Thirty percent of patients with heartburn and regurgtitation did not have abnormal acid reflux. Therefore, these symptoms are not specific for gastroesophageal reflux.
The diagnosis of hepatocellular carcinoma in cirrhotic patients has increased, mainly due to early detection using newer imaging techniques. The therapeutic approach depends on the tumor staging and the liver function. Cardiac involvement has a very (Rev Méd Chile 2004; 132: 1517-22E l carcinoma hepatocelular (CHC) representa más de 5% de todos los cánceres en el mundo y las muertes relacionadas con éste se estiman en 500 mil por año 1 . Este tumor puede debutar sintomáticamente con descompensación de la cirrosis de base, o ser de sospecha en pacientes asintomáticos por estudio de imágenes o medición de alfafetoproteína (AFP). En los países desarrollados se ha visto un aumento de su incidencia en el último tiempo, probablemente relacionado con la mejoría de exámenes diagnós-ticos y por la inmigración proveniente de zonas de alta prevalencia. Por otro lado, el mejor manejo de los pacientes cirróticos y la consiguiente mayor expectativa de vida de éstos, favorece su aparición, con una sobrevida que en casos avanzados suele ser inferior a 3 meses 2,4 .El diagnóstico de CHC en pacientes cirróticos se basa actualmente en los criterios establecidos en Barcelona 3 , que consideran la presencia de al menos dos técnicas de imagen que muestren un nódulo de 2 o más centímetros con hipervascularización, o por una sola imagen asociada a AFP >400 ng/ml. Se han desarrollado varias clasificaciones para determinar el estadio tumoral y la función
Effects of gastric bypass for morbid obesity on Barrett esophagusBackground: Besides the weight reducing effects of gastric bypass, it is also a good antirefl ux procedure since there is no acid production by the gastric pouch and there is no duodenal refl ux due to the presence of a Roux en Y. Aim: To describe the effect of gastric bypass on Barrett esophagus among patients with morbid obesity. Material and Methods: Among 896 patients subjected to gastric bypass, 14 patient with a Barrett esophagus diagnosed with endoscopy and biopsy, were followed. A new endoscopy was performed one to 30 months after the surgical procedure. Results: Short (< = 30 mm) and long segment (> = 31 mm) Barrett esophagi were present in eight and six patients, respectively. Gastroesophageal refl ux symptoms relieved in 70% of these cases in a mean lapse of 6.5 months. There was regression from intestinal metaplasia to cardial mucosa in six patients (75%) with short-segment, and in one patient (16%) with long-segment Barrett esophagus. Conclusions: Gastric bypass in patients with morbid obesity and Barrett esophagus is a very good antirefl ux operation. This was proved by the disappearance of symptoms in almost all patients and by the regression of the intestinal metaplasia which is time and length dependent.
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