Ausencia de interferencia de almagato en los resultados de la prueba de aliento para el diagnóstico de Helicobacter pylori (estudio Almatest) / Lack of almagate interference in breath test results for Helicobacter pylori diagnosis (Almatest study)

Objetivo: El test del aliento con 13C-urea (TAU) es la prueba no invasiva más utilizada para diagnosticar Helicobacter pylori (H. pylori). La posible interferencia de la toma de antiácidos en su resultado es aún controvertida. El estudio se dirige a confirmar la no interferencia del almagato en la determinación de H. pylori mediante el TAU. Pacientes y métodos: Estudio observacional, multicéntrico, en pacientes adultos en tratamiento con almagato y a los que se indicó un TAU (TAUKIT®). Cuando el resultado del TAU fue negativo, se suprimió la toma de almagato durante 30 días y se repitió un segundo TAU. En los pacientes cuyo resultado fue positivo, no se realizaron más determinaciones. La variable principal a estudio fue el porcentaje de pacientes que teniendo resultado negativo en la primera prueba de aliento, tras suprimir la toma de almagato y repetirla, ésta se positivizó (falsos negativos del TAU, posiblemente atribuibles a almagato). Resultados: De los 167 pacientes evaluables, 59% fueron mujeres, la media de edad fue de 49 años y 97% de los casos presentaban sintomatología digestiva. El resultado del primer TAU fue negativo en un 71% de casos. De éstos, en la segunda prueba de TAU tras suprimir almagato, este resultado se confirmó en el 97,5%. El porcentaje de falsos negativos sobre el total de casos evaluados fue del 1,8%. Conclusiones: La toma de almagato tiene una interferencia mínima o nula en el resultado del TAU para el diagnóstico de la infección por H. pylori; por tanto, se puede utilizar en las semanas previas a la realización del TAU.(AU)

Objective: The 13C-urea breath test (UBT) is the most widely used non-invasive diagnostic test for Helicobacter pylori. Debate continues to surround the possible interference of antacid intake on its result. This study aims to confirm the non-interference of almagate in the determination of H. pylori by UBT. Patients and methods: Observational, multicentre study in adult patients treated with almagate in whom a UBT (TAUKIT®) was indicated. When the UBT result was negative, use of almagate was stopped for 30 days and the UBT was repeated. When the result was positive, no further determinations were made. The primary endpoint was the percentage of patients who, having had a negative result in the first breath test, were positive in the second after having stopped taking almagate (UBT false negatives, possibly attributable to almagate). Results: Of the 167 evaluable patients, 59% were female, average age was 49 and 97% had gastrointestinal symptoms. The result of the first UBT was negative in 71% of cases. Of these, in the second UBT test after stopping the almagate, the negative result was confirmed in 97.5%. Out of the total number of cases evaluated, the rate of false negatives was 1.8%. Conclusions: Taking almagate has minimal or no interference in the result of UBT for the diagnosis of H. pylori infection. It can therefore be used in the weeks prior to a UBT.(AU)

Lack of almagate interference in breath test results for Helicobacter pylori diagnosis (Almatest study). / Ausencia de interferencia de almagato en los resultados de la prueba de aliento para el diagnóstico de Helicobacter pylori (estudio Almatest).

OBJECTIVE: The 13C-urea breath test (UBT) is the most widely used non-invasive diagnostic test for Helicobacter pylori. Debate continues to surround the possible interference of antacid intake on its result. This study aims to confirm the non-interference of almagate in the determination of H. pylori by UBT. PATIENTS AND METHODS: Observational, multicentre study in adult patients treated with almagate in whom a UBT (TAUKIT®) was indicated. When the UBT result was negative, use of almagate was stopped for 30 days and the UBT was repeated. When the result was positive, no further determinations were made. The primary endpoint was the percentage of patients who, having had a negative result in the first breath test, were positive in the second after having stopped taking almagate (UBT false negatives, possibly attributable to almagate). RESULTS: Of the 167 evaluable patients, 59% were female, average age was 49 and 97% had gastrointestinal symptoms. The result of the first UBT was negative in 71% of cases. Of these, in the second UBT test after stopping the almagate, the negative result was confirmed in 97.5%. Out of the total number of cases evaluated, the rate of false negatives was 1.8%. CONCLUSIONS: Taking almagate has minimal or no interference in the result of UBT for the diagnosis of H. pylori infection. It can therefore be used in the weeks prior to a UBT.

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain.

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. "Optimized" H. pylori therapies achieve over 90% success in Spain.

Prospective, study comparing the accuracy of two different stool antigen tests (Premier Platinum HpSA and novel ImmunoCard STAT rapid test) for the diagnosis of Helicobacter pylori infection / Estudio prospectivo y comparativo entre la exactitud de 2 pruebas de antígenos en heces (Premier Platinum HpSA® y el nuevo test rápido ImmunoCard® STAT) para el diagnóstico de la infección por Helicobacter pylori

BACKGROUND: At present only monoclonal EIA (enzyme-immunoassay) stool antigen-tests have obtained optimal accuracy in the diagnosis of Helicobacter pylori. Our aim was to evaluate the accuracy of two stool antigen-tests, the validated Premier Platinum HpSA PLUS (EIA test) and the newly available ImmunoCard STAT! HpSA HD (rapid test) for the initial diagnosis and the confirmation of eradication of H. pylori infection. PATIENTS AND METHODS: Patients with indication of H. pylori diagnosis, or confirmation after treatment were included. Data were coded to protect personal data and ensure blindness between tests. Accuracy was considered as coincident diagnosis with the gold standard (13C-urea breath test, UBT). The EIA was used as a bench standard. All stool tests were performed in duplicate. RESULTS: 264 patients completed the protocol (100 naïve, 164 post-eradication). Average age was 52 years, 61% women, 11% ulcer. Positive diagnoses by UBT were 41% for naïve and 17% for post-eradication. Overall ImmunoCard and EIA accuracies were respectively 91% (95%C. I. =88-94%) and 89% (86-93%), sensitivities 72% (67-78%) and 72% (67-78%), and specificities 98% (96-100%), and 95% (92-97%). Concordance between ImmunoCard and EIA was 95% (93-98%). DISCUSSION: Our results indicate that the newly available ImmunoCard rapid stool antigen-test achieves 90% accuracy, with high specificity but suboptimal sensitivity. The ImmunoCard attained equivalent accuracies as the EIA bench standard, with 95% concordance

ANTECEDENTES: En la actualidad, únicamente los métodos de detección de antígenos en heces monoclonales basados en enzimoinmunoanálisis (ELISA) han obtenido una adecuada precisión para el diagnóstico de la infección por Helicobacter pylori. Nuestro objetivo fue evaluar la exactitud (sensibilidad y especificidad) de 2 métodos de antígenos en las heces, el previamente validado Premier Platinum HpSA® PLUS (ELISA) y el nuevo ImmunoCard® STAT! HpSA® HD (test rápido), para el diagnóstico inicial y la confirmación de la erradicación de la infección por H. pylori. PACIENTES Y MÉTODOS: Se incluyeron pacientes en los que estaba indicado el diagnóstico inicial de la infección por H. pylori o su confirmación tras el tratamiento. Los datos fueron codificados y los evaluadores de ambos test fueron ciegos para los resultados de las pruebas diagnósticas. El resultado principal fue la coincidencia con el resultado del patrón oro (prueba del aliento con 13C-urea). Los test en heces se realizaron por duplicado. RESULTADOS: Doscientos sesenta y cuatro pacientes completaron el protocolo (100 naïve, 164 posterradicación). La edad media fue de 52 años, el 61% fueron mujeres y el 11% tenían úlcera péptica. La prueba del aliento fue positiva en el 41% de los pacientes naïve y en el 17% posterradicación. La exactitud global del método rápido y del ELISA fue, respectivamente, 91% (IC 95%: 88-94%) y 89% (86-93%), la sensibilidad 72% (67-78%) y 72% (67-78%), y la especificidad 98% (96-100%) y 95% (92-97%). La concordancia entre el método ImmunoCard® y ELISA fue del 95% (93-98%). DISCUSIÓN: El nuevo método rápido de antígenos en heces (ImmunoCard® STAT! HpSA® HD) tiene una exactitud diagnóstica del 90%, con una elevada especificidad, pero una sensibilidad insuficiente. El método ImmunoCard® tiene una exactitud equivalente al método ELISA estándar, con una concordancia del 95%

Prospective, study comparing the accuracy of two different stool antigen tests (Premier Platinum HpSA and novel ImmunoCard STAT! rapid test) for the diagnosis of Helicobacter pylori infection.

BACKGROUND: At present only monoclonal EIA (enzyme-immunoassay) stool antigen-tests have obtained optimal accuracy in the diagnosis of Helicobacter pylori. Our aim was to evaluate the accuracy of two stool antigen-tests, the validated Premier Platinum HpSA PLUS (EIA test) and the newly available ImmunoCard STAT! HpSA HD (rapid test) for the initial diagnosis and the confirmation of eradication of H. pylori infection. PATIENTS AND METHODS: Patients with indication of H. pylori diagnosis, or confirmation after treatment were included. Data were coded to protect personal data and ensure blindness between tests. Accuracy was considered as coincident diagnosis with the gold standard (13C-urea breath test, UBT). The EIA was used as a bench standard. All stool tests were performed in duplicate. RESULTS: 264 patients completed the protocol (100 naïve, 164 post-eradication). Average age was 52 years, 61% women, 11% ulcer. Positive diagnoses by UBT were 41% for naïve and 17% for post-eradication. Overall ImmunoCard and EIA accuracies were respectively 91% (95%C.I.=88-94%) and 89% (86-93%), sensitivities 72% (67-78%) and 72% (67-78%), and specificities 98% (96-100%), and 95% (92-97%). Concordance between ImmunoCard and EIA was 95% (93-98%). DISCUSSION: Our results indicate that the newly available ImmunoCard rapid stool antigen-test achieves 90% accuracy, with high specificity but suboptimal sensitivity. The ImmunoCard attained equivalent accuracies as the EIA bench standard, with 95% concordance.

Comprehensive analysis of copy number aberrations in microsatellite stable colon cancer in view of stromal component.

BACKGROUND: Somatic copy number aberrations (CNAs) are common acquired changes in cancer cells having an important role in the progression of colon cancer (colorectal cancer, CRC). This study aimed to perform a characterisation of CNA and their impact in gene expression. METHODS: Copy number aberrations were inferred from SNP array data in a series of 99 CRC. Copy number aberration events were calculated and used to assess the association between copy number dosage, clinical and molecular characteristics of the tumours, and gene expression changes. All analyses were adjusted for the quantity of stroma in each sample, which was inferred from gene expression data. RESULTS: High heterogeneity among samples was observed; the proportion of altered genome ranged between 0.04 and 26.6%. Recurrent CNA regions with gains were frequent in chromosomes 7p, 8q, 13q, and 20, whereas 8p, 17p, and 18 cumulated losses. A significant positive correlation was observed between the number of somatic mutations and total CNA (Spearman's r=0.42, P=0.006). Approximately 37% of genes located in CNA regions changed their level of expression and the average partial correlation (adjusted for stromal content) with copy number was 0.54 (interquartile range 0.20 to 0.81). Altered genes showed enrichment in pathways relevant for CRC. Tumours classified as CMS2 and CMS4 by the consensus molecular subtyping showed higher frequency of CNA. Losses of one small region in 1p36.33, with gene CDK11B, were associated with poor prognosis. More than 66% of the recurrent CNA were validated in the The Cancer Genome Atlas (TCGA) data when analysed with the same procedure. Furthermore, 79% of the genes with altered expression in our data were validated in the TCGA. CONCLUSIONS: Although CNA are frequent events in microsatellite stable CRC, few focal recurrent regions were found. These aberrations have strong effects on gene expression and contribute to deregulate relevant cancer pathways. Owing to the diploid nature of stromal cells, it is important to consider the purity of tumour samples to accurately calculate CNA events in CRC.

False-negative rate cannot be reduced by lowering the haemoglobin concentration cut-off in colorectal cancer screening using faecal immunochemical test.

The aim of this study was to analyse false-negative (FN) results of the faecal immunochemical test (FIT) and its determinants in a colorectal cancer screening programme in Catalonia. We carried out a cross-sectional study among 218 screenees with a negative FIT result who agreed to undergo a colonoscopy. A false-negative result was defined as the detection, at colonoscopy, of intermediate/high-risk polyps or colorectal cancer in a patient with a previous negative FIT (<20 µgHb/g). Multivariate logistic regression models were constructed to identify sociodemographic (sex, age) and screening variables (quantitative faecal haemoglobin, colonoscopy findings) related to FN results. Adjusted odds ratios and their 95% confidence intervals were estimated. There were 15.6% FN FIT results. Faecal haemoglobin was undetected in 45.5% of these results and was below 4 µgHb/g in 94.0% of the individuals with a FN result. About 60% of the lesions were located in the proximal colon, whereas the expected percentage was 30%. Decreasing the positivity threshold of FIT does not increase the detection rate of advanced neoplasia, but may increase the costs and potential adverse effects.

Dietary flavonoids, lignans and colorectal cancer prognosis.

Flavonoids and lignans are polyphenol classes with anticarcinogenic activities against colorectal cancer (CRC). However, very limited epidemiological evidence exists on their effects on CRC prognosis. This study aimed to evaluate the association between flavonoid and lignan intakes with the risk of CRC recurrence and overall survival in CRC patients. The study followed incident histologically confirmed CRC cases in Barcelona (Spain). Validated dietary questionnaires and lifestyle information were collected at recruitment. An ad hoc food composition database on flavonoids and lignans was compiled by using data from the US Department of Agriculture and Phenol-Explorer databases. Adjusted hazards ratios (HR) and 95% confidence intervals (CIs) were estimated using multivariable Cox models. After 8.6 years of mean follow-up, 133 of 409 (32.5%) participants died and 77 of 319 (24.1%) had a CRC recurrence. Total flavonoids were associated neither with CRC recurrence (HR comparing extreme tertiles 1.13, 95% CI 0.64-2.02; P-trend 0.67) nor with overall survival (HR(T3vsT1) 1.06, 95% CI 0.69-1.65; P-trend 0.78) in the multivariable models. No associations were also observed with either total lignans or any flavonoid subclass intake. In conclusion, the results of the current study do not support a role of flavonoid and lignan intake in the CRC prognosis.

Carcinoma neuroendocrino de colon poco diferenciado con metástasis hepáticas / Poorly differentiated neuroendocrine carcinoma of the colon with liver metastases

Resumen Los tumores neuroendocrinos del tubo digestivo son lesiones muy poco frecuentes. Se presenta el caso de una mujer de 57 años de edad que consulta por síndrome tóxico, vómitos y diarrea de 3 meses de evolución, con diagnóstico final de tumor neuroendocrino pobremente diferenciado. A partir de esta observación clínica se revisan las características clínicas y procedimientos diagnósticos, los factores pronósticos y las posibilidades terapéuticas en este tipo de tumores. Ante una tumoración colónica con metástasis hepáticas hiperecogénicas se debe considerar siempre el diagnóstico de tumor neuroendocrino (AU)

Abstract Neuroendocrine tumors of the gastrointestinal tract are highly infrequent. We report the case of a 57-year-old woman who presented with toxic syndrome, vomiting and a 3-month history diarrhea, with a final diagnosis of poorly-differentiated neuroendocrine tumor. Based on this case, we review the clinical characteristics, diagnostic procedures, prognostic factors and therapeutic possibilities in this type of tumor. Neuroendocrine tumors should be considered in the diagnosis of colonic tumors with hyperechoic liver metastases (AU)

[Poorly differentiated neuroendocrine carcinoma of the colon with liver metastases]. / Carcinoma neuroendocrino de colon poco diferenciado con metástasis hepáticas.

Neuroendocrine tumors of the gastrointestinal tract are highly infrequent. We report the case of a 57-year-old woman who presented with toxic syndrome, vomiting and a 3-month history diarrhea, with a final diagnosis of poorly-differentiated neuroendocrine tumor. Based on this case, we review the clinical characteristics, diagnostic procedures, prognostic factors and therapeutic possibilities in this type of tumor. Neuroendocrine tumors should be considered in the diagnosis of colonic tumors with hyperechoic liver metastases.

La coordinación entre atención primaria y especializada de digestivo es insuficiente. Resultados de una encuesta realizada a gastroenterólogos y médicos de familia / Coordination between primary and specialized care in gastroenterology is insufficient. A survey of gastroenterologists and general practitioners

Fundamento y objetivoLa colaboración entre médicos de familia (MF) y especialistas se considera indispensable para una asistencia sanitaria de calidad. El objetivo del presente estudio es analizar la relación entre los gastroenterólogos (GAS) y los MF en el ámbito de los hospitales comarcales de Cataluña y sus centros de atención primaria de referencia.Material y métodosEstudio descriptivo, observacional y transversal, realizado mediante cuestionario anónimo entre los meses de enero y abril de 2008.ResultadosSe recogieron 314 encuestas (261 MF y 53 GAS). La valoración global de la relación se consideró muy deficiente o insuficiente por el 62,3% de los GAS (IC95%, 47,9–74,9) y por el 55,6% de MF (IC95%, 49,3–61,7). El 56,6% de GAS no conoce o conoce a pocos MF y lo mismo sucede con el 80,4% de MF. El 64% de GAS considera que la calidad asistencial para la patología digestiva en AP es muy deficiente o insuficiente. Por su parte, el 21,1% de MF considera muy deficiente o insuficiente la calidad asistencial por parte de GAS. La percepción de la calidad de la asistencia tanto en atención especializada como en AP mejora significativamente cuando el grado de conocimiento personal entre GAS y MF es alto o muy alto.ConclusionesLos profesionales perciben como insuficiente el nivel de relación entre niveles asistenciales. Además, los GAS evalúan como deficiente el manejo de la patología digestiva en atención primaria. La existencia de una relación personal mejora significativamente la valoración mutua (AU)

Background and objectivesCollaboration between general practitioners (GPs) and specialists is considered crucial to provide high-quality healthcare. The objective of this study was to analyze the relationship between gastroenterologists and GPs in regional hospitals and their referring primary care centers in Catalonia (Spain).Materials and methodsA descriptive, observational, cross-sectional study was carried out using anonymous questionnaires between January and April 2008.ResultsA total of 314 surveys were administered (261 GPs and 53 gastroenterologists). The overall relationship was considered highly deficient or insufficient by 62.3% of gastroenterologists (95% CI, 47.9–74.9) and by 55.6% of GPs (95% CI, 49.3–61.7). More than half (56.6%) of the gastroenterologists did not know any GPs, or only a very few, and the situation was the same for 80.4% of GPs. Sixty-four percent of gastroenterologists considered that the quality of care for digestive diseases in primary care was highly deficient or insufficient while 21.1% of GPs considered that the care provided by gastroenterologists was highly deficient or insufficient. The perception of healthcare in both primary and specialized settings was substantially better when there was good interaction between gastroenterologists and GPs.ConclusionsPractitioners acknowledge that the degree of interaction between different levels of healthcare is insufficient. Moreover, gastroenterologists consider that the management of digestive diseases in primary care is deficient. Establishing a personal relationship between the two types of practitioners substantially improves mutual assessment (AU)

Fiebre prolongada e ictericia en un paciente con hepatopatía alcohólica / Prolonged fever and jaundice in a patient with alcoholic liver disease

Presentamos el caso clínico de un varón de 40 años con hepatopatía alcohólica de base que presenta fiebre prolongada, ictericia e insuficiencia hepática asociados a infección por Coxiella burnetti. Tras el diagnóstico y el tratamiento antibiótico adecuado el paciente se recuperó por completo. Se documenta el caso adecuadamente y, a propósito del mismo, se revisa de forma práctica la literatura y se discute la importancia de esta infección, y la necesidad de insistir en su inclusión en el diagnóstico diferencial ante a esta situación clínica (AU)

We report the case of a 40-year-old man with underlying alcoholic liver disease who presented with prolonged fever, jaundice and liver failure associated with Coxiella burnetii infection. After diagnosis and appropriate antibiotic treatment, the patient made a complete recovery. We describe aspects of this case and provide a practical review of the literature on the topic. We also discuss the importance of this infection and the need for its inclusion in the differential diagnosis of this clinical picture (AU)

[Coordination between primary and specialized care in gastroenterology is insufficient. A survey of gastroenterologists and general practitioners]. / La coordinación entre atención primaria y especializada de digestivo es insuficiente. Resultados de una encuesta realizada a gastroenterólogos y médicos de familia.

BACKGROUND AND OBJECTIVES: Collaboration between general practitioners (GPs) and specialists is considered crucial to provide high-quality healthcare. The objective of this study was to analyze the relationship between gastroenterologists and GPs in regional hospitals and their referring primary care centers in Catalonia (Spain). MATERIALS AND METHODS: A descriptive, observational, cross-sectional study was carried out using anonymous questionnaires between January and April 2008. RESULTS: A total of 314 surveys were administered (261 GPs and 53 gastroenterologists). The overall relationship was considered highly deficient or insufficient by 62.3% of gastroenterologists (95% CI, 47.9-74.9) and by 55.6% of GPs (95% CI, 49.3-61.7). More than half (56.6%) of the gastroenterologists did not know any GPs, or only a very few, and the situation was the same for 80.4% of GPs. Sixty-four percent of gastroenterologists considered that the quality of care for digestive diseases in primary care was highly deficient or insufficient while 21.1% of GPs considered that the care provided by gastroenterologists was highly deficient or insufficient. The perception of healthcare in both primary and specialized settings was substantially better when there was good interaction between gastroenterologists and GPs. CONCLUSIONS: Practitioners acknowledge that the degree of interaction between different levels of healthcare is insufficient. Moreover, gastroenterologists consider that the management of digestive diseases in primary care is deficient. Establishing a personal relationship between the two types of practitioners substantially improves mutual assessment.

[Prolonged fever and jaundice in a patient with alcoholic liver disease]. / Fiebre prolongada e ictericia en un paciente con hepatopatía alcohólica.

We report the case of a 40-year-old man with underlying alcoholic liver disease who presented with prolonged fever, jaundice and liver failure associated with Coxiella burnetii infection. After diagnosis and appropriate antibiotic treatment, the patient made a complete recovery. We describe aspects of this case and provide a practical review of the literature on the topic. We also discuss the importance of this infection and the need for its inclusion in the differential diagnosis of this clinical picture.

Applying artificial neural networks to the diagnosis of organic dyspepsia.

BACKGROUND: Dyspepsia diagnoses and treatment decisions are made in situations in which multiple factors must be taken into account. Evolving from neuro-biological insights, artificial neural networks (ANNs) can employ multiple factors in resolving medical prediction, classification, pattern recognition, and pattern completion. The objective of this study was to compare predictive results classifying people with organic dyspepsia with Helicobacter pylori testing (rapid urease test), a scoring system based on patients' symptoms (derived using logistic regression), classification and regression trees (CART) and the most common ANN approach used in medicine: a feed-forward multilayer perceptron (MLP) trained by back-propagation. METHODS: A scoring system, CART algorithm, and MLP model were constructed. Predictive accuracy was calculated for them and for Helicobacter pylori testing. RESULTS: MLP model had a sensitivity of 0.91 (0.81 for all data) and a specificity of 0.74 (0.79 for all data) for test data. That compares favorably with Helicobacter pylori testing (sensitivity = 0.80, specificity = 0.43), the scoring system (sensitivity = 0.85, specificity = 0.60), and the CART model (sensitivity = 0.88, specificity = 0.53). Diagnostic accuracy, the area under the curve, was 0.82 using the MLP model, 0.61 using Helicobacter pylori testing, 0.78 using the scoring system, and 0.72 for the test set using CART. CONCLUSIONS: The results of the analysis showed that the ANN model derived has better predictive accuracy than Helicobacter pylori testing, than a scoring system based on patients' symptoms and than a decision tree algorithm (CART). ANN model could be used as a predictive tool for organic dyspepsia and would be useful in the process of referral of dyspeptic patients from primary care to endoscopy units.

Cost-effectiveness of a 'score and scope' strategy for the management of dyspepsia.

OBJECTIVE: It is important to identify the best initial work-up in patients with uninvestigated dyspepsia because of its epidemiological and economical relevance. The objective of the study was to assess systematically the effectiveness and cost-effectiveness of invasive and non-invasive strategies for the management of dyspepsia. METHODS: A decision analysis was performed to compare prompt endoscopy, score and scope, test and scope, test and treat, and empirical antisecretory treatment. Published and local data on the prevalence of different diagnoses, rates of Helicobacter pylori infection, accuracy values of diagnostic tests, and effectiveness of drug treatments were used. The perspective of analysis was that of the public healthcare payer, and only direct costs were included, with a one-year post-therapy time horizon. The main outcome measure was cost per asymptomatic patient, valued in 2003 Euros. RESULTS: Endoscopy was found to be the most effective strategy for the management of dyspepsia (38.4% asymptomatic patients), followed by test and scope (35.5%), test and treat (35.3%), score and scope (34.7%), and empirical treatment (28.5%). Incremental cost-effectiveness ratios showed that score and scope was the most cost-effective alternative (483.17 Euros per asymptomatic patient), followed by prompt endoscopy (1396.85 Euros). Sensitivity analyses showed variations when varying the values of prevalence of duodenal ulcer, and the values of healing of functional dyspepsia with antisecretory and eradication drugs. There were no changes when varying the prevalence of H. pylori in dyspepsia. CONCLUSIONS: We would recommend stratifying patients by a score system, referring first to endoscopy those patients at higher risk of organic dyspepsia.

[Prospective validation of a clinical scoring system for the diagnosis of organic dyspepsia]. / Estudio prospectivo de un modelo clínico predictivo de dispepsia orgánica.

BACKGROUND AND OBJECTIVE: Predictive symptomatic scoring models have been proposed to select patients with dyspepsia, who may be candidates to endoscopy. In a previous study performed by gastroentrologists from our group, we obtained three scales of symptoms to predict organic dyspepsia, peptic ulcer and esophagitis, respectively. Here we analyze the reproducibility of those scoring models of symptoms when used either by other gastroenterologists or general practitioners. PATIENTS AND METHOD: It was a clinical prospective study of 230 patients from the Viladecans hospital area (120 from primary healthcare and 110 from the gastroenterologist's consultation). The three validation scales were performed in each patient. Then, we performed a diagnostic gastroscopy which allowed to classify patients into those with organic dyspepsia (ulcer, esophagitis, cancer) or those with functional dyspepsia. We calculated the overall predictive accuracy for the gastroenterologist and the general practitioner and for the three diagnoses (organic dyspepsia, ulcer or esophagitis) using the C statistic. RESULTS: Discriminative capacities were 0.75 and 0.82 for organic dyspepsia, 0.78 and 0.86 for ulcer disease, and 0.78 and 0.82 for esophagitis, for the general practitioner and the gastroenterologist, respectively. In this validation study, the best cut-off value, namely the one combining good sensitivity and specificity, was found to be 7. CONCLUSIONS: A correct predictive capacity of the symptomatic score models when used by other gastroenterologists or by primary healthcare practioners confirms its reproducibility and transferability. The use of predictive symptomatic score models in everyday clinical practice can allow to rationalize the referral for endoscopy in our local setting.

Estudio prospectivo de un modelo clínico predictivo de dispepsia orgánica / Prospective validation of a clinical scoring system for the diagnosis of organic dyspepsia

FUNDAMENTO Y OBJETIVO: Los modelos predictivos basados en un conjunto de síntomas pueden ser útiles para seleccionar a los pacientes con dispepsia candidatos a endoscopia. Un estudio previo realizado por gastroenterólogos obtuvo tres escalas de síntomas con alto valor predictivo para dispepsia orgánica, úlcera péptica y esofagitis. El objetivo del presente estudio fue validar de forma prospectiva la reproducibilidad de dichos modelos al ser utilizados por médicos de atención primaria o por otros gastroenterólogos. PACIENTES Y MÉTODO: Estudio clínico prospectivo en 230 pacientes del área del hospital de Viladecans (120 de atención primaria y 110 de consulta de gastroenterología) a los que se aplicaron las tres escalas a validar. Posteriormente se realizó una endoscopia que clasificó a los pacientes en dispepsia orgánica (úlcera, esofagitis, cáncer) o funcional. La capacidad discriminante para dispepsia orgánica, úlcera y esofagitis del médico de primaria y del gastroenterólogo al aplicar cada una de las escalas se calculó mediante el estadístico c. RESULTADOS: Las capacidades discriminantes fueron 0,75 y 0,82 para dispepsia orgánica, 0,78 y 0,86 para úlcera, y 0,78 y 0,82 para esofagitis, para médicos de atención primaria y para gastroenterólogos, respectivamente. El punto de corte óptimo para discriminar dispepsia orgánica, el que combina la mayor sensibilidad con la mayor especificidad, subió de 6 a 7 puntos en esta validación con respecto al estudio inicial. CONCLUSIONES: La confirmación de la reproducibilidad y transferibilidad de un modelo predictivo sencillo de dispepsia orgánica abre la posibilidad de utilizar este tipo de instrumentos para conseguir un abordaje más eficiente de la dispepsia (AU)