Comparison of Controlling Nutritional Status Score with Bedside Index for Severity in Acute Pancreatitis Score and Atlanta Classification for Mortality in Patients with Acute Pancreatitis.

Background/Objectives: Acute pancreatitis (AP) is characterized by pancreatic gland inflammation, and its clinical course ranges from mild to severe. Predicting the severity of AP early and reliably is important. In this study, we investigate the potential use of the Controlling Nutritional Status (CONUT) score as a prognostic marker in acute pancreatitis. Methods: We examined 336 patients who had been hospitalized with an AP diagnosis in the internal medicine clinic. The patients included in the study were followed up for 5 years. The study analyzed the specific variables of age, gender, and AP etiology as recorded biochemical parameters for all study participants and calculated the effects of age, sex, Bedside Index of Severity in AP (BISAP), the revised Atlanta classification, and the CONUT score on mortality. Results: When compared with surviving patients, non-surviving patients had higher scores for BISAP, CONUT, and the Atlanta Classification (p ˂ 0.001). In the non-surviving group, hemoglobin, lymphocyte, and albumin levels were significantly lower and creatinine, uric acid, and procalcitonin levels were significantly higher compared to the surviving group (p ˂ 0.001, 0.003, ˂0.001, ˂0.001, 0.005, ˂0.001, respectively). The multivariate analysis showed a significant association of mortality with age, CONUT, and BISAP scores (p ˂ 0.003, 0.001, 0.012 respectively). The CONUT score was separated into two groups based on the median value. The predicted survival time in the group with a CONUT score > 2 (53.8 months) was significantly lower than in the group with a CONUT score ≤ 2 (63.8 months). The cumulative incidence of all-cause mortality was significantly higher in the patients with higher CONUT scores. Conclusions: This study has assigned the CONUT score as an independent risk factor for mortality in AP.

El curso endoscópico de manchas blancas dispersas en la porción descendente del duodeno: un estudio prospectivo / The endoscopic course of scattered white spots in the descending duodenum: A prospective study

Objetivo Las manchas blancas dispersas (MBD) en la porción descendente del duodeno son un hallazgo poco frecuente en la endoscopia del sistema digestivo superior (ESDS). Las MBD se han asociado con linfangiectasia intestinal, duodenitis crónica inespecífica y giardiasis. El objetivo de este estudio fue determinar la frecuencia de hallazgos de MBD en endoscopias rutinarias, así como evaluar el efecto del tratamiento de dicho hallazgo. Material y métodos Se incluyeron de forma prospectiva a pacientes sometidos a ESDS con MBD en el duodeno. La apariencia de las MBD se clasificó mediante endoscopia, de acuerdo con la densidad, después de dividir a los pacientes en dos grupos: grupo 1 (grupo tratado) y grupo 2 (grupo sin tratar). Los pacientes con infección por Helicobacter pylori recibieron un tratamiento de erradicación, mientras que a los pacientes con linfangiectasia intestinal se les recomendó una dieta. Los pacientes con gastritis y negativos en H. pylori iniciaron un tratamiento con inhibidores de la bomba de protones. Todos los pacientes volvieron a ser evaluados 3 meses después del inicio del tratamiento para detectar cambios en la presencia de MBD. Resultados se observaron MBD en 97 pacientes (3,2%) de los 3.010 incluidos en el estudio. Las MBD se asociaron más comúnmente con duodenitis crónica inespecíficas, seguida de linfangiectasia intestinal. En el grupo sin tratamiento, no se observaron cambios estadísticamente significativos en el aspecto de la MDB, pero se observó una disminución estadísticamente significativa de la densidad en el grupo tratado (p<0,001). Conclusión La prevalencia de MBD durante ESDS rutinaria fue del 3,2%. Este hallazgo se asoció más frecuentemente con duodenitis crónica inespecífica y linfangiectasia intestinal. El tratamiento de las causas subyacentes, entre ellas la erradicación de H. pylori, los inhibidores de la bomba de protones y la dieta, disminuyeron la densidad de ESDS (AU)

Aim Scattered white spots (SWSs) in the descending duodenum are an uncommon finding of upper gastrointestinal system endoscopy (UGSE). Intestinal lymphangiectasia, chronic nonspecific duodenitis and giardiasis are associated with a SWS appearance. The aim of this study was to determine the frequency of SWS during routine endoscopy, as well as to evaluate the effect of treatment on this finding. Materials and methods Patients undergoing UGSE with a SWS appearance in the descending duodenum were included prospectively. Appearance of SWSs was graded endoscopically based on density, after which patients were divided into two groups; group 1 (treated group) and group 2 (untreated group). Patients with Helicobacter pylori infection were given eradication therapy, whereas a diet was recommended to patients with intestinal lymphangiectasia. Proton pump inhibitors were initiated for patients with H. pylori negative gastritis. All patients were re-evaluated three months after therapy for the presence of any changes in the SWS appearance. Results SWSs were observed in 97 (3.2%) out of 3010 patients. This appearance was most commonly associated with chronic non-specific duodenitis followed by intestinal lymphangiectasia. While in the untreated group no statistically significant change in SWS appearance was observed, the decrease in endoscopic grade seen in the treated group was statistically significant (p<0.001).Conclusion The prevalence of SWSs during routine UGSE was 3.2%, with this finding being more commonly associated with chronic non-specific duodenitis and intestinal lymphangiectasia. Treatment of the underlying causes, including H. pylori eradication, proton pump inhibitors and diet decreased the density of the SWS (AU)