[Study of celiac disease in adults with type 1 diabetes mellitus]. / Estudio de enfermedad celíaca en pacientes adultos con diabetes mellitus de tipo 1.

Celiac disease (CD) presents a wide clinical spectrum. There are asymptomatic or oligosymptomatic forms, which are difficult to diagnose. Since patients with untreated CD can develop severe complications, early diagnosis of these forms is important. Consequently, in groups at risk for CD, such as patients with type 1 diabetes (DM1), screening through determination of antigliadin (AGA), anti-tissue transglutaminase (ATG) and antiendomysial antibodies (EMA) is recommended. In the present study, 463 DM1 patients were screened for these antibodies. Patients who were positive for one or more were offered an upper endoscopy to obtain distal duodenum biopsies. Histological lesions, when present, were classified using Marsh's classification. Of the 463 patients, 62 (13.4%) were positive for at least one of the three antibodies, and 42 accepted to undergo an endoscopy. Fourteen patients (3% of the DM1 patients) were histologically diagnosed with CD. Most of these patients had no symptoms of CD, although some showed laboratory findings frequent in CD. The presence of clinical or analytical data compatible with CD was independent of the grade of histological lesions. Finally, we calculated the sensitivity and positive predictive value for each antibody. The most sensitive were ATG and EMA. Because of the technical simplicity of determining ATG with ELISA, in our opinion, this test should be the option of choice for screening.

[Analysis of the clinical benefits and cost-effectiveness of performing a systematic second-look gastroscopy in benign gastric ulcer]. / Estudio del beneficio clínico y de coste-efectividad tras efectuar sistemáticamente una segunda gastroscopia en la úlcera gástrica benigna.

INTRODUCTION: We analyzed the need to routinely perform a second gastroscopy after an initial diagnosis of benign gastric ulcer. METHOD: A total of 226 consecutive cases of gastric ulcer were reviewed. Sensitivity (S), specificity (Sp), positive and negative predictive value (PPV and NPV) and the accuracy of the initial gastroscopy plus biopsy were analyzed, both overall and according to the initial endoscopist's experience (attending or resident physician). The diagnostic accuracy of the initial and second-look gastroscopies was compared. The number of second endoscopies required to diagnose a new case of malignant gastric ulcer and their cost was calculated, both overall and according to the endoscopist's experience. RESULTS: There were 178 benign ulcers (79%) and 48 malignant ulcers (21%). The initial gastroscopy (S: 87.2%; Sp: 100%; PPV: 100%; PNV: 96.7%; accuracy: 96.7%) was performed by an attending physician in 74% of the patients and by a resident physician in the remaining 26%. Diagnostic accuracy was higher for attending physicians than for residents (98.2% vs. 94.8%; p=0.18). The accuracy of second-look endoscopy was 100%, with a significant improvement when compared with the initial procedure (p=0.035). Three new cases of MALT lymphoma and three new cases of gastric adenocarcinoma were diagnosed and could be treated with curative intent. The number of second gastroscopies required to diagnose a new case of malignant gastric ulcer and their economic cost was: 37.3 (4,675 Euros) for the whole group, 55.2 (6,845 Euros) for attending physicians and 19.3 (2,393 Euros) for residents. CONCLUSIONS: Initial gastroscopy showed high diagnostic accuracy, which was slightly lower when performed by resident physicians. Second-look gastroscopy significantly improved the results, confirming the clinical benefit of this procedure in diagnosing potentially curable malignant lesions. The mean cost of each new diagnosis of malignancy was 4,675 Euros, which was three times lower if the initial gastroscopy was performed by a less experienced endoscopist.

[Acute generalized exanthematous pustulosis induced by omeprazole]. / Pustulosis exantemática aguda generalizada inducida por omeprazol.

Acute generalized exanthematous pustulosis (AGEP) comprises a group of eruptions characterized by several small sterile pustules over an erythematous-edematous skin. These eruptions are usually drug induced and show some characteristics that suggest an immunologic background. Treatment is based on withdrawal of the drug causing the eruption. Prognosis is generally good and the skin lesions usually resolve in a few days with characteristic postpustular pin-point desquamation. We report three cases of AGEP induced by omeprazole, a drug with a good safety profile. Some adverse cutaneous reactions have been described as secondary effects. However, to our knowledge, no cases of omeprazole-induced AGEP have previously been reported. AGEP related to other proton pump inhibitors is exceptional.

Pustulosis exantemática aguda generalizada inducida por omeprazol / Acute generalized exanthematous pustulosis induced by omeprazole

La pustulosis exantemática aguda generalizada (PEAG) englobaun subgrupo de erupciones, caracterizadas por la apariciónde numerosas pústulas estériles sobre un fondo eritematosoedematoso.Generalmente, son inducidas por fármacos y suscaracterísticas indican un trasfondo inmunológico. El tratamientoconsiste en la supresión del fármaco responsable. Engeneral, el pronóstico es bueno, y la lesión cutánea se resuelveen unos pocos días, con su peculiar descamación.Presentamos 3 casos de PEAG inducidos por omeprazol, unfármaco con un excelente perfil de seguridad, entre cuyosefectos secundarios se han descrito varios tipos de lesionescutáneas, sin que hayamos encontrado en la revisión bibliográficaninguna referencia a casos de PEAG por este fármaco.La PEAG relacionada con otros inhibidores de la bombade protones es excepcional (AU)

generalized exanthematous pustulosis (AGEP) comprisesa group of eruptions characterized by several smallsterile pustules over an erythematous-edematous skin. Theseeruptions are usually drug induced and show some characteristicsthat suggest an immunologic background. Treatmentis based on withdrawal of the drug causing the eruption.Prognosis is generally good and the skin lesions usuallyresolve in a few days with characteristic postpustular pinpointdesquamation.We report three cases of AGEP induced by omeprazole, adrug with a good safety profile. Some adverse cutaneous reactionshave been described as secondary effects. However,to our knowledge, no cases of omeprazole-induced AGEPhave previously been reported. AGEP related to other protonpump inhibitors is exceptional (AU)