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Biomedical subjects

José María Remes-Troche

Publications and source records attributed to José María Remes-Troche.

14 recordsLinked to original sources
PubMed2006

Celiac disease could be a frequent disease in Mexico: prevalence of tissue transglutaminase antibody in healthy blood donors.

INTRODUCTION/AIM: In North America and Europe, the prevalence of celiac disease (CD) might be much greater than expected in previous estimates. Until recently, the prevalence of CD in Latin America remained largely unknown. So far, information regarding CD in Mexico is limited, and it is still considered a rare disease. Our aim was to determine the prevalence of tTGA in a large group of apparently healthy blood donors. SUBJECTS AND METHODS: Serum samples from 1009 consecutive blood donors, who attended a third level referral center in Mexico City, were collected between June 2004 and December 2004. Only Mexican Mestizo individuals were included. All sera were tested with a new generation human recombinant protein based tTGA-IgA ELISA commercial kit (Aeskulisa tTG-IgA, Wendelsheim, Germany). The cut-off value provided by the manufacturer was 15 U/mL. RESULTS: The mean age of the blood donors was 34+/-10 years and 68% (n=683) were men. Six hundred fifty two subjects (65%) were born in Mexico City; and from the remaining 357 subjects, at least one was born in each of the 31 different states in our country. Twenty-seven (2.7%) blood donors were positive for tTGA-IgA; all of them with tTGA-IgA values above 30 U/mL (range 36 to 1639). Overall prevalence was 1:37 [27/1009, 95% confidence interval (CI)=1.6-3.7]. The prevalence among women was 1:33 (10/326, 95% CI=1.04-5.09) and for men 1:40 (17/683, 95% CI=1.24-3.73). CONCLUSIONS: On the basis of a well-recognized serologic screening method performed to blood donor samples, we demonstrated an unexpectedly high prevalence of tTGA positivity (2.6%) in the adult Mexican Mestizo population. Thus, the prevalence of CD in Mexico could be higher or similar to that observed in other countries. This observation contributes to increase the awareness for this under diagnosed disease in clinical practice and to consider CD as a global health problem.

Adolescent↗
PubMed2005

Performance, tolerability, and symptoms related to prolonged pH monitoring using the Bravo system in Mexico.

BACKGROUND: The traditional system for esophageal 24-h pH monitoring requires transnasal introduction of the catheter with pH sensors; this technique produces discomfort, inconvenience, and interference with daily activity. Recently, a catheter-free pH monitoring system (Bravo) has been proposed as an alternative and promising method for 24-h pH. AIM: To evaluate performance, tolerability, and symptoms related to this new technology in our population. METHODS: Consecutive patients with gastroesophageal reflux disease (GERD) with indication for 24-h pH were included. pH Bravo capsule was placed 6 cm above the squamocolumnar junction using endoscopic measurement. Symptoms associated were evaluated daily in a personal diary until 7 days after the capsule attachment. Severity of symptoms was assessed by a 5-point Likert scale. Capsule detachment was assessed by chest X-ray. RESULTS: Eighty-four patients were included. Forty-nine were female (mean age 44 +/- 12 yr). Indications for pH monitoring were: nonresponse to proton pump inhibitor therapy in 38 (45%), preoperative evaluation for anti-reflux surgery in 36 (43%), previous failed transnasal 24-h pH monitoring in 6 (7%), and extra-esophageal manifestations of GERD in 4 (5%). The capsule was successfully attached in 95% of patients. At day 7, capsule detachment occurred spontaneously in all cases. Symptoms related to capsule attachment were: chest pain in 26 (33%), foreign body sensation in 11 (14%), nausea in 5 (6%), and 9 (11%) patients had more than one symptom. Severities of those symptoms were mild, and no patient required removal of the capsule. Women and younger patients had more symptoms related to the procedure (p < 0.05). CONCLUSIONS: Esophageal pH monitoring with Bravo capsule is a safe, reliable, and tolerable method in patients with GERD.

Adult↗
PubMedDate not supplied

Thymectomy in myasthenia gravis: response, complications, and associated conditions.

BACKGROUND: Thymectomy is considered the most effective treatment for achieving sustained improvement as well as remission in patients with myasthenia gravis (MG), and most neurologists favor the use of this procedure. The main focus of many current studies is to determine response-predicting factors. METHODS: Clinical records of 152 patients with an established diagnosis of MG who underwent thymectomy at our institution were reviewed. The purpose was to evaluate outcome of surgical management for MG and prognostic factors that influence that outcome. RESULTS: The majority of patients were women (119 of 152); mean age was 32.10 +/- 14.42 years, while time elapsed from diagnosis to surgery was 20.67 +/- 19.7 months. Transsternal thymectomy was performed on 113 patients and transcervical on 39. Forty percent of patients achieved remission and 28% showed improvement; with this, a good response to thymectomy was seen in 68% of patients (n = 103). The most important variables associated with remission were <60 years of age, <2 years of preoperative symptoms, and use of pyridostigmine at low doses. Factors related with poor response were >60 years of age, preoperative Osserman stage other than II, use of high doses of pyridostigmine, use of corticosteroids, and presence of thymic atrophy or thymoma in histopathologic analyses. There was no mortality, although 20 patients (13%) presented complications. CONCLUSIONS: Mexican patients with MG undergoing thymectomies show improvement and remission rates similar to those reported by other studies. Age, length of symptoms, thymic pathology, and medications appear to be predictors of response to thymectomy for MG.

Adolescent↗
PubMedDate not supplied

[Surgical treatment of lower digestive tract hemorrhage. Experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán].

BACKGROUND: Lower gastrointestinal bleeding is usually self-limiting in about 80% of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome. OBJECTIVE: To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding. MATERIAL AND METHODS: Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded. RESULTS: There were 54% women and 46% men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69%). Colonoscopy was the most used diagnostic procedure (69%). The bleeding source was located in 90% of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97% of cases. Morbidity was 23% with 18% of mortality. Recurrence occurred in 9% of survivors. CONCLUSIONS: Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.

Academies and Institutes↗
PubMedDate not supplied

[Colonic stenosis secondary to non-steroid anti-inflammatory agents as a cause of anemia and chronic diarrhea].

Gastroduodenal mucosal injury is a widely recognized side effect of non-steroidal antiinflammatory agents (NSAID). Distal small bowel and colon are additional organs of the gastrointestinal tract exposed to deleterious effects of these drugs. Inflammation and ulceration have been described as pathologic damage associated with NSAID. Strictures of colon induced by NSAID are a new entity characterized by diaphragm-like strictures. Most patients present with anemia, obstructive symptoms, diarrhea, or weight loss. Endoscopic dilation, surgical resection, symptomatic treatment, and interruption of NSAID ingestion are treatment of choice. Only 23 cases of NSAID-related, colonic, diaphragm-like strictures have been reported. Here we describe a case of concentric colonic stricture related to naproxen and clinical features of this entity are discussed.

Aged↗
PubMedDate not supplied

[Current concepts on celiac disease physiopathology].

Celiac sprue (CS) is defined as a chronic small bowel malabsorption disorder caused by ingestion of gluten, affecting those genetically predisposed individuals. It is characterized by intestinal villi atrophy, increased number of intraepithelial lymphocytes and extense inflammatory infiltrate in the intestinal lamina propria. The role of gluten as responsible for the intestinal damage seen in CS patients is clear, however, the physiopathological mechanisms involved are still unknown. Several factors and theories have been proposed: 1) Genetic predisposition, based on the association to mendelian factors as well to the presence of particular major histocompatibility complex (MHC) haplotypes in CS patients; 2) Immunological factors, that consider the derangements that occur in the immune response of CS patients, and 3) Gliadin partial deamination by the tissular transglutaminase (tTG). In an effort to explain all these complex mechanisms, recently, all these theories have been unified, yielding one complex physiopathogenic mechanism that we tray to explain in the present review.

Celiac Disease↗
PubMedDate not supplied

[Fecal incontinence in the elderly].

UNLABELLED: Fecal incontinence (FI) is a devastating condition that affects quality of life. Age and gender are related with the prevalence of FI. In adults, prevalence varies from 2% to 7%. It is more frequent in women than in men (3:1) and is more prevalent in elderly patients. There are no studies in Mexico that evaluate the frequency of FI in adults older than 60 years. AIM: To investigate the FI frequency, severity and associated factors in patients > or = 60 years. PATIENTS AND METHODS: Three groups of patients were included: a) Group I: consecutive outpatients patients from the Gastroenterology and Geriatrics Clinics of the INCMNSZ; b) Group II: INCMNSZ inpatients admitted due to a non-related condition with FI; c) Group III: Reyna Sofia nursing home residents (NHR) in Mexico City. A structured questionnaire was used to obtain demographic data, comorbidity and associated factors with FI. Grade of FI was assessed with the Wexner scale. RESULTS: 159 patients were included, 89 (56%) were women. Mean age was 75 years (range 59-98). There were 54 patients in group I, 50 in group II and 55 in group III. Overall frequency of FI was 33% (n = 53). Frequency of FI was 26% in group 1, 20% in group II and 53% in group III. Sixty six percent (n = 35) of the FI cases were female. Neuropsychiatric disorders were associated to FI in 29 patients (54%) and diabetes mellitus in 17 (32%). Eighty percent of patients wore disposable pads for FI. Urinary incontinence was associated to FI in 31 (58%). Thirteen (24%) patients had mild FI, 20 (38%) moderate, and 20 (38%) severe FI. The severity score for FI was lower in groups I and II (8.1 y 9.7) than in group III (18, p = 0.001). Age in patients with mild FI was significantly lower (73 years) than in patients with severe FI (83y, p = 0.01). CONCLUSIONS: FI in patients older than 60 years old is a very common condition. FI was more frequent and severe in women, in NHR and in those with neuropsychiatric disorders. Urinary incontinence was associated in half of patients with FI.

Age Factors↗
PubMedDate not supplied

[Diagnostic usefulness of the Carlsson-Dent questionnaire in gastroesophageal reflux disease (GERD)].

BACKGROUND: Diagnosis of GERD is based on presence of symptoms (heartburn) associated to abnormal esophageal acid exposure or esophageal erosions determined by 24-hr pH monitoring and/or endoscopy, respectively. Different instruments have been evaluated in order to diagnose GERD without invasive studies. Carlsson-Dent questionnaire (CDQ), validated among European patients, have shown good sensitivity and positive predictive values for detection of GERD. Diagnostic usefulness of the CDQ in Mexican patients is unknown. OBJECTIVE: To evaluate usefulness of CDQ among patients with erosive GERD (EG) and non-erosive GERD (NERD). PATIENTS AND METHODS: Consecutive patients with heartburn at least twice per week during the last three months and previous endoscopy were included. All patients answered a self-administered Spanish version of the CDQ, previously evaluated for its content validity and easy application. A score of > or = 4 was considered as positive for GERD. All patients underwent 24-hr pH esophageal monitoring to determine the presence of pathologic reflux (% time pH < 4, > 4.2), as well as the symptom index (SI). Questionnaire's sensitivity (S), specificity (E), positive and negative predictive values (PPV, NPV) were calculated using 24-hr pH monitoring and endoscopic oesophagitis as gold-standard tests. RESULTS: A total of 125 patients were evaluated, 81 women (65%) and 44 men (35%) with an age of 47.9 (21-83). Eighty-six patients (69%) had NERD and 39 (31%) EG. Among patients with NERD, 28 (32%) had abnormal pH study, 10 (12%) had normal pH study with positive SI (> 50%), and 48 (65%) had normal pH study with negative SI. Most common symptom was a burning feeling rising from the stomach or lower chest up towards the neck (classic definition of heartburn) in 53%, noncardiac chest pain in 14%, and nausea in 5%. In 44 patients (35%) the main discomfort occurred within 2 hours of taking food, and in 77% it worsed with larger meals and food rich in fat, as well as in 77% after taking spicy food. One hundred and seven patients (86%) scored > or = 4 on CDQ and there was no significantly difference between CDQ score among groups. CDQ's sensitivity compared to pH monitoring was 89%, and PPV 55%. When compared to endoscopic findings, sensitivity was 94% and PPV 90. There was strong and significative correlation between esophageal acid exposure and higher CDQ's scores. CONCLUSIONS: CDQ in Spanish is an useful instrument for detection of GERD, and its score correlates with the degree of esophageal acid exposure.

Adult↗
PubMedDate not supplied

[Perception of symptoms with minimal reductions of esophageal pH in patients with erosive and non-erosive GERD].

BACKGROUND: Patients with gastrointestinal reflux disease GERD perceive < 5% of acid reflux episodes, independently of GERD type. The role of minimal changes on esophageal pH (1 or 2 units) on development of symptoms is unknown. OBJECTIVE: To evaluate symptom perception and its relationship with minimal changes on esophageal pH in patients with erosive and non-erosive GERD (NERD). PATIENTS AND METHODS: We evaluated consecutive patients with symptomatic GERD. All patients had endoscopy in the previous 8 weeks. All patients underwent 24-h esophageal pH-monitoring. Abnormal pH-metry was defined as % time of pH < 4 > 4.2. Symptom index (SI) was considered positive when > or = 50. We also calculated SI at pH 5 and pH 6. Patients with GERD were classified into three groups: 1) abnormal pH and negative SI. For statistical analysis, we used the test-Student, chi 2, and ANOVA test. P < 0.05 was considered statistically significant. RESULTS: We evaluated 120 patients, 79 (66%) females and 41 (34%) males with mean age of 47.8 years (range 21-83 years). Eighty three (69%) patients had NERD and 37 (31%), erosive esophagitis (EE). Seventy two patients (87%) with NERD and 36 (97%) with erosive GERD developed symptoms during the study. NERD patients had mean of 69 reflux episodes compared with 184 of patients with EE. Perception of reflux symptoms was significantly higher in the group with EE (3.4 vs. 1.02 p < 0.0001). Among patients with NERD, 33% had abnormal pH-metry and 67%, a normal test. Of these patients, nine (16%) had normal pH test and positive SI, and 47 (83%) normal pH test and negative SI. There was no difference in symptom perception among the three groups. Patients with NERD and abnormal pH had similar SI patients with EE; 4% of patients with normal pH and negative SI at pH 4 had positive SI when calculated at pH 5, and 68% when SI was calculated at pH 6. CONCLUSIONS: The majority of acid reflux episodes are not perceived and this phenomenon is independent of erosive or non-erosive GERD. Patients with erosive esophagitis had significantly higher esophageal acid exposure than patients with NERD. Minimal changes in esophageal pH (1 or 2 pH units) increases SI in patients with GERD, especially in those with normal esophageal acid exposure.

Adult↗
PubMedDate not supplied

Hepatic adenomatosis in an Hispanic patient. A case report and review of the literature.

Liver adenomatosis (LA) is a rare disease originally defined by Flejou et al. in 1985 from a series of 13 cases. Only 57 cases have been reported in the literature, and all have been documented among Caucasian population. The aim of this study is to review and reappraise the characteristics of this rare liver disease, and to discuss the diagnosis and therapeutic options.LA is defined as the presence of >10 adenomas in an otherwise normal liver parenchyma. Neither female predominance nor a relation with estrogen/progesterone intake has been noted. Natural progression is poorly understood. We describe the clinical presentation, evolution, radiologic studies, histologic characteristics and therapeutic options in a 3rd generation Mexican woman with LA. We also include an updated review of the literature. The natural history and pathogenesis of LA are unclear. The risk of spontaneous hemorrhage or malignant transformation are a major concern. There is controversy regarding the optimal treatment for this disease; treatment options range from conservative medical therapy to surgical resection and even liver transplantation. LA is a rare disease, more common in women, and its outcome and evolution vary. Most often, conservative surgery is indicated. Liver transplantation is indicated only in highly symptomatic and aggressive forms of the disease.

Adenoma, Liver Cell↗
PubMedDate not supplied

[Recommended endoscopic surveillance of patients with Barrett's esophagus (BE) is a cost-effective strategy?].

OBJECTIVE: Evaluate the cost-effectiveness of the American College of Gastroenterology (ACG) guidelines for the surveillance of Barrett's esophagus (BE) in the context of a Mexican cohort of patients with BE and no dysplasia. BACKGROUND: For patients with BE and no dysplasia, the ACG has recommended endoscopic surveillance every three years. The cost-benefit of this strategy has been evaluated in populations with an annual incidence of esophageal adenocarcinoma (EA) of 1%-5%. METHODS: Demographic, clinical, surveillance and disease progression characteristics were analysed in patients with BE and no dysplasia seen at a terciary care center. Four surveillance strategies were considered, namely endoscopy every one, two, three and four years. Direct medical cost of endoscopy was dollar 2,950.00 Mexican pesos (dollar 256.52 USD). Total costs, cost-effectiveness ratios and marginal costs were determined assuming a cohort of 100 BE patients followed for a period of 10 years. RESULTS: A cohort of 185 BE patients was incepted, with a male:female ratio of 1.28:1, mean age of 55.14 years and mean follow-up of 7.1 years. Annual progression rate from no dysplasia to high grade dysplasia and AE was 0.30%. The lowest cost-effectiveness ratio was observed with endoscopic surveillance every five years, with a cost of dollar 202,913.86 Mexican pesos (dollar 17,644.68 USD) per high grade dysplasia and AE diagnosed. CONCLUSIONS: In Mexican patients with BE and no dysplasia, progression to high grade dysplasia and AE is lower than reported. This makes the performance of endoscopy every five years a more cost-effective surveillance strategy in our environment.

Adolescent↗
PubMedDate not supplied

[Utility of rabeprazole as a diagnostic test in non-erosive gastroesophageal reflux disease].

BACKGROUND: Proton pump inhibitor test (PPIt) has been shown adequate diagnostic usefulness and cost-effectiveness in the evaluation of patients with gastroesophageal reflux disease (GERD). However, comparative studies of PPIt with 24 hr esophageal pH-metry (24-pH) in non erosive GERD (NERD) are scarce and the utility of rabeprazole as a PPIt has not been evaluated. OBJECTIVE: To investigate the diagnostic utility of rabeprazole test in patients with NERD. MATERIAL AND METHODS: An open label trial was performed, and NERD patients with heartburn at least 3 times per week were included. Symptomatic evaluation before, during and after rabeprazole 20 mg bid for 7 days was performed. All patients underwent 24-pH before treatment with rabeprazole. Patients were classified in three groups: 1) abnormal pH, 2) normal pH and symptom index (SI) positive, and 3) normal pH and SI negative. A positive rabrepazole test was considered when symptoms improvement was higher than 50% at the end of the test. Sensitivity, specificity, negative predictive value, positive predictive value and positive likelihood ratio were calculated considering the 24-pH as gold standard. RESULTS: Sixty four patients, 47 (72%) female were studied. Forty four percent of the patients had normal pH, 29% with SI positive and 71% with SI negative. Sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio were 82%, 47%, 78%, 52% and 1.406 respectively. No adverse events were reported. CONCLUSION: PPI test with rabeprazole 20 mg bid for 7 days is a simple and useful test in the diagnostic approach of patients with NERD.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMedDate not supplied

[Constipation: Initial evaluation and diagnostic approach].

Constipation is a common gastrointestinal symptom and affects about 20% of the general population. This symptom can reflect a vast array of problems, from inadequate fiber intake to colonic dismotility function. Identifying chronic constipation subtypes on underlying physiology guides the therapeutic choices. Chronic constipation subtypes includes: slow-transit constipation, functional constipation, irritable bowel syndrome with constipation predominance and pelvic floor dysfunction. The most useful tests for the evaluation of those patients are the colonic transit time with radiopaque markers and anorrectal manometry with balloon expulsion test. Patients with both normal tests have either functional constipation or irritable bowel syndrome with constipation. Subjects with a delayed colonic transit and normal anorectal manometry maybe classified as colonic inertia. Pelvic floor dysfunction maybe suspected if the patient had an abnormal manometry with failure to expulse de balloon. Initial treatments of chronic constipation are dietary fiber and medicinal bulk. Subsequent treatments if fiber is not successful or tolerated would include saline osmotic laxatives such as lactulose and polyethylene glycol, or stimulants like senna or bisacodyl. For patients with pelvic floor dyssynergia biofeedback therapy is the first therapeutic option. In this article we present an overview of current diagnostic tools for patients with chronic constipation.

Algorithms↗