Biomedical subjects

P Burdiles

Publications and source records attributed to P Burdiles.

At least 37 records · Page 2Linked to original sources

PubMed1998

'Carditis': an objective histological marker for pathologic gastroesophageal reflux disease.

In a prospective endoscopic and bioptic study, 141 control subjects and 359 patients with symptoms of gastroesophageal reflux (GER) were included to determine the prevalence of cardial epithelium inflammation or 'carditis' and to determine the prevalence of Helicobacter pylori in this area. Two biopsies at the antrum, four distal to the squamous-columnar junction and two proximal in the esophageal mucosa, were taken. Patients with gastroesophageal reflux were divided into four groups, according to the severity of endoscopic findings: patients without esophagitis, patients with erosive esophagitis, patients with short-segment and long-segment Barrett's esophagus (BE). Control subjects had normal histological findings at the cardia in 90% of cases, fundic mucosa being present twice as cardial epithelium. Carditis was present in 8% of cases and intestinal metaplasia (IM) in 2%. On the contrary, patients with GER had carditis in nearly 50% of cases. Intestinal metaplasia was present in 12% of cases with GER without esophagitis or erosive esophagitis, in 35% of cases with short-segment BE and in 65% of the cases with long-segment BE. IM at the antrum was present in only 5% of cases. Helicobacter pylori at the squamous-columnar junction was present in 13% of control subjects and in 30% of the patients with GER. It is concluded that carditis is an easy and objective marker for the presence of chronic gastroesophageal reflux and the presence of Helicobacter pylori at this region must be carefully evaluated in order to determine some pathogenic role for the development of Barrett's esophagus.

Adolescent↗

PubMed1998

Long-term results of classic antireflux surgery in 152 patients with Barrett's esophagus: clinical, radiologic, endoscopic, manometric, and acid reflux test analysis before and late after operation.

BACKGROUND: The classic surgical procedure for patients with Barrett's esophagus (BE) has been either Nissen fundoplication or posterior gastropexy with calibration of the cardia. METHODS: The purpose of our study was to determine late subjective and objective results of these classic surgical techniques in a large number of patients with BE. A total of 152 patients were included in this prospective protocol. RESULTS: There was 1 death (0.7%) after operation. The late follow-up of 100 months demonstrated a high percentage of failures among patients with noncomplicated BE (54%) and an even higher figure in patients with complicated BE (64%). In 15 patients low grade dysplasia appeared at 8 years of follow-up and an adenocarcinoma in 4 patients. Twenty-four-hour pH monitoring demonstrated a decrease in acid reflux into the esophagus, and Bilitec studies also demonstrated a decrease of duodenoesophageal reflux, but in all cases with a higher value than the normal limit. CONCLUSIONS: Classic antireflux surgery in patients with BE results in a high percentage of failures at very late follow-up because it cannot completely avoid acid and duodenal reflux into the esophagus.

Adult↗

PubMed1998

[Clinical and laboratory characteristics of patients with pathologic chronic gastroesophageal reflux].

BACKGROUND: Sixty percent of adults has typical symptoms of gastroesophageal reflux in Chile. AIM: To report the clinical and laboratory features of patients with gastroesophageal reflux. PATIENTS AND METHODS: Five hundred thirty-four patients (255 male) with gastroesophageal reflux were included in a prospective protocol that included clinical analysis, manometry and endoscopy in all patients, barium swallow in 427, scintigraphy in 195, acid reflux test in 359, 24 h pH in 175, and differential potential of gastroesophageal mucosa in 73 patients. RESULTS: There was no correlation between the severity of symptoms and the endoscopical severity. Patients with Barret esophagus were 12 years older, were male in a greater proportion and had a higher proportion of manometrically incompetent sphincters than patients with esophageal reflux but without esophagitis or with erosive esophagitis. Severity of acid reflux, measured with 24 h pH monitoring was proportional to the endoscopical damage of the mucosa. There was a close relationship between the mucosal change limit determined with differential potentials and with endoscopy. No short esophagi were found. CONCLUSIONS: Patients with symptoms of gastroesophageal reflux must be assessed using several objective measures to determine the severity of their pathological alterations.

Adult↗

PubMed1997

Prevalence of Helicobacter pylori infection in 190 control subjects and in 236 patients with gastroesophageal reflux, erosive esophagitis or Barrett's esophagus.

A prospective study was performed in 190 control subjects and in 236 patients with different degrees of endoscopic esophagitis in order to determine the prevalence of Helicobacter pylori infection at duodenal gastric and esophageal mucosa and its correlation with histological findings. All patients with pathologic gastroesophageal reflux had 24-h pH monitoring studies confirming the presence of acid reflux into the esophagus. Besides the endoscopic findings, biopsies were taken from the duodenal bulb, gastric antrum, gastric fundus and distal esophagus or at the specialized columnar epithelium in patients with Barrett's esophagus. Patients with pathological gastroesophageal reflux were divided into three groups: 55 with absence of endoscopic esophagitis (gastroesophageal reflux), 81 patients with erosive esophagitis and 100 patients with Barrett's esophagus. There was no H. pylori infection present at duodenal or esophageal mucosa or at the specialized columnar epithelium of the distal esophagus in any case. The prevalence of H. pylori infection at gastric antrum was similar in controls and in any group of patients with reflux disease (20-25% of H. pylori infection). No differences in age and sex distribution were seen. H. pylori infection at gastric fundus was very low (less than 5%). The presence of HP infections was correlated with the finding of chronic active superficial or athrophic gastritis while, in the absence of H. pylori infection, gastric mucosa was normal. In the presence of intestinal metaplasia, no H. pylori infection occurred. Based on these findings, it seems that there is no significant evidence for an important pathogenic role for H. pylori infection in the development of pathologic chronic gastroesophageal reflux, erosive esophagitis or Barrett's esophagus, and the presence of antral gastritis in patients with Barrett's esophagus is closely related to the presence of H. pylori infection, and probably not related to an increased duodenogastric reflux.

Adolescent↗

PubMed1997

A new physiologic approach for the surgical treatment of patients with Barrett's esophagus: technical considerations and results in 65 patients.

OBJECTIVE: To determine the results of a new surgical procedure for patients with Barrett's esophagus. SUMMARY BACKGROUND DATA: In addition to pathologic acid reflux into the esophagus in patients with severe gastroesophageal reflux and Barrett's esophagus, increased duodenoesophegeal reflux has been implicated. The purpose of this study was to establish the effect of a new bile diversion procedure in these patients. METHODS: Sixty-five patients with Barrett's esophagus were included in this study. A complete clinical, radiologic, endoscopic, and bioptic evaluation was performed before and after surgery. Besides esophageal manometry, 24-hour pH studies and a Bilitec test were performed. After surgery, gastric emptying of solids, gastric acid secretion, and serum gastrin were determined. All patients underwent highly selective vagotomy, antireflux procedure (posterior gastropexy with cardial calibration or fundoplication), and duodenal switch procedure, with a Roux-en-Y anastomosis 60 cm in length. RESULTS: No deaths occurred. Morbidity occurred in 14% of the patients. A significant improvement in symptoms, endoscopic findings, and radiologic evaluation was achieved. Lower esophageal sphincter pressure increased significantly (p < 0.0001), as did abdominal length and total length of the sphincter (p < 0.0001). The presence of an incompetent sphincter decreased from 87.3% to 20.9% (p < 0.0001). Three of seven patients with dysplasia showed disappearance of this dysplasia. Serum gastrin and gastric emptying of solids after surgery remained normal. Basal and peak acid output values were low. Twenty-four hour pH studies showed a mean value of 24.8% before surgery, which decreased to 4.8% after surgery (p < 0.0001). The determination of the percentage time with bilirubin in the esophagus was 23% before surgery; this decreased to 0.7% after surgery (p < 0.0001). Late results showed Visick I and II gradation in 90% of the patients and grade III and IV in 10% of the patients. CONCLUSIONS: This physiologic approach to the surgical treatment of patients with Barrett's esophagus produces a permanent decrease of acid secretion (and avoids anastomotic ulcer), decreases significantly acid reflux into the esophagus, and abolishes duodenoesophageal reflux permanently. Significant clinical improvement occurs, and dysplastic changes at Barrett's epithelium disappear in almost 50% of the patients.

Adult↗

PubMed1997

[Gastroesophageal reflux and obesity].

BACKGROUND: There is a possible relationship between gastroesophageal reflux and overweight, that has not been studied extensively. AIM: To study the association between overweight and gastroesophageal reflux in a group of patients and normal controls. SUBJECTS AND METHODS: Body mass index of 85 patients with gastroesophageal reflux and 100 patients with Barrett esophagus, was compared with that of 171 healthy controls. RESULTS: There were no differences in body mass index between healthy subjects and patients with gastroesophageal reflux. However, there was a higher proportion of overweight males and obese females with Barrett esophagus than among healthy controls. CONCLUSIONS: We did not find an association between overweight and gastroesophageal reflux, but patients with Barrett esophagus had a higher body mass index than normal controls.

Adolescent↗

PubMed1996

Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones.

OBJECTIVES: To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bacteriologic findings. METHODS: A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultaneously for aerobic and anaerobic cultures. RESULTS: Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile. CONCLUSIONS: In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.

Acute Disease↗

PubMed1996

[Subjective and objective evaluation of the results of laparoscopic antireflux surgery in patients with gastroesophageal reflux].

BACKGROUND: Laparoscopic antireflux surgery is a minimally invasive procedure that should have similar results than classical surgical treatment. AIM: To report the results of a prospective study of laparoscopic antireflux surgery in patients with gastroesophageal reflux. PATIENTS AND METHODS: Thirty two patients with gastroesophageal reflux and without Barret's esophagus, were subjected to endoscopy, manometry and measurement of intraesophageal pH before and after laparoscopic surgery. RESULTS: There were no postoperative deaths or complications. Gastroesophageal sphincter pressure and abdominal sphincter length increased from 9.1 +/- 3.9 to 13.0 +/- 3.5 mm Hg and from 8.1 +/- 6.2 to 13.5 +/- 5.4 cm after surgery (p < 0.01). There was a decrease in acid reflux in 82% of patients. CONCLUSIONS: Laparoscopic antireflux surgery reproduces exactly the results of open surgical procedures.

Adult↗

PubMed1996

[Long-term follow-up of non-operated patients with symptomatic and asymptomatic cholelithiasis].

BACKGROUND: In Chile, cholelithiasis is a serious public health problem and there are no studies about its natural history. AIM: To assess the long term evolution of patients with symptomatic and asymptomatic cholelithiasis. PATIENTS AND METHODS: Ninety two patients with cholelithiasis (57 female), aged 15 to 80 years old and that were not operated, were followed during a period of 9 to 14 years. RESULTS: Thirteen patients were initially asymptomatic. Of them, seven bad complications or symptoms during follow-up and two were operated. Among the 69 symptomatic patients, 38 (55%) were not operated during follow-up, and seventeen (25%) did not have symptoms again. Ten patients died during follow-up, four due to complications of biliary tract stones. CONCLUSIONS: The present finding suggest that the evolution of cholelithiasis in Chile is more aggressive than abroad, and an early surgical treatment is warranted.

Adolescent↗

PubMed1995

Does duodenal juice reflux into the esophagus of patients with complicated GERD? Evaluation of a fiberoptic sensor for bilirubin.

BACKGROUND: It is controversial whether duodenal juice can damage esophageal mucosa in patients with gastroesophageal reflux disease (GERD). The issue remains unresolved partly because of difficulties in detecting the presence of duodenal juice in the lower esophagus. OBJECTIVES AND METHODS: This study utilized an in vitro portable spectrophotometer with a fiberoptic probe capable of detecting bile as a marker of duodenal juice. Absorbance/concentration curves were established with known bilirubin concentrations at pH 1.4 and pH 7.7. Esophageal pH and bilirubin absorbance were monitored in vivo over a 24-hour period in 20 healthy volunteers to determine the absorbance threshold for clinical use. The study population consisted of 21 patients with GERD. Four had no mucosal injury, 5 erosive esophagitis, and 12 Barrett's esophagus. RESULTS: The correlation between absorbance and bilirubin concentration was 0.98 and 0.99 for acid and alkaline environments, but bilirubin absorbance was 35% less in an acid environment. Using an absorbance threshold of 0.14, patients with GERD taken in toto had elevated esophageal exposure to bilirubin. No difference was observed in bilirubin exposure between reflux patients without mucosal injury and controls. Highest exposure occurred in patients with Barrett's esophagus. An important observation was that esophageal bilirubin exposure frequently occurred during periods when the esophageal pH was in the normal range. CONCLUSIONS: The fiberoptic probe accurately detects esophageal bilirubin as a marker of duodenal juice. Esophageal exposure to bilirubin is uncommon in normal subjects. Patients with erosive esophagitis and Barrett's metaplasia have increased esophageal exposure to duodenal juice compared to normal subjects. Reflux of duodenal juice into the esophagus can occur when the esophageal pH is within its normal range and is undetectable by pH monitoring alone.

Adult↗

PubMed1995

[Presence of Helicobacter pylori in the duodenum, antrum, and fundus in control subjects and patients with duodenal ulcer, gastric ulcer, gastritis, or erosive duodenitis. Histological analysis of 357 subjects].

The prevalence of Helicobacter pylori infection was studied in 152 subjects with a normal upper gastrointestinal endoscopy, 125 with duodenal ulcer, 25 with gastric ulcer, 46 with erosive gastritis and 9 with erosive duodenitis. Two biopsies from duodenum, antrum and fundus were obtained from each subject during endoscopy for histological diagnosis and Helicobacter pylori search. None of the patients with normal endoscopy and 2% of patients with duodenal ulcers had Helicobacter pylori in duodenal biopsies. These last patients had a significantly higher frequency of Helicobacter pylori in the antrum (71%) than the rest of the studied groups. Five percent of subjects with normal endoscopy and 5% of those with duodenal ulcers had Helicobacter pylori in the antrum. An active gastritis was demonstrated in almost all patients with Helicobacter infection. Intestinal metaplasia occurred almost exclusively in the absence of Helicobacter pylori infection.

Adolescent↗

PubMed1994

Is Barrett's metaplasia the source of adenocarcinomas of the cardia?

OBJECTIVE: To investigate the prevalence of Barrett's esophagus in patients with adenocarcinomas located at the gastroesophageal junction. DESIGN: A case series of patients who underwent esophagogastrectomy for adenocarcinoma was retrospectively reviewed. Tumors were grouped by location as esophageal, cardiac, and subcardiac, and the prevalence of specialized intestinal metaplasia in the histological specimens was determined. SETTING: A university department of surgery that specializes in esophageal diseases. PATIENTS: One hundred patients with adenocarcinoma of the esophagus, cardia, or proximal stomach. MAIN OUTCOME: Cardiac adenocarcinomas were associated with Barrett's esophagus in 42% of the patients. RESULTS: Specialized intestinal metaplasia was identified in the histological sections from the resected specimen in 42% (13/31) of cardiac adenocarcinomas and in 79% (38/48) of esophageal adenocarcinomas but in only 5% (1/21) of subcardiac adenocarcinomas. The preoperative endoscopic biopsy results concurred with the final diagnosis of Barrett's esophagus in 33 of the 38 esophageal tumors, six of the 13 cardiac tumors, and the one subcardiac tumor but failed to detect specialized intestinal metaplasia in 54% (7/13) of cardiac tumors. Cardiac tumors were associated with shorter lengths of Barrett's mucosa than esophageal tumors (2.7 +/- 1.8 cm vs 7.4 +/- 3.4 cm, P < .01). The Barrett's metaplasia was dysplastic in 36 of the 38 esophageal tumors, 10 of the 13 cardiac tumors, but not in the subcardiac tumor. CONCLUSIONS: Adenocarcinomas located at the gastroesophageal junction were associated with Barrett's metaplasia in nearly one half of the patients. The length of the Barrett segment tends to be short and may be missed during endoscopy. The presence of high-grade dysplasia within Barrett's mucosa supports a barrett's origin for half of the adenocarcinomas arising at this location.

Adenocarcinoma↗

PubMed1994

Late results of primary repair and follow-up in 53 patients with injuries to the common bile duct occurring during cholecystectomy (distal perforation, tears, ligation or suture).

The late results of primary repair of accidental injuries to the common bile duct occurring during cholecystectomy were evaluated in 53 cases. These lesions occurred in 20 patients who had distal perforation produced by the Bakes dilator, in 17 cases with accidental tearing of the anterior or posterior wall of the common bile duct, and in 16 cases in whom the common bile duct was accidentally ligated or sutured. In cases of perforation, choledochostomy plus suturing of the perforation had a high operative mortality and 4 out of 6 cases developed benign stricture soon after surgery. When sphincteroplasty or choledochoduodenostomy was added, a stricture developed in only 1 out of 7 cases. In cases with accidental tears, suturing of the lesion plus choledochostomy produced very good late results. In patients with accidental ligation or suturing of the common bile duct, two different postoperative complications were seen: seven cases had biliary fistula and all developed benign stricture 2 years after surgery. In nine cases jaundice appeared 6 months after surgery, and a benign stricture developed in 7 of them. The most important "treatment" of these lesions is to prevent them from occurring during cholecystectomy by employing a meticulous surgical technique.

Cholecystectomy↗

PubMed1994

[Magnitude of acid gastroesophageal reflux measured by 24-hour esophageal pH monitoring compared to the degree of endoscopic esophagitis].

Twenty four hour esophageal pH monitoring was performed in 110 patients, placing a pH electrode 5 cm above the proximal border of the lower esophageal sphincter. This test allows to measure the total lapse in which there is an acid pH in the esophagus, the ability of the esophagus to get rid of the acid reflux and documents the relationship between esophageal pH and symptoms. Upper GI endoscopy showed a normal esophagus in 38 patients, and esophagitis grade I in 25, grade II in 11, grade III in 25 and grade IV in 11. There was a high correlation between the severity of esophagitis and the total time in which the esophagus was exposed to an acid pH. It is concluded that this test can be used as a "gold standard" for gastroesophageal reflux detection.

Adolescent↗

PubMed1993

Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer.

A prospective randomized clinical trial was performed in order to evaluate the results of three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Ninety patients with clinical and laboratory evidence of gastric retention were enrolled. After laparotomy, patients underwent either highly selective vagotomy (HSV) + gastrojejunostomy, HSV + Jaboulay gastroduodenostomy, or selective vagotomy (SV) + antrectomy. One patient died after HSV + Jaboulay gastroduodenostomy due to postoperative acute pancreatitis. There were no differences in the postoperative course of the three groups. Patients were followed for a mean of 98 months (range: 30 to 156 months). There was a significantly better result after HSV + gastrojejunostomy than after Jaboulay anastomosis (p < 0.01), but not after SV + antrectomy. Gastric acid reduction was similar in the small group of patients studied. We propose HSV + gastrojejunostomy as the treatment of choice in patients with duodenal ulcer and gastric outlet obstruction.

Adult↗

PubMed1993

[Intestinal malabsorption in patients treated with total gastrectomy].

Weight loss, chronic diarrhea and fat malabsorption are frequent after total gastrectomy. The aim of this work was to study parameters of intestinal absorption and the histology of jejunal mucosa in 26 patients subjected, at least one year ago, to total gastrectomy and without evidences of tumoral relapse. There was a mean weight loss of 9 kg (range 4 to 20) and 46% of patients had intermittent or episodical diarrhea. Hemoglobin was below 12 g/dl in 4 patients, serum albumin was below 3.5 g/dl in 3, serum carotene was below 40 micrograms/dl in 5 and serum iron was below 80 micrograms/dl in 5. Jejunal biopsies were normal and steatocrit was abnormal in all patients. Present findings suggest that fat malabsorption in these patients is intraluminal and due to an unequal mix of pancreatic and biliary secretions, as a consequence of Y en Roux transit reconstruction.

Adult↗

PubMed1993

Results of Heineke-Mikulicz type choledochoplasty in benign biliary strictures.

During a 20-year period from 1970 to 1991, a total of 30,800 patients underwent biliary tract surgery at the Department of Surgery, University of Chile Clinical Hospital. Of these, seven female adults with a mean age of 39.7 years (range 29 to 54) were considered for analysis in this study. The results of the Heineke-Mikulicz type choledochoplasty repair in patients with short localized strictures of the biliary tract were analyzed in these patients. In six cases, the repair was performed at a mean time of 20 months after cholecystectomy and accidental injury of the common bile duct; in one case it was carried out during cholecystectomy and repair of a Mirizzi type II cholecysto-hepatic fistula. This patient remained asymptomatic during a follow-up of 120 months. Of the six cases on whom choledochoplasty was performed as treatment of short strictures, five patients (83%) developed a new stricture at a mean time of 14 months after surgery; a hepatico-jejunostomy was performed in all. After this procedure, only one patient was re-operated again, and all remained asymptomatic long after surgery. We believe that this Heineke-Mikulicz type choledochoplasty, which has been recommended in short distal strictures, is not advisable as a definitive surgical repair for this kind of stricture.

Adult↗

PubMed1992

Risk factors and classification of acute suppurative cholangitis.

A prospective study was performed in 1282 patients with common bile duct stones to determine the clinical and laboratory parameters that could predict cholangitis, and the factors associated with greater severity of cholangitis. Patients were divided into two groups, with or without acute cholangitis, depending on the macroscopic appearance of bile aspirated from the common bile duct during surgery. Acute cholangitis was diagnosed when the aspirated fluid was turbid or clearly pus; the typical Charcot's triad was present in only 22 per cent of patients with acute cholangitis. Several clinical and laboratory parameters were significantly more common in these patients and, depending on their number, the probability of acute cholangitis increased significantly. The operative mortality rate was 1.2 per cent for patients without cholangitis and 11.9 per cent for patients with cholangitis. Depending on the number of factors present, patients with cholangitis were divided into three groups: mild acute cholangitis without mortality; moderate acute cholangitis with a mortality rate of 5.6 per cent; and severe acute cholangitis with a mortality rate of 27.5 per cent. The present classification allows the group of patients needing prompt endoscopic or surgical drainage to be identified.

Acute Disease↗