[Intragastric migration of a plastic prosthesis placed for repair of a diaphragmatic perforation. Case report]

CASE

We report the case of a 21-year old female with multiple surgeries. Her problem began after last surgery, which got complicated by a diaphragmatic perforation on the left side so it was necessary to repair the defect with a plastic prosthesis, since that time she complained of abdominal pain. In an abdominal computed axial tomography prosthesis was observed and by endoscopy its presence into stomach was confirmed, because its size and rigidity its endoscopic extraction was impossible, so it was surgically extracted. One and half month after surgery the patient's evolution was satisfactory.

DISCUSSION

Migration is one of the most common complications of medical prosthesis placed into abdominal cavity. However precise incidence is unknown, neither intraluminal migration to the gastrointestinal tract. We didn't find previews reports about intragastric migration of a prosthesis that was used to repair a diaphragmatic defect.

[Level of satisfaction from patients who undergone an endoscopic procedure and related factors]

BACKGROUND

Patient satisfaction is a cognitive and emotional evaluation of the patient on the performance of health staff and is based on relevant aspects of their experience in health care.

AIM

To determine the satisfaction level of patients after an endoscopic procedure in the gastrointestinal endoscopy service Specialty Hospital National Medical Center La Raza and to evaluate associated factors.

MATERIAL AND METHODS

A modified and validated questionnaire was applied to assess patient satisfaction after an endoscopic procedure (mGHAA-9) in patients who underwent a gastroscopy or colonoscopy. Factors that influenced patient satisfaction were assessed.

RESULTS

Two-hundred questionnaires were applied (response rate: 89.5%), in 62 men (34.6%) and 117 women (65.4%). Mean patient age was 51.3 years. The average score for the overall group was 30.9 (maximum score of 35). In the overall assessment of satisfaction patients reported 60.9% excellent, very good 29.6%, good 8.9% and 0.6% regular. Factors that influenced patient satisfaction were: waiting time for appointment (OR 3.104), explaining and answering questions (OR 2.961) and waiting time for performing the procedure (OR 2.408) Some factors did not influence on patient satisfaction: Sex: Male 58.1%, female 62.4% (p = 0.63), age 52 vs. 50 years (p = 0.48) and sedation 64.7% vs. 60.5% (p = 0.8)

CONCLUSIONS

The level of satisfaction of patients undergoing a gastroscopy or colonoscopy is good. The factors that influence the satisfaction of these patients are related to communication between doctor and patient, and waiting time for the study.

Good clinical practice recommendations for the diagnosis and treatment of functional dyspepsia: An expert review from the Asociación Mexicana de Gastroenterología

INTRODUCTION AND AIMS

Functional dyspepsia (FD) is a highly prevalent condition characterized by upper gastrointestinal symptoms with no apparent organic cause. It is a complex and multifactorial disease that frequently overlaps with other disorders of gut-brain interaction. It is recurrent, has a variable therapeutic response, and affects patient quality of life. Our aim was to formulate good practice recommendations for the management of FD through a consensus review of the disease, updating and complementing the 2017 consensus on dyspepsia from the Asociación Mexicana de Gastroenterología (AMG).

METHODS

Sixteen experts summoned by the AMG carried out a literature review (2017-2024) and formulated good clinical practice recommendations for the diagnosis and treatment of FD. They were discussed until reaching a consensus, and the most recent evidence on the theme was evaluated, utilizing the GRADE system.

RESULTS

Twenty-three good clinical practice recommendations for the management of FD were developed that addressed the following aspects: (1) definition, pathophysiology, and epidemiology; (2) diagnosis; (3) nonpharmacologic treatment; (4) Helicobacter pylori eradication; (5) antisecretory and anti-acid therapy; and (6) prokinetics and neuromodulators.

CONCLUSIONS

FD is one of the most frequent gastrointestinal conditions seen in daily practice. We present good clinical practice recommendations for the specific management of this disorder, taking into account the most recent advances that complement and update the consensus on dyspepsia published by the AMG in 2017.

[Indicators of quality evaluation registry for upper gastrointestinal endoscopy in a tertiary referral Hospital in Mexico City.]

BACKGROUND

There is a need to evaluate the process of quality improvement in health care services.

AIMS

To determine quality indicators, frequencies into the registry of upper gastrointestinal endoscopies in a tertiary academic hospital in Mexico City.

MATERIAL AND METHODS

A retrospective, observational and transversal study was performed in the Specialty Hospital Dr. Antonio Fraga Mouret IMSS between July 2007 and June 2008. Registry of several quality indicators for upper gastrointestinal endoscopy was sought.

RESULTS

A total of 485 endoscopic reports were included. The reason for upper endoscopy was as follows: Barrett's esophagus 161, esophageal dilation 133, gastric ulcer 82, peptic ulcer 120, and upper gastrointestinal bleeding 130. The indicators evaluated were: Informed consent 91.3%, complete examination 97.7%, Barrett's esophagus measured and biopsy specimens taken 85.7% y 96.2% respectively. Biopsy specimens were taken in gastric ulcer 87.8%. Description and localization of upper gastrointestinal lesion 99.2%, ulcer haemostatic treatment 98.2%, and haemostasis documented 94.6%, proton pump inhibitors were recommended to patients undergone esophageal dilation and peptic ulcer 80.3% y 29.2% respectively.

CONCLUSIONS

Registry frequencies of quality indicators were high for upper gastrointestinal bleeding, completeness of examination and Barrett's oesophagus. Pharmacological treatment recommendation in peptic disease is an area that has to be improved. It was not possible to establish either the indicator or only its register was omitted. Key words: Quality indicators, endoscopy, registries, gastroscopy, consent forms, Mexico.

Approach to the patient with cholestasis and jaundice syndrome. Joint AMH, AMG, and AMEG scientific position statement

The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

Approach to the patient with cholestasis and jaundice syndrome. Joint AMH, AMG, and AMEG scientific position statement

The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

[Obesity, symptoms of gastroesophageal reflux and endoscopic findings in a referral hospital]

OBJECTIVE

To determine association between obesity, gastroesophageal reflux symptoms, hiatus hernia and erosive esophagitis.

METHODS

Consecutive patients who underwent upper endoscopies at our center were studied. Before endoscopy, through a direct interview all subjects were asked to complete the Carlsson-Dent questionnaire. Weight and height of all patients were determined. Body mass index was calculated. At endoscopy it was looked for the presence of hiatus hernia and erosive esofagitis. We excluded patients with some of the following conditions: Pregnancy, ascitis, esophageal varices, esophageal, gastric or duodenal stenosis, and patient who required an emergency or therapeutic endoscopy. We compared prevalence of symptomatic GERD, hiatus hernia and erosive esophagitis between normal weight patients, overweight and obese.

RESULTS

A total of 196 patients were included for analysis, 122 women and 74 men, mean age 52.5 years, 40.3% were overweight and 28.1% were obese. There were 124 patients (63.3%) with symptoms of GERD determined by the C-D Questionnaire obtained. Hiatus hernia was observed in 87 patients (44.4%), and erosive esophagitis in 69 patients (35.7%). Prevalence of GERD symptoms in obese or overweight patients were similar to those normal-weight patients (66.4% and 56.5% respectively, p = 0.20) OR 1.52 (IC 95%, 0.82-2.82). Among obese or overweight hiatus hernia was observed in 47% compared to 38.7% of those normal-weight (p = 0.28) OR 1.40 (IC 95%, 0.76-2.59). Prevalence of erosive esofagitis was also similar in both groups 37.3% and 32.3% respectively (p = 0.52) OR 1.25 (IC 95%, 0.66-2.36).

CONCLUSIONS

This study didn't show association between symptoms of GERD, hiatus hernia or erosive esofagitis and overweight or obesity.

National survey regarding the timing of endoscopic procedures during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, several questions have arisen about which endoscopic procedures (EPs) must be performed and which ones can be postponed. The aim of this study was to conduct a nationwide survey regarding the appropriate timing of EPs during the COVID-19 pandemic.

METHODS

This prospective study was performed through a nationwide electronic survey. The survey consisted of 15 questions divided into three sections. The first evaluated the agreement for EPs classified as "time sensitive" and "not time sensitive". Two other sections assessed "high-priority" and "low-priority" scenarios. Agreement was considered when > 75% of respondents answered a question in the same direction.

RESULTS

The response rate was 27.2% (214/784). Among the respondents, agreement for the need to perform EP in < 72 h was only reached for variceal bleeding (93.4%). Dysphagia with alarm symptoms was the scenario in which the highest percentage of physicians (95.9%) agreed that an EP needed to be performed within a month. Less than 30% of endoscopists would perform an EP within the first 72 h for patients with mild cholangitis, non-variceal upper gastrointestinal bleeding without hemodynamic instability, or severe anaemia without overt bleeding. In time-sensitive clinical scenarios suggestive of benign disease, none of the scenarios reached agreement in any sense. Among the time-sensitive clinical scenarios suggestive of malignancy, > 90% of the surveyed respondents considered that EP could not be postponed for > 8 weeks.

CONCLUSIONS

There was no consensus among endoscopists about the timing of EPs in patients with pathologies considered time sensitive or in those with high-priority pathologies. Agreement was only reached in five (17%) of the evaluated clinical scenarios.

[Influence of obesity on dyspepsia symptoms]

BACKGROUND

There is a high prevalence of dyspepsia and obesity in Mexican population. A relationship between obesity and dyspeptic symptoms has been proposed.

OBJECTIVE

To determine prevalence of dyspeptic symptoms in patients with normal weight, overweight and obesity.

METHODS

Prospective study on consecutive patients who attend for medical assistance for any reason in a first level medical center. Weight, height, and body mass index (BMI) were measured. A validated questionnaire for dyspepsia was applied.

RESULTS

Three-hundred and twenty patients were included (61.6% women, n = 197). The mean patient age was 37 ± 14.4 years old. Mean BMI was 26.68 with 42.2% of patients (n = 135) overweight, 35.6% (n = 114) with normal weight and 22.2% (n = 71) were obese. Compared to patients with normal weight and overweight the obesity group showed a higher prevalence of gastritis symptoms, pain, stomachache, heartburn, a worst quality of life, and a higher frequency of medication intake. Patients with overweight presented a higher score in quality of life and treatment compared with normal weight patients.

CONCLUSIONS

Obese patients showed a higher prevalence of dyspeptic symptoms compared to normal weight and overweight patients.

[Association between symptomatic gastroesophageal reflux and Barrett's esophagus]

BACKGROUND DATA

Barrett esophagus is a proximal displacement of the squamocolumnar junction relative to the gastroesophageal junction with intestinal metaplasia, it has been linked to gastroesophageal reflux disease. However, it has been observed in individuals without gastroesophageal reflux symptoms, with prevalence up to 25% in 50 years older men.

OBJECTIVE

Assess the association between symptomatic gastroesophageal reflux and Barrett's esophagus.

METHODS

Consecutive patients undergoing endoscopy at our center were studied. Before endoscopy, through a direct interview all subjects were asked to complete the Carlsson-Dent questionnaire for determining 2 groups (patients with and without gastroesophageal reflux symptoms). Those subjects with suggestive image of Barrett's esophagus, biopsy specimens were obtained from the distal esophageal mucosa with the intention of find intestinal metaplasia. We compared prevalence of Barrett's esophagus between groups.

RESULTS

One hundred and nine patients were studied. Prevalence of symptomatic gastroesophageal reflux disease was 37.6%. Barrett's esophagus was found in 9.7% of symptomatic gastroesophageal reflux disease patients and in 9.6% of subjects without symptoms of gastroesophageal reflux disease (p = 0.87). Gender and age were similar between groups. Prevalence of hernia hiatal was bigger in patients with Barrett's esophagus (90 vs. 42%) (p = 0.004).

CONCLUSION

Our study didn't show association between symptomatic gastroesophageal reflux detected by a questionnaire and Barrett's esophagus.

[Staging gastritis with the OLGA system: prevalence of advanced stages of gastric atrophy in Mexican patients]

INTRODUCTION

Gastric adenocarcinoma of intestinal type is preceded by inflammation, which produces mucosal atrophy and intestinal metaplasia, progressing eventually to dysplasia and invasive cancer. Recently an international group, the Operative Link on Gastritis Assessment (OLGA) proponed a staging system for gastric biopsies.

OBJECTIVE

To recognize the distribution of advanced stages of gastric mucosal atrophy in Mexican patients with dyspepsia according to the OLGA system.

METHODS

We apply the OLGA system for cancer risk (Stages 0 to IV) to 322 gastric biopsies from consecutive patients with dyspepsia. Using the Sydney protocol, we recorded the presence of atrophy, dysplasia and the relationship with ulcer disease. We report the stage of atrophy for each region and the Helicobacter pylori infection status.

RESULTS

We documented 72 (22.4%) cases with atrophy, 50 of them (69.4%) were metaplastic-type. Overall, nine biopsies (2.78%) were stage III (all of them with metaplastic-type atrophy) and there was not stage IV cases. We did not find high-grade dysplasia or intramucosal carcinoma. In 8 of subjects with stage III, we observed low-grade dysplasia. We documented gastric ulcer in 5 patients with stage II, 60% of them with associated low-grade dysplasia. Five patients with duodenal ulcer were found in stages 0 and I.

CONCLUSIONS

We found low prevalence of advanced stages of mucosal gastric atrophy among patients with dyspepsia. However we recognized 9 patients with stage III according to OLGA system worthy of follow-up because the high risk for developing gastric cancer.

Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic

Introduction

The SARS-CoV-2 virus that causes the COVID-19 disease is transmitted through the inhalation of droplets or aerosols and inoculation via the oronasal or ocular routes, transforming the management of swallowing disorders into a challenge for healthcare teams, given their proximity to the aerodigestive tract and the high probability of aerosol generation during patient evaluation and treatment.

Aim

To provide essential guidance for Latin American multidisciplinary teams, regarding the evaluation and treatment of oropharyngeal and esophageal dysphagia, at the different levels of healthcare. The position statement was formulated for the purpose of maintaining medical service continuity, in the context of a pandemic, and minimizing the propagation and infection risks of the virus.

Methods

Thirteen experts in swallowing disorders were summoned by the Latin American Dysphagia Society to formulate a series of clinical suggestions, based on available evidence and clinical experience, for the management of dysphagia, taking the characteristics of Latin American healthcare systems into account.

Results

The position statement of the Latin American Dysphagia Society provides a series of clinical suggestions directed at the multidisciplinary teams that manage patients with oropharyngeal and esophageal dysphagia. It presents guidelines for evaluation and treatment in different contexts, from hospitalization to home care.

Conclusions

The present statement should be analyzed by each team or healthcare professional, to reduce the risk for COVID-19 infection and achieve the best therapeutic results, while at the same time, being mindful of the reality of each Latin American country.

[Appropriate use of diagnostic esophagogastroduodenoscopy and its relation with positive results]

INTRODUCTION

Upper gastrointestinal endoscopy is a sensitive and safe procedure, but expensive and with certain risks. The range of inappropriate use of upper gastrointestinal endoscopy in open access system is between 5.6 to 61.7%. In our department we use restricted access system.

OBJECTIVE

To determine the accuracy of Gastrointestinal Endoscopy American Society guidelines in the diagnosis through the upper gastrointestinal endoscopies performed in a reference hospital setting with restricted access.

METHODS

We review requests for diagnostic upper gastrointestinal endoscopies and their reports between March 1st 2003 and February 29th 2004. It was defined as an appropriate diagnostic esophagogastroduodenoscopy which followed the American Gastrointestinal Endoscopy society guidelines. It was done statistical descriptive analysis.

RESULTS

A total of 3033 requests and reports of upper gastrointestinal endoscopies were reviewed. The proportion of clinical diagnoses that followed the guidelines was 74.3%. We found a 56.3% of abnormal positive endoscopy findings, concordance between clinical diagnosis and abnormal positive endoscopy findings was 46.8%.

CONCLUSION

The proportion of upper gastrointestinal endoscopies that follow the American Gastrointestinal Endoscopy Society guidelines in our restricted access system is low.