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Resumen: La infección por Clostridium difficile (ICD) en las últimas décadas se ha convertido en un problema de salud mundial. Nuestro país no es la excepción, y por ello la Asociación Mexicana de Gastroenterología reunió a un grupo multidisciplinario (gastroenterólogos, endoscopistas, internistas, infectólogos y microbiólogos), para que realizaran el «Consenso sobre prevención, diagnóstico y tratamiento de la infección por Clostridium difficile» y se establecieran recomendaciones (dirigidas a población adulta) de utilidad para la comunidad médica.Las recomendaciones emitidas se presentan en este documento. Se reconoce que la ICD debe sospecharse en sujetos con diarrea con antecedente de uso de antibióticos y/o inmunosupresión, pero que también puede adquirirse en la comunidad. Se propone seguir un algoritmo de dos pasos para el diagnóstico, utilizando una primera prueba de alta sensibilidad como la glutamato deshidrogenasa (GDH) y, en caso de resultado positivo, se debe confirmar mediante detección de toxinas por técnica de inmunoensayo o con pruebas de detección de ácidos nucleicos. Se recomienda categorizar la ICD con base en la evaluación clínica en leve-moderada, grave o grave complicada, ya que esto permite una mejor decisión terapéutica. En la ICD leve-moderada la vancomicina oral es el medicamento de elección, y se recomienda usar metronidazol como tratamiento alternativo. El trasplante de microbiota fecal se reconoce como una opción eficaz ante las recurrencias o los casos más graves, y la cirugía debe reservarse a pacientes con colitis grave (megacolon tóxico) que han fallado a todo tratamiento médico. Abstract: In recent decades, Clostridium difficile infection (CDI) has become a worldwide health problem. Mexico is no exception, and therefore the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, endoscopists, internists, infectious disease specialists, and microbiologists) to carry out the “Consensus on the prevention, diagnosis, and treatment of Clostridium difficile infection”, establishing useful recommendations (in relation to the adult population) for the medical community.Said recommendations are presented herein. Among them, it was recognized that CDI should be suspected in subjects with diarrhea that have a history of antibiotic and/or immunosuppressant use, but that it can also be a community-acquired infection. A 2-step diagnostic algorithm was proposed, in which a highly sensitive test, such as glutamate dehydrogenase (GDH), is first utilized, and if positive, confirmed by the detection of toxins through immunoassay or nucleic acid detection tests. Another recommendation was that CDI based on clinical evaluation be categorized as mild-moderate, severe, and complicated severe, given that such a classification enables better therapeutic decisions to be made. In mild-moderate CDI, oral vancomycin is the medication of choice, and metronidazole is recommended as an alternative treatment. In addition, fecal microbiota transplantation was recognized as an efficacious option in patients with recurrence or in the more severe cases of infection, and surgery should be reserved for patients with severe colitis (toxic megacolon), in whom all medical treatment has failed. Palabras clave: Clostridium difficile, México, Diarrea, Hospitalario, Infección, Disbiosis, Keywords: Clostridium difficile, Mexico, Diarrhea, In-hospital, Infection, Dysbiosis

Introduction and aims: An association between long-term use of proton pump inhibitors and the development of gastric neuroendocrine tumors has been reported, but it is still a subject of debate. The aims of the present study were to determine the presence of this association in a Mexican population and to identify the risk factors for developing gastric neuroendocrine tumors. Materials and methods: A case-control study was conducted, in which the cases were patients with a histopathologic diagnosis of gastric neuroendocrine tumor and the controls were patients evaluated through upper endoscopy. The controls were paired by age, sex, and endoscopic examination indication. Proton pump inhibitor use was considered prolonged when consumption was longer than 5 years. Results: Thirty-three patients with gastric neuroendocrine tumor and 66 controls were included in the study. Eighteen (54.5%) patients in the case group were women, as were 39 (59%) of the patients in the control group. The median age of the patients in the case group was 55 years (minimum-maximum range: 24-82) and it was 54 years (minimum-maximum range:18-85) in the control group. A greater number of patients in the gastric neuroendocrine tumor group presented with gastric atrophy (p

Resumen: Introducción y objetivo: Se ha reportado una asociación entre el uso prolongado de inhibidores de la bomba de protones (IBP) y el desarrollo de tumores neuroendocrinos gástricos (TNE-G), la cual aún es controversial. El objetivo fue determinar esta asociación en nuestra población e identificar los factores de riesgo para el desarrollo de los TNE-G. Material y métodos: Estudio de casos y controles, se incluyeron pacientes con diagnóstico histopatológico de TNE-G, los controles fueron pacientes evaluados con endoscopia superior pareados por edad, sexo e indicación del estudio endoscópico. Se consideró uso prolongado de IBP cuando se utilizó por más de 5 años. Resultados: Se incluyeron en el estudio 33 pacientes con TNE-G y 66 controles. En el grupo de casos 18 (54.5%) son mujeres y en el grupo control 39 (59%). La mediana de edad es de 55 (rango mínimo-máximo: 24-82) años en el grupo de casos y 54 (rango mínimo-máximo: 18-85) años en el grupo control. En el grupo de los TNE-G se encontró una proporción mayor de pacientes con atrofia gástrica (p

Introduction Eosinophilic esophagitis (EoE) is a chronic, immune disorder mediated largely by food antigens. It shares nonspecific symptoms with gastroesophageal reflux disease (GERD). EoE is rarely reported in Mexico, perhaps due to the racial characteristics of the population or because of insufficient diagnostic suspicion. Aims Our aim was to describe a Mexican cohort with EoE and evaluate the usefulness of the clinical history and endoscopy in the EoE diagnosis, in comparison with GERD patients. Materials and methods A retrospective study was carried out on the clinical characteristics and endoscopic and histopathologic findings in patients with EoE, along with a case-control study on patients with GERD. The endoscopic images obtained were interpreted in a blind and randomized manner by 4 gastroenterologists, before and after providing them with information on the characteristic alterations of EoE. The esophageal biopsies were also blinded to 2 pathologists that evaluated their diagnostic correlation. The Fisher's exact test and Mann-Whitney U test were used in the statistical analysis. Results Fourteen patients with EoE were included in the study. Ten (71%) of them were men and the mean age of the patients was 35 years. There were more subjects with a personal history of asthma ( p = .0023) and food impaction ( p = 0.04) in the EoE group. The initial evaluation of the endoscopic findings showed 53% correct EoE interpretations and rose to 96% in the second revision (sensitivity 100%, specificity 71%, PPV 65%, NPV 100%). Conclusions Mexican patients with EoE have similar characteristics to those of patients in western case series. Clinical awareness of the disorder increases endoscopic diagnosis in up to 40% of cases.

ResumenIntroducciónLa esofagitis eosinofílica (EEo) es un padecimiento crónico e inmunológico mediado por antígenos habitualmente alimentarios. Comparte síntomas inespecíficos con la enfermedad por reflujo gastroesofágico (ERGE). En México es rara vez reportada, tal vez por las características raciales de la población o por una sospecha diagnóstica insuficiente.ObjetivosDescribir una cohorte mexicana con EEo. Evaluar la utilidad de la historia clínica y de la endoscopia para diagnosticar EEo al compararla con ERGE.Material y métodosEstudio retrospectivo de las características clínicas, hallazgos por endoscopia e histopatología de pacientes con EEo. Se realizó además un estudio de casos y controles con ERGE. Las imágenes obtenidas por endoscopia fueron interpretadas de forma ciega y aleatorizada por 4 gastroenterólogos, antes y después de otorgarles información sobre las alteraciones características de la EEo. Las biopsias esofágicas también fueron cegadas a 2 patólogos para evaluar su correlación diagnóstica. El análisis estadístico fue elaborado por pruebas exacta de Fisher y U de Mann-Whitney.ResultadosSe incluyeron 14 pacientes con EEo, 10 (71%) del sexo masculino de 35 años en promedio. En el grupo de EEo hubo más sujetos con historia personal de asma (p=0.0023) e impactación alimentaria (p=0.04). La evaluación inicial de los hallazgos endoscópicos mostró el 53% de interpretaciones acertadas para EEo incrementando al 96% en la segunda revisión (sensibilidad 100%, especificidad 71%, VPP 65%, VPN 100%).ConclusionesLos pacientes con EEo en México tienen características similares a los de series occidentales. La sospecha clínica incrementa el diagnóstico por endoscopia hasta en un 40% cuando se mejora el conocimiento acerca de la enfermedad.AbstractIntroductionEosinophilic esophagitis (EoE) is a chronic, immune disorder mediated largely by food antigens. It shares nonspecific symptoms with gastroesophageal reflux disease (GERD). EoE is rarely reported in Mexico, perhaps due to the racial characteristics of the population or because of insufficient diagnostic suspicion.AimsOur aim was to describe a Mexican cohort with EoE and evaluate the usefulness of the clinical history and endoscopy in the EoE diagnosis, in comparison with GERD patients.Materials and methodsA retrospective study was carried out on the clinical characteristics and endoscopic and histopathologic findings in patients with EoE, along with a case-control study on patients with GERD. The endoscopic images obtained were interpreted in a blind and randomized manner by 4 gastroenterologists, before and after providing them with information on the characteristic alterations of EoE. The esophageal biopsies were also blinded to 2 pathologists that evaluated their diagnostic correlation. The Fisher's exact test and Mann-Whitney U test were used in the statistical analysis.ResultsFourteen patients with EoE were included in the study. Ten (71%) of them were men and the mean age of the patients was 35 years. There were more subjects with a personal history of asthma (p=.0023) and food impaction (p=0.04) in the EoE group. The initial evaluation of the endoscopic findings showed 53% correct EoE interpretations and rose to 96% in the second revision (sensitivity 100%, specificity 71%, PPV 65%, NPV 100%).ConclusionsMexican patients with EoE have similar characteristics to those of patients in western case series. Clinical awareness of the disorder increases endoscopic diagnosis in up to 40% of cases.