[Use of cyanoacrylate as a treatment of gastric varices in a public hospital in Lima - Peru]. / Uso de cianoacrilato como tratamiento de várices gástricas en un hospitalp úblico nivel III en Lima - Per ú.

OBJECTIVE: To evaluate the therapeutic success of endoscopic therapy with N-butyl-2-cyanoacrylate and to determine the re- bleeding and mortality rates. MATERIALS AND METHODS: Prospective analytical observational study of 47 cases of patients with gastric varices who were treated with N-butyl-2-cyanoacrylate, using a 1: 1 mixture with lipiodol between 2013 and 2017 in a level III public hospital in Lima - Peru. The therapeutic indication was active hemorrhage, primary or secondary prophylaxis. RESULTS: Of the 47 patients, 5 (10.6%) had active hemorrhage, control was obtained in all cases, 24 (51.1%) had stigmas of recent bleeding during endoscopy. Secondary prophylaxis was performed in 16 (34%) patients and primary prophylaxis in 2 (4.7%). 59.6% required a single session with a total volume of cyanoacrylate (ml / patient) of 1.28 ± 0.44. The endoscopic finding was GOV-2 in 78.7% of the cases, IGV-1 in 12.8% and GOV-1 in 8.5%. Seven patients (14.8%) presented late re- bleeding, with successful new therapy in 6 of them, one dying due to therapy failure. Of the six (12.76%) patients who died in total, 5 (83.3%) were due to other causes. No adverse events related to the therapy were reported. No adverse events were reported. Variceal obturation was observed in 28 (59.5%) patients. CONCLUSIONS: Endoscopic management of gastric varices with cyanoacrylate is a safe and effective treatment, with low recurrence and mortality rates.

[Validation of the rapid urease test for the detection of Helicobacter pylori in a Peruvian hospital]. / Validación del test rápido de la ureasa para la detección del Helicobacter pylori en el Hospital Nacional Cayetano Heredia, Lima, Perú.

OBJECTIVE: To validate a rapid urease test (RUT) in Cayetano Heredia Hospital (HCH) in Lima, Peru. MATERIALS AND METHODS: This is a prospective observational study that included 181 patients over 18 years old with dyspeptic symptoms. All of them underwent upper gastrointestinal endoscopy at the Department of Gastroenterology at HCH. They had not received, during the last four weeks, proton pump inhibitors (PPIs), bismuth or antibiotics. Two biopsies of antrum were taken, one to perform the TRU (Sensibacter pylori test®) and the other one for pathology, in order to determine by both methods the presence of H. pylori infection. TRU's results were compared with pathology ́s (gold standard). RESULTS: 181 patients, average age 52.8±13.5 years, were evaluated. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) at 20 minutes were 86.8%, 98.5%, 81.5% and 99% and at 24 hours 97.3%, 99.5%, 95.7% y 99.1% respectively. CONCLUSION: The rapid urease test is a reliable, accessible and easy to apply test for the diagnosis of H. pylori infection.

[Porphyria cutanea tarda as extrahepatic manifestation of chronic hepatitis C: a case report]. / Porfiria cutánea tarda como manifestación extrahepática de hepatitis Ccrónica: reporte de un caso.

The present case is a 56 year old male who present hyperpigmented and hypopigmented scars in both hands, associated with the presence of milia cysts. It was studied the metabolism of porphyrins and skin biopsy of the lesions which were compatible with porphyria cutanea tarda. In the initial laboratory, elevated transaminases values were found and subsequently identified chronic infection of hepatitis C virus. In order to treat viral infection and resolve the dermal commitment; considered extrahepatic manifestation of hepatitis C virus, treatment was started with pegylated interferon and ribavirin, with favorably development and rapid viral response, with undetectable viral load until now (24 weeks of treatment), decreased level of serum transaminases and improvement of skin lesions.

[Association between ulcerative colitis and primary esclerosing cholangitis]. / Asociación entre colitis ulcerativa y colangitis esclerosante primaria.

Ulcerative Colitis (UC) is associated to Primary Sclerosing Cholangitis (PSC) in 80% of cases, and this association is more common than the one with Crohn’s disease. Nevertheless, the prevalence of PSC in patients with UC is only 2.9% in Latin America. We present the case of a female patient who presents a clinical history characterized for chronic diarrhea of one year of evolution, associated to fever, oral ulcers and loss of weight. In the laboratory results there is an elevation in the following: alkaline phosphatase, GGT, ALT and AST, for that reason we decide to do an abdominal ultrasound finding a hepatomegaly. In the colonoscopy we found an ulcerative colitis. Later, we do a magnetic resonance cholangiopancreatography, because of the diagnosis of UC and the abnormalities at the liver function tests, diagnosing PSC associated to UC. At that moment, the patient starts treatment with sulfasalazine that is stopped because of an adverse effect, starting prednisone and azathioprine. The patient then is discharged with the medication already mentioned and has a favorable clinical outcome. We decide to report the case because is the second reported case in Peru, being this association not commonly found in the South hemispheric.

[Comparison between Glascow-Blatchford, Rockall and AIMS65 scores in patients with upper gastrointestinal bleeding in a hospital in Lima, Peru]. / Comparación de los scores Glasgow-Blatchford, Rockall y AIMS65 en pacientes con hemorragia digestiva alta en un hospital de Lima, Perú.

OBJECTIVE: Identify the best score that predicts each variable outcome (mortality, rebleeding and need for transfusion for more than 2 red blood cells pack) in patients with upper gastrointestinal bleeding until 30 days of the event. Material y methods: Patients included were those over 18 years, who had upper gastrointestinal bleeding between January 2014 to June 2015 in a general hospital of third level. The data was analyzed by the area under the curve ROC (Receiver Operating Characteristic). RESULTS: In total, there were 231 cases of upper gastrointestinal bleeding, 154 (66.7%) cases were male, the average age was 57.8 ± 20.02 years, the most common cause of bleeding was peptic ulcer: 111 (48.1%) cases, the mortality rate and rebleeding was 7.8% and 3.9% respectively. 5 patients were excluded from the analysis because they do not count with endoscopy study, the analysis was performed in 226 rest. In the evaluation of mortality, it was found an area under the curve ROC for Glasgow-Blatchford: 0.73, Rockall score: 0.86 and AIMS65 score: 0.90 (p<0.05) to predict rebleeding the Glasgow-Blatchford score: 0.73 Rockall score: 0.66 and AIMS65 score: 0.64 (p=0.41) and transfusion requirements of more than 2 globular packages the Glasgow-Blatchford score: 0.72, Rockall score: 0.67 and AIMS65 score: 0.77 (p=0.09). CONCLUSIONS: AIMS65 score is a good predictor of mortality and is useful in predicting the need for more than 2 transfusions of red blood cells pack compared to score Glasgow-Blatchford and Rockall score.

[Venous tromboembolism in a patient with Crohn disease with ileal stenosis]. / Trombosis venosa profunda en un paciente con enfermedad de Crohnilealestenosante.

Inflammatory bowel disease is associated with extraintestinal manifestations. Among these manifestations is the venous tromboembolism which presents a risk three times more than that presented in general population. We report the case of a 61-year-old male with a history of abdominal pain, chronic diarrhea and fever, with leukocytosis, and fecal samples containing leukocytes, partial ileal stenosis with multiple ulcers in the enteroscopy, with histologic findings compatible with Crohn's disease. The patient has a good outcome with prednisone and maintenence azathioprine, presenting at the fifth month deep venous thrombosis of both lower extremities that resolvewith anticoagulation treatment.

[AIMS65 score validation for upper gastrointestinal bleeding in the National Hospital Cayetano Heredia]. / Validación del score AIMS65 para hemorragia digestiva alta en el Hospital Nacional Cayetano Heredia.

OBJECTIVE: To validate the score AIMS65 in patients with upper gastrointestinal bleeding, in terms of mortality and rebleeding a 30-day event. MATERIAL AND METHODS: Patients included were those with higher age to 18 years attending the Hospital Nacional Cayetano Heredia during the period May 2013 to December 2014, by upper gastrointestinal bleeding. Data were analyzed using ROC curve (Receiver Operating Characteristic) and the area was obtained under the curve (AUC) to properly qualify the score AIMS65. RESULTS: 209 patients were included, 66.03% were male, with an average age of 58.02 years. The mortality rate was 7.65%, the multiorgan failure the most common cause of death. Plus 3.82% of the patients had recurrent bleeding and 11% required a transfusion of more than 2 units of blood. When analyzing the ROC curve with AIMS65 and mortality score a value of 0.9122 is reported; identifying it as cutoff greater than or equal to 3 value in the score AIMS65 to discriminate patients at high risk of death, likewise the ROC curve was analyzed for recurrence of bleeding with a value of 0.6266 and the need to Transfusion of packed red blood cells over two a value of 0.7421. And it was determined the average hospital stay with a value of 4.8 days, however, no correlation was found with the score AIMS65. CONCLUSIONS: AIMS65 score is a good predictor of mortality, and is useful for predicting the need for transfusion of more than 2 globular packages. However it is not a good predictor for recurrence of bleeding, or hospital stay.

[Validation of the Rockall score in elderly patients with non variceal upper gastrointestinal bleeding in a third level general hospital]. / Validación del score de Rockall en pacientes adultos mayores con hemorragia digestiva alta no variceal en un hospital general de tercer nivel.

OBJECTIVE: To validate the Rockall score in elderly patients with non variceal upper gastrointestinal bleeding, in terms of mortality and recurrent bleeding at 30 days follow-up. MATERIAL AND METHODS: Patients older than 60 year-old, with non variceal upper gastrointestinal bleeding demonstrated by endoscopy, who were attended in a third level general hospital from June 2009 to June 2013, were included. Data was analyzed with the ROC (Receiver Operating Characteristic) curve. The area under curve was obtained to assess the Rockall score. RESULTS: One hundred ninety patients were included, 64.2% were males, with an average age of 74 years old. Overall mortality was 16.8% and respiratory failure with second bleeding episode was the most common cause of death (34.3% and 31.3% respectively). 5.52% of patients presented a second bleeding episode. A transfusion of more than 2 blood-packs was needed in the 24.7% of the patients. The area under ROC curve using the Rockall score was 0,76 (IC: 0.68-0.84) for mortality risk, 0.71 (IC: 0.55-0.88) for the risk of rebleeding and 0.66 (IC: 0.58-0.74) for needing a more than 2 blood-packs transfusion. CONCLUSIONS: Rockall score is a good predictor for mortality and rebleeding during the 30 day-period after a non-variceal bleeding episode in elderly patients. The best sensibility and specificity was obtained with the scores of 5 and 6, respectively.

Pancreatitis aguda asociada a balón intragástrico: reporte de caso y revisión de la literatura

La obesidad es una patología de importancia a nivel mundial porque conlleva a una alta carga de mortalidad y morbilidad. El balón intragástrico representa una técnica no quirúrgica empleada cada vez con más frecuencia para lograr pérdida de peso. Si bien, este se considera un método seguro, se han reportado algunas complicaciones desde náuseas y vómitos, hasta eventos adversos graves, tales como perforación. La pancreatitis aguda constituye una complicación muy rara del balón intragástrico y se atribuye su efecto a la compresión directa que ejerce sobre el páncreas. Presentamos el caso de una paciente mujer de 21 años, quien después de 7 meses de colocación de balón intragástrico, cursó con dolor abdominal, náuseas y vómitos, asociados a elevación de enzimas pancreáticas. Se hizo diagnóstico de pancreatitis aguda y se corroboró compresión de la cola del páncreas mediante estudio tomográfico. Se decidió retiro del balón mediante endoscopía, cursando luego con evolución favorable.

Obesity is a pathology of importance worldwide because it leads to a high burden of mortality and morbidity. The intragastric balloon represents a non-surgical technique used more and more frequently to achieve weight loss. Although this is considered a safe method, some complications have been reported, from nausea and vomiting to serious adverse events, such as perforation. Acute pancreatitis is a very rare complication of the intragastric balloon, and its effect is attributed to the direct compression it exerts on the pancreas. We present the case of a 21-year-old female patient who, after 7 months of intragastric balloon placement, developed abdominal pain, nausea, and vomiting, associated with elevated pancreatic enzymes. A diagnosis of acute pancreatitis was made and compression of the tail of the pancreas was confirmed by tomographic study. It was decided to remove the balloon by endoscopy, which then progressed favorably.

Uso de cianoacrilato como tratamiento de várices gástricas en un hospital público nivel III en Lima - Perú

Objetivo: Evaluar el éxito de la terapia endoscópica con N-butil-2-cianoacrilato sobre las várices gástricas y determinar las tasas de resangrado y mortalidad. Materiales y métodos: Estudio observacional prospectivo de 47 casos de pacientes con várices gástricas que fueron tratados con N-butil-2-cianoacrilato, utilizando una dilución 1:1 con lipiodol entre febrero de 2013 a marzo de 2017 en un hospital público de nivel III en Lima- Perú. La indicación terapéutica fue hemorragia activa, profilaxis primaria o secundaria. Resultados: De los 47 pacientes, 5 (10,6%) presentaban hemorragia activa, se obtuvo control de la misma en todos los casos, 24 (51,1%) tuvieron estigmas de sangrado reciente durante la endoscopía. Se realizó profilaxis secundaria en 16 (34%) pacientes y profilaxis primaria en 2 (4,7%), 59,6% requirió una sola sesión. El volumen total de cianoacrilato (ml/paciente) promedio fue 1,28 ± 0,44. Se aplicó una sola inyección por sesión en el 87,2% de los pacientes. El hallazgo endoscópico fue GOV-2 en el 78,7% de los casos, IGV-1 en el 12,8% y GOV-1 en el 8,5%. Siete pacientes (14,8%) presentaron resangrado tardío, con nueva terapia exitosa en 6 de ellos, uno fallece por fracaso de la terapia. Seis (12,76%) pacientes fallecen en total, cinco (83,3%) por otras causas. Se realizó 18 meses de seguimiento. No se reportaron eventos adversos relacionados con la terapia. Se constata obturación en 28 (59,5%) pacientes. Conclusiones: El manejo endoscópico de várices gástricas con cianoacrilato es un tratamiento seguro y eficaz, con baja tasa de recurrencia y mortalidad.

Objective: To evaluate the therapeutic success of endoscopic therapy with N-butyl-2-cyanoacrylate and to determine the rebleeding and mortality rates. Materials and methods: Prospective analytical observational study of 47 cases of patients with gastric varices who were treated with N-butyl-2-cyanoacrylate, using a 1: 1 mixture with lipiodol between 2013 and 2017 in a level III public hospital in Lima - Peru. The therapeutic indication was active hemorrhage, primary or secondary prophylaxis. Results: Of the 47 patients, 5 (10.6%) had active hemorrhage, control was obtained in all cases, 24 (51.1%) had stigmas of recent bleeding during endoscopy. Secondary prophylaxis was performed in 16 (34%) patients and primary prophylaxis in 2 (4.7%). 59.6% required a single session with a total volume of cyanoacrylate (ml / patient) of 1.28 ± 0.44. The endoscopic finding was GOV-2 in 78.7% of the cases, IGV-1 in 12.8% and GOV-1 in 8.5%. Seven patients (14.8%) presented late rebleeding, with successful new therapy in 6 of them, one dying due to therapy failure. Of the six (12.76%) patients who died in total, 5 (83.3%) were due to other causes. No adverse events related to the therapy were reported. No adverse events were reported. Variceal obturation was observed in 28 (59.5%) patients. Conclusions: Endoscopic management of gastric varices with cyanoacrylate is a safe and effective treatment, with low recurrence and mortality rates.

Validación del test rápido de la ureasa para la detección del Helicobacter pylori en el Hospital Nacional Cayetano Heredia, Lima, Perú / Validation of the rapid urease test for the detection of Helicobacter pylori in a Peruvian hospital

Objetivos: Validar un test rápido de la ureasa (TRU) en el Hospital Cayetano Heredia (HCH) de Lima, Perú Materiales y métodos: Estudio observacional prospectivo. Se incluyó 181 pacientes mayores de 18 años de edad con síntomas dispépticos, que fueron sometidos a endoscopía digestiva alta en el Servicio de Gastroenterología del HCH y que no hubiesen recibido durante las últimas cuatro semanas inhibidores de la bomba de protones (IBPs), bismuto o antibióticos. Se tomó dos biopsias de antro una para hacer el TRU (Sensibacter pylori test®) y otra para anatomía patológica con el fin de determinar la presencia de la infección por H. pylori por ambos métodos. Finalmente se comparó el resultado de la anatomía patológica (patrón de oro) con el de TRU. Resultados: Se evaluó 181 pacientes, la edad promedio fue 52,8±13,5 años. La sensibilidad, especificidad, valor predictivo negativo (VPN), valor predictivo positivo (VPP) a los 20 minutos fueron de 86,8%, 98,5%, 81,5% y 99% y a las 24 horas 97,3%, 99,5%, 95,7% y 99,1% respectivamente. Conclusión: El TRU es un test confiable, accesible y de fácil aplicación para hacer el diagnóstico de la infección por H. pylori.

Objective: To validate a rapid urease test (RUT) in Cayetano Heredia Hospital (HCH) in Lima, Peru. Materials and methods: This is a prospective observational study that included 181 patients over 18 years old with dyspeptic symptoms. All of them underwent upper gastrointestinal endoscopy at the Department of Gastroenterology at HCH. They had not received, during the last four weeks, proton pump inhibitors (PPIs), bismuth or antibiotics. Two biopsies of antrum were taken, one to perform the TRU (Sensibacter pylori test®) and the other one for pathology, in order to determine by both methods the presence of H. pylori infection. TRU’s results were compared with pathology´s (gold standard). Results: 181 patients, average age 52.8±13.5 years, were evaluated. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) at 20 minutes were 86.8%, 98.5%, 81.5% and 99% and at 24 hours 97.3%, 99.5%, 95.7% y 99.1% respectively. Conclusion: The rapid urease test is a reliable, accessible and easy to apply test for the diagnosis of H. pylori infection.

Porfiria cutánea tarda como manifestación extrahepática de hepatitis C crónica: reporte de un caso / Porphyria cutanea tarda as extrahepatic manifestation of chronic hepatitis C: a case report

Se presenta el caso de un paciente varón de 56 años quien es evaluado por presentar a nivel del dorso de ambas manos cicatrices hiperpigmentadas e hipopigmentadas, asociadas a quistes de milia. Se le realizó estudios del metabolismo de las porfirinas y biopsia cutánea de las lesiones los cuales resultaron compatibles con porfiria cutánea tarda. En el laboratorio inicial se encontró elevación de los valores de transaminasas, identificándose posteriormente infección crónica por virus de hepatitis C. Con la finalidad de tratar la infección viral y resolver el compromiso dérmico, considerado como manifestación extrahepática del virus hepatitis C, se inició tratamiento con interferón pegilado y ribavirina evolucionando favorablemente con respuesta viral rápida, carga viral no detectable hasta la actualidad (36 semanas de tratamiento), disminución del nivel de transaminasas séricas y mejoría de las lesiones dérmicas.

The present case is a 56 year old male who present hyperpigmented and hypopigmented scars in both hands, associated with the presence of milia cysts. It was studied the metabolism of porphyrins and skin biopsy of the lesions which were compatible with porphyria cutanea tarda. In the initial laboratory, elevated transaminases values were found and subsequently identified chronic infection of hepatitis C virus. In order to treat viral infection and resolve the dermal commitment; considered extrahepatic manifestation of hepatitis C virus, treatment was started with pegylated interferon and ribavirin, with favorably development and rapid viral response, with undetectable viral load until now (24 weeks of treatment), decreased level of serum transaminases and improvement of skin lesions.

Asociación entre colitis ulcerativa y colangitis esclerosante primaria / Association between ulcerative colitis and primary esclerosing cholangitis

La Colitis Ulcerativa (CU) está asociada a la Colangitis Esclerosante primaria (CEP) en 80% de los casos y esta concurrencia entre CEP y CU es mayor en comparación con la enfermedad de Crohn. Sin embargo, la prevalencia de CEP en pacientes con CU es sólo 2,9% en Latinoamérica. Presentamos el caso de una paciente mujer que presenta un cuadro caracterizado por diarrea crónica de un año de evolución, asociado a sensación de alza térmica, ulceras orales y pérdida de peso. En los exámenes auxiliares se encuentra una fosfatasa alcalina, GGT, TGO y TGP elevados por ello se decide realizar una ecografía abdominal encontrándose hepatomegalia. En el examen de colonoscopia se encuentran hallazgos compatibles con colitis ulcerativa. Entonces se realiza una colangioresonancia debido al diagnóstico de CU y las anormalidades en los valores de función hepática; diagnosticándose CEP asociada a CU. Es así que la paciente recibe tratamiento con sulfazalasina que se suspende por efecto adverso, iniciándose prednisona y azatioprina. La paciente es dada de alta con el tratamiento ya descrito y tiene buena evolución clínica. Se decide reportar el presente caso debido a que es el segundo caso reportado en el Perú, siendo esta asociación poco frecuente en el hemisferio sur...

Ulcerative Colitis (UC) is associated to Primary Sclerosing Cholangitis (PSC) in 80% of cases, and this association is more common than the one with CrohnÆs disease. Nevertheless, the prevalence of PSC in patients with UC is only 2.9% in Latin America. We present the case of a female patient who presents a clinical history characterized for chronic diarrhea of one year of evolution, associated to fever, oral ulcers and loss of weight. In the laboratory results there is an elevation in the following: alkaline phosphatase, GGT, ALT and AST, for that reason we decide to do an abdominal ultrasound finding a hepatomegaly. In the colonoscopy we found an ulcerative colitis. Later, we do a magnetic resonance cholangiopancreatography, because of the diagnosis of UC and the abnormalities at the liver function tests, diagnosing PSC associated to UC. At that moment, the patient starts treatment with sulfasalazine that is stopped because of an adverse effect, starting prednisone and azathioprine. The patient then is discharged with the medication already mentioned and has a favorable clinical outcome. We decide to report the case because is the second reported case in Peru, being this association not commonly found in the South hemispheric...

Comparación de los scores Glasgow-Blatchford, Rockall y AIMS65 en pacientes con hemorragia digestiva alta en un hospital de Lima, Perú / Comparison between Glascow-Blatchford, Rockall and AIMS65 scores in patients with upper gastrointestinal bleeding in a hospital in Lima, Peru

Identificar el mejor score que predice cada variable resultado (mortalidad, resangrado y necesidad de transfusión de más de 2 paquetes globulares) en pacientes con hemorragia digestiva alta hasta los 30 días del evento. Material y métodos: Los pacientes incluidos fueron aquellos mayores de 18 años que presentaron hemorragia digestiva alta entre enero 2014 y junio 2015 en un hospital general de tercer nivel. Los datos se analizaron mediante el área bajo la curva de ROC (Receiver Operating Characteristic). Resultados: En total fueron 231 casos de hemorragia digestiva alta, de los cuales 154 (66,7%) casos fueron varones, la edad promedio fue de 57,8 +/- 20,02 años, la causa más frecuente de sangrado fue úlcera péptica: 111 (48.1%) casos, la tasa de mortalidad y de resangrado fue de 7,8% y 3,9% respectivamente. Se debió excluir del análisis a 5 pacientes porque no contaban con estudio endoscópico, entre los 226 restantes se realizó el análisis, al evaluar mortalidad se encontró un área bajo la curva ROC para el score Glasgow- Blatchford: 0,73, score Rockall: 0,86 y el score AIMS65: 0,90 (p<0,05), para predecir resangrado el score Glasgow- Blatchford: 0,73, score Rockall: 0,66 y el score AIMS65: 0,64 (p=0,41) y necesidad de transfusión de más de 2 paquetes globulares el score Glasgow- Blatchford: 0,72, score Rockall: 0,67 y el score AIMS65: 0,77 (p=0,09). Conclusiones: El score AIMS65 es un buen predictor de mortalidad y es útil para predecir la necesidad de transfusión de más de 2 paquetes globulares en comparación al score Glasgow-Blatchford y el score Rockall...

Identify the best score that predicts each variable outcome (mortality, rebleeding and need for transfusion for more than 2 red blood cells pack) in patients with upper gastrointestinal bleeding until 30 days of the event. Material y methods: Patients included were those over 18 years, who had upper gastrointestinal bleeding between January 2014 to June 2015 in a general hospital of third level. The data was analyzed by the area under the curve ROC (Receiver Operating Characteristic). Results: In total, there were 231 cases of upper gastrointestinal bleeding, 154 (66.7%) cases were male, the average age was 57.8 +/- 20.02 years, the most common cause of bleeding was peptic ulcer: 111 (48.1%) cases, the mortality rate and rebleeding was 7.8% and 3.9% respectively. 5 patients were excluded from the analysis because they do not count with endoscopy study, the analysis was performed in 226 rest. In the evaluation of mortality, it was found an area under the curve ROC for Glasgow Blatch ford: 0.73, Rockall score: 0.86 and AIMS65 score: 0.90 (p<0.05) to predict rebleeding the Glasgow-Blatchford score: 0.73 Rockall score: 0.66 and AIMS65 score: 0.64 (p=0.41) and transfusion requirements of more than 2 globular packages the Glasgow-Blatchford score: 0.72, Rockall score: 0.67 and AIMS65 score: 0.77 (p=0.09). Conclusions: AIMS65 score is a good predictor of mortality and is useful in predicting the need for more than 2 transfusions of red blood cells pack compared to score Glasgow- Blatchford and Rockall score...

Validación del score de Rockall en pacientes adultos mayores con hemorragia digestiva alta no variceal en un hospital general de tercer nivel / Validation of the Rockall score in elderly patients with non variceal upper gastrointestinal bleeding in a third level general hospital

Objetivo: Validar el score de Rockall en adultos mayores con hemorragia digestiva alta no variceal, como un discriminante de mayor riesgo para mortalidad y recidiva de hemorragia a 30 días de seguimiento. Material y métodos: Se incluyeron los pacientes mayores de 60 años que cursaron con hemorragia digestiva alta no variceal demostrada por endoscopía, desde junio 2009 hasta junio 2013, en un hospital general de tercer nivel. Los datos se analizaron con la curva ROC y se calculó el área bajo la curva para evaluar la utilidad del score de Rockall. Resultados: Entre los 190 pacientes registrados, el 64,2% fueron varones y la edad promedio de 74 ± 9,4 años, teniéndose 29% de pacientes con 80 o más años (55 pacientes). Se halló una mortalidad de 16,8% (32 pacientes), siendo la insuficiencia respiratoria y el resangrado las causas más frecuentes (34,3% y 31,3%). El 6,84% (13 pacientes) tuvieron recidiva de hemorragia y un 24,7% (47 pacientes) necesitó transfusión de más de 2 paquetes globulares. El área bajo la curva ROC para el riesgo de mortalidad fue de 0,76 (IC: 0,68-0,84), para recidiva de hemorragia de 0,71 (IC: 0,55-0,88) y para transfusión de más de 2 paquetes globulares de 0,66 (IC: 0,58-0,74). Conclusión: El score de Rockall es un buen predictor de mortalidad y de recidiva de hemorragia durante los 30 días posteriores a un episodio de hemorragia digestiva altano variceal en adultos mayores, siendo los score 5 y 6, respectivamente, los de mejor sensibilidad y especificidad.

Objective: To validate the Rockall score in elderly patients with non variceal upper gastrointestinal bleeding, in terms of mortality and recurrent bleeding at 30 days follow-up. Material and methods: Patients older than 60 year-old, with non variceal upper gastrointestinal bleeding demonstrated by endoscopy, who were attended in a third level general hospital from June 2009 to June 2013, were included. Data was analyzed with the ROC (Receiver Operating Characteristic) curve. The area under curve was obtained to assess the Rockall score. Results: One hundred ninety patients were included, 64.2% were males, with an average age of 74 years old. Overall mortality was 16.8% and respiratory failure with second bleeding episode was the most common cause of death (34.3% and 31.3% respectively). 5.52% of patients presented a second bleeding episode. A transfusion of more than 2 blood-packs was needed in the 24.7% of the patients. The area under ROC curve using the Rockall score was 0,76 (IC: 0.68-0.84) for mortality risk, 0.71 (IC: 0.55-0.88) for the risk of rebleeding and 0.66 (IC: 0.58-0.74) for needing a more than 2 blood-packs transfusion. Conclusions: Rockall score is a good predictor for mortality and rebleeding during the 30 day-period after a non-variceal bleeding episode in elderly patients. The best sensibility and specificity was obtained with the scores of 5 and 6, respectively.