Browsing by Author "Espino, Alberto"
Now showing 1 - 7 of 7
Results Per Page
Sort Options
Item Escurrimiento oleoso anaranjado o «keriorrea», («orange oily anal leakage»): una nueva enfermedad ligada a cambios de hábito alimentario(Elsevier España, 2012) Robles, Ignacio; Vásquez, Jose Manuel; Loehnert, Rodrigo; Espino, Alberto; Biel, Francisco; Correa, Ismael; Gobelet, Jaquelina; Sáenz, Marcela; Saenz, Constanza; Sáenz, RoqueINTRODUCTION: Information is accumulating on exceptional cases of oily orange anal leakage, probably caused by certain foods and their form of consumption. The leakage is usually inadvertent and is worrisome for patients. METHOD: Clinical data was gathered on a case series presenting with massive and inadvertent orange oily anal leakage, without sphincter sensation, causing the patients to feel alarmed. This condition usually occurs after eating fish, especially Japanese cuisine. RESULTS: Eleven patients were included (four women and seven men). The mean age was 47.3 years. Colonoscopy had previously been performed in four patients, with normal results. The symptoms, described as keriorrhea, were probably produced by accumulation of indigestible "wax esters", es Mero present in some oily fish, recently incorporated in raw fish dishes (sashimi) or as Japanese Mero sea bass. These oils, which cannot be absorbed or digested, accumulate in the rectum and may also filter spontaneously and induce toxin-related sphincter dysfunction. The same symptoms are sometimes produced after consumption of cooked versions of these species. The diagnosis is given by clinical data, prior ingestion of these types of fish and the self-limiting nature of the symptoms, without the need for further investigations. CONCLUSION: We describe a case series of a recently described entity associated with dietary changes. This entity is benign and self-limiting. Clinicians should be familiar with the symptoms to inform patients correctly and avoid unnecessary laboratory studies.Item Esofagitis eosinofílica: diagnóstico y manejo(2021) Ballart, María Jesús; Monrroy, Hugo; Iruretagoyena, Mirentxu; Parada, Alejandra; Torres, Javiera; Espino, AlbertoEosinophilic esophagitis (EoE) is a chronic, immune-mediated disease, induced by food allergens, clinically characterized by symptoms of esophageal dysfunction. Pathologically there is a predominant eosinophilic inflammation. This disease is relatively new, and its definitions have evolved over time. Its prevalence and incidence are increasing and causes clinical problems both in children and adults. Its symptoms include food impaction, dysphagia, symptoms that resemble gastroesophageal reflux, abdominal pain, and vomiting. It can also have extra-digestive symptoms such as rhinosinusitis, chronic cough, recurrent croup and hoarseness. EoE can be associated with other atopic conditions, such as asthma, eczema and food allergies. The diagnosis is made by the analysis of endoscopic biopsies (> 15 eosinophils per high power field). Proton pump inhibitors (PPIs) are currently accepted as a treatment for EoE. The clinical and pathological improvement with the use PPIs ceased to be a criterion to define Esophageal eosinophilia responsive to PPIs as a differential diagnosis, since this condition is currently considered within the EoE spectrum. There are three main treatment approaches for EoE: diet, drugs and dilation. Its diagnosis and early treatment are key to avoid or delay its complications, such as stenosis and severe esophageal dysfunction.Item Esofagitis eosinofílica: diagnóstico y manejo(2020) Ballart, María Jesús; Monrroy, Hugo; Iruretagoyena, Mirentxu; Parada, Alejandra; Torres, Javiera; Espino, Albertoinduced by food allergens, clinically characterized by symptoms of esophageal dysfunction. Pathologically there is a predominant eosinophilic inflammation. This disease is relatively new, and its definitions have evolved over time. Its prevalence and incidence are increasing and causes clinical problems both in children and adults. Its symptoms include food impaction, dysphagia, symptoms that resemble gastroesophageal reflux, abdominal pain, and vomiting. It can also have extra-digestive symptoms such as rhinosinusitis, chronic cough, recurrent croup and hoarseness. EoE can be associated with other atopic conditions, such as asthma, eczema and food allergies. The diagnosis is made by the analysis of endoscopic biopsies (> 15 eosinophils per high power field). Proton pump inhibitors (PPIs) are currently accepted as a treatment for EoE. The clinical and pathological improvement with the use PPIs ceased to be a criterion to define Esophageal eosinophilia responsive to PPIs as a differential diagnosis, since this condition is currently considered within the EoE spectrum. There are three main treatment approaches for EoE: diet, drugs and dilation. Its diagnosis and early treatment are key to avoid or delay its complications, such as stenosis and severe esophageal dysfunction.Item Infección por Helicobacter pylori en pacientes sintomáticos con patología gastroduodenal benigna. Análisis de 5.664 pacientes(2010) ROLLÁN, ANTONIO; RIQUELME, ARNOLDO; PADILLA, OSLANDO; VILLARROEL, LUIS; NILSEN, EVA; PRUYAS, MARTHA; VERDUGO, PATRICIA; CALVO, ALFONSO; Espino, Alberto; ORTEGA, JUAN PABLOInfection with Helicobacter pylori (H. pylori) is highly prevalent in Chile, but there are no systematic studies in patients with upper gastrointestinal symptoms. Aim: To determine the prevalence of H. pylori infection, according to age, gender and endoscopic pathology in a large sample of patients. Methods: We studied 7,893 symptomatic patients submitted to upper gastrointestinal endoscopy between July 1996 and December 2003 in the context of a screening program of gastric cancer in a high risk population. H. pylori infection was determined by rapid urease test (RUT) in antral mucosa. We excluded 158 patients with gastric cancer (2%) and 2,071 patients without RUT. Results: We included 5,664 patients, mean age 50.7 ± 13.9 years, women 72.1%. Endoscopic diagnoses were normal in 59.3%, erosive esophagitis in 20%, gastric ulcer (GU) in 8.1%, duodenal ulcer (DU) in 6.4%, and erosive gastropathy in 6.2%. RUT was positive in 78% of patients. After adjusting for age and sex and with respect to patients with normal endoscopy, frequency of H. pylori infection was 86.6% in DU (OR 2.1, 95% CI 1.5-2.8, p < 0.001); 81.4% in GU (OR 1.8, 95% CI 1.4-2.4; p < 0.001 ); 79.9% in erosive gastropathy (OR 1.4, 95% CI 1.03-1.8; p = 0.03) and 77.4% in erosive esophagitis (OR 1.1, 95% CI: 0.9-1.3; p = NS). The probability of H. pylori infection decreased significantly with age, more markedly in men with normal endoscopy. Conclusions: Prevalence of H. pylori infection is very high in symptomatic Chilean patients and even higher in those with gastroduodenal ulcer or erosions, while in patients with erosive esophagitis is similar to those with normal endoscopy. The frequency of infection decreases with age, probably as a consequence of rising frequency of gastric mucosal atrophyItem Management of Helicobacter pylori infection in Latin America: A Delphi technique-based consensus(Baishideng Publishing Group, 2014) Rollan, Antonio; Arab, Juan; Camargo, Constanza; Candia, Roberto; Harris, Paul; Ferreccio, Catterina; Rabkin, Charles; Gana, Juan; Cortés, Pablo; Herrero, Rolando; Durán, Luisa; García, Apolinaria; Toledo, Claudio; Espino, Alberto; Lustig, Nicole; Sarfatis, Alberto; Figueroa, Catalina; Torres, Javier; Riquelme, ArnoldoAIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature. METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria. RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing. CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.Publication Terapias cuádruples son superiores a terapia triple estándar en primera línea de erradicación de Helicobacter pylori en Chile(2022) Reyes, Diego; Ortiz, Javier; Fuentes-López, Eduardo; Budnik, Sigall; Gándara, Vicente; Gallardo, Andrea; Seydewitz, María Francisca; Candia, Roberto; Vargas, José Ignacio; Rollan, María Paz; Godoy, Javiera; Rollan, Antonio; Mansilla, Rodrigo; Arenas, Alex; Chahuán, Javier; Espino, Alberto; Pizarro, Margarita; Riquelme, ArnoldoIntroducción: La infección por Helicobacter pylori afecta aproximadamente al 70% de lapoblación chilena. Es un problema de salud pública cuyo tratamiento de erradicación formaparte de políticas públicas en Chile.Objetivos: Caracterizar los esquemas de erradicación de primera línea de H. pylori más uti-lizados en nuestro medio y evaluar su eficacia.Métodos: Se realizó un estudio observacional retrospectivo donde, en pacientes con infecciónpor H. pylori certificada, se evaluó el esquema de erradicación indicado por el médico tratante,su eficacia, adherencia y efectos adversos.Resultados: Se analizaron 242 pacientes y 4 esquemas de erradicación; terapia triple estándar,terapia dual, concomitante y cuadriterapia con bismuto. Se observaron tasas de erradicaciónde 81,9% (IC 95% 74,44---87,63), 88,5% (IC 95% 73,13---95,67), 93,7% (IC 95% 78,07---98,44) y 97,6%(IC 95% 84,81---99,67) respectivamente, siendo más eficaces la terapia concomitante (RR: 1,14;IC 95% 1,01---1,29; p = 0,028) y cuadriterapia con bismuto (RR: 1,19; IC 95% 1,09---1,31; p <0,001) que la triple terapia estándar. La tasa de efectos adversos reportados fue de 58,5%(IC 95% 50,66---65,92), 35,4% (IC 95% 24,6---48,11), 22,9% (IC 95% 11,81---37,14) y 63,4% (IC95% 47,8---76,64), para la terapia triple estándar, dual, concomitante, y cuádruple con bis-muto, respectivamente. La terapia dual y concomitante tuvieron menos efectos adversos encomparación con la terapia estándar.Conclusiones: Las cuadriterapias son superiores a la triple terapia estándar por lo que deberíanser consideradas como tratamiento de primera línea en Chile. La terapia dual es promisoria.Más estudios serán requeridos para determinar qué esquemas son más costo-efectivos.© 2021 Elsevier Espa˜na, S.L.U. Todos los derechos reservados.Item Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy: a double-blind, randomized controlled trial(2018) Monrroy, Hugo; Vargas, José; Glasinovic, Esteban; Candia, Roberto; Azúa, Emilio; Gálvez, Camila; Cabrera, Natalia; Vidaurre, Josefa; Álvarez, Natalia; González, Jessica; Espino, Alberto; González, Robinson; Parra, AdolfoBackground and aim: Upper GI endoscopy (UGE) is essential for the diagnosis of gastrointestinal diseases. Mucus and bubbles may decrease mucosal visibility. The use of mucolytics could improve visualization. Our aim was to determine whether premedication with simethicone or simethicone plus N-acetylcysteine is effective in improving visibility during UGE. Methods: This was a randomized, double-blinded, placebo-controlled trial with 2 control groups: no intervention and water 100 mL (W); and 3 intervention groups: simethicone 200 mg (S); S + N-acetylcysteine (NAC) 500 mg (S+NAC500); and S + NAC 1000 mg (S+NAC1000). The solution was ingested 20 minutes before UGE. Gastric visibility was evaluated in 4 segments with a previously described scale. A score of less than 7 points was defined as adequate visibility (AV). Water volume was used to improve visibility, and adverse reactions were evaluated as a secondary outcome. Multiple group comparison was performed using non-parametric one-way analysis of variance (ANOVA). Results: Two hundred thirty patients were included in the study, 68% female, mean age 49 years. The most common indication for UGE was epigastric pain/dyspepsia (33%). AV was more frequent in the S+NAC500 and S+NAC1000 groups (65% and 67%) compared with no intervention (44%, P = .044) and water (41%, P = .022). The gastric total visibility scale (TVS) was significantly better in the S+NAC500 and S+NAC1000 groups compared with water (P = .03 and P = .008). Simethicone was not different from no intervention and water. S+NAC1000 required less water volume to improve visibility. No adverse reactions from the study drugs were observed. Conclusions: Premedication with S+NAC500 and S+NAC1000 improves visibility during UGE. The use of simethicone did not show improvements in gastric visibility. TVS was worse in patients using water alone. (Clinical trial registration number: NCT 01653171.).