To analyze our experience with adenoma detection rates in patients with liver cirrhosis in a community setting. Colorectal cancer (CRC) is the third most common cancer and leading cause of cancer death in men and women in the USA. The majority of CRCs arise from premalignant polyps (adenomas), which are typically detected and removed during colonoscopy. Data are limited on the risk of CRC in patients with various chronic liver diseases and the association between CRC and demographics, liver disease etiology and colonoscopy findings. A total of 351 colonoscopies were performed (2006 to 2019) in patients with liver cirrhosis. Mean age was 62.3 ± 9.4 years, there were 158 females and 193 males. Adenomas were found in 159 procedures (49.07

Introduction. Irritable bowel syndrome (IBS) accounts for a significant deterioration in the quality of life of patients who suffer from it and is a common reason for consultation in gastroenterology. The treatment of this syndrome includes a wide variety of medications and recommendations based on different factors of its physiopathology. However, the results are usually variable and sometimes unsatisfactory for either the patient or the treating physician. The main objective of the present work is to describe the different treatments used by gastroenterologists in the management of IBS in Argentina. Materials and methods. Questionnaire of forty-seven questions, prepared by experts, distributed by medical associations of gastroenterology in Argentina and answered by specialists via Google Forms. Results. 304 responses, 157 from women (51.6%) and 147 from men (48.4%). The mean age was 44 and 49.9 years, respectively. 87.5% consider improvement of quality of life as the main goal of treatment. Regarding physiopathology of diarrhea variant irritable bowel syndrome (IBS-D), 49.5% considered emotional stress, while for constipation variant irritable bowel syndrome (IBS-C), 42.8% considered it multifactorial, with a predominance of slow colonic transit. No treatment option was rated as very effective by more than 50% of the respondents. Rifaximin was considered the most effective treatment in IBS-D, while polyethylene glycol was for IBS-C. Statistical significant differences were observed among gastroenterology subspecialties in the treatment of IBS-D with respect to the efficacy of diet, amitriptyline and antibiotics other than rifaximin, and regarding the effectiveness for bisacodyl/picosulfate and antibiotics in the treatment of IBS-C. Conclusion. The most common pathophysiological mechanism in IBS-D is stress. The vast majority of respondents consider that the main goal of treatment is the improvement of the quality of life, over symptomatic relief. None of the drugs is considered very effective in the treatment of the different IBS variants by at least 50% of those surveyed. Statistically significant differences were observed in the proportion of monthly consultations for IBS regarding to age and in the effectiveness considered for some treatments in relation to the subspecialty of physicians. The therapeutic approach to IBS by Argentine gastroenterologists is varied and somewhat heterogeneous, resulting in a still inappropriate management of this condition.

Introduction. The heterotopic gastric mucosal patch or inlet patch is the presence of gastric columnar mucosa outside the stomach, most frequently located in the proximal esophagus. Its manifestations vary from esophageal and extraesophageal reflux symptoms to major complications, most of them being asymptomatic. Aim. To determine the prevalence of cervical heterotopic gastric mucosa in our environment and its association with esophageal and extraesophageal reflux symptoms. Material and methods. Prospective cross-sectional and observational study; consecutive patients who came to our institution between December 2018 and October 2019 for diagnostic upper gastrointestinal videoendoscopy were included, following a questionnaire on clinical manifestations. Results. A total of 1,408 patients were included. In 89 (6.3%), a cervical heterotopic gastric mucosal patch was described. The mean age of the patients without this condition was 54.6 and 55.5 in patients with it. The esophageal symptoms of gastroesophageal reflux (heartburn, regurgitation, and chest pain) in patients with cervical heterotopic gastric mucosa was observed in 40 (44.9% / p = 0.473), 12 (13.5% / p = 0.783) and 4 (4.5% / p = 0.199) patients respectively. The presence of extraesophageal symptoms (globus, chronic cough, dysphonia, and throat clearing) in patients with cervical heterotopic gastric mucosa was: 9 (10.1% / p = 0.011); 7 (7.9% / p = 0.155); 4 (4.5% / p = 0.458) and 9 (10.1% / p = 0.036) respectively. Conclusions. A statistically significant association was found between the presence of cervical heterotopic gastric mucosal patch and symptoms of globus (p = 0.011) and throat clearing (p = 0.036). It could be interpreted that this group of patients would benefit from the research and treatment of this condition with the intention of improving their symptoms.

Background and Objectives. Since the onset of the COVID-19 pandemic, concerns have been raised regarding the risk of infection to both healthcare staff and patients during gastrointestinal endoscopy procedures. Given the importance of performing routine endoscopic procedures to an individual’s future health, we sought to estimate the risk of COVID-19 infection for healthcare staff and patients undergoing endoscopic studies at an ambulatory endoscopy center during the pandemic. Material and Methods. This is a prospective(and) analytical cohort study conducted in an ambulatory gastroenterology center located in the Autonomous City of Buenos Aires, Argentina. Patients undergoing different endoscopic procedures were evaluated for COVID-19 between April 14 and August 31, 2020. COVID-19 was also evaluated in all healthcare and associated staff during the same time period. The risk (cumulative incidence) of acquiring COVID-19 in all patients and staff was calculated. Results. Between April 14 and August 31, 2020, procedures were performed in 3,745 patients with a mean age of 51.12 years; 2,102 (56.18%) were male and 1,643 (43.82%) were female. Follow-up was completed in 3,492 patients, 18 of whom tested positive for COVID-19 standing for an incidence of 0.52% (95%CI 0.31 – 0.81%). Six (5.45%) out of 110 staff members were infected with COVID-19 (1 endoscopist, 4 endoscopy assistants and 1 administrative staff member). In this group, the incidence of positive tests for COVID-19 was 5.45% (95%CI: 2.03 – 11.50%). The increased rates of positive cases among our patients and healthcare professionals were respectively 7.9 and 23.6 times lower than in general population. Conclusion. During the study period, the proportion of COVID-19 infections in our ambulatory specialized in gastrointestinal endoscopy was low and much lower than that in the general population for both patients and healthcare professionals. Endoscopic procedures undertaken at this center were low risk, likely due to strict compliance with established pandemic protocols. Future studies should compare the risk of infection in the hospital setting.

Rome IV incorporated a new diagnostic category into the functional esophageal disorders group called reflux hypersensitivity. This new name replaced the term hypersensitive esophagus and included patients with normal acid reflux parameters but with symptomatic correlation with reflux events. Functional heartburn, which denoted lack of correlation between symptoms and reflux events in the background of normal pH test, and reflux hypersensitivity, should be excluded in heartburn patients who failed proton pump inhibitor treatment. Reflux hypersensitivity patients demonstrates esophageal hypersensitivity to reflux (any type), and both, reflux hypersensitivity and functional heartburn’s symptoms are driven by central and peripheral sensitization. The correct differentiation between these two esophageal disorders allows a therapeutic approach with greater chance of success. Neuromodulators are considered the mainstay of treatment for these patients even though patients with reflux hypersensitivity demonstrate response to anti-reflux treatment as well.

INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer and leading cause of cancer death in men and women in the US. Premalignant polyps are common, occurring in 25-50% of all people of screening age, and about 5% of the population will develop CRC in their lifetime. In patients with cirrhosis, colonoscopy is performed routinely for CRC screening and for a variety of indications related to GI complications of cirrhosis as well as to assess eligibility for liver transplantation. We aimed to analyze our experience with colonoscopy findings in patients with liver cirrhosis in a community setting. Methods: All colonoscopies performed in patients with a diagnosis of liver cirrhosis at South Denver Gastroenterology, P.C. in between 2006 and 2019 were retrospectively analyzed. First, a Poisson Generalized Linear Mixed Model (GLMM) was used to analyze the effect size of gender and age. Then, the effect of multiple colonoscopies was evaluated in a sub-cohort by including it as an effect in the model along with sex and age. Last, a binary GLMM was used to detect associations linking colonoscopy indications to findings. Results: Our study included 351 outpatient elective colonoscopies performed in patients with liver cirrhosis for the following indications: colon cancer screening (n = 147), prior personal or family history of colon polyps or cancer (n = 109), diarrhea (n = 31), constipation (n = 8), anemia (n = 31), GI bleed (n = 28) and abdominal pain (n = 12). Mean age of the group was 62.3 +/- 9.4 years; 158 patients were female and 193 were male. Adenomatous polyps were found in 159 procedures (49.07%, Table 1) and were 4 times more likely to be in the right colon (76.73%) than the left colon (18.87%). Left-sided adenoma occurrence was 61% lower in women than men (P = 0.042). Neither indication for the procedure (P = 0.08) nor advancing age (P = 0.94) impacted ADR. In patients with multiple colonoscopies (n = 49), there was no increase in number of adenomas found in subsequent exams (P = 0.11) on the contrary, significantly less right sided adenomatous polyps were detected (P = 0.025). Conclusion: Adenoma detection rate in elective colonoscopies performed in a community setting in patients with liver cirrhosis is greater than that in the general population, regardless of indication, gender and age. Our ADR (49%) was greater than that usually reported in the literature (23-30%). Male patients were more likely to have left sided colon adenomas than females, the impact of cirrhosis etiology and hormonal milieu is raised.Figure 1.: Frequency and number of adenomas found in colonoscopies in patients with liver cirrhosis.Table 1.: Frequency of adenomas found in patients with liver cirrhosis according to age

Introduction. Barrett Esophagus is an acquired condition secondary to gastroesophageal reflux disease, and it´s the main risk factor for Esophageal Adenocarcinoma. Although there is controversy about tissue sampling at endoscopy when segments are lesser than 10 mm, the prevalence of ultrashort Barrett´s esophagus is up to 20%. Objective. To estimate ultrashort Barrett Esophagus prevalence in a poblational cohort of Argentina and to assess the presence of dysplasia. Methods. A cross-sectional study of the endoscopic and pathological reports of ultrashort Barrett suspicion in an outpatient endoscopy center was performed during 2016-2017. 894 patients were enrolled. Results. 52% of the cohort were male, whose mean age was 56 years (± 12 years). Average Body Mass Index was 26 ± 4 kg/m2. Endoscopically, 50% had hiatal hernia and mean length was 2.32 ± 0.59 cm. Virtual chromoendoscopy was applied in 60% of patients. Ultrashort Barrett´s Esophagus prevalence was 25% (IC 95%), 224/894 patients. Median length was 0.74 ± 0.24 cm. Male sex and presence of hiatal hernia showed a statistically significant association with ultrashort BE presence in multivariate analysis. Conclusion. Ultrashort BE was identified in 25% of the patients, being more frequent in male sex and in patients with hiatal hernia; two variables that are independently related to intestinal metaplasia. Dysplasia was not observed.

Functional chest pain accounts for about a third of the patients with noncardiac chest pain. It is a very common functional esophageal disorder that remains even today a management challenge to the practicing physician. Based on the definition offered by the Rome IV criteria, diagnosis of functional chest pain requires a negative workup of noncardiac chest pain patients that includes, proton pump inhibitor test or empirical proton pump inhibitor trial, endoscopy with esophageal mucosal biopsies, reflux testing, and esophageal manometry. The mainstay of treatment are neuromodulators that are primarily composed of anti-depressants. Alternative medicine and psychological interventions may be provided alone or in combination with other therapeutic modalities.

Globus is an area of interest for many medical specialists including otorhinolaryngologists, gastroenterologist, allergists, and psychiatrists. It may be caused by an organic disease, but it is not uncommon that an underlying etiology remains unidentified even after a full workup has been performed. Patients who suffer from globus usually visit several physicians from different specialties without finding a solution for their symptoms. Identifying the underlying cause of globus is not always a simple task; therefore, structural or functional abnormalities of the thyroid, larynx, pharynx, and esophagus should be investigated. Gastroesophageal reflux disease is commonly considered to be the underlying cause after being identified in an otorhinolarygeal (ear, nose, and throat) evaluation, which is usually the first diagnostic step. In the last few years, an inlet patch in the proximal esophagus has been shown to be associated with globus, and its elimination has resulted in symptom resolution in some patients. Finally, globus can be associated with psychiatric disorders as well as oropharyngeal hypersensitivity that could be either chemical or mechanical. Treatment is directed toward an identified organic cause; in those with a functional disorder, the mainstay of therapy includes neuromodulators and psychiatric/psychological interventions.

Diverticulosis is an acquired condition resulting from herniation of the mucosa through the muscular layer of the colon. It is more common in Western industrialized countries and is asymptomatic in most patients. Its genesis is associated with multiple factors such as age, body mass index (BMI), lifestyle and diet.