GERD symptoms, signs, and physiological abnormalities are found more often in patients with Barrett's esophagus than in those with IMC, and the duration of acid reflux in patients with LSBE is greater than that in patients with SSBE. These findings suggest that the extent of intestinal metaplasia in the esophagus is related directly to the severity of underlying GERD.
In recent years, the diagnosis of short segments of intestinal metaplasia lining the distal esophagus has increased. The aim of the present study was to determine the clinical, endoscopic, histologic and functional results in patients with intestinal metaplasia at the cardia (IMC), carditis and short-segment columnar epithelium (CE) lining the distal esophagus with and without intestinal metaplasia. Four groups were studied: 48 patients with carditis, 105 patients with IMC, 78 patients with short-segment CE (SSCE) without IM and 69 patients with short-segment CE with IM. All had clinical questionnaire, endoscopic and histological evaluation, manometric studies and measurements of acid and bilirubin exposition of the distal esophagus over 24 h. Patients without IM were found to be younger than those with IM. Erosive esophagitis was observed in similar proportions, but hiatal hernia was present in patients with SSCE with or without IM. Patients without IM had mainly cardial mucosa more than fundic mucosa. However, patients with IM had almost exclusively cardial mucosa. Low-grade dysplasia was observed only in patients with IM. Manometric evaluation demonstrated a structural defective lower esophageal sphincter in all groups. Acid and duodenal exposures of the distal esophagus over 24 h were significantly greater in patients with SSCE with IM. In the presence of pathologic gastroesophageal reflux (GER), there are several histological changes at the mucosa distal to the squamous columnar junction. The first metaplastic change is one from fundic to cardial mucosa and, when duodenal reflux occurs, a second metaplastic change to intestinal metaplasia from cardial mucosa occurs. Therefore, in all patients with symptoms of GER, biopsies specimens distal to the squamous columnar junction should be taken routinely.
ResumenObjetivo: el objetivo de este artículo es presentar una simulación del hurto por intimidación para un período de un año que permita realizar un análisis comparativo y una reflexión sobre las políticas públicas. Método: se empleó la simulación computacional basada en agentes (ABM) con el fin de recrear la interacción entre los diferentes actores sociales y registrar los niveles de hurto a medida que varía la eficiencia de las políticas públicas. Resultados: Los resultados sugieren que las políticas de prevención poseen mayor impacto para reducir la cantidad de hurtos respecto a las medidas coercitivas, así como la existencia de una tasa natural de hurtos cuando las políticas aumentan su capacidad de impacto. Conclusiones: Las políticas coercitivas sólo cumplen un rol de contención y no ayudan para la reducción de los niveles de hurto; a nivel espacial, se configuran nichos de robos en el "territorio" virtual donde los agentes interactúan, y se observa rendimientos marginales decrecientes para la capacidad de impacto de las políticas simuladas.
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