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In this article we present the case and images of an infrequent submucosal gastric tumor: an inflammatory fibroid polyp or Vanek´s tumor. When the tumor size exceeds the centimeter, it may be difficult to differentiate from malignant lesions. Endoscopic removal may be feasible and curative.

Background and objective: the prevalence of gastric polyps in esophagogastroduodenoscopies (EGDs) ranges between 0.33 and 6.35%. The relative frequency of histological subspecies varies widely among published series. The objective is to describe the endoscopic and histological characteristics of the polypoid lesions, and to study possible associations. Material and methods: we retrospectively revised the EGDs done in our center in 2009. Demographic, endoscopic and histological data were gathered. We proceeded to a descriptive analysis and studied possible associations. Results: gastric polypoid lesions were found in 269 of the 6307 (4.2%) reviewed EGDs, 61% were found in women. Mean age was 64.93 years (SD: ±15.23). A single polyp was found in 186 patients (69.1%), over 10 lesions appeared in 31 (11.5%). An estimated size of ≤ 3 mm was found in 108 lesions (37.2%) and greater than 10 mm in 52 cases (17.9%). Most lesions were sessile (90.8%). The location of 34.8% was the gastric antrum, 39.3% were found in the gastric body and 25.9% were in the fundus. Chronic gastritis was confirmed in 53.5% of the patients and 46.5% had received protom pump inhibitors (PPIs). Histopathological diagnosis was: hyperplastic polyps 50.9%, fundic gland polyps 7.4%, adenomas 3%, adenocarcinomas 1.9% and normal mucosa 29.7%. We found no significant association between the histopathological type of lesions and the use of proton pump inhibitor. Conclusions: we found polypoid lesions in 4.2% of the EGDs. The most frequent histopathological findings were hyperplastic polyps (50.9%), followed by fundic gland polyps (7.4%), adenomas (3%), and adenocarcinomas (1.9%).

Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by Leon Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.

Fundamento y objetivo La hemocromatosis hereditaria (HH) presenta una importante variabilidad fenotipica y es una enfermedad en la que influyen muchos factores. Pacientes y metodo Incluimos a 88 pacientes diagnosticados de HH, en los que se analizo los principales datos clinicos y analiticos y se valoro la influencia de 6 variables en la intensidad de la sobrecarga de hierro. Resultados Un 38,6% (intervalo de confianza [IC] del 95%, 28,5-49,6) de los pacientes no mostro ninguno de los sintomas tipicos de la enfermedad. Un 30,9% (IC del 95%, 21,7-41,7) presentaba alteraciones del metabolismo de la glucosa. Se detecto elevacion de la sideremia en un 75,0% (IC del 95%, 64,4-83,3), del indice de saturacion de la transferrina (IST) en un 95,4% (IC del 95%, 88,1-98,5) y de la ferritina serica en un 93,2% (IC del 95%, 85,1-97,1) de los casos, respectivamente, ademas de objetivarse una elevacion de la alaninoaminotransferasa y de la fosfatasa alcalina en un porcentaje apreciable de pacientes. La ferritina se elevo significativamente mas en varones (1.329,4 [913,2] frente a 656,6 [644,5] ng/ml; p Conclusiones Los pacientes de HH presentan una marcada variabilidad fenotipica, por lo que los sintomas sirven unicamente como orientacion diagnostica. Debe profundizarse en la relacion entre la HH y el metabolismo de la glucosa. Los indices relacionados con el hierro pueden estar influidos por la edad, el sexo, el genotipo, la donacion habitual de sangre, la ingesta de alcohol y la infeccion por el virus de la hepatitis C.

We report the case of a female patient who was diagnosed with Vogt-Koyanagi-Harada disease at the age of 14 years and who developed myelopathy, resulting in paraparesis. A cerebral magnetic resonance imaging scan revealed the presence of T2-hyperintense lesions in the periventricular white matter, suggesting demyelinization. Twelve years later, ulcerative colitis was diagnosed during workup for abdominal pain associated with bloody diarrhea. The association of these two diseases has previously been reported anecdotically. The management of the ulcerative colitis was complicated by the patient's neurological manifestations. Even though recent reports support the use of anti-TNF drugs in the management of Vogt-Koyanagi-Harada-associated uveitis, because of the lack of experience in patients with neurological symptoms, and the presence of apparently demyelinating lesions in our patient, we did not use these drugs in this case.

Metformin is an oral antidiabetic agent frequently used to manage type II diabetes. This drug produces nonspecific gastrointestinal symptoms in 5-20% of patients and, more rarely, has also been associated with severe adverse effects such as lactic acidosis. Only a few isolated cases of hepatotoxicity due to this drug have been documented. We report the case of an 83-year-old man with constitutional syndrome and hepatic biochemical alterations, which were attributed to metformin after ruling out an oncologic etiology and observing complete clinical and biochemical resolution after withdrawal of the drug.

Consulta de Alto Riesgo de Cancer Colorrectal. Unidad de Endoscopia. Department of Gastroenterology. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain. Endoscopy Division. National Cancer Center Hospital. Tokyo, Japan. Department of Gastroenterology. Fujita Health University University School of Medicine. Aichi, Japan. Department of Gastroenterology. Hospital Virgen de la Arrixaca. Murcia, Spain. Department of Pathology. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain. Departmento of General and Digestive Surgery. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain PICTURES IN DIGESTIVE PATHOLOGY

Fundamento y objetivo Se analiza la influencia de la erradicacion de Helicobacter pylori en la evolucion clinica de enfermos con urticaria cronica idiopatica, cuestion controvertida en la bibliografia Pacientes y metodo Se estudio la evolucion de los sintomas dermatologicos tras la erradicacion de la infeccion por H. pylori en un grupo de 55 pacientes diagnosticados previamente de urticaria cronica idiopatica e infectados por dicha bacteria Resultados El 74,6% (intervalo de confianza del 95%, 61–85%) de los pacientes estudiados presento mejoria parcial o total de los sintomas cutaneos. No se detecto influencia estadisticamente significativa del sexo, de la edad o de los hallazgos endoscopicos en la evolucion clinica de la urticaria tras la erradicacion Conclusiones Los resultados indican la posible utilidad de la erradicacion de H. pylori en algunos pacientes con urticaria cronica idiopatica, aunque es necesaria la realizacion de estudios aleatorizados

Like other chronic diseases, inflammatory bowel disease impairs the quality of life of affected individuals, with an impact on all phases of sexual functioning. The most important factors in this dysfunction are depressed mood, inflammatory activity and concomitant diseases. While the main objective of physicians is to improve the systemic and gastrointestinal symptoms of this disease, other factors are also involved in restoring quality of life. Although sexual problems are a concern to patients, this topic has been insufficiently studied and is not generally taken into account by physicians treating inflammatory bowel disease. If comprehensive care is to be provided to patients with inflammatory bowel disease, sexuality should be approached directly and patients should be referred to appropriate specialists if dysfunction is detected.

We report the case of a female patient who was diagnosed with Vogt-Koyanagi-Harada disease at the age of 14 years and who developed myelopathy, resulting in paraparesis. A cerebral magnetic resonance imaging scan revealed the presence of T2-hyperintense lesions in the periventricular white matter, suggesting demyelinization. Twelve years later, ulcerative colitis was diagnosed during workup for abdominal pain associated with bloody diarrhea. The association of these two diseases has previously been reported anecdotically. The management of the ulcerative colitis was complicated by the patient's neurological manifestations. Even though recent reports support the use of anti-TNF drugs in the management of Vogt-Koyanagi-Harada-associated uveitis, because of the lack of experience in patients with neurological symptoms, and the presence of apparently demyelinating lesions in our patient, we did not use these drugs in this case.

Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.

Metformin is an oral antidiabetic agent frequently used to manage type II diabetes. This drug produces nonspecific gastrointestinal symptoms in 5-20% of patients and, more rarely, has also been associated with severe adverse effects such as lactic acidosis. Only a few isolated cases of hepatotoxicity due to this drug have been documented. We report the case of an 83-year-old man with constitutional syndrome and hepatic biochemical alterations, which were attributed to metformin after ruling out an oncologic etiology and observing complete clinical and biochemical resolution after withdrawal of the drug.

Hereditary hemochromatosis (HH) displays an important phenotypic variability and is a disease influenced by many factors.We included 88 patients with HH. Main clinical and laboratory data were analyzed, and the influence of 6 variables on intensity of iron overload was evaluated.In 38.6% (95% confidence interval [CI], 28.5-49.6%) patients, none of the typical symptoms of the disease was observed. 30,9% (95% CI, 21.7-41.7%) showed abnormalities of the glucose metabolism. We detected an increase in sideremia in 75.0% patients (CI 95%, 64.4-83.3%), transferrin saturation index (TSI) in 95.4% (CI 95%, 88.1-98.5%) and ferritin in 93.2% (CI 95%, 85.1-97.1%) of patients. In addition, we observed increased values of GPT and alkaline phosphatase in an appreciable percentage of patients. Ferritin was significantly higher in men (1329.4 [913.2] ng/ml vs 656.6 [644.5] ng/ml; p0.001), and in those older than 45 years (1293.9 [1006.9] ng/ml vs 868.9 [642.8] ng/ml; p = 0.023] and in not blood donors (1205.2 [926.8] vs 524.8 [365.9] ng/ml; p0.001). TSI was 81.9% (19.6) in C282Y homozygotes and 65.7% (19.2) in the rest of HFE genotypes (p = 0.002). Differences of TSI with regard to sex, age or status of blood donor were not detected. Sideremia was significantly higher in patients infected by virus C (251.8 [24.4] microg/dl vs 182.8 [45.8] microg/dl; p = 0.001).HH patients have a noticeable phenotypic variability, and for that reason clinical symptoms are only orientative for the diagnosis. The relationship between HH and glucose metabolism should be investigated further. Iron parameters can be influenced by age, sex, HFE genotype, blood donation, alcohol intake and hepatitis C virus infection.

We intended to analyze the influence of Helicobacter pylori eradication on the clinical evolution of patients with chronic idiopathic urticaria.The evolution of dermatological symptoms after eradication was studied in a group of 55 patients previously diagnosed with chronic idiopathic urticaria who were infected by Helicobacter pylori.There was a partial or complete improvement in 74.6% (CI 95%, 61-85%) of studied patients. We could not demonstrate a statistically significant influence of sex, age or endoscopic lesions on the clinical evolution of urticaria after eradication.These results suggest a possible usefulness of Helicobacter pylori eradication in some patients with chronic idiopathic urticaria. Controlled and randomized studies are necessary to confirm it.