RESUMO
INTRODUCTION: Risk factors for developing pancreatitis due to thiopurines in patients with inflammatory bowel disease (IBD) are not clearly identified. Our aim was to evaluate the predictive pharmacogenetic risk of pancreatitis in IBD patients treated with thiopurines. METHODS: We conducted an observational pharmacogenetic study of acute pancreatitis events in a cohort study of IBD patients treated with thiopurines from the prospectively maintained ENEIDA registry biobank of GETECCU. Samples were obtained and the CASR, CEL, CFTR, CDLN2, CTRC, SPINK1, CPA1, and PRSS1 genes, selected based on their known association with pancreatitis, were fully sequenced. RESULTS: Ninety-five cases and 105 controls were enrolled; a total of 57% were women. Median age at pancreatitis diagnosis was 39 years. We identified 81 benign variants (50 in cases and 67 in controls) and a total of 35 distinct rare pathogenic and unknown significance variants (10 in CEL, 21 in CFTR, 1 in CDLN2, and 3 in CPA1). None of the cases or controls carried pancreatitis-predisposing variants within the CASR, CPA1, PRSS1, and SPINK1 genes, nor a pathogenic CFTR mutation. Four different variants of unknown significance were detected in the CDLN and CPA1 genes; one of them was in the CDLN gene in a single patient with pancreatitis and 3 in the CPA1 gene in 5 controls. After the analysis of the variants detected, no significant differences were observed between cases and controls. CONCLUSION: In patients with IBD, genes known to cause pancreatitis seem not to be involved in thiopurine-related pancreatitis onset.
Assuntos
Doenças Inflamatórias Intestinais , Pancreatite , Sistema de Registros , Humanos , Feminino , Pancreatite/induzido quimicamente , Pancreatite/genética , Masculino , Adulto , Estudos de Casos e Controles , Doenças Inflamatórias Intestinais/genética , Doenças Inflamatórias Intestinais/tratamento farmacológico , Pessoa de Meia-Idade , Predisposição Genética para Doença , Fatores de Risco , Variação Genética , Mercaptopurina/efeitos adversos , Mercaptopurina/uso terapêuticoRESUMO
Ogilvie syndrome is a functional disorder of colonic motility that causes acute and progressive dilation, which can lead to necrosis and perforation. Early diagnosis and management are essential to avoid serious complications. The case of a patient with Ogilvie syndrome refractory to medical and endoscopic treatment that required surgery is presented. This is a 68-year-old man with decreased level of consciousness and abdominal distension for 3 days. Last bowel movement 4 days ago. The data and tests appear in table 1. We are faced with a patient with neurological alteration and hemodynamically unstable secondary to complicated Ogilvie syndrome. After admission to the ICU, where a 2.5 mg bolus of neostigmine was administered, he was transferred to the ward. Despite 250 mg of intravenous erythromycin every 6 hours together with metoclopramide every 8 hours, high doses of polyethylene glycol and daily cleansing enemas and rectal catheterization, only a brief and mild improvement is achieved. Given the failure of conservative measures, colectomy was performed, achieving complete resolution. Ogilvie syndrome is a functional disorder1 that usually associates predisposing factors that impact intestinal motility 2 ; In our case: bedridden, the use of anticholinergics, hydroelectric alteration both due to the use of antidepressants and the creation of a third space secondary to colonic dilation and severe intestinal ischemia². In one third it is resolved by early correction of the triggering factors, adding neostigmine if necessary with high rates of effectiveness¹. In our case, a second bolus of neostigmine could have been administered or even as an infusion since greater efficacy has been demonstrated in this way given its short half-life². Electrolyte imbalance is a predictor of poor response to neostigmine, a factor that was associated with our patient 3. Colonic decompression and finally surgery are reserved as a last measure, being necessary in a very small percentage as in this case 1. As a preventive measure, the administration of 29.5 g of oral polyethylene glycol per day has been effective 4. Therefore, we should suspect Ogilvie syndrome in patients with predisposing factors who present acute dilation of the colon without mechanical obstruction, and although it usually resolves with medical and endoscopic treatment, we should not delay surgery to avoid complications.
RESUMO
We report the case of a middle-aged man who had undergone two diagnostic laparoscopies with no significant findings after he was attended at the emergency department with cramping pain, abdominal distention and vomiting, with radiological images simulating a small bowel obstruction. After multiple hospitalisations and an extensive set of tests, including a genetic study, he was diagnosed with chronic pseudo-obstruction, an uncommon, unrecognides syndrome with high morbidity. Being aware of this pathology can make it easier to diagnose, and thereby, we can avoid unnecessary surgical interventions, because its management and treatment are mainly based on pharmacological therapy. After a proper diagnosis our patient's progression was satisfactory due to the treatment introduced, with no further hospitalisations.(AU)
Assuntos
Humanos , Masculino , Adulto , Obstrução Intestinal/diagnóstico por imagem , Laparoscopia , Pseudo-Obstrução Intestinal/diagnóstico por imagem , Apendicectomia , Intestino Delgado , Vômito , Dor Abdominal , Pacientes Internados , Exame Físico , Resultado do TratamentoRESUMO
Introducción: La incidencia de la enfermedad inflamatoria intestinal (EII) está aumentando en todo el mundo. Objetivos: Evaluar la incidencia de EII en la comunidad autónoma de Castilla y León y describir las características clínicas de los pacientes al diagnóstico, el tipo de tratamiento recibido y la evolución clínica durante el primer año. Material y métodos: Estudio prospectivo, multicéntrico y poblacional en el que se incluyeron pacientes adultos diagnosticados de EII (enfermedad de Crohn [EC], colitis ulcerosa [CU] o colitis indeterminada [CI]) durante el año 2017 procedentes de 8 centros de Castilla y León. Se incluyeron variables epidemiológicas, clínicas y terapéuticas. Se calculó la incidencia global y por enfermedades. Resultados: Doscientos noventa pacientes fueron diagnosticados de EII (54,5% de CU, 45.2% de EC y 0,3% de CI), con una mediana de seguimiento de 9 meses (rango 8-11). La tasa de incidencia fue de 16,6 casos/100.000 habitantes-año (9/105 casos de CU y 7,5/105 casos de EC), con una proporción CU/EC de 1,2:1. Los pacientes con EC recibieron significativamente más corticoides sistémicos (47% vs. 30%; p=0,002), más tratamiento inmunomodulador (81% vs. 19%; p=0,000), más tratamiento biológico (29% vs. 8%; p=0,000) y mayor necesidad de cirugía (11% vs. 2%; p=0,000). Conclusiones: La incidencia de pacientes con CU en nuestro medio se incrementa, mientras que la de EC se mantiene estable, con una historia natural de la enfermedad peor (uso de corticoides, inmunosupresores, biológicos y cirugía) para los pacientes con EC comparado con los pacientes con CU en el primer año de seguimiento.(AU)
Introduction: The incidence of inflammatory bowel disease (IBD) is increasing worldwide. Objectives: To evaluate the incidence of IBD in Castilla y León describing clinical characteristics of the patients at diagnosis, the type of treatment received and their clinical course during the first year. Materials and methods: Prospective, multicenter and population-based incidence cohort study. Patients aged >18 years diagnosed during 2017 with IBD (Crohn's disease [CD], ulcerative colitis [UC] and indeterminate colitis [IC]) were included from 8 hospitals in Castilla y León. Epidemiological, clinical, and therapeutic variables were registered. The global incidence and disease incidence were calculated.Results290 patients were diagnosed with IBD (54.5% UC, 45.2% CD, and 0.3% IC), with a median follow-up of 9 months (range 8−11). The incidence rate of IBD in Castilla y Leon in 2017 was 16.6 cases per 10,000 inhabitants-year (9/105 UC cases and 7.5/105 CD cases), with a UC/CD ratio of 1.2:1. Use of systemic corticosteroids (47% vs 30%; P=.002), immunomodulatory therapy (81% vs 19%; P=.000), biological therapy (29% vs 8%; P=.000), and surgery (11% vs 2%; p=.000) were significatively higher among patients with CD comparing with those with UC. Conclusions: The incidence of patients with UC in our population increases while the incidence of patients with CD remains stable. Patients with CD present a worse natural history of the disease (use of corticosteroids, immunomodulatory therapy, biological therapy and surgery) compared to patients with UC in the first year of follow-up.(AU)
Assuntos
Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/história , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doença de Crohn , Incidência , Colite Ulcerativa , Gastroenterologia , Gastroenteropatias , Estudos Prospectivos , Estudos Populacionais em Saúde PúblicaRESUMO
La linfangiectasia intestinal primaria es un trastorno raro asociado a una enteropatía pierde-proteínas. Las principales manifestaciones son las derivadas de la hipoalbuminemia. Para lograr el diagnóstico se necesita la imagen endoscópica típica de la linfangiectasia intestinal y el aumento de las cifras de alfa-1-antitripsina en las heces de 24 horas. El tratamiento es básicamente dietético. (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Hipoalbuminemia , Edema , Linfangiectasia , Cápsulas Endoscópicas , Intestino DelgadoRESUMO
Introduction: per-oral endoscopic myotomy (POEM) hasbecome a mainstream treatment for achalasia and is apromising therapy in spastic disorders.Methods: this is a retrospective study of prospectively collected data (case series). We present the first results of theuse of POEM in patients with atypical spastic esophagealmotor disorders that do not satisfy current Chicago Classification criteria. Seven consecutive patients with troublesome and persistent symptoms (12-180 months) relatedto atypical spastic esophageal motor dysfunction weresystematically assessed before and after POEM, the extentof which was tailored by manometric findings. In five ofthe patients, other endoscopic or surgical procedures hadfailed.Results: high-resolution manometry (HRM) showed a spasticesophageal body contractile segment in varying positionsand lengths along the esophageal body which did not meet Chicago Classification criteria. After POEM, dysphagia and/or chest pain had either resolved or was greatly reduced.HRM 3-6 months after myotomy showed that the regions ofspastic contraction targeted by myotomy had been ablated.There were no major complications. The clinical responseswere fully maintained up to the most recent assessmentsafter POEM (range 7-44 months).Conclussion: in our seven patients, POEM was a highly effective treatment for patients with troublesome symptoms related to atypical spastic esophageal motility disorders. (AU)
Assuntos
Humanos , Acalasia Esofágica/diagnóstico , Transtornos da Motilidade Esofágica , Esofagoscopia/métodos , Manometria/métodos , Espasticidade Muscular/etiologia , Miotomia/métodos , Resultado do Tratamento , Estudos RetrospectivosRESUMO
Introducción: El consumo de antibióticos en España es elevado y más del 90% de las prescripciones se realizan en ámbito extrahospitalario. La exposición a antibióticos en la edad infantil es alta. El objetivo de este estudio es describir la evolución del consumo extrahospitalario de antibióticos en la población pediátrica del Principado de Asturias entre 2005 y 2018.Material y métodos: Estudio descriptivo y retrospectivo del consumo de antibacterianos de uso sistémico (grupo J01 de la clasificación ATC, Anatomical Therapeutic Chemical Classification) en ámbito extrahospitalario en la población pediátrica (0-13 años) del Principado de Asturias entre 2005 y 2018. Se compara el consumo, medido en número de dosis diarias definidas (DDD) por 1.000 habitantes y día (DHD), en 3 periodos de tiempo.Resultados: El consumo medio de antibacterianos en la población pediátrica asturiana (2005-2018) fue de 14 DHD (IC95% 13,4-14,6), con un aumento hasta 2009 (15,2 DHD) y descenso a partir de 2015 (11,9 DHD en 2018). A lo largo del estudio se detectó: 1) un aumento del consumo de amoxicilina (p=0,027), que supera al de amoxicilina-clavulánico desde el año 2011; 2) un consumo estable de macrólidos, con un aumento de azitromicina (p<0,001) y un descenso de claritromicina (p=0,001); 3) un descenso del consumo de cefalosporinas (p<0,001); 4) un aumento del consumo de quinolonas (p=0,002).Conclusiones: El consumo de antibióticos a nivel extrahospitalario en la población pediátrica del Principado de Asturias entre los años 2005 y 2018 ha experimentado un descenso mantenido en los últimos años y una mejora evolutiva del patrón de uso. (AU)
Introduction: Data about consumption of antibiotics in Spain are worrisome. They are mainly prescribed in the community sector and there is a high exposure to antibiotics in the pediatric population. The aim of this study is to describe the evolution of antibiotic consumption in the pediatric population of Asturias during 2005-2018 period.Material and methods: Retrospective and descriptive study using data about consumption of antibacterial agents for systemic use (J01 group of the Anatomical Therapeutic Chemical Classification) in pediatric outpatients in Principado de Asturias between 2005 and 2018. Data, expressed as defined daily dose (DDD) per 1000 inhabitants per day (DID), in three periods were compared.Results: Mean antibiotic consumption in pediatric outpatients in Principado de Asturias (2005-2018) was 14 DID (CI95% 13.4-14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). Remarkable data along the study were: 1) increase in amoxicillin consumption (p=0.027), that have exceeded that of amoxicillin-clavulanate since 2011; 2) steady consumption of macrolides, with an increase in azithromycin (p<0.001) and a decrease in clarithromycin (p=0.001); 3) reduction of cephalosporins consumption (p<0.001); 4) increase in quinolones consumption (p=0.002).Conclusions: Global antibiotic consumption in pediatric outpatients in Principado de Asturias between 2005 and 2018 has experienced a constant decrease lately and an improvement in patterns of antibacterial use. (AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Antibacterianos/história , Pediatria , Antibacterianos/farmacologia , Estudos Retrospectivos , Epidemiologia DescritivaRESUMO
INTRODUCCIÓN: la ecoendoscopia permite el diagnóstico histológico de lesiones renales radiológicamente indeterminadas, aunque existen pocas series disponibles. OBJETIVOS: describir el procedimiento, rendimiento y complicaciones de las punciones renales guiadas por ecoendoscopia. MATERIAL Y MÉTODOS: serie de casos retrospectiva sobre una base prospectiva que incluye consecutivamente las ecoendoscopias de marzo/2014-agosto/2018. Recogimos complicaciones, evolución y seguimiento. Definimos punción exitosa si permitió realizar un diagnóstico histológico. Se consideraron lesiones malignas aquellas confirmadas quirúrgicamente (en pacientes no quirúrgicos se asumió el diagnóstico histológico); la benignidad requirió estabilidad radiológica ≥ 12 meses. RESULTADOS: identificamos a ocho pacientes con una edad mediana de 61,6 años (57,3-71,9), cinco (62,5 %) mujeres, cinco punciones de riñón derecho y tres de riñón izquierdo. Se emplearon agujas de citología de 22G. La punción fue diagnóstica en el 100 %, sin complicaciones. CONCLUSIONES: la punción guiada por ecoendoscopia puede resultar una herramienta efectiva y segura en el diagnóstico de lesiones renales de origen incierto
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Nefropatias/diagnóstico , Nefropatias/patologia , Estudos Retrospectivos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Centros de Atenção Terciária , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Estatísticas não Paramétricas , Fatores de RiscoRESUMO
INTRODUCCIÓN: la colangiopancreatografía retrógrada endoscópica vía acceso transprotésico USE-guiado (CPRE-GATU) es una opción emergente en el bypass gástrico en Y de Roux. MÉTODOS: estudio unicéntrico de revisión de 14 pacientes consecutivos para evaluar los resultados de la CPRE-GATU. RESULTADOS: se realizaron 14 gastrogastrostomías/gastroyeyunostomías USE-guiadas en las que se emplearon prótesis de aposición luminal (PAL; n=10) o duodenales metálicas autoexpandibles (PMA; n = 4). Se obtuvo éxito clínico en la CPREGATU en sesión única en 9/12 (75%) y en la CPRE-GATU en dos tiempos por abordaje diferido o por seguimiento en 6/7 (85% Se obtuvo acceso papilar y canulación biliar en todos los casos. No se logró extraer una prótesis biliar migrada, por lo que el éxito clínico final de la CPRE-GATU fue de 13/14 (93%). Hubo 4/19 desalojos protésicos, todos ellos rescatados endoscópicamente. Se registraron 3 eventos adversos leves (16%). Las prótesis transgástricas se retiraron tras una media de 30 días; 256 días después de la retirada de la prótesis transgástrica no se registraron recidivas sintomáticas ni presencia de fístulas persistentes. CONCLUSIONES: tanto las PMA duodenales como las PAL pueden emplearse en sesión única o diferida de CPRE-GATU en pacientes con bypass gástrico en Y de Roux
No disponible
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Doenças dos Ductos Biliares/cirurgia , Pancreatite/cirurgia , Resultado do Tratamento , Estudos RetrospectivosRESUMO
Introducción: existe controversia respecto a los riesgos asociados a las prótesis de aposición luminal (PAL), con importantes variaciones entre los trabajos disponibles. Objetivos: describir el tipo y la proporción de complicaciones durante la permanencia y retirada de PAL tipo Axios(TM). Describir la relación entre tiempo de permeabilidad, diana terapéutica y presencia de complicaciones. Métodos: serie de casos retrospectiva y multicéntrica que incluyó todos los pacientes consecutivos a los que se les colocó una PAL para acceder a estructuras extraluminales durante el año 2017. Se registraron únicamente aquellos casos que alcanzaron éxito técnico. Resultados: se incluyeron 179 pacientes de siete centros (rango 4-68 casos/centro) con edad media de 64,3 años (DE: 15,8, rango 24,6-98,8 años), 122 (68,2%) de ellos varones. Las indicaciones más frecuentes fueron las necrosis encapsuladas (58, 32,4%), seguidas de pseudoquistes (31, 17,3%) y drenajes vesiculares (26, 14,5%). Durante la permanencia de la PAL se documentaron complicaciones en 19 pacientes (10,9%), siendo las más frecuentes las obstrucciones de la luz protésica o del marco gastroduodenal en ocho (4,5%) casos y las hemorragias en siete (3,9%) pacientes. Las PAL no se retiraron en 86 pacientes (48%) por los siguientes motivos: intención permanente de la PAL en 46 (53,5%), pérdida del seguimiento en 18 (20,9%), fallecimiento del paciente en 16 (18,6%) y migración en seis (7%). Durante la retirada se observaron cinco complicaciones (5,4%), tres casos de hemorragia y dos perforaciones. No observamos una asociación entre el tiempo de permanencia y las complicaciones (p = 0,67). Conclusión: la aparición de complicaciones secundarias a la inserción de PAL es poco frecuente, aunque pueden ser graves. En este estudio no se ha observado una asociación entre la aparición de complicaciones y el tiempo de permanencia de la prótesis
Introduction: there is controversy with regard to the risks associated with lumen-apposing metal stents (LAMSs), with significant variations between available reports. Objectives: to describe the types and proportions of complications that arise during the permanence time and removal of Axios(TM) LAMS. Furthermore, the relationship between patency time, therapeutic target and the presence of complications was also described. Methods: a retrospective, multicenter case series study was performed of all patients with an implanted LAMS to access extra-luminal structures during 2017. Only technically successful cases were recorded. Results: a total of 179 patients from seven sites (range, 4-68 cases/site) were included in the study, with a mean age of 64.3 years (SD: 15.8; range: 24.6-98.8 years) and 122 (68.2%) were male. Most common indications included encapsulated necrosis (58, 32.4%), pseudocysts (31, 17.3%) and gallbladder drains (26, 14.5%). Complications during LAMS stay were reported in 19 patients (10.9%); stent lumen or gastroduodenal obstruction (8, 4.5%) and bleeding (7, 3.9%) were the most common. LAMS were not removed in 86 (48%) patients due to the following reasons: a permanent stent was used (46, 53.5%), loss to follow-up (18, 20.9%), patient demise (16, 18.6%) and stent migration (6, 7%). Five (5.4%) complications were reported during stent removal, which were three bleeds and two perforations. No association was found between stent duration and complications (p = 0.67). Conclusion: complications secondary to LAMS insertion are uncommon but may be serious. This study found no association between complications and stent duration
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Stents/estatística & dados numéricos , Implantação de Prótese/métodos , Necrose/cirurgia , Sucção/instrumentação , Endoscopia Gastrointestinal/métodos , Estudos Retrospectivos , Doença Iatrogênica/epidemiologia , Remoção de Dispositivo/métodosRESUMO
La manometría esofágica de alta resolución (MAR) está en fase de desarrollo, como se evidencia por las diferentes clasificaciones de Chicago. Con el fin de unificar criterios en algunos aspectos prácticos con limitada evidencia científica se llevó a cabo la Primera Reunión Nacional de Consenso en Manometría de Alta Resolución del Grupo Español de Motilidad Digestiva, en la que participaron un amplio grupo de expertos. Las propuestas se basaron en una encuesta previa con 47 preguntas, la exhaustiva revisión de la bibliografía disponible y la experiencia de los participantes. Se plantearon aspectos metodológicos sobre criterios de análisis poco definidos de algunos nuevos parámetros de alta resolución y otros aspectos no considerados, como la actividad espontánea o las ondas secundarias, elaborándose conclusiones finales con utilidad práctica (AU)
High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical application (AU)
Assuntos
Humanos , Masculino , Feminino , Manometria/instrumentação , Manometria/métodos , Manometria , Conferências de Consenso como Assunto , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Anestesia/tendências , Anestesia , Administração Tópica , Motilidade Gastrointestinal , Motilidade Gastrointestinal/fisiologia , Transtornos da Motilidade Esofágica/induzido quimicamente , Transtornos da Motilidade Esofágica/complicações , Contração Muscular , Perfusão/métodosRESUMO
INTRODUCCIÓN: El esófago de Barrett (EB) es una lesión esofágica ocasionada mayoritariamente por reflujo gastroesofágico ácido. El control del reflujo ácido es uno de los principales objetivos del tratamiento de esta patología. OBJETIVO: Evaluar en nuestra área de salud el grado de control del reflujo ácido en los pacientes con EB en función del tratamiento de mantenimiento recibido, médico o quirúrgico. MÉTODOS: Estudio retrospectivo de pacientes con diagnóstico endoscópico e histológico de EB. Un grupo de pacientes recibió tratamiento médico con inhibidores de la bomba de protones (IBP) y otro grupo fue sometido a intervención quirúrgica (funduplicatura de Nissen). Se compararon datos epidemiológicos y resultados de pHmetría (tiempo de pH < 4, reflujos prolongados > 5 min, puntuación de DeMeester) de cada grupo. La pH-metría se realizó con IBP en el grupo de tratamiento médico y en el grupo de cirugía sin consumo de antisecretores ácidos. Se definió fracaso del tratamiento como un pH < 4 total superior al 5%. RESULTADOS: Fueron incluidos 128 pacientes con EB (tratamiento médico 75, tratamiento quirúrgico 53). Ambas cohortes eran homogéneas respecto a sus características demográficas. Las puntuaciones de DeMeester, fracción de tiempo de pH < 4 y cantidad de reflujos prolongados fueron significativamente inferiores en los pacientes con funduplicatura frente a los que recibían IBP (p < 0,001). De forma global se apreció un fracaso de tratamiento en el 29% de los pacientes, que fue significativamente mayor en el grupo de tratamiento médico (40% vs 13%; p < 0,001). CONCLUSIONES: El grado de control del reflujo ácido gastroesofágico es subóptimo en un elevado porcentaje de pacientes con EB. El tratamiento médico ofrece resultados inferiores a la cirugía antirreflujo y se debería intentar optimizar sus resultados
INTRODUCTION: Barrett's oesophagus (BE) is an oesophageal injury caused by gastroesophageal acid reflux. One of the main aims of treatment in BE is to achieve adequate acid reflux control. OBJECTIVE: To assess acid reflux control in patients with BE based on the therapy employed: medical or surgical. METHODS: A retrospective study was performed in patients with an endoscopic and histological diagnosis of BE. Medical therapy with proton pump inhibitors (PPI) was compared with surgical treatment (Nissen fundoplication). Epidemiological data and the results of pH monitoring (pH time < 4, prolonged reflux > 5min, DeMeester score) were evaluated in each group. Treatment failure was defined as a pH lower than 4 for more than 5% of the recording time. RESULTS: A total of 128 patients with BE were included (75 PPI-treated and 53 surgically-treated patients). Patients included in the two comparison groups were homogeneous in terms of demographic characteristics. DeMeester scores, fraction of time pH < 4 and the number of prolonged refluxes were significantly lower in patients with fundoplication versus those receiving PPIs (P < .001). Treatment failure occurred in 29% of patients and was significantly higher in those receiving medical therapy (40% vs 13%; P < .001). CONCLUSIONS: Treatment results were significantly worse with medical treatment than with anti-reflux surgery and should be optimized to improve acid reflux control in BE. Additional evidence is needed to fully elucidate the utility of PPI in this disease
Assuntos
Humanos , Esôfago de Barrett/terapia , Refluxo Gastroesofágico/complicações , Ácido Gástrico , Regulador de Acidez , Determinação da Acidez Gástrica , Procedimentos Cirúrgicos do Sistema DigestórioAssuntos
Humanos , Masculino , Idoso , Diarreia/complicações , Diarreia/etiologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Somatostatina/uso terapêutico , Neoplasias Pancreáticas/fisiopatologia , Neoplasias Pancreáticas , Biomarcadores Tumorais/análiseRESUMO
El objetivo de este estudio es analizar las tasas de consumo y el perfil y la calidad de prescripción de antibióticos en Asturias durante el año 1998. Se han utilizado datos referentes al consumo de especialidades farmacéuticas prescritas en receta oficial de la Seguridad Social en Asturias, en el ámbito de la atención extrahospitalaria, dispensadas en oficinas de farmacia y facturadas con cargo al INSALUD. Se obtiene para cada principio activo el número de Dosis Diarias Definidas (DDD) Y los datos de utilización se expresan en Dosis Diaria Definida / 1000 habitantes y día (DHD). Se clasifican los antibióticos en dos grupos, según el nivel deseable de utilización en Atención Primaria. Las penicilinas son los antibióticos de mayor consumo (52,48% del total), seguidas de macrólidos (19,91%), quinolonas (11,24%), cefalosporinas (7,56%), tetraciclinas (3,40%) y sulfonamidas (3,23%); el resto de familias de antibióticos (antiinfecciosos urinarios, lincosamidas, aminoglucósidos y otros) tienen escasa significación en el consumo global (2, 18%). Los principios activos más prescritos son amoxicilinaácido cIavulánico (4,5311 DHD) Y amoxicilina (4,5270). El porcentaje de DDD de antibióticos correspondientes al primer nivel es de 70,78%. Parece adecuado instaurar programas que informen sobre la variabilidad del consumo de antibióticos y promuevan modificaciones en la prescripción de los mismos. Las estrategias de intervención encaminadas a conseguir una utilización racional de antiinfecciosos se deben planificar incidiendo principalmente sobre determinados grupos (quinolonas y celalosporinas de 3ª generación) y sobre principios activos de reciente aparición (nuevas quinolonas, nuevos macrólidos) (AU)
The object of this study is to analyze the consumption rates and the profile and quality of antibiotic prescriptions in Asturias (Spain) in 1998. Data referring to the consumption of official prescriptions orders of the National Health Service in Asturias in non-hospital environment and dispensed in community pharmacies has been used. The number of Daily Defined Doses (DDD) for each active substance was obtained and the use data is expressed in Daily Defined Doses / 1000 inhabitants and day (DHD). The antibiotics are classified in two groups according to the desired level of utilization in primary care. Penicillins are the antibiotic major consumption (52.48% of the total), followed by macrilids (19.91 %), quinolones (11.24%), cephalosporins (7.56%), tetracyclins (3.40%), and sulphonamides (3.23%); the rest of the families of antibiotics (urinary antiinfectives, lincosamides, aminoglycosides, and others) are of a little significance in the global consumption (2.18%). The most prescribed substance are amoxycillin+clavulanic (4,5311 DHD), and amoxycillin (4,5270 DHD). The percentage of antibiotics corresponding to the first level is 70.78%. It seems to be adequate the setting up of programs that inform about the variability of antibiotic consumption and promote modifications in their prescription. The intervention strategies designed to obtain a rational use of antibiotics should be Planned incising mainly on determined groups (third generation cephalosporins and quinilones) and on substances of recent appearance (new quinolones, new macrolids) (AU)