1-L polyethylene glycol + ascorbic acid versus sodium picosulfate + magnesium citrate bowel preparations for colonoscopy: effectiveness and safety

Background: adequate bowel preparation is crucial for the protective effect of colonoscopy. Commonly used preparation regimens like polyethylene glycol (PEG) or sodium picosulfate with magnesium citrate (SPMC) have shown similar results in clinical trials, but low-volume PEG + ascorbic acid (1-L PEG + ASC) versus SPMC have never been compared in a real-life setting. Aim: to evaluate the effectiveness and safety of 1-L PEG + ASC versus SPMC in a real-life setting for the overall population, for patients aged ≥ 65 years, and males versus females. Methods: out-patients aged ≥ 18 years who underwent colonoscopy for any indication were randomly assigned to the 1-L PEG + ASC or SPMC group. Using the Boston Bowel Preparation Scale (BBPS), the primary endpoints were the bowel cleansing success of the overall colon and right colon, as well as high-quality (HQ) cleansing. Furthermore, the effectiveness and safety outcomes for age groups and males versus females were compared. Results: 1-L PEG + ASC showed significantly better bowel cleansing success than SPMC. Particularly remarkable is the HQ cleansing reached with 1-L PEG + ASC compared with SPMC (55.5 % versus 25.4 % in the overall colon, and 58.7 % versus 27.2 % in the right colon). 1-L PEG + ASC was equally effective for men and women while SPMC showed significant differences between genders (men had worse bowel cleansing). Age did not affect the cleansing effectiveness. 1-L PEG + ASC versus SPMC showed significant differences in tolerance and safety; women also had significantly worse tolerance than men for both solutions, but these did not affect the quality of bowel cleansing. Conclusions: in our real-life setting, 1-L PEG + ASC offered better adequate and HQ bowel cleansing than SPMC, achieving excellent cleansing quality, regardless of gender or tolerance. (AU)

1L polyethylene glycol + ascorbic acid versus sodium picosulphate + magnesium citrate bowel preparations for colonoscopy: effectiveness and safety.

BACKGROUND: Adequate bowel preparation is crucial for the protective effect of colonoscopy. Commonly used preparation regimens like PEG or SPMC have shown similar results in clinical trials, but low-volume PEG+ Ascorbic Acid (1L-PEG+ASC) versus SPMC have never been compared in a real-life setting. AIM: We evaluated the effectiveness and safety of 1L PEG+ASC versus SPMC in a real-life setting for the overall population, for patients aged ≥65 years, and men versus women. METHODS: Out-patients aged 18 years who underwent colonoscopy for any indication were randomly assigned to the 1L-PEG+ASC or SPMC group. Using the Boston Bowel Preparation Scale (BBPS), the primary endpoints were the bowel cleansing success of the overall colon and right colon, as well as high-quality (HQ) cleansing. Also, we compared effectiveness and safety outcomes for age groups and men versus women. RESULTS: 1L-PEG+ASC showed significantly better bowel cleansing success than SPMC. Especially remarkable is the HQ cleansing reached with 1L-PEG+ASC compared with SPMC (55.5% versus 25.4% in the overall colon, and 58.7% versus 27.2% in the right colon). 1L-PEG+ASC was equally effective for men and women while SPMC showed significant differences between genders (men showed worse bowel cleansing). Age did not affect the cleansing effectiveness. 1L-PEG+ASC versus SPMC showed significant differences in tolerance and safety, women also showed significantly worse tolerance than men for both solutions, but these did not affect the quality of bowel cleansing. CONCLUSIONS: In our real-life setting, 1L-PEG+ASC offered better adequate and HQ bowel cleansing than SPMC, achieving excellent cleansing quality regardless of gender or tolerance.

Metástasis adrenal como presentación de un hepatocarcinoma / Adrenal metastasis as presentation of hepatocellular carcinoma

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Tratamiento con ribavirina de la hepatitis E aguda con afectación renal grave en un paciente inmunocompetente / Treatment with ribavirin of acute hepatitis and severe renal damage in an immunocompetent patient

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Perforación intestinal secundaria a linfoma intestinal B difuso de células grandes en un paciente con enfermedad celiaca / Intestinal perforation secondary to intestinal diffuse large b-cell lymphoma in a patient with coeliac disease

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Limited effectiveness with a 10-day bismuth-containing quadruple therapy (Pylera® ) in third-line recue treatment for Helicobacter pylori infection. A real-life multicenter study.

BACKGROUND: Helicobacter pylori antibiotic resistance is an increasing problem worldwide. Pylera® may be an option as salvage therapy. AIM: To assess the effectiveness, safety, and tolerance of Pylera® as a third-line in clinical practice. MATERIALS AND METHODS: This was a multicenter, observational, prospective database study in four Spanish hospitals. Consecutive H. pylori-infected individuals treated with Pylera® and a proton-pump inhibitor (PPI) were invited to participate if they had failed to respond to PPI-clarithromycin-amoxicillin as first-line and to levofloxacin-amoxicillin-PPI as second-line therapy. Eradication was tested 4-8 weeks after Pylera® using a C13 -urea breath test. Treatment-related adverse effects (TRAEs) were assessed through a questionnaire and by reviewing databases. A questionnaire on patient satisfaction was completed in the last visit. RESULTS: Of 103 subjects fulfilling the selection criteria, 101 were included in the intention-to-treat (ITT) analysis and 97 in the per-protocol (PP) analysis. A 10 day course was prescribed in all patients. Esomeprazole 40 mg b.i.d. was the most used PPI regimen (ITT=94.1%). Ninety-seven individuals (ITT=96.04%) completed more than 90% of the treatment. Overall eradication rates were ITT=80.2% (95% confidence interval [CI]: 72.3%-88.1%) and PP=84.4% (95% CI: 76.8%-91.8%). One or more TRAEs were experienced by 67.3% (95% CI: 57.7%-75.7%), all mild or moderate. TRAEs and the number of pills were the main complaints. CONCLUSION: In an area of high antibiotic resistance to H. pylori, 10-day Pylera® plus double-dose PPI emerged as an alternative as third-line therapy, although not achieving optimal eradication rates. TRAEs were common but were neither severe nor did they condition compliance.