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New insights into the pathophysiology of achalasia and implications for future treatment

World Journal of Gastroenterology 2016年第35期22卷 7892-7907页

作者： Janette Furuzawa-Carballeda Samuel Torres-Landa Miguel ángel Valdovinos Enrique Coss-Adame Luis A Martín del Campo Gonzalo Torres-Villalobos Department of Immunology and Rheumatology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Department of Experimental Surgery Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Idiopathic achalasia is an archetype esophageal motor disorder, causing significant impairment of eating ability and reducing quality of life. The pathophysiological underpinnings of this condition are loss of esophageal peristalsis and insufficient relaxation of the lower esophageal sphincter(LES). The clinical manifestations include dysphagia for both solids and liquids, regurgitation of esophageal contents, retrosternal chest pain, cough, aspiration, weight loss and heartburn. Even though idiopathic achalasia was first described more than 300 years ago, researchers are only now beginning to unravel its complex etiology and molecular pathology. The most recent findings indicate an autoimmune component, as suggested by the presence of circulating anti-myenteric plexus autoantibodies, and a genetic predisposition, as suggested by observed correlations with other well-defined genetic syndromes such as Allgrove syndrome and multiple endocrine neoplasia type 2 B syndrome. Viral agents(herpes, varicella zoster) have also been proposed as causative and promoting factors. Unfortunately, the therapeutic approaches available today do not resolve the causes of the disease, and only target the consequential changes to the involved tissues, such as destruction of the LES, rather than restoring or modifying the underlying pathology. New therapies should aim to stop the disease at early stages, thereby preventing the consequential changes from developing and inhibiting permanent damage. This review focuses on the known characteristics of idiopathic achalasia that will help promote understanding its pathogenesis and improve therapeutic management to positively impact the patient's quality of life.

关键词： Achalasia Treatment Autoimmune disease Pathophysiology

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Clinical characteristics and surgical treatment of schwannomas of the esophagus and stomach: A case series and systematic review

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World Journal of Gastrointestinal Oncology 2019年第9期11卷 750-760页

作者： Jesús Morales-Maza Francisco Ulises Pastor-Sifuentes Germán E Sánchez-Morales Emilio Sanchez-Garcia Ramos Oscar Santes Uriel Clemente-Gutiérrez Adriana Simoneta Pimienta-Ibarra Heriberto Medina-Franco Department of Surgery Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

BACKGROUND Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach′s plexus or less frequently from Meissner′s *** main differential diagnosis of gastric schwannomas are the gastrointestinal stromal tumors(GISTs),which are classified by their *** treatment of choice for gastric schwannomas is surgery where laparoscopy plays an important *** resection,subtotal or total gastrectomy can be *** its counterpart,esophageal schwannomas are benign tumors of the esophagus that are very uncommon since they comprise less than 2%of all esophageal *** main differential diagnosis is the leiomyoma which corresponds to the most common benign esophageal tumor,followed by *** treatment consists on tumoral enucleation or *** To review the available literature about gastrointestinal schwannomas;especially lesions from de stomach and esophagus,including diagnosis,treatment,and follow up,as well as,reporting our institutional *** A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes *** following databases were used for reviewing process:Pub Med,Ovid,MEDLINE,and *** English language manuscripts were *** gastrointestinal schwannomas specifically located in the esophagus and stomach were *** that did not report long-term follow-up were *** Gastric localization showed a higher prevalence in both,the literature review and our institution:94.95%(n=317)and 83%(n=5)*** a follow-up with disease-free survival greater than 36 mo in most cases:62.01%(n=80)vs66.66%(n=4).In both groups,the median size was>4.1 *** treatment is curative in most cases CONCLUSION Schwannoma must be taken into account in the differential diagnosis of gastrointestinal mesenchymal *** has a good prognosis,and most are benig

关键词： Schwannoma Esophagus Stomach Surgery Systematic review

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Predictors of dehydration and acute renal failure in patients with diverting loop ileostomy creation after colorectal surgery

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World Journal of Clinical Cases 2019年第14期7卷 1805-1813页

作者： Omar Vergara-Fernández Mario Trejo-Avila Oscar Santes Danilo Solórzano-Vicu?a Noel Salgado-Nesme Department of Colorectal Surgery Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"

BACKGROUND Despite the potential benefits of fecal diversion after low pelvic anastomosis in colorectal surgery, diverting loop ileostomy construction is related to significant rates of complications. AIM To determine potential predictors of high output related complications in patients with diverting loop ileostomy creation after colorectal surgery. METHODS Patients who underwent open and laparoscopic colorectal surgery requiring a diverting loop ileostomy from January 2010 to March 2018 were retrospectively analyzed. We included patients older than 18 years, who underwent colorectal surgery with primary low pelvic anastomosis, and with the creation of a diverting loop ileostomy, at elective or emergency settings for the treatment of benign or malignant conditions. Univariate and multivariate logistic regression analysis was used to determine the effect of the potential predictors on the rate of high output related complications. The high output related complications were dehydration and acute renal failure that required visits to the emergency department and hospitalizations. RESULTS Of the 102 patients included in the study, 23.5%(n = 24) suffered high output related complications. In this group of patients at least one visit to the emergency department (mean 1.6), and at least one readmission to the hospital was needed. The factors associated with high-output ileostomy, in the univariate analysis, were: urgent surgical intervention (OR = 2.6;P = 0.047), the development of postoperative complications (OR = 3;P = 0.024), have ulcerative colitis (OR = 4.8;P = 0.017), use of steroids (OR = 4.3;P = 0.010), mean output at discharge greater than 1000 mL/24 h (OR = 3.2;P = 0.016), and use of loperamide at discharge (OR = 2.8;P = 0.032). Multivariate logistic regression analysis identified two independent risk factors for high output related complications: ulcerative colitis [OR = 7.6 (95%CI: 1.81-31.95);P = 0.006], and ileostomy output at discharge ≥ 1000 mL/24 h [OR =

关键词： Loop ileostomy High-output ileostomy Loop ileostomy complications Dehydration Colorectal surgery

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Diagnosis and treatment of hepatocellular carcinoma: An update

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World Journal of Hepatology 2015年第3期7卷 362-376页

作者： Javier Tejeda-Maldonado Ignacio García-Juárez Jonathan Aguirre-Valadez Adrián González-Aguirre Mario Vilatobá-Chapa Alejandra Armengol-Alonso Francisco Escobar-Penagos Aldo Torre Juan Francisco Sánchez-ávila Diego Luis Carrillo-Pérez Department of Internal Medicine Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Department of Interventional Radiology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Department of Transplantation Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Department of Hematology and Oncology Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Hepatocellular carcinoma(HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium "washout" in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and locoregional therapies(alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion's stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib.

关键词： Hepatocellular carcinoma Surveillance Liver transplant Sorafenib Catheter ablation

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Follow-up of patients with pseudotumoral chronic pancreatitis: Outcome and surveillance

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World Journal of Gastroenterology 2014年第26期20卷 8612-8616页

作者： Félix Ignacio Téllez-ávila álvaro Villalobos-Garita Marc Giovannini Carlos Chan Jorge Hernández-Calleros Luis Uscanga Miguel ángel Ramírez-Luna Endoscopy Department Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Gastroenterology Department Hospital Calderón GuardiaCCSS Endoscopic Unit Paoli-Calmettes Institute Surgery Department Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Gastroenterology Department Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"

AIM: To follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval.

关键词： Chronic pancreatitis Pseudotumoral chronic pancreatitis Surveillance Endoscopic ultrasound

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Sarcopenia in patients with colorectal cancer:A comprehensive review

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World Journal of Clinical Cases 2020年第7期8卷 1188-1202页

作者： Omar Vergara-Fernandez Mario Trejo-Avila Noel Salgado-Nesme Department of Colorectal Surgery Instituto Nacional de Ciencias Medicas y Nutrición“Salvador Zubirán”Mexico 14080Mexico

Colorectal cancer(CRC)is the third most commonly diagnosed cancer globally and the second cancer in terms of *** prevalence of sarcopenia in patients with CRC ranges between 12%-60%.Sarcopenia comes from the Greek“sarx”for flesh,and“penia”for *** is considered a phenomenon of the aging process and precedes the onset of frailty(primary sarcopenia),but sarcopenia may also result from pathogenic mechanisms and that disorder is termed secondary *** diagnosis is confirmed by the presence of low muscle quantity or *** parameters need to be measured:muscle strength,muscle quantity and physical *** standard method to evaluate muscle mass is by analyzing the tomographic total cross-sectional area of all muscle groups at the level of lumbar 3rd *** may negatively impact on the postoperative outcomes of patients with colorectal cancer undergoing surgical *** has been described an association between sarcopenia and numerous poor short-term CRC outcomes like increased perioperative mortality,postoperative sepsis,prolonged length of stay,increased cost of care and physical *** may also negatively impact on overall survival,disease-free survival,recurrence-free survival,and cancerspecific survival in patients with non-metastatic and metastatic colorectal ***,patients with sarcopenia seem prone to toxic effects during chemotherapy,requiring dose deescalations or treatment delays,which seems to reduce treatment efficacy.A multimodal approach including nutritional support(dietary intake,high energy,high protein,and omega-3 fatty acids),exercise programs and anabolic-orexigenic agents(ghrelin,anamorelin),could contribute to muscle mass *** of sarcopenia screening to the established clinical-pathological scores for patients undergoing oncological treatment(chemotherapy,radiotherapy or surgery)seems to be the next step for the best of care of CRC pati

关键词： Colorectal cancer Sarcopenia Nutrition Muscle mass loss Oncologic outcomes Survival

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Clinical assessment and management of liver fibrosis in nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2020年第39期26卷 5919-5943页

作者： Alejandro Campos-Murguía Astrid Ruiz-Margáin JoséA González-Regueiro Ricardo U Macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

Non-alcoholic fatty liver disease(NAFLD)is among the most frequent etiologies of cirrhosis worldwide,and it is associated with features of metabolic syndrome;the key factor influencing its prognosis is the progression of liver *** review aimed to propose a practical and stepwise approach to the evaluation and management of liver fibrosis in patients with NAFLD,analyzing the currently available *** the assessment of NAFLD patients,it is important to identify clinical,genetic,and environmental determinants of fibrosis development and its *** properly detect fibrosis,it is important to take into account the available methods and their supporting scientific evidence to guide the approach and the sequential selection of the best available biochemical scores,followed by a complementary imaging study(transient elastography,magnetic resonance elastography or acoustic radiation force impulse)and finally a liver biopsy,when *** help with the selection of the most appropriate method a Fagan′s nomogram analysis is provided in this review,describing the diagnostic yield of each method and their post-test probability of detecting liver ***,treatment should always include diet and exercise,as well as controlling the components of the metabolic syndrome,+/-vitamin E,considering the presence of sleep apnea,and when available,allocate those patients with advanced fibrosis or high risk of progression into clinical *** final end of this approach should be to establish an opportune diagnosis and treatment of liver fibrosis in patients with NAFLD,aiming to decrease/stop its progression and improve their prognosis.

关键词： Non-alcoholic fatty liver disease Liver fibrosis Clinical assessment Diagnosis Treatment Test accuracy

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Prognostic performance of an index based on lactic dehydrogenase and transaminases for patients with liver steatosis and COVID-19

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World Journal of Gastroenterology 2022年第37期28卷 5444-5456页

作者： Ricardo Ulises Macías-Rodríguez Alberto Adrián Solís-Ortega Victoria J Ornelas-Arroyo Astrid Ruiz-Margáin Maria Sarai González-Huezo Nestor A Urdiales-Morán Berenice M Román-Calleja Juan M Mayorquín-Aguilar JoséA González-Regueiro Alejandro Campos-Murguía Israel Vicente Toledo-Coronado Mónica Chapa-Ibargüengoitia Bernardo Valencia-Peña Carlos Fernando Martínez-Cabrera Nayelli C Flores-García Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Gastroenterology Centro Médico ISSEMYMToluca 52140Mexico Department of Radiology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

BACKGROUND Metabolic associated fatty liver disease(MAFLD)is associated with complications and mortality in patients with coronavirus disease 2019(COVID-19).However,there are no prognostic scores aimed to evaluate the risk of severe disease specifically in patients with MAFLD,despite its high *** dehydrogenase,aspartate aminotransferase and alanine aminotransferase have been used as markers of liver ***,we propose an index based on lactate dehydrogenase,aspartate aminotransferase and alanine aminotransferase for the prediction of complications and mortality in patients with MAFLD and *** To evaluate the prognostic performance of an index based on lactate dehydrogenase and transaminases(aspartate aminotransferase/alanine aminotransferase)in patients with COVID-19 and MAFLD[liver fibrosis and nutrition(LNF)-COVID-19 index].METHODS In this retrospective cohort study,two cohorts from two different tertiary centers were *** first was the derivation cohort to obtain the score cutoffs,and the second was the validation *** included hospitalized patients with severe COVID-19 and *** steatosis was evaluated by computed tomography *** under the receiver operating characteristic(ROC)curve analysis and survival analysis were *** In the derivation cohort,44.6%had MAFLD;ROC curve analysis yielded a LFN-COVID-19 index>1.67 as the best cutoff,with a sensitivity of 78%,specificity of 63%,negative predictive value of 91%and an area under the ROC curve of *** the multivariate analysis,the LFN-COVID-19 index>1.67 was independently associated with the development of acute kidney injury(odds ratio:1.8,95%confidence interval:1.3-2.5,P<0.001),orotracheal intubation(odds ratio:1.9,95%confidence interval:1.4-2.4,P<0.001),and death(odds ratio:2.86,95%confidence interval:1.6-4.5,P<0.001)in both *** LFN-COVID-19 index has a good performance to predict prognosis in patients with MAFLD and COVID-19,which

关键词： COVID-19 Metabolic associated fatty liver disease Lactate dehydrogenase Transaminases Prognosis Nonalcoholic fatty liver disease

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Hematological abnormalities in liver cirrhosis

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World Journal of Hepatology 2024年第9期16卷 1229-1244页

作者： Oscar Manuel Fierro-Angulo JoséAlberto González-Regueiro Ariana Pereira-García Astrid Ruiz-Margáin Fernando Solis-Huerta Ricardo Ulises Macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico 14080Mexico Department of Hematology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico 14080Mexico

Hematological abnormalities are common in cirrhosis and are associated with various pathophysiological *** have documented a prevalence of thrombocytopenia,leukopenia,and anemia in patients with compensated cirrhosis of 77.9%,23.5%,and 21.1%,*** abnormalities carry significant clinical implications,including considerations for invasive procedures,infection risk,bleeding risk,and ***,cirrhosis was believed to predispose patients to bleeding due to alterations observed in classical coagula-tion tests such as prothrombin time,partial thromboplastin time,international normalized ratio,and ***,this understanding has evol-ved,and cirrhosis patients are now also acknowledged as being at a high risk for thrombotic *** in cirrhosis patients presents a complex pheno-type,with procoagulant and anticoagulant abnormalities offsetting each *** multifactorial phenomenon is inadequately reflected by routine laboratory *** complications are more prevalent in decompensated cirrhosis and may correlate with disease *** is primarily associated with portal hypertension,endothelial dysfunction,mechanical vessel injury,dissem-inated intravascular coagulation,endotoxemia,and renal *** review comprehensively outlines hematologic index abnormalities,mechanisms of hemostasis,coagulation,and fibrinolysis abnormalities,limitations of laboratory testing,and clinical manifestations of bleeding and thrombosis in patients with liver cirrhosis.

关键词： Cirrhosis Anemia Leukopenia Thrombocytopenia Coagulopathy Bleeding Thrombosis

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Secondary sclerosing cholangitis after critical COVID-19:Three case reports

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World Journal of Hepatology 2022年第8期14卷 1678-1686页

作者： Juan M Mayorquín-Aguilar Aldo Lara-Reyes Luis Alberto Revuelta-Rodríguez Nayelli C Flores-García Astrid Ruiz-Margáin Marco Antonio Jiménez-Ferreira Ricardo Ulises Macías-Rodríguez Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Pathology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

BACKGROUND The global coronavirus disease 2019(COVID-19)pandemic has caused more than 5 million *** involvement is well described,including liver *** patients with critical COVID-19,a new entity called"post-COVID-19 cholangiopathy"has been *** SUMMARY Here,we present three patients with severe COVID-19 that subsequently developed persistent cholestasis and chronic liver *** three patients required intensive care unit admission,mechanical ventilation,vasopressor support,and broad spectrum antibiotics due to secondary *** transplant protocol was started for two of the three *** Severe COVID-19 infection should be considered a potential risk factor for chronic liver disease and liver transplantation.

关键词： SARS-CoV-2 Persistent cholestasis Liver chemistry Hypoxic cholangiopathy Case report

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