Seudodiverticulosis intramural esofágica. Un nuevo caso

La seudodiverticulosis intramural esofágica es una enfermedad rara, de origen desconocido, que cursa de forma benigna y que afecta en especial a enfermos varones en la quinta década de su vida. Se presenta el caso de un enfermo varón en edad temprana con disfagia de larga evolución, en quien el diagnóstico se consiguió mediante estudios radiológicos. El tratamiento con dilataciones fue eficaz tanto en controles clínicos como radioló gicos

Introduction. Changes in the gastric mucosal barrier appear to play a fundamental role in the physiopathology of acute gastric mucosal lesions secondary to sepsis. The efficacy and integrity of this barrier depend to a great extent on its hydrophobicity, which requires the presence of a phospholipid layer, of which phosphatidylcholine (PC) is the major component. Somatostatin (SS) has been found to exert a protective effect on the gastric mucosa, while pentoxifylline (PTXF) is known to reduce tissue damage in different experimental models of sepsis. Objectives. To investigate PC synthesis by the gastric mucosa in a model of sepsis induced by lipopolysaccharide (LPS) in rats, as well as the possible involvement of arachidonic acid metabolites and oxygen free radicals in gastric mucosal damage. Material and methods. The animals were divided into 6 groups: control (saline/saline), control (SS/SS), control (PTXF/PTXF), LPS/saline, LPS/SS and LPS/PTXF. LPS (10 mg/kg body weight) was administered intraperitoneally 30 or 120 minutes prior to treatment. Tritiated choline was administered simultaneously with saline, SS or PTXF as a marker of PC synthesis. All the rats were sacrificed 2 hours after treatment (150 or 240 minutes after LPS administration) and their stomachs were resected and rinsed. PC, prostanoids (PGE2, PGI2, TXB2 and LTB4) and malondialdehyde (MDA) were extracted and measured and myeloperoxidase (MPO) activity was assessed.
Results. LPS administration induced a decrease in PC synthesis as well as changes in prostanoid production. We observed an increment in polymorphonuclear cell infiltration, as indicated by the MPO activity, and increased lipid peroxidation, according to the MDA concentration. Both SS and PTXF totally or partially reversed these effects.
Conclusions.. Our results show that PTXF and SS counteract some of the physiopathologic mechanisms involved in acute gastric mucosa lesions secondary to sepsis and, thus, may prove beneficial in the treatment of these lesions