Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study.

BACKGROUND AND AIMS: The aims of this study were to determine the prevalence of fatigue in patients with inflammatory bowel disease [IBD], to identify the factors associated with fatigue and its severity, to assess the impact of fatigue on quality of life [QoL], and to evaluate the relationship between fatigue and sleep disorders. METHODS: This was a prospective multicentre study conducted at 22 Spanish centres. Consecutive patients followed at IBD Units were included. Fatigue was evaluated with the Fatigue Severity Scale [FSS] and the Fatigue Impact Scale [FIS]. Quality of life and sleep quality were assessed using the IBD Questionnaire-Short Form [IBDQ-9] and the Pittsburgh Sleep Quality Index [PSQI], respectively. RESULTS: A total of 544 consecutive adult IBD patients were included [50% women, mean age 44 years, 61% Crohn's disease]. The prevalence of fatigue was 41% (95% confidence interval [CI] = 37-45%). The variables associated with an increased risk of fatigue were: anxiety [OR = 2.5, 95% CI = 1.6-3.7], depression [OR = 2.4, 95% CI = 1.4-3.8], presence of extraintestinal manifestations [EIMs] [OR = 1.7, 95% CI = 1.1-2.6], and treatment with systemic steroids [OR = 2.8, 95% CI = 1.4-5.7]. The presence of EIMs [regression coefficient, RC = 8.2, 95% CI = 2.3-14.2], anxiety [RC = 25.8, 95% CI = 20.0-31.5], depression [RC = 30.6, 95% CI = 24.3-37.0], and sleep disturbances [RC = 15.0, 95% CI = 9.3-20.8] were associated with severity of fatigue. Patients with fatigue had a significantly decreased IBDQ-9 score [p < 0.001]. CONCLUSIONS: The prevalence of fatigue in IBD patients is remarkably high and has a negative impact on QoL. Therapy with systemic steroids is associated with an increased risk of fatigue. The severity of fatigue is associated with anxiety, depression, sleep disorders, and the presence of EIMs. Fatigue was not associated with anaemia, disease activity or anti-TNF therapy.

First-line triple therapy with levofloxacin for Helicobacter pylori eradication.

BACKGROUND: At present, the efficacy of proton pump inhibitor-clarithromycin-amoxicillin regimen is relatively low. AIM: To evaluate the efficacy and tolerability of a first-line triple clarithromycin-free regimen including ranitidine bismuth citrate, levofloxacin and amoxicillin. DESIGN: Prospective study. PATIENTS: Helicobacter pylori-positive patients complaining of dyspeptic symptoms referred for gastroscopy. INTERVENTION: Levofloxacin (500 mg b.d.), amoxicillin (1 g b.d.) and ranitidine bismuth citrate (400 mg b.d.) was prescribed for 10 days. OUTCOME: Eradication was confirmed by a (13)C-urea breath test 8 weeks after therapy. Compliance with therapy was determined by questioning and the recovery of empty envelopes of medications. Incidence of adverse effects was evaluated by means of a specific questionnaire. RESULTS: Sixty-four patients were included (30% peptic ulcer, 70% functional dyspepsia). Almost all (97%) patients took all the medications correctly. Per-protocol and intention-to-treat eradication rates were 88.5% (95% CI =78-95%) and 84.4 (74-91%). Adverse effects were reported in 9.5% of the patients, mainly including diarrhoea (7.9%); none of them were severe. CONCLUSION: This new 10-day levofloxacin-based combination represents an alternative to clarithromycin-based therapy, as it meets the criteria set for regimens used as primary H. pylori treatment: effectiveness (>80%), simplicity (twice-daily dosing and excellent compliance) and safety (low incidence of adverse effects).

Epidemiological changes in diagnosed coeliac disease in a population of Spanish children.

AIM: To investigate the incidence rate of diagnosed coeliac disease among the paediatric population in the province of Cáceres and the changes over the years. METHODS: The incidence rate of diagnosed coeliac disease between the years 1981 and 1999, age at diagnosis and clinical presentation form were investigated. The study was carried out over two periods: A (1981 to 1990) and B (1991 to 1999). RESULTS: The incidence rate for period A was 6.87/100,000 (CI 95%: 5.26-8.83) and for period B 16.04/100,000 (CI 95%: 12.99-19.59) (p < 0.0001). The relative risk of receiving a diagnosis of coeliac disease during the first four years of life was 2.31% (CI 95%:1.61-3.31) greater in period B than in period A. The mean age at diagnosis was 37.4 +/- 47.4 mo and 43.9 +/- 43.7 mo in A and B, respectively (p = 0.0058). The typical clinical pattern was the most frequent (83.6% in A and 58.3% in B). The mean age of introduction of gluten to the diet was 4.6 +/- 2.0 mo and 6.9 +/- 1.7 mo, for period A and B, respectively (p < 0.0001). CONCLUSION: The incidence rate of coeliac disease has increased during the two periods studied. In recent years, the relative risk of receiving a diagnosis of coeliac disease during the first four years of life has increased. The atypical clinical presentation has also increased, although the typical clinical form is still the most frequent in younger children.

Gastrostomía endoscópica percutánea: su utilidad en Atención Primaria / Percutaneous endoscopic gastrostomy: its use in Primary Health Care

La colocación de una sonda de alimentación a través de una gastrostomía endoscópica percutánea es un método seguro y efectivo para proveer nutrición enteral prolongada en pacientes que no pueden deglutir y ofrece claras ventajas respecto a la alimentación por sonda nasogástrica. Esta técnica de alimentación es relativamente desconocida en Atención Primaria. Revisamos las indicaciones de dicha técnica y los cuidados que estos pacientes requieren desde el punto de vista de los profesionales de Atención Primaria. La gastrostomía endoscópica percutánea se ha convertido en el método de elección para facilitar una nutrición enteral prolongada en pacientes atendidos a domicilio (AU)

Síndrome de obstrucción de intestino distal: una complicación digestiva de la fibrosis quística / Distal intestinal obstruction syndrome: a digestive complication of Cystic Fibrosis

Los pacientes con Fibrosis Quística (FQ) pueden desarrollar complicaciones gastrointestinales y pancreáticas que aumentan la morbimortalidad, derivadas de la alteración básica secretora producida por la proteína anómala o Regulador de la Conductancia Transmembrana de la Fibrosis Quística (CFTR), que condiciona un defecto en el transporte extracelular de los iones Cl- y aumento de la reabsorción de Na+ a través de las membranas apicales celulares.Las manifestaciones clínicas del Síndrome de Obstrucción del Intestino Distal (SOID) son episodios recurrentes de obstrucción intestinal completa o parcial, secundaria a la impactación de material fecal en el íleon terminal, ciego y colon ascendente.Varios factores han sido implicados en la patogénesis: motilidad intestinal anormal, desarrollo de insuficiencia pancreática, suplementos inadecuados de enzimas pancreáticos y deshidratación.La prevalencia de SOID en pacientes FQ es del 15 por ciento y algunas veces es el único síntoma de presentación de la enfermedad. En menores de 5 años la prevalencia es del 2 por ciento y asciende al 30 por ciento en adultos.El diagnóstico es clínico y radiológico. El manejo médico inicial incluye hidratación adecuada, reajuste de dosis de suplementos de enzimas pancreáticos y fibra dietética y, si no hay respuesta, laxantes y lavado intestinal con solución electrolítica isosmolar, no absorbible. El tratamiento quirúrgico está limitado a la obstrucción completa. Comunicamos dos casos clínicos, ambos con obstrucción parcial e insuficiencia pancreática, de 7 y 23 años (AU)

[Lower digestive hemorrhage. Its etiology and the diagnostic efficacy of different explorations. A study of 2646 patients]. / Hemorragia digestiva baja. Etiología y rentabilidad diagnóstica de diversas exploraciones. Un estudio sobre 2.646 enfermos.

Lower gastrointestinal bleeding (LGB) is more frequent than upper gastrointestinal bleeding (UGB) with a better course and a more difficult diagnosis. We reviewed retrospectively 8544 cases from patients who were admitted at the Coloproctology Unit of Hospital de la Princesa. Those with the diagnosis of LGB with visible blood in stools (2646-31%) were outpatients, with a mean age of 43 years (range 9-91). Males represented 56.4% and females 43.6. All of them underwent at least sigmoidoscopic examination. The more frequent disorder was hemorrhoids (48.5%) and the bleeding source was found in the anus in 61%. Most of lesions (86%) could be reached with the short colonoscope and 92.7% of the bleeding sources were found with total colonoscopy. In 7.3% colonoscopy was not diagnostic and fiber gastroscopy identified the bleeding spot in 1.5% of the total. Barium studies were diagnostic in 0.5%, arteriography in 0.25% and radionuclide bleeding scan in 0.1%. Finally in 130 patients the bleeding source could not be found. We conclude that most of hemorrhagic lesions occur in the descending colon and that total colonoscopy can localize more than 92%. When total colonoscopy fails only 33% of the lesions can be found (2.35% from total) and 19% (1.5% from the total number) with UGB are identified with the fiber gastroscopic examination.