Publications (18)3.12 Total impact
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Article: Helicobacter pylori-associated chronic atrophic gastritis involving the gastric body and severe disease by Vibrio cholerae.
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ABSTRACT: Evidence has associated chronic infection by Helicobacter pylori with chronic gastritis, low gastric acid production and an increased risk of life-threatening cholera. However, the relationship of specific patterns of histological damage in the gastric mucosa associated with H. pylori infection and the occurrence of cholera has not been described. The purpose of this study was to compare the gastric pH and histopathological findings in gastric biopsies taken from patients with severe diarrhoeal disease due to Vibrio cholerae with those taken from a control (cholera-negative) population. Thirty-five H. pylori-positive patients who had severe dehydration from culture-confirmed cholera (cases) and 40 patients with H. pylori but with no history of cholera (controls) were recruited. Gastric pH was measured and multiple biopsies were taken from the gastric antrum and body for histopathological examination. The results revealed that patients with severe cholera had a significantly higher prevalence of hypochlorhydria at endoscopy compared with controls. Furthermore, cases had significantly more chronic atrophic gastritis (45.7% vs. 12.5%; P=0.002) and intestinal metaplasia (37.1% vs. 2.5%; P<0.01) in the gastric body than controls. Our findings suggest that the nature and location of these gastric lesions may predispose a subset of H. pylori-infected individuals to severe disease by V. cholerae.Transactions of the Royal Society of Tropical Medicine and Hygiene 07/2006; 100(6):567-72. · 2.16 Impact Factor -
Article: Environmental temperature, cholera, and acute diarrhoea in adults in Lima, Peru.
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ABSTRACT: The effects of environmental temperature, presence and severity of El Niño, presence of cholera in the community, and interactions among these variables on the number of adult diarrhoeal patients attending the Hospital Nacional Cayetano Heredia in Lima, Peru, during 1991-1998, were evaluated. During 1991-1996, an increased number of visits to the hospital due to acute diarrhoea in the warmer months was observed. This periodic pattern was altered in 1997, when rising of the environmental temperature was observed in Lima secondarily associated with a strong El Niño event. A multivariate model was built in which environmental temperature and interaction between environmental temperature and presence of cholera predicted the number of adult patients with acute diarrhoea attending the Hospital Nacional Cayetano Heredia. Monitoring of environmental temperature and presence of cholera may be used as a warning system to predict epidemics of diarrhoea in adults, which may have a tremendous impact on healthcare strategies and management of health services in general.Journal of Health Population and Nutrition 01/2005; 22(4):399-403. · 0.95 Impact Factor -
Article: [HELICOBACTER PYLORI, CHRONIC GASTRITIS, GASTRIC ANDDUODENAL ULCER: STUDY OF 1638 PATIENTS]
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ABSTRACT: We anaylize in patients from high socio economic level the histologic findings of biopsies from the gastric mucosa taken endoscopically. Patients with upper gastrointestinal symptoms were examined with esophagogastroduodenoscopy. In the histologic study we considered: presence of Helicobacter pylori, mucinous damage, displasia, atrophy and intestinal metaplasia. Patients were divided in two groups: those who endoscocopically did not present gastric or duodenal active ulcer, gastric neoplasia or were not gastrectomized or vagotomized and those in which active gastric or duodenal ulcer was found. The first group was comprised of 1406 patients (647 women and 769 men). 57.33% (806) showed presence of Helicobacter pylori in the histologic study. Males presented higher prevalence of the bacteria (57.32% vs 42.68%, p=0.021873). Atrophys was found in 8.25% and was more frequent in patients with H. pylori (78.45% vs 21.55% p=0.0000026) / Intestinal metaplasla was found in 11.24% being related more with the presence of H.pylori (74.68% vs 25.32%, p=0.0000043). In the second group comprised of 232 patients: 192 males (82.7%) 82.75% showed presence of the bacteria. There was not a statistical difference by comparing sex and age vs presence of ulcer.Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru 02/1999; 19(3):196-201. -
Article: [CONTRIBUTION STUDY TO THE EPIDEMIOLOGY OF HELICOBACTERPYLORI IN PERU: ANALYSIS OF 3005 CASES]
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ABSTRACT: Compiling our observations from the last 15 years in regard to the epidemiology of Helicobacter pylori in Perú, we have analized 3005 cases. Studying and comparing the rates of infection among japanese inmigrants living in Perú for more than 10 years, niseis, japanese visitors and peruvians, we found similar rates. According to these results it seems that at least in japaneses there is not any genetic predisposition to acquire the infection. Studying peruvians of different socioeconomic levels, we observed similar rates of infection with the exception of women of high socioeconomic level. It seems that the last group of people is not exposed to the different mechanisms of infection. We found similar rates of infection in patients of low socioeconomic level living in the coast, sierra and jungle. Our studies in children showed that the infection is acquired during early childhood. Therefore in Perú we have not observed an ascending rate of infection according to age as has been described in industrialized countries. Analizing water from 48 sources we found Helicobacter pylori in 24 samples, 20 of them were taken from the municipal source of water. Water seems to be an important vehicle of infection, according to our studies, in children drinking water from different sources.Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru 02/1999; 19(3):208-215. -
Article: [HELICOBACTER PYLORI INFECTION ERRADICATION IN DISPEPTIC PATIENTS WITH AND WITHOUT PEPTIC ULCER]
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ABSTRACT: BACKGROUND: Helicobacter pylori (HP) infection is very prevalent worldwide, and has been associated with the presence of duodenal ulcer, gastric ulcer and chronic active gastritis. It is also speculated that HP may have a role in gastric cancer development. Triple drug schemes have been shown to be the most effective approach to erradicate HP infection. Nevetheless, high rates of resistance against some antibiotics as well as high costs affect the effectiveness of these therapies. The goal of the present study is to assess the effectiveness of the combination of tetracycline, furazolidone and bismuth in erradicating HP, as well as the changes in the histology.METHODS: Patients with diagnosis of HP infection, found in their antral gastric biopsies (hematoxylin and eosin staining (H-E)), were included. They received the following scheme for 10 days: tetracycline 500 mg qid., furazolidone 100 mg qid., and colloidal bismuth subcitrate 120 mg qid. Patients were instructed to come back for follow-up 6 to 8 weeks after starting the therapy. At that time a control upper endoscopy was performed and 3 antral biopsies were taken. Biopsies were stained with H-E and read by experienced pathologists. In both, the biopsy before treatment and the control biopsy, the following parameters were looked for: presence and density of HP; presence, depth and grade of chronic gastritis (lymphoplasmocytic infiltrate); presence and grade of inflammatory activity (polymorphonuclear inflitrate); presence of glandular atrophy; presence, grade (partial or total) and extent (focal or multifocal) of mucinous damage (epithelial damage); presence of intestinal metaplasia; and presence of lymphoid follicles.RESULTS: Fifty-nine patients (30 men and 29 women) completed per protocol. Mean age was 43 +/- 18 (range: 14-73). HP erradication was achieved in 54 patients (91.5%). Control biopsies showed improvement in the following parameters: presence and density of HP (p<0.001); presence, depth and grade of chronic gastritis (p<0.001); presence and grade of inflammatory activity (p<0.001); presence, grade and extent of mucinous damage (p<0.001); and presence of lymphoid follicles (p<0.001). Neither the presence of glandular atrophy nor the presence of intestinal metaplasia showed any significant change. Patients who did not erradicate HP showed no significant difference in any of the parameters.CONCLUSIONS: The triple drug scheme including tetracycline, furazolidone and bismuth is effective in HP erradication. Erradication of HP is followed by an improvement in the following histologic parameters: presence, depth and grade of chronic gastritis (LMN infiltrate); presence and grade of inflammatory activity (PMN infiltrate); presence, grade and extent of mucinous damage; and presence of lymphoid follicles. This scheme is a cost-effective alternative for the therapy of HP infection in low income populations with a high prevalence of infection with this bacteria.Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru 01/1999; 19(3):179-194. -
Article: [The high fermentative capacity of colonic bacteria in the origin of flatulence and its sensibility to bismuth subsalicylate].
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ABSTRACT: Using a previously described technique, "in vitro" determinations were carried out for faecal fermentation (FF): basal faecal fermentation (BFF), i.e, only with faeces, with faeces and lactulose (LFF) and with faeces, lactulose and bismuth subsalicylate (BiLFF) in 34 patients with flatulence. The media+d.s. of the difference between the LFFand BFF levels (LFF-BFF) in patients with flatulence was significant and markedly higher than the respective media +d.s. in 30 normal control patients previously studied (9.1+4.7 vs. 3.9+3.2 ml gas/24 hrs; p<0.000001 respectively). And, although FF was reduced by adding bismuth salicylate in only 24% (70.6%) of the patients with flatulence but not in the remaining 10 (29.4%), in total the media+d.s. of the differences between the levels BiLFF and BFF (BiLFFBFF) was significantly lower that the media+d.s. of the differences between the LFF and BFF levels (LFF-BFF) (6.0+4.2 vs 9.1+4.7 ml gas/24 hrs; p<0.01 respectively). These results confirm that: 1) The fermentative capacity of the colonic bacteriae is most likely to be abnormally intense in peoples with flatulence and 2) Bismuth subsalicylate can be useful in the control of excessive colonic fermentation and flatulence; they raise, furthermore, the interesting possibility that we may have found the way to predict when the use of bismuth subsalicylate could be effective in the treatment of a patient with flatulence.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 27(1):21-4. -
Article: [Major gastrointestinal syndromes (1): general remarks].
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ABSTRACT: We will review concepts of the maladies of the people, focusing the problems as "great" syndromes, that are those that include the greater number of gastrointestinal symptoms. We begin this series of articles, reviewing aspects of the multifactorial genesis of the diseases, the real core of the diagnosis and the classification of the organic and "functional" gastrointestinal disorders.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 27(3):283-6. -
Article: [Viral hepatitis A as a triggering agent of autoimmune hepatitis report of a case and review of literature].
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ABSTRACT: The case of a 61-year-old woman who developed a picture of viral Hepatitis A with an uncomplicated clinical course is reported herein. However, nine months after the diagnosis, the aminotransferases still remained discretely elevated (AST 78 UI/L, ALT 95 UI/L). At that moment, the patient started to present transient arthralgias and markers were requested for autoimmune hepatitis, which turned out positive, besides presenting hypergammaglobulinemia. A liver biopsy was performed showing changes consistent with mild autoimmune hepatitis. It was considered that the case did not warrant treatment with corticosteroids or immunosuppresants and continued to observe the patient, who is asymptomatic until the publishing of this report. To our knowledge, this is the first report in our country of autoimmune hepatitis triggered by a viral Hepatitis A. The case is reported and the literature is being reviewed.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 23(2):134-7. -
Article: [Small intestine bacterial overgrowth in patients with chronic diarrhea and normal control subjects].
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ABSTRACT: The purpose of this study was to investigate the prevalence and meaning of small intestine bacterial overgrowth (SIBO) in patients with chronic diarrhea and normal control subjects. To that effect, a hydrogen breath test was performed using lactulose on 54 patients with chronic diarrhea and 16 normal control subjects. The presence of SIBO was defined as an increase in the hydrogen concentration, of > 20 parts per million above the basal value in any of the breath tests after the ingestion of lactulose. In addition, the logarithms of the areas under the hydrogen concentration curves were calculated.SIBO was present in two (12.5%) of the 16 normal control subjects. The frequency of SIBO was higher in patients with chronic diarrhea (24.1%) than in the normal control subjects; however, this difference was not statistically significant (p:0.27). Finally, the mean + sd of the logarithms of the areas under the hydrogen concentration curves was significantly higher in patients with chronic diarrhea (6.485 + 0.751) than in normal control subjects (6.135 + 0.500) (p<0.05). The results obtained show that SIBO occurs in a certain percentage of the population, without presenting diarrhea. For SIBO to produce diarrhea, it probably requires some additional characteristics. However, it is worth it to suspect and investigate for SIBO in all chronic diarrhea cases.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 23(2):111-4. -
Article: [Flatulence].
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ABSTRACT: At present physicians focus their medicine studies in well defined illnesses as peptic ulcer, gastric cancer, ulcerative colitis and so on. However, patients reveal their discomfort to us, that is their symptoms or group of symptoms (syndromes). For this reason, our concern for many years has been the study of symptoms and syndromes. In this review we will be looking at the concepts and information gathered with respect to intestinal gases, clinically known as flatulence.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 22(3):234-42. -
Article: [Prevalence and relation of dyspepsia to irritable bowel syndrome in a native community of the Peruvian jungle].
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ABSTRACT: Dyspepsia and irritable bowel syndrome (IBS) are two of the most frequent syndromes in gastroenterology. However, very few epidemiological studies have been conducted in Peru and none in the Peruvian Jungle. The objective of this study is to determine the prevalence of dyspepsia and irritable bowel syndrome in a jungle community of Peru and the recurrence percentage of these syndromes. A sample was taken from 231 persons randomly selected using the "home by home" method, according to the map provided by Punta del Este Medical Center (city of Tarapoto - Department of San Mart n). The persons, considered to best typify the general population of the city, took two tests (Dyspepsia Test and Manning Test) that were previously validated during the months of January through March 1999. The prevalence of dyspepsia was 37.6%, and that of IBS, 22.0%. From those with dyspepsia, 38% had also IBS. From those with IBS, 65% reported dyspepsia symptoms. Prevalence of IBS was higher in individuals with dyspepsia (37.9%) than in individuals without dyspepsia (12.5% p< 0.01). The prevalence of both dyspepsia and IBS decreases as age increases. A statistically significant difference related to ethnicity was found in individuals with IBS. Dyspepsia and ethnicity were associated in 31.4% to individuals having both pathologies (p< 0.0001 and OR=4.28). The dyspepsia/IBS ratio was 1.7/1. There is a high prevalence of IBS and dyspepsia in the study population. The high association found between both syndromes may be due to the common etiopathogenic mechanisms they share such as: a visceral hypersensibility due to peripheral or central mechanisms, bowel motility disturbances or parasitosis. Our study suggests that both dyspepsia and IBS are the manifestations of the same digestive disorder, which has not been fully clarified yet.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 22(2):129-40. -
Article: [Gastroesophageal reflux symptoms: their association with dyspepsia].
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ABSTRACT: The clinical histories of 364 patients with heartburn and/or regurgitations, that is, with symptoms of gastroesophageal reflux (GER), were reviewed to determine the frequencies with which these symptoms appeared in isolated form or associated with manifestations of dyspepsia. Only 41 (11.3%) of the patients presented symptoms of GER in isolated form; in the remaining 323 (88.7%), the symptoms appeared associated with manifestations of dyspepsia. In view of these results and various reasons exposed in the present article, we question the decision of the Rome Working Group of separating the GER from the dyspeptic syndrome.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 26(2):125-7. -
Article: [Gastrointestinal syndromes (3): flatulence (2)].
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ABSTRACT: The second part of the article on flatulence reviewed aspects of the pathogenesis, diagnosis and treatment of this syndrome.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 29(3):262-5. -
Article: [Comments on irritable bowel syndrome].
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ABSTRACT: The Author comments about the inadequacy of the organic and functional terminology in the description of digestive problems categorized as Irritable Bowel Syndrome (IBS), also the adjective irritable and wrong is ambiguous and equivocal and the consideration in the definition of the Rome I, II , and III criteria for IBS since 3 months of discomfort is subject to great debate. Keywords: Irritable Bowel Syndrome, Rome criteria, functional diseases.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 30(1):52-4. -
Article: [Common gastrointestinal syndromes (2): dyspepsia or upper digestive tract syndrome related to food (I)].
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ABSTRACT: We expose, this time, our ideas and findings on the definition, the classification and the cardinal symptoms of the dyspeptic syndrome.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 28(2):150-3. -
Article: [Pepsinogen and gastrin in the noninvasive diagnosis of gastric atrophy. A case-control study in Peruvian population].
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ABSTRACT: Detection of gastric atrophy could be used for early diagnosis of gastric cancer in Perú. It was determined the pepsinogens I and II (PGI, PGII) and Gastrin-17 (G17) serum levels, and the PGI/PGII ratio as a non-invasive diagnostic test for gastric atrophy in Peruvian patiens. Dyspeptic adults undergoing endoscopy and gastric biopsies were studied.For each case with atrophy two controls without atrophy were selected. Differences were evaluated and ROC curves constructed. A serologic profile was produced combining PGI and PGI/PGII ratio. Sensitivity and specificity were calculated. 22 cases and 44 controls were included. Areas under ROC curves were 0.599, 0.546 and 0.534 for PGI, PGII and PGI/PGII ratio, respectively. None of these allowed for discrimination between cases and controls. The serological profile did not reach appropriate sensitivity and specificity. This first study of pepsinogen, gastrin and atrophy in Peru showed none of these tests to be useful. Their potential impact in early detection and prevention of prevalent cancer justify further investigation. Recruiting more patients, excluding those previously treated for Helicobacter pylori, and processing independently the antrum and corpus biopsies, could reveal findings not seen in present study.Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru 31(2):110-5. -
Article: [Major gastrointestinal syndromes (2): dyspepsia or syndrome of the upper digestive system related with food (2)].
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ABSTRACT: We expose, this time, our ideas and findings on the etiopathogenesis, diagnosis and treatment of the dyspeptic syndrome.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 28(3):267-9. -
Article: [Gastrointestinal syndromes (3): flatulence (1)].
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ABSTRACT: Now we expose important data on definition and cardinal symptoms of the flatulence syndrome and, besides, on accumulated knowledge in relation to digestive tract gases.Revista de gastroenterologia del Peru: organo oficial de la Sociedad de Gastroenterologia del Peru 29(2):171-3.
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2006
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Universidad Peruana Cayetano Heredia
Lima, LMA, Peru
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