Unrestricted vs 3-day low-residue diet for colonoscopy preparation. Results of a feasibility randomized trial.

AIM: To compare the impact of an unrestricted diet with a 3-day low-residue diet before colonoscopy on bowel preparation quality. METHODS: A randomized, multicenter, researcher-blinded, parallel-group feasibility trial was conducted to assess the efficacy of an unrestricted diet versus a 3-day low-residue diet for colonoscopy preparation. Participants, aged 50 to 69, were enrolled in a colorectal cancer screening program with no factors linked to poor bowel cleansing. The Boston Bowel Preparation Scale was used to evaluate colon preparation during intubation and withdrawal. Secondary outcomes included bowel exploration time, adenoma and polyp detection rates, and preparation and diet tolerability. The trial is registered under Clinical Trials (NCT04664543). RESULTS: One hundred and two individuals (mean age 59.3 ± 5.5 years, 40.1% female) were randomly assigned to each diet. All participants in both groups achieved adequate preparation (Boston scores ≥ 2 in each segment). Complete adherence to preparation was observed in the majority of participants in both groups. No significant differences were noted between groups in withdrawal or cecal intubation times, or in adenoma detection rates. The unrestricted diet was better tolerated than the 3-day low-residue diet (82.5% vs. 32.3%). Preparation assessed during intubation was adequate in 82.5% of the unrestricted diet group and in 90.3% of the 3-day low-residue diet group. CONCLUSIONS: It is feasible to test the impact of an unrestricted diet for adequate bowel preparation. Comparable cleansing results were achieved, but the unrestricted diet showed better tolerability.

Microscopic Colitis and Celiac Disease: Sharing More than a Diagnostic Overlap.

Microscopic colitis (MC) is an emergent group of chronic inflammatory diseases of the colon, and celiac disease (CD) is a chronic gluten-induced immune-mediated enteropathy affecting the small bowel. We performed a narrative review to provide an overview regarding the relationship between both disorders, analyzing the most recent studies published at the epidemiological, clinical and pathophysiological levels. In fact, MC and CD are concomitantly prevalent in approximately 6% of the cases, mainly in the subset of refractory patients. Thus, physicians should screen refractory patients with CD against MC and vice versa. Both disorders share more than a simple epidemiological association, being multifactorial diseases involving innate and adaptive immune responses to known or unknown luminal factors based on a rather common genetic ground. Moreover, autoimmunity is a shared characteristic between the patients with MC and those with CD, with autoimmunity in the latter being quite well-established. Furthermore, CD and MC share some common clinical symptoms and risk factors and overlap with other gastrointestinal diseases, but some differences exist between both disorders. More studies are therefore needed to better understand the complex mechanisms involving the common pathogenetic ground contributing to the CD and MC epidemiological association.

Improving the Diagnosis of Dermatitis Herpetiformis Using the Intraepithelial Lymphogram.

Dermatitis herpetiformis is a cutaneous manifestation of celiac disease. Phenotyping of intraepithelial lymphocytes in the small bowel mucosa can strengthen the diagnosis of celiac disease when it is not clear-cut. We aim to evaluate the usefulness of the intraepithelial lymphogram to confirm dermatitis herpetiformis in equivocal cases. We performed a retrospective multicenter study on patients diagnosed with dermatitis herpetiformis and collected data from the intraepithelial lymphogram assessed by flow cytometry. A total of 36 patients were analyzed in relation to the severity of intestinal damage (18 had non-atrophic mucosa) at baseline (N = 28) and/or after the adoption of a gluten-free diet (median follow-up of three years, N = 16). We observed that patients with atrophy more often had positive celiac serology (p = 0.019), celiac clinical symptoms (p = 0.018), and iron-deficiency anemia (p = 0.018), but the severity of skin damage was similar in both groups (p = 0.79). At baseline, increased TCRγδ+ cells were present in 94% of patients with atrophy and 67% with non-atrophic lesions (p = 0.13). After a gluten-free diet, increased TCRγδ+ cells persisted in 100% and 63% of cases, respectively (p = 0.21). We concluded that increased TCRγδ+ cells may be helpful in confirming the diagnosis of dermatitis herpetiformis in equivocal cases, even in patients who were started on a gluten-free diet.

γδ+ T-Cells Is a Useful Biomarker for the Differential Diagnosis between Celiac Disease and Non-Celiac Gluten Sensitivity in Patients under Gluten Free Diet.

BACKGROUND: The differential diagnosis between patients with celiac disease (CD) and non-celiac gluten sensitivity (NCGS) is difficult when a gluten-free diet (GFD) has been initiated before the diagnostic work-up. Isolated increases in TCRγδ+ and celiac lymphogram (increased TCRγδ+ plus decreased CD3-) may enable differential diagnosis in this challenging clinical setting. This study evaluated: (1) the accuracy of %TCRγδ+ and celiac lymphogram for diagnosing CD before and after GFD and for differentiation with NCGS; (2) TCRγδ+ kinetics at baseline and after starting GFD in both CD and NCGS. METHODS: The inclusion criteria were patients with CD (n = 104), NCGS (n = 37), and healthy volunteers (n = 18). An intestinal biopsy for intraepithelial lymphogram by flow cytometry was performed at baseline and after GFD. The optimal cutoff for CD diagnostic accuracy was established by maximizing the Youden index and via logistic regression. RESULTS: %TCRγδ+ showed better diagnostic accuracy than celiac lymphogram for identifying CD before and after GFD initiation. With a cutoff > 13.31, the accuracy for diagnosing CD in patients under GFD was 0.88 [0.80-0.93], whereas the accuracy for diagnosing NCGS (%TCRγδ+ ≤ 13.31) was 0.84 [0.76-0.89]. The percentage of TCRγδ+ cells showed differential kinetics between CD (baseline 22.7% [IQR, 16.4-33.6] vs. after GFD 26.4% [IQR, 17.8-36.8]; p = 0.026) and NCGS (baseline 9.4% [IQR, 4.1-14.6] vs. after GFD 6.4% [IQR, 3.2-11]; p = 0.022). CONCLUSION: TCRγδ+ T cell assessment accurately diagnoses CD before and after a GFD. Increased TCRγδ+ was maintained in the long term after GFD in CD but not in NCGS. Altogether, this suggests the potential usefulness of this marker for the differential diagnosis of these two entities in patients on a GFD.

A Population-Based Cross-Sectional Study of Paediatric Coeliac Disease in Catalonia Showed a Downward Trend in Prevalence Compared to the Previous Decade.

(1) Background: Previous studies showed an increased prevalence and incidence of coeliac disease (CD) over time. The objective is to ascertain whether the CD prevalence in Catalonia (a region of Southern Europe) among children aged 1-5 is as high as previously found in 2004-2009; (2) Methods: From 2013 to 2019, 3659 subjects aged 1-5 years were recruited following the previously used methodology. Factors with a potential impact on CD prevalence were investigated; (3) Results: In 2013-2019, 43/3659 subjects had positive serology, giving a standardised seroprevalence of 12.55/1000 (95% CI: 8.92; 17.40), compared to 23.62 (13.21; 39.40) in 2004-2007. The biopsy-proven crude prevalence was 7.92/1000 (95% CI: 5.50; 11.30), and the crude prevalence based on ESPGHAN criteria was 8.74/1000 (95% CI: 6.20-12.30). In contrast to 2004-2009, we did not find differences in the seroprevalence rates between 1 and 2 years vs. 3 and 4 years of age (age percentage of change -7.0 (-29.5; 22.8) vs. -45.3 (-67.5; -8.0)). Rotavirus vaccination was the most remarkable potential protective factor (48% vs. 9% in 2004-2009; p < 0.0001), but not the time of gluten introduction. (4) Conclusion: The present study did not confirm a worldwide CD prevalence increase and emphasizes the need to perform prevalence studies over time using the same methodology in the same geographical areas.

Usefulness of endoscopic ultrasound in patients with minilithiasis and/or biliary sludge as a cause of symptoms of probable biliary origin after cholecystectomy / Utilidad de la ecoendoscopia en pacientes con minilitiasis y/o barro biliar como causa de síntomas digestivos de probable origen biliar después de la colecistectomía

Introduction: Endoscopic ultrasound (EUS) is a more sensitive technique than transabdominal ultrasound for the diagnosis of gallstones. This greater sensitivity, especially in the diagnosis of microlithiasis/biliary sludge, facilitates the indication of cholecystectomy in patients with symptoms of probable biliary origin but may result in over-indication of this surgery.Objectives: Evaluate the role of EUS in the diagnosis of minilithiasis/biliary sludge in patients with digestive symptoms of probable biliary origin by resolving the symptoms after cholecystectomy. Analyse factors related to the remission of symptoms following cholecystectomy.Patients and methods: Retrospective, longitudinal, single-centre study based on a prospective database of 1.121 patients undergoing EUS. Seventy-four patients were identified as meeting inclusion-exclusion criteria (diagnosed with minilithiasis/sludge by EUS after presenting digestive symptoms of probable biliary origin without a history of complicated cholelithiasis). A telephone questionnaire for symptoms was conducted with cholecystectomized patients. Factors related to a good response were analysed with logistic regression analysis.Results: Of the 74 patients, 50 were cholecystectomized (67.5%), mean age 49 years (SEM 2.26) (41 women). Seventy percent of patients (35/50) presented remission of symptoms with median follow-up 353.5 days (95% CI, 270–632.2). The only variable associated with remission of symptoms was the presence of typical biliary colic with an OR of 7.8 (95% CI, 1.8–34; p=0.006). No complications associated with EUS were recorded. One patient (2%) suffered haemoperitoneum and 18% (9/50) suffered diarrhoea following cholecystectomy.Conclusions: EUS is a very useful technique for the indication of cholecystectomy in patients with minilithiasis/sludge and typical symptoms of biliary colic.

Introducción: La ecoendoscopia (USE) presenta mayor sensibilidad que la ecografía abdominal para el diagnóstico de litiasis biliar. Esta mayor sensibilidad, sobre todo en diagnóstico de microlitiasis/barro biliar, facilitaría una colecistectomía en pacientes con clínica digestiva de probable origen biliar, aunque podría inducir su sobre indicación.ObjetivosEvaluar el papel de la USE en el diagnóstico de minilitiasis-barro biliar en pacientes con clínica digestiva de probable origen biliar y ecografía normal mediante la resolución de los síntomas después de colecistectomía. Analizar los factores relacionados con la remisión de la sintomatología tras colecistectomía.Pacientes y método: Estudio retrospectivo, longitudinal, en un centro, sobre base de datos prospectiva de 1.121 pacientes sometidos a USE. Setenta y cuatro pacientes cumplían criterios inclusión-exclusión (realización USE para estudio de minilitiasis/barro por síntomas digestivos de probable origen biliar, sin historia de colelitiasis complicada). Se realizó cuestionario telefónico de síntomas a los pacientes colecistectomizados. Los factores relacionados con buena evolución se analizaron con análisis de regresión logística.Resultados: De los 74 pacientes, 50 fueron colecistectomizados (67,5%), edad media 49 años (ESM 2,26) (41 mujeres). El 70% de pacientes (35/50) presentó remisión de la sintomatología (mediana de seguimiento 353,5 días) (IC 95%, 270-632,2). La única variable asociada con una remisión de la sintomatología fue la presencia de cólico biliar típico con una OR de 7,8 (IC 95%, 1,8-34; p=0,006). No se registró ninguna complicación asociada a la USE. Un paciente (2%) sufrió hemoperitoneo y un 18% (9/50) presentaron diarrea post-colecistectomía.Conclusiones: La USE es de gran utilidad para la indicación de colecistectomía en los pacientes con minilitiasis-barro biliar y clínica típica de cólico biliar.

Escasa eficacia de metronidazol en la erradicación de Blastocystis hominis en pacientes sintomáticos: serie de casos y revisión sistemática de la literatura / Low efficacy of metronidazole in the eradication of Blastocystis hominis in symptomatic patients: Case series and systematic literature review

Introducción: El Blastocystis hominis (B. hominis) es un protozoo comúnmente encontrado en el tracto gastrointestinal. Existen dudas sobre su significado clínico. El metronidazol (MTZ) es el tratamiento aconsejado de primera línea. Material y métodos: Se realizó una revisión retrospectiva entre 2011 y 2012. Se seleccionaron de forma aleatoria 151 de 383 muestras positivas para B. hominis. Los criterios de inclusión fueron: clínica sugestiva, indicación de tratamiento y realización de control microbiológico. Se realizó una revisión sistemática de los estudios que evalúan el efecto de MTZ sobre la infestación por B. hominis. Resultados: Cuarenta y seis pacientes cumplían criterios de inclusión (el 64% eran mujeres; edad, 44,2±2 años). Se utilizó MTZ en 39 pacientes, de los cuales 31 obtuvieron respuesta clínica (79,5%) pero solo 15 respuesta microbiológica (48,4%). No se apreció una relación dosisefecto. Veinte pacientes sin respuesta microbiológica inicial recibieron una segunda tanda de tratamiento (MTZ, cotrimoxazol, paramomicina, otros), con una respuesta microbiológica del 70%. De forma global, se consiguió la curación de B. hominis en un 72% (IC95%: 57-83%). De 54 tratamientos asociados a respuesta clínica, se produjo respuesta microbiológica en 31 (57%); mientras que de los 12 que se siguieron de ausencia de respuesta clínica solo se observó la curación microbiológica en 2 (17%) (p = 0,022). La tasa de erradicación en la revisión sistemática osciló entre 0 y 100%. Conclusiones: Parece existir relación entre la respuesta clínica y microbiológica al tratamiento de B. hominis. En nuestro entorno geográfico la respuesta microbiológica al tratamiento con MTZ es insuficiente. La revisión sistemática muestra que la respuesta a MTZ es muy variable (AU)

Introduction: Blastocystis hominis (B. hominis) is a protozoan commonly found in the gastrointestinal tract. There are doubts about its clinical significance. Metronidazole (MTZ) is the recommended first-line treatment. Materials and methods: A retrospective review was carried out between 2011 and 2012. A total of 151 samples were randomly selected from 383 samples positive for B. hominis. Inclusion criteria were: suggestive symptoms, treatment indication and microbiological follow-up. A systematic review was performed of all studies that evaluated the effect of MTZ on B. hominis infection. Results: Forty-six patients met the inclusion criteria (64% women; age, 44.2±2 years). MTZ was used in 39 patients, 31 of whom obtained a clinical response (79.5%) but only 15 a microbiological response (48.4%). No dose-effect relationship was observed. Twenty patients with no initial microbiological response received a second round of treatment (MTZ, cotrimoxazole, paramomycin, others), with a microbiological response in 70%. Overall, B. hominis was cured in 72% (95% CI: 57%-83%). Of 54 treatments associated with a clinical response, a microbiological response occurred in 31 (57%), while in the remaining 12 with no clinical response, microbiological cure was observed in only 2 (17%) (P = .022). The eradication rate in the systematic review varied between 0% and 100%. Conclusions: There seems to be a relationship between the clinical and microbiological response to B. hominis treatment. The microbiological response to MTZ treatment is insufficient in our geographical setting. The systematic review shows that the response to MTZ is very variable (AU)

Colitis microscópica: avances para una mejor identificación en los pacientes con diarrea crónica / Advances for improved diagnosis of microscopic colitis in patients with chronic diarrhoea

Colitis microscópica es un término genérico que incluye 2 formas principales, colitis colágena y colitis linfocítica, que describe una forma de enfermedad inflamatoria intestinal con curso crónico y recidivante. La incidencia de colitis microscópica es entre 2 y 8 veces más alta en mujeres que en hombres; sin embargo, la edad contribuye más que el sexo en el riesgo de colitis colágena (OR 8,3 para edad ≥65 vs. <65años y OR 2,8 para sexo femenino). El síntoma principal es la diarrea crónica acuosa, no sanguinolenta. Otros síntomas frecuentes incluyen el dolor abdominal (50-70%), lo que hace que muchos pacientes con colitis microscópica cumplan criterios de síndrome de intestino irritable. Hoy en día se recomienda la realización de una colonoscopia, con toma de biopsias escalonadas en todos estos pacientes, ya que el diagnóstico es principalmente histológico. La mucosa colónica suele ser macroscópicamente normal, aunque se han descrito alteraciones endoscópicas mínimas

Microscopic colitis is a generic term that includes 2 main forms, collagenous colitis and lymphocytic colitis, and describes a form of inflammatory bowel disease with a chronic and relapsing course. The incidence of microscopic colitis is between 2 and 8 times higher in women than in men, although age, more than sex, increases the risk of collagenous colitis (odds ratio [OR] 8.3 for age ≥65 vs. <65 and OR 2.8 for women). The main symptom is chronic non-bloody watery diarrhoea. Other common symptoms include abdominal pain (50%-70%), with the result that many patients with microscopic colitis meet criteria for irritable bowel syndrome. Colonoscopy with multiple colonic biopsies is currently recommended, as histological changes are the main characteristic feature. The colonic mucosa is macroscopically normal, although certain minimal endoscopic abnormalities have been described

The low-FODMAP diet for irritable bowel syndrome: Lights and shadows / Dieta con bajo contenido en FODMAP para el síndrome del intestino irritable: luces y sombras

Irritable bowel syndrome (IBS) affects 10-15% of the western population. Drug therapy for this entity has shown limited efficacy. The low Fermentable Oligo-, Di-, Monosaccharides And Polyols (FODMAP) diet has recently emerged as an effective intervention for reducing gastrointestinal symptoms in IBS. Currently, several mechanistic studies have proven the rational basis of carbohydrate restriction. In addition, high-quality evidence (prospective studies and randomized controlled trials) from a variety of countries supports the high effectiveness of a low-FODMAP diet for IBS symptoms (70%), especially abdominal bloating, pain, and diarrhea. Importantly, this diet seems to be superior to a gluten-free diet for patients with non-celiac gluten sensitivity. The most controversial features of the low FODMAP diet are its short- and long-term limitations (a high level of restriction, the need for monitoring by an expert dietitian, potential nutritional deficiencies, significant gut microbiota reduction, lack of predictors of response), as well as the potential lack of advantage over alternative dietary, pharmacological and psychological interventions for IBS. Although liberalization of carbohydrate intake is recommended in the long-term, the reintroduction process remains to be clarified as, theoretically, global carbohydrate restriction is deemed to be necessary to avoid additive effects

El síndrome de intestino irritable (SII) es una entidad clínica que afecta al 10-15% de la población occidental, para la que los fármacos disponibles han demostrado una eficacia limitada. La dieta con bajo contenido en oligo, di, monosacáridos y polioles (FODMAP) ha surgido recientemente como una medida eficaz para el control de los síntomas gastrointestinales del SII. En la actualidad, los estudios fisiopatológicos han confirmado la base racional de la restricción de carbohidratos en el SII y existe evidencia científica de alta calidad (estudios prospectivos y ensayos clínicos controlados) proveniente de diversos países confirmado la eficacia de la dieta con bajo contenido en FODMAP para el SII (70%), especialmente para la hinchazón y dolor abdominal, así como la diarrea. Cabe destacar que esta dieta parece ser más eficaz que la dieta sin gluten para los pacientes con sensibilidad al gluten no celíaca. Los aspectos más controvertidos de esta dieta son las limitaciones que implica a corto y largo plazo (nivel alto de restricción alimentaria, la necesidad de monitorización por dietistas, riesgo de déficits nutricionales, una descenso marcado de la microbiota intestinal, la ausencia de herramientas predictoras de respuesta), al igual que una eficacia similar a otras intervenciones dietéticas menos restrictivas, farmacológicas y psicológicas en recientes estudios. Pese a que se recomienda liberalizar el consumo de carbohidratos a largo plazo, queda por dilucidar con exactitud la estrategia de reintroducción, ya que teóricamente el éxito de la dieta reside en una restricción global de carbohidratos para evitar efectos aditivos

Diarrea crónica: definición, clasificación y diagnóstico / Chronic diarrhoea: definition, classification and diagnosis

La diarrea crónica es un síntoma de presentación frecuente, tanto en las consultas de medicina de familia como en las de digestivo. Se estima que >5% de la población sufre diarrea crónica y que cerca del 40% de estos sujetos son mayores de 60 años. El clínico se enfrenta con frecuencia a la necesidad de decidir cuál es el mejor enfoque diagnóstico de estos pacientes y elegir entre las múltiples pruebas diagnósticas existentes. En 2014 la Societat Catalana de Digestologia creó un grupo de trabajo con el objetivo principal de crear algoritmos diagnósticos en base a la práctica clínica y evaluar las pruebas diagnósticas disponibles y la evidencia científica para su utilización. Para clasificar la evidencia científica y la fuerza de las recomendaciones se utilizó el sistema GRADE. Se han establecido 28 recomendaciones y 6 algoritmos diagnósticos. Se describen los criterios de derivación desde medicina primaria a digestivo de un paciente con diarrea crónica

Chronic diarrhoea is a common presenting symptom in both primary care medicine and in specialized gastroenterology clinics. It is estimated that >5% of the population has chronic diarrhoea and nearly 40% of these patients are older than 60 years. Clinicians often need to select the best diagnostic approach to these patients and choose between the multiple diagnostic tests available. In 2014 the Catalan Society of Gastroenterology formed a working group with the main objective of creating diagnostic algorithms based on clinical practice and to evaluate diagnostic tests and the scientific evidence available for their use. The GRADE system was used to classify scientific evidence and strength of recommendations. The consensus document contains 28 recommendations and 6 diagnostic algorithms. The document also describes criteria for referral from primary to specialized care

Benefit on health-related quality of life of adherence to gluten-free diet in adult patients with celiac disease

INTRODUCTION: Celiac disease (CD) affects health-related quality of life (HRQOL) of patients suffering it. The exclusion of gluten from the diet (GFD) improves HRQOL, but involves difficulties in following the diet that could adversely affect HRQOL. OBJECTIVE: To determine the effect of adherence to the diet on HRQOL of adult CD patients. METHODS: A prospective, cross-sectional, multicenter study of CD patients treated with a GFD for longer than 1 year. Adherence to the GFD was measured using the Morisky scale, and health status using the specific CD-QOL questionnaire and the generic EuroQol-5D questionnaire. RESULTS: 366 patients from 7 hospitals were included: 71.5% of patients reported a perfect treatment adherence, 23.5% unintentional poor adherence and 5% intentional poor adherence. Good adherence to a GFD was related to a higher mean score on the CD-QOL (75 vs. 68, respectively, p < 0.05) and EuroQol-5D (0.9 vs. 0.8, respectively, p < 0.05). Ease of adherence to a GFD was also related to a better HRQOL (total CD-QOL score of 82 vs. 67 in patients who consider the GFD difficult to follow, p < 0.05). Good symptom control was also related to a better HRQOL (total CD-QOL score of 78 vs. 67 in asymptomatic vs. symptomatic patients, p < 0.01). The worse scored dimension of CD-QOL was related to 'inadequate treatment.' CONCLUSIONS: In CD, good adherence to a GFD and adequate symptom control result in improved HRQOL. Many patients consider that the lack of therapeutic alternatives to diet worsens their quality of life

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Grado de adecuación de las indicaciones de la colonoscopia en una unidad de acceso abierto / Inappropriateness rate for colonoscopy indications in an open access unit

INTRODUCCIÓN Y OBJETIVO: La adecuación de las indicaciones de la colonoscopia a las recomendaciones vigentes es importante para optimizar los recursos disponibles. El objetivo fue valorar el grado de adecuación de las indicaciones de colonoscopia en una unidad de endoscopia de acceso abierto utilizando los criterios EPAGE II. MÉTODOS: Se incluyeron de forma retrospectiva las colonoscopias realizadas entre el 1 de octubre y el 30 de noviembre de 2011. La adecuación de la colonoscopia se estableció de acuerdo con los criterios EPAGE II. Se registraron datos demográficos, médicos solicitantes, indicaciones y hallazgos relevantes de estas exploraciones. RESULTADOS: Se incluyeron 440 colonoscopias (54% mujeres; edad, 60,8 ± 16,3 años). La indicación fue apropiada en 75,4% (IC: 71-79,3%), incierta en 13,1% (IC: 10,2-16,6%) e inapropiada en 11,4% (IC: 8,7-14,8%). En el análisis univariante la presencia de hallazgos relevantes se asoció a la edad, el sexo, la indicación y EPAGE II. En el análisis de regresión logística la edad ≥ 50 años (OR: 1,84), el sexo masculino (OR: 2,7) y 2 indicaciones, control EII y vigilancia pospolipectomía (p < 0,03), se asociaron de forma independiente con la presencia de hallazgos relevantes. El rendimiento diagnóstico de los criterios EPAGE II fue 37,3% para las exploraciones consideradas apropiadas y 28,3% para las inadecuadas (p = 0,09). CONCLUSIONES: El grado de inadecuación de la colonoscopia es elevado, sobre todo en pacientes jóvenes (< 50 años) y en algunas indicaciones. La edad (≥ 50 años) y el sexo masculino se asocian de forma independiente con la presencia de hallazgos relevantes. El rendimiento diagnóstico de los criterios EPAGE II no fue diferente entre exploraciones adecuadas e inadecuadas

INTRODUCTION AND OBJECTIVE: The suitability of indications for colonoscopy is important to optimize the available resources. The aim of this study was to assess the appropriateness of colonoscopy indications in an open access endoscopy unit using the EPAGE II criteria. METHODS: Colonoscopies performed between October 1 and November 30, 2011 were retrospectively included. The appropriateness of the colonoscopy was established according to the EPAGE II criteria. Demographics, medical applicants, indications and relevant findings from these examinations were recorded. RESULTS: We included 440 colonoscopies (60.8 ± 016.3 years, 54% women). The indication was appropriate in 75.4% (CI, 71-79.3%), uncertain in 13.1% (CI, 10.2-16.6%) and inappropriate in 11.4% (CI, 8.7-14.8%). In the univariate analysis, the relevant findings in the colonoscopy were associated with age, sex, colonoscopy indications and EPAGE II. In the logistic regression analysis, factors independently associated with the presence of relevant findings were age (≥ 50 years) (OR, 1.84), male sex (OR, 2.7) and two indications, inflammatory bowel disease and post-polypectomy surveillance (P < .03). The diagnostic yield of EPAGE II criteria was 37.3% for appropriate colonoscopies and 28.3% for inappropriate colonoscopies (P = .09). CONCLUSIONS: The rate of unnecessary colonoscopy is high, especially in young patients (< 50 years) and some colonoscopy indications. Age (≥ 50 years) and male sex are independently associated with the presence of relevant findings in colonoscopy. The diagnostic yield of EPAGE II criteria does not differ between appropriate and inappropriate examinations

Sensibilidad al gluten no celiaca: una revisión crítica de la evidencia actual / Non-celiac gluten sensitivity: A critical review of current evidence

La sensibilidad al gluten no celiaca (SGNC) es una entidad emergente caracterizada por síntomas gastrointestinales y extraintestinales dependientes del gluten en pacientes no celiacos, cuya prevalencia se estima hasta 10 veces superior a la de la enfermedad celiaca (EC). La dieta sin gluten es el tratamiento recomendado, pero el agente causal es desconocido y no existen criterios diagnósticos consensuados. Bajo la denominación de SGNC se han incluido pacientes con potenciales formas menores de EC o con síndrome de intestino irritable sin percepción de intolerancia al gluten, pero respondedores a la dieta sin gluten. Estudios recientes han propuesto los FODMAP (oligo, di, monosacáridos fermentables y polioles) como componente del trigo causante de los síntomas en la SGNC, en vez del gluten. Esta revisión actualiza la evidencia sobre la etiopatogenia y el beneficio de diversas intervenciones dietéticas en la SGNC, enfatizando la necesidad de un despistaje previo riguroso de la EC

Non-celiac gluten sensitivity (NCGS) is an emerging disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food in non-celiac patients. Its prevalence has been estimated to be six to ten-times higher than that of celiac disease (CD). A gluten-free diet is the most widely recommended therapy, but the causative agent remains unknown and there are no consensus diagnostic criteria. Recent studies on NCGS have included patients with possibly overlooked minor CD and diarrhea-predominant irritable bowel syndrome without self-reported gluten intolerance, but showing a response to a gluten-free diet. Furthermore, FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) have recently been postulated as the culprit component for NCGS in wheat, instead of gluten. This review updates evidence on the pathophysiology of NCGS and the efficacy of different dietary interventions in its treatment, stressing the need for proper screening for CD before a diagnosis of NCGS is made

Adaptación transcultural y validación del “Celiac Disease Quality of Life (CD-QOL) survey”, un cuestionario específico de medida de la calidad de vida en pacientes con enfermedad celiaca / Transcultural adaptation and validation of the Celiac Disease Quality of Life (CD-QOL) survey, a specific questionnaire to measure quality of life in patients with celiac disease

Introducción: la enfermedad celiaca es una enfermedad crónica que requiere de un tratamiento continuado, lo que conlleva un impacto sobre la calidad de vida relacionada con la salud (CVRS) de las personas que la padecen. La mayoría de estudios en nuestro medio han utilizado cuestionarios genéricos para medir la CVRS en los pacientes celiacos, lo que ha motivado el presente estudio para traducir y validar al castellano un cuestionario específico para la enfermedad celiaca, el “Celiac Disease Quality Of Life Survey” (CD-QOL). Objetivos: traducir y validar al castellano el cuestionario específico para la enfermedad celiaca CD-QOL. Métodos: se ha diseñado un estudio multicéntrico, prospectivo y observacional desarrollado en dos fases: la primera de traducción/adaptación al idioma castellano mediante el procedimiento de traducción/retrotraducción y estudio de comprensibilidad. A continuación se desarrolló la segunda fase de análisis de la consistencia interna del cuestionario traducido. Para ello se han comparado los resultados del CD-QOL con los del EuroQol y la escala de impacto diario de la fatiga (EIDF). El estudio de comprensibilidad del cuestionario traducido y adaptado se realizó en 6 pacientes, y el estudio de validación en 298 celiacos (201 tratados con dieta sin gluten y 97 al momento del diagnóstico). Resultados: en ambos grupos de celiacos el coeficiente alfa de Cronbach fue elevado (0,90), la factibilidad fue excelente (99,2 % de pacientes completaron todas las preguntas) y el efecto techo y suelo fue nulo. La correlación de Spearman con el EuroQol y el EIDF fue estadísticamente significativa (p < 0,05). El CD-QOL puntuó diferente según el estado de salud fuera bueno, regular o malo en función de la puntuación del EuroQol. Conclusión: la versión en castellano del CD-QOL es un instrumento válido de medida de la CVRS de los pacientes celiacos (AU)

Introduction: celiac disease is a chronic condition that requires continued treatment, with the resultant impact on health-related quality of life (HRQOL) of people who suffer it. Most studies in this field have used generic questionnaires to measure HRQOL in celiac patients. It was therefore decided to conduct a study to translate into Spanish and validate a specific questionnaire for celiac disease, the Celiac Disease Quality Of Life Survey (CD-QOL). Objectives: to translate and validate in Spanish the specific celiac disease questionnaire CD-QOL. Methods: a multicenter, prospective, observational study was designed consisting of two phases: In the first phase, the questionnaire was translated and adapted into Spanish using the translation/back translation procedure and an understandability study. In the second phase, internal consistency of the translated questionnaire was analyzed. For this, results of the CD-QOL were compared to those of EuroQol and the Daily Fatigue Impact Scale (D-FIS). Understandability of the translated and adapted questionnaire was tested in six patients, and the validation study was done in 298 celiac patients (201 treated with a gluten-free diet and 97 at diagnosis). Results: in both celiac groups, Cronbach’s alpha coefficient was high (0.90), feasibility was excellent (99.2 % of patients completed all questions), and there were no ceiling and floor effects. Spearman correlation to EuroQol and D-FIS was statistically significant (p < 0.05). CD-QOL score was different depending on whether state of health was good, fair, or poor based on the EuroQol score. Conclusion: the Spanish version of the CD-QOL is a valid tool for measuring HRQOL in celiac patients (AU)

Enteropatía sensible al gluten y dispepsia funcional / Gluten-sensitive enteropathy and functional dyspepsia

La enteropatía sensible al gluten (ESG) cada vez se diagnostica con mayor frecuencia en el adulto, siendo frecuente su presentación con síntomas que en ocasiones se solapan con los de la dispepsia funcional. Se ha descrito una prevalencia de la ESG en la dispepsia entre el 1,2-6,2%, que podría ser superior si se tiene presente todo el espectro de lesiones relacionadas con la sensibilidad al gluten, incluida la enteropatía linfocítica. Un paciente con dispepsia secundaria a ESG podría ser erróneamente diagnosticado de dispepsia funcional, si la endoscopia digestiva alta no se completa con la toma de biopsias de duodeno y se realiza inmunotinción para linfocitos intraepiteliales. Este hecho podría tener importantes consecuencias en términos de morbimortalidad y calidad de vida de los pacientes. En consecuencia, la biopsia de duodeno debería completar el estudio endoscópico del paciente con dispepsia cuando el contexto clínico sugiere una ESG (AU)

Gluten-sensitive enteropathy (GSE) is increasingly diagnosed in adults. The symptoms of this disease can overlap with those of functional dyspepsia. The prevalence of GSE in dyspepsia has been reported to be 1.2-6.2% and could be higher if the entire spectrum of lesions related to gluten sensitivity, including lymphocytic enteropathy, is considered. Patients with dyspepsia secondary to GSE could be mistakenly diagnosed with functional dyspepsia unless upper gastrointestinal endoscopy is completed with duodenal biopsy and immunostaining for intraepithelial lymphocytes. A missed diagnosis could have major consequences in terms of morbidity and mortality and quality of life. Consequently, endoscopic study of patients with dyspepsia should be completed by duodenal biopsy when there are symptoms suggestive of GSE (AU)