A double-blind crossover trial was performed to test the therapeutic usefulness and safety of lactitol, a beta-galactoside sorbitol, against lactose in 18 patients with chronic portal-systemic encephalopathy (PSE). The study included four periods: two for washout and two for lactitol and lactose administration. During washout periods, which lasted two weeks each, patients were stabilized with neomycin plus milk of magnesia. Lactitol and lactose were administered during four weeks each. Ten patients were randomly assigned to receive lactose (group A) and eight patients to receive lactitol (group B) first. PSE parameters, ie, mental state, number connection test performance, asterixis and blood ammonia levels were assessed fortnightly. Electroencephalographic tracings and stool pHs were evaluated at the end of each study period. After the first administration of lactose and lactitol, no statistically significant differences in PSE parameters were found. At the same stage, a significant stool acidification (P less than 0.05) was detected. It is concluded that lactitol seems to be safe and efficacious in treating patients with chronic PSE.

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Se presenta el caso de un varón de 66 años con gastrectomía Billroth II por ulcus duodenal hace 30 años. Dos episodios previos de melenas con ulcus de boca anastomótica en probable relación con AINE e histología no maligna. Ingresa por melenas sin dispepsia ni repercusión hemodinámica pero con anemia que precisa transfusión, toma previa de Aspirina y ausencia de eosinofilia, sin sospecha de ingesta de alimento mal cocinado.Se realiza gastroscopia precoz con hallazgo de gastrectomía Billroth II con abundante reflujo biliar sin sangre y en cara anterosuperior distal de muñón gástrico ulcus de 2 cm (Forrest IIc) con parásito incrustado en el lecho (Fig. 1). Se procede a la extracción con pinza (Fig. 2). La gastroscopia diferida evidenció ulcus sin estigmas y la histología fue de metaplasia interstinal completa con infiltrado eosinófilo sin parásitos ni H. pylori.La infestación por Anisakis es una zoonosis de incidencia creciente (4 casos/100.000 habitantes/año) producida por un nemátodo del orden Ascaridae. De máxima prevalencia en Japón y en aumento en Europa. El primer caso publicado fue en 1960 (Van Thiel) y en España en 1991. Su ciclo comienza en cetáceos siendo crustáceos y peces huéspedes intermedios y el hombre accidental al ingerir pescado mal cocinado con las larvas en fase III del ciclo. Induce una reacción de hipersensibilidad mixta (tipos I y III) mediada por linfocitos Th e IgE. Histológicamente produce infiltración eosinófila y edema intersticial en fase aguda con granulomas eosinófilos e incluso abscesos al morir el parásito. La clínica presenta un cuadro sistémico y otro Cartas al Director

Inflammatory pseudopolyps associated with inflammatory bowel disease occur on inflamed colon mucosa due to the regeneration and healing of ulcerated epithelium. They are classified as giant when they are over 1.5-cm in diameter. These are a rare, benign complication, but can be similar in appearance to colorectal cancer. It has been reported that they do not usually regress after medical treatment, requiring endoscopic resection or even surgery. In this paper, we report an unusual case with gradual regression of giant pseudopolyps with medical treatment, in a patient with inflammatory bowel disease, and another very uncommon case of a giant pseudopolyp in indeterminate colitis, with obstruction requiring surgery, as it was not possible to rule out carcinoma. A multidisciplinary team is very important.