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P Hergueta Delgado

Publications and source records attributed to P Hergueta Delgado.

13 recordsLinked to original sources
PubMed2006

Diagnostic yield of 335 push video-enteroscopies.

BACKGROUND AND OBJECTIVES: The diagnostic yield of push enteroscopy (PE) varies widely from 13 to 78% of cases, according to the various series. The aim of this retrospective cohort study was to determine the endoscopic and histological yield of PE in our health area. PATIENTS AND METHODS: A total of 355 consecutive patients (190 males/165 females; mean age 45 years, range 15-89) underwent PE over a 6-year period, from 1997 to 2003. PE was performed under sedation and without overtube. Small-bowel mucosa biopsies were taken in 199 explorations (56%). Clinical indications for PE included: chronic diarrhea (35%), occult digestive bleeding (ODB) or iron-deficiency anemia (28%), suspected small-bowel malignancy (16%), chronic abdominal pain (28/355; 8%), follow-up of polyposis or malabsorption syndromes (7%), and abnormal radiographic findings (6%). RESULTS: PE detected lesions in 122 cases (34%); in 6 cases (6%) lesions were within the reach of esophagogastroduodenoscopy. A normal macroscopic appearance of the small intestinal mucosa with an abnormal histological study was seen in 16 patients (6%). Major findings included: malabsorptive diseases (14%), nonspecific enteropathy (5%), angiodysplasia (3,5%), lymphangiectasia (3%); jejunal polyps (2%), Crohn s disease (2%), intestinal tumors (2%), extrinsic jejunal strictures (0.5%), and other (10/355; 3%). Abnormal radiographic findings (62%), chronic diarrhea (37%) and ODB (31%) were the indications with a higher diagnostic yield. No major complications were seen. CONCLUSIONS: According to our experience, PE is a safe and useful tool for the evaluation of small-bowel disease, especially in some indications (abnormal radiographic findings, chronic diarrhea, and ODB). Small-bowel biopsy increases PE's diagnostic yield in patients with chronic diarrhea.

Adolescent↗
PubMed2004

Incidence and factors influencing on Helicobacter pylori infection recurrence.

OBJECTIVES: a) To determine the rate of H. pylori reinfection after successful eradication in a 4-year follow-up study; and b) To evaluate the contribution of different factors in the infection relapse. PATIENTS AND METHODS: A total of 208 patients (age range 18-81 years; average 50 years; 87 women) who had been successfully treated for H. pylori infection were included. Annually, urea breath test was assessed to determine H. pylori status after eradication. Age, sex, rural/urban environment, smoking habit, treatment regimens against H. pylori and urea breath test values were evaluated. RESULTS: reinfection occurred in 9,6% of patients observed, 6,7% (14/208) in the first year, 1,9% (4/208) in the second year, 1% (2/208) in the third and 0% in the forth. Risk factors for infection recurrence were younger age and higher values of urea breath test in the multivariante analysis. CONCLUSIONS: annual reinfection rate was 2,4 pacients-year. Younger patients and higher values of urea breath test were factors associated with a higher rate of reinfection relapse. Annually, urea breath test should be performed to detect reinfection in order to avoid ulcer complications.

Adolescent↗
PubMed2002

Ranitidine bismuth citrate in the treatment of Helicobacter pylori infection.

OBJECTIVE: Examine the effectiveness of treatments that include ranitidine bismuth citrate (RBC) for Helicobacter pylori infection. DESIGN: Prospective and randomised study. PATIENTS AND METHOD: 137 patients were included (62 women, 75 males, average age 46.9 +/- 13) diagnosed with peptic ulcer and infection by Helicobacter pylori. None had received treatment previously. 67 patients were treated with RBC 400 mg bd and clarithromycin 500 mg bd for 14 days, and 70 patients with RBC 400 mg bd, clarithromycin 500 mg bd and amoxycillin 1 g bd for 7 days. The infection eradication was proven eight weeks after treatment end. The efficacy of treatment was evaluated using the intention-to-treat method. The Chisquare test (chi 2) was used for the statistical analysis of data. RESULTS: Infection in 48 out of 67 patients (71.64%) treated with RBC-clarithromycin for 14 days was eradicated, versus 88.57% (62 out of 70) among those treated with RBC-clarithromycin-amoxycillin for 7 days, with a significant difference between both regimens (p < 0.05). CONCLUSIONS: 7-day treatment with RBC-clarithromycin-amoxycillin has a good eradication rate (88.57%) and represents a valid alternative to regimens including a PPI and two antibiotics, as both regimens have a similar efficacy. Results obtained with the double therapy of RBC-clarithromycin for 14 days were not satisfactory, the rate of eradication being 71.64%. The use of an RBC treatment for Helicobacter pylori infection should always be accompanied by two antibiotics in a triple therapy.

Bismuth↗
PubMed2000

Clinical relevance of Helicobacter pylori CagA-positive strains: gastroduodenal peptic lesions marker.

OBJECTIVES: peptic ulcer is characterized by its recurrent nature, which necessitates maintenance treatment in most patients. But this natural history can be changed in patients with peptic ulcer associated to Helicobacter pylori, as shown by the low rates of recurrence and decreased hemorrhagic recidivism associated with this infection. Whether CagA or VacA strains are associated with a greater risk of peptic ulcer is controversial. This study was designed to examine endoscopic findings and their relation with H. pylori phenotype (CagA or VacA). METHODS: 106 selected dyspeptic patients underwent upper gastrointestinal tract endoscopic examination between September 1996 and May 1997 [69 with H. pylori (Hp) and 37 without this infection]. Endoscopic findings were classified as gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), duodenitis (Du), chronic gastritis (CG) and normal mucosa (NM). Hp phenotype was analyzed with a western blot test. RESULTS: 75% of H. pylori strains were CagA-positive and 54.2% were VacA-positive. 82.4% of the cases of DU were associated with a CagA+ phenotype, but the association was not statistically significant. Otherwise 100% of gastric ulcers were associated with CagA+ strains (p < 0.005). VacA phenotype was not associated with any particular endoscopic finding. Peptic ulcer (DU or GU) was also associated with the CagA+ phenotype (p < 0.05). CONCLUSIONS: the CagA+ H. pylori phenotype seems to be a peptic lesion marker, but was more frequently related with GU than with DU in our sample of Spanish patients.

Adolescent↗
PubMed2000

Pathogenic implications of interleukin-8 activity and bacterial phenotype in antral gastritis associated with Helicobacter pylori.

OBJECTIVE: Helicobacter pylori (Hp) infection is characterized by an intense inflammatory infiltrate in the gastric mucosa, which is chemoattracted by different cytokines. Interleukin-8 (IL-8) seems to play an important role in the recruitment of circulating neutrophils, and modulation of IL-8 secretion seems to be a strain marker. This study was designed to examine IL-8 concentrations in the gastric mucosa and their relationship with H. pylori phenotype and histologic findings. METHODS: Gastric biopsies were obtained from the antrum and corpus in 106 patients (69 Hp-positive and 37 Hp-negative). IL-8 levels in the gastric mucosa were analyzed by ELISA and Hp phenotype was determined with a western blot test. RESULTS: 75% of H. pylori strains were CagA+ and 54.2% were VacA+. The Houston classification was used for histologic findings. No association between gastric atrophy or intestinal metaplasia and Hp phenotype was found. The highest IL-8 levels were found in CagA+ infected gastric mucosa, but the difference with respect to infection by a VacA+ strain was not statistically significant. IL-8 levels were highest when neutrophils were the predominant cell in the gastric inflammatory infiltrate (p < 0.05). IL-8 levels were higher in patients with atrophic gastritis than in patients with nonatrophic gastritis (p < 0.05). CONCLUSIONS: In patients with H. pylori infection, IL-8 levels are higher than in Hp-negative patients regardless of Hp phenotype. There is an association between IL-8 and a neutrophilic infiltrate. Perpetuation of a chronic infiltrate could lead to more severe lesions such as atrophic gastritis or intestinal metaplasia, as deduced from the IL-8 levels found in these types of lesion.

Adolescent↗
PubMed2000

Resistance of Helicobacter pylori to antimicrobial treatment in a Seville hospital catchment area.

AIM: To determine the sensitivity to metronidazol, clarithromycin, amoxicillin and tetracycline of strains of Helicobacter pylori isolated in a prospective series of patients referred to a university hospital in Seville for endoscopic examination. METHODS: During the period from March 1998 to July 1999 we studied 117 patients with ulcer. The diagnosis of bacterial infection was based on the rapid urease test, histological study, Gram staining or culture of gastric biopsy material (from the antrum and corpus) obtained during gastroscopy. Susceptibility studies were done with the diffusion method using E-test strips. RESULTS: Helicobacter pylori infection was found in 64 patients. A total of 58 strains were grown, 40 of which were from patients who had received no previous treatment to eradicate the infection (69%), and 18 of which were from patients who had failed one or more eradication therapies (31%). In the first group, metronidazol resistance was found in 42%, clarithromycin resistance in 13%, and resistance to both in 10% of the patients. In the second group these rates were 39%, 44% and 17% respectively, and one strain was found which was also resistant to tetracyclines (2%). No strains resistant to amoxicillin were found. CONCLUSIONS: We found high rates of resistance, especially to clarithromycin, and especially in patients who had received previous eradication therapy. Empirical treatments should use effective antimicrobials and avoid regimens based on a single antibiotic. Culture of gastric biopsy samples provides information on the resistance to antimicrobials in a given setting, and this information can be used to develop the most rational treatment for the infection.

Adolescent↗
PubMed1999

[Non-steroidal anti-inflammatory drugs and cyclooxygenase-2 selectivity in gastroenterology].

The discovery of, at least, two isoforms of the enzyme cyclooxygenase, named by the numbers 1 and 2, has updated our knowledge about the NSAID. This has led investigators to reconsider what we can expect from this kind of drugs. The two isoforms share enzymatic and structural properties, although they are regulated differently, at molecular level and can be distinguished from their functions, although an overlap of roles between them do exist. The main goal of the development of highly selective inhibitors is to improve gastric tolerability. The classical NSAID inhibit preferentially the isoform 1 of the cyclooxygenase, in vitro, which appears to be dangerous, according to gastrointestinal safety profile. The new compounds with high selectivity for the isoform 2 of the cyclooxygenase could be better tolerated at gastrointestinal level. Meanwhile these compounds also could have a potential use in several diseases such as colorectal cancer and neurodegenerative processes. The potential occurrence of side effects, perhaps related with renal function, should be noted. Finally large controlled clinical trials are needed to estimate the therapeutic advantages which can be offered by the new highly selective NSAID, and the potential consequences which can result from the isoform 2 of the cyclooxygenase prolonged inhibition

Animals↗
PubMed1999

[Sump syndrome. Treatment by endoscopic biliary "rendez-vous" procedure].

Sump syndrome consists on an entity in which the distal portion of the biliary tree does not drainage by the major papilla, so food and bile are retained and infections could appear leading to cholangitis. The real incidence of the sump syndrome after side-to-side choledocoduodenostomy is unknown, but has been described less than 10%. Several procedures have been used to solve it but at present endoscopic sphincterotomy is of choice the treatment of this condition that is followed by a good outcome. When major papilla can not be negotiated, an endoscopic approach consisting in a biliary endoscopic < > procedure could be used, negotiating the biliary tree by the side-to-side choledocoduodenostomy in this case. We report a clinical case of a patient with a side-to-side choledocoduodenostomy because of choledocolithiasis who developed a sump syndome. He was treated by a biliary endoscopic < > procedure because a papillary stenosis did not allow a transpapillar access to the biliary tree.

Aged↗
PubMed1998

Endoscopic pancreatic stent drainage improves pain in chronic pancreatitis.

UNLABELLED: Pain in chronic pancreatitis is due to intraglandular neural affection and to pancreatic duct drainage obstruction with an increased intraductal pressure. To achieve pain relief, medical, surgical and endoscopic procedures have been developed. AIM: To evaluate the efficacy of pancreatic duct stenting in patients with narcotic-dependent pain due to chronic pancreatitis. PATIENTS AND METHOD: From May-1994 to May-1996, ten patients (medium age: 47.5 yr) with alcoholic chronic pancreatitis were selected for this procedure. Pancreatography showed single or multiple Wirsung strictures in all cases. Papillotomy and pancreatic duct sphincterotomy were performed before stenting. Strictures were negotiated with a 7F dilating catheter over a guide wire, and intraductal calculi were removed as well. We used 7F plastic stents with variable lengths (5-10 cm), that were exchanged when the patient presented pain recurrence. Stent survival time was defined as the patient's pain-free time. RESULTS: In 6 of the 10 patients stent placement was carried out successfully. A single distal Wirsung stricture was diagnosed in 3 patients while in the remaining 3 there were several strictures associated to ductal lithiasis in two of them. Mean time to achieve pain relief was 3 days and mean stent survival time was 166.5 days. There were no complications due to the procedure. CONCLUSIONS: When placed through the stricture, endoscopic pancreatic stent drainage is effective in achieving pain relief. It is a safe procedure with no complications in our short series.

Adult↗
PubMed1998

Endoscopic stenting in the management of malignant biliary obstruction.

UNLABELLED: A relevant percentage of patients with malignant biliary obstruction are not candidates for surgery when the diagnosis is made. Endoscopically placed biliary stents have shown their efficacy in the palliative management of these patients although they do not seem to increase their survival. We report on a retrospective analysis of 37 patients with malignant biliary obstruction treated with endoscopic biliary stents. The distal third (62%) of the main life duct was the most frequent common location for the obstruction, and pancreatic cancer was the most frequent cause of obstruction (64%). Twenty three plastic (13-7F and 10-10F) and 14 metallic stents were placed initially. Forty four percent of the plastic stents (all of them 7F, none 10F) were removed after 39 days against 30% of the metallic stents after a mean period of 60 days. Global survival was 153 days (110 in the plastic stents' group versus 195 in the metallic one, p: NS). We could only make a complete follow up in 52% of the patients. CONCLUSIONS: endoprotheses are a good palliative treatment for malignant biliary obstruction. When plastic stents are used they should have a wide calibre (10F or greater). Metallic stents result in an increase of survival time without statistical significance.

Aged↗
PubMed1997

[A retroperitoneal abscess after endoscopic sphincterotomy: a severe and infrequent complication].

We report the case of a 55-year-old female patient, previously cholecystectomized, who was admitted to the Hospital because of recurrent biliary abdominal pain, cholestasis and common bile duct enlargement by ultrasonography. 48 hours after an endoscopic sphincterotomy the patient developed abdominal pain and fever. CT scan demonstrated air and an infected liquid collection in the retroperitoneum. Although a percutaneous drainage was attempted, the persistence of the symptoms and the low drainage outflow of the infected material made surgical treatment necessary. Duodenal perforation in endoscopic sphincterotomy is an unusual but severe complication that leads to a high mortality rate if surgical treatment is not applied promptly. Sometimes retropneumoperitoneum can be satisfactory solved just with a conservative medical therapy, but if there is a suspected or confirmed infected collection surgical treatment must be applied promptly.

Abscess↗