Publications by authors named "Lisandro Pereyra"

21 Publications

  • Page 1 of 1

PULSE-HF: A simple clinical and geriatric score to predict systolic dysfunction in the elderly without heart failure.

Curr Probl Cardiol 2021 Nov 21:101066. Epub 2021 Nov 21.

Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina; Geriatric Unit, Hospital Alemán, Buenos Aires, Argentina.

Objective: To develop a clinical score to determine preclinical predictors of systolic dysfunction in an outpatient elderly population without a diagnosis of heart failure (HF).

Patients And Methods: PULSE-HF is a cross-sectional study in elderly at-risk (coronary artery disease, diabetes or hypertension) outpatients without a diagnosis of HF. Clinical and geriatric variables were analyzed; independent predictive factors in the logistic regression analysis were included for the score calculation.

Results: Of the 722 subjects enrolled, 47 (6.5%) had a left ventricular ejection fraction (LVEF) < 50% and 15 (2.1%) a LVEF < 40%. Mean age was 76.5 years (5.18) and 445 (61.6%) were female. Multiple logistic regression analysis identified abnormal Q waves (odds ratio [OR]: 4.36; p=0.003), cardiomegaly (OR: 3.32; p < 0.001), right bundle branch block (OR: 2.84; p=0.011), cognitive dysfunction (OR: 2.14; p=0.027) and NT-proBNP (OR 5.43; p < 0.001) as independent predictors of LVEF < 50%. Two prediction scores were built, without and with NT-proBNP inclusion; the area under ROC curves were 0.70 and 0.76, respectively. As the score increased, the sensitivity decreases but increases specificity and accuracy (97.17% and 91.64% respectively in ≥ 6 points). NT-proBNP was associated with an increment in the performance (accuracy of 93.18% for score ≥ 10).

Conclusion: A simple score using clinical information might be useful to predicting asymptomatic systolic dysfunction in the elderly.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.101066DOI Listing
November 2021

Usefulness of a mobile app to improve performance of specialists in responding correctly to CRC screening and surveillance clinical scenarios.

Endosc Int Open 2021 Nov 12;9(11):E1640-E1648. Epub 2021 Nov 12.

Endoscopy Unit, Clinics Hospital, Federal University of Minas Gerais, Brasil.

The adherence to and knowledge of physicians about colorectal cancer (CRC) screening and surveillance guidelines is still suboptimal, threatening the effectiveness of CRC screening. This study assessed the usefulness of a mobile decision support system (MDSS) to improve physician ability to recommend proper timing of and intervals for CRC screening and surveillance. This was a binational, single-blinded, randomized clinical trial including gastroenterologists and colorectal surgeons from Argentina and Uruguay. The specialists were invited to respond to a questionnaire with 10 CRC screening and surveillance clinical scenarios, randomized into two groups, with and without access to a dedicated app (CaPtyVa). The main outcome measure was the proportion of physicians correctly solving at least 60 % of the clinical cases according to local guidelines. A total of 213 physicians were included. The proportion of physicians responding correctly at least 60 % of the vignettes was higher in the app group as compared to the control group (90 % versus 56 %) (relative risk [RR] 1.6 95 % confidence interval [CI] 1.34-1.91). The performance was also higher in the app group for both vignette categories: CRC screening (93 % vs 75 % RR 1.24, 95 %CI 1.01-1.40) and surveillance (85 % vs 47 % RR 1.81 95 %CI 1.46-2.22), respectively. Physicians considered the app easy to use and of great utility in daily practice. A MDSS was shown to be a useful tool that improved specialist performance in solving CRC screening and surveillance clinical scenarios. Its implementation in daily practice may facilitate the adherence of physicians to CRC screening and surveillance guidelines.
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http://dx.doi.org/10.1055/a-1544-4773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589534PMC
November 2021

Efficacy and tolerability of a low-residue diet for bowel preparation: systematic review and meta-analysis.

Surg Endosc 2021 Sep 1. Epub 2021 Sep 1.

Department of Gastroenterology and Endoscopy, German Hospital, Buenos Aires, Argentina.

Background: Colorectal cancer (CRC) contributes significantly to cancer mortality worldwide. In an effort to reduce the risk of death, detection of polyps through colonoscopy is crucial. The success of the colonoscopy depends on the diet administered the day before the test. Our aim was to evaluate the efficacy, tolerability, and adverse effects of bowel preparation when using a low-residual diet (LRD) compared to a clear-liquid diet (CLD) the day before a scheduled colonoscopy.

Methods: PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched. We included studies of patients undergoing a scheduled colonoscopy for CRC screening and surveillance or for diagnostic purposes that compared a LRD with a CLD the day before the colonoscopy. Efficacy, the primary outcome, was evaluated as the rate of adequate bowel preparation. Secondary outcomes were tolerability and adverse effects of bowel preparation.

Results: Thirteen RCTs (N = 2587) were included. Patients receiving a LRD compared to a CLD showed no difference in adequate bowel preparations (RR 1.02; 95% CI 0.99-1.05; I = 60%). However, the LRD improved patient tolerability (RR 1.17; 95% CI 1.12-1.23; I = 66%) and had fewer adverse effects (RR 0.89; 95% CI 0.84-0.94; I = 73%) compared to the CLD. Groups using a LRD with 4L of polyethylene glycol in a single dose or a LRD with < 2000 kcal < 32 g of fibres/day had better tolerability.

Conclusion: Based on these findings, our recommendation is strong in favour of a LRD for bowel preparation of patients undergoing a scheduled colonoscopy. This diet could also be useful as a preoperative colonic preparation, but this requires further research.
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http://dx.doi.org/10.1007/s00464-021-08703-8DOI Listing
September 2021

Care bundle to reduce readmission in patients with heart failure: a modified Delphi consensus panel in Argentina.

BMJ Open 2020 12 29;10(12):e040028. Epub 2020 Dec 29.

Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.

Objectives: The aim of this study was to develop consensus among Argentine cardiologists on a care bundle to reduce readmissions of patients with heart failure (HF).

Setting: Hospitals and cardiology clinics in Argentina that provide in-hospital care for patients with HF.

Participants: Twenty-four cardiology experts participated in the two online rounds and 18 (75%) of them participated in the third-round meeting.

Methods: This study used a mixed-method design; it was conducted between August 2019 and January 2020. The development of a care bundle (a set of evidence-based interventions applied to improve clinical outcomes) involved three phases: (1) a literature review to define the list of interventions to be evaluated; (2) a modified Delphi panel to select interventions for the bundle and (3) definition of the HF care bundle. Also, the process included three rounds of scoring.

Results: Twenty-six interventions were evaluated. The interventions in the final bundle covered four categories: medication, continuum of care, lifestyle habits, predischarge tests. These were: medication: beta-blockers, angiotensin receptor neprilysin inhibitors or ACE-inhibitors, furosemide and antimineralocorticoids; continuum of care: follow-up appointment, daily weight monitoring; lifestyle habits: smoking cessation counselling and low-sodium diet; predischarge tests: renal function, ionogram, blood pressure control, echocardiogram and determination of decompensating cause.

Conclusion: Following a systematic mixed-method approach, we have developed a care bundle of interventions that could decrease readmission of patients with HF. The application of this bundle could contribute to scale evidence-based interventions.
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http://dx.doi.org/10.1136/bmjopen-2020-040028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778781PMC
December 2020

Acetic acid for subtle serrated lesions of the right colon: does it facilitate diagnosis?

Endoscopy 2020 12 6;52(12):E432-E433. Epub 2020 May 6.

Endoscopy Unit, Hospital Aleman, Buenos Aires, Argentina.

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http://dx.doi.org/10.1055/a-1158-8780DOI Listing
December 2020

Prevalence of incidental clinically relevant pancreatic cysts at diagnosis based on current guidelines.

Gastroenterol Hepatol 2018 May 9;41(5):293-301. Epub 2018 Feb 9.

Av. Pueyrredón 1640, Hospital Alemán, Zip Code 1118, CABA, Buenos Aires, Argentina.

Background: Most pancreatic cysts (PCs) found incidentally by CT and MRI scans might not be clinically important according to the Fukuoka guidelines, the American Gastroenterological Association (AGA) guidelines and European guidelines.

Aims: To determine and compare the prevalence of incidental clinically important PCs (CIPCs).

Methods: Abdominal contrast-enhanced CT or MRI scans performed during a one-year period were retrospectively reviewed to identify incidental PCs. CIPCs were defined as those cysts that would be capable of triggering further evaluation with endoscopic ultrasound, immediate surveillance (within 3-6 months) and/or surgery. Prevalence was calculated as the number of patients with CIPCs per 100 subjects imaged (%).

Results: Sixty patients (mean age 70±14 years) out of 565 were found to have incidental PCs, representing a prevalence of 8.7% (95% CI 6.3-11.5) in CT scans and 27.5% (95% CI 16-41) in MRI scans. Seven patients (11.6%, 95% CI 5-22) had CIPCs based on size ≥ 30mm (n=5), size ≥ 30mm and pancreatic duct (PD) dilation (n=1) and PD dilation and presence of solid component (n=1). Based on the Fukuoka guidelines, the prevalence of CIPCs was 1.2% (95% CI 0.4-2.5) in CT scans (6/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Based on the AGA and European guidelines, the prevalence of CIPCs was 0.2% (95% CI 0.1-1) in CT scans (1/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Patients with PCs initially classified as "AGA- or European-positive" had a higher surgical probability and this decision was taken earlier in the follow-up.

Conclusions: In our cohort, the prevalence of important incidental pancreatic cysts was not negligible at around 1% according to current guidelines.
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http://dx.doi.org/10.1016/j.gastrohep.2017.12.005DOI Listing
May 2018

Anemia and iron deficiency in gastrointestinal and liver conditions.

World J Gastroenterol 2016 Sep;22(35):7908-25

Jürgen Stein, Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt am Main, Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt am Main, 60594 Frankfurt, Germany.

Iron deficiency anemia (IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.
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http://dx.doi.org/10.3748/wjg.v22.i35.7908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028806PMC
September 2016

Risk of Metachronous Advanced Neoplastic Lesions in Patients with Sporadic Sessile Serrated Adenomas Undergoing Colonoscopic Surveillance.

Am J Gastroenterol 2016 Jun 12;111(6):871-8. Epub 2016 Apr 12.

Endoscopy Unit, Hospital Alemán, Buenos Aires, Argentina.

Objectives: The risk of developing metachronous advanced neoplastic lesions (ANLs) during surveillance after resection of sessile serrated adenomas (SSAs) has not been quantified.

Methods: Patients with sporadic SSAs resected between 1 April 2007 and 31 December 2009 who underwent surveillance colonoscopy in our institution were prospectively evaluated. Patients with low-risk adenomas (LRAs), high-risk adenomas (HRAs), and negative index colonoscopy (NIC) during the same period were identified using the pathology database and electronic medical records, and were also included as a comparison cohort. The primary outcome was the comparison of the study groups with regard to incidence of metachronous ANLs during surveillance colonoscopy.

Results: A total of 185 patients had SSAs, of whom 75 with 101 resected polyps were finally included. The comparison cohort consisted of 564 patients: 140 LRAs (160 polyps), 87 HRAs (478 polyps), and 337 NICs. The overall mean colonoscopy follow-up was for 54.5 months (±s.d. 14). SSA patients with synchronous HRA on index colonoscopy presented a higher incidence rate of metachronous ANL (12.96 per 1,000 person-months) compared with patients with HRA (5.07 per 1,000 person-months), whereas those with synchronous LRA and without synchronous adenoma on index colonoscopy presented a low incidence rate of metachronous ANL (0 and 1.41 per 1,000 person-months, respectively) similar to LRA (1.47 per 1,000 person-months). Among patients with SSA the 3- and 5-year ANL free-cumulative probability was 64.3 and 32.1% in those with synchronous HRA, 100 and 100% in those with synchronous LRA, and 95.1 and 91.7% if no synchronous adenoma was found.

Conclusions: Among patients with resected sporadic SSAs the risk of developing metachronous ANL is influenced by the presence of synchronous HRA on index colonoscopy. Patients with SSAs and synchronous HRA on index colonoscopy require closer surveillance, whereas those with synchronous LRA and those without synchronous adenomas may be followed up in the same way as those with LRAs.
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http://dx.doi.org/10.1038/ajg.2016.120DOI Listing
June 2016

Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy?

Dig Dis Sci 2014 Dec 30;59(12):3021-6. Epub 2014 Jul 30.

Division of Gastroenterology and Endoscopy, Department of Medicine, Hospita Alemán, Pueyrredón 1640, Buenos Aires, Argentina,

Background And Aim: Proximal colorectal cancer may arise from sessile serrated adenomas (SSAs). Recognition of these lesions during colonoscopy can optimize the endoscopic approach. We aimed to identify specific endoscopic features of SSA with conventional colonoscopy.

Methods: Patients undergoing screening colonoscopies from January 2011 to September 2012, in whom colonic polyps were found, were prospectively included in our study. Polyp morphology, location, polyp pit pattern (Kudo classification), and other previously reported features of SSA were evaluated. Histological examination was conducted independently by two pathologists. Multivariate analysis was performed to identify independent predictors of SSA.

Results: A total of 272 patients were included, and 440 polyps were evaluated (1.6 polyps per patient). Thirty-four polyps (8%) were SSA, 135 (31%) hyperplastic, and 249 (56%) adenomas. The most prevalent endoscopic features of SSA were right-side location (94%), type II Kudo pit pattern (91%), mucus cap (41%), flat morphology (29%) and red-colored surface (26%). Multivariate analysis revealed that flat morphology (p = 0.002, OR = 3.81 CI 1.53-9.09), red-colored surface (p < 0.001, OR = 12.97 CI 4.43-37.69), right-side location (p < 0.001, OR = 22.21 CI 5.09-135.94) and mucus cap (p < 0.001, OR 8.77 CI 3.76-20.44) were independent predictors of SSA.

Conclusion: We were able to identify specific features of SSA during conventional colonoscopy, which may help to identify, and therefore to optimize the endoscopic approach of these lesions.
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http://dx.doi.org/10.1007/s10620-014-3295-zDOI Listing
December 2014

[Colorectal cancer screening with colonoscopy].

Medicina (B Aires) 2013 ;73(6):567-72

Servicio de Gastroenterología y Endoscopia, Hospital Alemán, Buenos Aires. E-mail:

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.
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July 2014

Colonic preparation before colonoscopy in constipated and non-constipated patients: a randomized study.

World J Gastroenterol 2013 Aug;19(31):5103-10

Department of Endoscopy, Hospital Alemán, 1118 Buenos Aires, Argentina.

Aim: To compare the efficacy of different doses of sodium phosphate (NaP) and polyethylenglicol (PEG) alone or with bisacodyl for colonic cleansing in constipated and non-constipated patients.

Methods: Three hundred and forty-nine patients, older than 18 years old, with low risk for renal damage and who were scheduled for outpatient colonoscopy were randomized to receive one of the following preparations (prep): 90 mL of NaP (prep 1); 45 mL of NaP + 20 mg of bisacodyl (prep 2); 4 L of PEG (prep 3) or 2 L of PEG + 20 mg of bisacodyl (prep 4). Randomization was stratified by constipation. Patients, endoscopists, endoscopists' assistants and data analysts were blinded. A blinding challenge was performed to endoscopist in order to reassure blinding. The primary outcome was the efficacy of colonic cleansing using a previous reported scale. Secondary outcomes were tolerability, compliance, side effects, endoscopist perception about the necessity to repeat the study due to an inadequate colonic preparation and patient overall perceptions.

Results: Information about the primary outcome was obtained from 324 patients (93%). There were no significant differences regarding the preparation quality among different groups in the overall analysis. Compliance was higher in the NaP preparations being even higher in half-dose with bisacodyl: 94% (prep 1), 100% (prep 2), 81% (prep 3) and 87% (prep 4) (2 vs 1, 3 and 4, P < 0.01; 1 vs 3, 4, P < 0.05). The combination of bisacodyl with NaP was associated with insomnia (P = 0.04). In non-constipated patients the preparation quality was also similar between different groups, but endoscopist appraisal about the need to repeat the study was more frequent in the half-dose PEG plus bisacodyl than in whole dose NaP preparation: 11% (prep 4) vs 2% (prep 1) (P < 0.05). Compliance in this group was also higher with the NaP preparations: 95% (prep 1), 100% (prep 2) vs 80% (prep 3) (P < 0.05). Bisacodyl was associated with abdominal pain: 13% (prep 1), 31% (prep 2), 21% (prep 3) and 29% (prep 4), (2, 4 vs 1, 2, P < 0.05). In constipated patients the combination of NaP plus bisacodyl presented higher rates of satisfactory colonic cleansing than whole those PEG: 95% (prep 2) vs 66% (prep 3) (P = 0.03). Preparations containing bisacodyl were not associated with adverse effects in constipated patients.

Conclusion: In non-constipated patients, compliance is higher with NaP preparations, and bisacodyl is related to adverse effects. In constipated patients NaP plus bisacodyl is the most effective preparation.
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http://dx.doi.org/10.3748/wjg.v19.i31.5103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746382PMC
August 2013

Risk of colorectal neoplasia in patients with celiac disease: a multicenter study.

J Crohns Colitis 2013 Dec 9;7(12):e672-7. Epub 2013 Jul 9.

Digestive Endoscopy and Gastroenterology Services, Internal Medicine Department, Hospital Alemán, Buenos Aires, Argentina. Electronic address:

Background And Aims: The association of celiac disease with colorectal neoplasia is controversial. The aim of this study was to determine the risk of colorectal neoplasia among patients with celiac disease.

Methods: We carried out a multicenter, retrospective case-control study, within four community hospitals. Celiac disease patients with a complete colonoscopy were regarded as cases and those without celiac disease as controls. For each case, two controls matched for age, sex, indication for colonoscopy and colorectal cancer family history, were randomly selected. The main outcome evaluated was risk of colorectal polyps, adenomas, advanced neoplastic lesions and cancer.

Results: We identified 118 patients with celiac disease and 236 controls. The risk of polyps, adenomas and advanced neoplastic lesions was similar in both groups (OR 1.25, CI 0.71-2.18, p=0.40; OR 1.39, CI 0.73-2.63, p=0.31; and OR 1.00, CI 0.26-3.72, p=1.00, respectively). On multivariate analysis, age >75 years old, and first-grade CRC family history were associated with adenomas (OR 2.68 CI 1.03-6.98, OR 6.68 CI 1.03-47.98 respectively) and advanced neoplastic lesions (OR 15.03, CI 2.88-78.3; OR 6.46 CI 1.23-33.79, respectively). With respect to celiac disease characteristic, a low adherence to a gluten free diet was independently associated with the presence of adenomas (OR 6.78 CI 1.39-33.20 p=0.01).

Conclusions: Celiac disease was not associated with an increased risk of colorectal neoplasia. Nonadherence to a strict gluten free diet was associated with the presence of adenomas. Further studies addressing celiac disease characteristics are needed to confirm this observation.
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http://dx.doi.org/10.1016/j.crohns.2013.06.005DOI Listing
December 2013

Risk of colorectal polyps in patients with sporadic gastric polyps: A case-control study.

World J Gastrointest Endosc 2013 May;5(5):240-5

Daniel Gustavo Cimmino, José Manuel Mella, Pablo Luna, Raquel González, Lisandro Pereyra, Carolina Fischer, Adriana Mohaidle, Beatriz Vizcaino, Mario Andres Medrano, Adrián Hadad, Silvia Pedreira, Luis Boerr, Digestive Endoscopy and Gastroenterology Units, Internal Medicine Department, Hospital Alemán, Buenos Aires, CP 1118, Argentina.

Aim: To assess the risk of colonic polyps, adenomas and advanced neoplastic lesions (ANL) in patients with sporadic gastric polyps, especially those with fundic gland polyps (FGP).

Methods: Clinical records of patients who had performed an upper and a lower digestive endoscopy between September 2007 and August 2008 were retrospectively analyzed. A case-control study was carried out, calling patients with gastric polyps as "cases" and patients without gastric polyps as "controls". The risk of colonic polyps, adenomas and ANL (villous component ≥ 25%, size ≥ 10 mm, or high grade dysplasia) was assessed [odds ratio (OR) and its corresponding 95%CI].

Results: Two hundred and forty seven patients were analyzed: 78 with gastric polyps (cases) and 169 without gastric polyps (controls). Among the cases, the majority of gastric polyps were FGP (80%, CI: 69-88) and hyperplastic (20%, CI: 12-31); 25% had colonic polyps (25% hyperplastic and 68% adenomas, from which 45% were ANL). Among the controls, 20% had colonic polyps (31% hyperplastic and 63% adenomas, from which 41% were ANL). The patients with sporadic FGP had an OR of 1.56 (CI: 0.80-3.04) for colonic polyps, an OR of 1.78 (CI: 0.82-3.84) for colonic adenomas, and an OR of 0.80 (CI: 0.21-2.98) for ANL. Similar results were found in patients with gastric polyps in general.

Conclusion: The results of this study did not show more risk of colorectal adenomas or ANL neither in patients with sporadic gastric polyps nor in those with FGP.
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http://dx.doi.org/10.4253/wjge.v5.i5.240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653023PMC
May 2013

[Prevalence of serrated adenomas of the colon and association with synchronic and metachronic neoplastic lesions].

Acta Gastroenterol Latinoam 2012 Jun;42(2):92-8

Servicio de Gastroenterología y Endoscopía Digestiva, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.

Objective: To determine the prevalence of serrated adenomas (SA), the frequency of high grade dysplasia (HGD) and adenocarcinoma in these polyps, and the association with synchronic (SNL) and metachronic neoplastic lesions (MNL).

Methods: Reports from patients undergoing colonoscopy and polypectomy from January 2003 to April 2010, were obtained from our electronic database. SA were reanalyzed by two pathologists and classified on the basis of Snover's diagnostic criteria. The prevalence of these polyps and the clinical and endoscopic features were determined. SNL were defined by adenomas, cancer or advanced neoplastic lesions (ANL) (> 1 cm, HGD and/or >75% of villous component) in the same colonoscopy. MNL were identified in patients who underwent surveillance colonoscopies. An univariate and multivariate analysis was performed, looking for independent predictors of HGD/ cancer, SNL and MNL in patients with SA.

Results: The prevalence of SA was 0.87%. The mean age was 60 years old and 50.5% of patients were women. Most of the polyps were sessile (67%), small (63%) and located in ceco-ascending colon (47%). We found HGD in 4.4% ofSA and no adenocarcinoma. SNL was found in 31% ofpatients: 46% adenomas, 40.5% ANL and 13.5% adenocarcinoma. MNL was found in 29% of patients: 25% SA, 31% adenomas, 44% ANL and 0% adenocarcinoma. Age over 60 years old was significantly associated with MNL [Odds ratio 3.7 (95% confidence interval 1.16-11.8)] and polyp's size higher than 1 cm with sessile SA histology [Odds ratio 8 (95% confidence interval 1.28-49.4)].

Conclusion: The prevalence of SA was low. We found an association with neoplastic lesions. Therefore, it is important to establish specific guidelines for the management of these polyps.
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June 2012

[Celiac disease and risk of colorectal neoplasia].

Acta Gastroenterol Latinoam 2012 Jun;42(2):87-91

Servicio de Gastroenterología y Endoscopía Digestiva, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.

Background: Although small bowel and esophagus neoplasia are recognized to occur more frequently in patients with celiac disease, the association with colorectal cancer is still controversial.

Objective: To determine the risk of colorectal neoplasia among patients with celiac disease.

Methods: A case-control study was conducted using the gastroenterology and endoscopy unit electronic data base. Patients with celiac disease and colonoscopy were regarded as cases and those without celiac disease and colonoscopy as controls. Patients were matched for age, sex, colonoscopy purpose and family history of colorectal cancer. The main outcome was the risk of colorectal polyps, adenomas, advanced lesions and cancer. The risk was expressed as odds ratio (OR) with the respective 95% confidence intervals (95% CI).

Results: Out of 178 celiac disease patients, 44 were included as cases. Eighty-eight non-celiac patients were included as controls. In cases, the presence of polyps, adenomas and advanced colonic lesions was 20%, 16% and 4.5%, respectively. In controls, it was 15%, 9% and3.4%, respectively. The risk of polyps, adenomas and advanced colonic lesions was similar in both groups: OR 1.48 (95% CI 0.59-3.73), OR 1.89 (95% CI 0.66-5.42) and OR 1.34 (95% CI 0.26-7.05). No colorectal cancer was identified.

Conclusion: The risk of colorectal neoplasia within this cohort of patients with celiac disease was similar to the control population.
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June 2012

[Diffuse gastric cancer associated with Ménétrier's disease].

Acta Gastroenterol Latinoam 2011 Jun;41(2):142-5

Servicio de Gastroenterología, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.

Background: Ménétrier's disease is a rare disease of the stomach generally described as hypertrophic gastropathy. Its etiology is unknown and its malignant potential is controversial. Only a few reports supporting its association with gastric cancer have been found. We present a case of gastric cancer associated with Ménétrier's disease.

Case Report: We present a 72 year-old-male with epigastric pain and early satiety during the last 5 months. He had been treated with proton pump inhibitors with unfavorable response and began with loss of weight and asthenia. An upper digestive endoscopy showed an erythematous nodular gastric mucosa, with enlarged folds. An abdominal CT scan demonstrated a circumferential parietal thickening of the gastric wall and adenopathies. A gastric macrobiopsy done by endoscopic mucosal resection evidenced a mucin infiltrating adenocarcinoma with invasion of the lamina propria. Subtotal gastrectomy was done. The histology showed a stomach with changes compatible with Ménétrier's disease and diffuse infiltration by a highly undifferentiated adenocarcinoma (plastic linitis).

Conclusion: A patient with diffuse gastric adenocarcinoma and Ménétrier's disease is reported.
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June 2011

[Role of antibodies in celiac disease after one year of treatment to predict the adherence to gluten-free diet].

Acta Gastroenterol Latinoam 2011 Mar;41(1):23-8

Servicio de Gastroenterología, Departamento de Medicina Interna, Hospital Alemdn, Buenos Aires, Argentina.

Introduction: The celiac disease (CD) is characterized by a permanent sensitivity to gluten. The treatment for this disease is the life-long strict compliance with a gluten-free diet (GFD). The average of compliance with GFD ranges between 15% and 80%. Antibodies' role in the follow up of these patients regarding the adherence to the GFD is not well established. Objective. To determine the relationship between the antibodies for CD and the adherence to the GFD in patients with over a year of treatment.

Material And Methods: Patients with CD with a minimum of one year of GFD were prospectively included They were asked to complete a self-survey regarding to the compliance to GFD and the level of adherence was determined: low (no compliance or more than 2 gluten intakes per week), medium (1 or 2 gluten intakes per week or 2 or 3 gluten intakes per month), or high (1 gluten intake per month or less than 3 intakes per year). The follow up was performed by their general practitioners. From one year of GFD onwards, the results of the available antibodies at the time of the last follow up were assessed: antigliadine IgA (AGA) and IgG (AGG), anti-endomysium IgA (EMA) and IgG (EMG), anti-transglutaminase (ATG), and deaminated peptides of gliadine IgA and IgG, considering them as positive or negative. Through an univariate analysis, the above-mentioned antibodies were correlated (independent variables) in order to identify predicting factors of high and low adherence to the GFD (dependent variables).

Results: Ninety patients were analyzed, age 43.6 +/- 15.3 years old, 89% women, 58% classic celiacs. The average time of GFD was 7.9 years and 63% had been on a GFD for over 3 years. A 71% of patients (95% CI 69%-80%) showed high adherence to the GFD, and a 67% (95% CI 2%-13%) showed low adherence. GFD of less than 3 years was a determining factor for low adherence [relative risk (RR) 2.41 (95% CI 1.2-2.89)]. The predictive antibodies for GFD high adherence were: (1) negative EMA [RR 1.27 (95% CI 1.03-1.54)], (2) negative ATG [RR 1.62 (95% CI 1.12-2.47)], and (3) all negative requested ones [RR 1.60 (95% CI 1.17-2.18)]. The predictive antibodies for GFD low adherence were: (1) positive AGA [RR 15.5 (95% CI 2.29-105)], (2) positive EMA [RR 10.2 (95% CI 2.19-47.7)], (3) positive ATG [RR 9.63 (95% CI 1.53-63.4)], and 4) all negative requested ones [RR 0.11 (95% CI 0.018-0.71)].

Conclusion: After one year of treatment, the negativity of EMA or ATG antibodies had a significant correlation with the high adherence to GFD and the positivity of AGA, EMA or ATG antibodies had a significant correlation with a low adherence.
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March 2011

[Surveillance colonoscopy before scheduled: is it worthwhile?].

Acta Gastroenterol Latinoam 2011 Mar;41(1):17-22

Servicio de Endoscopia Digestiva, Hospital Alemán, Buenos Aires, Argentina.

Objective: To determine de incidence of colonic polyps in colonoscopies performed before scheduled and to identifY the clinical and endoscopic features that predicted this finding.

Methods: All patients who underwent at least two complete colonoscopies less than three years apart were retrospectively identified in our computerized database. We excluded patients with high risk of colonic neoplasm requiring a new colonoscopy in less than three years. We analyzed the incidence of polyps before the first and third year after the first study, and the clinical and endoscopic features related to this finding by means of multivariate logistic regression.

Results: 378 paired colonoscopies fulfilled criteria, 129 were performed less than one year apart (group 1), and 249 less than three years apart (group 2). Regarding surveillance colonoscopies, 19% of patients presented adenomas and 1.5% high grade dysplasia (HGD) in group 1, and 21% presented adenomas and 2% HGD in group 2. In group 1 fair preparation (P = 0.03), and prolonged colonoscopy (P = 0.02) on the first study were independent predictors to find any polyp on the second study before scheduled. In group 2 fair cleansing (P = 0.04), history of sessile polyps (P = 0.01) and 3 or more polyps in the first study (P = 0.01) were independent predictors to find any polyp, while more than 5 polyps in the first study predicate adenomas.

Conclusion: During the first year incident polyps related to difficult procedures (missed polyps?) while at 3 years the history of previous polyps was also important.
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March 2011

[A rare cause of lower gastrointestinal bleeding].

Acta Gastroenterol Latinoam 2011 Mar;41(1):5, 80

Servicio de Gastroenterología y Endoscopía Digestiva, Hospital Alemán, Buenos Aires, Argentina.

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March 2011

A colorectal mosaic pattern might be an endoscopic feature of collagenous colitis.

J Crohns Colitis 2010 Jun 24;4(2):139-43. Epub 2009 Oct 24.

Endoscopy Unit and Gastroenterology Unit, Hospital Alemán, Buenos Aires, Argentina.

Background And Aims: The endoscopic aspect of the colorectal mucosa in those patients with collagenous colitis is usually normal, or with non-specific changes. Until now it had never been related to a mucosal pattern of mosaic type. Our aim was to determine the diagnostic accuracy of the presence of mosaic pattern in the colorectal mucosa for collagenous colitis.

Methods: Patients who had undergone a colonoscopy with random biopsies performed in the diagnostic evaluation of chronic diarrhea between 2004 and 2008 were studied. We defined patients with chronic diarrhea and mosaic mucosal pattern as "cases", and patients with chronic diarrhea without mosaic pattern as "controls". The odds ratio (OR) of finding a collagenous colitis in view of a mosaic pattern in colon was determined; as well as sensitivity and specificity; positive and negative likelihood ratios (LR+, LR-), considering this finding as a diagnostic instrument for collagenous colitis.

Results: 252 patients who had undergone colonoscopy with biopsy due to chronic diarrhea were analyzed. In 6 patients, a mosaic pattern was identified in the colorectal mucosa. The histological diagnose of 36 of the 252 patients (14%) was microscopic colitis, 27 of which (11%) had collagenous colitis. The colonoscopy was found normal in 21 of these 27 patients; in 2 patients, congestion or petechiae was found in the rectum; and in 4 patients (15%), all women, a mosaic pattern was found in the rectosigmoid mucosa. The OR of this finding was 19.4 (CI 95% 3.9-95.4) for collagenous colitis. It had a sensitivity of 14.8% (CI 95% 6.8-20), a specificity of 99.1% (CI 95% 98.2-99.7), LR+ of 16.6 (CI 95% 3.7-76.4), and LR- of 0.86 (CI 95% 0.80-0.95) for a collagenous colitis.

Conclusion: The mosaic pattern in the colorectal mucosa of patients studied due to chronic diarrhea could be a distinguishing feature of collagenous colitis.
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http://dx.doi.org/10.1016/j.crohns.2009.09.004DOI Listing
June 2010

ACE inhibition and AT1 receptor blockade prevent fatty liver and fibrosis in obese Zucker rats.

Obesity (Silver Spring) 2008 Apr 24;16(4):770-6. Epub 2007 Jan 24.

Laboratory of Experimental Medicine, Hospital Alemán, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.

Objective: Non-alcoholic steatohepatitis (NASH), which is a common liver disease in industrialized countries, is associated with obesity, hypertension, and type-2 diabetes (metabolic syndrome). Since angiotensin II (ANG II) has been suggested to play an important role in liver inflammation and fibrosis, the purpose of this study was to investigate whether therapy against renin-angiotensin system (RAS) may provide some beneficial effect in liver of an animal model of metabolic syndrome.

Methods And Procedures: For 6 months, obese Zucker rats (OZRs) were treated as follows: OZR-group, OZR + Perindopril (P) group, OZR + Irbesartan (IRB) group, OZR + Amlodipine (AML) group, and lean Zucker rats (LZRs) group as a control. Livers were evaluated by immunohistochemistry techniques using corresponding antibodies.

Results: All treated groups showed a similar reduction in blood pressure compared to untreated OZR. Therapy either with IRB or P improves insulin sensitivity and reduces hepatic enzyme level with respect to untreated OZR. Conversely, AML failed to modify both parameters. Untreated OZR displayed higher hepatic ANG II levels and steatosis together with a marked increase in tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and transforming growth factor-beta1 (TGF-beta1) level compared to LZR. Following RAS inhibition either by P or IRB, a significant reduction (P < 0.01) in the immunostaining of TNF-alpha, IL-6 and TGF-beta1 compared to untreated OZR was observed.

Discussion: These results indicate that ANG II expression is increased in the liver of these animals with steatohepatitis. Furthermore, RAS control by either angiotensin-converting enzyme inhibition or AT1 receptor blockade seems to provide a beneficial modulation concerning the inflammatory response to liver injury in this model. Consequently, blockade of RAS could be a new approach to prevent or to treat patients with NASH.
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http://dx.doi.org/10.1038/oby.2007.114DOI Listing
April 2008
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