Revista de Gastroenterología del Perú

Enterocolitis secundaria a coinfección parasitaria y bacteriana en un paciente pediátrico de Ecuador: reporte de un caso

2026-01-27T14:12:22-05:00

Casi la mitad de la población mundial, aproximadamente 3 500 millones de personas, está actualmente infectada con al menos un parásito, y alrededor de 1 500 millones de estas infecciones son causadas por helmintos. Estas cifras suelen asociarse con regiones extremadamente empobrecidas como África o el Sudeste Asiático; sin embargo, en el continente americano, una de cada tres personas se ve afectada por infecciones parasitarias, siendo los niños el grupo más vulnerable, con aproximadamente 43 millones de casos. Esta situación representa más que un problema de salud pública, ya que su mitigación depende no solo de programas de profilaxis farmacológica, sino también de acciones sinérgicas que involucren políticas públicas y la asignación de recursos destinados a modificar los determinantes de salud que facilitan estas infecciones. En este estudio, presentamos un caso clínico de coinfección parasitaria por helmintos y protozoos, agravada por la presencia concomitante de tres cepas enteropatógenas de Escherichia coli. Este informe tiene como objetivo describir en detalle los factores de riesgo, presentación clínica, microbiología y patogénesis de los agentes infecciosos involucrados, así como la utilidad de los estudios de laboratorio necesarios para su identificación oportuna.

From presumed metastasis to infection: coccidioidomycosis mimicking metastatic gastroesophageal adenocarcinoma

2026-04-17T11:54:20-05:00

Early gastroesophageal junction (GEJ) cancer commonly presents without distant disease. The development of locoregional lymphadenopathy and acute pulmonary embolism raises concern for metastatic disease and may lead to inappropriate upstaging if not properly investigated. We present a 51-year-old immunocompetent Hispanic man with newly diagnosed T1a GEJ adenocarcinoma who developed FDG-avid mediastinal lymphadenopathy and an incidental subsegmental pulmonary embolism on staging computed tomography. Histological sampling via endobronchial ultrasound-guided fine needle aspiration revealed granulomatous inflammation without malignancy. Further workup confirmed an acute Coccidioides lymphadenitis. The patient was successfully treated with fluconazole 400 mg daily for three months, with complete radiological and endoscopic resolution. This case underscores the critical importance of histological confirmation of lymphadenopathy before attributing it to metastatic disease in early-stage GEJ cancer. Failure to consider infectious etiologies, particularly coccidioidomycosis in endemic areas or in patients with travel history, may result in unnecessary upstaging, inappropriate treatment escalation, and avoidable harm.

Metástasis ganglionar cervical como presentación inicial de carcinoma esofágico pobremente diferenciado que simula origen mamario: un desafío diagnóstico

2026-05-10T02:01:44-05:00

El cáncer de esófago es una neoplasia maligna de alta mortalidad, frecuentemente diagnosticada en estadios avanzados debido a su presentación clínica inespecífica. La disfagia progresiva constituye el síntoma cardinal; sin embargo, en ocasiones puede manifestarse inicialmente mediante metástasis ganglionares, lo que dificulta la identificación del tumor primario. Se presenta el caso de una mujer de 49 años con tumoración cervical derecha de crecimiento progresivo asociada a disfagia de tres meses. La tomografía evidenció un nódulo en el espacio carotídeo derecho. La biopsia ganglionar reveló metástasis de carcinoma pobremente diferenciado. La inmunohistoquímica mostró positividad para CK7, GATA3 focal débil y receptores hormonales, sugiriendo inicialmente origen mamario; no obstante, los estudios mamarios fueron negativos. Posteriormente, la tomografía torácica identificó engrosamiento mural esofágico, confirmado mediante endoscopia y biopsia como carcinoma esofágico pobremente diferenciado con estenosis significativa. Se realizó gastrostomía para soporte nutricional y se planificó tratamiento con quimiorradioterapia. La presentación inicial del cáncer de esófago como adenopatía cervical metastásica es infrecuente y puede generar confusión diagnóstica, especialmente cuando el perfil inmunohistoquímico sugiere otro origen tumoral. Reconocer estas formas atípicas es fundamental para orientar la búsqueda del tumor primario y establecer un tratamiento oportuno.

Scientific productivity of gastroenterologists in Peru: a nationwide cross-sectional study

2026-03-08T20:57:17-05:00

Objectives: To describe the characteristics of scientific publications by Peruvian gastroenterologists. Materials and methods: A descriptive cross-sectional study was conducted in a random sample of 357 gastroenterologists registered with the Colegio Médico del Perú as of July 2025. The literature search was performed in PubMed/MEDLINE, Scopus, and Google Scholar between August and October 2025, including articles published up to 2024. Results: Most gastroenterologists were male (64.2%), with a median age of 49 years (IQR: 39-63). Overall, 42.9% had published at least one scientific article, mostly 1-2 publications; only 5.9% had more than 10 articles. The median h-index was 1 (IQR: 1-2). A total of 559 articles were identified, of which 61.5% were published in Peruvian journals and 67.3% in Spanish. Original articles accounted for 56.7%, predominantly with analytical designs, and 53.9% were published in Q3-Q4 journals. The median number of citations per article was 2 (IQR: 0-6). Among articles with more than 10 citations, only 10.2% had a Peruvian gastroenterologist as first author. The main research topics were Helicobacter pylori and gastric diseases, hepatology, and diagnostic and therapeutic endoscopy. Conclusions: Fewer than half of Peruvian gastroenterologists have published at least one scientific article, and among those who did, both productivity and academic impact were low. Publications were mainly concentrated in local, lower-quartile journals, with few citations.

Trends in the clinical presentation of celiac disease over time: a study from a national university hospital in Uruguay

2026-03-09T09:10:37-05:00

The clinical presentation of celiac disease (CD) has evolved over recent decades. Understanding these shifts is essential to strengthen diagnostic suspicion and improve detection. Objectives: To evaluate temporal trends in the clinical presentation of CD at a university hospital in Uruguay. Materials and methods: A retrospective cross-sectional study, approved by the institutional ethics committee, was conducted. It included patients diagnosed with CD between 1970 and 2023 who presented positive IgA anti-tissue transglutaminase antibodies and compatible duodenal histology (Marsh III). Patients were categorized by diagnostic period: before 1986, 1986-1995, 1996-2005, 2006-2015, and 2016-2023. Clinical presentation was classified according to the Oslo criteria as classical, non-classical, or asymptomatic. Results: A total of 331 patients were included; 84% were female. The mean age at diagnosis was 32 years (range 0-77), showing a progressive shift toward adulthood diagnosis. Overall, 61% presented with classical CD, 27% with non-classical CD, and 12% were asymptomatic. Linear trend analysis demonstrated a significant decrease in classical CD (slope -15.7, p=0.0003), accompanied by an increase in non-classical (slope 12.5, p=0.00267) and asymptomatic presentations (slope 3.15, p=0.042). Conclusions: Over the past four decades, CD presentation has shifted toward later diagnosis and away from classical phenotypes, with an increasing recognition of non-classical and asymptomatic forms. These findings underscore the importance of maintaining clinical suspicion beyond traditional malabsorptive presentations.

Risk factors for thiopurine-related toxicity in Latin American inflammatory bowel disease patients

2026-03-17T22:06:55-05:00

Objectives: Thiopurines continue to play a role in inflammatory bowel disease (IBD) treatment, particularly in resource-limited countries. However, there are scarce data from Latin America regarding thiopurines-associated AE. We aim to describe the thiopurine-associated AE and determine risk factors for its occurrence. Materials and methods: Clinical data from IBD patients treated with thiopurines in a Chilean tertiary centre were retrospectively collected including AE that required thiopurine withdrawal and weight-based thiopurine dose. A multivariable model was fitted to determine independent risk factors of thiopurine-related AE. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: A total 163 out of 587 (27.7%) patients discontinued thiopurine treatment due to AE including myelosuppression, hepatitis, pancreatitis, and gastrointestinal intolerance. Multivariate analysis showed that older age (OR: 1.02; 95% CI: 1.01-1.04; p=0.01) and lower body weight (OR: 0.97; 95% CI: 0.95-0.99; p=0.01) were independent risk factors for thiopurine-associated AE. Conclusions: Discontinuation of thiopurines due to AE is frequent in Latin IBD patients. Particular caution should be exerted in older and low-weight IBD patients starting thiopurine treatment.

Comparison between the different suction techniques for eus-guided tissue acquisition in pancreatic diseases and other gastrointestinal lesions: a systematic review and meta-analysis of randomized controlled trials

2026-04-10T11:38:59-05:00

Objectives: Endoscopic ultrasound–guided fine-needle aspiration/biopsy (EUS-FNA/B) is pivotal for diagnosing solid pancreatic lesions and other gastrointestinal (GI) masses. Multiple suction strategies are used to optimize tissue acquisition. Currently, their comparative performance remains uncertain. Materials and methods: We searched PubMed, Medline, Cochrane, and Ovid through July 2025 for English-language. RCTs comparing four suction methods during EUS-FNA/B of solid pancreatic or other GI lesions. Primary outcomes were specimen tissue adequacy and diagnostic accuracy. Results: Twenty-two RCTs encompassing 2,922 patients were included; pancreas was the sampled organ in 81% of cases, with the remainder primarily lymph nodes. Across 20 RCTs reporting adequacy, WS was associated with lower specimen adequacy than no suction (RR 0.88, 95% CI 0.77-0.99). WS likewise yielded lower diagnostic accuracy than no suction (RR 0.89, 95% CI 0.82-0.97). In head-tohead comparisons versus DS, differences among DS, SSP/capillarity, no suction, and WS were generally nonsignificant. Ranking analyses favoured no suction as the top performer and consistently placed WS lowest for both adequacy (p=0.92 vs 0.06, respectively) and accuracy (p=0.96 vs 0.04, respectively). In the needle-stratified analysis, results were concordant: with 22-G devices, WS showed lower adequacy (RR 0.86, 95% CI 0.74-0.99) and lower accuracy (RR 0.86, 95% CI 0.77-0.95) than with no suction. Conclusions: This meta-analysis suggests that wet suction may be associated with lower diagnostic yield and reduced tissue adequacy compared to no suction, especially with 22G needles. However, outside of these comparisons, no consistent differences were observed among the other techniques. Future comparative studies with standardized methodology and stricter control of confounding factors are needed.

Guía informada por la evidencia para el manejo de la enfermedad de Crohn en población adulta: recomendaciones de la Pan American Crohn's and Colitis Organisation (PANCCO)

2026-08-16T02:09:59-05:00

Introducción. La enfermedad de Crohn (EC) es una enfermedad inflamatoria intestinal crónica, recidivante y progresiva cuya incidencia y prevalencia han aumentado de forma sostenida en América Latina, asociadas a la urbanización y la occidentalización de los estilos de vida. Su curso heterogéneo, el daño estructural acumulativo y el impacto en la calidad de vida justifican recomendaciones regionales que orienten el tratamiento médico, endoscópico y quirúrgico de los adultos afectados. Objetivo. Presentar las recomendaciones informadas por la evidencia de la guía de la Pan American Crohn's and Colitis Organisation (PANCCO) para el manejo de la EC en adultos latinoamericanos. Metodología. La guía se desarrolló mediante adaptación y actualización de la guía de la Asociación Colombiana de Gastroenterología (2020), siguiendo las orientaciones de la OPS/OMS. Un grupo desarrollador interdisciplinario formuló siete preguntas clínicas en formato PICO; cuatro fueron actualizadas mediante búsquedas sistemáticas (enero 2020–febrero 2026) en MEDLINE, Embase, Cochrane y Epistemonikos, con evaluación de calidad mediante AMSTAR-2, ROBIS, RoB 2.0 y ROBINS-I, y calificación de la certeza y formulación de recomendaciones mediante el sistema GRADE. Resultados. Se formularon 52 recomendaciones organizadas en siete preguntas clínicas sobre predicción de recaída, inducción y mantenimiento de la remisión con terapia convencional, terapia avanzada en enfermedad moderada a grave, enfermedad perianal fistulizante, abordaje quirúrgico-endoscópico y prevención de la recurrencia posquirúrgica, complementadas con puntos de buena práctica clínica. Conclusiones. Esta guía reúne la evidencia más reciente disponible para el tratamiento de la EC en adultos, incorporando el uso de terapias avanzadas, el manejo multidisciplinario de la enfermedad perianal fistulizante, y el papel de la cirugía y la endoscopia terapéutica, ofreciendo un marco práctico para la toma de decisiones clínicas en el contexto de recursos y necesidades propio de América Latina.