[Show abstract][Hide abstract]ABSTRACT: Introduction:
The eradication rate of the Helicobacter pylori (H pylori) infection using standard triple therapy has dropped globally in recent years, primarily due to the occurrence of antibiotic resistance.
Several therapy regimens were assessed in 823 patients treated the first time for H pylori infection in Uruguay, during the 1997 to 2011 period, divided into five-year groups. All patients underwent 13C isotope-urea breath testing, between the 8th and 24th weeks after therapy. The standard triple plan (amoxicillin, clarithromycin and proton pump inhibitors) was the most commonly used (86.8%).
The overall eradication rate was 66.6% (548 patients). With the standard triple plan, the reported eradication rates were 75% for the first 5-year term and 70.1% for the second 5-year term. The difference between these two periods was not statistically significant (P = 0.201). However, in the last term the eradication rate further declined to 62.4%, with a statistically significant difference (P = 0.014). No significant correlations were found between the response to therapy in this population and either the use of alcohol and/or yerba mate or the smoking habits.
In Uruguay, the eradication rate of H pylori infection has dropped in the last five years and is below the internationally accepted levels. This feature demands searching for more effective alternative therapies, adapting the management to the national reality based on local antibiotic resistance patterns and drug availability.
Article · Jun 2014 · Acta gastroenterologica Latinoamericana
[Show abstract][Hide abstract]ABSTRACT: To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection (ESD), thus contributing to its subsequent application in human patients.
This study/learning process was carried out in 3 phases: Phase I: Ex vivo animal; Phase II: In vivo animal; Phase III: Humans. One endoscopist performed 30 gastric ESDs in porcine models, and later 5 gastric ESDs in 5 patients. The ESD was done following the method practiced at the National Cancer Center in Tokyo, Japan. Technical aspects, size, time and speed of ESD, as well as complications were registered. In patients, their clinical, endoscopic and histologic evolution was additionally added.
Thirty en bloc ESDs were carried out in animal models. The mean ± SD size of the pieces was of 28.4 ± 1.2 mm, and the time of ESD was 41.7 ± 2.4 min. The time of ESD in the first 15 procedures was 43.0 ± 3.0 min whereas in the next 15 procedures, the time was 40.3 ± 3.9 min, P = 0.588. The speed in the first 15 ESDs was 1.25 ± 0.11 cm(2)/min vs 2.12 ± 0.36 cm(2)/min in the remaining 15, P = 0.028. There were no complications. In patients, 5 lesions were resected en bloc. The size of the pieces was 25.2 ± 5.1 mm and the time was 85.0 ± 25.6 min. Endoscopic and histological controls did not show evidence of residual neoplastic tissue.
A sequential ESD training program of a unique endoscopist, based on the practice in porcine models, contributed to learning ESD for its subsequent application in humans, yielding good results in efficacy and safety.
Article · Dec 2013 · World Journal of Gastroenterology
[Show abstract][Hide abstract]ABSTRACT: The incidence of inflammatory bowel disease (IBD) is different according to the geographical areas. No data on the incidence of IBD in Uruguay are available.
To determine the incidence of IBD, ulcerative colitis (UC) and Crohn's disease (CD), in five areas of Uruguay and to compare the results with those from other geographical regions.
A prospective study was performed in five areas of Uruguay during 2007-2008. The study population included 645,695 inhabitants. Multiple independent sources were used for the uptake of cases. Patients older than 14 years and living in the selected areas were included only after reviewing their medical history. Confirmed IBD was defined by a standard protocol after one year of follow up.
A total of 34 cases were diagnosed in the study period, 29 UC and 5 CD. Crude incidence rate for IBD was 2.63 per 100,000 inhabitants/year, 2.25 and 0.39 for UC and CD, respectively. Adjusted rates were 4.26 per 100,000 inhabitants/year for UC and 0.74 per 100,000 inhabitants/year for CD. The UC/CD ratio was 5.8. The average age for IBD was 40.7 years. No statistically significant differences were found between UC and CD by age (P = 0.267) or gender (P = 0.489).
Incidence rates of IBD place Uruguay in the regions of low incidence. As it has been described in low-incidence countries, UC is more common than CD. This study establishes a precedent to follow the evolution of IBD epidemiology in Uruguay.
Article · Dec 2011 · Acta gastroenterologica Latinoamericana