those in group I (52% and 40 months)(p < 0.05). The number of diagnostic tests requested was greater in group II. Psychiatric pathology was in turn more common in group II than in group I (20 versus 7%)(p < 0.05).

[Adenocarcinoma in Barrett's esophagus. A retrospective study of 46 patients followed during 3.5 years]

OBJECTIVE

To determine the incidence of adenocarcinoma in patients with Barrett's esophagus and to study the characteristics in these patients.

METHODS

Between January 1988 and June 1997 was diagnosed 46 patients with Barrett's esophagus. In all tem was analyzed the age, the follow-up period, the chief presenting symptoms leading to endoscopy, endoscopy esophagitis and complications of Barrett's esophagus.

RESULTS

The mean age at the time of Barrett's diagnosis was 58 years. The mean follow-up period was 43 months. Presenting symptoms were heartburn in 35 (76%) patients, dysphagia in 3 (6.5%), thoracic pain 3 (6.5%), hemorrhage 2 (4.5%) and others in 3 (6.5%). Endoscopic esophagitis was present in 24 (52%) patients during the follow-up. Complications developed was stricture, ulceration or haemorrhage in 14 (30.4%) patients, two (4.3%) have adenocarcinoma and one dysplasia. Incidence of adenocarcinoma was 1/82 patient-years of follow-up. All three patients with adenocarcinoma or dysplasia was males. Two of the three presented with heartburn and the mean follow-up until development of dysplasia or cancer was 63 months.

CONCLUSIONS

Heartburn and endoscopic esophagitis is frequent in these patients. The risk of development of and adenocarcinoma or others complications is high.