To the Editor, Esophageal-pleural fistulas are a rare complication of thoracic surgery. They may occur as the direct result of trauma during surgery or use of a transesophageal device. The management ...of esophageal-pleural fistulas can be difficult, and they rarely heal spontaneously. Conservative management of esophageal-pleural fistulas are associated with high mortality rates. The traditional treatment of symptomatic patients is surgery. However, this type of surgery has high morbidity and mortality rates; for this reason, many patients are not eligible for surgery. The endoscopic treatment options to repair esophageal fistulas include the injection of glue, covered stents, and endoscopic suture or clipping. After treatment failure, we considered the use of an emerging therapeutic technique as an alternative treatment. In this context, we present a case of a iatrogenic esophageal fistula treated with an Amplazer device. This is the case of a 72-year-old woman, former smoker with a past medical history of hypertension, chronic atrial fibrillation, and rheumatic mixed mitral valve disease who was admitted due to acute coronary syndrome. A thrombotic occlusion...
Background and Aim: Even with the current most effective treatment regimens for Helicobacter pylori infection, a considerable number of patients will be resistant to eradication. The aim of the ...present study was to evaluate the H. pylori eradication rate in patients resistant to standard therapies when treated with a triple therapy of pantoprazole, rifabutin and amoxicillin.
Methods: Ninety‐two consecutive patients diagnosed with H. pylori infection resistant to two previous treatment regimens were treated with pantoprazole, rifabutin and amoxicillin for 10 days. The persistence or eradication of H. pylori was determined by a 13C‐urea breath test performed 4 weeks after the treatment.
Results: Per protocol eradication was achieved in 62.2% of patients and the intention‐to‐treat eradication was 60.8%. Only two patients were excluded for adverse events related to the treatment.
Conclusions: The eradication rate is acceptable as a third‐line therapy, particularly in centers with high cure rate for first line therapy. Another important value of this study is the good tolerance for the treatment observed in our patients. It is possible that rifabutin‐based triple therapy may be of use in hospital centers that do not have disposable culture and susceptibility methods against H. pylori.
Sr. Editor: Las fístulas esofagopleurales son una complicación rara de la cirugía torácica. Sobrevienen como resultado directo de un traumatismo durante la cirugía o por el uso de un dispositivo ...transesofágico. El tratamiento de las fístulas esófago-pleurales puede resultar difícil y raras veces curan espontáneamente. El tratamiento conservador de las fístulas esofagopleurales se asocia a índices altos de mortalidad. El tratamiento tradicional de pacientes sintomáticos es quirúrgico. Sin embargo, este tipo de cirugía presenta índices altos de morbilidad y mortalidad, por lo que son muchos los pacientes considerados no aptos para la cirugía. Las opciones de tratamiento endoscópico para reparar fístulas esofágicas incluyen la inyección de pegamento, el uso de stents recubiertos y suturas o clips por endoscopia. Tras fracasar el tratamiento, consideramos el uso de una técnica terapéutica emergente como tratamiento alternativo. En este contexto, presentamos el caso de una fístula esofágica iatrogénica tratada con un dispositivo Amplazer. Se trata de una mujer de 72 años, exfumadora, con antecedents de hipertensión, fibrilación auricular crónica y enfermedad de la válvula mitral mixta reumática que ingresó con un síndrome coronario agudo. Se trató con éxito una oclusión trombótica de la arteria circunfleja mediante implante de un stent farmacoactivo. Durante su estancia hospitalaria, la...
La obesidad es una enfermedad multifactorial, crónica, progresiva y recidivante considerada un problema de salud pública a nivel mundial y un importante determinante de discapacidad y muerte. En ...España su prevalencia actual en población adulta se sitúa en el 24%, y se estima su incremento hasta el 37% en 2035. La obesidad aumenta la probabilidad de diversas enfermedades vinculadas a una mayor mortalidad, como diabetes, enfermedades cardiovasculares, hiperlipidemia, hipertensión arterial, enfermedad del hígado graso no alcohólico, varios tipos de cáncer o apnea obstructiva del sueño. Por otra parte, aunque la incidencia de enfermedad inflamatoria intestinal (EII) se está estabilizando en los países occidentales, su prevalencia supera ya el 0,3%. Paralelamente a lo que ocurre en la población general, la prevalencia actual de obesidad en pacientes adultos con EII se estima en el 15-40%. La obesidad en pacientes con EII podría comportar, además de su impacto sobre la discapacidad y la mortalidad ya conocido, una peor evolución de la EII y una peor respuesta a los tratamientos. El objetivo del presente documento, elaborado en colaboración por cuatro sociedades científicas implicadas en la atención médica de la obesidad grave y la EII, es establecer unas recomendaciones claras y concisas sobre las posibilidades terapéuticas de la obesidad grave en pacientes con EII. En el documento se establecen recomendaciones generales sobre el tratamiento dietético, farmacológico, endoscópico y quirúrgico de la obesidad grave en pacientes con EII, así como la evaluación pre y postratamiento.
Obesity is a multifactorial, chronic, progressive and recurrent disease considered a public health issue worldwide and an important determinant of disability and death. In Spain, its current prevalence in the adult population is about 24% and an estimated prevalence in 2035 of 37%. Obesity increases the probability of several diseases linked to higher mortality such as diabetes, cardiovascular disease, hyperlipidemia, arterial hypertension, non-alcoholic fatty liver disease, several types of cancer, or obstructive sleep apnea. On the other hand, although the incidence of inflammatory bowel disease (IBD) is stabilizing in Western countries, its prevalence already exceeds 0.3%. Paralleling to general population, the current prevalence of obesity in adult patients with IBD is estimated at 15-40%. Obesity in patients with IBD could entail, in addition to its already known impact on disability and mortality, a worse evolution of the IBD itself and a worse response to treatments. The aim of this document, performed in collaboration by four scientific societies involved in the clinical care of severe obesity and IBD, is to establish clear and concise recommendations on the therapeutic possibilities of severe or typeIII obesity in patients with IBD. The document establishes general recommendations on dietary, pharmacological, endoscopic, and surgical treatment of severe obesity in patients with IBD, as well as pre- and post-treatment evaluation.
Background and Aim:Even with the current most effective treatment regimens for Helicobacter pylori infection, a considerable number of patients will be resistant to eradication. The aim of the ...present study was to evaluate the H. pylori eradication rate in patients resistant to standard therapies when treated with a triple therapy of pantoprazole, rifabutin and amoxicillin. Methods:Ninety-two consecutive patients diagnosed with H. pylori infection resistant to two previous treatment regimens were treated with pantoprazole, rifabutin and amoxicillin for 10 days. The persistence or eradication of H. pylori was determined by a super(13)C-urea breath test performed 4 weeks after the treatment. Results:Per protocol eradication was achieved in 62.2% of patients and the intention-to-treat eradication was 60.8%. Only two patients were excluded for adverse events related to the treatment. Conclusions:The eradication rate is acceptable as a third-line therapy, particularly in centers with high cure rate for first line therapy. Another important value of this study is the good tolerance for the treatment observed in our patients. It is possible that rifabutin-based triple therapy may be of use in hospital centers that do not have disposable culture and susceptibility methods against H. pylori.
Caveolae are involved in physical compartmentalization between different groups of signaling events. Its main component, CAV1, modulates different pathways in cellular physiology. The emerging ...evidence pointing to the role of CAV1 in cancer led us to study whether different alleles of this gene are associated with colorectal cancer (CRC). Since one of the most characterized enzymes regulated by CAV1 is eNOS, we decided to include both genes in this study. We analyzed five SNPs in 360 unrelated CRC patients and 550 controls from the general population. Two of these SNPs were located within eNOS and three within the CAV1 gene. Although haplotype distribution was not associated with CRC, haplotype TiA (CAV1) was associated with familiar forms of CRC (p<0.05). This was especially evident in CRC antecedents and nuclear forms of CRC. If both CG (eNOS) and TiA (CAV1) haplotypes were taken together, this association increased in significance. Thus, we propose that CAV1, either alone or together with eNOS alleles, might modify CRC heritability.
The relationship between Helicobacter pylori infection and functional dyspepsia (FD) is disputed. Although there is a greater prevalence of infection by H. pylori in subjects with non-ulcer dyspepsia ...than in healthy subjects, results regarding the eradication of infection have been inconclusive so far in terms of disease improvement. In this study, we administered eradicating treatment to a group of patients with both FD and infection by H. pylori to determine the possible beneficial effect of such a treatment. Thus, our objective was to study the effectiveness of eradication therapy for H. pylori in the clinical course of FD.
This was a randomized, double-blind study in 93 consecutive patients diagnosed with FD and infection by H. pylori who received eradicating treatment with omeprazol, amoxicillin and clarythromicin for 7 days (group A, n = 47) vs. placebo, amoxicillin and clarythromicin for 7 days (group B, n = 46). We analyzed the clinical evolution of the disease within the following 9 months.
Both groups of treatment were comparable concerning all the variables studied except for the consumption of alcohol, with a greater prevalence in group A, yet no patient consumed more than 40 g per day. The average age of patients was 42 (18-65). Eradication of H. pylori occurred in 65.9% of patients in group A and 4.3% of patients in group B. 40% of all patients included in the study had improved symptoms. In 60.6% of patients whose infection was eradicated, their symptoms improved, as opposed to 25% of patients whose infection was not eradicated (p = 0.001). Among patients whose symptoms improved following eradication, 70% had had an FD duration of less than 3 years and in 30% FD had lasted for more than 3 years (p < 0.05).
The eradication of H. pylori in patients with short-lasting FD may lead to a significant clinical benefit, especially in those whose duration of symptoms is below 3 years.
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