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

INTRODUCCIÓN La escala de Boston es una herramienta útil para estandarizar el nivel de preparación en la colonoscopia. El objetivo del trabajo fue analizar el grado de limpieza de la colonoscopia y los factores asociados a este en la práctica clínica habitual. MATERIAL Y MÉTODOS: Se incluyeron las colonoscopias realizadas desde enero hasta junio de 2013. Los motivos de exclusión fueron: edad < 15 años, antecedentes de cirugía colónica, enfermedad inflamatoria intestinal o hemorragia digestiva activa. Los parámetros estudiados en relación con el grado de limpieza (mediante la escala de Boston) fueron: la edad, el sexo, la indicación, el turno de la exploración (mañana o tarde), la procedencia (ambulante o ingresado) y los hallazgos encontrados. RESULTADOS: Se analizaron 947 exploraciones, excluyéndose 297. El 5,8% (38/650) de las exploraciones fueron incompletas, el 50% por falta de preparación. La edad media fue de 61,27 años (DS: 16,1), siendo el 51,8% mujeres. La distribución del nivel de preparación fue: 0-3 6,3%; 4-5 12,6%; 6-7 30,6%; 8-9 50,4%, siendo la media 7,04 (DS: 2,03). En el análisis multivariante los factores asociados a una mejor preparación que resultaron estadísticamente significativos fueron: una edad menor, el turno de tarde y el régimen ambulatorio. El porcentaje de pólipos en pacientes con una escala de Boston 5 fue de 10%, frente al 27,8% en pacientes con una puntuación > 5 (p = 0,014). CONCLUSIÓN: En la práctica clínica se obtiene un grado de preparación aceptable en el 80% de los pacientes. Los pacientes con más edad, aquellos que se realizan la colonoscopia de mañana o estando ingresados serían candidatos a medidas para mejorar el grado de preparación

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(R). 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

[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.

Manifestaciones gastrointestinales en pacientes con inmunodeficiencias primarias que cursan con déficit de anticuerpos / Gastrointestinal manifestations in patients with primary immunodeficiencies causing antibody deficiency

Introducción. Las inmunodeficiencias primarias pueden presentar manifestaciones digestivas aún no bien definidas. Objetivo. Analizar la patología digestiva que se asocia a las inmunodeficiencias primarias. Material y métodos. Estudio retrospectivo que incluyó a los pacientes diagnosticados de deficiencias primarias de anticuerpos en un hospital de tercer nivel. Fueron divididos en 2 grupos: déficit aislado de IgA (Def-IgA) y síndrome de inmunodeficiencia común variable (SICV). Se analizaron el momento de presentación y tipo de sintomatología digestiva. Resultados. Se recogieron 57 pacientes: 20 con SICV (35%) y 37 con Def-IgA (65%). El diagnóstico fue realizado en edad pediátrica en 17 casos, de los cuales 13 cursaban con Def-IgA. El diagnóstico de inmunodeficiencia fue previo a las manifestaciones digestivas en el 84% de los casos. La clínica digestiva se presentaba en un 74% de los pacientes, la diarrea fue el síntoma más frecuente. La patología se confirmó en el 46% de los casos principalmente mediante endoscopia. La enfermedad celiaca-like, gastritis crónica atrófica, colitis ulcerosa-like y enfermedad de Crohn fueron más comunes en el SICV. Mientras que en el Def-IgA predominaron la gastritis crónica con Helicobacter positivo. La edad media fue significativamente mayor (36 vs. 24 años, p=0,02) y el título de IgA menor (17 vs. 34UI/ml; p=0,008) en los pacientes que presentaban patología digestiva asociada. Conclusiones. Los síntomas digestivos son frecuentes y se llega al diagnóstico en la mitad de los pacientes con inmunodeficiencias primarias mediante estudio endoscópico. La colitis ulcerosa, Crohn y celiaca-like son entidades atípicas y propias del SICV (AU)

ObjectiveTo analyze gastrointestinal manifestations associated with primary immunodeficiencies. Material and methods. We performed a retrospective study that included patients diagnosed with primary antibody deficiencies in a third-level hospital. The patients were divided into two groups: isolated IgA deficiency and common variable immunodeficiency syndrome (CVIS). The timing of presentation and type of gastrointestinal symptoms were analyzed. Results. There were 57 patients: 20 with CVIS (35%) and 37 with isolated IgA deficiency (65%). Diagnosis was made in the pediatric age in 17 patients, of whom 13 had isolated IgA deficiency. In 84% of the patients, diagnosis of immunodeficiency was made before the development of gastrointestinal manifestations. Digestive symptoms were found in 74% of the patients, the most frequent being diarrhea. In 46% of the patients, digestive disease was confirmed, mainly through endoscopy. Celiac-like lesions, chronic atrophic gastritis, ulcerative colitis-like disease and Crohn's disease were more common in CVIS. In isolated IgA deficiency, Helicobacter pylori-positive chronic gastritis predominated. Mean age was significantly higher (36 vs. 24 years, p=0.02) and IgA titer significantly lower (17 vs. 34UI/ml; p=0.008) in patients with associated gastrointestinal disease. Conclusions. Gastrointestinal symptoms are frequent and lead to endoscopic diagnosis in half of patients with primary immunodeficiencies. Ulcerative colitis, and celiac- and Crohn's-like disease are atypical entities that occur in CVIS (AU)

[Gastrointestinal manifestations in patients with primary immunodeficiencies causing antibody deficiency]. / Manifestaciones gastrointestinales en pacientes con inmunodeficiencias primarias que cursan con déficit de anticuerpos.

INTRODUCTION: Primary immunodeficiencies can lead to gastrointestinal manifestations that are still not well defined. OBJECTIVE: To analyze gastrointestinal manifestations associated with primary immunodeficiencies. MATERIAL AND METHODS: We performed a retrospective study that included patients diagnosed with primary antibody deficiencies in a third-level hospital. The patients were divided into two groups: isolated IgA deficiency and common variable immunodeficiency syndrome (CVIS). The timing of presentation and type of gastrointestinal symptoms were analyzed. RESULTS: There were 57 patients: 20 with CVIS (35%) and 37 with isolated IgA deficiency (65%). Diagnosis was made in the pediatric age in 17 patients, of whom 13 had isolated IgA deficiency. In 84% of the patients, diagnosis of immunodeficiency was made before the development of gastrointestinal manifestations. Digestive symptoms were found in 74% of the patients, the most frequent being diarrhea. In 46% of the patients, digestive disease was confirmed, mainly through endoscopy. Celiac-like lesions, chronic atrophic gastritis, ulcerative colitis-like disease and Crohn's disease were more common in CVIS. In isolated IgA deficiency, Helicobacter pylori-positive chronic gastritis predominated. Mean age was significantly higher (36 vs. 24 years, p=0.02) and IgA titer significantly lower (17 vs. 34UI/ml; p=0.008) in patients with associated gastrointestinal disease. CONCLUSIONS: Gastrointestinal symptoms are frequent and lead to endoscopic diagnosis in half of patients with primary immunodeficiencies. Ulcerative colitis, and celiac- and Crohn's-like disease are atypical entities that occur in CVIS.

Primary liver carcinoid tumour with a Zollinger Ellison syndrome - an unusual diagnosis: a case report.

Carcinoids are neuroendocrine tumours which may secrete hormones like gastrin, insulin, ACTH, etc. Liver is a common site for metastasis of carcinoid origin and an unusual site for a primary carcinoid tumour to arise.We present the case of a 51-year-old Caucasian man with diarrhoea, weight loss, duodenum ulcers and a liver mass in ultrasonography. A primary hepatic carcinoid tumour with a Zollinger Ellison syndrome was diagnosed. Surgery resection was performed and the patient remained free of symptoms two years after, with normalisation of gastrin levels.Primary hepatic carcinoid tumour represents an uncommon diagnosis, based on radiological and pathological features. The exclusion of different primary locations is necessary. Once associated with a Zollinger Ellison syndrome, diagnose may be more complicated and challenging since only 7 cases of hepatic carcinoids with gastrin secretion were reported in medical literature.A review of medical literature is performed and diagnoses tools that should be used for an accurate diagnosis and available treatment approaches are commented here.

Paciente con hiperaminotransferasemia y mononeuritis múltiple / Patient with hypertransaminasemia and mononeuritis multiplex

Se presenta el caso de un paciente de 57 años con hiperaminotransferasemia y mononeuritis múltiple. Tras los estudios realizados se le diagnosticó infección aguda por el virus de la hepatitis B, con panarteritis nodosa (PAN) asociada. La PAN, en general, cursa con signos y síntomas muy inespecíficos. La afectación del sistema nervioso en forma de mononeuritis múltiple puede ser una de las formas de presentación. La PAN es una de las manifestaciones extrahepáticas de la hepatitis B, pero desde la introducción de la vacuna para la hepatitis B su incidencia ha disminuido notablemente. Después de un año de seguimiento el paciente se encuentra asintomático tras recibir tratamiento con antivíricos y corticoides(AU)

We present the case of a 57-year-old man with mononeuritis multiplex and high transaminase levels. After investigations, the patient was diagnosed with acute hepatitis B infection and polyarteritis nodosa (PAN). The symptoms of PAN are nonspecific. Nervous system involvement in the form of mononeuritis multiplex can be one of the forms of presentation. PAN is one of the extrahepatic manifestations of hepatitis B, but since the introduction of the hepatitis B vaccine, its incidence has markedly declined. After 1 year of follow-up, the patient is asymptomatic following treatment with antiviral drugs and steroids(AU)

[Patient with hypertransaminasemia and mononeuritis multiplex]. / Paciente con hiperaminotransferasemia y mononeuritis múltiple.

We present the case of a 57-year-old man with mononeuritis multiplex and high transaminase levels. After investigations, the patient was diagnosed with acute hepatitis B infection and polyarteritis nodosa (PAN). The symptoms of PAN are nonspecific. Nervous system involvement in the form of mononeuritis multiplex can be one of the forms of presentation. PAN is one of the extrahepatic manifestations of hepatitis B, but since the introduction of the hepatitis B vaccine, its incidence has markedly declined. After 1 year of follow-up, the patient is asymptomatic following treatment with antiviral drugs and steroids.

Carcinoma sarcomatoide en paciente diagnosticado de síndrome de Sjõgren / Sarcomatoid carcinoma in a patients with Sjõgren & apos; s syndrome

El carcinoma sarcomatoide de intestino delgado es un tumor extremadamente raro cuyas manifestaciones clínicas son insidiosas e inespecíficas, las cuales abarcan desde tumor abdominal difuso, hasta hemorragia gastrointestinal u obstrucción intestinal. Estos datos explican el retraso importante del diagnóstico definitivo, la poca eficacia del tratamiento y el pronóstico reservado. Hasta el momento existen solamente 20 casos publicados. En el presente trabajo se presenta un caso de carcinoma sarcomatoide con localización yeyunal, y se subrayan las peculiaridades clínico-patológicas, a la vez que se discute una asociación hipotética con la enfermedad autoinmunitaria el síndrome de Sjõgren(AU)

Sarcomatoid carcinoma is an extremely rare small bowel tumor whose clinical manifestations are insidious and nonspecific, ranging from diffuse abdominal pain to gastrointestinal bleeding or intestinal occlusion. Thus, diagnostic delay is highly common with poor treatment outcome and prognosis. To date, only 20 cases have been reported in the literature. We describe the case of a small bowel sarcomatoid carcinoma localized in the jejunum, with emphasis on the clinical and pathological features of this entity. The hypothetical association with Sjõgren's syndrome, an autoimmune disease, is also discussed(AU)

[Sarcomatoid carcinoma in a patient with Sjögren's syndrome]. / Carcinoma sarcomatoide en paciente diagnosticado de síndrome de Sjögren.

Sarcomatoid carcinoma is an extremely rare small bowel tumor whose clinical manifestations are insidious and nonspecific, ranging from diffuse abdominal pain to gastrointestinal bleeding or intestinal occlusion. Thus, diagnostic delay is highly common with poor treatment outcome and prognosis. To date, only 20 cases have been reported in the literature. We describe the case of a small bowel sarcomatoid carcinoma localized in the jejunum, with emphasis on the clinical and pathological features of this entity. The hypothetical association with Sjögren's syndrome, an autoimmune disease, is also discussed.

Retinopatía de Purtscher asociada a pancreatitis aguda / Purtscher’s retinopathy associated with acute pancreatitis

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