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BACKGROUND: Proton pump inhibitors (PPIs) are widely prescribed worldwide, often resulting in their overuse. Consequently, it is essential to identify the likely causes of this overuse to facilitate their appropriate prescription. OBJECTIVE: This study aims to assess physician prescribing patterns, their knowledge of PPIs, and factors affecting their knowledge. METHODS: An online survey was conducted among Latin American and Spanish physicians, collecting the following data: professional information, patterns of PPI usage, familiarity with published evidence, and the management approach in three hypothetical case-scenarios. Participant knowledge was categorized as sufficient or insufficient based on the results of the case scenarios. Subsequently, subgroup analysis was performed based on physician training level, years in practice, specialty, and time since the last PPI literature review. RESULTS: A total of 371 physicians participated in the survey. Thirty-eight percent frequently prescribe PPIs, primarily for prophylactic purposes (57.9%). Eighty percent were unfamiliar with PPI deprescribing strategies, and 54.4% rarely reviewed the ongoing indication of patients taking a PPI. Sixty-four percent demonstrated sufficient knowledge in the case-scenarios. A significant association was observed between specialty type (medical vs surgical: 69.4% vs 46.8%, P<0.001), the timing of the PPI indication literature review (<5 years vs >5 years: 71.4% vs 58.7%, P=0.010), and sufficient knowledge. CONCLUSION: While most participants prescribed PPIs regularly and for prophylaxis purposes, the majority were unfamiliar with deprescribing strategies and rarely reviewed ongoing indications. Sufficient knowledge is correlated with recent literature reviews and medical specialty affiliation. BACKGROUND: ⢠The study aims to evaluate physician prescribing patterns, assess their knowledge of proton pump inhibitors, and identify factors influencing their knowledge. BACKGROUND: ⢠An online survey of Latin American and Spanish physicians assessed proton pump inhibitor usage patterns and case-scenario responses, categorizing knowledge, and conducting subgroup analysis based on training, experience, specialty, and literature review timing. BACKGROUND: ⢠Thirty-eight percent of surveyed physicians commonly prescribed proton pump inhibitors, and among them, 80% were unfamiliar with deprescribing strategies, with 54.4% rarely reviewing ongoing indications. BACKGROUND: ⢠Sufficient knowledge was correlated with recent literature reviews and medical specialty affiliations.
Assuntos
Médicos , Inibidores da Bomba de Prótons , Humanos , Padrões de Prática Médica , Prescrições , Inibidores da Bomba de Prótons/uso terapêuticoRESUMO
Acute pancreatitis (AP) is the leading hospital admission in Gastroenterology and has a variable clinical course. Identifying severity of AP patients in its early stages is of foremost importance to improve prognosis. The revised Atlanta Classification grades AP severity by the presence of organ failure and local complications. (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pancreatite/sangue , Pancreatite/diagnóstico , AnemiaRESUMO
OBJECTIVE: Early disease prediction is challenging in acute pancreatitis (AP). Here, we prospectively investigate whether the microbiome predicts severity of AP (Pancreatitis-Microbiome As Predictor of Severity; P-MAPS) early at hospital admission. DESIGN: Buccal and rectal microbial swabs were collected from 424 patients with AP within 72 hours of hospital admission in 15 European centres. All samples were sequenced by full-length 16S rRNA and metagenomic sequencing using Oxford Nanopore Technologies. Primary endpoint was the association of the orointestinal microbiome with the revised Atlanta classification (RAC). Secondary endpoints were mortality, length of hospital stay and severity (organ failure >48 hours and/or occurrence of pancreatic collections requiring intervention) as post hoc analysis. Multivariate analysis was conducted from normalised microbial and corresponding clinical data to build classifiers for predicting severity. For functional profiling, gene set enrichment analysis (GSEA) was performed and normalised enrichment scores calculated. RESULTS: After data processing, 411 buccal and 391 rectal samples were analysed. The intestinal microbiome significantly differed for the RAC (Bray-Curtis, p value=0.009), mortality (Bray-Curtis, p value 0.006), length of hospital stay (Bray-Curtis, p=0.009) and severity (Bray-Curtis, p value=0.008). A classifier for severity with 16 different species and systemic inflammatory response syndrome achieved an area under the receiving operating characteristic (AUROC) of 85%, a positive predictive value of 67% and a negative predictive value of 94% outperforming established severity scores. GSEA revealed functional pathway units suggesting elevated short-chain fatty acid (SCFA) production in severe AP. CONCLUSIONS: The orointestinal microbiome predicts clinical hallmark features of AP, and SCFAs may be used for future diagnostic and therapeutic concepts. TRIAL REGISTRATION NUMBER: NCT04777812.
Assuntos
Microbioma Gastrointestinal , Pancreatite , Humanos , Pancreatite/terapia , Doença Aguda , RNA Ribossômico 16S/genética , Índice de Gravidade de DoençaRESUMO
ABSTRACT Background: Proton pump inhibitors (PPIs) are widely prescribed worldwide, often resulting in their overuse. Consequently, it is essential to identify the likely causes of this overuse to facilitate their appropriate prescription. Objective: This study aims to assess physician prescribing patterns, their knowledge of PPIs, and factors affecting their knowledge. Methods: An online survey was conducted among Latin American and Spanish physicians, collecting the following data: professional information, patterns of PPI usage, familiarity with published evidence, and the management approach in three hypothetical case-scenarios. Participant knowledge was categorized as sufficient or insufficient based on the results of the case scenarios. Subsequently, subgroup analysis was performed based on physician training level, years in practice, specialty, and time since the last PPI literature review. Results: A total of 371 physicians participated in the survey. Thirty-eight percent frequently prescribe PPIs, primarily for prophylactic purposes (57.9%). Eighty percent were unfamiliar with PPI deprescribing strategies, and 54.4% rarely reviewed the ongoing indication of patients taking a PPI. Sixty-four percent demonstrated sufficient knowledge in the case-scenarios. A significant association was observed between specialty type (medical vs surgical: 69.4% vs 46.8%, P<0.001), the timing of the PPI indication literature review (<5 years vs >5 years: 71.4% vs 58.7%, P=0.010), and sufficient knowledge. Conclusion: While most participants prescribed PPIs regularly and for prophylaxis purposes, the majority were unfamiliar with deprescribing strategies and rarely reviewed ongoing indications. Sufficient knowledge is correlated with recent literature reviews and medical specialty affiliation.
RESUMO Contexto: Os inibidores da bomba de prótons (IBPs) são amplamente prescritos em todo o mundo, muitas vezes resultando em seu uso excessivo. Consequentemente, é essencial identificar as prováveis causas desse uso excessivo para facilitar sua prescrição adequada. Objetivo: Este estudo tem como objetivo avaliar o padrão de prescrição dos médicos, seu conhecimento sobre IBPs e fatores que afetam seu conhecimento. Métodos: Uma pesquisa on-line foi conduzida entre médicos latino-americanos e espanhóis, coletando os seguintes dados: informações profissionais, padrões de uso de IBP, familiaridade com evidências publicadas e abordagem de manejo em três casos-cenários hipotéticos. O conhecimento dos participantes foi categorizado em suficiente ou insuficiente com base nos resultados dos cenários de caso. Posteriormente, a análise de subgrupos foi realizada com base no nível de formação do médico, anos de prática, especialidade e tempo desde a última revisão da literatura dos IBPs. Resultados: Um total de 371 médicos participaram da pesquisa. Trinta e oito por cento prescrevem frequentemente IBP, principalmente para fins profiláticos (57,9%). Oitenta por cento não estavam familiarizados com as estratégias de prescrição de IBP, e 54,4% raramente revisaram a indicação contínua de pacientes em uso de IBP. Sessenta e quatro por cento demonstraram conhecimento suficiente nos cenários-caso. Observou-se associação significativa entre o tipo de especialidade (médica vs cirúrgica: 69,4% vs 46,8%, P<0,001), o momento da revisão da literatura de indicação do IBP (<5 anos vs >5 anos: 71,4% vs 58,7%, P=0,010) e conhecimento suficiente. Conclusão: Embora a maioria dos participantes prescrevesse IBPs regularmente e para fins de profilaxia, no entanto, não estava familiarizada com estratégias de prescrição e raramente revisava as indicações em andamento. O conhecimento suficiente está correlacionado com revisões recentes da literatura e afiliação à especialidade médica.
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Introduction: Acute pancreatitis is a frequent inflammatory gastrointestinal disorder with high mortality rates in severe forms. An early evaluation of its severity is key to identify high-risk patients. This study assessed the influence of waist circumference together with hypertriglyceridemia on the severity of acute pancreatitis. Methods: A retrospective study was performed, which included patients admitted with acute pancreatitis from March 2014 to March 2021. Patients were classified into four phenotype groups according to their waist circumference and triglyceride levels: normal waist circumference and normal triglycerides; normal waist circumference and elevated triglycerides; enlarged waist circumference and normal triglycerides; and enlarged waist circumference and triglycerides, namely hypertriglyceridemic waist (HTGW) phenotype. Clinical outcomes were compared among the groups. Results: 407 patients were included. Systemic inflammatory response syndrome (SIRS) and intensive care unit admission were most frequent among patients in the HTGW phenotype group, at 44.9% and 8.2%, respectively. The incidence of local complications was higher in the normal waist circumference with elevated triglycerides group (27%). On multivariable analysis, an enlarged waist circumference was related to an increase of 4% and 2% in the likelihood of developing organ failure and SIRS, respectively. Hypertriglyceridemia was an independent risk factor for both organ failure and local complications. Conclusions: HTGW phenotype was significant related to developing of SIRS. It seems that an enlarged waist circumference has a greater role than hypertriglyceridemia in the development of SIRS. Obesity and hypertriglyceridemia were both independent risk factors for organ failure. Patients with hypertriglyceridemia were more likely to develop local complications. (AU)
Introducción: La pancreatitis aguda es una patología frecuente con altas tasas de mortalidad en sus formas graves. Este estudio evaluó la influencia de la circunferencia de la cintura (CC) junto con la hipertrigliceridemia en la gravedad de la pancreatitis aguda. Métodos: Se realizó un estudio retrospectivo que incluyó pacientes con pancreatitis aguda desde 2014 hasta 2021. Los pacientes se clasificaron en cuatro grupos fenotípicos según su CC y los niveles de triglicéridos: CC normal y triglicéridos normales, CC normal y triglicéridos elevados, CC aumentada y triglicéridos normales, y CC aumentada y triglicéridos elevados, es decir, el fenotipo cintura hipertrigliceridémica (HTGW). Resultados: Se incluyeron 407 pacientes. El síndrome de respuesta inflamatoria sistémica (SIRS) y la admisión a la unidad de cuidados intensivos fueron más frecuentes entre los pacientes con fenotipo HTGW, en 44,9 y 8,2%, respectivamente. La incidencia de complicaciones locales fue mayor en el grupo de CC normal con triglicéridos elevados (27%). En el análisis multivariable, una CC aumentada se relacionó con un aumento de 4 y 2% en la probabilidad de desarrollar fallo orgánico y SIRS, respectivamente. La hipertrigliceridemia fue un factor de riesgo tanto para el fallo orgánico como para las complicaciones locales. Conclusiones: El fenotipo HTGW se relacionó con el desarrollo de SIRS. Parece que una CC aumentada tiene un papel más importante que la hipertrigliceridemia en el desarrollo de SIRS. La obesidad y la hipertrigliceridemia fueron factores de riesgo independientes para el fallo orgánico. Los pacientes con hipertrigliceridemia tenían más probabilidades de desarrollar complicaciones locales. (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hipertrigliceridemia/complicações , Cintura Hipertrigliceridêmica/complicações , Cintura Hipertrigliceridêmica/epidemiologia , Pancreatite/complicações , Fenótipo , Estudos Retrospectivos , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/complicações , Triglicerídeos , Circunferência Abdominal/fisiologiaRESUMO
Introduction: the C-reactive protein (CRP) to albumin ratio is an inflammatory marker that has shown promise in the prognosis of critically ill patients. This study is aimed to assess the value of CRP/albumin ratio to predict severity in acute pancreatitis. Methods: a retrospective study was performed using a prospectively collected database of patients diagnosed with AP admitted to the Department of Gastroenterology between March 2014 and December 2021. Results: among 722 patients included in the study, 78.67 % had mild, 15.65 % had moderately severe, and 5.67 % had severe acute pancreatitis. The CRP/albumin ratio was significantly associated with severe AP (OR 1.02; 95 % CI: 1.01-1.03; p < 0.001), and each ten-unit increase in the ratio was associated with a 20 % increased likelihood of severe acute pancreatitis. The area under the ROC curve (AUC) value of the CRP/albumin ratio in severe acute pancreatitis was 0.68 (95 % CI: 0.58-0.77), which was higher than that of the Ranson criteria (0.62). The optimal cut-off value for predicting severe acute pancreatitis was 7.51, with a sensitivity of 63.4 % and specificity of 65.6 %. Conclusions: despite its low sensitivity and specificity, the CRP/albumin ratio could be used as a complementary marker to the current scoring systems for the initial assessment of acute pancreatitis prognosis. It is easily obtainable and can provide additional prognostic information to clinicians.(AU)
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Humanos , Masculino , Feminino , Albuminas , Biomarcadores , Proteína C-Reativa , Pancreatite , Sensibilidade e Especificidade , Estudos Retrospectivos , Gastroenteropatias , Doenças do Sistema DigestórioRESUMO
Data on recurrent episodes of acute pancreatitis (RAP) are scarce. The aim of the study was to evaluate our rate of RAP and risks factors. This is a retrospective, single-center, study of consecutive patients admitted for AP and followed-up. Patients with more than one AP attack (RAP) were compared with patients with only a single AP episode (SAP) Clinical, demographic, outcome measures and severity were studied. 561 patients were included and follow-up over a mean 67.63 months' time. Our rate of RAP was 18,9%. Most patients suffered form only one episode of RAP (93%). Etiology of RAP episodes was mainly biliary (67%). On univariate analysis younger age (p 0.004), absence of high blood pressure (p 0.013) and absent of SIRS (p 0.022) were associated with recurrence of AP. On multivariate analysis only younger age was related to RAP (OR 1.015 95%IC 1.00-1.029). There were no statistical differences in outcome measures between both cohorts. RAP had a milder course in terms of severity (SAP 19% moderately severe/severe versus 9% in SAP). Almost 70% of the biliary RAP patients did not have a cholecystectomy performed. In this subset of patients, age OR 0.964 (95%IC 0.946-0.983), cholecystectomy OR 0.075 (95%IC 0.189-0.030) and cholecystectomy plus ERCP OR 0.190 (95%IC 0.219-0.055) were associated with absent of RAP. The rate of RAP in our series was 18,9%. Younger age was the only risk factor associated. Biliary etiology accounts for a large proportion of our RAP which could have been prevented with cholecystectomy or cholecystectomy plus ERCP.
La Pancreatitis Aguda Recurrente (PAR) es una entidad frecuente de la que hay pocos datos publicados. El objetivo del estudio es hallar la tasa y factores de riesgo asociados a PAR en nuestro medio. Es un estudio retrospectivo, unicéntrico, de pacientes ingresados por Pancreatitis Aguda (PA) y seguidos posteriormente. Se dividen en 2 grupos de pacientes: 1.- pacientes con un solo episodio de PA (PAS) y 2.- pacientes con más de un ingreso por PA (PAR). Se comparan variables clínicas, demográficas y de resultado. Resultados: 561 pacientes fueron incluidos y seguidos durante una media de 67,63 meses. 18,9% tuvieron al menos otro ingreso por PA. La mayoría sufrieron un solo episodio de PAR (93%). La etiología más frecuente fue biliar (67%). En el análisis univariado, una menor edad (p 0,004), la ausencia de hipertensión arterial (p 0,013) y de SIRS (p 0,022) se asociaron con PAR. En el análisis multivariado solo una menor edad se relacionó con PAR (OR 1,015, 95%, IC 1,00-1,029). No encontramos diferencias en las variables resultados entre ambos grupos. La PAR cursó de forma más leve (9% de pancreatitis moderada/graves o graves versus 19%). Casi un 70% de los pacientes con PAR biliar no tenían realizada una colecistectomía tras el ingreso índice. En este subgrupo de PAR, la edad OR 0,964 (95% IC 0,946-0,983), la colecistectomía OR 0,075 (95% IC 0,189-0,030) y la colecistectomía más colangiografía retrógrada OR 0,190 (95% IC 0,219-0,055) se asociaban a ausencia de PAR. Conclusión: Nuestra tasa de PAR fue 18,9%, con una menor edad como factor de riesgo. La etiología biliar fue la más frecuente que podría haberse evitado de haber realizado colecistectomía o colecistectomía más colangiografía retrógrada tras el primer ingreso.
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Humanos , Feminino , Pessoa de Meia-Idade , Pancreatite , Doença Relacionada a Imunoglobulina G4 , Pâncreas/lesões , Pâncreas/cirurgia , Exame Físico , Pacientes Internados , Avaliação de Sintomas , Gastroenterologia , Gastroenteropatias , Espectroscopia de Ressonância Magnética , PancreatectomiaRESUMO
No disponible
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Humanos , Masculino , Idoso , Actinomicose/diagnóstico , Neoplasias Esofágicas/diagnóstico , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Gastroscopia , BiópsiaRESUMO
No disponible
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Colorretais/diagnóstico por imagem , Colonoscopia/métodos , Adenoma/diagnóstico por imagem , Estudos RetrospectivosRESUMO
INTRODUCCIÓN: La colonoscopia es el gold standard en la detección y prevención del cáncer colorrectal (CCR). No obstante, en la práctica clínica habitual nos encontramos con pacientes que desarrollan un CCR a pesar de que se habían sometido a una colonoscopia previamente. OBJETIVOS: Estudiar la prevalencia de CCR de novo o no detectados tras la realización de una colonoscopia y valorar los posibles factores de riesgo. PACIENTES: Se incluyen los pacientes diagnosticados de CCR registrados en la base de datos endoscópicos de nuestro hospital entre marzo de 2004 y septiembre de 2011. Identificamos los pacientes que tenían realizada una colonoscopia en los 5 años previos. Se recogieron: edad, sexo, comorbilidades e indicación de la colonoscopia, tamaño y localización del tumor, así como su grado de diferenciación, su clasificación TNM y las posibles causas. Posteriormente comparamos este subgrupo de pacientes con los que habían sido diagnosticados de CCR en su primera colonoscopia (CCR esporádico, grupo control). RESULTADOS: Se incluyeron 712 pacientes diagnosticados de CCR. Veinticuatro de ellos (3,6%) tenían una colonoscopia realizada en los 5 años previos (50% varones, 50% mujeres, edad media 72años). Estos CCR poscolonoscopia se atribuyeron: uno (4,2%) a colonoscopia incompleta, 4 (16,6%) a resección incompleta de adenoma, uno (4,2%) a biopsia fallida, 8 (33,3%) a «lesiones no detectadas» y 10 (41,7%) fueron CCR de nueva aparición. Los CCR poscolonoscopia eran de menor tamaño que los CCR esporádicos (3,2 vs 4,5cm, p < 0,001), principalmente localizados en colon proximal (62% vs 35%, p = 0,006); no hubo diferencias en cuanto al grado histológico (p = 0,125), pero sí una tendencia a presentar un mejor estadio TNM (p = 0,053). CONCLUSIONES: La tasa de CCR tras una colonoscopia previa en nuestra serie es del 3,6%. Las posibles causas de estos CCR se atribuyeron en su mayoría (58,4%) a factores relacionados al procedimiento endoscópico y, por tanto, evitables. Estos hallazgos reafirman la importancia de ajustarse a los indicadores de calidad de la colonoscopia. Los CCR poscolonoscopia fueron de menor tamaño, localizados fundamentalmente en colon derecho y con tendencia a presentar un estadio TNM más precoz
BACKGROUND: Colonoscopy is the gold standard for the detection and prevention of colorectal cancer (CRC). However, some individuals are diagnosed with CRC soon after a previous colonoscopy. AIMS: To evaluate the rate of new onset or missed CRC after a previous colonoscopy and to study potential risk factors. METHODS: Patients in our endoscopy database diagnosed with CRC from March 2004 to September 2011 were identified, selecting those with a colonoscopy performed within the previous 5years. Medical records included age, gender, comorbidities and colonoscopy indication. Tumour characteristics studied were localization, size, histological grade and TNM stage and possible cause. These patients were compared with those diagnosed with CRC at their first endoscopy (sporadic CRC-control group). RESULTS: A total of 712 patients with CRC were included; 24 patients (3.6%) had undergone colonoscopy within the previous 5 years (50% male, 50% female, mean age 72). Post-colonoscopy CRCs were attributed to: 1 (4.2%) incomplete colonoscopy, 4 (16.6%) incomplete polyp removal, 1 (4.2%) failed biopsy, 8 (33.3%) 'missed lesions' and 10 (41.7%) new onset CRC. Post-colonoscopy CRCs were smaller in size than sporadic CRCs (3.2cm vs. 4.5cm, P<.001) and were mainly located in the proximal colon (63% vs. 35%, P=.006); no difference in histological grade was found (P=.125), although there was a tendency towards a lower TNM stage (P=.053). CONCLUSIONS: There is a minor risk of CRC development after a previous colonoscopy (3.6%). Most of these (58.4%) are due to preventable factors. Post-colonoscopy CRCs were smaller and mainly right-sided, with a tendency towards an earlier TNM stage
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/estatística & dados numéricos , Neoplasias do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Reações Falso-Negativas , Fatores de Risco , Neoplasias do Colo/epidemiologia , Neoplasias Colorretais/epidemiologiaAssuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Divertículo do Colo/complicações , Divertículo do Colo/diagnóstico , Endoscopia , Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo , Colonoscopia/métodos , Divertículo do Colo/patologia , Divertículo do Colo , Necrose Gordurosa/complicações , Necrose GordurosaRESUMO
No disponible
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Humanos , Controle de Qualidade , Colonoscopia/tendências , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/tendências , Fatores de Risco , Programas de Rastreamento/métodosRESUMO
La hepatotoxicidad farmacológica es un reto en la práctica clínica diaria. Los antibióticos son una de las causas más frecuentes. Sin embargo, el daño hepático por amoxicilina sola es poco frecuente. Presentamos el caso de un paciente varón de 87 años que presentó colestasis hepática con buena evolución clínica tras la ingesta de amoxicilina 500mg/8h por patología dental. Se hace una revisión de la literatura médica publicada sobre este tema (AU)
Drug-induced hepatotoxicity is a challenge in daily clinical practice. One of the most frequent causes is antibiotics. However, amoxicillin-induced liver injury is uncommon. We report the case of an 87-year-old man who developed cholestatic hepatitis after ingesting amoxicillin 500mg/8hours for dental disease. A review of the literature on this topic is provided (AU)