Compromiso gastrointestinal inusual en paciente pediátrico con vasculitis asociada a anticuerpos anticitoplasma de neutrófilos. Reporte de un caso

Vasculitis is characterized by presenting inflammation of the wall of blood vessels, one type of these diseases are those associated with anti-neutrophil cytoplasm antibodies. They usually occur in adulthood and are rare in childhood. The disease generally affects the lung, kidney, and skin, with gastrointestinal involvement being rare. Here we describe the case of a pediatric patient with gastrointestinal bleeding secondary to ANCA positive vasculitis. Endoscopy revealed patchy erythematous lesions and wall hematoma at the level of the colon. Although we report a fairly infrequent clinical condition, it is not without complications. We believe it is appropriate to suspect it, first of all, intestinal involvement where the underlying inflammatory process is not clear, even more so when it involves other organs.

Endometriosis intestinal, una causa de suboclusión intestinal poco sospechada. Serie de casos

Endometriosis is defined as the presence of endometrial glands in extrauterine sites. Intestinal deep infiltrating endometriosis is considered when the endometriotic lesion is located more than 5 mm below the peritoneum. Intestinal obstruction due to endometriosis is rare, occurring in approximately 1% of cases. We present three cases with intestinal occlusion as deep infiltrating endometriosis debut. Its symptomatic presentation can mimic multiple gastroenterological entities, mainly irritable bowel syndrome or inflammatory bowel disease so its diagnosis can be difficult. However, suspecting this pathology and diagnosing it is important to define therapeutic behavior and improve the quality of life of our patients.

Gut Microbiome and Its Role in the Pathophysiology of Irritable Bowel Syndrome

Irritable bowel syndrome is the most common functional gastrointestinal disorder, affecting up to 9% individuals globally. Although the etiology of this syndrome is likely heterogenous, it presents with its hallmark symptoms of abdominal pain and altered intestinal motility. Moreover, it is considered to be a disorder of the gut-brain interaction, and the microbiome has often been implicated as a central player in its pathophysiology. Patients with irritable bowel syndrome display altered composition and function of the gut microbiota compared to healthy controls. Microbiome directed therapies, such as probiotics, antibiotics and fecal microbiome transplantation, appear to be beneficial for both gut symptoms and psychiatric comorbidities. This review aims to recapitulate the available literature on the microbiome contribution to the pathophysiology and symptoms presentation of irritable bowel syndrome, as well as the current literature on microbiome-targeted treatments for this disease.

Mecanismos patogénicos del microbioma en la enfermedad inflamatoria intestinal: rol de la actividad proteolítica bacteriana

nflammatory bowel disease is an immune mediated condition that includes Crohn’s disease and ulcerative colitis and causes chronic inflammation of the gastrointestinal tract. Although the exact cause for inflammatory bowel disease is unknown, there is consensus that a combination of genetic, environmental, and immune factors participate in its pathogenesis. To date, all the studies have been focused on alterations that occur once IBD has developed, however, the causes triggering the onset of the disease are still unclear. There is an evident genetic basis in which multiple genes involved in intestinal homeostasis are affected, such as NOD2, ATG16L1 and XBP1. However, these genetic factors are not sufficient for disease onset and additional environmental factors such as those related to dysregulation of gut microbiota and the immune system are required. A lower microbial diversity and a decrease in the relative abundance of Firmicutes, as well as an increase in Proteobacteria, have been described in patients with inflammatory bowel disease, but are not found in all studies. In addition to variations in microbial composition, functional changes have also been observed in cross-sectional studies. Longitudinal cohorts in patients at risk for inflammatory bowel disease have recently been conducted allowing us to interrogate whether specific microbial communities and functions could be influencing the onset of the disease. Indeed, a translational study performed in a cohort of at-risk individuals for inflammatory bowel disease (GEM cohort) showed an increased fecal proteolytic activity, associated with microbial composition changes, before the onset of ulcerative colitis. These findings may help develop new non-invasive diagnostic techniques, as well as new therapeutical approaches for inflammatory bowel disease.

Probióticos en enfermedad celíaca: ¿estamos listos para su aplicación en la práctica clínica?

Probiotics, live microorganisms that produce a beneficial effect on health, are a possible supplement to a gluten-free diet in the treatment of celiac disease. Several clinical studies have shown that celiac patients treated with probiotics improved their gastrointestinal symptoms. Although the mechanisms of probiotics in celiac disease are unclear, preclinical studies in mice suggest different mechanisms, such as the modulation of the intestinal microbiota and the immune system, or through the production of proteases. We conducted a review of the literature to address the current evidence on the efficacy of probiotics in the treatment of celiac disease, possible mechanisms of action, and areas of interest for future research studies.

Tratamiento del síndrome de intestino irritable por gastroenterólogos: resultados de un estudio de corte transversal a partir de una encuesta elaborada por expertos

Introduction. Irritable bowel syndrome (IBS) accounts for a significant deterioration in the quality of life of patients who suffer from it and is a common reason for consultation in gastroenterology. The treatment of this syndrome includes a wide variety of medications and recommendations based on different factors of its physiopathology. However, the results are usually variable and sometimes unsatisfactory for either the patient or the treating physician. The main objective of the present work is to describe the different treatments used by gastroenterologists in the management of IBS in Argentina. Materials and methods. Questionnaire of forty-seven questions, prepared by experts, distributed by medical associations of gastroenterology in Argentina and answered by specialists via Google Forms. Results. 304 responses, 157 from women (51.6%) and 147 from men (48.4%). The mean age was 44 and 49.9 years, respectively. 87.5% consider improvement of quality of life as the main goal of treatment. Regarding physiopathology of diarrhea variant irritable bowel syndrome (IBS-D), 49.5% considered emotional stress, while for constipation variant irritable bowel syndrome (IBS-C), 42.8% considered it multifactorial, with a predominance of slow colonic transit. No treatment option was rated as very effective by more than 50% of the respondents. Rifaximin was considered the most effective treatment in IBS-D, while polyethylene glycol was for IBS-C. Statistical significant differences were observed among gastroenterology subspecialties in the treatment of IBS-D with respect to the efficacy of diet, amitriptyline and antibiotics other than rifaximin, and regarding the effectiveness for bisacodyl/picosulfate and antibiotics in the treatment of IBS-C. Conclusion. The most common pathophysiological mechanismin IBS-D is stress. The vast majority of respondents consider that the main goal of treatment is the improvement of the quality of life, over symptomatic relief. None of the drugs is considered very effective in the treatment of the different IBS variants by at least 50% of those surveyed. Statistically significant differences were observed in the proportion of monthly consultations for IBS regarding to age and in the effectiveness considered for some treatments in relation to the subspecialty of physicians. The therapeutic approach to IBS by Argentine gastroenterologists is varied and somewhat heterogeneous, resulting in a still inappropriate management of this condition.

Disección endoscópica con técnica de bolsillo submucoso. ¿Puede reemplazar a la disección convencional?

Endoscopic submucosal dissection is a complex technique that allows en bloc resection of large lesions. It is associated with long-term, technically complex procedures and a high risk of complications. The creation of a submucosal pocket is a variant of the conventional technique that reduces these difficulties, generating a high rate of complete resection with a shorter procedure time, a faster dissection speed and a lower rate of adverse events. Even though this variant was initially described in the stomach, its application has been generalized to other areas of the digestive tract. We present two cases where this variant technique was applied to treat large early lesions, with technical success.

Fascioliasis: una causa infrecuente de obstrucción de vía biliar. Reporte de un caso

Hepatic fascioliasis is a parasitic disease caused by the fluke Fasciola hepatica. In the chronic phase of the disease, the adult form of the parasite adopts the bile ducts as the ideal environment to develop, causing them to dilate and simulating an obstructive jaundice process. The case of a 48-year-old woman is presented, who was admitted for jaundice, choluria and eight loss. After the corresponding complementary studies had been carried out, an endoscopic retrograde cholangiography (ERCP) was performed and an adult Fasciola hepatica parasite was extracted from the biliary tract. Subsequently, anthelmintic treatment with triclabendazole was started, resulting in a favorable evolution and resolution of the condition.

Úlcera gigante gástrica como forma de presentación del linfoma gástrico primario. Presentación de un caso y revisión de la bibliografía

Giant peptic ulcers are defined as having a diameter greater than 2 cm in the case of duodenal ulcers, and greater than 3 cm in the case of gastric ulcers. The presentation is infrequent, but raises questions about the etiological factor and the definitive treatment. The literature on its physio-pathology is scarce and the cases described are unusual. The following case is presented to review the conduct to be followed in the presence of a giant gastric ulcer. We highlight the difficulty to assess the differential diagnosis of malignant pathology, trying to emphasize the value of the predictive factors of malignancy to define the conduct to follow. Finally, we focus on the relationship between the clinical presentation of gastric giant ulcer with primary gastric lymphomas and their clinical characteristics.