Search

Accidental corrosive ingestion is not rare in pediatric patients in developing countries. We report a case of gastric outlet obstruction after the accidental ingestion of an acidic substance by a child who was successfully treated with endoscopic balloon dilatation.

Background: Adult-type hypolactasia (AH) is the most common form of disaccharidase deficiency in humans, with a prevalence that varies among ethnic groups. In Brazil, the few available studies suggest a high prevalence of this condition. The objective of this study was to determine the prevalence of AH in Brazilian patients at the Ribeirão Preto University Hospital, and to study its morphologic and functional expression., Methods: One hundred fifteen patients between 5 and 60 years undergoing upper gastrointestinal endoscopy were included. Mucosal biopsy specimens were obtained from the second portion of the duodenum. AH was defined by the disaccharidase activity (lactase/sucrase ratio) of the duodenal mucosa. The morphologic expression of lactase was studied by immunohistochemistry., Results: The mean age of the subjects was 28.8 +/- 14.8 years. Seventy of the 115 subjects (60.8% prevalence) had AH by enzyme activity measurements. Milk drinking was common and similar in patients with and without AH. Among the patients, 91.3% of the nonwhite and 53.2% of the white individuals had hypolactasia (P = 0.002). Immunohistochemistry revealed the presence of lactase in 73.3% of individuals with normal lactase activity. Two different expression patterns were found in patients with AH., Conclusions: The prevalence of AH was high in our subjects and similar to that reported in other Brazilian studies. Hypolactasia was more common among nonwhites. Immunohistochemistry permitted the identification of two phenotypes of AH, the first characterized by the absence of both stainable lactase and lactase activity, and the second by the presence of stainable lactase without significant activity.

Background: Celiac disease (CD) is a permanent gluten intolerance disorder characterized by malabsorption, intestinal mucosa villus atrophy, and crypt hyperplasia. Clinical and histologic features improve in persons consuming a gluten free diet. The pathogenesis of CD involves environmental, genetic, and immunologic factors., Methods: The frequencies of human leukocyte antigen (HLA) class II alleles were evaluated in white Brazilian patients who had CD and compared with those observed in healthy individuals from the same geographical area (Ribeirão Preto, São Paulo) and of similar ethnic background. Twenty-five patients with CD, 11 females and 14 males, and 91 control individuals were studied. The HLA class II alleles were typed using amplified DNA hybridized with sequence-specific primers. Statistical analysis was performed using the two-tailed Fisher exact test. The relative risk (RR), etiologic fraction (EF), and preventive fraction (PF) were also estimated. The EF represents the attributable risk for the development of CD at the population level, whereas PF represents the protective risk., Results: The frequency of the HLA-DRB1*03, HLA-DRB1*07, and HLA-DQB1*02 alleles was significantly increased in patients. The RR conferred by these alleles was 5.35, 7.15, and 10.6, respectively, and the EF was 48.7%, 44.7%, and 76%, respectively. The frequency of HLA-DQB1*06 alleles was significantly decreased in CD patients, conferring an RR of 0.08 and a PF of 48%., Conclusions: The results show that HLA-DRB1*03, HLA-DRB1*07, and HLA-DQB1*02 alleles conferred susceptibility to CD in Brazilian patients. In contrast, HLADQB1*06 alleles conferred protection against development of the disease.