Management of analgesia in acute pancreatitis: Results of a national survey. / Manejo de la analgesia en la pancreatitis aguda. Resultados de una encuesta nacional.

INTRODUCTION: Acute pancreatitis is one of the main reasons for digestive admissions. Adequate pain treatment is crucial in its management. However, there are hardly any descriptions of the analgesic guidelines used in our setting. METHODS: On-line survey on analgesic management in acute pancreatitis, aimed at attending physicians and residents practising in Spain. RESULTS: Two hundred and nine physicians from 88 centres responded to the survey. Ninety percent were specialists in gastrointestinal medicine and 69% worked in a tertiary centre. The majority (64.4%) do not routinely use scales to measure pain. When choosing a drug, experience in its use was the most important factor. The most commonly prescribed initial treatments are: combination of paracetamol and metamizole (53.5%), paracetamol alone (19.1%) and metamizole alone (17.4%). As rescue: meperidine (54.8%), tramadol (17.8%), morphine chloride (17.8%) and metamizole (11.5%). Continuous perfusion is used in 8.2% of initial treatments. Physicians with >10 years of service use more metamizole as monotherapy (50%), while residents and attending physicians with <10 years of service prescribe it in combination with paracetamol (85%). If progression is needed, morphine chloride and meperidine are mainly used. The speciality of the respondent, the size of the work centre and the unit/service where the patients were admitted did not influence the analgesia prescribed. Satisfaction with pain management reached 7.8/10 (SD 0.98). CONCLUSION: In our setting, metamizole and paracetamol are the most commonly used analgesics as initial pain treatment in acute pancreatitis, and meperidine is the most commonly used rescue analgesic.

Primary adenocarcinoma of the fourth portion of the duodenum, an unsuspected diagnosis.

Small bowel adenocarcinoma is a rare tumor accounting for only 0.3-0.4% of all gastrointestinal tumors, with duodenal adenocarcinoma being the most common subtype. In most patients, it presents with nonspecific signs and symptoms, often leading to a delay in diagnosis. Therefore, it is essential to establish an adequate initial clinical suspicion to carry out an adequate diagnostic approach, being necessary to perform both radiological and endoscopic diagnostic techniques.

Dubin-Johnson syndrome as a laparoscopic finding.

We present the case of a 35-year-old female with a history of polycystic ovary syndrome, treated with oral contraceptives. She was under study due to nine months evolution of pain in the right iliac fossa, associated with hyporexia and mild hyperbilirubinemia with a predominance of the conjugated fraction (total Bi 3.7 mg/dl, conjugated Bi 2.9 mg/dl). An abdominal computed tomography (CT) was performed showing homogeneous hepatosplenomegaly and adenopathies in both iliac chains, the largest in the right external iliac chain of 1.6 x 3.6 cm.

Esophageal lichen planus: a rare cause of dysphagia.

Lichen planus (LP) is an idiopatic inflammatory disorder of mucocutaneous tissue, most frequently involving the skin or oral cavity, and rarely the esophagus, resulting in symptomatic dysphagia. Esophageal lichen planus most commonly presents in middle-aged women and the endoscopic finding are not specific; erosions, exudates, pseudomembranes and even stenosis can be found. Treatment generally starts with oral glucocorticoid. The risk of malignant transformation justifies endoscopic follow-up.

Use of patency capsule in daily practice.

We read with great interest the paper by Albuquerque et al. entitled "Predictive factors of small bowel patency in Crohn's disease patients". Despite being a safe procedure, capsule endoscopy (CE) retention is a complication that should be kept in mind, especially in Crohn's disease (CD) patients. However, the risk of CE retention can be minimized using the patency capsule (PC). Although some clinical trials confirm its effectiveness, its use in daily practice has been poorly investigated. Albuquerque et al. report a PC negative predictive value (NPV) of 100% in this setting.