Abdomen agudo durante la gestación y el puerperio / Acute abdomen during pregnancy and the puerperium

El abdomen agudo en la gestación y el puerperio constituye un diagnóstico complejo y un reto terapéutico. Nuestro objetivo es realizar una revisión bibliográfica de esta patología a propósito de un caso de peritonitis secundaria a absceso tubárico con apendicitis por helmintos concomitante. Principalmente, su sintomatología se resume en el dolor y la distensión abdominal, las náuseas y/o los vómitos. Estos síntomas se encuentran presentes en el embarazo normal, dificultando el diagnóstico diferencial. El abdomen agudo es relativamente infrecuente durante la gestación y el puerperio, siendo la apendicitis aguda la principal causa de origen no obstétrico. Asocia una elevada morbimortalidad materno-fetal, que aumenta a medida que la gestación avanza, requiriendo un manejo multidisciplinar para alcanzar un diagnóstico precoz y un tratamiento efectivo. Fundamentalmente, el abordaje terapéutico es quirúrgico debido, en gran medida, al diagnóstico tardío con frecuente asociación de complicaciones. Un manejo temprano será primordial para minimizar riesgos para la madre y el feto

Acute abdomen in pregnancy and the postpartum period is a complex diagnostic and therapeutic challenge. We review the literature on this topic and report a case of peritonitis secondary to tubal abscess with concomitant helminth appendicitis. The main symptoms of this entity are pain and bloating, nausea and/or vomiting. These symptoms are present in normal pregnancy, which hampers the differential diagnosis. Acute abdomen is relatively uncommon during pregnancy and the postpartum, and the main obstetric cause is acute appendicitis. Maternal and fetal morbidity and mortality are high and increase as the pregnancy progresses, requiring multidisciplinary management to achieve early diagnosis and effective treatment. The therapeutic approach is mainly surgical, largely due to late diagnosis and associated complications. Early management is essential to minimize the risks to the mother and fetus

Onset and disappearance rates of gastroesophageal reflux symptoms in the Spanish population, and their impact on quality of life.

BACKGROUND: few studies have reported the onset and disappearance rates of gastroesophageal reflux symptoms (GERS) in the population. AIM: to assess the occurrence and disappearance rates of GERS in Spain, and their impact on health-related quality of life (HRQL). PARTICIPANTS AND METHODS: participants were selected at random from the general population of Madrid in age and sex strata. They were interviewed at home twice, 6 months apart. Heartburn, acid regurgitation and consultation were assessed with the gastroesophageal reflux questionnaire, and HRQL with the SF-36. RESULTS: 709 individuals were included, and 451 (63.6%) were re-interviewed 6 months later. Among the 325 individuals without GERS, 9 developed weekly symptoms (2.2% [95% CI: 0.8, 3.4%]); 2 (22%) consulted because of GERS. Among the 34 subjects reporting weekly GERS initially, 26 did not report them at 6-months. Onset of GERS was associated with worsening scores in the physical summary of SF-36 (delta = -6.6 [95% CI: -11.8, -1.42]), while disappearance with an improved score (delta = -3.0 [95% CI: 0.0, 5.9]). CONCLUSION: despite the lower prevalence of GERS in Spain, the occurrence rate is 2.2% in 6 months; however symptoms disappeared in more than half of subjects six months later. Developing GERS was associated with reduced HRQL, and their disappearance with improvement.

Onset and disappearance rates of gastroesophageal reflux symptoms in the Spanish population, and their impact on quality of life

Background: few studies have reported the onset and disappearancerates of gastroesophageal reflux symptoms (GERS) inthe population.Aim: to assess the occurrence and disappearance rates ofGERS in Spain, and their impact on health-related quality of life(HRQL).Participants and methods: participants were selected atrandom from the general population of Madrid in age and sexstrata. They were interviewed at home twice, 6 months apart. Heartburn,acid regurgitation and consultation were assessed withthe gastroesophageal reflux questionnaire, and HRQL with theSF-36.Results: 709 individuals were included, and 451 (63.6%)were re-interviewed 6 months later. Among the 325 individualswithout GERS, 9 developed weekly symptoms (2.2% [95% CI:0.8, 3.4%]); 2 (22%) consulted because of GERS. Among the 34subjects reporting weekly GERS initially, 26 did not report themat 6-months. Onset of GERS was associated with worseningscores in the physical summary of SF-36 (delta = -6.6 [95%CI: -11.8, -1.42]), while disappearance with an improved score(delta = -3.0 [95% CI: 0.0, 5.9]).Conclusion: despite the lower prevalence of GERS in Spain,the occurrence rate is 2.2% in 6 months; however symptoms disappearedin more than half of subjects six months later. DevelopingGERS was associated with reduced HRQL, and their disappearancewith improvement(AU)

Impact of gastroesophageal reflux symptoms on health resource usage and work absenteeism in Spain.

OBJECTIVES: To estimate the impact of gastroesophageal reflux (GER) symptoms on the utilization of healthcare services and work absenteeism in Spain. METHODS: A cross-sectional study on 2,500 subjects representative of the Spanish population from 40 to 79 years of age. Data were collected via a telephone interview in January 2002 using Locke s questionnaire after its cross-cultural adaptation and validation for telephone use in Spain. RESULTS: GER is responsible for 296.8 doctor consultations (95% CI: 245.3-348.7) per 1,000 inhabitants per year, for 24 esophagogastrointestinal radiographic studies per 1,000 inhabitants per year (95% CI: 18-30), for 32.4 (95% CI: 25.5-39.3) high digestive endoscopies per 1,000 inhabitants per year, and for the loss of 201 (95% CI: 0-411.1) working days per 1,000 employed inhabitants with GER per year. In relation to medication intake, GER resulted in 4,092 (95% CI: 3,300-5,133) treatment days with H2 antagonists per 1,000 inhabitants per year, 9,030 (95% CI: 7,846-10,332) treatment days with proton pump inhibitors per 1,000 inhabitants per year, and 1,082 (95% CI: 519-1,549) treatment days with prokinetics per 1,000 inhabitants per year. CONCLUSIONS: GER has a large impact on the utilization of healthcare resources and work absenteeism in Spain, in contrast to the widespread belief that it is an illness of little importance.

Impacto de los síntomas de reflujo gastroesofágico sobre el uso de servicios sanitarios y el absentismo laboral en España / Impact of gastroesophageal reflux symptoms on health resource usage and work absenteeism in Spain

Objetivos: estimar el impacto de los síntomas de reflujo gastroesofágico(SRGE) sobre el uso de servicios sanitarios y el absentismolaboral en España.Métodos: estudio transversal sobre 2.500 personas representativasde la población española de 40 a 79 años. La informaciónse recogió mediante entrevista telefónica en enero de 2002 usandoel cuestionario de Locke, después de su adaptación transculturaly validación para uso telefónico en España.Resultados: los SRGE son responsables de 296,8 (IC95%:245,3-348,7) visitas al médico por 1.000 habitantes/año, de larealización de 24 (IC95%: 18-30) estudios radiológicos esófagogastroduodenalespor 1.000 habitantes-año, 32,4 (IC95%: 25,5-39,3) endoscopias digestivas altas por 1.000 habitantes/año, y dela pérdida de 201 (IC95%: 0-411,1) días laborables por 1.000habitantes empleados con SRGE y año. Respecto al consumo defármacos, los SRGE generaron 4.092 (IC95%: 3.300-5.133) díasde tratamiento con antagonistas H2 por 1.000 habitantes-año,9.030 (IC95%: 7.846-10.332) días de tratamiento con inhibidoresde la bomba de protones por cada 1.000 habitantes/año, y1.082 (IC95%: 519-1549) días de tratamiento con procinéticospor 1.000 habitantes/año.Conclusiones: los SRGE tienen un gran impacto sobre la utilizaciónde recursos sanitarios y el absentismo laboral en España.Ello contrasta con la extendida opinión de que se trata de un trastornode escasa importancia

Objectives: to estimate the impact of gastroesophageal reflux(GER) symptoms on the utilization of healthcare services and workabsenteeism in Spain.Methods: a cross-sectional study on 2,500 subjects representativeof the Spanish population from 40 to 79 years of age. Datawere collected via a telephone interview in January 2002 usingLocke’s questionnaire after its cross-cultural adaptation and validationfor telephone use in Spain.Results: GER is responsible for 296.8 doctor consultations(95% CI: 245.3-348.7) per 1,000 inhabitants per year, for 24esophagogastrointestinal radiographic studies per 1,000 inhabitantsper year (95% CI: 18-30), for 32.4 (95% CI: 25.5-39.3)high digestive endoscopies per 1,000 inhabitants per year, andfor the loss of 201 (95% CI: 0-411.1) working days per 1,000employed inhabitants with GER per year. In relation to medicationintake, GER resulted in 4,092 (95% CI: 3,300-5,133) treatmentdays with H2 antagonists per 1,000 inhabitants per year,9,030 (95% CI: 7,846-10,332) treatment days with proton pumpinhibitors per 1,000 inhabitants per year, and 1,082 (95% CI:519-1,549) treatment days with prokinetics per 1,000 inhabitantsper year.Conclusions: GER has a large impact on the utilization ofhealthcare resources and work absenteeism in Spain, in contrastto the widespread belief that it is an illness of little importance

Symptoms of gastro-oesophageal reflux: prevalence, severity, duration and associated factors in a Spanish population.

AIM: To measure the prevalence of gastro-oesophageal reflux symptoms and to identify associated factors in a representative sample of the Spanish population. METHODS: A telephone survey of 2500 subjects was performed using a validated questionnaire. The association of gastro-oesophageal reflux symptoms (defined as the presence of heartburn or acid regurgitation) and their clinical characteristics with potential risk factors was summarized using the odds ratios (OR) obtained by multiple logistic regression. RESULTS: The response rate was 71.2%. The annual prevalence of gastro-oesophageal reflux symptoms was 31.6% [95% confidence interval (CI), 29.8-33.4] and the weekly prevalence was 9.8% (95% CI, 8.6-10.9). Gastro-oesophageal reflux symptoms were associated with excess weight (OR, 1.53; 95% CI, 1.23-1.92), obesity (OR, 1.74; 95% CI, 1.30-2.32), the psychosomatic symptom score (OR, 2.98; 95% CI, 2.41-3.67) and the presence of gastro-oesophageal reflux symptoms in a direct family member (OR, 1.61; 95% CI, 1.17-2.23). Gastro-oesophageal reflux symptoms of > or =10 years' duration were more frequent in obese subjects (OR, 1.92; 95% CI, 1.14-3.22) and those with a direct family member with gastro-oesophageal reflux symptoms (OR, 2.42; 95% CI, 1.44-4.06). Factors associated with gastro-oesophageal reflux symptoms of < or =1 year duration were a spouse with gastro-oesophageal reflux symptoms (OR, 2.33; 95% CI, 1.39-3.9) and the consumption of 1-5 aspirins/week (OR, 1.70; 95% CI, 1.01-2.86). CONCLUSIONS: The prevalence of frequent gastro-oesophageal reflux symptoms in Spain is lower than that observed in other Western populations. The psychosomatic symptom score is the factor most strongly associated with gastro-oesophageal reflux symptoms. Long-term gastro-oesophageal reflux symptoms are associated with certain genetic factors (obesity, family history of gastro-oesophageal reflux symptoms), whereas short-term gastro-oesophageal reflux symptoms are associated with factors of probable environmental nature.

Adaptación y validación de un cuestionario sobre el reflujo gastroesofágico para su uso en población española / Adaptation and validation of a gastroeso phageal reflux questionnaire for use on a spanish population

Objetivo: realizar una adaptación transcultural al español y validar, para su uso telefónico, el cuestionario de reflujo gastroesofágico (CRGE) desarrollado por Locke y cols.Material y método: se desarrolló la versión española del cuestionario mediante traducción, evaluación de la comprensibilidad, retrotraducción y examen de su aplicabilidad. Posteriormente, se midió su reproducibilidad mediante el procedimiento "testretest" en 125 pacientes, y su validez concurrente en 50 pacientes, comparando los resultados del cuestionario con los de la entrevista clínica por un gastroenterólogo.Resultados: la versión española tuvo buena comprensibilidad y aplicabilidad. La reproducibilidad para los dos principales síntomas cardinales de la enfermedad por reflujo gastroesofágico (pirosis y regurgitación ácida) medida por el índice kappa [intervalo confianza (IC) 95 por ciento] fue 0,85 (0,73-0,97) y 0,81 (0,70-0,92), respectivamente. Respecto al proceso de validación concurrente los valores de kappa para la pirosis y la regurgitación ácida fueron 0,85 (0,68-1,00) y 0,91 (0,79-1,00) respectivamente. La mediana de valores del índice kappa para todas las preguntas del cuestionario fue de 0,75 (rango: 0,42 a 1) en el análisis de reproducibilidad y de 0,83 (rango: 0,44 a 1) en el análisis de validez concurrente.Conclusiones: la reproducibilidad y validez concurrente de la versión española del CRGE es excelente y similar a los de la versión inglesa original. (AU)

Adaptation and validation of a gastroesophageal reflux questionnaire for use on a Spanish population.

OBJECTIVE: To produce and validate for telephone use in Spain a cross-cultural adaptation of the gastroesophageal reflux questionnaire (GERQ) developed by Locke et al. MATERIAL AND METHOD: The Spanish version of the questionnaire was developed through translation, assessment of comprehensibility, back translation, and appraisal of applicability. Subsequently, reproducibility was measured by a test-retest procedure in 125 patients, and concurrent validity was evaluated by comparing self-reported questionnaire data against a gastroenterologist's findings from clinical interviews with 50 patients. RESULTS: The Spanish version showed itself to be easily understandable and widely applicable. Reproducibility for the two cardinal symptoms of gastroesophageal reflux disease (heartburn and acid regurgitation) as measured by the kappa index (95% confidence interval), was 0.85 (0.73-0.97) and 0.81 (0.70-0.92), respectively. With respect to the process of concurrent validation, kappa values (95% confidence interval) for heartburn and acid regurgitation were 0.85 (0.68-1) and 0.91 (0.79-1), respectively. Median kappa for all questions on the questionnaire was 0.75 (range: 0.42 a 1) in the reproducibility analysis and 0.83 (range: 0.44 a 1) in the concurrent validity analysis. CONCLUSIONS: The reproducibility and concurrent validity of the Spanish version of the GERQ is excellent and comparable to that of the original English version.