Amyloidosis and Crohn´s disease.

Secondary amyloidosis is a rare but serious complication of inflammatory bowel disease that may influence the prognosis even more than the underlying disease. Due to a better knowledge of the association of secondary amyloidosis to inflammatory bowel disease, early diagnosis of this complication is becoming more frequent, but its treatment continues to pose a challenge. We report 4 cases of patients with Crohn´s disease and amyloidosis diagnosed in the inflammatory bowel disease Units of Toledo and Ciudad Real, which represent 0.68% of the patients with Crohn´s disease of our health areas. There have been not cases of amyloidosis in patients with ulcerative colitis. In our 4 patients the secondary amyloidosis was clearly related to Crohn´s disease,which was often of fistulising type. The predominant clinical picture of amyloidosis was nephrotic syndrome. The patients responded to medical and surgical treatment of Crohn´s disease and colchicine, which improved renal function in all cases except in one who required kidney transplantation.

Amiloidosis y enfermedad de Crohn / Amyloidosis and Crohn's disease

La amiloidosis sistémica adquirida es una complicación rara pero grave de la enfermedad inflamatoria intestinal crónica, pudiendo condicionar el pronóstico más que la propia enfermedad de base. Debido al mejor conocimiento de la asociación de amiloidosis secundaria a enfermedad inflamatoria intestinal, el diagnóstico temprano se hace cada vez con mayor frecuencia, pero su tratamiento continúa siendo un reto. Describimos 4 casos clínicos de pacientes con enfermedad de Crohn (EC) y amiloidosis diagnosticados en las Unidades de EIIC de Toledo y Ciudad Real, lo que representa el 0,68% de los caso de EC de nuestras áreas sanitarias. No se ha descrito ningún caso de amiloidosis en pacientes con colitis ulcerosa. En los 4 pacientes la AA estaba claramente relacionada con la EC, y predominaron las formas estenosantes-perforantes. El cuadro clínico de presentación de la amiloidosis en la mayoría de los casos fue un síndrome nefrótico. Los pacientes respondieron al tratamiento médico-quirúrgico de la EC y a la colchicina, con lo que mejoró la función renal en todos los casos salvo en uno que precisó trasplante renal(AU)

Secondary amyloidosis is a rare but serious complication of inflammatory bowel disease that may influence the prognosis even more than the underlying disease. Due to a better knowledge of the association of secondary amyloidosis to inflammatory bowel disease, early diagnosis of this complication is becoming more frequent, but it s treatment continues to pose a challenge. We report 4 cases of patients with Crohn’s disease and amyloidosis diagnosed in the inflammatory bowel disease Units of Toledo and Ciudad Real, which represent 0.68% of the patients with Crohn’s disease of our health areas. There have been not cases of amyloidosis in patients with ulcerative colitis. In our 4 patients the secondary amyloidosis was clearly related to Crohn’s disease, which was often of fistulising type. The predominant clinical picture of amyloidosis was nephrotic syndrome. The patients responded to medical and surgical treatment of Crohn’s disease and colchicine, which improved renal function in all cases except in one who required kidney transplantation(AU)

[Metastatic Crohn's disease]. / Enfermedad de Crohn metastásica.

Metastatic Crohn's disease is a granulomatous cutaneous lesion that appears in patients with Crohn's disease and is located in any skin area, separated from the lesions in the gastrointestinal tract. This entity is characterized by its heterogeneous behavior, both in its localization and clinical expression and in its effect on patients' quality of life. Histology is essential for diagnosis and shows non-caseating granulomas. There are no treatment guidelines and various therapeutic strategies have been employed, with variable response. In most patients, treatment with biological agents is highly effective. We describe three cases of metastatic Crohn's disease with the aim of analyzing the characteristics of this entity, which should always be included in the differential diagnosis of skin lesions in patients with Crohn's disease. A literature review is also provided.

Eficacia y seguridad de la vacunación para la hepatitis A y la hepatitis B en pacientes con hepatopatía crónica / Efficacy and safety of vaccination against hepatitis A and B in patients with chronic liver disease

La vacunación para la hepatitis A y para la hepatitis B en pacientes con enfermedad hepática crónica (EHC) debe formar parte de su tratamiento habitual.ObjetivosValorar la eficacia y seguridad de la vacunación para los virus de la hepatitis A (VHA) y de la hepatitis B (VHB) en un grupo de pacientes con EHC y averiguar la existencia de parámetros predictivos de respuesta.Pacientes y métodosEstudio prospectivo y unicéntrico con 194 pacientes (123 varones y 71 mujeres; edad media de 48,9 ± 10,7 años) diagnosticados de EHC: 107 con hepatitis crónica (HC) y 87 con cirrosis hepática (CH), todos en estadio A de la escala Child-Pugh. La etiología más frecuente fue la infección por el virus de la hepatitis C seguida de la enólica. Recibieron la vacuna para el VHA (1.440 unidades en 2 dosis) los pacientes negativos para los anticuerpos contra el VHA y la vacuna para el VHB (20μg en 3 dosis) los pacientes con marcadores negativos para el VHB. Los que no respondieron adecuadamente a esta última vacuna recibieron una cuarta dosis doble de ésta. Treinta pacientes recibieron la vacuna combinada para ambos tipos de hepatitis (3 dosis).ResultadosRecibieron la vacuna para el VHA 60 pacientes (31%) y la de la hepatitis B, 150 (77%). Respondió el 91,6% para el VHA y el 57% para el VHB. Tras la cuarta dosis, la respuesta aumentó al 74%. La eficacia fue similar para el VHA en los pacientes con HC y en los pacientes con CH. La vacuna para el VHB fue menos eficaz en los pacientes con CH que en los pacientes con HC, y con tasas de respuesta significativamente menores en los pacientes con CH y algún episodio previo de descompensación. La vacuna combinada (30 pacientes) resultó altamente inmunogénica. No se registraron efectos secundarios con ninguna de las 3 vacunas.Conclusiones(..) (AU)

Vaccination to protect against hepatitis A and B should be part of the routine management of patients with chronic liver disease (CLD).ObjectivesTo evaluate the efficacy and safety of hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination in a group of patients with CLD and to assess the presence of factors predictive of response.Patients and methodsWe performed a prospective, single-center study in 194 patients (123 men, 71 women; mean age, 48.9±10.7 years) with CLD: 107 with chronic hepatitis (CH) and 87 with hepatic cirrhosis (HC), all Child-Pugh class A. The most frequent causes of CLD were HCV infection and alcohol. Patients negative for anti-HAV IgG received the HAV vaccination (1440 ELISA units in two doses) and those with negative HBV serology received the HBV vaccination ( three 20μg doses). Patients with inadequate response to the latter vaccine received an additional double dose. Thirty patients received a combination vaccine (three doses).ResultsSixty patients (31%) received the HAV vaccine and 150 (77%) patients received the HBV vaccine. Seroconversion was achieved by 91.6% of patients for HAV and by 57% of the patients for HBV. After the additional dose, the response increased to 74%. Efficacy was similar between CH and HC. HBV vaccination was less effective in HC than in CH and the seroconversion rate was significantly lower in patients with HC and previous decompensation. The combination vaccine (30 patients) was highly im munogenic. No adverse effects were registered.ConclusionsHAV vaccination has high efficacy in patients with CLD. Patients with HC respond weakly to HBV vaccination compared with those with CH and especially if there is prior decompensation. The combination vaccine seems particularly effective in patients with CLD. The three vaccines are safe(AU)

[Efficacy and safety of vaccination against hepatitis A and B in patients with chronic liver disease]. / Eficacia y seguridad de la vacunación para la hepatitis A y la hepatitis B en pacientes con hepatopatía crónica.

UNLABELLED: Vaccination to protect against hepatitis A and B should be part of the routine management of patients with chronic liver disease (CLD). OBJECTIVES: To evaluate the efficacy and safety of hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination in a group of patients with CLD and to assess the presence of factors predictive of response. PATIENTS AND METHODS: We performed a prospective, single-center study in 194 patients (123 men, 71 women; mean age, 48.9+/-10.7 years) with CLD: 107 with chronic hepatitis (CH) and 87 with hepatic cirrhosis (HC), all Child-Pugh class A. The most frequent causes of CLD were HCV infection and alcohol. Patients negative for anti-HAV IgG received the HAV vaccination (1440 ELISA units in two doses) and those with negative HBV serology received the HBV vaccination ( three 20 microg doses). Patients with inadequate response to the latter vaccine received an additional double dose. Thirty patients received a combination vaccine (three doses). RESULTS: Sixty patients (31%) received the HAV vaccine and 150 (77%) patients received the HBV vaccine. Seroconversion was achieved by 91.6% of patients for HAV and by 57% of the patients for HBV. After the additional dose, the response increased to 74%. Efficacy was similar between CH and HC. HBV vaccination was less effective in HC than in CH and the seroconversion rate was significantly lower in patients with HC and previous decompensation. The combination vaccine (30 patients) was highly immunogenic. No adverse effects were registered. CONCLUSIONS: HAV vaccination has high efficacy in patients with CLD. Patients with HC respond weakly to HBV vaccination compared with those with CH and especially if there is prior decompensation. The combination vaccine seems particularly effective in patients with CLD. The three vaccines are safe.

Diagnóstico serológico de gastritis atrófica con una combinación de pepsinógeno I y II, gastrina-17 y anticuerpos anti-Helicobacter pylori / Serological diagnosis of atrophic gastritis with a combination of pepsinogen I and II, gastrin-17 and anti-Helicobacter pylori antibodies

Objetivo: El diagnóstico no invasivo de gastritis atrófica ayudaría a identificar individuos con un riesgo elevado de carcinoma gástrico. En este estudio se ha evaluado la utilidad de un panel serológico que combina pepsinógeno I y II, gastrina-17 y anticuerpos anti-Helicobacter pylori (Gastropanel) como método de cribado de la gastritis atrófica. Pacientes y métodos: El panel serológico se evaluó en 56 pacientes de dos grupos: a) 47 pacientes con dispepsia no investigada, y b) 9 pacientes consecutivos con carcinoma gástrico. En todos ellos se realizó una endoscopia con toma de biopsias del antro y el cuerpo gástricos. Los valores de pepsinógeno I y II, gastrina-17 y anticuerpos anti-H. pylori se determinaron mediante test EIA específicos (Biohit plc, Helsinki, Finlandia) en muestras de suero de los pacientes obtenidas en ayunas. Resultados: La gastritis atrófica fue significativamente más frecuente en los pacientes con carcinoma gástrico que en los pacientes dispépticos (el 56 frente al 6%; p = 0,0015). El grado de concordancia entre el panel serológico y la histología gástrica fue bueno (kappa = 0,68). La sensibilidad y la especificidad del panel serológico para diagnosticar la gastritis atrófica fueron del 87,5 y el 100%, respectivamente. Sin embargo, el panel serológico no habría detectado 4 de los 9 casos de carcinoma gástrico, ya que se originaron en un estómago con mucosa no atrófica. Conclusiones: El panel serológico es un método no invasivo útil para el diagnóstico de gastritis atrófica. Sin embargo, su utilidad como método de cribado está limitada por la existencia de casos de carcinoma gástrico que aparecen en estómagos sin atrofia mucosa

Objective: Noninvasive diagnosis of atrophic gastritis would help to identify individuals at increased risk of gastric carcinoma. In the present study, we evaluated the utility of a serological panel combining pepsinogen I and II, gastrin-17, and anti-Helicobacter pylori antibodies (Gastropanel) as a screening method for atrophic gastritis. Patients and methods: The serological panel was evaluated in 56 patients divided in two groups: group 1 consisted of 47 patients with uninvestigated dyspepsia and group 2 was composed of nine consecutive patients with gastric carcinoma. In all patients, we performed endoscopy with biopsies of the gastric antrum and body. Levels of pepsinogen I and II, gastrin-17, and anti-H. pylori antibodies were determined through a specific EIA test (Biohit plc, Helsinki, Finland) in fasting serum samples. Results: Atrophic gastritis was significantly more frequent in patients with gastric carcinoma than in those with dyspepsia (56 vs 6%; p = 0.0015). Agreement between the Gastropanel and gastric histology was good (kappa = 0.68). The sensitivity and specificity of the Gastropanel in the diagnosis of atrophic gastritis was 87.5% and 100%, respectively. However, the Gastropanel would not have detected four of the nine cases of gastric carcinoma, since these tumors arose in stomachs with nonatrophic mucosa. Conclusions: Gastropanel is a useful noninvasive method for the diagnosis of atrophic gastritis. However, its utility as a screening method is limited by cases of gastric carcinoma that arise in stomachs without atrophic mucosa

[Serological diagnosis of atrophic gastritis with a combination of pepsinogen I and II, gastrin-17 and anti-Helicobacter pylori antibodies]. / Diagnóstico serológico de gastritis atrófica con una combinación de pepsinógeno I y II, gastrina-17 y anticuerpos anti-Helicobacter pylori.

OBJECTIVE: Noninvasive diagnosis of atrophic gastritis would help to identify individuals at increased risk of gastric carcinoma. In the present study, we evaluated the utility of a serological panel combining pepsinogen I and II, gastrin-17, and anti-Helicobacter pylori antibodies (Gastropanel) as a screening method for atrophic gastritis. PATIENTS AND METHODS: The serological panel was evaluated in 56 patients divided in two groups: group 1 consisted of 47 patients with uninvestigated dyspepsia and group 2 was composed of nine consecutive patients with gastric carcinoma. In all patients, we performed endoscopy with biopsies of the gastric antrum and body. Levels of pepsinogen I and II, gastrin-17, and anti-H. pylori antibodies were determined through a specific EIA test (Biohit plc, Helsinki, Finland) in fasting serum samples. RESULTS: Atrophic gastritis was significantly more frequent in patients with gastric carcinoma than in those with dyspepsia (56 vs 6%; p = 0.0015). Agreement between the Gastropanel and gastric histology was good (kappa = 0.68). The sensitivity and specificity of the Gastropanel in the diagnosis of atrophic gastritis was 87.5% and 100%, respectively. However, the Gastropanel would not have detected four of the nine cases of gastric carcinoma, since these tumors arose in stomachs with nonatrophic mucosa. CONCLUSIONS: Gastropanel is a useful noninvasive method for the diagnosis of atrophic gastritis. However, its utility as a screening method is limited by cases of gastric carcinoma that arise in stomachs without atrophic mucosa.

[Value of contrast-enhanced ultrasound in the diagnosis of hepatocarcinoma in focal lesions detected in patients with liver disease]. / Valor de los contrastes ecográficos en el diagnóstico de hepatocarcinoma en lesiones ocupantes de espacio detectadas en pacientes con hepatopatía.

OBJECTIVE: To assess the value of contrast-enhanced ultrasound in the detection of arterial hypervascularity as a diagnostic criterion of hepatocellular carcinoma (HCC) in patients with focal lesions and liver disease. PATIENTS AND METHODS: This prospective study included patients with chronic liver disease and focal liver lesions on ultrasound (US) examination. SonoVue was used as contrast agent. We employed a US imaging technique with contrast-specific software operating at a low mechanical index (< 0.14) (Hitachi EUB 6500). The contrast enhancement pattern was analyzed during the arterial phase and classified as diffuse (homogeneous or heterogeneous), peripheral, adjacent parenchyma-like enhancement, and absent. The diagnostic procedure was completed by combined study with computed tomography, magnetic resonance imaging, histologic data and clinical features. RESULTS: A total of 23 nodules in 22 patients were included in the study (one patient had two different US lesions). The final diagnosis was hepatocellular carcinoma (HCC) in 12 patients, benign lesions in nine, metastases in one and cholangiocarcinoma in one. In the 10 patients with diffuse contrast enhancement, the lesion was malignant and in the eight patients with diffuse homogeneous enhancement, the lesion was a HCC. Seventy-five percent of the patients with HCC had a diffuse enhancement pattern during the arterial phase. This pattern involved malignancy with 71.4% sensitivity, 100% specificity, 100% positive predictive value, 69.2% negative predictive value, and 82.6% accuracy. The diffuse homogeneous pattern involved HCC with 66.7% sensitivity, 100% specificity, 100% positive predictive value, 73.3% negative predictive value and 82.6% accuracy. CONCLUSIONS: Contrast-enhanced US with SonoVue allows the vascularity of focal liver lesions to be assessed. In our study, 75% of patients with HCC showed arterial hypervascularity. A diffuse homogeneous enhancement pattern during the arterial phase was highly specific to HCC. In cirrhotic patients, this arterial pattern could avoid the need for further investigations, although clinical staging should be completed with another diagnostic test.

Valor de los contrastes ecográficos en el diagnóstico de hepatocarcinoma en lesiones ocupantes de espacio detectadas en pacientes con hepatopatía / Value of contrast-enhanced ultrasound in the diagnosis of hepatocarcinoma in focal lesions detected in patients with liver disease

Objetivo: Determinar la utilidad de la ecografía con contraste en la detección de hipervascularización arterial como criterio diagnóstico de carcinoma hepatocelular (CHC) en lesiones ocupantes de espacio (LOE) de pacientes con hepatopatía. Pacientes y métodos: Estudio prospectivo en el que se incluyen pacientes con hepatopatía crónica a los que se detectó alguna LOE mediante ecografía. Como potenciador se administró un contraste de segunda generación (SonoVue®). Se utilizó un ecógrafo Hitachi EUB 6500 con un programa específico para potenciadores, y se empleó un índice mecánico inferior a 0,14. Se analizó el patrón de captación en fase arterial, clasificándose en patrón difuso (homogéneo o heterogéneo), periférico, captación similar al parénquima circundante y ausencia de captación. El diagnóstico definitivo se confirmó mediante el estudio combinado de tomografía computarizada, resonancia magnética y análisis histológico, junto con la evolución clínica. Resultados: Se incluyen 23 lesiones en 22 pacientes (uno presentó 2 lesiones de características ecográficas diferentes). El diagnóstico final fue: CHC en 12 casos, lesiones benignas en 9, metástasis en uno y colangiocarcinoma en otro caso. Todos los casos que presentaron un patrón difuso con el contraste tenían una lesión maligna, y los 8 casos con patrón difuso homogéneo tenían un CHC. El 75% de los pacientes con CHC presentó una hipervascularización arterial con un patrón difuso tras el contraste. Este patrón difuso presentó una sensibilidad del 71,4%, especificidad del 100%, valor predictivo positivo (VPP) del 100%, valor predictivo negativo (VPN) del 69,2% y exactitud del 82,6% para el diagnóstico de malignidad. El patrón difuso homogéneo presentó una sensibilidad del 66,7%, una especificidad del 100%, un VPP del 100%, un VPN del 73,3% y una exactitud del 82,6% para el diagnóstico de CHC. Conclusiones: La utilización de la ecografía con contraste de segunda generación facilita una caracterización vascular inmediata de la lesión. En nuestro estudio se detecta una hipervascularización arterial en el 75% de los pacientes con CHC. Un patrón de realce difuso homogéneo es muy específico de CHC. Creemos que la detección de este tipo de patrón en un paciente con cirrosis haría innecesaria la utilización de más pruebas de imagen para el diagnóstico, si bien el estudio de extensión debe completarse con otra técnica

Objective: To assess the value of contrast-enhanced ultrasound in the detection of arterial hypervascularity as a diagnostic criterion of hepatocellular carcinoma (HCC) in patients with focal lesions and liver disease. Patients and methods: This prospective study included patients with chronic liver disease and focal liver lesions on ultrasound (US) examination. SonoVue® was used as contrast agent. We employed a US imaging technique with contrast-specific software operating at a low mechanical index (< 0.14) (Hitachi EUB 6500). The contrast enhancement pattern was analyzed during the arterial phase and classified as diffuse (homogeneous or heterogeneous), peripheral, adjacent parenchyma-like enhancement, and absent. The diagnostic procedure was completed by combined study with computed tomography, magnetic resonance imaging, histologic data and clinical features. Results: A total of 23 nodules in 22 patients were included in the study (one patient had two different US lesions). The final diagnosis was hepatocellular carcinoma (HCC) in 12 patients, benign lesions in nine, metastases in one and cholangiocarcinoma in one. In the 10 patients with diffuse contrast enhancement, the lesion was malignant and in the eight patients with diffuse homogeneous enhancement, the lesion was a HCC. Seventy-five percent of the patients with HCC had a diffuse enhancement pattern during the arterial phase. This pattern involved malignancy with 71.4% sensitivity, 100% specificity, 100% positive predictive value, 69.2% negative predictive value, and 82.6% accuracy. The diffuse homogeneous pattern involved HCC with 66.7% sensitivity, 100% specificity, 100% positive predictive value, 73.3% negative predictive value and 82.6% accuracy. Conclusions: Contrast-enhanced US with SonoVue® allows the vascularity of focal liver lesions to be assessed. In our study, 75% of patients with HCC showed arterial hypervascularity. A diffuse homogeneous enhancement pattern during the arterial phase was highly specific to HCC. In cirrhotic patients, this arterial pattern could avoid the need for further investigations, although clinical staging should be completed with another diagnostic test

[Clinicopathological characteristics of uninvestigated dyspepsia in Spain]. / Características clinicopatológicas de la dispepsia no investigada en España.

INTRODUCTION: Most patients with uninvestigated dyspepsia are diagnosed with functional dyspepsia. Various types of Helicobacter pylori gastritis have been described, each of which is associated with a distinct natural history of the infection (i.e. a different risk of ulcer or gastric cancer). OBJECTIVE: To determine the clinical and pathological characteristics of patients with uninvestigated dyspepsia in our area and the prevalence of the distinct types of H. pylori gastritis among patients with functional dyspepsia. MATERIAL AND METHODS: Ninety-eight patients (47 men and 51 women, mean age 35.8+/-13 years) with uninvestigated dyspepsia were included in this study. All the patients completed the Dyspepsia-Related Health Scale and all patients underwent gastroscopy with biopsy and the C13-urea breath test. RESULTS: Fourteen patients had organic causes of dyspepsia and 78 had functional dyspepsia. Fifty-one patients with functional dyspepsia (65%) had H. pylori infection; of these, 27 had pangastritis, 21 had antrum-predominant gastritis, 2 had multifocal atrophic gastritis and 1 had normal gastric mucosa. Among uninfected patients, 2 had multifocal atrophic gastritis. CONCLUSIONS: The prevalence of functional dyspepsia in this series was 85%. Twenty-seven percent of patients with functional dyspepsia had a combination of H. pylori infection and antrum-predominant gastritis, the type of gastritis predisposing to duodenal ulcer. Only 5% of the patients had multifocal atrophic gastritis, which is associated with a high risk of gastric cancer.

Características clinicopatológicas de la dispepsia no investigada en España / Clinicopathological characteristics of uninvestigated dyspepsia in Spain

Introducción: La mayoría de los pacientes con dispepsia no investigada son diagnosticados de dispepsia funcional. Se han descrito varios tipos de gastritis por Helicobacter pylori, cada uno de los cuales se asocia a una historia natural diferente de la infección (p. ej., diferente riesgo de enfermedad ulcerosa o de cáncer gástrico). Objetivo: Determinar las características clínicas y patológicas de los pacientes con dispepsia no investigada en nuestra área y la prevalencia de los diferentes tipos de gastritis por H. pylori en los pacientes con dispepsia funcional. Material y métodos: Se incluyó en el estudio a 98 pacientes (47 varones y 51 mujeres, con una media de edad de 35,8 ± 13 años) con dispepsia no investigada. Todos ellos rellenaron el Cuestionario de Calidad de Vida Asociada a Dispepsia, y a todos se les realizó gastroscopia con toma de biopsias y test del aliento con C13-Urea. Resultados: Catorce pacientes tenían causas orgánicas de dispepsia y 78 dispepsia funcional; 51 pacientes con dispepsia funcional (65%) tenían infección por H. pylori y, de ellos, 27 tenía pangastritis, 21 gastritis de predominio antral, 2 gastritis atrófica multifocal y 1 mucosa gástrica normal. Entre los pacientes no infectados, 2 presentaban gastritis atrófica multifocal. Conclusiones: La prevalencia de dispepsia funcional en esta serie fue del 85%. Un 27% de los pacientes con dispepsia funcional presenta la combinación de infección por H. pylori y gastritis de predominio antral, que es el tipo de gastritis que predispone a la aparición de enfermedad ulcerosa duodenal. Sólo un 5% de los pacientes tiene gastritis atrófica multifocal, que es la que se asocia con un riesgo elevado de cáncer gástrico

Introduction: Most patients with uninvestigated dyspepsia are diagnosed with functional dyspepsia. Various types of Helicobacter pylori gastritis have been described, each of which is associated with a distinct natural history of the infection (i.e. a different risk of ulcer or gastric cancer). Objective: To determine the clinical and pathological characteristics of patients with uninvestigated dyspepsia in our area and the prevalence of the distinct types of H. pylori gastritis among patients with functional dyspepsia. Material and methods: Ninety-eigth patients (47 men and 51 women, mean age 35.8 ± 13 years) with uninvestigated dyspepsia were included in this study. All the patients completed the Dyspepsia-Related Health Scale and all patients underwent gastroscopy with biopsy and the C13-urea breath test. Results: Fourteen patients had organic causes of dyspepsia and 78 had functional dyspepsia. Fifty-one patients with functional dyspepsia (65%) had H. pylori infection; of these, 27 had pangastritis, 21 had antrum-predominant gastritis, 2 had multifocal atrophic gastritis and 1 had normal gastric mucosa. Among uninfected patients, 2 had multifocal atrophic gastritis. Conclusions: The prevalence of functional dyspepsia in this series was 85%. Twenty-seven percent of patients with functional dyspepsia had a combination of H. pylori infection and antrum-predominant gastritis, the type of gastritis predisposing to duodenal ulcer. Only 5% of the patients had multifocal atrophic gastritis, which is associated with a high risk of gastric cancer