Gammagrafía con 75Se-ácido tauroselcólico (75SeHCAT(R)), ¿prueba de referencia en la malabsorción de ácidos biliares? / 75Se-Homocholic acid taurine scintigraphy (75SeHCAT(R)), a standard benchmark test in bile acid malabsorption?

La diarrea crónica por malabsorción de ácidos biliares (MAB) es una patología infradiagnosticada. Se dispone de diferentes herramientas diagnósticas, aunque en la actualidad no existe consenso sobre cuál de estas sería la prueba de referencia o gold standard. En esta revisión se valora la posibilidad de utilizar la gammagrafía con 75Se-ácido tauroselcólico (75SeHCAT(R)) como prueba diagnóstica de referencia y su perspectiva de futuro. Se realizó una búsqueda bibliográfica en Pubmed y OVID, obteniéndose un total de 57 trabajos y usándose finalmente 26 de ellos tras ser seleccionados bajo los conceptos de gold standard, exactitud diagnóstica y otros biomarcadores. Valoramos las ventajas e inconvenientes de las diferentes herramientas diagnósticas: 14C-glicocolato, medición de ácidos biliares en heces, C4 en suero, FGF19 en suero, colestiramina y gammagrafía con ácido tauroselcólico. Consideramos que la gammagrafía con 75SeHCAT(R) es la prueba diagnóstica más recomendada en Europa para el diagnóstico de MAB al presentar los índices más elevados de sensibilidad y especificidad. Presenta una gran relación coste-beneficio, por lo que es la prueba con mayor grado de recomendación. Sin embargo, aún no es posible su uso de forma reconocida como gold standard debido a la falta de estudios que proporcionen datos concluyentes que permitan su consenso. Mientras tanto, se podría aconsejar el uso combinado de la prueba con colestiramina en todos los pacientes que queramos evaluar, independientemente del resultado gammagráfico, como uso de patrón de referencia

Chronic diarrhoea due to bile acid malabsorption (BAM) is an underdiagnosed pathology. Different diagnostic tools are available. However, there is currently no consensus on which of these would be the benchmark test or gold standard. This review evaluates the possibility of using 75Se-taurocholic acid (75SeHCAT(R)) scintigraphy as a benchmark diagnostic test and its perspective for the future. A literature review was conducted in Pubmed and OVID obtaining a total of 57 papers, 26 of which were finally used after being selected under the concepts of gold standard, diagnostic accuracy and other biomarkers. We evaluated the advantages and disadvantages of the different diagnostic tools: 14C-glycocholate, measurement of bile acids in faeces, C4 in serum, FGF19 in serum, cholestyramine, and 75Se-tauroselcolic acid scintigraphy. We consider that the 75SeHCAT(R) scan is the most recommended diagnostic test in Europe for diagnosing BAM as it presents the highest values of sensitivity and specificity. It has a significant cost-benefit ratio, making it the test with the highest degree of recommendation. However, it is still not possible to use it in a recognised way as a gold standard due to the lack of studies that provide conclusive data that allow consensus. In the meantime, the combined use of cholestyramine testing in all patients we want to evaluate, regardless of the scintigraphy result, could be encouraged as a benchmark standard

75Se-Homocholic acid taurine scintigraphy (75SeHCAT®), a standard benchmark test in bile acid malabsorption? / Gammagrafía con 75Se-ácido tauroselcólico (75SeHCAT®), ¿prueba de referencia en la malabsorción de ácidos biliares?

Chronic diarrhoea due to bile acid malabsorption (BAM) is an underdiagnosed pathology. Different diagnostic tools are available. However, there is currently no consensus on which of these would be the benchmark test or gold standard. This review evaluates the possibility of using 75Se-taurocholic acid (75SeHCAT®) scintigraphy as a benchmark diagnostic test and its perspective for the future. A literature review was conducted in Pubmed and OVID obtaining a total of 57 papers, 26 of which were finally used after being selected under the concepts of gold standard, diagnostic accuracy and other biomarkers. We evaluated the advantages and disadvantages of the different diagnostic tools: 14C-glycocholate, measurement of bile acids in faeces, C4 in serum, FGF19 in serum, cholestyramine, and 75Se-tauroselcolic acid scintigraphy. We consider that the 75SeHCAT® scan is the most recommended diagnostic test in Europe for diagnosing BAM as it presents the highest values of sensitivity and specificity. It has a significant cost-benefit ratio, making it the test with the highest degree of recommendation. However, it is still not possible to use it in a recognised way as a gold standard due to the lack of studies that provide conclusive data that allow consensus. In the meantime, the combined use of cholestyramine testing in all patients we want to evaluate, regardless of the scintigraphy result, could be encouraged as a benchmark standard.

[Analysis of gastric emptying dynamics in relationship to qualitative composition of intake. Comparison between normal-weight and obese subjects]. / Análisis de la dinámica de vaciamiento gástrico en relación con la composición cualitativa de la ingesta. Comparación entre sujetos con normopeso y obesos.

AIMS: To analyze whether the gastric emptying profile could define obesity and to study the impact of macronutrients diet composition on gastric emptying in obese and non obese people. MATERIAL AND METHODS: 47 subjects were selected (12 non obese and 35 obese). The study was organized in 4 visits. In each visit the subject was given isocaloric breakfast differing in macronutrient composition, (either equilibrated, or lipid, protein or carbohydrate rich) quantitative gastric emptying assay was done realized, every 15 minutes for two hours using a radionuclide technique. The week prior to the visit, the subject followed a standard 1,800 cal/day diet. RESULT: A significant interaction between time and diet composition is shown regardless of the group (obese or non-obese) the subject belongs to. The different macronutrient composition differentially affected gastric emptying only in the obese group. Post hoc analysis of the results showed significant differences after 45 min post breakfast between protein and carbohydrate rich breakfast. CONCLUSIONS: Gastric emptying in obese but not in non obese subjects, was significantly modified depending on the intake qualitative composition. These differences are clear when protein rich (significantly slower emptying) is compared versus hydrocarbon enriched diet (significantly faster emptying). A significant difference in gastric emptying between obese and non-obese subjects cannot be established.

Análisis de la dinámica de vaciamiento gástrico en relación con la composición cualitativa de la ingesta. Comparación entre sujetos con normopeso y obesos / Analysis of gastric emptying dynamics in relationship to qualitative composition of intake. Comparison between normal weight and obese subjects

Objetivos. Analizar si el perfil de vaciamiento gástrico podría ser característico en obesidad y estudiar el impacto que la relación de macronutrientes en la dieta tiene sobre el vaciamiento gástrico y las diferencias entre obesos y normopesos. Material y método. Se seleccionan 47 sujetos (12 normopeso y 35 obesos), que realizan 4 visitas durante el estudio. En cada una se administraba un desayuno isocalórico con distinta composición de macronutrientes (equilibrados, lipídico, proteico o hidrocarbonato). Se realizaron estudios cuantitativos de vaciamiento gástrico cada 15 minutos durante dos horas usando la técnica de gammagrafía. La semana previa a cada visita todos los sujetos realizaron una dieta estándar de 1.800 cal/día. Resultados. Se observa una interacción significativa entre los factores tiempo y dieta. Sin embargo, el mismo análisis no demostró esta tendencia al estudiar la evolución del vaciamiento en relación con el grupo al que pertenecía el sujeto (normopeso u obeso). La composición cualitativa de la dieta sólo influyó sobre el vaciamiento gástrico en obesos. El estudio post hoc demostró diferencias significativas fundamentalmente a partir de los 45 minutos postingesta, y entre ingestas ricas en hidratos de carbono y proteínas. Conclusiones. La composición cualitativa de la ingesta ha influido de forma significativa sobre la velocidad de vaciamiento gástrico en sujetos obesos, pero no en normopesos. Esta influencia se hace más evidente en la dieta hidrocarbonada (vaciamiento significativamente más rápido) y proteica (vaciamiento significativamente más lento). No puede establecerse una diferencia significativa de la velocidad de vaciamiento gástrico entre sujetos obesos o normopeso

Aims. To analyze whether the gastric emptying profile could define obesity and to study the impact of macronutrients diet composition on gastric emptying in obese and non obese people. Material and methods. 47 subjects were selected (12 non obese and 35 obese). The study was organized in 4 visits. In each visit the subject was given isocaloric breakfast differing in macronutrient composition, (either equilibrated, or lipid, protein or carbohydrate rich) quantitative gastric emptying assay was done realized, every 15 minutes for two hours using a radionuclide technique. The week prior to the visit, the subject followed a standard 1,800 cal/day diet. Result. A significant interaction between time and diet composition is shown regardless of the group (obese or non obese) the subject belongs to. The different macronutrient composition differentialy affected gastric emptying only in the obese group. Post hoc analysis of the results showed significant differences after 45 min post breakfast between protein and carbohydrate rich breakfast. Conclusions. Gastric emptying in obese but not in non obese subjects, was significantly modified depending on the intake qualitative composition. These differences are clear when protein rich (significantly slower emtying) is compared versus hydrocarbon enriched diet (significantly faster emptying). A significant difference in gastric emptying between obese and non obese subjects cannot be stablished

[Septic paniculitis and 67Ga scintigraphy]. / Paniculitis séptica y gammagrafía con 67 Ga.

A 50 year-old patient presenting septicemia, septic panniculitis from Staphylococcus aureus and skin lesions on the buttocks, thighs and left arm was referred to the Nuclear Medicine Service, with a suspected underlying osseus problem. A whole body scan with 67Ga revealed generalized disease of the soft tissues with no bone involvement. Gallium was used for the monitor of the evolution of the lesions, since this is a good indicator of the treatment effectiveness. In this case, the use of nuclear techniques was fundamental for diagnosing the spread and evolution of the lesions until they were cured (cured being considered as when there is no gallium uptake by the lesions, months prior to this stage).