Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up. PANCR-EVOL Study.

BACKGROUND/OBJECTIVES: Exocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL). METHODS: This was a cross-sectional, multicenter Spanish study. CP patients without follow-up by a gastroenterologist or surgeon in at least 2 years were included. EPI was defined as fecal elastase test <200mcg/g. For nutritional assessment, laboratory and anthropometric data were obtained. QoL was investigated using the EORTC QLQ-C30 questionnaire. RESULTS: 64 patients (mean age 58.8±10.3 years, 85.9% men) from 10 centers were included. Median time since diagnosis of CP was 58.7 months [37.7-95.4]. Forty-one patients (64.1%) had EPI. Regarding nutritional status, the following differences were observed (EPI vs. Non-EPI): BMI (23.9±3.5kg/m2 vs. 25.7±2.5, p=0.03); glucose (121 [96-189] mg/dL vs. 98 [90-116], p=0.006); HbA1c 6.6% [6.0-8.4] vs. 5.5 [5.3-6.0], p=0.0005); Vitamin A (0.44mg/L [0.35-0.57] vs. 0.53 [0.47-0.63], p=0.048) and Vitamin E (11.2±5.0µg/ml vs. 14.4±4.3, p=0.03). EPI group showed a worse EORTC QLQ-C30 score on physical (93.3 [66.7-100] vs. 100 [93.3-100], p=0.048) and cognitive function (100 [83.3-100] vs. 100 [100-100], p=0.04). CONCLUSIONS: Prevalence of EPI is high in patients with CP without follow-up. EPI group had higher levels of glucose, lower levels of vitamins A and E and worse QoL.

[Effect of the implementation of a program to improve referrals by primary care on appropriateness and wait times in endoscopic examinations]. / Efecto de la implantación de un programa de mejora de la capacidad resolutiva de atención primaria en la adecuación y la demora de las exploraciones endoscópicas.

INTRODUCTION: Within a program to improve referrals by primary care (PC) in Ourense (Spain), we implemented practice guidelines on dyspepsia and rectal bleeding. Our aim was to evaluate the reasons for referral to endoscopy, the appropriateness of these referrals, and wait times. MATERIAL AND METHODS: We performed a retrospective cohort study in the Ourense health area between February 2009 and January 2010. The endoscopies performed with the indications of dyspepsia and rectal bleeding requested directly from PC were compared with those referred initially to specialist care (SC). The reasons for the referral, the priority of the endoscopy, compliance with the protocol, endoscopic finding and the wait time from referral were gathered. RESULTS: During the period analyzed, 158 upper gastrointestinal endoscopies (SC: 121; PC: 37) and 243 colonoscopies (SC: 193; PC: 50) were performed with the indications of dyspepsia and rectal bleeding. Among endoscopies, 34.5% and 77.7% were requested with high priority from PC and SC, respectively (p<0.001). The criteria for referral were met in 86.5% of upper gastrointestinal endoscopies and in 82% of colonoscopies requested from PC. No differences were found in endoscopic findings. The median wait time from referral was lower in upper gastrointestinal endoscopy (PC: 105±5.5 days, SC: 174±17.8 days; p: 0.003) and colonoscopies (PC: 101±11.8 days, SC: 187±9.6 days; p<0.001) referred from PC. CONCLUSIONS: The use of the program for improved referrals by PC reduces wait times. The examinations requested complied with the indications.

Prevalence of exocrine pancreatic insufficiency in patients with chronic pancreatitis without follow-up. PANCR-EVOL Study / Prevalencia de insuficiencia pancreática exocrina en pacientes con pancreatitis crónica sin segruimiento. Estudio PANCR-EVOL

Background/objectives. Exocrine pancreatic insufficiency (EPI) is an important complication of chronic pancreatitis (CP). Guidelines recommend to rule out EPI in CP, to detect those patients who would benefit from pancreatic enzyme replacement therapy. The aim of this study was to evaluate the prevalence of EPI in patients with CP without follow-up in the last 2 years and to describe their nutritional status and quality of life (QoL). Methods. This was a cross-sectional, multicenter Spanish study. CP patients without follow-up by a gastroenterologist or surgeon in at least 2 years were included. EPI was defined as fecal elastase test <200mcg/g. For nutritional assessment, laboratory and anthropometric data were obtained. QoL was investigated using the EORTC QLQ-C30 questionnaire. Results. 64 patients (mean age 58.8±10.3 years, 85.9% men) from 10 centers were included. Median time since diagnosis of CP was 58.7 months [37.7-95.4]. Forty-one patients (64.1%) had EPI. Regarding nutritional status, the following differences were observed (EPI vs. Non-EPI): BMI (23.9±3.5kg/m2 vs. 25.7±2.5, p=0.03); glucose (121 [96-189] mg/dL vs. 98 [90-116], p=0.006); HbA1c 6.6% [6.0-8.4] vs. 5.5 [5.3-6.0], p=0.0005); Vitamin A (0.44mg/L [0.35-0.57] vs. 0.53 [0.47-0.63], p=0.048) and Vitamin E (11.2±5.0μg/ml vs. 14.4±4.3, p=0.03). EPI group showed a worse EORTC QLQ-C30 score on physical (93.3 [66.7-100] vs. 100 [93.3-100], p=0.048) and cognitive function (100 [83.3-100] vs. 100 [100-100], p=0.04). Conclusions. Prevalence of EPI is high in patients with CP without follow-up. EPI group had higher levels of glucose, lower levels of vitamins A and E and worse QoL (AU)

Antecedentes/objetivos. la insuficiencia pancreática exocrina (IPE) es una importante complicación de la pancreatitis crónica (PC). Las guías recomiendan el seguimiento de la IPE en PC, para identificar a aquellos pacientes que puedan beneficiarse del tratamiento enzimático sustitutivo. El objetivo de este estudio fue evaluar la prevalencia de IPE en pacientes con PC sin seguimiento en los últimos 2 años y describir su estado nutricional y calidad de vida (QoL). Métodos. estudio trasversal, multicéntrico, español. Se incluyeron pacientes con PC sin seguimiento por un gastroenterólogo/cirujano en los últimos 2años. Se definió IPE como elastasa fecal<200mcg/g. Se recogieron parámetros de laboratorio y datos antropométricos para el análisis nutricional. Para la evaluación de QoL se utilizó el cuestionario EORTC QLQ-C30. Resultados. se incluyeron prospectivamente 64 pacientes (58,8±10,3 años, media 85,9%) de 10 centros. Tiempo medio desde el diagnóstico de PC: 58,7meses [37,7-95,4]. 41 pacientes (64,1%) tenían IPE. Estado nutricional: se observaron las siguientes diferencias (IPE vs No-IPE): IMC (23,9±3,5kg/m2 vs. 25,7±2,5,p=0,03); glucosa 121 [96-189] mg/dL vs. 98 [90-116];p =0,006); HbA1c 6,6% [6,0-8,4] vs. 5,5 [5,3-6,0],p=0,0005); Vitamina-A (0,44mg/L [0,35-0,57] vs. 0,53 [0,47-0,63],p=0,048), Vitamina-E (11,2±5,0μg/ml vs. 14,4±4,3,p=0,03). El grupo de IPE mostró una peor puntuación en el EORTC QLQ-C30 en las funciones física (93,3 [66,7-100] vs. 100 [93,3-100], p=0,048) y cognitiva (100 [83,3-100] vs. 100 [100-100],p=0,04). Conclusiones. la prevalencia de IPE en pacientes con PC sin seguimiento es elevada. En el grupo de IPE se observaron niveles elevados de glucosa, bajos de vitaminas A y E y peor calidad de vida (AU)

Efecto de la implantación de un programa de mejora de la capacidad resolutiva de atención primaria en la adecuación y la demora de las exploraciones endoscópicas / Effect of the implementation of a program to improve referrals by primary care on

IntroducciónDentro del programa de aumento de capacidad resolutiva de atención primaria (AP) en Ourense se han implementado las guías de práctica clínica en dispepsia y rectorragia. Nuestro objetivo es evaluar los motivos de solicitud de las exploraciones, el nivel de adecuación de las solicitudes, los hallazgos endoscópicos y los tiempos de demora.Material y métodosEstudio de cohortes retrospectivo en el área sanitaria de Ourense entre febrero de 2009 y enero de 2010. Se analizaron las endoscopias realizadas con las indicaciones de dispepsia y rectorragia solicitadas directamente desde AP frente a las derivadas inicialmente a atención especializada (AE). Se recogieron los motivos de solicitud, el nivel de prioridad, la adecuación al protocolo, los hallazgos endoscópicos y los tiempos de demora desde la derivación.ResultadosEn el periodo analizado, se realizaron 158 endoscopias digestivas altas (EDA) (AE 121, AP 37) y 243 colonoscopias (AE 193, AP 50). Se solicitaron de forma preferente el 34,5% de las endoscopias de AP y el 77,7% de AE (p<0,001). El 86,5% de las EDA y el 82% de las colonoscopias solicitadas desde AP cumplieron los criterios de derivación. No se encontraron diferencias en los hallazgos. La mediana del tiempo de demora desde la derivación fue inferior tanto en la EDA (AP: 105±5,5 días; AE: 174±17,8 días; p: 0,003) como en la colonoscopia (AP: 101±11,8 días; AE: 187±9,6 días; p<0,001) solicitada desde AP.ConclusionesLa utilización del programa de aumento de capacidad resolutiva reduce los tiempos de demora. Las exploraciones solicitadas se han adecuado a las indicaciones (AU)

Introduction: Within a program to improve referrals by primary care (PC) in Ourense (Spain),we implemented practice guidelines on dyspepsia and rectal bleeding. Our aim was to evaluatethe reasons for referral to endoscopy, the appropriateness of these referrals, and wait times.Material and methods: We performed a retrospective cohort study in the Ourense health areabetween February 2009 and January 2010. The endoscopies performed with the indications ofdyspepsia and rectal bleeding requested directly from PC were compared with those referredinitially to specialist care (SC). The reasons for the referral, the priority of the endoscopy,compliance with the protocol, endoscopic finding and the wait time from referral were gathered.Results: During the period analyzed, 158 upper gastrointestinal endoscopies (SC: 121; PC: 37)and 243 colonoscopies (SC: 193; PC: 50) were performed with the indications of dyspepsiaand rectal bleeding. Among endoscopies, 34.5% and 77.7% were requested with high priorityfrom PC and SC, respectively (p < 0.001). The criteria for referral were met in 86.5% of uppergastrointestinal endoscopies and in 82% of colonoscopies requested from PC. No differenceswere found in endoscopic findings. The median wait time from referral was lower in uppergastrointestinal endoscopy (PC: 105±5.5 days, SC: 174±17.8 days; p: 0.003) and colonoscopies(PC: 101±11.8 days, SC: 187±9.6 days; p < 0.001) referred from PC.Conclusions: The use of the program for improved referrals by PC reduces wait times. Theexaminations requested complied with the indications (AU)