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P0042 GASTROESOPHAGEAL REFLUX AND CHRONIC CONSTIPATION: IS THERE ANY RELATION?
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Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
C. Difficile toxin A and B. At first we stopped ciprofloxacin and treated him with intravenous metronidazole. Due to his remaining symptoms and leucocytocis, he was then administered with vancomycin per os, this was being the successful treatment. The diagnosis was confirmed by colon endoscopy, where lesions of pseudomembranous colitis were found. Discussion & conclusion: C. difficile -associated disease is increasing in frequency and severity and has become a major focus of the medical literature. Complications such as pseudomembranous colitis,toxic megacolon,intestinal perforation and sepsis may appear from the beginning,widowing a very difficult differential diagnosis.The appearance of more resistant strains dictates a very careful usage of broad spectrum antibiotics in our effort to fight infections. Keywords: Clostridium Difficile, toxic megacolon, cefuroxime, vancomycin
P0041 PARTIAL INTESTINAL OBSTRUCTION DUE TO THE PORTAL VEIN THROMBOSIS AS CLINICAL PRESENTATION FOR A NON-HODGKIN’ LYMPHOMA – CASE REPORT
Gabriela Udrea, Igor Balan, Marilena Stoica. Dr I Cantacuzino Clinical Hospital Introduction: Non-Hodgkin lymphoma is a rare cause of portal vein thrombosis. To the best of our knowledge non-Hodgkin lymphoma causing partial intestinal obstruction with simultaneous portal vein thrombosis has not yet been reported. Case report: A 72-years-old man presented with colicky abdominal pain, abdominal distension and constipation. Physical examination revealed hepatosplenomegaly, varices of the lower leg and Kaposy dermatitis of the lower leg. Blood samples did not show any abnormalities except for a high ESR (erythrocyte sedimentation rate). We investigated patient by colonoscopy, abdominal ultrasound, esophagogastroduodenoscopy, abdominal CT, bonemarrow biopsy, peripheral blood smear. Diagnosis: Non-Hodgkin lymphoma - marginal zone lymphoma type (L26/CD20 positive, UCHL1 positive, DBA44 positive) with hepatic infiltration causing portal hypertension and portal vein thrombosis. Management anticoagulants and chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone). Keywords: partial intestinal obstruction, hepatosplenomegaly, portal hypertension, portal vein thrombosis, lymphoma
P0042 GASTROESOPHAGEAL REFLUX AND CHRONIC CONSTIPATION: IS THERE ANY RELATION?
João Xavier Jorge 1 , Claudia Cardoso Borges 2 , Álvaro Correia Coelho 3 , Carlos Costa Almeida 1 . 1 University of Coimbra- Faculty of Medicine; 2 Service of Internal Medicine (hospital Santo André- Leiria); 3 Department of Internal Medicine (centro Hospitalar of Coimbra) Introduction: Some investigators believe that physiological alterations which conditionate gastroesophagus reflux subsist in all gastrointestinal tracts. In this base, for them, it’s common between individuals with gastrointestinal reflux other symptoms as chronic constipation. The main of this work is to contribute for the knowledge of that eventual relation. Material and methods: A questionnaire based in gastrointestinal symptoms scale (GISC) was made to 266 healthy adult individuals (149 women and 117 men), with ages between 22 and 81 years old and mean age of 44,84 years old. We have analyzed the frequency of chronic constipation and the gastroesophageal reflux (GER) isolated and we have correlated these symptoms. Results: From the total 266, 87 (32,7%) referred chronic constipation and 98 (36,84%) complained of gastroesophagus reflux. Alone, the constipation have been referred by 58 individuals (21,8%), while the gastrointestinal reflux have been referred by 69 individuals (25,93%). The complains of chronic constipation and gastrointestinal associated have been referred by 26 individuals (10,9% of the total). The gravity of symptoms (in %), presented the following tendency: symptoms of constipation in the groups (constipation isolated/constipation+GER): minimum (26,7/24,1); medium (26,8/24,1), moderated (20,7/20,7); moderately severe (18,9/17,4); severe (1,7/3,45); very intense (5,1/10,3). The symptoms of GER in the groups (GER isolated/GER+constipation): minimum (52,1/48,2); medium (21,3/20,7); moderated (11,6/13,8); moderately severe (8,7/10,3); severe (1,4/6,9); very intense (4,3/0,0). Conclusions: The chronic constipation and the GER presented more fre-
quently isolated than associated in this group. The gravity of symptoms was similar in groups in which it has been presented isolated or associated.
P0043 MANOMETRIC CHARACTERISTIC OF WAVES IN THE ESOPHAGEAL BODY IN TYPE 2 DIABETIC PATIENTS ACCORDING TO THE BASAL MORNING GLYCEMIA
João Xavier Jorge 1 , Cláudia Cardoso Borges 1 , Edgard Augusto Panão 3 , Maria Henriqueta Oliveira 5 , Manuel Resende Oliveira 5 , Amilcar Lima Silva 4 , Mário Amaral Simões 1 , Álvaro Correia Coelho 4 , Carlos Costa Almeida 1 . 1 University of Coimbra- Faculty of Medicine; 2 Service of Internal Medicine (hospital Santo André- Leiria); 3 Department of Gastroenterology (centro Hospitalar of Coimbra); 4 Department of Internal Medicine (centro Hospitalar of Coimbra); 5 Service of Biochemistry (centro Hospitalar of Coimbra) Introduction: Recent studies referred there is the possibility of existing an influence of acute glycemia on the esophagus’ motor activities and the other parts of gastrointestinal tracts. Other investigators refuse that any possibility could exist when relating to the same fact. Our objective is to have a say in the knowledge of this phenomena. Material and methods: The esophageal body’s motor activity was studied by stationary manometry with 6-channel catheter in 25 type 2 diabetic patients aged between 44 and 81 years old (mean age 58,25 years old) with different glycemic levels in fast. We have compared the manometric characteristics of esophageal waves between diabetics with glycemia equal or lower than 7,0 mmol/l and above 7,0 mmol/l. Results: The percentual distribution of esophageal waves in both groups (glicemia<7,1 mmol/l/glycemia>7,0 mmol/l) was: peristaltic waves=(84,9/80,1); no transmitted waves=(4,5/16,3); retrograde waves=(3,5/2,0); simultaneous waves=(6,2/1). When relating to the waves’ amplitude, mean and maximum strength in 3 different channels (P), we verified in both groups (glycemia<7,1 mmol/l/ glycemia>7,0 mmol/l) that: amplitude: P1=(32,3/31,1), P2=(44,8/44,2), P3=(49,2/49,8); mean amplitude=(42,2/41,7); mean strength: P1=(22,8/25,5), P2=(29,6/31,4), P3=(28,8/31,2): mean strength’s mean=(27,1/28,9); maximum strength: P1=(39,7/39,5), P2=(52,1/52,3), P3=(52,3/56,5); maximum strength’s mean=(49,1/49,3). The velocity of waves were similar between the both groups Conclusion: In the studied type 2 diabetic we saw that the percentage of nontransmitted waves was significantly higher between patients with glycemia in fast>7,0 mmol/l than with glicemia <7,1 mmol/l (4,5/16,3% p<0,01). The other characteristics of the esophageal waves didn’t reveal any significant difference.
P0044 RELATION BETWEEN RECTAL CAPACITY AND THE VELOCITY OF RADIO OPAQUE MARKERS IN THE DIGESTIVE TUBE: IS THERE ANY?
João Xavier Jorge 1 , Hugo Cruz Matos 2 , Cláudia Cardoso Borges 3 , Joaquim Pinto Machado 2 , Edgard Augusto Panão 4 , Mário Amaral Simões 1 , Àlvaro Correia Coelho 5 , Carlos Costa Almeida 1 . 1 University of Coimbra- Faculty of Medicine; 2 Department of Imagery (centro Hospitalar of Coimbra); 3 Service of Internal Medicine (hospital Santo André- Leiria); 4 Department of Gastroenterology (centro Hospitalar of Coimbra); 5 Department of Medicine (centro Hospitalar of Coimbra) Introduction: The rectal distention by faeces origin physiologic reflexes which modify the motility and the velocity of gastrointestinal continent. However, a little is known about the any relation witch may exist between the rectal capacity and the velocity of gastrointestinal transit. Our aim is to contribute for this acknowledgement. Material and methods: A stationary recto anal manometry with 6-channel catheter had been made in a 25 Caucasoid healthy (13 women and 12 men), aged between 22 and 81 years old. The maxima rectal capacity of an air balloon has been evaluated. In the other hand, the same individuals swallowed 25 radio opaque particles and an abdominal radiography was made 24 hours after that. According the maxima rectal capacity, the individuals were distributed for 3 groups: Rectal capacity (in ml of air) <150 (N=12); 151-200 (N=8); >200 (N=5). The number of particles in each segment of the gastrointestinal tract (GIT) was verified. The relation between both phenomena was analyzed into each group. Results: The percentage of particles in the intestine (colon) in each group (<150/151-200/>200 ml), in relation with the total swallowed for each
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
C. Difficile toxin A and B. At first we stopped ciprofloxacin and treated him with intravenous metronidazole. Due to his remaining symptoms and leucocytocis, he was then administered with vancomycin per os, this was being the successful treatment. The diagnosis was confirmed by colon endoscopy, where lesions of pseudomembranous colitis were found. Discussion & conclusion: C. difficile -associated disease is increasing in frequency and severity and has become a major focus of the medical literature. Complications such as pseudomembranous colitis,toxic megacolon,intestinal perforation and sepsis may appear from the beginning,widowing a very difficult differential diagnosis.The appearance of more resistant strains dictates a very careful usage of broad spectrum antibiotics in our effort to fight infections. Keywords: Clostridium Difficile, toxic megacolon, cefuroxime, vancomycin
P0041 PARTIAL INTESTINAL OBSTRUCTION DUE TO THE PORTAL VEIN THROMBOSIS AS CLINICAL PRESENTATION FOR A NON-HODGKIN’ LYMPHOMA – CASE REPORT
Gabriela Udrea, Igor Balan, Marilena Stoica. Dr I Cantacuzino Clinical Hospital Introduction: Non-Hodgkin lymphoma is a rare cause of portal vein thrombosis. To the best of our knowledge non-Hodgkin lymphoma causing partial intestinal obstruction with simultaneous portal vein thrombosis has not yet been reported. Case report: A 72-years-old man presented with colicky abdominal pain, abdominal distension and constipation. Physical examination revealed hepatosplenomegaly, varices of the lower leg and Kaposy dermatitis of the lower leg. Blood samples did not show any abnormalities except for a high ESR (erythrocyte sedimentation rate). We investigated patient by colonoscopy, abdominal ultrasound, esophagogastroduodenoscopy, abdominal CT, bonemarrow biopsy, peripheral blood smear. Diagnosis: Non-Hodgkin lymphoma - marginal zone lymphoma type (L26/CD20 positive, UCHL1 positive, DBA44 positive) with hepatic infiltration causing portal hypertension and portal vein thrombosis. Management anticoagulants and chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone). Keywords: partial intestinal obstruction, hepatosplenomegaly, portal hypertension, portal vein thrombosis, lymphoma
P0042 GASTROESOPHAGEAL REFLUX AND CHRONIC CONSTIPATION: IS THERE ANY RELATION?
João Xavier Jorge 1 , Claudia Cardoso Borges 2 , Álvaro Correia Coelho 3 , Carlos Costa Almeida 1 . 1 University of Coimbra- Faculty of Medicine; 2 Service of Internal Medicine (hospital Santo André- Leiria); 3 Department of Internal Medicine (centro Hospitalar of Coimbra) Introduction: Some investigators believe that physiological alterations which conditionate gastroesophagus reflux subsist in all gastrointestinal tracts. In this base, for them, it’s common between individuals with gastrointestinal reflux other symptoms as chronic constipation. The main of this work is to contribute for the knowledge of that eventual relation. Material and methods: A questionnaire based in gastrointestinal symptoms scale (GISC) was made to 266 healthy adult individuals (149 women and 117 men), with ages between 22 and 81 years old and mean age of 44,84 years old. We have analyzed the frequency of chronic constipation and the gastroesophageal reflux (GER) isolated and we have correlated these symptoms. Results: From the total 266, 87 (32,7%) referred chronic constipation and 98 (36,84%) complained of gastroesophagus reflux. Alone, the constipation have been referred by 58 individuals (21,8%), while the gastrointestinal reflux have been referred by 69 individuals (25,93%). The complains of chronic constipation and gastrointestinal associated have been referred by 26 individuals (10,9% of the total). The gravity of symptoms (in %), presented the following tendency: symptoms of constipation in the groups (constipation isolated/constipation+GER): minimum (26,7/24,1); medium (26,8/24,1), moderated (20,7/20,7); moderately severe (18,9/17,4); severe (1,7/3,45); very intense (5,1/10,3). The symptoms of GER in the groups (GER isolated/GER+constipation): minimum (52,1/48,2); medium (21,3/20,7); moderated (11,6/13,8); moderately severe (8,7/10,3); severe (1,4/6,9); very intense (4,3/0,0). Conclusions: The chronic constipation and the GER presented more fre-
quently isolated than associated in this group. The gravity of symptoms was similar in groups in which it has been presented isolated or associated.
P0043 MANOMETRIC CHARACTERISTIC OF WAVES IN THE ESOPHAGEAL BODY IN TYPE 2 DIABETIC PATIENTS ACCORDING TO THE BASAL MORNING GLYCEMIA
João Xavier Jorge 1 , Cláudia Cardoso Borges 1 , Edgard Augusto Panão 3 , Maria Henriqueta Oliveira 5 , Manuel Resende Oliveira 5 , Amilcar Lima Silva 4 , Mário Amaral Simões 1 , Álvaro Correia Coelho 4 , Carlos Costa Almeida 1 . 1 University of Coimbra- Faculty of Medicine; 2 Service of Internal Medicine (hospital Santo André- Leiria); 3 Department of Gastroenterology (centro Hospitalar of Coimbra); 4 Department of Internal Medicine (centro Hospitalar of Coimbra); 5 Service of Biochemistry (centro Hospitalar of Coimbra) Introduction: Recent studies referred there is the possibility of existing an influence of acute glycemia on the esophagus’ motor activities and the other parts of gastrointestinal tracts. Other investigators refuse that any possibility could exist when relating to the same fact. Our objective is to have a say in the knowledge of this phenomena. Material and methods: The esophageal body’s motor activity was studied by stationary manometry with 6-channel catheter in 25 type 2 diabetic patients aged between 44 and 81 years old (mean age 58,25 years old) with different glycemic levels in fast. We have compared the manometric characteristics of esophageal waves between diabetics with glycemia equal or lower than 7,0 mmol/l and above 7,0 mmol/l. Results: The percentual distribution of esophageal waves in both groups (glicemia<7,1 mmol/l/glycemia>7,0 mmol/l) was: peristaltic waves=(84,9/80,1); no transmitted waves=(4,5/16,3); retrograde waves=(3,5/2,0); simultaneous waves=(6,2/1). When relating to the waves’ amplitude, mean and maximum strength in 3 different channels (P), we verified in both groups (glycemia<7,1 mmol/l/ glycemia>7,0 mmol/l) that: amplitude: P1=(32,3/31,1), P2=(44,8/44,2), P3=(49,2/49,8); mean amplitude=(42,2/41,7); mean strength: P1=(22,8/25,5), P2=(29,6/31,4), P3=(28,8/31,2): mean strength’s mean=(27,1/28,9); maximum strength: P1=(39,7/39,5), P2=(52,1/52,3), P3=(52,3/56,5); maximum strength’s mean=(49,1/49,3). The velocity of waves were similar between the both groups Conclusion: In the studied type 2 diabetic we saw that the percentage of nontransmitted waves was significantly higher between patients with glycemia in fast>7,0 mmol/l than with glicemia <7,1 mmol/l (4,5/16,3% p<0,01). The other characteristics of the esophageal waves didn’t reveal any significant difference.
P0044 RELATION BETWEEN RECTAL CAPACITY AND THE VELOCITY OF RADIO OPAQUE MARKERS IN THE DIGESTIVE TUBE: IS THERE ANY?
João Xavier Jorge 1 , Hugo Cruz Matos 2 , Cláudia Cardoso Borges 3 , Joaquim Pinto Machado 2 , Edgard Augusto Panão 4 , Mário Amaral Simões 1 , Àlvaro Correia Coelho 5 , Carlos Costa Almeida 1 . 1 University of Coimbra- Faculty of Medicine; 2 Department of Imagery (centro Hospitalar of Coimbra); 3 Service of Internal Medicine (hospital Santo André- Leiria); 4 Department of Gastroenterology (centro Hospitalar of Coimbra); 5 Department of Medicine (centro Hospitalar of Coimbra) Introduction: The rectal distention by faeces origin physiologic reflexes which modify the motility and the velocity of gastrointestinal continent. However, a little is known about the any relation witch may exist between the rectal capacity and the velocity of gastrointestinal transit. Our aim is to contribute for this acknowledgement. Material and methods: A stationary recto anal manometry with 6-channel catheter had been made in a 25 Caucasoid healthy (13 women and 12 men), aged between 22 and 81 years old. The maxima rectal capacity of an air balloon has been evaluated. In the other hand, the same individuals swallowed 25 radio opaque particles and an abdominal radiography was made 24 hours after that. According the maxima rectal capacity, the individuals were distributed for 3 groups: Rectal capacity (in ml of air) <150 (N=12); 151-200 (N=8); >200 (N=5). The number of particles in each segment of the gastrointestinal tract (GIT) was verified. The relation between both phenomena was analyzed into each group. Results: The percentage of particles in the intestine (colon) in each group (<150/151-200/>200 ml), in relation with the total swallowed for each