Even non-experts identify non-dysplastic lesions in inflammatory bowel disease via chromoendoscopy: results of a screening program in real-life.

Background and study aims Chromoendoscopy with targeted biopsy is the technique of choice for colorectal cancer screening in longstanding inflammatory bowel disease. We aimed to analyze results of a chromoendoscopy screening program and to assess the possibility of identifying low-risk dysplastic lesions by their endoscopic appearance in order to avoid histological analysis. Materials and methods We retrospectively reviewed chromoendoscopies performed between February 2011 and June 2017 in seven Spanish hospitals in a standardized fashion. We analyzed the findings and the diagnostic yield of the Kudo pit pattern for predicting dysplasia. Results A total of 709 chromoendoscopies (569 patients) were reviewed. Median duration of disease was 16.7 years (SD 8.1); 80.4 % had ulcerative colitis. A total of 2025 lesions (3.56 lesions per patient) were found; two hundred and thirty-two lesions were neoplastic (11.5 %) (223 were LGD (96.1 %), eight were HGD (3.4 %), and one was colorectal cancer (0.5 %). The correlation between dysplasia and Kudo pit patterns predictors of dysplasia (≥ III) was low, with an area under the curve of 0.649. Kudo I and II lesions were correctly identified with a high negative predictive value (92 %), even by non-experts. Endoscopic activity, Paris 0-Is classification, and right colon localization were risk factors for dysplasia detection, while rectum or sigmoid localization were protective against dysplasia. Conclusions Chromoendoscopy in the real-life setting detected 11 % of dysplastic lesions with a low correlation with Kudo pit pattern. A high negative predictive value would prevent Kudo I and, probably, Kudo II biopsies in the left colon, reducing procedure time and avoiding complications.

Salud bucodental y riesgo de neumonía en pacientes asmáticos con tratamiento inhalado / Oral health and risk of pneumonia in asthmatic pacients with inhaled treatment

Introducción y objetivo: El asma es una enfermedad crónica que precisa tratamiento inhalado y que, a su vez, es factor de riesgo (FR) de neumonía. En la cavidad orofaríngea existen numerosas especies de bacterias que podrían ser arrastradas a nivel broncoalveolar. Objetivo: determinar si la salud bucodental es un FR de neumonía adquirida en la comunidad (NAC) en pacientes asmáticos que realizan tratamiento inhalado y determinar si la frecuencia de utilización de los dispositivos de inhalación y el tipo de fármaco inhalado son FR de NAC. Pacientes y método: Estudio de casos y controles en población asmática con tratamiento inhalado. Se seleccionaron 126 pacientes asmáticos diagnosticados de neumonía por criterios clínicos y radiológicos (casos) y 252 asmáticos no diagnosticados de neumonía durante el último año (controles), emparejados por edad. El principal factor de estudio fue la puntuación del General Oral Health Assessment Index (GOHAI). Resultados: El análisis bivariado muestra una asociación estadísticamente significativa de la NAC con un índice de GOHAI≤57 puntos (mala salud bucodental) (OR 1,69), el tratamiento anticolinérgico (OR 2,41), realizar 6 o más inhalaciones al día (OR 3,23), el uso de cámara (OR 1,62), el FEV1 (OR 0,98), una alteración de la funcionalidad (OR 2,08) y los trastornos psiquiátricos o la depresión (OR 0,41). El análisis multivariante muestra una asociación independiente de realizar 6 o más inhalaciones al día (OR 2,74) y de las alteraciones de la funcionalidad (OR 1,67). Conclusiones: Los resultados evidencian que una mala salud bucodental podría ser un FR de NAC

Introduction and objective: Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. Objective: to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. Patients and method: Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. Results: Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). Conclusions: The results suggest that poor oral health may be a CAP RF

Oral health and risk of pneumonia in asthmatic pacients with inhaled treatment. / Salud bucodental y riesgo de neumonía en pacientes asmáticos con tratamiento inhalado.

INTRODUCTION AND OBJECTIVE: Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. OBJECTIVE: to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. PATIENTS AND METHOD: Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. RESULTS: Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). CONCLUSIONS: The results suggest that poor oral health may be a CAP RF.

[Autoimmune enteropathy in an adult patient]. / Enteropatía autoinmune en un paciente adulto.

Autoimmune enteropathy (AIE) is an infrequent cause of malabsorption that is usually associated with the presence of circulating autoantibodies and a predisposition to autoimmune disorders. This disease is more frequent in children. The diagnosis of this disorder is based on five criteria: chronic diarrhea (>6 weeks), malabsorption, specific histological findings, exclusion of similar disorders, and the presence of specific antibodies such as anti-enterocyte and anti-goblet cell antibodies. We present the case of a 63-year-old patient with chronic diarrhea, weight loss and significant deterioration of nutritional status.

Enteropatía autoinmune en un paciente adulto / Autoimmune enteropathy in an adult patient

El diagnóstico de esta entidad se basa en cuatro criterios, la presencia de diarrea crónica (más de 6 semanas), un cuadro clínico compatible con malabsorción, una histología específica, la exclusión de otras enfermedades que pueden cursar de forma similar y la presencia de autoanticuerpos específicos como pueden ser los anticuerpos entienterocito y anticélula caliciforme. Presentamos a continuación el caso de un paciente de 63 años de edad con un cuadro clínico que consiste en diarrea crónica, pérdida de peso e importante repercusión en su estado nutricional (AU)

Autoimmune enteropathy (AIE) is an infrequent cause of malabsorption that is usually associated with the presence of circulating autoantibodies and a predisposition to autoimmune disorders. This disease is more frequent in children.The diagnosis of this disorder is based on five criteria: chronic diarrhea (>6 weeks), malabsorption, specific histological findings, exclusion of similar disorders, and the presence of specific antibodies such as anti-enterocyte and anti-goblet cell antibodies. We present the case of a 63-year-old patient with chronic diarrhea, weight loss and significant deterioration of nutritional status (AU)

[Emphysematous pancreatitis: Conservative or surgical treatment?]. / Pancreatitis enfisematosa. ¿Tratamiento conservador o quirúrgico?

Emphysematous pancreatitis is a severe and rare complication of acute pancreatitis. This entity is diagnosed on clinical grounds and on the basis of the radiologic finding of gas in the retroperitoneum. Infected pancreatic necrosis is potentially lethal, with mortality rates of more than 35%. Surgery is associated with significant morbidity and mortality in these critically ill patients. Endoscopic ultrasonography techniques, laparoscopic surgery and percutaneous drainage have the potential to offer a safe and effective alternative treatment modality. However, the precise role of these procedures requires further investigation. The treatment of these patients should be individualized, dynamic and multidisciplinary. We present two cases of emphysematous pancreatitis with distinct therapeutic management.

Pancreatitis enfisematosa. ¿Tratamiento conservador o quirúrgico? / Emphysematous pancreatitis: Conservative or surgical treatment?

La pancreatitis enfisematosa (PE) es una complicación grave y rara de la pancreatitis aguda. El diagnóstico se basa en los datos clínicos y en el hallazgo radiológico de gas en el retroperitoneo. La necrosis pancreática infectada es potencialmente letal, con una tasa de mortalidad superior al 35%. La cirugía en estos pacientes asocia una alta morbimortalidad. La ultrasonografía endoscópica, el tratamiento quirúrgico laparoscópico y el drenaje percutáneo ofrecen una modalidad de tratamiento alternativo a la cirugía, seguro y eficaz. Sin embargo, se requieren más estudios para definir el lugar que ocupan estas técnicas en el tratamiento de estos pacientes, que debe ser individualizado, dinámico y multidisciplinario. Presentamos 2 casos de PE con distinto tratamiento terapéutico(AU)

Emphysematous pancreatitis is a severe and rare complication of acute pancreatitis. This entity is diagnosed on clinical grounds and on the basis of the radiologic finding of gas in the retroperitoneum. Infected pancreatic necrosis is potentially lethal, with mortality rates of more than 35%. Surgery is associated with significant morbidity and mortality in these critically ill patients. Endoscopic ultrasonography techniques, laparoscopic surgery and percutaneous drainage have the potential to offer a safe and effective alternative treatment modality. However, the precise role of these procedures requires further investigation. The treatment of these patients should be individualized, dynamic and multidisciplinary. We present two cases of emphysematous pancreatitis with distinct therapeutic management(AU)