Indicadores de calidad en gastroscopia. Procedimiento de la gastroscopia / Quality indicators in gastroscopy. Gastroscopy procedure

Enmarcado dentro del proyecto "Indicadores de calidad en endoscopia digestiva", liderado por la Sociedad Española de Patología Digestiva (SEPD), el objetivo de esta investigación es proponer los procedimientos e indicadores de estructura, proceso y resultado necesarios para aplicar y evaluar la calidad en la gastroscopia. Primero, se ha diseñado un diagrama con los pasos a seguir durante el procedimiento de gastroscopia. En segundo lugar, un grupo de expertos en calidad asistencial y/o endoscopia han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en los procedimientos endoscópicos, incluidas las gastroscopias. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y el análisis de la literatura seleccionada. Se ha identificado para gastroscopias un total de nueve indicadores de procesos (uno de preprocedimiento y ocho de procedimiento). La calidad de la evidencia se ha analizado aplicando la escala de clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation)

Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale

Quality indicators in gastroscopy. Gastroscopy procedure.

Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale.

Indicadores de calidad en colangiopancreatografía retrógrada endoscópica. Procedimiento de la colangiopancreatografía retrógrada endoscópica / Quality indicators for endoscopic retrograde cholangiopancreatography. The procedure of endoscopic retrograde cholangiopancreatography

El objetivo del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de endoscopia digestiva. En este tercer resultado se proponen procedimientos e indicadores de la colangiopancreatografía retrógrada endoscópica (CPRE). Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la CPRE. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva (SEPD), ha realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en la CPRE. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se han identificado un total de seis indicadores específicos, independientemente de los ya descritos comunes, todos de proceso (dos de preprocedimiento y cuatro de procedimiento). Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en Grading of Recommendations Assessment, Development and Evaluation) GRADE

The goal of the project encompassing the present paper is to propose useful quality procedures and indicators in order to improve quality in digestive endoscopy units. In this third part outcome procedures and indicators are suggested for endoscopic retrograde cholangiopancreatography (ERCP). First, a diagram of pre- and post-ERCP steps was developed. A group of experts in healthcare quality and/or endoscopy, under the shelter of the Spanish Society of Digestive Diseases (Sociedad Española de Patología Digestiva - SEPD), carried out a qualitative review of the literature regarding quality indicators for ERCP. Then, a paired analysis was used for the selection of identified references. A total of six specific indicators, apart from the common indicators already described, were identified, all of them process indicators (two pre-procedure and four post-procedure). Evidence quality was analyzed for each indicator using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification

Quality indicators for endoscopic retrograde cholangiopancreatography. The procedure of endoscopic retrograde cholangiopancreatography.

The goal of the project encompassing the present paper is to propose useful quality procedures and indicators in order to improve quality in digestive endoscopy units. In this third part outcome procedures and indicators are suggested for endoscopic retrograde cholangiopancreatography (ERCP). First, a diagram of pre- and post-ERCP steps was developed. A group of experts in healthcare quality and/or endoscopy, under the shelter of the Spanish Society of Digestive Diseases (Sociedad Española de Patología Digestiva - SEPD), carried out a qualitative review of the literature regarding quality indicators for ERCP. Then, a paired analysis was used for the selection of identified references. A total of six specific indicators, apart from the common indicators already described, were identified, all of them process indicators (two pre-procedure and four post-procedure). Evidence quality was analyzed for each indicator using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification.

Indicadores de calidad en colonoscopia. Procedimiento de la colonoscopia / Quality indicators in colonoscopy. The colonoscopy procedure

El objetivo del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de Endoscopia Digestiva. En este segundo resultado se proponen procedimientos e indicadores de la colonoscopia. Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la colonoscopia. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva (SEPD), han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en la colonoscopia. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se han identificado un total de 13 indicadores específicos, independientemente de los ya descritos comunes, de los cuales diez son de proceso (uno de preprocedimiento, siete de procedimiento y dos de posprocedimiento) y tres, de resultado. Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation)

The aim of the project this paper is part of was to propose quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. In this second issue, procedures and indicators are suggested regarding colonoscopy. First, a diagram charting the previous and subsequent steps of colonoscopy was designed. A group of experts in health care quality and/or endoscopy, under the auspices of the Sociedad Española de Patología Digestiva (SEPD), performed a qualitative review of the literature regarding colonoscopy-related quality indicators. Subsequently, using a paired-analysis method, the aforementioned literature was selected and analyzed. A total of 13 specific indicators were found aside of the common markers elsewhere described, ten of which are process-related (one pre-procedure, seven procedure, and two post-procedure markers) while the remaining three are outcome-related. Quality of evidence was assessed for each one of them using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification

Indicadores de calidad en endoscopia digestiva: introducción a los indicadores comunes de estructura, proceso y resultado / Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators

El objetivo general del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de Endoscopia Digestiva. En este primer resultado se proponen procedimientos e indicadores comunes a las pruebas de endoscopia digestiva. Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la endoscopia digestiva. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva, han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en los procedimientos endoscópicos. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se ha identificado un total de 20 indicadores, de los cuales siete son de estructura; once, de proceso (cinco de preprocedimiento, tres de procedimiento y tres de posprocedimiento); y dos, de resultado. Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation) (AU)

The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification (AU)

Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators.

The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.

Desarrollo y validación de indicadores y estándares de calidad en colonoscopia / Development and validation of quality standards for colonoscopy

Fundamento y objetivos: Antes de iniciar programas de cribado de cáncer colorrectal es necesario evaluar la calidad de la colonoscopia. Nos propusimos desarrollar un grupo de indicadores de calidad en colonoscopia fácilmente aplicables y determinar la variabilidad de su cumplimiento. Pacientes y método: A partir de la bibliografía se elaboraron 21 indicadores potenciales de calidad que se sometieron a un proceso de selección en el que se determinó su validez facial, de contenido, fiabilidad y viabilidad de su medición. Se estimó la variabilidad del cumplimiento de los indicadores mediante el coeficiente de variación (CV) y del cumplimiento de estándares mediante la ji al cuadrado. Resultados: Seis indicadores superaron el proceso de selección: consentimiento informado, medicación administrada, colonoscopia completa, complicaciones, pólipos extirpados y recuperados y detección de adenomas de colon en mayores de 50 años. Se incluyeron un total de 1.928 colonoscopias procedentes de 8 centros hospitalarios. Cada centro incluyó el mismo número de colonoscopias seleccionadas mediante muestreo aleatorizado simple con sustitución. Existía una importante variabilidad en el cumplimiento de algunos indicadores y estándares: medicación administrada (CV del 43%; p<0,01), registro de complicaciones (CV del 37%; p<0,01), todos los pólipos extirpados y recuperados (CV del 12%; p<0,01) y detección de adenomas en pacientes de más de 50 años (CV del 2%; p<0,01).Conclusiones: Hemos validado 6 indicadores de calidad en colonoscopia fácilmente medibles. Existe una importante variabilidad en el cumplimiento de algunos indicadores y estándares, lo que aconseja el desarrollo de programas de mejora de la calidad en colonoscopia antes de la implantación del cribado de cáncer colorrectal (AU)

Background and objectives: Before starting programs for colorectal cancer screening it is necessary to evaluate the quality of colonoscopy. Our objectives were to develop a group of quality indicators of colonoscopy easily applicable and to determine the variability of their achievement. Patients and methods: After reviewing the bibliography we prepared 21 potential indicators of quality that were submitted to a process of selection in which we measured their facial validity, content validity, reliability and viability of their measurement. We estimated the variability of their achievement by means of the coefficient of variability (CV) and the variability of the achievement of the standards by means of ÷2. Results: Six indicators overcome the selection process: informed consent, medication administered, completed colonoscopy, complications, every polyp removed and recovered, and adenoma detection rate in patients older than 50 years. 1928 colonoscopies were included from eight endoscopy units. Every unit included the same number of colonoscopies selected by means of simple random sampling with substitution. There was an important variability in the achievement of some indicators and standards: medication administered (CV 43%, p<0.01), complications registered (CV 37%, p<0.01), every polyp removed and recovered (CV 12%, p<0.01) and adenoma detection rate in older than fifty years (CV 2%, p<0.01). Conclusions: We have validated six quality indicators for colonoscopy which are easily measurable. An important variability exists in the achievement of some indicators and standards. Our data highlight the importance of the development of continuous quality improvement programmes for colonoscopy before starting colorectal cancer screening (AU)

[Development and validation of quality standards for colonoscopy]. / Desarrollo y validación de indicadores y estándares de calidad en colonoscopia.

BACKGROUND AND OBJECTIVES: Before starting programs for colorectal cancer screening it is necessary to evaluate the quality of colonoscopy. Our objectives were to develop a group of quality indicators of colonoscopy easily applicable and to determine the variability of their achievement. PATIENTS AND METHODS: After reviewing the bibliography we prepared 21 potential indicators of quality that were submitted to a process of selection in which we measured their facial validity, content validity, reliability and viability of their measurement. We estimated the variability of their achievement by means of the coefficient of variability (CV) and the variability of the achievement of the standards by means of chi(2). RESULTS: Six indicators overcome the selection process: informed consent, medication administered, completed colonoscopy, complications, every polyp removed and recovered, and adenoma detection rate in patients older than 50 years. 1928 colonoscopies were included from eight endoscopy units. Every unit included the same number of colonoscopies selected by means of simple random sampling with substitution. There was an important variability in the achievement of some indicators and standards: medication administered (CV 43%, p<0.01), complications registered (CV 37%, p<0.01), every polyp removed and recovered (CV 12%, p<0.01) and adenoma detection rate in older than fifty years (CV 2%, p<0.01). CONCLUSIONS: We have validated six quality indicators for colonoscopy which are easily measurable. An important variability exists in the achievement of some indicators and standards. Our data highlight the importance of the development of continuous quality improvement programmes for colonoscopy before starting colorectal cancer screening.

Use of sedation in gastrointestinal endoscopy: a nationwide survey in Spain.

INTRODUCTION: Gastrointestinal endoscopy causes discomfort and pain in patients. Sedation reduces anxiety and pain. Its use, however, continues to be a controversial issue and it varies greatly from one country to another. The use of sedation in Spanish gastrointestinal endoscopy (GIE) units is unknown. AIM: To determine the use of sedation in Spanish GIE units. MATERIALS AND METHODS: A 24-question survey on the use of sedation was distributed among 300 Spanish GIE units. RESULTS: Surveys were answered by 197 GIE units (65%), which had performed 588,326 endoscopies over the past 12 months. Sedation was used in more than 20% of gastroscopies performed at 55% of the GIE units, and more than 20% of colonoscopies were sedated at 71% of the units; endoscopic retrograde cholangiopancreatography (ERCP) is almost always performed under sedation. The most common drugs were midazolam for gastroscopy and midazolam and pethidine for colonoscopy and ERCP; propofol is used by anesthetists; pulse oximetry is used at 77% of GIE units; 42% of the GIE units fill in a nursing record; 52% of GIE units have recovery rooms and 91% have a cardiac arrest trolley. CONCLUSION: The use of sedation in endoscopy varies greatly in Spain. It is seldom used in gastroscopy; it is more frequent in colonoscopy, and in ERCP it is the norm. In most GIE units sedation is controlled by the endoscopist with pulse oximetry. The most commonly used drugs are benzodiazepines, on their own for gastroscopy and combined with opioids for colonoscopy and ERCP.

[Patient satisfaction in gastrointestinal endoscopy: results of a multicenter study]. / Satisfacción del paciente con la endoscopia digestiva: resultados de un estudio multicéntrico.

BACKGROUND AND AIM: The aim of this study was to determine the main quality problems perceived by patients in gastrointestinal endoscopy through a satisfaction survey. PATIENTS AND METHODS: A total of 321 patients from five gastrointestinal endoscopy units were included. Telephone interviews using a previously validated questionnaire on several aspects related to the procedure were carried out. Pareto analyses were performed to pinpoint the most common aspects among the vital few causes at each medical center. Based on the questionnaire, the satisfaction indicators were calculated for each center: the overall satisfaction score (the sum of the responses to the eight questions) and the rate of perceived problems (number of questions with a negative response divided by the number of questions asked). RESULTS: The most frequent aspects among the vital few were waiting time for an appointment and discomfort during the examination, since both factors were included in the vital few in four of the five medical centers. Significant differences were found among centers in the overall satisfaction score (questionnaire score) (p < 0.001) and for the rate of perceived problems (p < 0.001). CONCLUSION: According to the patients, the most problematic aspects were waiting time until the day of the appointment and discomfort during the examination. Perceived quality differed among the participating centers.

Variation among endoscopy units in the achievement of the standards of colonoscopic performance indicators.

BACKGROUND/AIMS: To assess the achievement of quality standards of colonoscopy at six endoscopy units. METHODOLOGY: Three indicators were used to assess the quality of 1056 colonoscopies performed at six hospitals: cecal intubation; adequate colon cleansing; and removal and recovery of all detected polyps. Analyses were performed on the total number of colonoscopies and on colonoscopies in which polyps were actually detected. The accomplishment of each indicator and a global compound index of all three indicators, named the Problem Rate, were analyzed. Results from each endoscopy unit were compared to previously established standards. RESULTS: Adequate colon cleansing was the most frequent problem for quality in all centers; adequate colon preparation was 67% (range 50 to 84%). The cecum was reached in 84% of all colonoscopies (range 76 to 90%). 75% of all patients (range 28. 79%) had all polyps excised and recovered. All centers had rates below standard for one or several indicators (p<0.01, all cases). Two of the participant hospitals had an overall problem rate above the estimated standard (p<0.01). CONCLUSIONS: There is a significant variation in the achievement of quality standards of colonoscopy between endoscopy units. Colon cleansing is the most frequent quality problem for colonoscopy.

Satisfacción del paciente con la endoscopia digestiva: resultados de un estudio multicéntrico / Patient satisfaction in gastrointestinal endoscopy: results of a multicenter study

FUNDAMENTO Y OBJETIVO: El objetivo de nuestro trabajo fuedeterminar los principales problemas de calidad desde elpunto de vista del paciente en la endoscopia digestiva medianteun cuestionario de satisfacción.PACIENTES Y MÉTODOS: Cinco unidades de endoscopia digestivaincluyeron a un total de 321 pacientes. Se realizó unaencuesta telefónica sobre diversos aspectos relacionados conla prueba utilizando un cuestionario previamente validado.Se realizó un análisis de Pareto para cada centro para averiguarcuáles eran los aspectos más representados entre lospoco vitales. A partir del cuestionario se calcularon dos indicadoresde satisfacción para cada centro: la puntuación globalde satisfacción (suma de los valores de las respuestas alas 8 cuestiones) y la tasa de problemas percibidos (númerode preguntas con respuesta negativa dividido por el númerode preguntas realizadas).RESULTADOS: Los aspectos más representados en los poco vitalesfueron el tiempo de espera para la cita y las molestiasdurante la exploración, pues ambos aparecían en los pocovitales de 4 de los 5 centros. Había diferencias significativasentre los centros para la puntuación global de satisfacción(puntuación del cuestionario) (p < 0,001) y para la tasa deproblemas percibidos (p < 0,001).CONCLUSIÓN: Los aspectos más problemáticos desde el puntode vista de los pacientes son el tiempo de espera hasta el díade la cita y las molestias durante la exploración. Hay diferenciasen la calidad percibida entre los centros participantes

BACKGROUND AND AIM: The aim of this study was to determinethe main quality problems perceived by patients in gastrointestinalendoscopy through a satisfaction survey.PATIENTS AND METHODS: A total of 321 patients from fivegastrointestinal endoscopy units were included. Telephoneinterviews using a previously validated questionnaire on severalaspects related to the procedure were carried out. Paretoanalyses were performed to pinpoint the most commonaspects among the vital few causes at each medical center.Based on the questionnaire, the satisfaction indicators werecalculated for each center: the overall satisfaction score (thesum of the responses to the eight questions) and the rate ofperceived problems (number of questions with a negativeresponse divided by the number of questions asked).RESULTS: The most frequent aspects among the vital fewwere waiting time for an appointment and discomfort duringthe examination, since both factors were included in thevital few in four of the five medical centers. Significant differenceswere found among centers in the overall satisfactionscore (questionnaire score) (p < 0.001) and for the rate ofperceived problems (p < 0.001).CONCLUSION: According to the patients, the most problematicaspects were waiting time until the day of the appointmentand discomfort during the examination. Perceivedquality differed among the participating centers

[Irritable bowel syndrome and cardiac right-to-left shunt through a patent foramen ovale]. / Síndrome del intestino irritable y cortocircuito cardíaco derecha-izquierda por foramen oval permeable.

BACKGROUND AND OBJECTIVE: Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentage of venous blood bypasses the lung filter and may increase these substances in blood. PATIENTS AND METHOD: A phone interview was done to determine the presence of IBS in patients previously attended for detection of RLS with transcranial Doppler ultrasound. The presence and grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS. RESULTS: Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for other FGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p < 0.05 for other FGD). CONCLUSIONS: We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies.

Síndrome del intestino irritable y cortocircuito cardíaco derecha-izquierda por foramen oval permeable / Irritable bowel syndrome and cardiac right-to-left shunt through a patent foramen oval

FUNDAMENTO Y OBJETIVO: El síndrome de intestino irritable (SII) y el foramen oval permeable(FOP) tienen una prevalencia similar en la población general, afectan más a mujeres y se relacionancon otras enfermedades como la migraña. La presencia de FOP con cortocircuito (shunt) derecha izquierda (CDI) podría alterar el metabolismo de ciertas sustancias como la serotonina, muy relacionadas con el SII. Sin embargo, hasta la fecha no se ha estudiado la posibleasociación entre ambas entidades.PACIENTES Y MÉTODO: Se ha realizado una encuesta telefónica para determinar la presencia de SII enpacientes atendidos previamente para detección de CDI mediante ultrasonografía Doppler transcraneal.Se analizó la presencia y el grado de CDI y se los comparó con los de sujetos sin síntomas gastrointestinales (NoGI). Se utilizaron los criterios de Roma II para el diagnóstico de SII u otra enfermedad funcional gastrointestinal (EFGI), y el consenso de Venecia-1999 para el CDI.RESULTADOS: De 180 pacientes encuestados, 33 (18,3%) tenían SII y 62 (34,4%), otra EFGI.Tenían CDI un 41% de los NoGI, un 64% de los pacientes con SII y un 68% de los pacientes con otra EFGI (odds ratio [OR] = 2,56; p < 0,05 para SII, y OR = 3,06; p < 0,01 para otra EFGI). Los patrones masivos de CDI se registraron en el 27% de los NoGI, en el 39% de lospacientes con SII y en el 45% de los afectados por otra EFGI (OR = 1,73; p = 1 para SII, y OR = 2,21; p < 0,05 para otra EFGI).CONCLUSIONES: Se encontró mayor prevalencia de CDI cardíaco por FOP en pacientes con SII y otros trastornos funcionales digestivos. Su posible relación etiopatogénica debería considerarse en futuros estudios

BACKGROUND AND OBJECTIVE: Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentageof venous blood bypasses the lung filter and may increase these substances in blood.PATIENTS AND METHOD: A phone interview was done to determine the presence of IBS in patientspreviously attended for detection of RLS with transcranial Doppler ultrasound. The presenceand grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS.RESULTS: Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for otherFGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p <0.05 for other FGD).CONCLUSIONS: We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies

Colitis isquémica y foramen oval permeable / Ischemic colitis and patent foramen oval

No disponible

[Heterotopic gastric mucosa in the upper esophagus. An unknown cause of dysphagia]. / Mucosa gástrica heterotópica en el esófago proximal. Una causa desconocida de disfagia.

Heterotopic gastric mucosa in the proximal third of the esophagus is an embryological lesion that has been described in between 1.1% and 10% of gastroscopies. Although most of these lesions are asymptomatic, they can sometimes be accompanied by upper esophageal symptoms due to acid secretion. We present a case of heterotopic gastric mucosa in the proximal third of the esophagus with dysphagia. pH-metry demonstrated acid secretion by these lesions, which was resolved by treatment with proton pump inhibitors.

Mucosa gástrica heterotópica en el esófago proximal. Una causa desconocida de disfagia / Heterotopic gastric mucosa in the upper esophagus. An unknown cause of dysphagia

La mucosa gástrica heterotópica localizada en el tercio proximal del cuerpo esofágico es una lesión de origen embriológico descrita en un 1,1-10% de las gastroscopias. Aunque la mayoría de estas lesiones son asintomáticas, en ocasiones pueden acompañarse de signos clínicos esofágicos, por su capacidad de secretar ácido. Presentamos un caso de mucosa gástrica heterotópica en el tercio proximal del esófago con disfagia, en la que se demostró mediante pH-metría la secreción ácida de estas lesiones y su corrección con inhibidores de la bomba de protones

Heterotopic gastric mucosa in the proximal third of the esophagus is an embryological lesion that has been described in between 1.1% and 10% of gastroscopies. Although most of these lesions are asymptomatic, they can sometimes be accompanied by upper esophageal symptoms due to acid secretion. We present a case of heterotopic gastric mucosa in the proximal third of the esophagus with dysphagia. pH-metry demonstrated acid secretion by these lesions, which was resolved by treatment with proton pump inhibitors