Utility of abdominal ultrasound for diagnosis of hepatic steatosis in patients with morbid obesity.

Metabolic dysfunction-associated fatty liver disease is the most common cause of liver disease in our environment. The gold standard for diagnosis continues to be liver biopsy, although, since it is an invasive test, the most commonly used test for the initial diagnosis of steatosis is abdominal ultrasound. We present the results on the diagnostic utility of ultrasound for the detection of steatosis in the population of morbidly obese patients who underwent bariatric surgery from 2004 to 2019 in our centre.

Autoimmune hepatitis after SARS-C¬¬oV-2 vaccination.

Vaccination against SARS-CoV-2 have been reported like a potential trigger of some autoimmune diseases, like autoimmune hepatitis (HAI). We present three cases of AIH developed after the administration of the SARS-Cov-2 vaccine.

Hematoma post-endoscopic retrograde cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently performed procedures in the treatment of biliary-pancreatic diseases. Hematoma after ERCP is an infrequent and highly serious complication. We present three cases with hepatic hematoma after a CPRE.

Gastrointestinal lymphoma, a rare endoscopic lesion.

We present the case of a 77-year-old male patient with iron deficiency anemia. His personal medical history is: dyslipidemia, high-grade diffuse centrofollicular lymphoma localized in the tonsil in 1984 and metastatic prostate cancer treated with hormone therapy.

[Upper endoscopy findings in obese morbid patients candidates for bariatric surgery]. / Hallazgos de la endoscopia digestiva alta en pacientes con obesidad mórbida candidatos a cirugía bariátrica.

INTRODUCTION: Body mass index has been associated with the presence and severity of various gastrointestinal symptoms. The aim of the study was to analyze the endoscopic findings and gastric histology of morbidly obese candidates for bariatric surgery. METHODS: We retrospectively included patients undergoing bariatric surgery at the Hospital de León from March 2005 to April 2013. The findings of upper gastrointestinal endoscopy and antral histology were collected. The relationship of body mass index (BMI) with gastroscopy findings and the presence of Helicobacter pylori were assessed. RESULTS: A total of 194 patients were included. An abnormality on endoscopy or antral biopsy was found in 48.7% and 78.9% of the patients, respectively. Three patients had gastric peptic ulcer, and consequently the intervention was postponed until healing. H.pylori infection was found in 63.9% of the patients. The presence of H.pylori and endoscopic findings were not related to BMI. CONCLUSION: Gastroesophageal disease is common in morbidly obese patients and approximately half of the patients had some kind of alteration on endoscopy. Gastroscopy and H.pylori testing prior to surgery is required to rule out disease that could delay or contraindicate surgery.

[Factors associated with colon cleansing measured with the Boston scale in routine clinical practice]. / Factores asociados al nivel de limpieza colónica medido mediante la escala de Boston en la práctica clínica habitual.

INTRODUCTION: The Boston scale is useful to standardize colon cleansing at colonoscopy. The aim of this study was to analyze the degree of preparation before colonoscopy and the factors associated with cleansing in routine clinical practice. MATERIAL AND METHODS: We included colonoscopies performed from January to June 2013. Exclusion criteria were age <15 years, a history of colon surgery, inflammatory bowel disease, and active gastrointestinal bleeding. The standard preparation was CitraFleet. The parameters related to the degree of bowel cleansing (using the Boston scale) were age, sex, indication, colonoscopy shift (morning or afternoon), patient origin (outpatient or hospitalized), and colonoscopy findings. RESULTS: We analyzed 947 colonoscopies, with exclusion of 297. A total of 5.8% (38/650) of the colonoscopies were incomplete, 50% due to lack of preparation. The mean age of the patients was 61.27 years (SD: 16.1), and 51.8% were women. The distribution of the Boston scale was 0-3 in 6.3%, 4-5 in 12.6%, 6-7 in 30.6%, and 8-9 in 50.4%, with a mean 7.04 (SD: 2.03). On multivariate analysis, the factors statistically associated with better preparation were younger age, afternoon colonoscopy and the outpatient setting. The percentage of polyps in patients with a Boston scale score ≤5 was 10% compared with 27.8% in patients with a score > 5 (P=.014). CONCLUSION: In clinical practice, 80% of patients had an acceptable level of preparation. Older patients, those undergoing colonoscopy in the morning and hospitalized patients would be candidates for measures to improve the degree of colonic preparation.

Insulin resistance and metabolic syndrome are related to non-alcoholic fatty liver disease, but not visceral adiposity index, in severely obese patients.

The visceral adiposity index (VAI) is a marker of visceral fat distribution and dysfunction. Visceral adiposity is related to nonalcoholic fatty liver disease (NAFLD); however, there is some controversy regarding the association between VAI and NAFLD.The aim of this study was to analyse the relationship between VAI and NAFLD and to describe the related factors in severely obese patients. A total of 139 patients who underwent bariatric surgery were included in this cross-sectional study. Liver biopsy was performed during surgery. Univariate and multivariate analysis were conducted to study the features related to VAI. A univariate analysis was conducted to identify which factors were associated with liver histology. In the univariate analysis, steatosis, liver inflammation, non-alcoholic steatohepatitis (NASH) and fibrosis were associated with VAI. In the multivariate analysis, only HOMA (Beta: 0.06; p < 0.01) and metabolic syndrome (Beta: 1.23; p < 0.01) were related to VAI. HOMA, the presence of metabolic syndrome, and waist circumference (WC) were statistically related to the NAFLD activity score (NAS score): HOMA: 0-2: 5.04; 3-4: 7.83; > or = 5: 11,32; p < 0.01; MS: 0-2: 37 %; 3-4: 33.3 %; > or = 5: 76%; p < 0.01; WC: 0-2: 128.7 cm; 3-4: 130.7; > or = 5: 140.6; p < 0.01). For the prediction of NASH (NAS score > or = 5), the AUROC curve were 0.71 (CI 95 %: 0.63-0.79) for VAI and 0.7 (CI 95 %: 0.62-0.78) for WC. In conclusion, HOMA, WC and metabolic syndrome are related to liver histology in patients with severe obesity. In the multivariate analysis, VAI was associated with HOMA and metabolic syndrome, but not with liver histology.

[Relationship of demographic and dietary hygiene factors with the pathology found in outpatient colonoscopies performed in a Castilla y León Health Service center]. / Relación de los factores demográficos e higiénico-dietéticos con la patología hallada en las colonoscopias ambulatorias realizadas en un centro del Servicio Castellano y Leonés de Salud.

Introduction: Background: colorectal cancer (CRC) is one of the most frequent tumors in terms of incidence and mortality. Several elements, both inherited and environmental, have been related with its pathogenesis. Aims: to analyze the influence of age, gender and nutritional factors on the diagnosis of colonic polyps and CRC. Methods: a prospective, descriptive study over outpatients from the Health Area of León who took a colonoscopy between 09/09/2012 and 06/30/2013. Patients were asked to fill a semiquantitative food frecuency questionnaire with data such a sociodemographic, toxic and dietetic facts. Differences in diagnosis according to sociodemographic and hygiene-dietetic data were analyzed with a multivariate analysis by forward stepwise logistic regression. Results: data were collected from 1390 patients. Mean age was 57.88 (15.17) years and 47.8 % were male. CRC was diagnosed in 5 % of colonoscopies, and polyps in 20.4 %, with 9.4 % of them being HRA. Risk of polyps and HRA was higher in males (26.9 % vs 14.5 %) and (12.6 % vs 6.3 %), respectively (p < 0.001). Mean age was significantly higher in patients who presented polyps (56.51 (15.45) vs 63.22 (12.69) years; p < 0.001). Among the group who reported intake of smoked and salted food, the risk of polyps doubled (2.9 % vs 6.7 %, p = 0.002). In relation to alcohol intake we found that subjects with daily alcohol consumption showed a higher incidence of polyps whe compared to occasional drinkers and teetotallers (32 % vs 20 % vs 18.6 %, p = 0.002) Conclusions: age correlated with higher risk of polyps, HRA and CRC. Moreover, male gender also was associated with a high risk of polyps and HRA. Alcohol and red and processed meat intake increased polyp risk.

Introducción: Introducción: el cáncer colorrectal (CCR) es un tumor muy frecuente en términos de incidencia y mortalidad. Su patogenia se ha relacionado con diversos factores ambientales y hereditarios. Objetivos: analizar la asociación de edad, sexo y factores dietéticos con el diagnóstico de adenomas y CCR. Métodos: se realizó un estudio descriptivo prospectivo con los pacientes del Área Sanitaria de León que se sometieron a una colonoscopia ambulatoria entre 09/09/2012 y 30/06/2013. Mediante un formulario autoadministrado se recogieron datos sociodemográficos, tóxicos y dietéticos usando un cuestionario alimentario de frecuencia semicuantitativo. Se analizaron las diferencias en el diagnóstico según los datos sociodemográficos e higiénico-dietéticos, con análisis multivariante mediante regresión logística por pasos hacia delante. Resultados: se recogieron datos de 1390 pacientes cuya edad media fue de 57 (15) años; de ellos, el 47,8 % eran varones. Se diagnosticaron CCR en el 5 % de los pacientes y pólipos en el 20,4 % (9,4 % de adenomas de alto riesgo (AAR)). El hallazgo de pólipos y AAR fue más frecuente en los varones (26,9 % vs. 14,5 % y 12,6 % vs. 6,3 %, respectivamente (p < 0,001)). La edad media fue significativamente superior en los pacientes que presentaban pólipos (56.51 (15.45) vs. 63.22 (12.69) años; p < 0,001). En la población que refirió un consumo diario de carnes procesadas se duplicaba la proporción de pólipos detectados (2,9 % vs. 6,7 %; p = 0,02). Aquellos pacientes que consumían alcohol diariamente tenían mayor incidencia de pólipos frente al consumo ocasional y los abstemios (32 % vs. 20 % vs. 18,6 %; p = 0,002). Conclusiones: la edad se relacionaba con un mayor riesgo de pólipos, AAR y CCR. Los varones también tenían más riesgo de pólipos y AAR. El consumo de alcohol, carnes rojas y procesadas incrementaba el riesgo de pólipos.

[Clinicopathologic features of colonic perineuriomas]. / Características clínico-patológicas de los perineuriomas colónicos.

Intestinal perineuriomas are uncommon tumors of the gastrointestinal tract. In this study, we analyzed the clinicopathologic and immunohistochemical features of nine colonic perineuriomas. Five patients were women and four were men (median age 59.5 years and 64 years, respectively). All lesions were smaller than 1cm and were located intramucosally, mainly in the distal colon. Immunohistochemical techniques for Glut-1, claudin-1 and EMA were especially useful in characterizing these lesions.

Relación de los factores demográficos e higiénico-dietéticos con la patología hallada en las colonoscopias ambulatorias realizadas en un centro del Servicio Castellano y Leonés de Salud / Relationship of demographic and dietary hygiene factors with the pathology found in outpatient colonoscopies performed in a Castilla y León Health Service center

Introducción: el cáncer colorrectal (CCR) es un tumor muy frecuente en términos de incidencia y mortalidad. Su patogenia se ha relacionado con diversos factores ambientales y hereditarios. Objetivos: analizar la asociación de edad, sexo y factores dietéticos con el diagnóstico de adenomas y CCR. Métodos: se realizó un estudio descriptivo prospectivo con los pacientes del Área Sanitaria de León que se sometieron a una colonoscopia ambulatoria entre 09/09/2012 y 30/06/2013. Mediante un formulario autoadministrado se recogieron datos sociodemográficos, tóxicos y dietéticos usando un cuestionario alimentario de frecuencia semicuantitativo. Se analizaron las diferencias en el diagnóstico según los datos sociodemográficos e higiénico-dietéticos, con análisis multivariante mediante regresión logística por pasos hacia delante. Resultados: se recogieron datos de 1390 pacientes cuya edad media fue de 57 (15) años; de ellos, el 47,8 % eran varones. Se diagnosticaron CCR en el 5 % de los pacientes y pólipos en el 20,4 % (9,4 % de adenomas de alto riesgo (AAR)). El hallazgo de pólipos y AAR fue más frecuente en los varones (26,9 % vs. 14,5 % y 12,6 % vs. 6,3 %, respectivamente (p < 0,001)). La edad media fue significativamente superior en los pacientes que presentaban pólipos (56.51 (15.45) vs. 63.22 (12.69) años; p < 0,001). En la población que refirió un consumo diario de carnes procesadas se duplicaba la proporción de pólipos detectados (2,9 % vs. 6,7 %; p = 0,02). Aquellos pacientes que consumían alcohol diariamente tenían mayor incidencia de pólipos frente al consumo ocasional y los abstemios (32 % vs. 20 % vs. 18,6 %; p = 0,002). Conclusiones: la edad se relacionaba con un mayor riesgo de pólipos, AAR y CCR. Los varones también tenían más riesgo de pólipos y AAR. El consumo de alcohol, carnes rojas y procesadas incrementaba el riesgo de pólipos. (AU)

Background: colorectal cancer (CRC) is one of the most frequent tumors in terms of incidence and mortality. Several elements, both inherited and environmental, have been related with its pathogenesis. Aims: to analyze the influence of age, gender and nutritional factors on the diagnosis of colonic polyps and CRC. Methods: a prospective, descriptive study over outpatients from the Health Area of León who took a colonoscopy between 09/09/2012 and 06/30/2013. Patients were asked to fill a semiquantitative food frecuency questionnaire with data such a sociodemographic, toxic and dietetic facts. Differences in diagnosis according to sociodemographic and hygiene-dietetic data were analyzed with a multivariate analysis by forward stepwise logistic regression. Results: data were collected from 1390 patients. Mean age was 57.88 (15.17) years and 47.8 % were male. CRC was diagnosed in 5 % of colonoscopies, and polyps in 20.4 %, with 9.4 % of them being HRA. Risk of polyps and HRA was higher in males (26.9 % vs 14.5 %) and (12.6 % vs 6.3 %), respectively (p < 0.001). Mean age was significantly higher in patients who presented polyps (56.51 (15.45) vs 63.22 (12.69) years; p < 0.001). Among the group who reported intake of smoked and salted food, the risk of polyps doubled (2.9 % vs 6.7 %, p = 0.002). In relation to alcohol intake we found that subjects with daily alcohol consumption showed a higher incidence of polyps whe compared to occasional drinkers and teetotallers (32 % vs 20 % vs 18.6 %, p = 0.002) Conclusions: age correlated with higher risk of polyps, HRA and CRC. Moreover, male gender also was associated with a high risk of polyps and HRA. Alcohol and red and processed meat intake increased polyp risk. (AU)

SHORT-TERM CHANGES IN MACRONUTRIENT INTAKE IN MORBIDLY OBESE PATIENTS UNDERGOING BILIOPANCREATIC DIVERSION: A LONGITUDINAL STUDY.

INTRODUCTION: biliopancreatic diversion (BPD) has been shown to be one of the most effective techniques for losing weight, although nutritional education also might play an important role. Our aim was to determine the effect of the combination of a nutrition educational program (NEP) and BPD on changes in the intake of energy and macronutrients after the surgery. METHODOLOGY: this longitudinal study included all patients eligible for BPD who filled in a dietary record. Two assessments were performed: six weeks before and twelve months after surgery. The nutrition educational program was given two weeks after surgery by a registered dietitian and a 3-day food record was collected for further analysis at both of the assessments. RESULTS: 68 patients were included. The percentage of excess weight loss was 60.76% (SD 14.50%). A year after the surgery there was a reduction of energy (-602.27 kcal [SD 930.19 kcal], p < 0.001), fat (-41.70 g [SD 77.87 g], p < 0.001), percentage of fat (-4.79% [SD 11.38%], p = 0.001), and an increase in the percentage of protein (+ 2.72% [SD 7.10%], p = 0.002). A lower consumption of fat, especially of polyunsaturated fatty acids, was observed in the patients that achieved the nutritional recommendations and in the super-obese patients. CONCLUSION: The combination of NEP and BPD resulted in an improvement in the nutritional profile, with a reduction of fat and maintenance of the protein intake.

Introducción: la derivación biliopancreática (DBP) ha demostrado ser una de las técnicas más efectivas en la pérdida de peso, aunque la educación nutricional también puede jugar un papel importante. El objetivo del estudio fue determinar el efecto de la combinación de un programa de educación nutricional (PEN) y DBP en los cambios de ingesta energética y de macronutrientes después de la cirugía. Métodos: estudio transversal que incluyó a todos los pacientes subsidiarios de DBP que cumplimentaron la encuesta dietética. Se realizaron dos valoraciones: seis semanas antes y doce meses después de la cirugía. El PEN fue impartido dos semanas después de la cirugía por una dietista-nutricionista. Fue recogida una encuesta dietética de tres días en ambas visitas para realizar el análisis nutricional de la ingesta. Resultados: fueron incluidos 68 pacientes. El porcentaje de exceso de peso perdido fue de 60,76% (DE 14,50%). Un año después de la intervención se produjo una disminución de la ingesta calórica (−602,27 kcal [DE 930,19 kcal], p.

Relationship Between Diet and Body Composition After Biliopancreatic Diversion.

BACKGROUND: Biliopancreatic diversion (BPD) has been shown to be one of the most effective techniques for losing weight, although the relationship between body composition and diet after the procedure is not well known. Our aim was to assess dietary changes and their effects on body composition. METHODOLOGY: This longitudinal study included all patients eligible for BPD who had undergone body composition analysis. Two assessments were performed: 6 weeks before and 1 year after surgery. Nutritional education was given after surgery by a registered dietitian, and dual energy X-ray absorptiometry was performed and a 3-day food record was collected for further analysis at both of the visits. RESULTS: Forty-six patients were included. The percentage of excess of weight loss was 61.03 % (SD 14.01 %), which was statistically different by gender (p = 0.045). The percentage of subjects reporting a low daily protein consumption of less than 60 g and 1.2 g/kg of ideal body weight (IBW)/day was 15.2 % before surgery and 19.6 % at 12 months (p = 0.006). The weight loss was mainly of fat mass (FM). There were differences of body composition by gender before and after surgery. A simple correlation analysis showed a significant association between daily energy intake and FM (g) only before surgery (p = 0.030), and also between daily protein intake (expressed as total g) and lean body mass (LBM) 12 months after surgery (p = 0.018), but no association was found with achieved protein goal. CONCLUSION: BPD enhanced by nutritional education seems to improve its results by achieving an adequate weight loss, preserving LBM, decreasing FM, and guaranteeing an appropriate protein intake.

Vitamin D levels and bone turnover markers are not related to non-alcoholic fatty liver disease in severely obese patients.

BACKGROUND: Morbidly obese patients usually present vitamin D deficiency or secondary hyperparathyroidism. Low vitamin D levels have been recently related to non-alcoholic fatty liver disease (NAFLD). The aim of this study was to analyse the relationship between vitamin D, bone turnover markers and non-alcoholic fatty liver disease and metabolic syndrome in severely obese patients. METHODS: One hundred and ten patients who underwent bariatric surgery were included. Liver biopsy was taken during surgery. Two univariate analyses were carried out in order to i) analyse the relationship between liver histology and vitamin D-bone turnover markers (intact parathyroid hormone (PTH), osteocalcin and Carboxy-terminal collagen crosslinks) and ii) establish the association between metabolic syndrome components-insulin resistance (HOMA) and vitamin D-bone turnover markers. RESULTS: 70% of the patients had lower levels of vitamin D or secondary hyperparathyroidism. None of the components of liver histology were associated with levels of vitamin D or with bone turnover parameters. Patients with metabolic syndrome showed lower levels of PTH and osteocalcin (72,42 (29,47) vs 61.25(19.59) p-Value: 0.022; 19.79 (10.43) vs 16.87(10.25) p-Value: 0,028, respectively). HOMA was not related to Vitamin D or bone turnover markers. CONCLUSION: Low levels of vitamin D or hyperparathyroidism are common in severely obese patients. Vitamin D and bone metabolism markers were associated neither to NAFLD nor with metabolic syndrome in our series of obese morbid patients.

Antecedentes: los pacientes con obesidad mórbida presentan frecuentemente déficit de vitamina D o hiperparatiroidismo secundario. Presentar niveles bajos de vitamina D se ha asociado recientemente con el hígado graso no alcohólico (EHNA). El objetivo de este estudio fue analizar la relación de la vitamina D y los marcadores de recambio óseo con el hígado graso no alcohólico y el síndrome metabólico, en pacientes con obesidad mórbida. Métodos: Ciento diez pacientes sometidos a cirugía bariátrica fueron incluidos, obteniéndose una biopsia hepática durante la cirugía. Dos análisis univariados se llevaron a cabo con el fin de: i) analizar la relación de la histología hepática con la vitamina D y marcadores de recambio óseo (hormona paratiroidea intacta (PTH), osteocalcina y enlaces cruzados de colágeno carboxi-terminal) y ii) establecer la asociación de los componentes del síndrome metabólico y resistencia a la insulina (HOMA) con los marcadores de recambio óseo y vitamina D. Resultados: El 70% de los pacientes presentaron niveles bajos de vitamina D o hiperparatiroidismo secundario. Ninguno de los componentes de la histología hepática resultó asociciado con los niveles de vitamina D o con los parámetros de recambio óseo. Los pacientes con síndrome metabólico mostraron un nivel menor de PTH (72,42 (29,47) vs 61,25 (19,59) Valor p: 0.022) y de osteocalcina 19,79 (10,43) vs 16,87 (10,25) p-valor: 0.028). El HOMA no resultó relacionado con la vitamina D o con los marcadores de recambio óseo. Conclusión: Niveles bajos de vitamina D e hiperparatiroidismo secundario son hallazgos frecuentes en pacientes con obesidad mórbida en nuestro medio. Los marcadores de la vitamina D y recambio óseo no resultaron asociados con el hígado graso no alcohólico, ni con el síndrome metabólico en nuestra serie de pacientes obesos mórbidos.

Utilidad del Hemospray en paciente con hemorragia digestiva baja refractaria secundaria a úlcera en ciego por citomegalovirus / Usefulness of Hemospray in a patient with refractory lower gastrointestinal bleeding secondary to a caecal ulcer caused by cytomegalovirus

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