BACKGROUND AND AIMS: Several methods are available to diagnose Helicobacter pylori infection. Our objective was to evaluate the tests used for both the initial diagnosis and the confirmation of eradication after treatment in Europe. METHODS: The European Registry on the management of Helicobacter pylori infection is an international, multicentre, prospective, non-interventional registry aiming to evaluate the management of Helicobacter pylori-infected patients in Europe. Countries with at least 100 cases registered from June 2013 to April 2021, and with a validated diagnostic method were analysed. Data were quality reviewed. RESULTS: A total of 34,920 adult patients from 20 countries were included (mean age 51 years; 61% women). To establish the initial diagnosis, invasive tests were performed in 19,801 (71%) patients, non-invasive in 11,369 (41%), and both in 3437 (12%). The most frequent were histology (n = 11,885; 43%), a rapid urease test (n = 10,636; 38%) and an urea breath test (n = 7577; 27%). According to the age, invasive tests were indicated in 11,179 (77%) ≥50 years, and in 8603 (65%) <50 years. Depending on the country, the use of invasive tests ranged from 29-99% in <50 years to 60-99% in ≥50. Most of the tests used to confirm eradication were non-invasive (n = 32,540; 93%), with the urea breath test being the most frequent (n = 32,540; 78%). In 2983 (9%) post-treatment tests, histology (n = 1887; 5%) or a rapid urease test (n = 1223; 4%) were performed. CONCLUSION: A great heterogeneity was observed for the initial diagnosis and confirmation of the eradication. The reasons for the apparent lack of adherence to the clinical guidelines should be further explored.
BACKGROUND: Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19. METHODS: This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p<0.05 was considered significant. RESULTS: Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms. CONCLUSION: GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.
COVID-19 , Gastrointestinal Diseases , Humans , COVID-19/complications , Retrospective Studies , SARS-CoV-2 , Prospective Studies , Aftercare , Patient Discharge , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/complications , Diarrhea/epidemiology , Diarrhea/etiology
OBJECTIVE: To evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe. DESIGN: International, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociación Española de Gastroenterología-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis. RESULTS: Overall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed >90% of cases. Overall effectiveness remained <90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p<0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted ≥14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%. CONCLUSION: Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update. TRIAL REGISTRATION NUMBER: NCT02328131.
Liver failure (LF) is a severe entity, which represents a diagnostic challenge for clinicians. Knowing the etiology of liver aggression is key for its management. We present a rare case of cholestatic LF secondary to primary AL (kappa-light chain) amyloidosis as a presentation associated to multiple myeloma.
Amyloidosis , Liver Failure , Multiple Myeloma , Amyloidosis/complications , Humans , Liver Failure/etiology , Multiple Myeloma/complications
La obesidad es una enfermedad con una elevada prevalencia a nivel mundial en la que el digestólogo puede tener una labor importante. Por una parte, algunas enfermedades digestivas son más frecuentes en este grupo de pacientes y es posible que sea necesario evaluarlos antes de la cirugía. Por otra, la cirugía bariátrica puede presentar complicaciones digestivas a corto y largo plazo en las que sea imprescindible nuestra actuación. Además, no podemos olvidar el papel que el tratamiento endoscópico puede tener en la pérdida de peso. El objetivo de la presente revisión es destacar el papel del digestólogo en el manejo del paciente obeso candidato y/o sometido a tratamiento quirúrgico o endoscópico de la obesidad (AU)
Abstract Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity (AU)
Humans , Bariatric Surgery , Endoscopy, Gastrointestinal , Obesity, Morbid/surgery , Postoperative Complications/epidemiology , Comorbidity , Treatment Outcome , Weight Loss
Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity.
Bariatric Surgery , Gastroenterology , Obesity/therapy , Physician's Role , Bariatric Surgery/adverse effects , Bariatric Surgery/methods , Colorectal Neoplasms/etiology , Colorectal Neoplasms/therapy , Disease Management , Disease Susceptibility , Endoscopy, Digestive System , Gallstones/etiology , Gallstones/surgery , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/therapy , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/prevention & control , Gastrointestinal Hemorrhage/therapy , Helicobacter Infections/complications , Helicobacter Infections/drug therapy , Helicobacter pylori , Humans , Non-alcoholic Fatty Liver Disease/etiology , Non-alcoholic Fatty Liver Disease/therapy , Obesity/complications , Obesity, Morbid/surgery , Postgastrectomy Syndromes/etiology , Postgastrectomy Syndromes/therapy , Postoperative Complications/etiology , Postoperative Complications/therapy , Stomach Ulcer/drug therapy , Stomach Ulcer/etiology , Stomach Ulcer/surgery
No disponible
Humans , Female , Adult , Liver Diseases/chemically induced , Antidepressive Agents/adverse effects , Citalopram/toxicity
