Revista Española de Enfermedades Digestivas

Portal hypertension is a hemodynamic abnormality that complicates the course of cirrhosis, as well as other diseases that affect the portal venous circulation. The development of portal hypertension compromises prognosis, especially when it rises above a certain threshold known as clinically significant portal hypertension (CSPH). In the consensus conference on Portal Hypertension promoted by the Spanish Association for the Study of the Liver and the Hepatic and Digestive diseases area of the Biomedical Research Networking Center (CIBERehd), different aspects of the diagnosis and treatment of portal hypertension caused by cirrhosis or other diseases were discussed...

A 57-year-old black male patient was admitted with flatulence and post-prandial fullness a month ago. No other gastrointestinal complaints. He had history of arterial hypertension, medicated with nifedipine 30mg/day and hydrochlorthiazide 50mg/day, and had been diagnosed and treated for malaria a week before admission. The patient reported frequent bathing in rivers and smoking habits since the age of 18, around a pack and a half a day. Abdominal ultrasound showed periportal fibrosis, without findings of portal hypertension...

OBJECTIVE: To investigate trends in gastric cancer (GC) incidence in Spain from 1990 to 2019, analysing variations by sex and age. METHOD: GC incidence data from the Global Burden of Disease database and population data from the Spanish National Institute of Statistics were used to calculate age-specific and age-standardized incidence rates (ASIR) with the European population as the reference. Temporal trends by sex and age groups were analyzed using joinpoint regression...

Although most melanomas are diagnosed in early stages of the disease, a significant percentage show metastases from the beginning or during follow-up. The most common route is lymphatic, while hematogenous spread is less frequent. The most common site for metastases is the skin itself, although they can also occur in other organs, including the digestive tract, where the small intestine is the most frequently affected organ (2). We present the case of a 48-year-old woman with a history of superficial spreading melanoma of the cervical region, surgically treated 7 years prior and in remission, who presented with painless jaundice of 48 hours duration, without fever or other infectious focus...

Esophageal squamous cell carcinoma (ESCC) remains the most prevalent subtype of esophageal cancer worldwide. Major risk factors include chronic alcohol consumption and heavy smoking. We present the case of a 65-year-old male with chronic alcoholism and a 75 pack-year smoking history, admitted for his first hydropic decompensation of alcoholic cirrhosis. The patient presented with abdominal distension and discomfort. Physical examination confirmed ascites, and further evaluation indicated decompensated cirrhosis...

Inflammatory cloacogenic polyp is an unusual anorectal lesion associated with benign polyp with malignant appearance. This pathology is associated with mucosal prolapse syndrome and inflammatory intestinal disease. The surgery is the gold standard treatment if malignancy cannot be excluded or the patient is symptomatic.

Sporadic non-ampullary duodenal adenomas are rare (prevalence<0.5%). We present the case of a 73-year-old woman in whom a large duodenal lesion with an adenomatous appearance was visualised during gastroscopy.

Before starting a drug that suppresses immunity, it is of paramount importance to screen for hidden infections in patients with inflammatory diseases. Latent tuberculosis infection (LTBI) is a condition characterized by an immune response to M. tuberculosis antigens without clinical manifestations. The highest risk of progression to active disease occurs in individuals who are immunosuppressed or in children. Patients who are candidates for treatment with TNF-alpha inhibitors should be evaluated with interferon gamma release assays and a chest radiograph...

Splenic infarction is a rare complication present in 7% of pancreatic inflammatory pathologies. This is justified by the close anatomical relationship between the pancreas and the splenic hilum. Although CT is considered the technique of choice for the diagnosis of this type of complications, the growing use of ultrasound in many digestive units, due to its accessibility and safety for patients, allows for early diagnosis and targeted treatment to prevent further complications. Splenectomy is reserved for cases where complications such as splenic abscess, spleen rupture, haemoperitoneum or persistent pain are present...

A 53-year-old man presented with abdominal pain and distension, accompanied with vomiting, and weight loss. Then he was treated with gastrointestinal decompression and enema, but the symptom of abdominal pain and distension continued with no relief. He had no drug or food allergies. He had no family history of liver disease, tuberculosis, asthma, and coagulation disorder. On physical examination, the patient had normal vital signs, abdominal distention, and generalized abdominal pain at palpation, with no rebound tenderness...

Bile acid malabsorption (BAM) is a common cause of chronic diarrhoea. Recent work has shown that it is probably an under-diagnosed entity. BAM is classified into 4 types depending on what conditions it. Type I involves organic involvement of the ileal mucosa. Type II is related to alterations in permeability in what is known as irritable bowel syndrome with a predominance of diarrhoea. Type III is related to other alterations of the digestive tract such as celiac disease, pancreatic insufficiency, cholecystectomy or bacterial overgrowth...

A 48-year-old woman presented to the outpatient clinic with a 4-month history of alternating diarrhea and constipation with bloating. Physical examination revealed a body mass index of 22.89 kg/m², normal development, and no tenderness or rebound tenderness in the abdomen. The patient has maintained a stable body size since birth, with a previously healthy status and no history of abdominal surgery or trauma. Endoscopic examination revealed an abnormal channel between the posterior wall of the duodenal bulb to the hepatic flexure of the colon...

Trousseau Syndrome (TS) is defined as the occurrence of thromboembolic events prior to or simultaneously with the diagnosis of visceral neoplasia. In cases of multiple thromboembolisms, considering the possibility of TS, a screening for neoplasms may be warranted. We present a case study of a 61-year-old female who presented a neurological deficit. Brain magnetic resonance imaging (MRI) showed multiple hyperintense bihemispheric foci in subcortical and cortical regions involving three different vascular territories in the FLAIR sequence, associated with restricted diffusion inferring cytotoxic edema and indicating that they were all recent ischemic lesions, raising the hypothesis of TS...

We present a review of 9 patients (44.4% women, 67.7 +/- 7.3 years) who had undergone diverticular peroral endoscopic myotomy (D-POEM) for symptomatic epiphrenic diverticula (ED) at our Unit from July 2020 to April 2024. One patient had received prior treatment, specifically, laparoscopic resection of the diverticulum, Heller myotomy and partial funduplication in 2014 with clinical improvement. The predominant symptoms were dysphagia and regurgitation and the average Eckardt Score (ES) were 6 +/- 1,1. A co-existing esophageal motility disorder was documented in 8 (88...

We present a 35-year-old Caucasian woman that was sent to the Hepatology clinics of our hospital in December 2023 for new onset jaundice. Without significant past medical history, the patient presented with bloating and dyspepsia for a week. No neurological abnormalities were found. She reported occasional alcohol intake, denying other drug consumption. No recent vaccination. She reported taking an over-the-counter supplement containing turmeric (tablet with 60 mg of curcumin and 10mg of black pepper) twice daily for 2 months with the aim of speedy recovery after CrossFit...

We present the case of a 75-year-old woman who presented to our hospital with upper gastrointestinal bleeding and altered liver function tests. MR cholangiography performed during hospitalization revealed a choledochoduodenal fistula. Gastroscopy confirmed the presence of this fistula, and after surgical correction, an adenocarcinoma at the biliopancreatic junction infiltrating the duodenum was diagnosed. This represents a rare and unusual presentation of biliopancreatic tumors, with endoscopy playing a crucial role in diagnosis...

We report a case of a 48-year-old male with HIV and poor adherence to antiretroviral therapy, presenting with two months of abdominal pain and diarrhea. His latest CD4 count was 11/µL. Imaging and biopsy confirmed CMV enteritis with ulcerated lesions in the distal ileum. Despite prolonged antiviral therapy with ganciclovir and foscarnet, the patient's condition remained refractory, necessitating ileocaecal resection and ileostomy, followed by further resection and anastomosis. Post-surgery, the patient recovered well and was discharged...

A 53-year-old woman was diagnosed with a 15-mm submucosal tumor located in the fundus of the stomach. Endoscopic ultrasonography suggested that the tumor originated from the muscularis propria layer. Therefore, we decided to use a novel hybrid EFTR to remove the lesion. First the tumor was marked and the mucosal was incised, followed by primary tumor dissection. Then the endoscope was withdrawn. A snare was fixed to the transparent cap at the front end of the endoscope without passing through the working channel...

This article describes an unusual case of a submucosal esophageal cancer, which should not typically arise and should not have the appearance that the present case had. This lesion was diagnosed only after endoscopic submucosal excavation was performed, given that the lesion was incorrectly diagnosed as an esophageal leiomyoma. The highlight of this case is that esophageal cancer can present as a benign submucosal tumor of the esophagus.

We present the case of a 57-year-old woman with metastatic colorectal cancer being treated with Bevacizumab and FOLFOX, who came to the emergency department with haematemesis. Gastroscopy showed a duodenal ulcer without active bleeding. Subsequently, he suffered haemodynamic instability and an Angio-CT scan revealed an aortoenteric fistula, requiring urgent surgery. Bevacizumab can cause rare complications such as this, and early detection is crucial for effective treatment.