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Childhood Cholelithiasis in a high prevalent populationBile duct disease and gallstone (cholelithiasis) have been considered an uncommon cause of acute abdominal pain in children compared to adults. However, there are significant differences with the adult gallstone disease: increased proportion of patients with an underlying condition, higher incidence of acalculous cholecystitis and lower frequency of choledocolithiasis. With ultrasound examination, it is possible to detect early gallstone in the fetal period and in asymptomatic patients, explaining the increase in gallstone incidence. This disease is more common than suggested in western literature and its diagnosis is increasing as well. The high prevalence of gallstone in adult population in Chile creates an ideal setting for cholesterol and gallstone candidate gene testing. Although the clinical diagnosis of gallstone is simple, there is no consensus about the best therapy in children, explained partially by the lack of knowledge of the natural history of the disease. The role of gallstone disease acquired early in life in gallbladder carcinoma deserves special attention. RESUMENLas enfermedades de la vía biliar y los cálculos vesiculares (colelitiasis) han sido consideradas como una causa poco frecuentes de dolor abdominal agudo en niños, a diferencia de lo que ocurre en adultos. Sin embargo, existen diferencias sustanciales con el adulto como son una mayor proporción de casos con causa identificable, mayor incidencia de colecistitis sin cálculos y menor frecuencia de coledocolitiasis. Con la masificación del ultrasonido es posible detectar litiasis biliar en etapa intrauterina, y en pacientes asintomáticos, lo que estaría explicando, en parte, el aumento de su incidencia. La litiasis biliar es más frecuente de lo sugerido clásicamente en la literatura occidental y su diagnóstico está en aumento. La alta prevalencia de colelitiasis en población adulta chilena, posicionan a nuestro país como un escenario ideal para el estudio de genes candidatos asociados a la etiopatogénesis de la litiasis de colesterol. Si bien el diagnóstico de la litiasis es relativamente simple, no hay consenso en la terapia de elección, lo que se explica fundamentalmente por una historia natural desconocida. El rol de la litiasis de colesterol a edades tempranas en la etiopatogénesis de procesos neoplásicos de la vía biliar merece especial atención.

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Vaccines under development: Helicobacter pyloriHelicobacter pylori causes gastrointestinal disease including peptic ulcer and gastric cancer. An H. pylori vaccine is relevant because of the high prevalence of the infection and its associated complications. Extensive use of traditional antimicrobial therapies to eradicate H. pylori is not feasable, specially in developing countries, in part because of their high cost, associated adverse effects, the risk of reinfection, and the emergence of antimicrobial drug resistance. Numerous animal studies have been performed to determine infection outcomes and to explore the feasibility of a vaccine eradication or prevention of infection. These animal models with the possible exception of monkeys, have not been sufficient to address fundamental issues due to controversial results. A human model of H. pylori infection needs to be developed aimed to select an optimum vaccine candidate. The ultimate scientific goal will be to develop field studies using advanced vaccine candidates, but the current state of knowledge does is insufficient and has provided such candidates. These studies need to be designed in order to provide relevant information on immunity and pathogenesis associated to H. pylori.