Primary prophylaxis with ciprofloxacin in cirrhotic patients with ascites: a randomized, double blind study.

UNLABELLED: INTRODUCTION AND AIM. There is scarce information about primary prophylaxis in cirrhotic patients. The aim was to assess the efficacy of ciprofloxacin for primary prophylaxis for bacterial infections in patients with cirrhosis of the liver and ascites. MATERIAL AND METHODS. A randomized, double-blind placebo-controlled clinical trial was conducted. Patients were randomized to receive oral ciprofloxacin 500 mg/day or placebo for one month. A basal evaluation and repeated assessments at 4, 6, 12, 18, and 24 weeks afterwards, or whenever a primary endpoint occurred were done. STATISTICAL ANALYSIS: probability curves were constructed with the Kaplan-Meier method and compared by the log-rank test. RESULTS. 95 patients were randomized to ciprofloxacin group (n = 49; 51.6%) and placebo group (n = 46; 48.4%). Six-teen (32.6%) patients in the ciprofloxacin group developed bacterial infections and thirteen (28.2%) patients developed bacterial infections in the placebo group (p = NS). The probability to remain free of bacterial infections did not reach statistical significance (p = 0.38). Probability of survival at 24 weeks was 91% in placebo group and 98% in the ciprofloxacin group (p = 0.28). The absolute risk reduction was 5%, the relative risk reduction was 6% and the NNT was 20 patients. CONCLUSION. Primary prophylaxis with ciprofloxacin for one month in cirrhotic patients with ascites who do not have a currently accepted indication, did not show a preventive effect on the development of bacterial infections at one month follow-up. Moreover in women could increases the odds for UTI. The administration of ciprofloxacin seemed to decrease the risk of mortality.

Rapid diagnosis of spontaneous bacterial peritonitis using leukocyte esterase reagent strips in emergency department: uri-quick clini-10SG® vs. Multistix 10SG®.

BACKGROUND AND AIM: Bacterial peritonitis (SBP) is the most frequent infection in patients with cirrhosis causing significant mortality. Delay in SBP diagnosis is a serious problem. The aim of this study was to evaluate the diagnostic yield of Uri-Quick Clini-10SG® vs. Multistix 10SG® reagent strips in an Emergency Department. MATERIAL AND METHODS: A prospective study of consecutive patients with ascites and paracentesis attending to Emergency Department from March 2005 to February 2007 was made. SBP was defined by ≥ 250 neutrophiles /mm³. The ascites obtained at bedside was immediately tested in a dry test tube with both the Uri-Quick Clini 10SG® and MultistixSG10®. The Uri-Quick Clini 10SG® and Multistix SG10®. Strips were considered positive at grade ≥ 3 (≥ 125 leukocytes/mL). RESULTS: A total of 223 ascitic fluid samples were obtained. There were 49 episodes of SBP. Median age was 54 (range 18-87 year) years; 62.3% were female. The sensitivity, specificity, PPV, NPV, and 95% CI for Uri-Quick Clini 10SG® were 79.6 (64-87), 98.2 (94-99), 90.5 (78-96) and 93.9 (89-96), respectively. For MultistixSG10® the values were 77.5 (64-88), 97.7 (93-98), 90 (77.9-96.2), and 94 (89.4-96.6), respectively. CONCLUSION: The use of reagent strip is useful for SBP diagnosis in an emergency setting. The high PPV allow start antibiotic treatment. In areas without the resources to perform conventional ascites fluid analyses, these strips could be presently used.

Vascular invasion in pancreatic cancer: predictive values for endoscopic ultrasound and computed tomography imaging.

OBJECTIVES: To evaluate the accuracy of endoscopic ultrasound (EUS) to determine vascular invasion in patients with pancreatic cancer. METHODS: Data were obtained prospectively from patients with a pancreatic lesion who underwent EUS, computed tomographic (CT) imaging, and surgery from March 2005 to March 2010. RESULTS: Fifty patients were included with a mean ± SD age 61 ± 11.5 years; 27 (54%) were women. The sensitivity, specificity, positive predictive value, and negative predictive value for EUS were the following: 61.1 (95% CI, 38.6-79.7), 90.3 (95% CI, 75.1-96.7), 78.6 (95% CI, 52.4-92.4), and 80 (95% CI, 64.1-90), respectively. The area under the curve for EUS and that for CT were 0.80 (95% CI, 0.68-0.92) and 0.74 (95% CI, 0.61-0.86), respectively. The positive predictive value for arterial invasion was 100% (95% CI, 61-100) for EUS and 60% (95% CI, 31.3-83.2) for CT. There were no complications associated with the EUS or the CT. CONCLUSION: Endoscopic US is a very good option to detect vascular invasion in patients with pancreatic cancer and is especially sensitive for arterial invasion. When it is available, we recommend that it be performed in addition to CT staging.

Utility of a simplified predictive model to predict rebleeding in patients with high-risk stigmata ulcers.

AIM: To evaluate a simplified Predictive Model (sPM) to predict rebleeding in patients with high-risk stigmata ulcers. PATIENTS AND METHODS: Retrospectively, patients seen from March 2002 to September 2007 with peptic ulcers Forrest Ia, Ib, IIa and/or IIb were included. A sPM based on modified Blatchford Score Risk System (mBRS) was used. RESULTS: One hundred and seven patients were included. The positive and negative predictive values for rebleeding with mBRS ≤1 were 15% [95% confidence interval (CI): 4-42] and 72% (95% CI: 61-80), respectively; for sPM ≤1 these values were 16% (95% CI: 8-29) and 65.3% (95% CI: 52-76), respectively. The odds ratio for rebleeding in patients with sPM ≤1 was 0.77 (95% CI: 0.6-0.97, P=0.03) and odds ratio for mBRS ≤1 was 0.84 (95% CI: 0.64-1.1, P=0.3). CONCLUSIONS: In patients with high-risk stigmata ulcers with sPM and mBRS ≤1 the risk of rebleeding is low and their early discharge could be considered.

Utility of endoscopy in patients with incidental gastrointestinal luminal wall thickening detected with CT.

BACKGROUND: Reports of incidental gastrointestinal luminal wall thickening (IGILWT) on computed tomography (CT) in patients without gastrointestinal complaints are not rare. Currently there is no consensus about what to do in those cases. The aim of this study was to evaluate the utility of endoscopic study in asymptomatic patients with IGILWT. MATERIAL AND METHODS: Retrospective analysis of data obtained prospectively between September 2004 and March 2007 was carried out. Patients without gastrointestinal symptoms/signs with IGILWT and assessed by endoscopy were included. The endoscopic findings were classified as follows: normal, abnormal or nonspecific. RESULTS: A total of 10,161 abdominal/pelvic CT scans were performed. Thirty-one patients were included (14 women and 17 men). Median age was 59 years (19-84 years). Distribution of IGILWT along the gastrointestinal (GI) tract was as follows: 1 esophagus, 19 stomach, 1 small-bowel, and 10 colon. Endoscopy was normal in 19 cases (61.2%) and abnormal/nonspecific in 12 cases (38.8%). Nine (29%) patients had cancer as a final diagnosis (gastric cancer in six, colon cancer in two, and non-Hodgkin's lymphoma in one). On multivariate analysis hemoglobin <12 g/dl was the only significant variable to predict an abnormal result by endoscopy. CONCLUSION: Endoscopic study is useful in patients with IGILWT. More than one-third of patients with IGILWT have a significant finding by endoscopic evaluation, mainly cancer. Absence of GI symptoms/signs, age or gender are not valid criteria to decide about further endoscopic evaluation.

Prevalence of metabolic syndrome, obesity and diabetes type 2 in cryptogenic cirrhosis.

AIM: To evaluate the prevalence of metabolic syndrome (MS), obesity and type 2 diabetes mellitus (T2DM) in a group of Mexican Mestizo patients with cryptogenic cirrhosis (CC) and to compare this group with patients with cirrhosis secondary to other causes (disease controls). METHODS: Patients with CC, diagnosed between January, 1990 and April, 2005, were included in a retrospective study. Patients with cirrhosis caused by chronic hepatitis C, alcohol abuse or autoimmune hepatitis (AIH) served as disease controls. RESULTS: A total of 134 patients with CC were analyzed. Disease controls consisted of 81 patients with chronic hepatitis C, 33 with alcohol abuse and 20 with AIH. The median age of patients with CC was 57 years (range, 16-87); 83 (61.9%) patients were female; 53 (39.6%) were Child A, 65 (48.5%) Child B, and 16 (11.9%) were Child C cirrhosis. The prevalence of MS (29.1% vs 6%; P<0.001), obesity (16.4% vs 8.2%; P=0.04) and T2DM (40% vs 22.4%; P=0.013) was higher in CC patients than in disease controls. There were no differences in sex, age or liver function tests between the two groups. CONCLUSION: The prevalence of MS, obesity and T2DM were higher in patients with CC than in patients with cirrhosis secondary to others causes. Our findings support the hypothesis that non-alcoholic steatohepatitis (NASH) plays an under-recognized role in CC.

[Critical analysis of awards in gastroenterology research. The Mexican experience]. / Análisis de los premios a la investigación en gastroenterología. Experiencia en México.

The impact of Mexican gastrointestinal research worldwide is limited and the outcome of the best research papers awarded by the Asociación Mexicana de Gastroenterología (AMG) is unknown. The objective of this study was to analyze the publication pattern of the research work, awarded by the AMG and their impact in international journals. The abstracts accepted for the annual meeting of the AMG from 1998 to 2006 were reviewed. Those presented in a plenary session or awarded were included. Their abstracts were searched in electronic databases. When not found, the main author was contacted by e-mail. In those papers published in a journal with an impact factor, the times it was cited were assessed. 35 abstracts were identified, mainly in gastroenterology (57.1%) and hepatology (34.3). Only in 5.7% (n=2) some of the authors were members of the governing board of AMG. The awarded institutions were Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (48.6%), Universities (Universidad Autónoma de Nuevo León, Universidad Nacional Autónoma de México and the Benemérita Universidad Autónoma de Puebla) (31.4%), Instituto Mexicano del Seguro Social (8.6%), Fundación Clínica Médica Sur (5.7%), Hospital Juárez (2.9%), Private hospital (2.9%). Most of the papers were published within a year (73.7%). Only 2 papers had more than 10 citations in another international journal with impact factor, with a median for all paper of 5 citations (0-45). Considering all institutions, the rate of publication is 48%. Only half of the awarded works were published and mainly in journals of local distribution. The impact of these studies worldwide is limited.

Análisis de los premios a la investigación en gastroenterología: Experiencia en México / Critical analysis of awards in gastroenterology research: The Mexican experience

El impacto internacional de la investigación gastroenterológica mexicana es limitado. Se desconoce cuál ha sido el resultado final de los trabajos de mejor calidad a nivel nacional de acuerdo a la Asociación Mexicana de Gastroenterología (AMG). El objetivo de este trabajo fue analizar el patrón de publicación e impacto en las publicaciones periódicas internacionales de los trabajos premiados por la AMG. Se revisaron las memorias del congreso anual de la AMG, período 1998-2006. Se seleccionaron resúmenes donde se indicara premiación o presentación en sesión plenaria. Los trabajos identificados fueron buscados en bases de datos electrónicas, o bien se contactó alguno de los autores para solicitar la información relacionada. De aquellos trabajos publicados en revistas con factor de impacto se buscaron las citas relacionadas. Se localizaron 35 premios, 57.1% fueron en el área de gastroenterología y 34.3% en hepatología. Las instituciones con los premios son Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (48.6%), Instituciones de Educación Superior (31.4%), Instituto Mexicano del Seguro Social (8.6%), Fundación Clínica Médica Sur (5.7%), Hospital Juárez (2.9%), Hospital privado (2.9%). De estos se han publicado 19 (54.8%), la mayoría antes de un año (73.7%). Unicamente dos de los trabajos publicados tienen registradas <10 citas en revistas con factor de impacto. La mitad de los trabajos meritorios de premiación han sido publicados. La mayoría se publican en revistas de circulación nacional. El impacto de estos trabajos a nivel internacional es limitado.

The impact of Mexican gastrointestinal research worldwide is limited and the outcome of the best research papers awarded by the Asociación Mexicana de Gastroenterología (AMG) is unknown. The objective of this study was to analyze the publication pattern of the research work, awarded by the AMG and their impact in international journals. The abstracts accepted for the annual meeting of the AMG from 1998 to 2006 were reviewed. Those presented in a plenary session or awarded were included. Their abstracts were searched in electronic databases. When not found, the main author was contacted by e-mail. In those papers published in a journal with an impact factor, the times it was cited were assessed. 35 abstracts were identified, mainly in gastroenterology (57.1%) and hepatology (34.3). Only in 5.7% (n=2) some of the authors were members of the governing board of AMG. The awarded institutions were Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (48.6%), Universities (Universidad Autónoma de Nuevo León, Universidad Nacional Autónoma de México and the Benemérita Universidad Autónoma de Puebla) (31.4%), Instituto Mexicano del Seguro Social (8.6%), Fundación Clínica Médica Sur (5.7%), Hospital Juárez (2.9%), Private hospital (2.9%). Most of the papers were published within a year (73.7%). Only 2 papers had more than 10 citations in another international journal with impact factor, with a median for all paper of 5 citations (045). Considering all institutions, the rate of publication is 48%. Only half of the awarded works were published and mainly in journals of local distribution. The impact of these studies worldwide is limited.

Upper gastrointestinal dieulafoy's lesions and endoscopie treatment: first report from a mexican centre.

The aim was to evaluate the initial success, rebleeding rate, need for emergent surgery, and mortality rates of patients with Dieulafoy's lesion (DL) and endoscopic treatment (ET). Patients with DL from a tertiary center were included. We included 20 patients with follow-up of 90 (60-550) days. The lesser curvature was the most common localization. Initial success, rebleeding, and emergent surgery requirement were observed in 90%, 10%, and 15%, respectively. No objective variables were related with response to ET. In conclusion, ET is secure and useful in patients with DL and it must be considered as the first-line treatment modality.

Endoscopic treatment of high-risk bleeding ulcers: success, rebleeding and mortality.

INTRODUCTION AND AIMS: Endoscopic treatment of peptic ulcers with high-risk stigmata has been probed. The rates of recurrent bleeding, need for emergent surgery and death are related to Forrest Classification, Blatchford's modified risk score and the kind of endoscopic treatment used (monotherapy vs. dual). The aims of the present study were to report the success of endoscopic therapy in the reduction of the rate of initial success, recurrent bleeding, the need for surgery, and the mortality rate for patients with bleeding peptic ulcer and high-risk stigmata. PATIENTS AND METHODS: From a retrospective view, patients seen from September 2004 to March 2007 who had peptic ulcers Forrest Ia, Ib, IIa and/or IIb were included. RESULTS: Fifty-six patients were included (mean [SD] age 57.3 +/-16.6 years). The success rate was 91%, whilst the rest of the patients required immediate surgery. Recurrent bleeding was presented in 14 (27%) patients and eight (14.2%) required emergency surgery. The mortality rate was 3.6%. No factors were associated with the risk of failure to initial treatment, recurrent bleeding or need for surgery. The use of monotherapy by endoscopy was associated with the mortality. The variable "performed by a fellow alone" was not associated with any kind of outcome. CONCLUSION: Complication rate is similar to previous reports of general hospitals, but is higher than those of referral centers. Endoscopic monotherapy is associated with a major mortality risk.