Psychiatric Emergencies and Suicide Attempts Before and During COVID-19 Lockdown in Spain.

Background: The COVID-19 pandemic had a significant impact on the mental health of the population. The lockdown period in Spain - from March 14 to June 21, 2020 - was particularly stressful. This study aims to examine the differences in visits to the emergency department for psychiatric reasons before and during the lockdown period in a hospital in the province of Lleida (Catalonia, Spain), which has a catchment area of 431,183 inhabitants. We hope that this study can contribute to the understanding of this difficult period in our recent history and help us to be prepared in case of new social emergencies that may affect the mental health of the general population. Aims: This study aims to examine the differences in ER visits due to psychiatric reasons before and during the COVID-19 lockdown period in a province hospital in Spain. Methods: We compared the n = 1,599 visits to the emergency room and their characteristics before (June 13 to March 13, 2020) and during (March 14 to June 21, 2020) the lockdown period in the province of Lerida, Spain. Data were obtained from the electronic health records. Information collected included sociodemographic variables, reason for consultation, previous diagnosis, and characteristics of suicidal ideation and attempts - including history of previous suicidal behavior, method, days spent in the ER, suicide reattempts at 6-month follow-up. Results: Before lockdown, there were an average of 11.2 psychiatric emergencies per day compared with 9.2 psychiatric emergencies per day during lockdown. Regarding suicidal behavior, before lockdown, there were an average of 0.9 suicide attempts before lockdown compared with 0.7 attempts per day during lockdown. Limitations: Since the data came from the electronic health records, we have relied on the clinical diagnosis made by different psychiatrists. Also, we did not record psychiatric comorbidities, but instead only registered one main Axis I diagnosis and one main Axis II diagnosis. Conclusions: We observed a decrease in the number of visits to the ER in general, as well as a lower frequency of patients with suicidal behavior during the first and only lockdown period in Spain, which occurred during the initial months of the pandemic. This is consistent with previous studies showing a reduction of suicidal behavior during periods of social emergency. However, this decrease could be only temporary, and several authors predict an increase of suicidal behavior in the aftermath of the COVID-19 crisis. Ensuring access to mental healthcare during periods of crisis is crucial for the population.

Characteristics of patients treated for suicidal behavior during the pandemic in a psychiatric emergency department in a Spanish province.

INTRODUCTION: Different studies have suggested that psychological, social and economic factors could contribute to an increase in the suicide. That is why the scientific community fear an epidemic of suicides secondary to this crisis. The objective is to evaluate the variables related to suicidal behavior during the two states of alarm and to review if there were sociodemographic or clinical differences with respect to periods prior to the COVID-19 pandemic. MATERIAL AND METHODS: We compared visits to the emergency room and their characteristics of all patients with suicidal behavior before and after the pandemic in Lérida. Information on sociodemographic status, reason for consultation, diagnosis and characteristics of suicidal behavior was obtained from the electronic medical record. RESULTS: No differences were observed in the percentage of suicidal ideation or attempts in the three periods (p=0.201). The characteristics in the multiple logistic regression associated with suicidal behavior are: being a woman (OR: 1.81 [1.27-2.56]), living with relatives (OR: 1.55 [1.05-2.32]) and have a diagnosis of non-alcohol related substance use disorder (OR: 1.94 [1.09-3.42]). As protective factors, being visited in the emergency room during the second state of alarm (OR: 0.68 [0.48-0.96]) and having depression (OR: 0.67 [0.47-0.96]). CONCLUSIONS: Emergency care for suicidal behavior did not increase during the pandemic and, in fact, in 2020 completed suicides decreased by almost half in the province. Risk factors for suicide attempt were female gender, living with relatives, and having a substance use disorder diagnosis. Instead, depression was a protective factor.

Emergency care carried out during the pandemic due to substance abuse in a Spanish province. / Atenciones urgentes realizadas durante la pandemia por consumo de tóxicos en una provincia española.

INTRODUCTION: During periods of isolation, people with substance use disorders may reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices that they have abused. The objective of this study was to evaluate the impact of the pandemic on emergency care and continuity of care for patients with substance use disorders. METHOD: Study carried out in the only psychiatric emergency service in the province at the Hospital Universitario Santa María de Lérida, which cares for 431,183 people. Sociodemographic, clinical and evolutionary variables were collected from all the patients treated during a period prior to lockdown (January 13, 2020, until March 14, 2020) and during the first (March 15, 2020 until June 20, 2020) and second states of emergency (from October 25, 2020 to May 9, 2021). RESULTS: 908 patients attended with substance use disorder, representing 23.8% of all visits. During the first state of emergency, visits increased (p < 0.001) with a decrease in the average age (p = 0.0023). During the second state of emergency, there was an increase in the use of alcohol with respect to the rest of toxic substances (p < 0.001) and an increase in the visits of patients without prior follow-up (p = 0.005). CONCLUSIONS: Substance use disorder consultations increased in the first state of emergency, with patients being younger and attending for reasons related to outpatient discontinuity, while in the second state of emergency, alcohol use increased in people without prior follow-up and with small social networks. Admissions in the first state of emergency were shorter, with no subsequent link to other detoxification treatment centers and with an earlier return to the emergency room, especially in female users.

Introducción: Durante los períodos de aislamiento, las personas con trastornos por uso de sustancias pueden reducir la tensión, el estrés, la incertidumbre y la posible angustia aumentando el uso de sustancias o prácticas de las que han abusado. El objetivo de este estudio es evaluar el impacto de la pandemia en las atenciones urgentes y continuidad asistencial de pacientes con trastorno por uso de sustancias. Método: Estudio realizado en el único servicio de urgencias de Psiquiatría de la provincia en el Hospital Universitario Santa María de Lérida, que atiende a 431.183 personas. Se recogen variables sociodemográficas, clínicas y evolutivas de todos los pacientes atendidos durante un periodo previo al confinamiento (13 de enero de 2020, hasta el 14 de marzo de 2020) y durante el primer (15 de marzo de 2020 hasta su 20 de junio de 2020) y segundo estado de alarma (desde el 25 de octubre de 2020 hasta el 9 de mayo de 2021). Resultados: 908 pacientes atendidos con Trastorno por Uso de Sustancias, representa el 23,8% de todas las visitas. Durante el primer estado de alarma, aumento de las visitas (p < 0,001) con una disminución de la edad media (p = 0,023). Durante el segundo estado de alarma, aumento del consumo de OH respecto al resto de tóxicos (p < 0,001) y un aumento de las visitas de pacientes sin seguimiento previo (p = 0,005). Conclusiones: Aumentaron las consultas por trastorno por uso de sustancias en el primer estado de alarma siendo más jóvenes y acudiendo por motivos de consulta relacionados con la discontinuidad ambulatoria mientras en el segundo estado de alarma repuntó el consumo de alcohol en personas sin seguimiento previo y con escasa red social. Los ingresos del primer estado de alarma fueron más breves, sin vinculación posterior a otros centros terapéuticos de desintoxicación y con un retorno más precoz a urgencias sobre todo en mujeres consumidoras.

Urgent care and suicidal behavior in the child and adolescent population in a psychiatric emergency department in a Spanish province during the two COVID-19 states of alarm.

Introduction: The COVID-19 outbreak and lockdown may have an impact in mental health among youth, but reports of psychiatry emergency department encounters in young Spanish population are scarce. The aim of this study is to characterize the reasons for psychiatric urgent care of youth during COVID-19 pandemic in our hospital. Material and methods: This cross-sectional study compare visits to the psychiatry emergency department and their characteristics in young patients in the province of Lleida before and after the pandemic with special attention to the two states of alarm and suicidal behavior. Information regarding sociodemographic status, chief complaints, diagnosis, characteristics of suicidal behavior, and other data were obtained from the electronic medical records. Results: Within the total psychiatric emergency attendances, youth patients increased a 83.5% in the second state of alarm (p = 0.001). In this period patients were younger (p = 0.006), had less psychiatric history (p = 0.017) and their living conditions changed with an increase of those living with relatives (p = 0.004). Suicidal ideation care increased without statistical significance (p = 0.073). Multiple logistic regression identifies independent risk factors for suicidal behavior being female (OR: 2.88 [1.39-5.98]), living with relatives (OR: 3.49 [1.43-8.54]), and having a diagnosis of depression (OR: 6.34 [3.58-11.24]). Conclusions: The number of young people seen in psychiatric emergencies during the chronic stage of the pandemic increased, and these were getting younger and without previous psychiatric contact. The trend to higher rates of suicidal ideation indicates that youth experienced elevated distress during these periods, especially women, living with relatives and presenting depression.

Introducción: El brote de COVID-19 y el confinamiento pueden tener un impacto en la salud mental entre los jóvenes, pero los estudios de visitas al servicio de urgencias de psiquiatría en la población joven española son escasos. El objetivo de este estudio es caracterizar los motivos de atención de urgencia psiquiátrica de los jóvenes durante la pandemia de COVID-19 en nuestro hospital. Material y métodos: Este estudio transversal compara las visitas a urgencias de psiquiatría y sus características en pacientes jóvenes de la provincia de Lleida antes y después de la pandemia, con especial atención a los 2 estados de alarma y la conducta suicida. La información sobre el estatus sociodemográfico, las principales quejas, el diagnóstico, las características de la conducta suicida y otros datos se obtuvieron de la historia clínica electrónica. Resultados: Dentro del total de atenciones de urgencias psiquiátricas, los pacientes jóvenes aumentaron un 83,5% en el segundo estado de alarma (p = 0,001). En este período los pacientes eran más jóvenes (p = 0,006), tenían menos antecedentes psiquiátricos (p = 0,017) y sus condiciones de vida cambiaron, con un aumento de los que vivían con familiares (p = 0,004). La atención a la ideación suicida aumentó sin significación estadística (p = 0,073). La regresión logística múltiple identifica factores de riesgo independientes para la conducta suicida: ser mujer (OR: 2,88 [1,39-5,98]), vivir con familiares (OR: 3,49 [1,43-8,54]) y tener un diagnóstico de depresión (OR: 6,34 [3,58-11,24]). Conclusiones: Aumentó el número de jóvenes atendidos en urgencias psiquiátricas durante la etapa crónica de la pandemia, y estos cada vez eran más jóvenes y sin contacto psiquiátrico previo. La tendencia a tasas más altas de ideación suicida indica que los jóvenes experimentaron una angustia elevada durante estos períodos, especialmente las mujeres, que vivían con familiares y presentaban depresión.

Increase in urgent care for patients with an eating disorder during the COVID-19 pandemic in a Spanish province.

INTRODUCTION: The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period. METHOD: We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records. RESULTS: Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p=0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p<0.001) and increasing suicidal behaviour (p=0.016) and behavioural disorder (p=0.022). CONCLUSIONS: In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed.

Increase in urgent care for patients with an eating disorder during the COVID-19 pandemic in a Spanish province / Incremento de la atención de urgencia para los pacientes con trastornos de la alimentación durante la pandemia de COVID-19 en una provincia española

Introduction: The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period.Method: We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records.Results: Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p=0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p<0.001) and increasing suicidal behaviour (p=0.016) and behavioural disorder (p=0.022).Conclusions: In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed. (AU)

Introducción: La pandemia de COVID-19 ha tenido un gran impacto en la salud mental de las personas. Los pacientes con trastornos de la alimentación (TA) también son altamente sensibles a la situación de la pandemia, debido a su salud física y mental. El objetivo de este estudio es evaluar el impacto que puede haber tenido la COVID-19 en los motivos de la atención de urgencia de los pacientes con TA, y comparar los motivos de dicha atención con los correspondientes a un periodo anterior.Método: Comparamos las visitas a la unidad de urgencias y sus características antes y después de la pandemia por parte de los pacientes con un TA en la provincia de Lleida. Se obtuvo información relativa al estatus sociodemográfico, el motivo de la consulta, el diagnóstico, las características del comportamiento suicida y otros datos, de la historia clínica digital.Resultados: Dentro de las visitas totales a urgencias, los TA se incrementaron del 1,7% en el periodo previo a la pandemia al 3,1% durante la pandemia (p=0,030). Con relación al motivo de la consulta, se observó un cambio de patrón, reduciéndose las consultas por descompensación por ansiedad (p<0,001) e incrementándose el comportamiento suicida (p=0,016) y el trastorno de conducta (p=0,022).Conclusiones: En nuestro estudio comprobamos un incremento de la atención de urgencia prestada a los pacientes con TA durante los 2 estados de alarma, reduciéndose notablemente las consultas por síntomas de ansiedad. Sin embargo, la atención por comportamiento suicida experimentó un aumento, especialmente en mujeres con comorbilidad por trastorno de la personalidad y en situación de desempleo. (AU)

Increase in urgent care for patients with an eating disorder during the COVID-19 pandemic in a Spanish province.

Introduction: The COVID-19 pandemic has had a great impact on people's mental health. Patients with eating disorders (ED) are also highly sensitive to the pandemic situation due to their physical and mental health. The objective of this study is to evaluate the impact that the COVID-19 pandemic may have had on the reasons for the urgent care of patients with an eating disorder, comparing the reasons for care with those from a previous period. Method: We compared the visits to the emergency room and their characteristics before and after the pandemic of patients with an eating disorder in the province of Lleida. Information regarding sociodemographic status, reason for consultation, diagnosis, characteristics of suicidal behaviour, and other data were obtained from the electronic medical records. Results: Within the total emergency attendances, eating disorders increased from 1.7% in the pre-pandemic period to 3.1% during the pandemic (p = 0.030). Regarding the reason for consultation, a change in the pattern is observed, decreasing consultations for anxious decompensation (p < 0.001) and increasing suicidal behaviour (p = 0.016) and behavioural disorder (p = 0.022). Conclusions: In our study we ascertained an increase in urgent care given to patients with an eating disorder during the two states of alarm, while consultations for anxiety symptoms decreased notably. However, care for suicidal behaviour increased, especially in women with comorbidity of personality disorders and who were unemployed.

Introducción: La pandemia de COVID-19 ha tenido un gran impacto en la salud mental de las personas. Los pacientes con trastornos de la alimentación (TA) también son altamente sensibles a la situación de la pandemia, debido a su salud física y mental. El objetivo de este estudio es evaluar el impacto que puede haber tenido la COVID-19 en los motivos de la atención de urgencia de los pacientes con TA, y comparar los motivos de dicha atención con los correspondientes a un periodo anterior. Método: Comparamos las visitas a la unidad de urgencias y sus características antes y después de la pandemia por parte de los pacientes con un TA en la provincia de Lleida. Se obtuvo información relativa al estatus sociodemográfico, el motivo de la consulta, el diagnóstico, las características del comportamiento suicida y otros datos, de la historia clínica digital. Resultados: Dentro de las visitas totales a urgencias, los TA se incrementaron del 1,7% en el periodo previo a la pandemia al 3,1% durante la pandemia (p = 0,030). Con relación al motivo de la consulta, se observó un cambio de patrón, reduciéndose las consultas por descompensación por ansiedad (p < 0,001) e incrementándose el comportamiento suicida (p = 0,016) y el trastorno de conducta (p = 0,022). Conclusiones: En nuestro estudio comprobamos un incremento de la atención de urgencia prestada a los pacientes con TA durante los 2 estados de alarma, reduciéndose notablemente las consultas por síntomas de ansiedad. Sin embargo, la atención por comportamiento suicida experimentó un aumento, especialmente en mujeres con comorbilidad por trastorno de la personalidad y en situación de desempleo.

Transcultural adaptation and validation of the "Adult Eosinophilic Esophagitis Quality of Life Questionnaire" into Spanish.

BACKGROUND: The "Adult Eosinophilic Esophagitis Quality of Life (EoE-QoL-A) Questionnaire" was developed in English as a valid, reliable, and disease-specific health-related QoL measure.This research aims to adapt and validate this questionnaire for Spanish-speaking patients. PATIENTS AND METHODS: A multicenter, observational, prospective study was conducted at 8 Spanish hospitals. The cultural adaptation of the original EoE-QoL-A questionnaire was undertaken through a standardized 3-phase procedure: 1. Translation; 2. Retrotranslation; and 3. Pilot study. Patients completed the Hospital Anxiety and Depression Scale (HADS), the Short Form (SF)-12, the Brief Illness Perception Questionnaire (BIPQ), and the adapted EoE-QoL-A, with a retest 3 months later.Statistical analysis included construct validity, internal consistency, criterion validity, and reproducibility. RESULTS: One hundred and seventy adult EoE patients (73.5 % male; aged 33.5 ± 11.4-y) were included in the study.With regard to internal validity, all Cronbach alpha values were > 0.75. A significant correlation between items assessed in the SF-12, BIPQ and EoE-QoL-A questionnaires (p < 0.001) was observed. Correlations with the HADS were stronger for anxiety than for depression levels. Anxiety related to disease diagnosis and choking were the most affected dimensions; less affected were the dimensions related to eating, social, and emotional development. Intraclass correlation coefficients between the test and retest assessments were acceptable for all questionnaires, with the highest values (0.73-0.84) calculated for the EoE-QoL-A Spanish version. CONCLUSION: The Spanish version of the EoE-QoL-A is a reliable, valid, and responsive questionnaire. Diagnosis and choking anxiety were the most affected dimensions in the health-related QoL in adult EoE patients.

Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study.

BACKGROUND: Eosinophilic esophagitis (EoE) is an esophageal disorder predominantly triggered by food antigens. A six-food group elimination diet (SFGED) achieves remission in more than 70% of adult patients with EoE. After individual food reintroduction, just 1 or 2 food triggers for EoE can be identified in 65% to 85% of the patients, so some dietary restrictions and endoscopies after food challenge may be unnecessary. OBJECTIVE: To evaluate the efficacy of a four-food group elimination diet (FFGED) (dairy products, wheat, egg, and legumes) for adult patients with EoE. METHODS: Prospective multicenter study. All patients were reevaluated after 6 weeks on an FFGED. Response to the FFGED was defined by clinical and histologic (<15 eos/hpf) remission. Responders underwent reintroduction of each individual food over 6 weeks followed by endoscopy and esophageal biopsies. Nonresponders were offered a rescue SFGED. RESULTS: A total of 52 adult patients were included, of whom 12 patients (23%) had previous failure to topical steroid therapy. Twenty-eight of the 52 patients (54%) achieved clinicopathologic remission on the FFGED and 6 of the 19 (31%) nonresponders to the FFGED were successfully rescued with the SFGED. Twenty-two of 28 responders to the FFGED (78%) finished the individual food reintroduction challenge. Milk was identified as an EoE trigger in 11 patients (50%), egg in 8 (36%), wheat in 7 (31%), and legumes in 4 (18%). All patients had just 1 or 2 food triggers, with milk being the only causative food in 27% of the patients. CONCLUSIONS: An FFGED achieved clinicopathologic remission in 54% of adult patients with EoE. An SFGED was effective in almost a third of FFGED nonresponders, resulting in a combined efficacy of 72% of both strategies.

Transcultural adaptation and validation of the "Adult Eosinophilic Esophagitis Quality of Life Questionnaire" into Spanish / Adaptación transcultural y validación al español del "Adult Eosinophilic Esophagitis Quality of Life Questionnaire"

Background: The "Adult Eosinophilic Esophagitis Quality of Life (EoE-QoL-A) Questionnaire" was developed in English as a valid, reliable, and disease-specific health-related QoL measure. This research aims to adapt and validate this questionnaire for Spanish-speaking patients. Patients and methods: A multicenter, observational, prospective study was conducted at 8 Spanish hospitals. The cultural adaptation of the original EoE-QoL-A questionnaire was undertaken through a standardized 3-phase procedure: 1. Translation; 2. Retrotranslation; and 3. Pilot study. Patients completed the Hospital Anxiety and Depression Scale (HADS), the Short Form (SF)-12, the Brief Illness Perception Questionnaire (BIPQ), and the adapted EoE-QoL-A, with a retest 3 months later. Statistical analysis included construct validity, internal consistency, criterion validity, and reproducibility. Results: One hundred and seventy adult EoE patients (73.5 % male; aged 33.5 ± 11.4-y) were included in the study. With regard to internal validity, all Cronbach alpha values were > 0.75. A significant correlation between items assessed in the SF-12, BIPQ and EoE-QoL-A questionnaires (p < 0.001) was observed. Correlations with the HADS were stronger for anxiety than for depression levels. Anxiety related to disease diagnosis and choking were the most affected dimensions; less affected were the dimensions related to eating, social, and emotional development. Intraclass correlation coefficients between the test and retest assessments were acceptable for all questionnaires, with the highest values (0.73-0.84) calculated for the EoE-QoL-A Spanish version. Conclusion: The Spanish version of the EoE-QoL-A is a reliable, valid, and responsive questionnaire. Diagnosis and choking anxiety were the most affected dimensions in the health-related QoL in adult EoE patients (AU)

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Same-day bidirectional endoscopy with nonanesthesiologist administration of propofol: safety and cost-effectiveness compared with separated exams.

BACKGROUND AND AIM: The safety and cost-effectiveness of a combination of esophagogastroduodenoscopy (EGD) and colonoscopy [or bidirectional endoscopy (BDE)] versus alternative-day EGD and colonoscopy when using nonanesthesiologist administration of propofol have never been evaluated. PATIENTS AND METHODS: This was a single-center prospective registry of consecutive American Society of Anaesthesiology class I-III outpatients undergoing EGD, colonoscopy, and BDE. Propofol was the sole sedative used. Adverse events, recovery time, and procedure-related costs were analyzed. RESULTS: Among the 1500 study participants (51.5% women), EGD, colonoscopy, and BDE were carried out on 449, 702, and 349 patients, respectively. All patients were discharged directly from the endoscopy unit. No sex differences were found with respect to age (mean 54.4, range 18-96 years), BMI, or procedure type. Propofol doses for BDE were 25.9% less than when EGD and colonoscopy were performed separately (P<0.001). Adverse events, including transient O2 saturation less than 90%, systolic blood pressure less than 90 mmHg, and bradycardia (<50 bpm), appeared in 10.7% of single EGD and 8.6% of EGD within BDE; for colonoscopies, the figures were 8.6 and 9.5%, respectively (P=NS). Recovery time to discharge after BDE was 47.9% shorter than when EGD and colonoscopy were performed separately (P<0.001). The cost of same-day BDE was 28.1% lower than that of EGD and colonoscopy performed as separated procedures (P<0.001). CONCLUSION: Same-day BDE with nonanesthesiologist administration of propofol resulted in reductions in propofol doses, recovery time, and procedure-related costs as compared with carrying out EGD and colonoscopy separately, without an increase in adverse events.

Adult versus pediatric eosinophilic esophagitis: important differences and similarities for the clinician to understand.

Eosinophilic esophagitis (EoE) is recognized as a common, allergy-associated cause of chronic esophageal symptoms affecting both children and adults. Research has begun to shed light on its epidemiology with consistent results from various geographical areas. Differences in clinical presentation, endoscopic aspects and response to treatment have all been reported for patients of different ages, and the question as to whether adult and pediatric EoE are manifestations of a single entity or in fact two distinct disorders has been posed. The most relevant differences between pediatric and adult EoE come from evolutionary changes in the consequences of the disease, including fibrous remodeling, and the ability to express symptoms. However, most studies support a common pathogenesis and similar histopathological features for adult and pediatric patients, being the same diagnostic criteria applied to them. This article comprehensively reviews the most recently published information and addresses important questions about the natural history of EoE.

Nonanesthesiologist-administered propofol sedation for colonoscopy is safe and effective: a prospective Spanish study over 1000 consecutive exams.

BACKGROUND AND STUDY AIMS: Propofol is increasingly being used in sedated colonoscopy. This paper assesses the safety and efficacy of nonanesthesiologist-administered propofol in a large series of colonoscopies. PATIENTS AND METHODS: A prospective registry of consecutive American Society of Anesthetics (ASA) class I and II outpatients undergoing colonoscopy was carried out. Propofol, administered by a nurse under an endoscopist's supervision, was the sole sedative agent used. RESULTS: Of the 1000 patients (563 women/437 men, mean age 57, range 8-89 years) included in the study, 57.4% showed ASA I and 42.6% ASA II characteristics. The cecal intubation rate was 96.9%. 48.2% of the procedures were for therapeutic purposes. The mean propofol dose was 177 mg (range 50-590 mg). Doses correlated inversely with patient age (r=-0.38; P<0.001) and were lower in ASA II patients (P<0.001) and in diagnostic (rather than therapeutic) exams (P<0.001). The average recovery time (from extracting the colonoscope to patient discharge) was 18.6 min (range 4-75) and longer in ASA II patients (P=0.05). A pulse oximetry saturation of less than 90% and a decrease in systolic blood pressure of more than 20 mmHg were observed in 24 (2.4%) and 385 (35.8%) patients, respectively. Both events were more frequent in patients older than 65 years (P<0.05); the latter was more common in ASA II patients. CONCLUSION: Colonoscopy under endoscopist-controlled propofol sedation in low-risk patients is safe and effective, allowing for a complete exploration, although patients at least 65 years old and/or classified as ASA II are more likely to present a decrease in blood pressure and have a prolonged recovery time.