Satisfacción de los pacientes diagnosticados de enfermedad de Crohn con respecto a la colonoscopia y entero-resonancia magnética / Crohn's disease patient's satisfaction with colonoscopy versus entero magnetic resonance imaging (MRI)

Objetivos. Evaluar la satisfacción y las preferencias sobre la colonoscopia (CL) y la entero-resonancia (ERM) de los pacientes que padecen enfermedad de Crohn a los que se les ha realizado ambas pruebas. Valorar también la eficacia del sistema de información para la recogida de estos datos. Método. Estudio piloto transversal, mediante una encuesta telefónica de satisfacción realizada a pacientes diagnosticados de enfermedad de Crohn (EC). Los pacientes del estudio se seleccionaron en la consulta del Servicio de Aparato Digestivo del Hospital Universitario Príncipe de Asturias. Se les realizaron las dos pruebas objeto del estudio durante el periodo comprendido entre el 1 de enero de 2011 y el 30 de junio de 2012. Las encuestas se efectuaron durante los meses de julio y agosto de 2012. Resultados. Han participado un total de 48 pacientes con enfermedad de Crohn. De ellos, 24 eran mujeres y 24 hombres. Con una media de edad de 43 años (DE: 13.8). La peor valoración se obtuvo en la preparación previa de ambas. Si los pacientes pudieran elegir, 23 preferían CL, 16 ERM y a 9 les era indiferente. Conclusiones. La preferencia de los pacientes hacia la CL pudo deberse a la administración previa de sedación. Una prueba como la CL, que a priori puede resultar desagradable para el paciente, resulta mucho mejor tolerada gracias a la sedación. En ambas pruebas las preparaciones previas se perciben como molestas. Nos plantearemos cómo poder mejorar la tolerancia a dicha preparación, quizá dando más información, puesto que muchas veces no se realiza correctamente y eso puede acentuar dicha percepción desagradable (AU)

Objectives. To evaluate satisfaction and preferences in Crohn's disease patients who have undergone a colonoscopy (CL) and a MRI colonography (MRI). As well as evaluate the effectiveness of the information system to collect the data. Method. A sectional pilot study conducted through a satisfaction survey questionnaire for patients diagnosed with Crohn’s disease (CD). Study patients were selected from the Gastroenterology Department in the Principe de Asturias University Hospital, where both the colonoscopy and the entero magnetic resonance imaging tests were done from the 1st of January to the 30th of June 2012. Surveys were conducted during July and August 2012. Results. A total of 48 patients with Crohn’s disease participated. Out of these, 24 were women and 24 were men. The mean age was 43 years (SD: 13.8). The worst score was obtained at the time of preparation for both procedures. If patients could choose they would prefer CL 23, 16 MRI and 9 were indifferent. Conclusions. The patients’ preference for CL could be due to the administration of sedatives prior to the procedure. A procedure such as the CL which initially may result unpleasant for the patient is tolerated much better as a result of the sedation. In both tests, the preparations prior to the procedures are perceived as unpleasant. We will think about how to improve patients’ tolerance to these preparations, maybe by giving more information as patients, because we don’t know often how to do it properly, which could magnify this unpleasant perception (AU)

[Chronic liver disease associated with cystic fibrosis: energy expenditure at rest, risk factors, and impact on the course of the disease]. / Hepatopatía crónica asociada a fibrosis quística: gasto energético en reposo, factores de riesgo y repercusión en la evolución de la enfermedad.

INTRODUCTION AND GOALS: Cystic fibrosis is the most frequent recessive disease. There are various hepato-biliary alterations, of which the most important is the development of biliary obstruction and periportal fibrosis. The goal is to assess the influence of liver disease on the nutritional status, the progress of the disease and the associated risk factors. SCOPE: Nutrition Unit of the Gastroenterology Department at La Paz Children's Hospital. MATERIAL AND METHODS: Prospective longitudinal study with 53 patients assessed on three occasions over 3 years: at inclusion, after 1 year and after 3 years. Only 37 of them were followed-up for 3 years. A total of 111 measurements were taken, including analysis of body composition, energy expenditure, intake and energy losses as well as nitrogen balance. Simultaneously, respiratory function tests were performed and the presence of repeated acute respiratory problems was evaluated. RESULTS: 37 patients, 19 females and 18 males (mean age 13.04 years +/- 3.28). Twelve (32.43%) were diagnosed as having liver disease (mean age 12.16% +/- 3.86 SD, 11 males, 1 female), of whom 1 presented meconial ileum, 5 were homozygotic, 5 heterozygotic and the other two presented other mutations. Those with liver disease presented anthropometric parameters that were better than or similar to the patients without liver involvement (p NS). Mean Waterlow index in liver disease sufferers: 93.62% +/- 7.87 SD; without liver disease: 93.06% +/- 10.97 SD (p NS). Mean of LVEF in liver disease sufferers: 88.81 +/- 27.32 SD; without liver disease: 75.21 +/- 27.92 SD (p < 0.05). Mean FVC in liver disease sufferers: 95.38 +/- 22.92 SD; without liver disease: 83 +/- 23.7 SD (p < 0.05). Mean energy expenditure at rest/lean body mass in liver disease sufferers: 38.81 kcal +/- 7.26 SD; without liver disease: 42.36 kcal +/- f 6.91 SD (p < 0.05). CONCLUSIONS: The prevalence of chronic liver disease in patients with cystic fibrosis increases with age and is more frequent in males. Liver disease sufferers present a better evolution in pulmonary function and present less energy expenditure.

Hepatopatía crónica asociada a fibrosis quística: gasto energético en reposo, factores de riesgo y repercusión en la evolución de la enfermedad / Chronic liver disease associated with cystic fibrosis: energy expended at rest, risk factors and impact on the disease's progress

Introducción y objetivos: La fibrosis quística es la enfermedad recesiva más frecuente. Existen diferentes alteraciones hepatobiliares; la más importante es el desarrollo de obstrucción biliar y fibrosis periportal. El objetivo es valorar la influencia de la hepatopatía en el estado nutricional, la evolución de la enfermedad y los factores de riesgo asociados. Ámbito: Unidad de Nutrición del Servicio de Gastroenterología del Hospital Infantil La Paz. Material y métodos: Estudio longitudinal prospectivo con 53 pacientes valorados en tres momentos durante 3 años; al inicio, al año y a los 3 años. Solo 37 se siguieron los 3 años. Se realizan 111 mediciones que incluyen: análisis de la composición corporal, del gasto energético, de la ingesta y de las pérdidas energéticas así como balance nitrogenado. Simultáneamente se realizan pruebas de función respiratoria y se valora la presencia de reagudización respiratoria. Resultados: 37 pacientes, 19 mujeres y 18 varones (edad media 13,04 años ñ 3,28). Doce (32,43 por ciento) fueron diagnosticados de hepatopatía (edad media 12,16 años ñ 3,86 DS, 11 varones, 1 mujer) de los cuales 1 presentó íleo meconial, 5 eran homocigotos, 5 heterocigotos y los 2 restantes presentaban otras mutaciones. Los hepatópatas presentan parámetros antropométricos mejores o similares que los pacientes sin hepatopatía (p NS). Media del índice de Waterlow en hepatópatas: 93,62 por ciento ñ 7,87 DS; no hepatópatas: 93,06 por ciento ñ 10,97 DS (p NS). Media de FEV1 en hepatópatas: 88,81 ñ 27,32 DS; no hepatópatas: 75,21 ñ 27,92 DS (p < 0,05). Media de FVC en hepatópatas: 95,38 ñ 22,92 DS; no hepatópatas: 83 ñ, menos satisfactorios han sido los logros obtenidos en cuanto a su caracterización clínica. La prevalencia de la enfermedad hepática crónica en los pacientes con FQ varía según los criterios diagnósticos empleados. Se considera que los datos actuales sobre la prevalencia subestiman el riesgo real debido a la ausencia de marcadores diagnósticos de alta sensibilidad de enfermedad hepática en la FQ y a la cuestionable precisión de la histología8 la 23,7 DS (p < 0,05). Media del gasto energético en reposo/masa corporal magra en hepatópatas: 38,81 kcal ñ 7,26 DS; no hepatópatas: 42,36 kcal ñ 6,91 DS (p < 0,05).Conclusiones: La prevalencia de hepatopatía crónica en pacientes con fibrosis quística aumenta con la edad y es más frecuente en varones. Los pacientes hepatópatas tienen mejor evolución de la función pulmonar y presentan menor gasto energético (AU)

Introduction and goals: Cystic fibrosis is the most frequent recessive disease. There are various hepato-biliary alterations, of which the most important is the development of biliary obstruction and periportal fibrosis. The goal is to assess the influence of liver disease on the nutritional status, the progress of the disease and the associated risk factors. Scope: Nutrition Unit of the Gastroenterology Department at La Paz Children’s Hospital. Material and methods: Prospective longitudinal study with 53 patients assessed on three occasions over 3 years: at inclusion, after 1 year and after 3 years. Only 37 of them were followed-up for 3 years. A total of 111 measurements were taken, including analysis of body composition, energy expenditure, intake and energy losses as well as nitrogen balance. Simultaneously, respiratory function tests were performed and the presence of repeated acute respiratory problems was evaluated. Results: 37 patients, 19 females and 18 males (mean age 13.04 years ± 3.28). Twelve (32.43%) were diagnosed as having liver disease (mean age 12.16% ± 3.86 SD, 11 males, 1 female), of whom 1 presented meconial ileum, 5 were homozygotic, 5 heterozygotic and the other two presented other mutations. Those with liver disease presented anthropometric parameters that were better than or similar to the patients without liver involvement (p NS). Mean Waterlow index in liver disease sufferers: 93.62% ± 7.87 SD; without liver disease: 93.06% ± 10.97 SD (p NS). Mean of LVEF in liver disease sufferers: 88.81 ± 27.32 SD; without liver disease: 75.21 ± 27.92 SD (p < 0.05). Mean FVC in liver disease sufferers: 95.38 ± 22.92 SD; without liver disease: 83 ± 23.7 SD (p < 0.05). Mean energy expenditure at rest/lean body mass in liver disease sufferers: 38.81 kcal ± 7.26 SD; without liver disease: 42.36 kcal ±f 6.91 SD (p < 0.05). Conclusions: The prevalence of chronic liver disease in patients with cystic fibrosis increases with age and is more frequent in males. Liver disease sufferers present a better evolution in pulmonary function and present less energy expenditure (AU)

Hepatitis grave con patrón de citólisis por amoxicilina-clavulánico / Severe hepatitis with hepatocellular necrosis due to amoxicilin-clavulanic

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