RESUMO
AIMS: Analyzing the readmission of patients with acute biliary edematous pancreatitis (ABEP) without cholecystectomy despite a previous episode of mild acute gallstone pancreatitis or lithiasic cholecystitis. Calculating the health costs associated with the non-performance of cholecystectomy. MATERIAL AND METHODS: Prospective observational study conducted at a tertiary hospital from July to November 2014. The study has consecutively included inpatients suffering from ABEP who: a) had suffered a previous episode of mild acute gallstone pancreatitis or cholecystitis at least 2 weeks before readmission; and b) had not undergone cholecystectomy despite the lack of contraindications. RESULTS: During the research period, 9 patients (7 females and 2 males) with a mean age of 65.3 years (standard deviation [SD] 19.2) were readmitted. The median number of days between the previous episode of ABEP or cholecystitis and the readmission was 114 days (interquartile range [IQR] 111.0). Reported median overall length of hospital stay was 10 days (IQR = 2.0). Patients underwent a mean of 2.8 (SD = 1.2) ultrasound scans, 1.3 (SD = 0.9) abdominal and pelvic CT, 0.8 (SD = 1.0) MRCP and 0.2 (SD = 0.4) ERCP. The mean cost per patient for each readmission, including hospital stay (143.0 /day), Emergency Service (332.31 ) and tests performed was 2,381.70 /patient. CONCLUSIONS: Not performing a cholecystectomy within two weeks after a first episode of mild ABEP or cholecystitis contributes to patient readmission due to recurrent pancreatitis, resulting in avoidable treatment costs.
Assuntos
Doenças Biliares/complicações , Colecistectomia , Pancreatite/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Biliares/economia , Colecistectomia/economia , Colecistite/complicações , Feminino , Cálculos Biliares/complicações , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatite/economia , Pancreatite/cirurgia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , RecidivaRESUMO
Irritable bowel syndrome (IBS) is characterized by symptoms of abdominal pain and altered bowel habits. This common disorder is managed by varying clinical styles as no dominant therapeutic strategy has emerged. The pathophysiology of IBS remains unknown, but several lines of evidence link this disorder with the gut microbiota. Although controversy exists, gut microbiota is likely contributing to symptoms of IBS, at least in some patients, through an altered fermentation process, an impaired intestinal barrier function, a harmful modulation of enteric sensorimotor function, a promotion of low-grade inflammation without tissue damage, and a harmful modulation of the brain-gut axis. Probiotic therapy has a modest effect on IBS symptomatic relief, but the actual evidence is not strong enough to support a general recommendation of use. The best results are achieved, in children, with Lactobacillus rhamnusus GG, which moderately improves abdominal pain, while in adults the benefit appears to be greatest employing Bifidobacterium species.
El Síndrome de intestino irritable (SII) se define por síntomas de dolor abdominal, y alteración del hábito intestinal. Cuenta con diversos tratamientos disponibles, sin que hasta el momento haya destacado ninguna estrategia terapéutica en especial. La fisiopatología del SII permanece inexplicada, aunque diversas líneas de evidencia sugieren un papel de la microbiota intestinal. A pesar de que existe controversia, es probable que la microbiota contribuya a la generación de síntomas, al menos en algunos pacientes, a través de un proceso de fermentación alterado, de la modificación de la función de barrera intestinal, de la modulación inadecuada de la función sesorio-motora entérica y del eje cerebro-enteral. La probiótico-terapia produce un modesto alivio sintomático en SII, aunque la evidencia actual no es suficiente para la recomendación general de uso. Los mejores resultados se obtienen, en niños, con Lactobacillus rhamnosus GG, que mejora discretamente el dolor abdominal, mientras que en adultos el beneficio parece mayor empleando especies de Bifidobacterium.