Showing papers in "Arquivos De Gastroenterologia in 2007"

Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies

Abstract: BACKGROUND: Gastric polyps are small gastric lesions, asymptomatic in most cases and are generally discovered inadvertently during upper digestive endoscopy. AIM: To retrospectively review the characteristics and frequency of gastric polyps, derived from the gastric mucosal epithelium in a large series of endoscopies. METHODS: One hundred and fifty three patients in a series of 26,000 consecutive upper digestive endoscopies done over a 5-year period, being that each patient had only one examination were analyzed and their histological and Yamada classification, as well as their location, size, histopathological findings and treatment studied. All patients had at least one gastric polyp, as confirmed by histological examination. RESULTS: The polyps were classified as hyperplastic, adenomatous and fundic gland polyps. The most of them measure less than 1 cm (hyperplastic polyps - 60,5%; adenomatous polyps - 73,6%; fundic gland polyps - 72%). Hyperplastic polyps were the most frequent and accounted for 71.3% of the cases, whereas fundic gland polyps accounted for 16.3% and adenomatous polyps for 12.4%. Hyperplastic and adenomatous polyps were primarily single, whereas fundic gland polyps tended to be multiple. A carcinoma was detected in one hyperplastic polyp (0.9%) and in two adenomatous polyps (10.5%). High grade dysplastic foci were found in four adenomatous polyps (21%). CONCLUSIONS: The digestive endoscopy is the safest and efficient method for the diagnosis of the gastric polyps, that in most of the patients does not show characteristic symptoms. The histopathological definition is not possible to the endoscopic glance being needed the pathologist's aid, once the conduct to be adopted will depend on the result of the biopsy.

Gender effect on the clinical measurement of swallowing

Abstract: – Background - Swallowing coordination is affected by cortical and subcortical inputs from the central nervous system. Our hypothesis is that the swallowing dynamics may be influenced by gender. Aim - To evaluate the influence of gender on water swallowing dynamics. Methods - We studied 111 health subjects, 36 men, aged 24-77 years (mean: 46.3 ± 16.1 years) and 75 women, aged 22- 75 years (mean: 39.6 ± 13.3 years). All volunteers swallowed in triplicate 50 mL of water at 4oC while precisely timed, when we measured the time to swallow all the volume and counted the number of swallows. We calculated the inter-swallow interval: the time to complete the task, in seconds, divided by the number of swallows; swallowing velocity: volume drunk (mL) by the time taken (s); swallowing volume capacity: volume drunk (mL) divided by the number of swallows. Results - Women had a shorter inter-swallow interval, slower swallowing velocity and lower volume capacity than men. Conclusion - Gender has an effect on water swallowing dynamics, with women having a lower swallowing velocity and a lower volume capacity in each swallow than men.

Quantitative and qualitative analysis of collagen types in the fascia transversalis of inguinal hernia patients.

Abstract: BACKGROUND: Inguinal hernia is the second most common surgical case in our field. The anatomical factors alone are not enough to explain the inguinal hernia. Studies show changes in the proportion and quantity of collagen fibers in the developing of inguinal hernia. The greater production of collagen type III compared to the type I could justify the thinning of the fascia transversalis and its weakness. AIM: To determine the quantitative and qualitative changes of collagen in the fascia transversalis in inguinal hernia patients and compare them to findings from corpses without inguinal hernia. METHOD: Prospective case-control study based on the biopsy of fascia transversalis of 27 patients and 24 corpses. The technique used was hematoxylin-eosin and picrosirius colorimetry. RESULTS: The medium percent area of collagen (types I + III) and collagen type I, in both groups, show no statistic difference. The quantity of collagen type III was greater in the patients. Patients classified with Nyhus IIIa presented greater quantity of collagen type III. CONCLUSION: There is no significant difference in the quantity of collagen in the fascia transversalis of patients compared to the controls. An increase in the quantity of collagen type III was found in patients with inguinal hernia and a greater quantity in those patients classified with Nyhus IIIa.

Prevalence of Helicobacter pylori infection and gastric cancer precursor lesions in patients with dyspepsia

Abstract: BACKGROUND: Helicobacter pylori infection has been considered to play significant role in gastric carcinogenesis, but only a minority of people who harbor this organism will develop gastric cancer. H. pylori infection first causes chronic non atrophic gastritis. Chronic non atrophic gastritis may evolve to atrophic gastritis and intestinal metaplasia and finally to dysplasia and adenocarcinoma. AIMS: To estimate the prevalence of H. pylori infection and the precancerous gastric lesions and their relationship, in patients with dyspeptic symptoms who underwent upper gastrointestinal endoscopy at a reference center in the central region of Rio Grande do Sul state, Brazil. METHODS: We analyzed gastric biopsies taken from corpus and antrum of patients who underwent upper gastrointestinal endoscopy for H. pylori detection, between 1994 and 2003. According to Sydney system, chronic non atrophic gastritis, atrophic gastritis and intestinal metaplasia were diagnosed by histological examination (H-E stain). The histological diagnoses were related to H. pylori infection status. RESULTS: Biopsies from 2,019 patients were included in the study. Patients mean age was 52 (±15) and 59% were female. Seventy six percent had H. pylori infection. Normal mucosa, chronic non atrophic gastritis, atrophic gastritis and intestinal metaplasia were diagnosed in 5%, 77%, 3% and 15%, respectively. The OR for any degree of gastric mucosa lesion in infected patients was 10 (CI95% 6.50 - 17%). The OR for infected patients had chronic non atrophic gastritis was 3 (CI95% 2,2 - 3,4). The OR for infected patients had atrophic gastritis or intestinal metaplasia was less than 1. CONCLUSIONS: The prevalence of H. pylori infection in this population was high (76%) and infected individuals had the probability 10 folds greater than non infected individuals to have any lesion of gastric mucosa. The prevalence of precancerous lesions was 77% for non atrophic chronic gastritis, 3% for atrophic gastritis and 15% for intestinal metaplasia. Infected patients had risk 3 folds greater than non-infected for the occurrence of non atrophic chronic gastritis. H. pylori infection did not show risk for occurrence of atrophic gastritis and intestinal metaplasia, suggesting that other risk factors should be involved in the carcinogenesis process.

The presence of Helicobacter Pylori in postmenopausal women is not a factor to the decrease of bone mineral density

Abstract: BACKGROUND: Osteoporosis affects approximately 30% of postmenopausal women. Gastrectomy, pernicious anemia, and more recently Helicobacter pylori infection, have all been implicated in the pathogenesis of osteoporosis. A reduced parietal cell mass is a common feature in these conditions. AIM: To study a possible relationship between chronic gastritis, parietal cell density of the oxyntic mucosa and bone mineral density in postmenopausal women, as chronic gastritis, Helicobacter pylori infection and osteoporosis are frequently observed in the elderly. METHODS: Fifty postmenopausal women (61.7 ± 7 years) were submitted to gastroduodenal endoscopy and bone densitometry by dual energy X-ray absorptiometry. Glandular atrophy was evaluated objectively by the determination of parietal cell density. Helicobacter pylori infection was evaluated by histology, urease test and breath test with 13C. RESULTS: Thirty-two patients (64%) presented chronic multifocal gastritis, and 20 of them (40%) showed signs of gastric mucosa atrophy. Lumbar spine osteoporosis was found in 18 patients (36%). The parietal cell density in patients with and without osteoporosis was 948 ± 188 and 804 ± 203 cells/mm2, respectively. Ten osteoporotic patients (55%) and 24 non-osteoporotic patients (75%) were infected by Helicobacter pylori. CONCLUSION: Postmenopausal women with osteoporosis presented a well-preserved parietal cell density in comparison with their counterparts without osteoporosis. Helicobacter pylori infection was not different between the two groups. We concluded that neither atrophic chronic gastritis nor Helicobacter pylori seem to be a reliable risk factor to osteoporosis in postmenopausal women.

Occult hepatitis B virus infection in patients with chronic liver disease due to hepatitis C virus and hepatocellular carcinoma in Brazil.

Abstract: BACKGROUND: The prevalence and consequences of occult HBV infection in patients with chronic liver disease by HCV remain unknown. AIMS: To evaluate the prevalence of occult HBV infection in a population of HCV-infected patients with hepatocellular carcinoma. METHODS: The serum samples were tested for HBV DNA by nested PCR and liver tissue analysis was carried out using the immunohistochemical technique of 66 HBsAg-negative patients: 26 patients with chronic hepatitis by HCV (group 1), 20 with hepatocellular carcinoma related to chronic infection by HCV (group 2) and 20 with negative viral markers for hepatitis B and C (control group). RESULTS: Occult HBV infection was diagnosed in the liver tissue of 9/46 (19.5%) HCV-infected patients. Prevalence of occult B infection was evaluated in the HCV-infected patients with and without hepatocellular carcinoma, and there were seven (77.7%) of whom from group 2, conferring a 35% prevalence of this group. No serum sample was positive for HBV DNA in the three groups. CONCLUSION: Occult infection B is frequently detected in liver tissue of HCV-infected patients, especially in cases of hepatocellular carcinoma. However large studies are needed to confirm that co-infection could determine a worse progress of chronic liver disease in this population.

Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

Abstract: – Background - Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. Aims - To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. Methods - Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatographyendoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful e�tracorporeal shoc�-wave lithotripsy and electrohydraulic were also performed before laser in-wave lithotripsy and electrohydraulic were also performed before laser in and electrohydraulic were also performed before laser inelectrohydraulic were also performed before laser in were also performed before laser in �5%5% and 26% of the cases, respectively. Results -

Prevalence of HBV-genotypes in immigrants affected by HBV-related chronic active hepatitis

Abstract: BACKGROUND: The genetic heterogeneity of the HBV genome has been established and eight genotypes can be classified according to the criterion of >8% differences in the complete nucleotide sequence of the viral genome. AIMS: To evaluate the prevalence of HBV-infection in a population of immigrants and to determine in patients with detectable serum HBV-DNA the HBV-genotypes. METHODS: Between January 2005 and December 2005 a total of 556 immigrants were tested for HBsAg. In HBsAg positive patients the biochemical and virological activity of infection and the possible presence of co-infections (HCV, HDV, HIV) were evaluated. In patients with detectable serum HBV DNA, the HBV-genotype was determined by INNOLiPA. RESULTS: Among the 556 subjects tested, 60 (10.7%) resulted HBsAg positive. All were men, and 42 (70%) come from Africa, 10 (16.6%) from Asia and 9 (14.4%) from East-Europe. 28/60 (46.6%) patients presented normal ALT levels (<40 IU/L) and undetectable serum HBV DNA (<100 copies/mL in real-time PCR), while 32 (53.4%) patients had ALT levels above laboratory normal values and detectable serum HBV DNA. Genotype distribution was as follow: genotype E, 16 (50%), genotype D, 9 (28.1%), genotype A, 7 (21.9%). CONCLUSION: Our study evidences a moderate prevalence of HBV-infection in immigrants, particularly in sub-Saharan African people, and the potentiality of migratory flow in the introduction of genotype non-D hepatitis B virus, potentially characterized by a different natural history and, possibly, a different response to antiviral treatment.

Socioeconomic and nutritional profile of patients with inflammatory bowel disease at a university hospital

Abstract: BACKGROUND: Inflammatory bowel diseases include chronic and relapsing inflammatory disorders, represented by ulcerative proctocolitis and Crohn’s disease, commonly associated with malnutrition. AIM: Characterize the nutritional and socioeconomic profile of patients hospitalized at the Pernambuco "Hospital das Clinicas", Recife, PE, Brazil. METHODS:Cross-sectional study carried out at the gastroenterology clinic, which was previously approved by the Ethics Commission for studies involving human beings. The methods included clinical history data, socioeconomic conditions and nutritional assessment. Data were subject to statistical analysis (Student’s t test for equal and unequal variables). RESULTS: The sample consisted of 24 male and female patients, with a mean age of 43.83 ± 16.13 years, mostly married, coming from Recife, with low income, who lived in their own house with relatives. We found a higher prevalence of ulcerative proctocolitis (62.5%), with diagnosis time of more than 5 years, symptoms of abdominal pain, bloody-mucous diarrhea with 6-9 evacuations/day, with the distal colon being the most affected part. Osteoporosis was present in 26.7% of cases. Nutritional status was assessed through the body mass index. The weight loss percentage corresponded to 41.7% and 70.8%, respectively, classified as malnourished, associated or not with high prevalence levels of anemia, hypoalbuminemia and hypocalcemia. Gender correlation evidenced higher triceps fold and arm circumference values in men. CONCLUSIONS: Despite the study limitations, data suggest relevant information about the occurrence of these diseases in the northeast of Brazil, as well as about its frequent association with important nutritional deficiencies.

Compliance to drug therapy in inflammatory bowel diseases outpatients from a university hospital

Abstract: BACKGROUND: Compliance to drug therapy is important for a successful treatment. Although many studies have assessed compliance to treatment in patients with chronic diseases, few investigations have been carried out in inflammatory bowel diseases. AIM: To assess compliance to drug therapy in patients with inflammatory bowel diseases - Crohn's disease and ulcerative colitis -, followed at a university hospital, who had prescribed medication supplied by the Brazilian National Health System. METHODS: In a cross sectional study, a structured interview was applied to assess the compliance of 26 Crohn's disease patients, 26 ulcerative colitis patients and 4 cases with undetermined colitis. Patients were characterized as presenting higher or lower degree of compliance, based on the comparison of the information provided by the patient in the interview and data in the medical records. The Morisky test was also used to assess the behavioral pattern of the patient regarding the daily use of the medication. RESULTS: The interview showed that 15.4% of patients with Crohn's disease and 13.3% of those with ulcerative colitis could be regarded as less compliant. However, the Morisky test revealed lower compliance in 50% of patients with Crohn's disease and 63.3% of those with ulcerative colitis. Univariate analysis showed an association between low compliance and long disease duration, married status and colon involvement in Crohn's disease, and between low compliance and increased disease activity and greater number of medications in ulcerative colitis. However, multivariate analysis did not confirm any association between low compliance and any demographic or clinical factor. CONCLUSIONS: A high degree of noncompliance to treatment, linked to habitual behavior and hard to predict from demographic or clinical factor, was detected in inflammatory bowel disease patients, which suggests the need for investment in patient education regarding medication use.

CA72-4 antigen levels in serum and peritoneal washing in gastric cancer: correlation with morphological aspects of neoplasia

Abstract: BACKGROUND: Determining levels of tumor markers in peritoneal washing enables likelihood of peritoneal recurrence to be ascertained in patients with high marker levels, thereby allowing provision of more accurate adjuvant treatment and postoperative follow up. AIM: To analyze the relationship between levels of tumor marker CA72-4 in serum and peritoneal washing, and morphological aspects of gastric carcinoma. METHOD: This study analyzed 32 consecutively-operated patients with gastric carcinoma, who underwent subtotal, total or palliative gastrectomy. The variables studied were CA72-4 levels in serum and peritoneal washing, lesion site, stage, degree of cell differentiation, operation performed, and number of extirpated and involvement lymph nodes. Of the 32 patient sample, 21 (65.6%) were male and 11 (34.4%) female. Mean age was 62.6 ± 14.2 years (29 to 91 years). Following anesthetic induction, peripherical venous blood was collected through percutaneous punction of an upper limb vein. After the procedure, 50 mL of physiologic solution at 37oC was introduced into the cul-de-sac. A 10 mL volume of this liquid was aspirated from the cavity and the peritoneal washing tested for CA72-4 levels. Normal values for CA72-4 levels in serum were considered 7U/mL, whilst for the peritoneal washing normal levels were 0.61 U/mL. RESULTS: Mean pre-operative serum levels for CA72-4 were 6.55 U/mL ± 15.30 (0.3 to 75.30 U/mL) whilst the mean level of CA72-4 in peritoneal washing was 8.50 U/mL ± 26.72 (0.3 to 142.00 U/mL); correlation between these levels was significant. Lymph nodes involvement by the gastric carcinoma correlated significantly with higher CA72-4 levels in both serum and peritoneal wash. There was no statistically significant correlation between serum level of CA72-4 and invasion into serosa by the gastric carcinoma. There was however, significant correlation between peritoneal washing levels of CA72-4 and involvement of serosa by gastric carcinoma. There was also a significant correlation between more advanced stages of gastric carcinoma and higher levels of CA72-4 in the peritoneal washing, although serum levels of CA72-4 and more advanced stage of gastric neoplasia showed no significant correlation. Degrees of cellular differentiation in the gastric carcinoma did not differ significantly with CA72-4 levels in serum or peritoneal washing. CONCLUSION: High levels of CA72-4 in peritoneal washing correlated significantly with lymph node metastasis and serosa involvement by the neoplasia, and also with more advanced stage of gastric carcinoma. The levels of CA72-4 in the blood correlated significantly with lymph node involvement by the gastric carcinoma, but not with serosa invasion or more advanced stage of neoplasia.

Redução da prevalência de úlcera duodenal: um estudo brasileiro (análise retrospectiva na última década: 1996-2005)

Abstract: RACIONAL: A ulcera duodenal sempre representou uma doenca muito prevalente entre as enfermidades digestivas, em qualquer parte do mundo. A prevalencia media era de aproximadamente 10% da populacao mundial. A partir do inicio dos anos 90, a literatura, tanto europeia como norte-americana, passou a demonstrar sua reducao gradativa entre seus paises. OBJETIVO: Demonstrar, atraves de analise retrospectiva, a prevalencia anual da ulcera duodenal nos ultimos 10 anos em um Servico de Endoscopia Digestiva que e referencia para o sistema publico de saude da cidade de Porto Alegre, municipios da Grande Porto Alegre e outras cidades vizinhas da mesma. Os dados analisados sao de marco de 1996 ate dezembro de 2005. METODOS: Estudo retrospectivo transversal, com analise documental de diagnosticos endoscopicos efetuados em endoscopia digestiva alta, no referido Servico. Foi feita a analise retrospectiva de diagnosticos endoscopicos efetuados em 13.130 pacientes submetidos a endoscopia digestiva alta no periodo de marco de 1996 a dezembro de 2005. A classificacao de Sakita foi utilizada para o estadio do grau evolutivo da ulcera duodenal e foi considerado por ela acometido o paciente com a lesao no estagio A1, ate o estagio S1, inclusive. Observou-se tambem a prevalencia nos dois sexos, na raca, o percentual medio total nos 10 anos, alem da prevalencia anual. Para verificar se houve significância estatistica dos resultados observados nos diferentes periodos, foi aplicado um teste de regressao linear ("linear regression model"). RESULTADOS: Observou-se decrescimo gradativo dos percentuais de prevalencia da ulcera duodenal, ano apos ano, iniciando-se em 1996 com 8,6% e se encerrando no final de 2005, com 3,3%. A excecao do periodo foi observada no ano de 2003 quando houve um acrescimo, comparando-se com o decrescimo gradativo dos 6 anos anteriores. Mas ja, a partir do periodo seguinte (2004), a queda gradativa voltou a ser observada. O valor medio de queda anual, aplicando o teste de regressao linear, foi da ordem de 1,3% ao ano, no periodo analisado (10 anos). Este teste mostrou tambem significância estatistica. A raca branca representou a maioria, com 78% dos pacientes, em relacao a raca negra. O sexo masculino, em todos os periodos analisados, exceto em um (1997), foi o sexo mais acometido, com uma relacao final masculino/feminino da ordem de 1.17/1.0. CONCLUSOES: Observou-se entao, neste estudo efetuado no Brasil, tambem uma reducao da prevalencia da ulcera duodenal, ja apontada pela literatura em outros paises. Estudos posteriores devem ser efetuados no sentido de apontar as razoes desta importante observacao.

Cross-cultural adaptation and validation for Portuguese (Brazil) of health related quality of life instruments specific for gastroesophageal reflux disease

Abstract: BACKGROUND: Gastroesophageal reflux disease has been shown patients to alter quality of life and working productivity. Most of the instruments available for this type of assessment come from English or French speaking countries. To use these instruments in Brazil requires a judicious process of translation and validation. AIM: Translating to Portuguese the questionnaires GSAS (Gastroesophageal Reflux Disease Symptom Assessment Scale), GERD-HRQL (Gastroesophageal Reflux Disease - Health Related Quality of Life) and HBQOL (Heartburn Specific Quality of Life Instrument) specific for quality of life assessment in gastroesophageal reflux disease. Testing the psychometric properties of reliability and validity of the referred disease specific instruments. METHODS: One hundred and thirty two gastroesophageal reflux disease patients (mean age 54.9 years and ± SD 13.9) from the Digestive Disease Motility Outpatient Clinic, Federal University of Sao Paulo, SP, Brazil and the Department of Surgical Gastroenterology "Sao Jose do Rio Preto" School of Medicine, Sao Jose do Rio Preto, SP, Brazil, accepted to participate and signed the informed consent form. Forty of these patients took part in the pre-test phase (28 females and 12 males, mean age 55.3 years ± SD 14.7) and the remaining 92 part in the validation phase (64 females and 28 males, mean age 54.7 years and ± SD 13.7). The translation and cultural adaptation processes were carried out accordingly us to the method of Guillemin et al (1993). The validation processes of the disease specific translated questionnaires (GSAS, GERD-HRQL and HBQOL) was performed in relation to a generic (SF-36) and a symptomatic (SQGERD) instrument. RESULTS: Nine words of the GSAS, four of the GERD-HRQL and six of the HBQOL were replaced during the cultural adaptation phase. The GSAS questionnaire was discontinued after this phase because of scoring problems. Therefore reliability and validity were tested only for the two remaining questionnaires. These questionnaires proved to be reproducible for both inter and intra-observer relationships (0.980 and 0.968 values for the GERD-HRQL and varying values of 0.868 to 0.972 for the HBQOL). The HBQOL questionnaire demonstrated high internal consistency (>0.70) for three of the four dimensions tested (physical aspect, pain, sleep). Good correlations levels with the SF-36 and SQGERD questionnaires were demonstrated during the validation phase. CONCLUSIONS: The cross cultural adaptation of the Portuguese (Brazil) versions of the GERD-HRQL and HBQOL instruments proved to be reliable and valid options with low burden level for assessment of quality of life in gastroesophageal reflux disease our country. The HBQOL is the only multidimensional questionnaire for quality of life assessment in gastroesophageal reflux disease currently available in Brazil. The Portuguese (Brazil) version of the GSAS instrument proved inadequate for quality of life assessment in our country.

Gastroesophageal reflux in cirrhotic patients with esophageal varices without endoscopic treatment

Abstract: BACKGROUND: Portal hypertension in patients with liver cirrhosis causes manifestations such as esophageal varices, ascites and edema. Some studies have been conducted about the role of esophageal varices in the development of esophageal motor disorders and abnormal gastroesophageal reflux in these patients. Ascites could be a factor promoting gastroesophageal reflux and it has been questioned whether reflux would favor the rupture of varices. However there are a few studies using ambulatory esophageal pH recording in the evaluation of these patients. AIMS: Evaluate gastroesophageal reflux by pH recording in cirrhotic patients with esophageal varices and possible predictors. METHODS: Fifty one patients (28 men, 23 women, mean age of 54 years) with liver cirrhosis, diagnosed by clinical, laboratorial, image and histological findings were prospectively evaluated. All patients had esophageal varices confirmed by endoscopy and were submitted to a questionnaire about typical gastroesophageal reflux disease symptoms (heartburn and or acid regurgitation). pH recording was performed with the probe placed 5 cm above the superior lower esophageal sphincter limit, as determined by manometry. Abnormal reflux (% total time with pH 4.5%) was related to the size of varices, congestive gastropathy, ascites, severity of cirrhosis and typical gastroesophageal reflux disease symptoms. RESULTS: The caliber of the varices was considered to be small in 30 patients (59%), medium in 17 (33%) and large in 4 (8%), 21 (41%) congestive gastropathy. Ascites was observed in 17 (33%), 32 patients (63%) were classified as Child-Pugh A, 17 (33%) Child-Pugh B and 2 (4%) Child-Pugh C. Twenty seven patients (53%) presented with typical gastroesophageal reflux disease symptoms. Abnormal reflux at pH recording was found in 19 patients (37%). One of them presented with erosive esophagitis at endoscopy. There was no relation between ascites, variceal size, congestive gastropathy and Child-Pugh score and abnormal reflux. There was a correlation between typical gastroesophageal reflux disease symptoms and abnormal reflux. CONCLUSION: Abnormal gastroesophageal reflux was found in 37% of the patients with hepatic cirrhosis and esophageal varices. Only typical gastroesophageal reflux disease symptoms predicted these findings.

Endoscopic and ultrasonographic evaluation before and after Roux-en-Y gastric bypass for morbid obesity

Abstract: BACKGROUND: Esophagogastric abnormalities are recognized prior and after bariatric procedures, but frequency and severity are debated. Liver and biliary tract findings are also of clinical importance, especially gallstones and liver steatosis. AIM: To compare pre-operative findings of hepatobiliary ultrasound and upper digestive endoscopy with post-operative results in patients submitted to open Roux-en-Y gastric bypass for morbid obesity. METHODS: A total of 80 patients were enrolled 16.8 ± 12.1 months after operation, all of them on routine follow-up program, and 8 were excluded. Retrospective analysis aimed at pre-operative clinical, endoscopic and ultrasonographic examinations and were prospectively repeated. RESULTS: Pre-operative endoscopical report was available in 42 cases, and 52 examinations were performed post-operatively. Frequency of esophagitis changed from 16.7% (7/42) to 15.4% (8/52), and of gastritis from 45.2% (19/42) to 21.2% (11/52). Gastric or gastrojejunal ulcers were initially present in 4.8% (2/42) and increased to 9.6% (5/52). Post-operatively, an unusual abnormality was silastic band erosion: 7.7% (4/52). Helicobacter pylori was present in 50.0% (21/42) before and 3.5% (2/52) after operation. Ultrasonographic study had been done before intervention in 63 subjects, and 57 were executed on follow-up. Liver steatosis occurred previously in 58.7% (37/63) and in 43.9% (25/57) later on. Only 12.7% (8/63) of the patients had undergone cholecystectomy before bariatric operation, 29.1%(16/55) suffered simultaneous resection of gallbladder because of stones during Roux-en-Y gastric bypass, and an additional 26.8% (10/36) developed gallstones post-operatively. CONCLUSIONS: Liver steatosis did not statistically improve, nor did inflammatory conditions of the upper digestive tube, despite reduction of H. pylori infections; gallbladder stones requiring intervention were common.

Randomized clinical trial comparing sodium picosulfate with mannitol on the preparation FOR colonoscopy in hospitalized patients

Abstract: BACKGROUND: The cleansing of the colon for a colonoscopy exam must be complete so as to allow the visualization and inspection of the intestinal lumen. The ideal cleansing agent should be easily administered, have a low cost, and minimum collateral effects. Sodium picosulfate together with the magnesium citrate is a cathartic stimulant and mannitol is an osmotic laxative, both usually used for this purpose. AIMS: Assess the colon cleanliness comparing the use of mannitol and sodium picosulfate as well as evaluate the level of patient satisfaction, the presence of foam, pain, and abdominal distension in hospitalized patients undergoing colonoscopy. METHODS: A prospective, randomized, single-blind study with 80 patients that compared two groups: mannitol (40) and sodium picosulfate (40). Both groups received the same dietary orientation. The study was approved by the hospital’s Ethics and Research Committee. The endoscopist was blind to the type of preparation. Outcomes evaluated: level of the colon’s cleanliness, patient’s satisfaction, the presence of foam, abdominal pain and distension, and the duration of the exam. The data was analyzed by means of the chi-squared test for proportions and Mann-Whitney for independent samples. RESULTS: There were no statistically significant differences between the groups in relation to the level of the colon’s cleanliness, patient’s satisfaction, the presence of foam, abdominal pain, and the duration of the exam. Fifteen percent of the exams of the mannitol group were interrupted while from the sodium picosulfate group it was 5%. The presence of foam was similar for both groups. The average duration for carrying out the exam was 28.44 minutes for the mannitol group and 35.59 minutes for the sodium picosulfate group. Abdominal distension was more frequent in the mannitol group. If they would have to do the same exam, the answer was that 80% said yes from the mannitol group and 92.5% from the sodium picosulfate group. CONCLUSION: The quality of the colon preparation, foam formation, exam duration, and the collateral effects (nauseas, vomiting, and abdominal pain) were similar in both kinds of preparations. Abdominal distension was greater in the mannitol group. Both methods of preparation were well accepted by the hospitalized patients.

Fibras solúveis no tratamento da doença hepática gordurosa não-alcoólica: estudo piloto

Abstract: The pilot study evaluated the efficiency of oral soluble fibers to treat patients with nonalcoholic fatty liver disease. Twelve patients received 10 g/day of soluble fibers during 3 months. After the treatment 100% of patients presented reduction in body mass index, waist circumference and insulin resistance index. In 66.7% of the patients were observed reduction of the cholesterol levels and 75% presented normal liver enzymes (AST, ALT, and GGT). The present study suggests that oral soluble fibers may be useful to control risk factors and liver enzymes in patients with nonalcoholic fatty liver disease. However, future studies with histological controls are considered necessary.

[Spontaneous bacterial peritonitis: impact of microbiological changes].

Abstract: BACKGROUND: Spontaneous bacterial peritonitis is a serious complication in cirrhotic patients, and the changes in the microbiological characteristics reported in the last years are impacting the choice of antibiotic used in the treatment. AIM: To evaluate the change in the epidemiology and antibiotic resistance of the bacteria causing spontaneous bacterial peritonitis in a 7 years period. METHODS: All the cases of cirrhotic patients with spontaneous bacterial peritonitis with positive cultural examination were retrospectively studied. Two periods were evaluated: 1997-1998 and 2002-2003. The most frequent infecting organisms and the sensitivity in vitro to antibiotics were registered. RESULTS: In the first period (1997-1998) there were 33 cases, 3 (9%) with polymicrobial infection. The most common were: E.coli in 13 (36,11%), Staphylococcus coagulase-negative in 6 (16,66%), K. pneumoniae in 5 (13,88%), S. aureus in 4 (11,11%) and S. faecalis in 3 (8,33%). In 2003-2004, there were 43 cases, 2 (5%) with polymicrobial infection. The most frequent were: Staphylococus coagulase-negative in 16 (35,55%), S. aureus in 8 (17,77%), E. coli in 7 (15,55%) and K. pneumoniae in 3 (6,66%). No one was using antibiotic prophilaxys. The prevalence of S. aureus methicillin-resitant to quinolone and trimethoprim-sulfamethoxazole changed from 25% to 50%, and vancomicin was the only one with absolute activity during all the period. In the same way, the prevalence of E. coli resistant to third generation cephalosporin and to quinolone changed from 0% to 16%. CONCLUSION: There was a modification of the bacterial population causing spontaneous bacterial peritonitis, with high frequency of gram-positive organisms, as well as an increase in the resistance to the traditionally recommended antibiotics. This study suggests a probable imminent inclusion of a drug against gram-positive organisms in the empiric treatment of spontaneous bacterial peritonitis.

Características clínicas de pacientes pediátricos com constipação crônica de acordo com o grupo etário

Abstract: BACKGROUND: There was no study evaluating clinical characteristics of constipation according pediatric age groups. AIM: To evaluate the clinical characteristics of patients with chronic constipation according to age group. METHODS: This retrospective study evaluated the demographic data and clinical characteristics of pediatric patients with chronic constipation who had been admitted to an outpatient clinic between May 1995 and December 2000. Data was analyzed according to the followings age groups: infants, pre-school, school age and adolescent. RESULTS: Five hundred and sixty one patients were included in the study. The percentage of patients according to age groups were: infants (19.1%), pre-school (42.9%), school age (26.9%), and adolescents (11.0%). There was no statistical gender difference among the four age groups. Less than three bowel movements per week were observed more frequently in pre-school (65.8%) and school age (59.6%) than in infants (52.4%) and adolescents (43.1%). Fecal escape ("soiling") was found in 75.6% of the pre-school patients aged more than 48 months, in 68.2% of the school age and in 76.7% of the adolescents. Soiling was more frequent in boys (80.7%) than in girls (50.0%) only in school age children. Retentive posture (67.6%, 40.7%, 27.2%), fear for defecation (70.2%, 44.2%, 29.7%) and abdominal pain (80.8%, 69.6%, 73.6%) were observed, respectively, more frequently in pre-school than in school age and adolescents. CONCLUSION: There were differences in clinical characteristics according to age group. However, prolonged duration of constipation and an elevated number of complications were observed in all age groups, especially fecal soiling and abdominal pain.

Cytomegaloviral colitis in HIV positive patients: endoscopic findings

Abstract: BACKGROUND: Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. AIM: To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. METHODS: Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. RESULTS: Total colonoscopy was possible in 98.03% and ileum intubation in 88.23% of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54%, an inflammatory process of the mucosa in 21.56% and 5.88% of the patients mucosa was endoscopically normal. CONCLUSION: Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea.

Lipase/amylase ratio in biliary acute pancreatitis and alcoholic acute/acutized chronic pancreatitis

Abstract: RACIONAL: Pancreatites agudas de causas alcoolica ou biliar podem necessitar de abordagens terapeuticas diferentes. OBJETIVO: Verificar a validade da relacao lipase/amilase em diferenciar as causas alcoolica ou biliar na pancreatite aguda/pancreatite cronica agudizada. METODOS: Foram avaliados nove pacientes com pancreatite aguda/pancreatite cronica agudizada alcoolica, todos homens, com idade media (desvio padrao) de 39,8 ± 7,0 anos (grupo I) e 29 com pancreatite aguda biliar, sendo 8 homens e 21 mulheres, com idade media de 43,6 ± 19,9 anos (grupo II). As amilasemias e lipasemias foram determinadas em pacientes com sintomatologia ha, no maximo, 48 horas. A relacao lipase/amilase foi calculada utilizando-se valores de amilasemia e lipasemia expressas como multiplos de seus respectivos valores superiores de referencia. RESULTADOS: As medias das lipasemias (4.814 ± 3.670 U/L) e amilasemias (1.282 ± 777 U/L) no grupo I foram semelhantes as do grupo II (2.697 ± 2.391 e 1.878 ± 1.319 U/L, respectivamente), mas a media das relacoes lipase/amilase foi significantemente maior no grupo I (4,4 ± 3,6) do que no grupo II (2,2 ± 2,2). Relacao lipase/amilase >3 foi significantemente mais frequente no grupo I (66,7%) do que no grupo II (24,1%) e diferenciou os dois grupos com sensibilidade de 67% e especificidade de 76%. CONCLUSOES: 1) as amilasemias e lipasemias nao diferenciaram os dois grupos avaliados; 2) relacao lipase/amilase >3 e mais frequente na pancreatite aguda/pancreatite cronica agudizada alcoolica do que na pancreatite aguda biliar, e pode ser util na diferenciacao destas duas causas de pancreatite.

[Serological screening of relatives of celiac disease patients: antiendomysium antibodies, anti-tissue transglutaminase or both?].

Abstract: RACIONAL: A doenca celiaca representa, na atualidade, a doenca intestinal mais comum em populacoes caucasoides e apresenta prevalencia que varia de 8% a 18% nos familiares dos pacientes. A pesquisa dos anticorpos anti-endomisio (EmA-IgA) e antitransglutaminase tecidual (anti-tTG-IgA) constitui importante recurso nao-invasivo e sensivel de triagem e diagnostico da doenca celiaca em grupos de risco e populacoes. OBJETIVO: Avaliar a prevalencia do EmA e anti-tTG em um grupo de familiares de celiacos e verificar o grau de concordância entre os dois metodos. METODOS: Foram estudados 177 familiares (76(feminino); 101(masculino); 2-79 anos) e 93 individuos voluntarios e sadios (34 (feminino); 59 (masculino); 2-71 anos) como grupo controle. O EmA foi detectado por imunofluorescencia indireta (substrato: cordao umbilical humano) e o anti-tTG pelo metodo de ELISA (kit comercial). RESULTADOS: A positividade total de anticorpos nos familiares em estudo foi de 21% (37/177), mostrando significativa diferenca em relacao aos controles (0%; 0/93). Doze por cento (21/177) dos familiares foram positivos para o EmA e 13,56% (24/177) para o anti-tTG, sendo 4,52% (8/177) positivos concomitantemente para os dois anticorpos. A concordância de resultados entre os dois metodos foi de 83,6% (148/177) e a discordância de 16,4% (29/177), caracterizando uma correlacao positiva significante (r= 0.435) entre ambos. Dentre os concordantes, 79,1% (140/177) eram negativos para o anti-tTG e EmA, e 4,52% (8/177) positivos para ambos. Nos casos discordantes, 7,34% (13/177) apresentaram EmA positivo e anti-tTG negativo e 9,04% (16/177) eram anti-tTG positivo e EmA negativo. CONCLUSAO: Embora a alta positividade obtida para o EmA e anti-tTG destaque a importância da triagem sorologica em familiares de pacientes com doenca celiaca, as discordâncias detectadas no estudo permitem ressaltar que o uso isolado de um unico metodo pode incorrer em reacoes falso-negativas. O impacto desse fato implica que tais familiares deixarao de ser submetidos a biopsia intestinal para confirmacao do diagnostico da doenca, e consequentemente, ao tratamento adequado e precoce.

Análise descritiva dos perfis social, clínico, laboratorial e antropométrico de pacientes com doenças inflamatórias intestinais, internados no Hospital Universitário Clementino Fraga Filho, Rio de Janeiro

Abstract: BACKGROUND: The epidemiologic survey in Brazil is limited probably due to a diagnosis deficiency and a small number of population-based studies performed. The majority of the prevalence studies available have evaluated inflammatory bowel diseases outpatients, but the knowledge of the profile of inflammatory bowel diseases inpatients is important in order to detect predictive markers of disease severity that will allow earlier medical intervention decreasing the rate of hospitalization and reducing the Health System costs. AIM: To determine social, clinical, laboratorial and anthropometric profiles of hospitalized adults inflammatory bowel diseases patients of a tertiary university hospital. METHODS: Prospective study was performed with 43 inflammatory bowel diseases inpatients from clinical and surgical wards and emergency section of university hospital. We characterized demographic data, presence of comorbidities, disease location and behavior, surgical past-history, extra intestinal manifestations using standardized definitions. Laboratory results were abstracted from medical records and anthropometric measures were performed during our visit. RESULTS: The vast majority of the inflammatory bowel diseases patients had Crohn's disease (72.1%), with ileocolic involvement (60%), with a penetrating disease behavior (77.4%) while ulcerative colitis group presented mostly pancolitis (50%). Articular pain was the most common (44.2%) extra intestinal manifestation of inflammatory bowel diseases patients and 97.7% of them had at least one type of complication related to disease. Although, the previous use of specific medical therapies to inflammatory bowel diseases before the hospitalization (more frequently corticosteroids) was done (79%), the majority of the patients were hospitalized because of inflammatory bowel diseases activity. Disease activity was present in 80.7% of Crohn's disease and 50% ulcerative colitis patients. Inflammatory bowel diseases mortality rate was 5.5% (2/36). Comorbidities presence occurred only in 30.2% of inflammatory bowel diseases patients. The predominant surgery performed was intestinal resection. The interval between the symptoms appearance and the definitive diagnosis was less than 1 year in more than 70% of inflammatory bowel diseases patients. Laboratory findings detected were a decreased serum albumin (85.7%) and anemia (69.8%). The majority of the patients had at least one anthropometric alteration. The social stratification of the inflammatory bowel diseases group was similar to the Brazilian population. CONCLUSION: The inflammatory bowel diseases inpatients from the university hospital wards had more severe evolution of these illnesses with an active and extensive disease with complications and frequent extra intestinal manifestations, despite the prolonged use of corticosteroids. The higher prevalence of Crohn's disease inpatients than ulcerative colitis could reflect a higher aggressive behavior of this disease. The reduced serum albumin, anemia and anthropometric alterations are common inflammatory bowel diseases inpatients and could be related to a major severity of inflammatory bowel diseases evolution.

Doença de Crohn e cálculo renal: muito mais que coincidência?

Abstract: – Background - Crohn’s disease is an inflammatory bowel disease associated with a wide variety of complications and manifestations secondary to the effects of underlie inflammatory process. In about 30% of the patients with Crohn’s disease can be found extra-intestinals symptoms. Nephrolithiasis is one of them and the appearance of kidney stones, mainly of oxalate of calcium, is more common in these patients than in general population. Aim - To evaluate urinary metabolic factors potentially involved in renal stones formation on patients with Crohn’s disease. Methods - We evaluated 29 patients with Crohn’s disease followed in the Outpatient Bowel Inflammatory Disease Clinics of State University Hospital, Londrina, PR, Brazil, from January to December of 2004. The metabolic evaluation included measured of blood and urine substances related to renal stones formation, kidneys, ureters and bladder ultrassonography and calculation of urinary supersaturation for calcium oxalate, uric acid and calcium phosphate.

Infections after liver transplantation in adults: data from a university hospital in southern Brazil (1996-2000)

Abstract: Background - Infections after liver transplantations are the most important cause of morbi-mortality. In this study, we assessed the main characteristics of these infections in a southern Brazilian university hospital. Methods - We conducted a retrospective cohort with 55 patients who underwent orthotopic liver transplantation between 1996 and 2000 in the "Hospital de Clinicas de Porto Alegre", Porto Alegre, RS, Brazil, to characterize the infections that occurred in the group. Results - One or more infections (average 2.10) were diagnosed in 47 patients, especially during the first month after transplantation. The most common were bacteremia, intra-abdominal infections and pneumonia, predominantly with bacteria, especially Staphylococcus sp (and particularly S. aureus) and E. coli. The mortality rate attributed to infections was high: 17 cases of all deaths (total 27 deaths). Significant risk factors for infections included reoperation, diabetes, biliary stenosis and higher Child-Pugh scores. Conclusion - Infections remain a severe threat in liver transplant patients, and special efforts should be made to prevent and manage them correctly. HEADINGS - Liver transplantation. Infection. Risk factors. Immunocompromised host.

Clinical profile of Santa Catarina members of Brazilian Celiac Association

Abstract: BACKGROUND: Celiac disease is an enteropathy induced by gluten in genetically predisposed individuals. AIM: To establish the demographic and clinical characteristics of this disease in Santa Catarina State, Brazil. METHODS: A descriptive transversal study was performed involving members of a regional celiac association, to whom a questionnaire focusing various aspects of the disease was sent. RESULTS: From a total of 506 members, 145 (28.7%) were enrolled in the study - all of them biopsy-proven celiacs. Their mean age was 30.8 years (range, 3.3-82.5 years). Female to male rate was 2.1:1. The mean age at diagnosis was 16 years for men and 26.7 years for women. Most frequently reported symptoms were: abdominal distention (71.8%), abdominal pain (71%) and diarrhea (65.5%). Anemia, aphthous ulcers and constipation were more related by women, while diarrhea and low weight were more frequent in men. Only 42.1% of the participants had been submitted to biopsies compatible with a correct investigation of the disease (44.2 % had been submitted to biopsy only after gluten exclusion of the diet and 11.7% did not mentioned whether they were in a gluten-free diet when biopsied). Only 61.4% had been submitted to serological tests for diagnostic or dietary control purposes. Associated diseases were related by 65% of the individuals, of which the most common was lactose intolerance (33%). Vitaminic or mineral supplementation was indicated to 45% and only 32.5% have had bone mineral density measured. Of these, 59% had altered results. CONCLUSIONS: The results suggest a tendency of diagnosis of celiac disease in older ages, specially among women. This may indicate the necessity of improving public and medical knowledge in Santa Catarina concerning the diagnosis and treatment of this disease.

Câncer do esôfago em paciente com megaesôfago chagásico

Abstract: BACKGROUND: Megaesophagus constitutes a public health problem in our country since it affects individuals in the most productive phase of their lives During the development of the disease, people suffering from it may present association with esophageal cancer AIM: To analyze the clinical and epidemiological aspects of patients with megaesophagus and esophageal cancer METHODS: Twenty patients with megaesophagus and cancer (group 1) and 20 patients with esophageal cancer (group 2) were retrospectively analyzed Demographic data, habits (alcoholism and smoking), tumor histological type, lesion location, cellular differentiation, staging, treatment and survival were assessed RESULTS: No difference was observed between the groups in relation to age, sex, lesion location, tumor histological type, cellular differentiation, staging or survival As regards habits, the association of alcoholism with smoking was observed in a larger number of patients with esophageal cancer without the megaesophagus antecedent CONCLUSION: The clinical characteristics of patients with megaesophagus and cancer do not differ from those of patients with malignant esophageal neoplasia, particularly as regards the unfavorable prognosis with the instituted treatment Patients with megaesophagus may present esophageal tumor at any part of the organ

An experimental study of the electrical activity of the bypassed stomach in the Roux-en-Y gastric bypass

Abstract: BACKGROUND: Surgical options for morbid obesity are diverse, and the Roux-en-Y gastric bypass, initially described by Fobi has gained popularity. Knowledge about the physiology of the bypassed stomach is limited because this newly produced segment of the stomach is inaccessible to endoscopic or contrast radiological studies. AIM: To evaluate the myoelectric activity of the bypassed stomach and its reply to the feeding. METHODS: An experimental protocol was conducted to evaluate postoperative gastric bypassed motility in dogs submitted to the Roux-en-Y gastric bypass procedure. Two groups of five animals were studied on postoperative fasting and after a standard meal, recording electrical response and control activity. Both control and Roux-en-Y gastric bypass operated study group had a pair of electrodes placed on three points of the remaining stomach: fundus, body and antrum. Data registration was performed after complete ileus resolution, and analysed with DATA Q Inst. series 200. RESULTS: The results achieved on the conditions of this study suggest that: 1. the remaining stomach maintain the same pattern of motility; 2. there is a reduced fasting electromyography activity following the Roux-en-Y gastric bypass procedure; 3. significantly reduced fasting electric control activity when compared both groups, and a markedly reduced fasting response electric activity and; 4. the electric response to the feeding kept the same standard of the stomach, however in a statistically reduced way. CONCLUSION: The electrical activity of the bypassed stomach of Roux-en-Y gastric bypass procedure kept the same pattern but in a statistically reduced number of contraction.

[Nonalcoholic fatty liver disease: evolution after gastric bypass].

Abstract: BACKGROUND: Nonalcoholic fatty liver disease is highly prevalent among morbidly obese patients and can progress from steatosis to steatohepatitis and chronic liver disease. AIM: To determine the effect of gastric bypass operation in the incidence of fatty liver disease and associated co-morbidities in morbidly obese patients. METHODS: Patients were prospectively evaluated in the pre-operative period and after at least 6 months after operation. We analysed: antropometric data, co-morbidities, use of medications, cholesterol and triglycerides levels, liver tests and incidence of nonalcoholic fatty liver disease. All patients with abnormal liver tests were subjected to per-operative liver biopsy. RESULTS: Twenty eight patients with nonalcoholic fatty liver disease with a mean body mass index of 42 ± 4 kg/m2 were evaluated. Twenty five patients had 59 co-morbidities and the most frequent were: elevated triglycerides (n = 23), elevated cholesterol (n = 13) and elevated blood pressure (n = 11). Biopsy was done in 22 patients: 10 presented moderate steatosis, 5 mild steatosis and 7 steatohepatitis. After follow-up of 230 days in average they presented weight excess loss of 64%, body mass index reduction to 29,6 ± 3 kg/m2 and 21 co-morbidities in 13 patients. There was a significant decrease in the number of patients with elevated triglycerides, elevated cholesterol, elevated blood pressure and in the incidence of nonalcoholic fatty liver disease. CONCLUSION: The weight loss secondary to the gastric bypass is associated with decrease in the incidence of nonalcoholic fatty liver disease and other co-morbidities.

Is there a role for sigmoidoscopy in symptomatic patients? Analysis of a study correlating distal and proximal colonic neoplasias detected by colonoscopy in a symptomatic population.

Abstract: BACKGROUND: Colonoscopy is the gold standard exam to investigate patients with colonic complaints. However, its availability is limited in developing countries. Sigmoidoscopy has been advocated as a first procedure in colorectal cancer screening strategies, in order to select those who need colonoscopy. AIM: To study the correlation between distal and proximal colonic neoplasias in symptomatic patients 50 years or older and patients 40 to 49 years old who underwent colonoscopy at a gastrointestinal endoscopy unit in 1999 and 2000 with the purpose to evaluate its role in a symptomatic population. METHODS: All colonoscopies performed in our Department in 1999-2000 were reviewed. The distal colon was defined as the colonic segment aboral to the splenic flexure. Advanced neoplasias were defined as adenomas larger than 10 millimeters and adenocarcinomas. RESULTS: Of the 2,701 colonoscopies retrieved, 1,125 were enrolled in this study. Prevalence rates for adenoma, advanced adenoma and carcinoma were 28.9%, 4.6% and 4% in the group of 830 patients 50 years or older (mean age 65 years, 491 women). The finding of one small (<10 mm) adenoma in the distal bowel doubled the likelihood of finding a proximal neoplasia (OR = 2.12, 95% CI, 1.27-3.54), and multiple (OR = 3.99, 95% CI, 1.72-9.28) or advanced (OR = 3.73, 95% CI, 1.81-7.7) adenomas increased this risk even further. Of the patients without adenoma or carcinoma in the distal colon, 1.93% had proximal advanced neoplasia. In the group of 40 to 49-year-old patients (n = 395; mean age 44.8 years, 208 women) the prevalence of adenomas (14.9%), advanced adenomas (3.4%), and carcinomas (1.7%) was lower. CONCLUSIONS: The likelihood of finding a proximal lesion is greater in patients with distal neoplasias. This likelihood is further increased when adenomas are multiple or larger than 10 mm. One out of 52 patients 50 years or older with an apparently normal distal colon has advanced proximal neoplasia. Sigmoidoscopy is not an adequate exam for symptomatic patients aged 50 years or older.