Introduction: Disconnected pancreatic duct syndrome (DPDS) is defined as the complete disruption ... more Introduction: Disconnected pancreatic duct syndrome (DPDS) is defined as the complete disruption of the main pancreatic duct, the result are peripancreatic fluid collections or pancreatic leaks. The aim of this study was to report the results of derivative endoscopic treatment of DPDS in a long-term follow-up period. Patients and Methods: We performed a retrospective analysis of prospectively collected data. Endoscopic treatment consisted of transmural drainage with 2 double pigtail plastic stents (7 F and 4 cm) deployed under endoscopic ultrasound guidance. Results: In total, 21 patients were included in our study. There were 15 (71%) men and the median age was 36 years (range, 23 to 86 y). The principal etiology of DPDS was acute pancreatitis. A total of 20 (95.2%) patients were diagnosed with DPDS by endoscopic pancreatography and only 1 (4.8%) patient by magnetic resonance cholangiopancreatography (MRCP). The median follow-up time was 28 months (range, 7 to 76 mo). Technique success was 100% and initial clinical success was 80.9% (17/21). Three (17.6%) of these patients required a new endoscopic procedure with success in all cases. During follow-up, 11 (52%) patients developed diabetes mellitus and 3 patients (14%) developed exocrine pancreatic insufficiency. There were 5 (15%) patients with complications. Conclusion: According to our data, endoscopic treatment with the placement of a permanent indwelling transmural stents is a useful and safe tool for the treatment of DPDS.
Surgical Endoscopy and Other Interventional Techniques, Jul 3, 2015
Background and aim Pancreatic pseudocysts (PPC) are a complication that occurs in acute and chron... more Background and aim Pancreatic pseudocysts (PPC) are a complication that occurs in acute and chronic pancreatitis. They comprise 75 % of cystic lesions of the pancreas. There are scarce data about surgical versus endoscopic treatment on PPC. The aim of this study was to compare both treatment modalities regarding clinical success, complication rate, recurrence, hospital stay and cost. Methods Retrospectively, data obtained prospectively from 2000 to 2012 were analyzed. A PPC was defined as a fluid collection in the pancreatic or peripancreatic area that had a well-defined wall and contained no solid debris or recognizable parenchymal necrosis. Clinical success was defined as complete resolution or a decrease in size of the PPC to 2 cm or smaller. Results Overall, 64 procedures in 61 patients were included: 21 (33 %) cases were drained endoscopically guided by EUS and 43 (67 %) cases were drained surgically. The clinical success of the endoscopic group was 90.5 versus 90.7 % for the surgical group (P = 0.7), with a complication rate of 23.8 and 25.6 %, respectively (P = 0.8), and a mortality rate of 0 and 2.3 % for each group, respectively (P = 0.4). The hospital stay was lower for the endoscopic group: 0 (0-10) days compared with 7 (2-42) days in the surgical group (P \ 0.0001). Likewise, the cost was lower in the endoscopic group (P \ 0.001). The recurrence rate was similar in both groups: 9.5 and 4.5 % respectively (P = 0.59). The two recurrences found in the endoscopic group were associated with stent migration, and the recurrence in the surgical group was due to the type of surgery performed (open drainage). Conclusion Endoscopic treatment of PPC offers the same clinical success, recurrence, complication and mortality rate as surgical treatment but with a shorter hospital stay and lower costs.
Revista de gastroenterología de México, Oct 1, 2018
Introduction and aims: A strong genetic association between celiac disease (CD) and the human leu... more Introduction and aims: A strong genetic association between celiac disease (CD) and the human leukocyte antigen (HLA) has been widely demonstrated. In Europe, the HLA-DQ2 allele is predominant. However, studies in Latin America indicate that HLA-DQ8 could be more frequent. In Mexico, the frequency of those alleles has not been reported in subjects with CD. Therefore, the aim of the present study was to evaluate the distribution of HLA-DQ2 and HLA-DQ8 in Mexican individuals with CD. Material and methods: An exploratory study was conducted on a cohort of 49 subjects with chronic diarrhea. Autoantibodies for CD, duodenal atrophy, and HLA haplotypes were determined. Results: Thirty individuals had CD (23 women, mean age 54.2 ± 15.5 years), 24 (80%) of whom expressed HLA-DQ8, 15 (50%) expressed HLA-DQ2, and 11 (37%) presented with both alleles. However, neither the HLA-DQ2 nor the HLA-DQ8 allele was found in 5 (10%) individuals. In subjects with chronic diarrhea that did not have CD, 12 (63%) presented with HLA-DQ2, and 7 (37%) with HLA-DQ8. Individuals with CD expressed the combinations of the HLA-DQ8/DQ2 alleles (37 vs. 5%) and the HLA-DR4/DQ8 alleles (60 vs. 26%) more frequently than the subjects without CD.
Revista de gastroenterología de México, Oct 1, 2018
Cómo citar este artículo: Cerda-Contreras E, et al. ¿Es posible una mejor identificación de la en... more Cómo citar este artículo: Cerda-Contreras E, et al. ¿Es posible una mejor identificación de la enfermedad celiaca en sujetos mexicanos por medio de HLA-DQ8 que de HLA-DQ2?
Revista de gastroenterología de México, Jul 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
[Deficient lactose digestion and intolerance in a group of patients with chronic nonspecific ulcerative colitis: a controlled, double-blind, cross-over clinical trial]
PubMed, Mar 28, 2012
Introduction: Despite the fact that the frequency of hypolactasia and lactose intolerance is simi... more Introduction: Despite the fact that the frequency of hypolactasia and lactose intolerance is similar in both chronic idiopathic ulcerative colitis patients and the general population, the elimination of dairy products from the patient's diet is a habitual recommendation. Hypolactasia is common in Mexico, but its relation to chronic idiopathic ulcerative colitis has not been established. Aims: To evaluate lactose digestion and lactose intolerance in persons with chronic idiopathic ulcerative colitis. Material and methods: Thirty-nine patients with confirmed chronic idiopathic ulcerative colitis diagnosis were included in the study (mean: 31 years, range: 15 to 38). Twenty-two patients presented with rectosigmoid involvement and the remaining patients with pancolitis. No patient showed inflammatory activity according to the Truelove-Witts criteria and all consumed dairy products before diagnosis. A prospective, controlled, double-blind, cross-over study was designed. Patients randomly received 12.5 g of lactose or maltose in 250 cc water- each test 72 hours apart - and ydrogen was measured in exhaled air before disaccharide ingestion and then every 30 minutes for 3 hours. Digestion was considered deficient when there was an increase in hydrogen of at least 20 ppm. Symptom intensities were evaluated by Visual Analog Scales before, during, and after the hydrogen test. Differences between the groups were contrasted with the Mann-Whitney U and the Wilcoxon tests. Results: Eighteen patients (46%) presented with deficient lactose digestion. No significant differences were found in the symptoms, extension, or progression of chronic idiopathic ulcerative colitis between patients that could digest and those that could not digest lactose. No patient had symptom exacerbation with the disaccharides used. Conclusions: Lactose digestion deficiency frequency is similar in subjects with chronic idiopathic ulcerative colitis and in healthy individuals in Mexico. We do not know whether higher doses could have some effect, but symptoms in patients with inactive chronic idiopathic ulcerative colitis were not modified using 12.5 g of lactose/day.
Pyoderma gangrenosum is one of the most severe extraintestinal manifestations in patients with ul... more Pyoderma gangrenosum is one of the most severe extraintestinal manifestations in patients with ulcerative colitis (UC) and Crohn s disease. This lesion is frequently located on the lower extremities and the torso. Peristomal pyoderma gangrenosum (PPG) is extremely rare. We report the first published patient with PPG and UC in Mexico. PPG occurred six weeks after restorative proctocolectomy. Diagnosis was performed by clinical presentation and biopsy. Ulcer resolution was achieved with oral steroids and local wound care. Patient did not show any recurrence at one year follow-up. We suggest suspecting this illness in all patients with UC who had a restorative proctocolectomy and present difficult management peristomal ulcers.
[Pancreatoduodenectomy in the treatment of carcinoma of Vater's ampulla]
PubMed, May 1, 1996
Objective: To analyze clinical characteristics, diagnostic methods, intraoperative findings, morb... more Objective: To analyze clinical characteristics, diagnostic methods, intraoperative findings, morbidity & mortality and outcome of a series of patients with ampullary adenocarcinoma. Design: Retrospective analysis. Setting: Tertiary-care medical center. Patients: Thirty four consecutive patients who underwent radical resection between 1960 and 1992. Results: The most frequent findings were jaundice (91%), weight loss (44%) and palpable gallbladder (42%). Thirty-three patients (97%) underwent Whipple resection and one total pancreatectomy (3%). The postoperative mortality was 15%. Overall survival at 1, 5, 10 and 14 years was 67, 36, 25 and 17% respectively. Fourteen patients died of tumor recurrence developed more than five years after the resection. Conclusion: Radical resection for ampullary carcinoma remains the procedure of first choice in these patients.
Tu1368 SIMILAR RATE OF POST-COVID-19 SYMPTOMS IN PATIENTS WITH CELIAC DISEASE AND NON-CELIAC POPULATION: RESULTS OF AN INTERNATIONAL CROSS-SECTIONAL STUDY
Tu1369 THE RATE OF ADVERSE EVENTS AFTER COVID-19 VACCINATION IS SIMILAR IN PATIENTS WITH CELIAC DISEASE AND NON-CELIAC POPULATION: RESULTS OF A LARGE INTERNATIONAL CROSS-SECTIONAL STUDY
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Background: In contrast to the well characterized Celiac Disease (CD), the clinical scenarios enc... more Background: In contrast to the well characterized Celiac Disease (CD), the clinical scenarios encompassed by non-celiac self-reported wheat sensitivity might be related to different antigens that trigger distinct immune-inflammatory reactions. Although an increased number of intestinal intraepithelial lymphocytes (IEL) is observed at the inception of both diseases, subsequent immunopathogenic pathways seem to be different. We aimed to describe the cytokine profile showcased by the duodenal mucosa of patients with self-reported wheat intolerance.Methods: In a blind, cross-sectional study, we included duodenal biopsies from 15 consecutive untreated patients with active CD, 9 individuals with self-reported NCSRWS and 10 subjects with dyspepsia without CD and food intolerances. Using Immunohistochemistry and flow- cytometry we determined the presence of pro-inflammatory cytokine expressing monocytes and monocyte-derived dendritic cells involved in innate immune activation, cytokine-driv...
Introduction: Disconnected pancreatic duct syndrome (DPDS) is defined as the complete disruption ... more Introduction: Disconnected pancreatic duct syndrome (DPDS) is defined as the complete disruption of the main pancreatic duct, the result are peripancreatic fluid collections or pancreatic leaks. The aim of this study was to report the results of derivative endoscopic treatment of DPDS in a long-term follow-up period. Patients and Methods: We performed a retrospective analysis of prospectively collected data. Endoscopic treatment consisted of transmural drainage with 2 double pigtail plastic stents (7 F and 4 cm) deployed under endoscopic ultrasound guidance. Results: In total, 21 patients were included in our study. There were 15 (71%) men and the median age was 36 years (range, 23 to 86 y). The principal etiology of DPDS was acute pancreatitis. A total of 20 (95.2%) patients were diagnosed with DPDS by endoscopic pancreatography and only 1 (4.8%) patient by magnetic resonance cholangiopancreatography (MRCP). The median follow-up time was 28 months (range, 7 to 76 mo). Technique success was 100% and initial clinical success was 80.9% (17/21). Three (17.6%) of these patients required a new endoscopic procedure with success in all cases. During follow-up, 11 (52%) patients developed diabetes mellitus and 3 patients (14%) developed exocrine pancreatic insufficiency. There were 5 (15%) patients with complications. Conclusion: According to our data, endoscopic treatment with the placement of a permanent indwelling transmural stents is a useful and safe tool for the treatment of DPDS.
Surgical Endoscopy and Other Interventional Techniques, Jul 3, 2015
Background and aim Pancreatic pseudocysts (PPC) are a complication that occurs in acute and chron... more Background and aim Pancreatic pseudocysts (PPC) are a complication that occurs in acute and chronic pancreatitis. They comprise 75 % of cystic lesions of the pancreas. There are scarce data about surgical versus endoscopic treatment on PPC. The aim of this study was to compare both treatment modalities regarding clinical success, complication rate, recurrence, hospital stay and cost. Methods Retrospectively, data obtained prospectively from 2000 to 2012 were analyzed. A PPC was defined as a fluid collection in the pancreatic or peripancreatic area that had a well-defined wall and contained no solid debris or recognizable parenchymal necrosis. Clinical success was defined as complete resolution or a decrease in size of the PPC to 2 cm or smaller. Results Overall, 64 procedures in 61 patients were included: 21 (33 %) cases were drained endoscopically guided by EUS and 43 (67 %) cases were drained surgically. The clinical success of the endoscopic group was 90.5 versus 90.7 % for the surgical group (P = 0.7), with a complication rate of 23.8 and 25.6 %, respectively (P = 0.8), and a mortality rate of 0 and 2.3 % for each group, respectively (P = 0.4). The hospital stay was lower for the endoscopic group: 0 (0-10) days compared with 7 (2-42) days in the surgical group (P \ 0.0001). Likewise, the cost was lower in the endoscopic group (P \ 0.001). The recurrence rate was similar in both groups: 9.5 and 4.5 % respectively (P = 0.59). The two recurrences found in the endoscopic group were associated with stent migration, and the recurrence in the surgical group was due to the type of surgery performed (open drainage). Conclusion Endoscopic treatment of PPC offers the same clinical success, recurrence, complication and mortality rate as surgical treatment but with a shorter hospital stay and lower costs.
Revista de gastroenterología de México, Oct 1, 2018
Introduction and aims: A strong genetic association between celiac disease (CD) and the human leu... more Introduction and aims: A strong genetic association between celiac disease (CD) and the human leukocyte antigen (HLA) has been widely demonstrated. In Europe, the HLA-DQ2 allele is predominant. However, studies in Latin America indicate that HLA-DQ8 could be more frequent. In Mexico, the frequency of those alleles has not been reported in subjects with CD. Therefore, the aim of the present study was to evaluate the distribution of HLA-DQ2 and HLA-DQ8 in Mexican individuals with CD. Material and methods: An exploratory study was conducted on a cohort of 49 subjects with chronic diarrhea. Autoantibodies for CD, duodenal atrophy, and HLA haplotypes were determined. Results: Thirty individuals had CD (23 women, mean age 54.2 ± 15.5 years), 24 (80%) of whom expressed HLA-DQ8, 15 (50%) expressed HLA-DQ2, and 11 (37%) presented with both alleles. However, neither the HLA-DQ2 nor the HLA-DQ8 allele was found in 5 (10%) individuals. In subjects with chronic diarrhea that did not have CD, 12 (63%) presented with HLA-DQ2, and 7 (37%) with HLA-DQ8. Individuals with CD expressed the combinations of the HLA-DQ8/DQ2 alleles (37 vs. 5%) and the HLA-DR4/DQ8 alleles (60 vs. 26%) more frequently than the subjects without CD.
Revista de gastroenterología de México, Oct 1, 2018
Cómo citar este artículo: Cerda-Contreras E, et al. ¿Es posible una mejor identificación de la en... more Cómo citar este artículo: Cerda-Contreras E, et al. ¿Es posible una mejor identificación de la enfermedad celiaca en sujetos mexicanos por medio de HLA-DQ8 que de HLA-DQ2?
Revista de gastroenterología de México, Jul 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
[Deficient lactose digestion and intolerance in a group of patients with chronic nonspecific ulcerative colitis: a controlled, double-blind, cross-over clinical trial]
PubMed, Mar 28, 2012
Introduction: Despite the fact that the frequency of hypolactasia and lactose intolerance is simi... more Introduction: Despite the fact that the frequency of hypolactasia and lactose intolerance is similar in both chronic idiopathic ulcerative colitis patients and the general population, the elimination of dairy products from the patient's diet is a habitual recommendation. Hypolactasia is common in Mexico, but its relation to chronic idiopathic ulcerative colitis has not been established. Aims: To evaluate lactose digestion and lactose intolerance in persons with chronic idiopathic ulcerative colitis. Material and methods: Thirty-nine patients with confirmed chronic idiopathic ulcerative colitis diagnosis were included in the study (mean: 31 years, range: 15 to 38). Twenty-two patients presented with rectosigmoid involvement and the remaining patients with pancolitis. No patient showed inflammatory activity according to the Truelove-Witts criteria and all consumed dairy products before diagnosis. A prospective, controlled, double-blind, cross-over study was designed. Patients randomly received 12.5 g of lactose or maltose in 250 cc water- each test 72 hours apart - and ydrogen was measured in exhaled air before disaccharide ingestion and then every 30 minutes for 3 hours. Digestion was considered deficient when there was an increase in hydrogen of at least 20 ppm. Symptom intensities were evaluated by Visual Analog Scales before, during, and after the hydrogen test. Differences between the groups were contrasted with the Mann-Whitney U and the Wilcoxon tests. Results: Eighteen patients (46%) presented with deficient lactose digestion. No significant differences were found in the symptoms, extension, or progression of chronic idiopathic ulcerative colitis between patients that could digest and those that could not digest lactose. No patient had symptom exacerbation with the disaccharides used. Conclusions: Lactose digestion deficiency frequency is similar in subjects with chronic idiopathic ulcerative colitis and in healthy individuals in Mexico. We do not know whether higher doses could have some effect, but symptoms in patients with inactive chronic idiopathic ulcerative colitis were not modified using 12.5 g of lactose/day.
Pyoderma gangrenosum is one of the most severe extraintestinal manifestations in patients with ul... more Pyoderma gangrenosum is one of the most severe extraintestinal manifestations in patients with ulcerative colitis (UC) and Crohn s disease. This lesion is frequently located on the lower extremities and the torso. Peristomal pyoderma gangrenosum (PPG) is extremely rare. We report the first published patient with PPG and UC in Mexico. PPG occurred six weeks after restorative proctocolectomy. Diagnosis was performed by clinical presentation and biopsy. Ulcer resolution was achieved with oral steroids and local wound care. Patient did not show any recurrence at one year follow-up. We suggest suspecting this illness in all patients with UC who had a restorative proctocolectomy and present difficult management peristomal ulcers.
[Pancreatoduodenectomy in the treatment of carcinoma of Vater's ampulla]
PubMed, May 1, 1996
Objective: To analyze clinical characteristics, diagnostic methods, intraoperative findings, morb... more Objective: To analyze clinical characteristics, diagnostic methods, intraoperative findings, morbidity & mortality and outcome of a series of patients with ampullary adenocarcinoma. Design: Retrospective analysis. Setting: Tertiary-care medical center. Patients: Thirty four consecutive patients who underwent radical resection between 1960 and 1992. Results: The most frequent findings were jaundice (91%), weight loss (44%) and palpable gallbladder (42%). Thirty-three patients (97%) underwent Whipple resection and one total pancreatectomy (3%). The postoperative mortality was 15%. Overall survival at 1, 5, 10 and 14 years was 67, 36, 25 and 17% respectively. Fourteen patients died of tumor recurrence developed more than five years after the resection. Conclusion: Radical resection for ampullary carcinoma remains the procedure of first choice in these patients.
Tu1368 SIMILAR RATE OF POST-COVID-19 SYMPTOMS IN PATIENTS WITH CELIAC DISEASE AND NON-CELIAC POPULATION: RESULTS OF AN INTERNATIONAL CROSS-SECTIONAL STUDY
Tu1369 THE RATE OF ADVERSE EVENTS AFTER COVID-19 VACCINATION IS SIMILAR IN PATIENTS WITH CELIAC DISEASE AND NON-CELIAC POPULATION: RESULTS OF A LARGE INTERNATIONAL CROSS-SECTIONAL STUDY
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Background: In contrast to the well characterized Celiac Disease (CD), the clinical scenarios enc... more Background: In contrast to the well characterized Celiac Disease (CD), the clinical scenarios encompassed by non-celiac self-reported wheat sensitivity might be related to different antigens that trigger distinct immune-inflammatory reactions. Although an increased number of intestinal intraepithelial lymphocytes (IEL) is observed at the inception of both diseases, subsequent immunopathogenic pathways seem to be different. We aimed to describe the cytokine profile showcased by the duodenal mucosa of patients with self-reported wheat intolerance.Methods: In a blind, cross-sectional study, we included duodenal biopsies from 15 consecutive untreated patients with active CD, 9 individuals with self-reported NCSRWS and 10 subjects with dyspepsia without CD and food intolerances. Using Immunohistochemistry and flow- cytometry we determined the presence of pro-inflammatory cytokine expressing monocytes and monocyte-derived dendritic cells involved in innate immune activation, cytokine-driv...
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