RESUMEN
Background: Helicobacter pylori (Hp) infection predisposes to malignant and non-malignant diseases warranting eradication. In Belgium, resistance rates for clarithromycin demonstrate regional variations making the use of standard triple therapy (STT) borderline acceptable. According to a recent Belgian survey, STT and bismuth-based quadruple therapy (BQT), are equally frequent prescribed as first line treatment for treatment naïve Hp positive patients. This study aims to evaluate the eradication rates (ER) of BQT versus STT. Methods: Multicentre, non-blinded randomized, prospective study comparing ER in treatment-naïve Hp positive patients. ER were compared by intention to treat (ITT) and per protocol (PP) analysis. Results: Overall 250 patients were included (STT 126, BQT 124). Seventeen patients were lost to follow-up (6,8%). No significant difference in ER between BQT and STT was observed in ITT (73% vs 68%, p= 0,54) neither in PP analysis (81% vs 75%, p= 0,33). Side effects and endoscopic findings were comparable between groups. Post-hoc analysis showed no differences according to gender or site allocation. Conclusion: The numerical advantage of BQT did not translate in a significant improvement of ER when compared with STT. These results question the cost-effectiveness of BQT, while confirming the suboptimal eradication rates on STT. A nationwide monitoring of resistance patterns, maximal investments in treatment adherence as well as a detailed follow-up of the changing treatment landscape are mandatory to continuously optimise Hp ER in Belgium.
Asunto(s)
Antibacterianos , Bismuto , Quimioterapia Combinada , Infecciones por Helicobacter , Helicobacter pylori , Humanos , Infecciones por Helicobacter/tratamiento farmacológico , Femenino , Masculino , Bélgica , Helicobacter pylori/efectos de los fármacos , Persona de Mediana Edad , Bismuto/uso terapéutico , Estudios Prospectivos , Antibacterianos/uso terapéutico , Adulto , Inhibidores de la Bomba de Protones/uso terapéutico , Inhibidores de la Bomba de Protones/administración & dosificación , Anciano , Claritromicina/uso terapéutico , Amoxicilina/uso terapéutico , Amoxicilina/administración & dosificación , Metronidazol/uso terapéutico , Resultado del TratamientoRESUMEN
This document analyzes the reasons for organizing an abdominal ultrasound training for Belgian trainees in hepatogastroenterology. The hepatogastroenterology speciality should implement, together with the radiology speciality and the national scientific and professional associations, the minimum training requirements which are proposed by the European Board of Gastroenterology and Hepatology and the European Federation of Societies for Ultrasound in Medicine and Biology. Trainees in hepatogastroenterology should acquire the same theoretical and practical training as radiologists, they should be taught and supervised by competent instructors and have their expertise evaluated.
Asunto(s)
Enfermedades del Sistema Digestivo/diagnóstico por imagen , Educación de Postgrado en Medicina , Gastroenterología/educación , Ultrasonografía , Abdomen/diagnóstico por imagen , Europa (Continente) , HumanosRESUMEN
Colorectal cancer (CRC) is the commonest site for malignancy in Europe. The Commissioner for Health wishes to promote screening for colorectal, breast and cervical cancer in Europe. The aim of this study was to assess public knowledge of CRC in Europe and likely take up of free screening. To this end 20710 members of the public from 21 European countries were interviewed by means of a regular survey amongst consumers (Omnibus survey) using 13 stem questions. Forty-eight per cent thought the population were at equal risk of CRC, only 57% were aware of age and 54% of family history as risk factors. Although 70% were aware of dietary factors, only 30% knew that lack of exercise might be a risk factor. Only 51% had knowledge of CRC screening but 75% were 'very', or 'quite interested, in taking up faecal occult blood (FOB) screening if offered free. Barriers to screening were lack of awareness of risk (31%), youth (22%) and an un-anaesthetic test (19%). There was a big cultural difference in willingness of the public to discuss bowel symptoms: there was a major barrier in Finland (91%), Britain (84%), Luxembourg (82%), Poland (81%) and Portugal (80%); less of a barrier in Spain (49%), Italy (44%) and Iceland (39%). In conclusion, the challenge of achieving high compliance for CRC screening must be a major objective amongst EU member states and non-aligned countries of Europe in the next decade, because it is known that the non-compliant group are those at greatest risk of death from CRC. This study has shown that awareness of CRC is low in Europe and that an educational programme will be essential to achieve high compliance for CRC screening as a means of reducing deaths from bowel cancer.
Asunto(s)
Actitud Frente a la Salud , Neoplasias Colorrectales/prevención & control , Tamizaje Masivo/organización & administración , Adulto , Distribución por Edad , Anciano , Concienciación , Colonoscopía/métodos , Neoplasias Colorrectales/epidemiología , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sangre Oculta , Cooperación del Paciente , Evaluación de Programas y Proyectos de Salud , Salud Pública , Factores de Riesgo , Distribución por Sexo , Encuestas y CuestionariosRESUMEN
"HP testing must be regarded as ONE of the important elements of the proper diagnostic work-up of a DISEASE, managed in close cooperation between GP's and specialists": that's the key message of the national consensus meeting held in CHU Brugmann on February 6th and 7th 1998. HP testing (usually by 2 direct methods: RUT-histology) and eradication treatment (ER), in infected patients, are strongly recommended in: 1. Past or current GDU (absolute indication), regardless of activity, complication(s), NSAID intake; 2. Low-grade MALT Lymphomas (Stage IE1) unequivocally diagnosed, managed and followed-up in specialised centers; 3. Post endoscopic resection of EGC. ER is advisable in HP carriers with a family history of gastric cancer. Chronic atrophic-, lymphocytic-, giant folds gastritis and hyperplastic polyps are acceptable indications for ER as well as scheduled long-term NSAID treatment in individuals with known HP status. Systematic ER in HP+ patients with fully investigated NUD is not indicated but could be considered in individual patients. Extra alimentary disorders and auto immune gastritis are no indication and there was no consensus for a "test and treat" policy in patients under 45 yrs old without alarm symptoms. Systematic screening of asymptomatic individuals is not recommended. A correct monitoring of eradication after treatment is recommended, mainly by UBT. In severe or refractory PUD, symptom recurrence and follow-up of EGC and Maltomas, endoscopic follow-up with HP testing is mandatory. The recommended first line treatment course (except known allergy or intolerance) is PPI full dose bid, Clarithromycin 500 mg bid Amoxycillin 1000 mg bid (7 days minimal 10 days maximal). RBC-based schemes must be locally validated and quadruple therapy is proposed when retreatment is needed. Culture, optional after the first treatment failure, is strongly recommended after a second failure. Overall, ER therapies are safe and neither the decreased efficacy of acid-lowering drugs, nor the possible increased risk of peptic oesophagitis are considered as contra-indications to eradicate. ER is cost-effective and cost-beneficial in PUD and adjusted number of pills delivered would cut costs. No clear economic data are currently available for a potential benefit of ER in GC prevention or NUD management. A national monitoring of HP resistance (Macrolides and Imidazoles) must be organized by specialised centers.
Asunto(s)
Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/terapia , Infecciones por Helicobacter/terapia , Helicobacter pylori/aislamiento & purificación , Infecciones por Helicobacter/diagnóstico , HumanosAsunto(s)
Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Infecciones por Helicobacter/patología , Helicobacter pylori/aislamiento & purificación , Ureasa/análisis , Biopsia con Aguja , Medios de Cultivo , Infecciones por Helicobacter/microbiología , Helicobacter pylori/enzimología , Humanos , Sensibilidad y EspecificidadAsunto(s)
Antibacterianos , Antiulcerosos/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Inhibidores de la Bomba de Protones , Ensayos Clínicos como Asunto , Humanos , Pronóstico , Bombas de Protones/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare 14 patients with gastric ulcer and Helicobacter heilmannii with other patients with gastric ulcer: age and sex matched patients, patients colonized by Helicobacter pylori and patients on nonsteroidal anti-inflammatory drugs (NSAIDs). SETTING: The endoscopy unit of a university-affiliated hospital. PATIENTS AND METHODS: All patients underwent endoscopy with two antral biopsies and smears from biopsies (touch cytology) in addition to biopsies of ulcers. Most patients had fundic biopsies (n = 10), antral biopsies for culture (n = 7) and/or a urease test (n = 9). Serologic determination of antibodies against H. pylori was obtained in nine patients. RESULTS: Patients with H. heilmannii diagnosed on smears from biopsies (touch cytology) had multiple and antral ulcers in 11 samples, and nodular or irregular lesions in five samples. No patient had a history of peptic ulcer disease. Biopsy revealed mild chronic gastritis in all patients, with features of reactive gastritis in nine. No patient had coexistent infection with H. pylori. Only two of ten patients with follow-up endoscopies had persistent H. heilmannii infection on smear or biopsy. No patient had symptomatic recurrence. Patients with H. pylori infection were older and often had recurrent ulceration. The majority of ulcers associated with NSAIDs occurred in elderly women. CONCLUSIONS: Newly diagnosed gastric ulcers are associated with H. heilmannii infection. Healing is associated with the disappearance of H. heilmannii and the regression of reactive gastritis. Ulcers differ from those associated with H. pylori infection or with the use of NSAIDs, suggesting that H. heilmannii is a possible cause of gastric ulcers.
Asunto(s)
Infecciones por Helicobacter/patología , Helicobacter/aislamiento & purificación , Úlcera Gástrica/microbiología , Adulto , Factores de Edad , Antiinflamatorios no Esteroideos/efectos adversos , Endoscopía , Femenino , Helicobacter/clasificación , Helicobacter pylori/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Úlcera Gástrica/diagnósticoAsunto(s)
Antiulcerosos/efectos adversos , Anticoagulantes/efectos adversos , Cimetidina/efectos adversos , Cumarinas/efectos adversos , Hemorragia Gastrointestinal/inducido químicamente , Hematoma/inducido químicamente , Enfermedades del Yeyuno/inducido químicamente , Adulto , Interacciones Farmacológicas , Hemorragia Gastrointestinal/diagnóstico por imagen , Tránsito Gastrointestinal , Hematoma/diagnóstico por imagen , Humanos , Enfermedades del Yeyuno/diagnóstico por imagen , Masculino , Tomografía Computarizada por Rayos XRESUMEN
The European Diploma of Gastroenterology has now been established by the European Board of Gastroenterology (EBG) and has been awarded to several individual doctors and to training centres. The EBG is a working party of the Gastroenterology Section of the European Union of Medical Specialists. The Diploma can be awarded to individual doctors who have been recognized as specialists in their own countries; trained in approved centres; and satisfied the training criteria of the EBG. The Diploma can also be awarded as a recognition of training competence to hospitals that meet the requirements of the EBG. Hospitals seeking recognition will be visited by members of the EBG and must show evidence that they can provide adequate clinical and technical experience to trainee gastroenterologists.
Asunto(s)
Certificación , Educación de Postgrado en Medicina , Gastroenterología/educación , Consejos de Especialidades , Certificación/normas , Educación de Postgrado en Medicina/normas , Europa (Continente) , Gastroenterología/normas , Humanos , Facultades de Medicina/normas , Consejos de Especialidades/normasAsunto(s)
Epinefrina/efectos adversos , Úlcera Péptica Hemorrágica/terapia , Soluciones Esclerosantes/efectos adversos , Estómago/patología , Anciano , Anciano de 80 o más Años , Epinefrina/uso terapéutico , Humanos , Masculino , Necrosis , Polidocanol , Polietilenglicoles/uso terapéutico , Soluciones Esclerosantes/uso terapéuticoRESUMEN
A 66-year-old woman presented with abdominal pain and weight loss. Ultrasonography and computed tomography demonstrated a cystic lesion of the pancreas. After surgical resection, the patient's symptoms disappeared. Microscopic examination of the cyst lining showed mature, keratinizing squamous epithelium, surrounded by lymphoid tissue. Only three cases of this type of lesion, called "lymphoepithelial cyst", have been described previously. Histogenesis of this particular type of cyst is not well know, but can be histologically differentiated from other pancreatic cysts.
Asunto(s)
Quiste Pancreático/patología , Anciano , Femenino , Humanos , Quiste Pancreático/diagnóstico por imagen , Quiste Pancreático/cirugía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
In a first step, midazolam 0.1 mg/kg, midazolam 0.05 mg/kg and diazepam 0.15 mg/kg administered intravenously were blindly evaluated as a sedating preparation in 3 groups of each 30 patients undergoing gastroscopy. Although amnesia is better with midazolam 0.1 mg/kg, the induced sedation is protracted, which is not to be wished in ambulatory patients. On the other side, diazepam 0.15 mg/kg was locally less well tolerated. Taking into consideration the efficacy and the general and local tolerance, the dose of midazolam 0.05 mg/kg seems the best compromise. In a second step, the specific benzodiazepine antagonist flumazenil was blindly evaluated at two intravenous doses, 1 mg and 0.5 mg, against placebo for reversal of midazolam (0.1 mg/kg) induced sedation in gastroscopy patients. 1 mg of flumazenil (and to a lesser degree 0.5 mg) suppresses the sedation and amnesia induced by midazolam and normalizes attention and sensori-motor functions. However a certain degree of resedation can reappear 45-60 min. after the administration of flumazenil. Though this phenomenon did not alter the tests measuring attention and sensorimotor functions and the recovery of memory (contrary to placebo), it incites to be cautious when the drug is given to ambulatory patients.
Asunto(s)
Diazepam/administración & dosificación , Endoscopía del Sistema Digestivo , Flumazenil/farmacología , Midazolam/administración & dosificación , Amnesia , Atención/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Humanos , Midazolam/efectos adversos , Midazolam/antagonistas & inhibidores , Destreza Motora/efectos de los fármacos , Factores de TiempoRESUMEN
With reference to a new case of pancreatic cystadenoma, the authors review the literature on the subject. These tumors are a relatively uncommon form of cystic lesion of the pancreas. They find the origin from pancreatic acinar cells or from ductal epithelium. Histologically, there are two different forms: benign, serous, microcystic adenoma and potentially malignant, mucinous, macrocystic adenoma. The type of the tumor is demonstrated by ultrasonography and computed tomography. but these examinations could not make a difference between benign and malignant form. Treatment of choice is complete tumor resection. Internal or external drainage of these cysts should not be done.
Asunto(s)
Cistoadenoma/cirugía , Neoplasias Pancreáticas/cirugía , Adulto , Cistoadenoma/diagnóstico , Diagnóstico por Imagen , Femenino , Humanos , Pruebas de Función Pancreática , Neoplasias Pancreáticas/diagnóstico , Procedimientos Quirúrgicos Operativos/métodosRESUMEN
A 62-year-old woman presented with massive right-sided hydrothorax associated with cirrhosis of the liver. Chest scintigraphy after intraperitoneal injection of labelled tracer showed movement of the tracer from the peritoneal to the pleural cavity. Medical therapy and thoracocentesis were successful in this case.
Asunto(s)
Hidrotórax/diagnóstico por imagen , Cirrosis Hepática Alcohólica/complicaciones , Derrame Pleural/diagnóstico por imagen , Agregado de Albúmina Marcado con Tecnecio Tc 99m , Femenino , Humanos , Hidrotórax/etiología , Persona de Mediana Edad , Derrame Pleural/etiología , CintigrafíaRESUMEN
A 69 yr old male patient developed an acute respiratory distress. The emergency bronchoscopic examination showed a polypoid tumour obstructing the left main bronchus. A snare used for colorectal polypectomy was introduced through the bronchofibrescope to remove the tumour. The patient then dramatically improved. No side effects were observed. Histopathological examination showed metastasis from a hypernephroma. This simple technique is useful for bronchial deobstruction, when the tumour is accessible with a snare.