Browsing by Author "Espino, Alberto"

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    A national online survey applied to patients with celiac disease in Chile
    (SOC MEDICA SANTIAGO, 2011) Espino, Alberto; Castillo L, Cecilia; Guiraldes, Ernesto; Santibanez, Helga; Francisco Miquel, Juan
    Background: Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Its prevalence in Europe and the USA is 0.5 to 1%. Aim: To analyze epidemiological aspect's and degree of compliance with gluten-free diet (GFD) among Chilean individuals with CD. Material and Methods: Subjects with confirmed or suspected CD were invited to answer an online survey published on the web at www.ftmdacionconvivir.cl. The answers were reinforced with a telephone interview. Results: The survey was answered by 1212 subjects (79% females). Median age at diagnosis was 25.8 years (range 1 to 84 years), with a bimodal curve with two peaks at less than 3 years and at 20 to 40 years of age. The diagnosis was made only by serologic markers in 9%, only by intestinal biopsy in 17.5%, and by a combination of both methods in 70%. Conditions associated with CD were reported by 30% of subjects and 20% had relatives with CD. The GFD was strictly adhered to by 70%, occasionally by 27% and never by 3%. Seventy five percent of subjects with a strict adherence to GFD had a favorable clinical response compared with 42% of those with incomplete or lack of adherence (odds ratio 4.0, 95% confidence intervals 2.8-5.7 p < 0.01). Conclusions: In 30% of respondents, the diagnosis of CD was not confirmed according to international guidelines that require serology and duodenal biopsy. One third of subjects recognized a poor compliance with GFD. Those with a strict adherence to it had a more favorable clinical course. However, 25% did not experience a clinical improvement despite a strict GFD, a finding which requires further study (Rev Med Chile 2011; 139: 841-847).
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    Amerindian ancestry proportion as a risk factor for inflammatory bowel diseases: results from a Latin American Andean cohort
    (2023) Pérez Jeldres, Tamara De Lourdes; Magne, Fabien; Ascui, Gabriel; Alvares, Danilo; Orellana, Matias; Álvarez Lobos Manuel Marcelo; Hernández Rocha, Cristián Antonio; Azocar, Lorena; Aguilar, Nataly; Espino, Alberto; Estela, Ricardo; Escobar, Sergio; Zazueta, Alejandra; Baez, Pablo; Silva, Veronica; de la Vega, Andres; Arriagada, Elizabeth; Pávez Ovalle, Carolina Denisse; Diaz-Asencio, Alejandro; Travisany, Dante; Miquel Poblete, Juan Francisco; Villablanca, Eduardo J.; Kronenberg, Mitchell; Bustamante, Maria Leonor
    Background and aimsLatin American populations remain underrepresented in genetic studies of inflammatory bowel diseases (IBDs). Most genetic association studies of IBD rely on Caucasian, African, and Asian individuals. These associations have yet to be evaluated in detail in the Andean region of South America. We explored the contribution of IBD-reported genetic risk variants to a Chilean cohort and the ancestry contribution to IBD in this cohort.MethodsA total of 192 Chilean IBD patients were genotyped using Illumina's Global Screening Array. Genotype data were combined with similar information from 3,147 Chilean controls. The proportions of Aymara, African, European, and Mapuche ancestries were estimated using the software ADMIXTURE. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for gender, age, and ancestry proportions. We also explored associations with previously reported IBD-risk variants independently and in conjunction with genetic ancestry.ResultsThe first and third quartiles of the proportion of Mapuche ancestry in IBD patients were 24.7 and 34.2%, respectively, and the corresponding OR was 2.30 (95%CI 1.52-3.48) for the lowest vs. the highest group. Only one variant (rs7210086) of the 180 reported IBD-risk SNPs was associated with IBD risk in the Chilean cohort (adjusted P = 0.01). This variant is related to myeloid cells.ConclusionThe type and proportion of Native American ancestry in Chileans seem to be associated with IBD risk. Variants associated with IBD risk in this Andean region were related to myeloid cells and the innate immune response.
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    High prevalence of autoimmune gastropathy, clinical characteristics and association with hypothyroidism: prospective analisys of 921 patients with gastric biopsies by sydney protocol
    (2018) Vargas Domínguez, José Ignacio; Maquilon, Sara; Torres, Javiera; Revelo, Santiago; Vargas, Camila; Garcia-Huidobro, Antonia; Castro, Josefina; Candia, Roberto; Gonzalez, Robinson G.; Baudrand, Rene; Espino, Alberto
    BACKGROUND: The prevalence of autoimmune gastropathy is increasing, and is considered underdiagnosed. The application of the Sydney protocol for gastric biopsies will probably allow to detect more cases at an early stage. AIM: To determine the prevalence of autoimmune gastropathy in gastric biopsies according to Sydney-OLGA protocol, and define its clinical and laboratory characteristics. Explore the association of autoimmune gastropathy with other autoimmune diseases. METHODS: Single center prospective observational study. Evaluation of gastric biopsies according to Sydney protocol between July 2016 and July 2017 to determine prevalence of autoimmune gastropathy. Autoimmune gastropathy was defined by histologic criteria as gastric corporal exclusive or predominant atrophy. Identification of histologic, clinical and laboratory findings of patients with autoimmune gastropathy. Descriptive statistics and inferential analysis comparing histological findings of autoimmune gastropathy and H. pylori-associated gastropathy. RESULTS: 921 gastric biopsies were evaluated. Mean age was 58 years (range 27-87), 58% female gender. The prevalence of autoimmune gastropathy was 8.8% (81/921). Presence of OLGA stages 3-4 was higher in autoimmune gastropathy than in HP-associated gastropathy (33.3 vs 15.8%, p = 0.004). Age was no different between the two groups (p=0.82). In the characterization of patients with autoimmune gastropathy, the prevalence of gastric polyps in autoimmune gastropathy was 11% (9/81), 4 of then were NETs. In patients with autoimmune gastropathy, only 3.3% had a previous diagnosis of pernicious anemia, and in 11% the reasons for endoscopy was the study of anemia. 18.5% had family history of gastric cancer. The prevalence of hypothyroidism was 30% (24/81). Other autoimmune disease was less frequent (13.5%). CONCLUSION: Our study shows a high prevalence of autoimmune gastropathy detected by gastric biopsies with Sydney protocol. In most cases, clinical characteristics of pernicious anemia was absent and the suspicion for this disease prior to endoscopy was low. Presence of advanced stages of gastric atrophy were frequent. The prevalence of thyrogastric syndrome, autoimmune gastropathy associated to hypothyroidism, was also frequent. The use of Sydney protocol for gastric biopsies allows to detect a higher proportion of patients with autoimmune gastropathy at early stages of the disease.
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    Prospective follow-up of chronic atrophic gastritis in a high-risk population for gastric cancer in latin america
    (2022) Latorre, Gonzalo; Silva, Felipe; Montero, Isabella; Bustamante, Miguel; Dukes, Eitan; Gandara, Vicente; Robles, Camila; Uribe, Javier; Corsi, Oscar; Crispi, Francisca; Espinoza Sepúlveda, Manuel Antonio; Cuadrado, Cristobal; Fuentes-Lopez, Eduardo; Shah, Shailja; Camargo, M. Constanza; Torres, Javiera; Roa, Juan Carlos; Corvalan, Alejandro H.; Candia, Roberto; Aguero, Carlos; Gonzalez, Robinson G.; Vargas Domínguez, José Ignacio; Espino, Alberto; Riquelme, Arnoldo
    Background. Gastric adenocarcinoma (GA) is preceded by premalignant conditions such as chronic atrophic gastritis (CAG) with or without gastric intestinal metaplasia (GIM). Endoscopic follow-up of these conditions has been proposed as a strategy for the detection of early-stage GA. Aim. To describe the risk of progression to gastric dysplasia (GD) and early-stage GA of patients who underwent esophagogastroduodenoscopy (EGD) with gastric biopsies obtained following the updated Sydney System biopsy protocol (USSBP). Methods. We conducted a real-world, multicenter, prospective cohort study. Patients undergoing EGD surveillance with USSBP were enrolled between 2015 and 2021 from three endoscopy units at Santiago, Chile. Patients with prior history of GA or gastric resection were excluded. Follow-up surveillance schedule was determined by gastroenterologist in accordance with the Chilean Digestive Endoscopy Association Guidelines. CAG was confirmed by two expert GI pathologists and categorized by the Operative Link on Gastritis Assessment as stage 0 (normal) through stage IV (advanced stage). The primary endpoint was a composite of GD (low-grade, LGD or high-grade, HGD) or GA, while secondary endpoints were progression in OLGA and separate outcomes of LGD, HGD or GA. Multivariable Cox regression analysis was used to estimate the association between CAG +/- GIM and the outcomes, adjusted for age, sex and Helicobacter pylori (Hp) infection. Results. 600 patients were included in the cohort (64% female; mean age 58 years). At baseline 32.3% (n=194) had active Hp infection. OLGA stage was: 31% (n=184) OLGA 0, 48% (n=291) OLGA I-II and 21% (125) OLGA III-IV. GIM was identified in 52% (n=312) and autoimmune gastritis in 6.2% (n=37). Median follow-up was 28 months (IQR 17-42). During follow-up, 6 early-stage GA, 3 HGD and 6 LGD were observed. No advanced-stage GA was diagnosed. Only 19% (n=35) of baseline OLGA 0 patients progressed to OLGA I-IV, with <2% progressing to OLGA III/IV (Figure 1). Persistence of Hp infection (aOR 2.1; 95%CI 1.1-4.0) was independently associated with increase of at least 1 point in the OLGA scale during follow-up. GA/GD free survival at 3- years for OLGA 0, I-II and III-IV was 99.4%, 97.1% and 91.7%, respectively (p=0.0015) (Figure 2). Based on multivariable Cox regression, OLGA III-IV (vs. OLGA 0) was associated with a 12.1-fold (95%CI 1.5-97.4) higher risk of GA, while GIM was associated with a 13.0-fold (95%CI 1.7-101.2) higher risk, although the CI was wide; this was particularly between 2 and 3 years of follow-up. Discussion: These findings, including the observation that all GAs were early-stage, support endoscopic/histologic surveillance for patients with advanced OLGA stages or GIM, which is a common finding in patients with advanced CAG. Further studies are needed to determine the optimal time interval for surveillance.