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Hepatic encephalopathy is a cerebral alteration mainly caused by hepatic insufficiency or portosystemic shunt. It ranges from minimal neurologic manifestations to coma in its overt stage. The multifactorial pathophysiology of hepatic encephalopathy has rendered numerous treatment alternatives, among which the modification of dysbiosis and hyperammonemia are currently considered to be effective, not only clinically, but also regarding cost. Recent work has developed knowledge of probiotics in different clinical settings including the relationship of the gut microenvironment to liver cirrhosis. The aim of this review was to analyze the results of clinical trials on the effect of different probiotics on hepatic encephalopathy.

Introduction Non-cardiac chest pain (NCCP) is mainly related to oesophageal disease, and in spite of being a common condition in Mexico, information regarding it is scarce. Aim To assess the clinical characteristics and health-related quality of life of patients with NCCP of presumed oesophageal origin. Material and methods Patients with NCCP of presumed oesophageal origin with no previous treatment were included in the study. Associated symptoms were assessed and upper gastrointestinal endoscopy and 24-hour oesophageal pH monitoring were performed to diagnose gastroesophageal reflux disease, while oesophageal manometry was used to determine oesophageal motility disorders. The SF-36 Health-Related Quality of Life (HR-QoL) questionnaire was completed and its results compared to a control group without oesophageal symptoms. Results The study included 33 patients, of which 61% were women, and the mean age was 46.1 (± 11.6) years. Causes of NCCP were gastroesophageal reflux disease in 48%, achalasia in 34%, and functional chest pain in 18%. The average progression time for chest pain was 24 (2-240) months, with ≤3 events/week in 52% of the patients. The most frequent accompanying symptoms were: regurgitation (81%), dysphagia (72%) and heartburn (66%). Patients with NCCP show deterioration in HR-QoL compared to the control group ( P = .01), regardless of chest pain aetiology. The most affected areas were general perception of health, emotional issues, and mental health sub-scale ( P > 0 .05). Conclusions In our population, patients with NCCP show deterioration in HR-QoL regardless of the aetiology, frequency, and accompanying symptoms.

ResumenIntroducciónEl dolor torácico no cardiaco (DTNC) se relaciona principalmente con enfermedades del esófago, y aunque se considera una condición común, en México la información aún es escasa.ObjetivoEvaluar las características clínicas y la calidad de vida relacionada con salud en pacientes con DTNC de presunto origen esofágico.Material y métodosSe incluyeron en el estudio pacientes con DTNC de presunto origen esofágico, sin tratamiento previo. Se evaluaron los síntomas asociados, se realizó endoscopia alta y monitorización de pH esofágico de 24h para establecer el diagnóstico de enfermedad por reflujo gastroesofágico, y para descartar trastornos en la motilidad esofágica se llevó a cabo manometría esofágica. Se aplicó el cuestionario de calidad de vida SF-36, y los resultados se compararon con un grupo control de sanos.ResultadosSe incluyeron 33 pacientes, el 61% mujeres, y la edad promedio fue 46.1 (±11.6) años. Las causas de DTNC fueron: enfermedad por reflujo gastroesofágico 48%, acalasia 34% y dolor torácico funcional 18%. El tiempo promedio de progresión del dolor torácico fue 24 (2-240) meses, con≤3 eventos/semana en el 52%. Los síntomas acompañantes más frecuentes fueron: regurgitaciones (81%), disfagia (72%) y pirosis (66%). Los pacientes con DTNC muestran deterioro en su calidad de vida comparado con el grupo control, independientemente de la etiología del dolor torácico. Los dominios más afectados son la percepción general de salud, problemas emocionales y la subescala de salud mental, sin diferencia estadística significativa (P > 0.05).ConclusionesEn nuestra población, los pacientes con DTNC muestran deterioro en su calidad de vida independientemente de la etiología, frecuencia y síntomas que acompañan al dolor torácico.AbstractIntroductionNon-cardiac chest pain (NCCP) is mainly related to oesophageal disease, and in spite of being a common condition in Mexico, information regarding it is scarce.AimTo assess the clinical characteristics and health-related quality of life of patients with NCCP of presumed oesophageal origin.Material and methodsPatients with NCCP of presumed oesophageal origin with no previous treatment were included in the study. Associated symptoms were assessed and upper gastrointestinal endoscopy and 24-hour oesophageal pH monitoring were performed to diagnose gastroesophageal reflux disease, whereas oesophageal manometry was used to determine oesophageal motility disorders. The SF-36 Health-Related Quality of Life (HR-QoL) questionnaire was completed and its results compared with a control group without oesophageal symptoms.ResultsThe study included 33 patients, of which 61% were women, and the mean age was 46.1 (±11.6) years. Causes of NCCP were gastroesophageal reflux disease in 48%, achalasia in 34%, and functional chest pain in 18%. The mean progression time for chest pain was 24 (2-240) months, with≤3events/week in 52% of the patients. The most frequent accompanying symptoms were: regurgitation (81%), dysphagia (72%) and heartburn (66%). Patients with NCCP showed deterioration in HR-QoL compared with the control group (P=0.01), regardless of chest pain aetiology. The most affected areas were general perception of health, emotional issues, and the mental health sub-scale (P>0.05).ConclusionsIn our population, patients with NCCP showed deterioration in HR-QoL regardless of the aetiology, frequency, and accompanying symptoms.

OBJECTIVE—The aim of this study was to describe the agreement between impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) in children with excess body weight using the original and the revised definitions of IFG. RESEARCH DESIGN AND METHODS—Obese and overweight children aged 4–17 years were included (n = 533). Anthropometric parameters and biochemical tests (fasting and 2-h glucose tests after an oral glucose load [1.75 g/kg]) were performed. Case subjects with a fasting plasma glucose ≥126 mg/dl were excluded. The diagnostic parameters of the original and the revised definitions of IFG for detecting IGT were estimated. The analysis of agreement between these categories was made using the κ test. RESULTS—The prevalence of IFG increased from 6.2 to 13.3% using the new criteria. The prevalence of IFG became closer to the prevalence of IGT (14.8%). The revised criteria increased the sensitivity from 26.6 to 36.7%. However, the new IFG definition was not useful for identifying IGT cases. Of the 71 case subjects with IFG, only 29 (40.8%) had IGT. In addition, 50 case subjects with IGT (9.4%) and 13 with diabetes (2.4%) had a fasting glycemia CONCLUSIONS—The new definition modestly increases the sensitivity of IFG for detecting IGT in children with excess body weight. Despite this, more than one-half of these cases are not detected. In addition, the false-positive rate was increased by 61%.

We undertook this study to compare the clinical outcome of stapled rectal mucosectomy (SRM) alone and in combination with sphincterotomy and cutaneous flap anoplasty and to determine the influence of factors related to complications and patient satisfaction.Patients with second- to fourth-degree hemorrhoids who underwent SRM alone or in combination with other anorectal procedures were included. Postoperative complications, symptom resolution and patient satisfaction were analyzed.Two hundred forty one patients with a minimum follow-up of 1 year were divided into three groups: SRM alone (n = 187), SRM combined with sphincterotomy (n = 31) and SRM combined with cutaneous flap anoplasty (n = 23). Patients with SRM with sphincterotomy showed a higher complication rate than the other groups (32 vs. 12.8% and 13%, respectively, p = 0.02). SRM combined with sphincterotomy was associated with a higher rate of complications (OR = 3.5; 95% CI = 1.4-8.7). SRM alone with low mucosal resection was associated with a lower complications rate (OR = 0.4, 95% CI = 0.2-0.8). Resolution of preoperative symptoms was80% among the three groups. There was no association between complications and type of procedure with satisfaction level. Resolution of symptoms80% was associated with low/intermediate level of satisfaction (p0.001).Resolution of preoperative symptoms is similar among the three groups. SRM combined with sphincterotomy has a higher risk of complications. The satisfaction level is associated with resolution of preoperative symptoms.

Steatorrhea represents the indirect sign of lipid maldigestion in chronic pancreatitis and even when the measurement of fecal fat is considered as a gold standard for the diagnosis of steatorrhea, this test is not commonly used within clinical practice because of the inconvenience related to sample collection. Although the use of breath test using mixted tryglicerides was initally validated as an indirect alternative for the assessment of exocrine pancreas reserve, only recently has used this method as a surrogate for the measurement of fat in feces.To evaluate fat digestion by means of the breath test with 13C labelled mixed triglycerides in patients with chronic pancreatitis.Patients with chronic pancreatitis underwent clinical and biochemical evaluation. The latter included serum amylase, lipase, betacarotenes; fecal fat analysis and breath test using 13C-mixed tryglicerides. Breath test results are expressed as the percentage of 13C recovered in the breath sample.Seventeen patients (age: 45 +/- 5 years) were included, of which 7 had steatorrhea (fecal fat greater than 7 g/day). In patients with steatorrhea, the percentage of recovered 13C from breath was significantly lower (6 +/- 4%) than in patients without it (25 +/- 5%).Results suggest the uselfuness of breath test with 13C-mixed tryglicerides as an alternative for the assessment of lipid digestion in patients with chronic pancreatitis.

Non-cardiac chest pain (NCCP) is defined by recurrent episodes of substernal chest pain non related to ischemic heart disease, it's origin being in many cases the gastrointestinal tract; however, it may be associated to psychosomatic disorder.To investigate the main causes of NCCP and to evaluate associated psychiatric comorbidity.Patients with NCCP referred by a cardiologist were assessed underwent an upper endoscopy, ambulatory pH monitoring and stationary esophageal manometry. NCCP was considered gastro esophageal reflux disease (GERD) positive when the endoscopy and/or ambulatory pH monitoring were abnormal. When all results were normal, the symptom was considered as a functional chest pain (FCP). Patients were assessed by the Psychiatry service and diagnosed in accordance to the Diagnostic and Statistics Manual of Mental Diseases, fourth edition (DSM-IV). Several other test were applied for the assessment of anxiety and depression.Thirty-four patients were included (25 women and nine men; average age: 46.2 +/- 11.56 years). Three patients were eliminated because of refusal of the psychiatric evaluation. In 21 (68%) patients, NCCP was GERD-positive and in 10 (32%) to FCP. The most common symptoms associated to chest pain were: heartburn in 23 (74%), regurgitation in 21 (68%) and dysphagia in 15 (48%) patients. Upper endoscopy was abnormal in four cases; ambulatory pH monitoring was abnormal in 21 (67.7%) patients. The frequency of psychiatric disorders related to NCCP was 52%, in 10 patients with GERD-positive (48%) and six patients with FCP (60%). Mayor depression was the most common diagnoses identified among both groups.The high frequency of GERD and psychiatric disorders found in NCCP supports the multidisciplinary approach to NCCP.

Cystic tumours of the spleen are generally rare, and a parasitic origin is relatively unlikely. The present case report shows, however that when a splenic cyst is found, the differential diagnosis must always consider the possibility of echinococcosis. We report the case of a patient suffering from a cystic lesion of the spleen where surgery and histopathology yielded the diagnosis of splenic echinococcosis. Abdominal pain in the left upper quadrant and splenomegaly detected by simple abdominal radiology are the most commonly found indicators for this disease. The treatment should be surgical, attempting to preserve as much splenic tissue as possible, although conservative treatment is frequently unfeasable due to massive involvement of the spleen. Although rare, splenic hydatidosis should be included in the differential diagnosis when a cystic splenic lesion is identified with sonography or CT scan.

Introduction. Extrahepatic portal vein obstruction is an important cause of portal hypertension among children. The etiology is heterogeneous and there are few evidences related to the optimal treatment. Aim and methods. To establish guidelines for the diagnosis and treatment of EHPVO in children, a group of gastroenterologists and pediatric surgery experts reviewed and analyzed data reported in the literature and issued evidence-based recommendations. Results. Pediatric EHPVO is idiopathic in most of the cases. Digestive hemorrhage and/or hypersplenism are the main symptoms. Doppler ultrasound is a non-invasive technique with a high degree of accuracy for the diagnosis. Morbidity is related to variceal bleeding, recurrent thrombosis, portal biliopathy and hypersplenism. Endoscopic therapy is effective in controlling acute variceal hemorrhage and it seems that vasoactive drug therapy can be helpful. For primary prophylaxis of variceal bleeding, there are insufficient data for the use of beta blockers or endoscopic therapy. For secondary prophylaxis, sclerotherapy or variceal band ligation is effective; there is scare evidence to recommend beta-blockers. Surgery shunt is indicated in children with variceal bleeding who fail endoscopic therapy and for symptomatic hypersplenism; spleno-renal or meso-ilio-cava shunting is the alternative when Mesorex bypass is not feasible due to anatomic problems or in centers with no experience. Conclusions. Prospective control studies are required for a better knowledge of the natural history of EHPVO, etiology identification including prothrombotic states, efficacy of beta-blockers and comparison with endoscopic therapy on primary and secondary prophylaxis.