Sometimes it is possible to differentiate whether the aspirate is gastric or pharyngeal. The kind of bacterial contamination is, however, more difficult to establish. Oral or dental disease, antibiotic therapy, systemic illness or malnutrition and reduction of salivary flow are responsible for colonization of Gram-negative bacteria in oral and pharyngeal flora in nasogastric-tube-fed patients. The use of a nasogastric feeding tube and the administration of food increase gastric pH and lead to colonization of gastric secretions. It has also been suggested that gastric bacteria could migrate upward along the tube and colonize the pharynx.
Celiac disease (CD) is a permanent condition of gluten intolerance and a number of autoimmune diseases have been associated with it. In the past few years, a relation between CD and dilated cardiomyopathy (CM) was described in Europe and United States. The aim of this study was to evaluate the prevalence of CD among south Brazilian precardiac transplant patients with advanced CM. A total of 74 patients on a list for heart transplantation were evaluated for the presence CD. The presence of anti-endomisial antibody (IgA-EmA) was determined by indirect immunofluorescence and for the anti-transglutaminase antibody (IgA anti-h-tTG) by ELISA. Serologically positive patients were submitted to upper endoscopy with intestinal biopsy. Two individuals (2.63%) were positive for IgA-EmA and 5 (6.75%) for IgA anti-h-tTG; 1 (1.35%) had both tests positive. Histologic confirmation of CD occurred only in the IgA-EmA positive patients. In conclusion, data from the present study allows recommend the screening for CD in patients with CM using IgA-EmA test as the method of choice.
DESCRITORES -Inibidores da bomba de prótons. Mucosa gástrica. Pólipos. ABSTRACT -Background -The medications most often prescribed and used chronically by patients with dyspeptic symptoms belong to the group of inhibitors of proton pump whose main representative is omeprazole, used clinically about 20 years. Recent studies have postulated the relationship between chronic use of this medication and macroscopic and microscopic proliferative changes in mucosal of gastric body, especially the fundic gland polyps. Aim -To analyze the frequency and type of gastric proliferative changes in chronic users of proton pump inhibitors proton and its association with age, dose, time of use, symptoms and Helicobacter pylori infection. Methods -A survey of prevalence was conducted in Digestive Endoscopy Service, Hospital de Clínicas, Federal University of Paraná, using questionnaire referring the use of these drugs and performed in subjects using this class of drugs during at least 12 months prior to the endoscopy. Gastric biopsies of fundus, body and antrum were performed in all patients. Polyps were removed when present for histopathological analysis. Research on Helicobacter pylori was done by urease test and histopathology. RESUMO -RacionalResults -Twenty-two individuals were included of which six (27.3%) had proliferative changes of the mucosa. Of these, two (9.1%) had sporadic fundic polyps and four only microscopic proliferative change as cystic glandular formation. Statistic significant (p <0.05) association between age ≥ 60 years and these changes was found. There was no association between dose of use, time of use, symptoms and Helicobacter pylori infection. Conclusions -It was observed the existence of proliferative mucosa changes in individuals with chronic use of inhibitors of proton pump. In this group, the association between age and proliferative changes was significant.
Objective: The aim of this study was to validate the endoscopic findings against histologic features of the distal esophageal mucosa for the diagnosis of reflux esophagitis in infants.Methods: The data records of 167 patients (88 M; 79F) aged 38-364 days, referred for investigation of reflux esophagitis, between January 1995 and December 2000 were retrospectively reviewed. The association between nominal (presence or absence of esophagitis) and ordinal (grades of esophagitis) variables was analyzed through a correlation between the results of endoscopic findings and histology.Results: Endoscopy when compared with histologic analysis had a sensitivity of 45%; specificity of 71%; positive and negative predictive value of 89% and 21% respectively; and accuracy of 50%. Additionally, this study demonstrated that there was a poor correlation between endoscopic and histologic findings when endoscopy was normal or when endoscopic grade I esophagitis was observed (p = 0.10). Normal esophageal appearance failed to identify 79.2% of patients with histologic esophagitis. Conversely, amongst patients with endoscopic grade I esophagitis, 12.1% had normal histology. Conclusions:We concluded that whilst endoscopy had a specificity of 71%, it did not attain an acceptable range of sensitivity (45%) to justify performing an endoscopy without biopsy, as many true cases of esophagitis would not be detected; and that the presence of grade I (non-erosive) esophagitis at endoscopy did not increase the value of the test in predicting histologic abnormality. ResumoObjetivo: O objetivo deste estudo foi o de validar os resultados do exame de endoscopia digestiva alta contra a histologia do esôfago distal para o diagnóstico da esofagite de refluxo em lactentes.Métodos: Foram revisados os prontuários de 167 pacientes (88 do sexo masculino e 79 do sexo feminino) com idade de 38 a 364 dias, encaminhados para investigação de esofagite de refluxo no período de janeiro de 1995 a dezembro de 2000. Analisou-se a associação entre as variáveis nominais (presença ou ausência de esofagite) e ordinais (graus de esofagite) através da comparação entre os resultados da endoscopia digestiva alta e histologia.Resultados: A endoscopia digestiva alta, quando comparada à histologia, apresentou sensibilidade de 45%, especificidade de 71%, valores preditivos positivo de 89% e negativo de 21%, e acurácia de 50%. Verificou-se baixa concordância entre os achados endoscópicos e histológicos na endoscopia digestiva alta normal ou na esofagite grau I (eritema leve ao nível da transição epitelial, apagamento, friabilidade e perda do brilho da mucosa) (p = 0,10). A endoscopia digestiva alta normal não identificou 79,2% dos pacientes com esofagite histológica. Entre os pacientes com esofagite grau I à endoscopia digestiva alta, 12,1% não apresentaram alterações histológicas.Conclusões: Concluiu-se que, enquanto a endoscopia digestiva alta apresentou especificidade de 71%, não atingiu sensibilidade aceitável (45%) para justificar sua realização sem biópsia; e que ...
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