Colitis eosinofílica primaria en paciente con enfermedad celíaca / Primary eosinophilic colitis in a celiac patient

Los trastornos eosinofílicos primarios del tracto gastrointestinal abarcan una serie de enfermedades crónicas que cursan con un infiltrado eosinofílico a nivel intestinal en ausencia de otras causas de eosinofilia. Pueden afectar a cualquier área del tubo digestivo, siendo excepcional la afectación exclusiva del colon. Dada su baja prevalencia no suelen tenerse en cuenta en el diagnóstico diferencial de los pacientes con diarrea crónica, por lo que en muchos casos la demora diagnóstica puede ser de años. Describimos el caso de una paciente con enfermedad celíaca bien controlada y diarrea crónica de origen indeterminado que fue finalmente diagnosticada de una colitis eosinofílica. Recibió tratamiento con budesonida oral con muy buena respuesta clínica y en la actualidad se mantiene asintomática

Primary eosinophilic gastrointestinal disorders include a spectrum of inflammatory chronic diseases in which eosinophils infiltrate the gut in the absence of known causes of such tissue eosinophilia. They may affect any area of the gastrointestinal tract although exclusive colonic disease is exceptional. Due to their low prevalence these disorders are not usually taken into account when making a differential diagnosis in a patient with chronic diarrhea, which is the reason why in many cases the diagnosis can take many years. We describe the case of a patient with well-controlled celiac disease and chronic diarrhea of indeterminate origin. The final diagnosis was eosinophilic colitis. A complete response was obtained when she was treated with oral budesonide. Nowadays she remains asymptomatic

Triple terapia 10 días con esomeprazol 40 mg/12 h vs. cuádruple concomitante sin bismuto como tratamiento de primera línea de la infección por Helicobacter pylori / 10-day triple therapy with esomeprazole 40 mg/12 h vs. quadruple concomitant non-bismuth therapy as first line treatment for Helicobacter pylori infection

INTRODUCCIÓN: Recientemente la cuádruple terapia concomitante sin bismuto se ha postulado como tratamiento de primera línea para la infección por Helicobacter pylori en España. Se desconoce si la optimización de la triple terapia clásica puede incrementar su efectividad hasta límites aceptables. MATERIAL Y MÉTODOS: Estudio retrospectivo que compara la eficacia de la triple terapia con la cuádruple concomitante realizando posteriormente un subanálisis cuando ambas se administran durante 10 días empleando esomeprazol 40mg/12h. RESULTADOS: Desde el 1 de enero de 2012 hasta el 31 de diciembre de 2014 recibieron al menos una primera línea de tratamiento 657 pacientes. La cuádruple combinación (n = 371) presentó una eficacia superior a la de la triple terapia clásica (n = 248) tanto «por intención de tratar» (85,9% vs. 65,5%; p < 0,001) como «por protocolo» (88,8% vs. 68,4%; p < 0,001). Cuando ambos tratamientos se administraron durante 10 días empleando esomeprazol 40 mg/12h la cuádruple terapia (n = 108) también fue más eficaz que la triple terapia clásica «optimizada» (n = 76), tanto «por intención de tratar» (90,7% vs. 73,6%; p = 0,003) como «por protocolo» (92,5% vs. 74,6%; p = 0,002). CONCLUSIONES: La terapia cuádruple concomitante con dosis altas de IBP durante 10 días consigue tasas de erradicación significativamente superiores a las obtenidos con la triple terapia optimizada y superiores al 90% cuando se utiliza esomeprazol 40 mg/12h

INTRODUCTION: Quadruple concomitant non-bismuth therapy has recently become the most widely prescribed first-line treatment for Helicobacter pylori infection in Spain. Whether optimized conventional triple therapy can achieve comparable efficacy rates remains to be seen. MATERIAL AND METHODS: Retrospective study comparing the efficacy of triple and quadruple concomitant therapy, and sub-analysis following administration of both for 10 days with esomeprazole 40 mg/12h. RESULTS: A first-line therapy was administered to 657 patients from 1st January 2012 to 31st December 2014. Quadruple therapy (n = 371) showed higher efficacy than triple therapy (n = 248) for both intention-to-treat (85.9% vs. 65.7%; P < .001) and per protocol analysis (92.5% vs. 68.4%; P < .001). When both therapies included esomeprazole 40 mg/12h administered for 10 days, quadruple concomitant therapy (n = 108) also had higher efficacy than triple therapy (n = 76) for intention-to-treat (90.7% vs. 73.6%; P = .003) and per protocol analysis (92.5% vs.74.6%; P = .002). CONCLUSIONS: Quadruple concomitant therapy with high dose proton pump inhibitor (PPI) for 10 days achieves a significantly higher eradication outcome than optimized triple therapy, with rates of over 90% when the PPI prescribed is esomeprazole 40 mg/12h

Comparación de cuádruple terapia concomitante sin bismuto con triple terapia clásica como primera línea de tratamiento para la erradicación del Helicobacter pylori / Cuadruple concomitant non-bismuth therapy vs. classical triple therapy as first line therapy forHelicobacter pylori infection

Fundamento y objetivo: Tras constatar que en nuestro medio la triple terapia clásica presentaba una eficacia subóptima en la erradicación del Helicobacter pylori (H. pylori), a mediados de 2012 decidimos implantar la cuádruple terapia concomitante sin bismuto. El objetivo de este estudio es comparar la eficacia de ambas pautas. Material y métodos: Estudio retrospectivo observacional de las pautas erradicadoras administradas entre el 1 de enero de 2012 y el 5 de mayo de 2014, así como su eficacia. Resultados: En el periodo de estudio 510 pacientes recibieron al menos una primera línea de tratamiento que en 179 casos (35,1%) consistió en amoxicilina+claritromicina+IBP durante 7-14 días, y en 298 (58,4%) en la combinación amoxicilina+claritromicina+metronidazol+IBP 10 días. La pauta cuádruple concomitante fue más eficaz que la combinación clásica, tanto «por intención de tratar» (84,8 vs. 65,7%; p=0,001) como «por protocolo» (86,9 vs. 67,2%; p=0,001). La triple terapia fue más eficaz cuando se empleaba en pautas de 10 días que de 7 (77,9 vs. 56,5%; p: 0,005 por «intención de tratar» y 77,9 vs. 58,5%; p: 0,011 por «protocolo»). Al comparar la eficacia de la cuádruple terapia con la triple administrada 10 días no se encontraron diferencias significativas. Conclusiones: En nuestro medio, la cuádruple terapia concomitante sin bismuto presenta una elevada eficacia como primera línea de tratamiento para la erradicación del H. pylori, superando ampliamente la de la triple terapia en la forma en que esta viene administrándose mayoritariamente (pautas cortas de 7 días) (AU)

Background and objective: In a previous study we found that the classical triple therapy for Helicobacter pylori (H. pylori)had low efficacy (under 70%) in our area. After this finding, in mid 2012 quadruple concomitant therapy started to be prescribed in our hospital. The aim of the present study is to compare the efficacy of classical triple therapy and quadruple concomitant therapy without bismuth. Material and methods: Observational retrospective study of prescribed treatments between 1st January 2012 and 5th May 2014 and their efficacy. Results: During the study period 510 patients were prescribed a first line therapy; in 179 cases (35,1%) the combination amoxiciline+clarithromicine+PPI was prescribed during 7-14 days, and 298 patients (58,4%) were treated with amoxicillin+clarithromycin+metronidazole+PPI for 10 days. The quadruple concomitant therapy had a higher efficacy than the classical triple therapy, both in an "intention to treat" (84.8% vs. 65.7%, P=.001) and "per protocol" (86.9% vs. 67.2%, P=.001) analysis. Triple therapy had a higher efficacy when it was prescribed for 10 days compared to 7 days (77.9% vs. 56.5%, P=.005 per "intention to treat" and 77.9% vs. 58.5%, P=.011 "per protocol"). When quadruple concomitant therapy was compared with classical triple therapy prescribed over 10 days no significant differences were found. Conclusions: In our setting, cuadruple concomitant therapy without bismuth has a high efficacy as first line therapy for H. pylori eradication, with much better results than classical triple therapy in the way that it is most widely prescribed (short courses of 7-day with a single dose of omeprazole) (AU)

[Cuadruple concomitant non-bismuth therapy vs. classical triple therapy as first line therapy for Helicobacter pylori infection]. / Comparación de cuádruple terapia concomitante sin bismuto con triple terapia clásica como primera línea de tratamiento para la erradicación del Helicobacter pylori.

BACKGROUND AND OBJECTIVE: In a previous study we found that the classical triple therapy for Helicobacter pylori (H. pylori) had low efficacy (under 70%) in our area. After this finding, in mid 2012 quadruple concomitant therapy started to be prescribed in our hospital. The aim of the present study is to compare the efficacy of classical triple therapy and quadruple concomitant therapy without bismuth. MATERIAL AND METHODS: Observational retrospective study of prescribed treatments between 1st January 2012 and 5th May 2014 and their efficacy. RESULTS: During the study period 510 patients were prescribed a first line therapy; in 179 cases (35,1%) the combination amoxiciline+clarithromicine+PPI was prescribed during 7-14 days, and 298 patients (58,4%) were treated with amoxicillin+clarithromycin+metronidazole+PPI for 10 days. The quadruple concomitant therapy had a higher efficacy than the classical triple therapy, both in an "intention to treat" (84.8% vs. 65.7%, P=.001) and "per protocol" (86.9% vs. 67.2%, P=.001) analysis. Triple therapy had a higher efficacy when it was prescribed for 10 days compared to 7 days (77.9% vs. 56.5%, P=.005 per "intention to treat" and 77.9% vs. 58.5%, P=.011 "per protocol"). When quadruple concomitant therapy was compared with classical triple therapy prescribed over 10 days no significant differences were found. CONCLUSIONS: In our setting, cuadruple concomitant therapy without bismuth has a high efficacy as first line therapy for H. pylori eradication, with much better results than classical triple therapy in the way that it is most widely prescribed (short courses of 7-day with a single dose of omeprazole).

[10-day triple therapy with esomeprazole 40 mg/12 h vs. quadruple concomitant non-bismuth therapy as first line treatment for Helicobacter pylori infection]. / Triple terapia 10 días con esomeprazol 40 mg/12 h vs. cuádruple concomitante sin bismuto como tratamiento de primera línea de la infección por Helicobacter pylori.

INTRODUCTION: Quadruple concomitant non-bismuth therapy has recently become the most widely prescribed first-line treatment for Helicobacter pylori infection in Spain. Whether optimized conventional triple therapy can achieve comparable efficacy rates remains to be seen. MATERIAL AND METHODS: Retrospective study comparing the efficacy of triple and quadruple concomitant therapy, and sub-analysis following administration of both for 10 days with esomeprazole 40mg/12h. RESULTS: A first-line therapy was administered to 657 patients from 1st January 2012 to 31st December 2014. Quadruple therapy (n=371) showed higher efficacy than triple therapy (n=248) for both intention-to-treat (85.9% vs. 65.7%; P<.001) and per protocol analysis (92.5% vs. 68.4%; P<.001). When both therapies included esomeprazole 40mg/12h administered for 10 days, quadruple concomitant therapy (n=108) also had higher efficacy than triple therapy (n=76) for intention-to-treat (90.7% vs. 73.6%; P=.003) and per protocol analysis (92.5% vs.74.6%; P=.002). CONCLUSIONS: Quadruple concomitant therapy with high dose proton pump inhibitor (PPI) for 10 days achieves a significantly higher eradication outcome than optimized triple therapy, with rates of over 90% when the PPI prescribed is esomeprazole 40mg/12h.

Localización endoscópica del cáncer colorrectal: estudio de su precisión y posibles factores de error / Endoscopic localization of colorectal cancer: study of its accuracy and possible error factors

Introducción: una correcta localización preoperatoria del cáncer colorrectal (CCR) es muy importante, siendo variables las tasas de error de localización endoscópica publicadas. Objetivo: determinar la precisión de la localización endoscópica del CCR, comparándola con la del TAC preoperatorio. Analizar las variables que pudieran asociarse a una localización endoscópica errónea. Pacientes y métodos: revisamos la localización endoscópica y por TAC de una serie de CCR sin cirugía previa. Estudiamos la concordancia entre localización endoscópica y radiológica frente a la operatoria, comparando la precisión de la endoscopia y del TAC. Analizamos la frecuencia de diagnósticos endoscópicos incorrectos con respecto a una serie de variables del paciente, de la endoscopia y del tumor. Resultados: estudiamos 237 CCR, en 223 pacientes. La concordancia con la localización quirúrgica fue: colonoscopia = 0,87 y TAC = 0,69. La precisión de la localización endoscópica fue: 91,1% (87,3-95); TAC: 76,2% (70,8-82): p = 0,00001; OR = 3,22 (1,82-5,72). El cáncer obstructivo presentó mayor frecuencia de localización errónea: 18% frente al no obstructivo: 5,7%, p = 0,0034; OR = 3,65 (1,35-9,96). Los errores endoscópicos de localización variaron según la ubicación tumoral, siendo más frecuentes en descendente: 36,3%, p = 0,014; OR = 6,23 (1,38-26,87) y ciego: 23,1%, p = 0,007; OR = 3,92 (1,20-12,43). Conclusiones: la precisión endoscópica para la localización del CCR resultó muy elevada y significativamente superior a la del TAC. El carácter obstructivo del tumor y el asentar en descendente o ciego se asocian con un significativo aumento del riesgo de error en la localización endoscópica del CCR(AU)

Introduction: accurate preoperative localization of colorectal cancer (CRC) is very important, with a wide range of published error rates. Aim: to determine accuracy of endoscopic localization of CRC in comparison with preoperative computed tomography (CT). To analyse variables that could be associated with a wrong endoscopic localization. Patients and methods: endoscopic and CT localization of a series of CRC without previous surgery were reviewed. We studied the concordance between endoscopic and radiologic localization against operative findings comparing accuracy of endoscopy and CT. We analysed the frequency of wrong endoscopic diagnoses with regard to a series of patient, endoscopy and tumor variables. Results: two hundred thirty seven CRC in 223 patients were studied. Concordance with surgical localization was: colonoscopy = 0.87 and CT = 0.69. Endoscopic localization accuracy was: 91.1%; CT: 76.2%: p = 0.00001; OR = 3.22 (1.82-5.72). Obstructive cancer presented a higher rate of wrong localization: 18 vs. 5.7% in non-obstructive tumors (p = 0.0034; OR = 3.65 (1.35- 9.96). Endoscopic localization mistakes varied depending on tumor location, being more frequent in descending colon: 36.3%, p = 0.014; OR = 6.23 (1.38-26.87) and cecum: 23.1%, p = 0.007; OR = 3.92 (1.20-12.43). Conclusions: endoscopic accuracy for CRC localization was very high and significantly better than CT accuracy. Obstructive tumor and those located in the descending colon or cecum were associated with a significant increase of the error risk of CRC endoscopic localization(AU)

Endoscopic and anesthetic feasibility of EUS and ERCP combined in a single session versus two different sessions.

AIM: To discuss the feasibility of single session endoscopic ultrasonography (EUS) to discuss and endoscopic retrograde cholangiopancreatography (ERCP) execution. METHODS: Retrospective endoscopic and anesthetic outcome comparison of performing both EUS and ERCP in a single endoscopic session (Group I) versus performing each procedure in two different sessions (Group II) was made. The following variables were evaluated: epidemiological variables, American Society of Anesthesiologists Physical Status Classification (ASA) level, procedural time, propofol dose, anesthetic complications, endoscopic complications and diagnostic yield, and therapeutic procedures on both groups. T-student, Chi-Square and Fisher test were used for comparison. RESULTS: We included 39 patients in Group I (mean age: 69.85 ± 9.25; 27 men) and 46 in Group II (mean age: 67.46 ± 12.57; 25 men). Procedural time did not differ significantly between both groups (Group Ivs Group II: 93 ± 32.78 vs 98.98 ± 38.17; P >0.05) but the dose of propofol differed (Group I vs Group II: 322.28 ± 250.54 mg vs 516.96 ± 289.06 mg; P = 0.001). Three patients had normal findings on both explorations. Three anesthetic complications [O(2) desaturation (2), broncoaspiration (1)] and 9 endoscopic complications [pancreatitis (6), bleeding (1), perforation (1), cholangitis (1)] occurred without significant differences between both groups (P > 0.05). We did not find any significant difference regarding age, sex, ASA scale level, diagnostic yield or therapeutic maneuvers between both groups. CONCLUSION: The performance of EUS and ERCP in a single session offers a similar diagnostic and therapeutic yield, does not entail a higher complication risk and requires a significantly smaller dose of propofol for sedation compared with performing each exploration in a different session.