Colorectal Cancer Prevention: Is Chat Generative Pretrained Transformer (Chat GPT) ready to Assist Physicians in Determining Appropriate Screening and Surveillance Recommendations?

OBJECTIVE: To determine whether a publicly available advanced language model could help determine appropriate colorectal cancer (CRC) screening and surveillance recommendations. BACKGROUND: Poor physician knowledge or inability to accurately recall recommendations might affect adherence to CRC screening guidelines. Adoption of newer technologies can help improve the delivery of such preventive care services. METHODS: An assessment with 10 multiple choice questions, including 5 CRC screening and 5 CRC surveillance clinical vignettes, was inputted into chat generative pretrained transformer (ChatGPT) 3.5 in 4 separate sessions. Responses were recorded and screened for accuracy to determine the reliability of this tool. The mean number of correct answers was then compared against a control group of gastroenterologists and colorectal surgeons answering the same questions with and without the help of a previously validated CRC screening mobile app. RESULTS: The average overall performance of ChatGPT was 45%. The mean number of correct answers was 2.75 (95% CI: 2.26-3.24), 1.75 (95% CI: 1.26-2.24), and 4.5 (95% CI: 3.93-5.07) for screening, surveillance, and total questions, respectively. ChatGPT showed inconsistency and gave a different answer in 4 questions among the different sessions. A total of 238 physicians also responded to the assessment; 123 (51.7%) without and 115 (48.3%) with the mobile app. The mean number of total correct answers of ChatGPT was significantly lower than those of physicians without [5.62 (95% CI: 5.32-5.92)] and with the mobile app [7.71 (95% CI: 7.39-8.03); P < 0.001]. CONCLUSIONS: Large language models developed with artificial intelligence require further refinements to serve as reliable assistants in clinical practice.

Management of colorectal cancer screening backlog due to the COVID-19 pandemic: A retrospective analysis of the use of a colorectal cancer screening clinical-decision support tool in Argentina.

BACKGROUND: The COVID-19 pandemic created a backlog in colorectal cancer (CRC) screening and surveillance colonoscopies. The real impact in Argentina is not fully known. GOAL: To estimate the impact of the COVID-19 pandemic on CRC prevention by comparing the number of CRC screening and surveillance consults in a clinical decision support-tool used in Argentina before, during and after pandemic lockdown. METHODS: We analyzed data from May 2019 to December 2021 from CaPtyVa, a clinical decision support tool for CRC screening and surveillance. Queries were divided in pre-pandemic (May 2019 to March 2020), lockdown (April 2020 to December 2020), and post-lockdown (January 2021 to December 2021). The number of CRC monthly screening and surveillance visits were compared among the three periods and stratified according to CRC risk. RESULTS: Overall, 27,563 consults were analyzed of which 9035 were screening and 18,528 were surveillance. Pre-pandemic, the median number of screening consults was 346 per month (IQR25-75 280-410). There was a decrease to 156 (80-210)/month (p<0.005) during lockdown that partially recovered during post-lockdown to 230 (170-290)/month (p=0.05). Pre-pandemic, the median number of surveillance consults was 716 (560-880)/month. They decreased to 354 (190-470)/month during lockdown (p<.05) and unlike screening, completely recovered during post-lockdown to 581 (450-790)/month. CONCLUSIONS: There was a >50% decrease in the number of CRC screening and surveillance consults registered in CaPtyVa during lockdown in Argentina. Post-lockdown, surveillance consults recovered to pre-pandemic levels, but screening consults remained at 66% of pre-pandemic levels. This has implications for delays in CRC diagnoses and patient outcomes.

Predictors of response to a dietary intervention in patients with irritable bowel syndrome.

BACKGROUND: Different diets have emerged as potential therapeutic options for patients with irritable bowel syndrome (IBS). OBJECTIVE: To identify predictors of improvement after a low-FODMAP, low-starch and low-sucrose diet among patients with IBS. METHODS: We performed a descriptive cross-sectional study including patients with IBS according to Rome IV criteria undertaking a social-media based program with a two-week dietary intervention. Patients completed an online survey before and after the intervention including the presence of intestinal and extra-intestinal symptoms, the IBS-SSS (irritable bowel syndrome symptoms severity scale) and the PHQ-9 (patient health questionnaire-9). Clinical improvement was defined as a decrease of at least 50% in IBS-SSS post dietary intervention. Variables associated with symptomatic response were identified with logistic regression analysis. A clinical score to predict response was created and tested with a with a receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 3583 patients with IBS were included. Mean IBS-SSS before and after dietary intervention was 295.5±52.32 and 240±48.66, respectively (p=0.01); 1178 (32.8%) patients showed clinical improvement. A mean basal IBS-SSS >400 (OR 3.04), chronic headache (OR 1.96), and chronic fatigue (OR 1.81) were significantly associated with symptomatic response. Patients with arthralgia (OR 0.41) and/or fibromyalgia (OR 0.33) were less likely to improve. Each variable received the following individuals scores: IBS-SSS >400: +2, chronic headache: +1.5, chronic fatigue: +1, arthralgia: -1, and fibromyalgia: -1. The ROC curve analysis of the proposed score showed an area under the curve of 0.72 (95% CI 0.69-0.76). A score ≥3 had a sensitivity of 72.64% and specificity of 60.56% for predicting symptomatic improvement. CONCLUSIONS: There are clinical variables that could serve as reliable predictors of response to a low-FODMAP, low-sucrose, low-starch diet among patients with IBS. Further research is needed to understand the link between the presence of extra-intestinal symptoms and clinical improvement after dietary interventions for IBS.

Endoscopic scoring system utilization for inflammatory bowel disease activity assessment: A multicenter real-world study from Argentina.

BACKGROUND: The frequency and patterns of use of scores for the assessment of endoscopic activity in inflammatory bowel disease patients are not known. AIM: To describe the prevalence of adequate use of endoscopic scores in IBD patients who underwent colonoscopy in a real-life setting. MATERIALS AND METHODS: A multicenter observational study comprising six community hospitals in Argentina was undertaken. Patients with a diagnosis of Crohn's disease or ulcerative colitis who underwent colonoscopy for endoscopic activity assessment between 2018 and 2022 were included. Colonoscopy reports of included subjects were manually reviewed to determine the proportion of colonoscopies that included an endoscopic score report. We determined the proportion of colonoscopy reports that included all of the IBD colonoscopy report quality elements proposed by BRIDGe group. Endoscopist's specialty, years of experience as well as expertise in IBD were assessed. RESULTS: A total of 1556 patients were included for analysis (31.94% patients with Crohn's disease). Mean age was 45.94±15.46. Endoscopic score reporting was found in 58.41% of colonoscopies. Most frequently used scores were Mayo endoscopic score (90.56%) and SES-CD (56.03%) for ulcerative colitis and Crohn's disease, respectively. In addition, 79.11% of endoscopic reports failed to comply with all recommendations on endoscopic reporting for inflammatory bowel disease. CONCLUSIONS: A significant proportion of endoscopic reports of inflammatory bowel disease patients do not include the description of an endoscopic score to assess mucosal inflammatory activity in a real-world setting. This is also associated with a lack of compliance in recommended criteria for proper endoscopic reporting.

Impact of an Educational Mobile App on Inflammatory Bowel Disease Colonoscopy Report Quality.

BACKGROUND: Inadequate endoscopic assessment of disease activity might lead to suboptimal treatment of patients with inflammatory bowel disease (IBD). AIMS: We aimed to determine if the implementation of an educational mobile app could help improving the quality of colonoscopy reports in patients with IBD. METHODS: We retrospectively analyzed a consecutive series of colonoscopy reports in patients with IBD during the period 2016-2023. The sample was divided into two groups: before and after the implementation of an educational mobile app (JEDII app ™). The main outcome was the inclusion of validated activity assessment scoring systems and previously stablished reporting required elements. RESULTS: A total of 883 IBD colonoscopy reports were included for analysis; 621 (70.3%) procedures were performed before the implementation of the app and 262 (29.7%) after. An IBD scoring system was included in 201 (32.4%) and 148 (56.5%) colonoscopy reports before and after the adoption of the mobile app, respectively (p < 0.001). The mean number of recommended elements for quality IBD colonoscopy reporting was significantly increased after the app implementation (4.3 vs. 1.9, p < 0.001). Diagnosis of ulcerative colitis, gastroenterologist as endoscopist, endoscopist with IBD clinical interest, and the implementation of the educational mobile app were independently associated with the inclusion of an IBD score in the colonoscopy report. CONCLUSION: The inclusion of scoring systems and recommended elements for quality IBD colonoscopy report significantly increased after the implementation of an educational mobile app. E-health technologies should be further explored to improve quality of care in patients with IBD.

Efficacy and tolerability of a low-residue diet for bowel preparation: systematic review and meta-analysis.

BACKGROUND: Colorectal cancer (CRC) contributes significantly to cancer mortality worldwide. In an effort to reduce the risk of death, detection of polyps through colonoscopy is crucial. The success of the colonoscopy depends on the diet administered the day before the test. Our aim was to evaluate the efficacy, tolerability, and adverse effects of bowel preparation when using a low-residual diet (LRD) compared to a clear-liquid diet (CLD) the day before a scheduled colonoscopy. METHODS: PubMed/Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched. We included studies of patients undergoing a scheduled colonoscopy for CRC screening and surveillance or for diagnostic purposes that compared a LRD with a CLD the day before the colonoscopy. Efficacy, the primary outcome, was evaluated as the rate of adequate bowel preparation. Secondary outcomes were tolerability and adverse effects of bowel preparation. RESULTS: Thirteen RCTs (N = 2587) were included. Patients receiving a LRD compared to a CLD showed no difference in adequate bowel preparations (RR 1.02; 95% CI 0.99-1.05; I2 = 60%). However, the LRD improved patient tolerability (RR 1.17; 95% CI 1.12-1.23; I2 = 66%) and had fewer adverse effects (RR 0.89; 95% CI 0.84-0.94; I2 = 73%) compared to the CLD. Groups using a LRD with 4L of polyethylene glycol in a single dose or a LRD with < 2000 kcal < 32 g of fibres/day had better tolerability. CONCLUSION: Based on these findings, our recommendation is strong in favour of a LRD for bowel preparation of patients undergoing a scheduled colonoscopy. This diet could also be useful as a preoperative colonic preparation, but this requires further research.

Prevalence of incidental clinically relevant pancreatic cysts at diagnosis based on current guidelines.

BACKGROUND: Most pancreatic cysts (PCs) found incidentally by CT and MRI scans might not be clinically important according to the Fukuoka guidelines, the American Gastroenterological Association (AGA) guidelines and European guidelines. AIMS: To determine and compare the prevalence of incidental clinically important PCs (CIPCs). METHODS: Abdominal contrast-enhanced CT or MRI scans performed during a one-year period were retrospectively reviewed to identify incidental PCs. CIPCs were defined as those cysts that would be capable of triggering further evaluation with endoscopic ultrasound, immediate surveillance (within 3-6 months) and/or surgery. Prevalence was calculated as the number of patients with CIPCs per 100 subjects imaged (%). RESULTS: Sixty patients (mean age 70±14 years) out of 565 were found to have incidental PCs, representing a prevalence of 8.7% (95% CI 6.3-11.5) in CT scans and 27.5% (95% CI 16-41) in MRI scans. Seven patients (11.6%, 95% CI 5-22) had CIPCs based on size ≥ 30mm (n=5), size ≥ 30mm and pancreatic duct (PD) dilation (n=1) and PD dilation and presence of solid component (n=1). Based on the Fukuoka guidelines, the prevalence of CIPCs was 1.2% (95% CI 0.4-2.5) in CT scans (6/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Based on the AGA and European guidelines, the prevalence of CIPCs was 0.2% (95% CI 0.1-1) in CT scans (1/507) and 1.7% (95% CI 0.1-9) in MRI scans (1/58). Patients with PCs initially classified as "AGA- or European-positive" had a higher surgical probability and this decision was taken earlier in the follow-up. CONCLUSIONS: In our cohort, the prevalence of important incidental pancreatic cysts was not negligible at around 1% according to current guidelines.

Risk of Metachronous Advanced Neoplastic Lesions in Patients with Sporadic Sessile Serrated Adenomas Undergoing Colonoscopic Surveillance.

OBJECTIVES: The risk of developing metachronous advanced neoplastic lesions (ANLs) during surveillance after resection of sessile serrated adenomas (SSAs) has not been quantified. METHODS: Patients with sporadic SSAs resected between 1 April 2007 and 31 December 2009 who underwent surveillance colonoscopy in our institution were prospectively evaluated. Patients with low-risk adenomas (LRAs), high-risk adenomas (HRAs), and negative index colonoscopy (NIC) during the same period were identified using the pathology database and electronic medical records, and were also included as a comparison cohort. The primary outcome was the comparison of the study groups with regard to incidence of metachronous ANLs during surveillance colonoscopy. RESULTS: A total of 185 patients had SSAs, of whom 75 with 101 resected polyps were finally included. The comparison cohort consisted of 564 patients: 140 LRAs (160 polyps), 87 HRAs (478 polyps), and 337 NICs. The overall mean colonoscopy follow-up was for 54.5 months (±s.d. 14). SSA patients with synchronous HRA on index colonoscopy presented a higher incidence rate of metachronous ANL (12.96 per 1,000 person-months) compared with patients with HRA (5.07 per 1,000 person-months), whereas those with synchronous LRA and without synchronous adenoma on index colonoscopy presented a low incidence rate of metachronous ANL (0 and 1.41 per 1,000 person-months, respectively) similar to LRA (1.47 per 1,000 person-months). Among patients with SSA the 3- and 5-year ANL free-cumulative probability was 64.3 and 32.1% in those with synchronous HRA, 100 and 100% in those with synchronous LRA, and 95.1 and 91.7% if no synchronous adenoma was found. CONCLUSIONS: Among patients with resected sporadic SSAs the risk of developing metachronous ANL is influenced by the presence of synchronous HRA on index colonoscopy. Patients with SSAs and synchronous HRA on index colonoscopy require closer surveillance, whereas those with synchronous LRA and those without synchronous adenomas may be followed up in the same way as those with LRAs.

Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy?

BACKGROUND AND AIM: Proximal colorectal cancer may arise from sessile serrated adenomas (SSAs). Recognition of these lesions during colonoscopy can optimize the endoscopic approach. We aimed to identify specific endoscopic features of SSA with conventional colonoscopy. METHODS: Patients undergoing screening colonoscopies from January 2011 to September 2012, in whom colonic polyps were found, were prospectively included in our study. Polyp morphology, location, polyp pit pattern (Kudo classification), and other previously reported features of SSA were evaluated. Histological examination was conducted independently by two pathologists. Multivariate analysis was performed to identify independent predictors of SSA. RESULTS: A total of 272 patients were included, and 440 polyps were evaluated (1.6 polyps per patient). Thirty-four polyps (8%) were SSA, 135 (31%) hyperplastic, and 249 (56%) adenomas. The most prevalent endoscopic features of SSA were right-side location (94%), type II Kudo pit pattern (91%), mucus cap (41%), flat morphology (29%) and red-colored surface (26%). Multivariate analysis revealed that flat morphology (p = 0.002, OR = 3.81 CI 1.53-9.09), red-colored surface (p < 0.001, OR = 12.97 CI 4.43-37.69), right-side location (p < 0.001, OR = 22.21 CI 5.09-135.94) and mucus cap (p < 0.001, OR 8.77 CI 3.76-20.44) were independent predictors of SSA. CONCLUSION: We were able to identify specific features of SSA during conventional colonoscopy, which may help to identify, and therefore to optimize the endoscopic approach of these lesions.

Prevalence of extra-intestinal symptoms according to irritable bowel syndrome subtype.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder commonly associated with extra-intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established. AIM: To compare the prevalence of extra-intestinal symptoms among patients with different subtypes of IBS. METHODS: A descriptive cross-sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS-SSS) to determine severity of IBS symptoms and patient health questionnaire- 9 (PHQ-9) to define presence and severity of depressive symptoms. The prevalence of reported extra-intestinal symptoms was also assessed and compared between groups. KEY RESULTS: A total of 4862 patients with IBS were included; 608 IBS-D (12.5%), 1978 IBS-C (40.7%), and 2276 IBS-M (46.8%). Patients with IBS-C had significantly lower IBS-symptoms severity (mean IBS-SSS 290 vs. 310 and 320 for IBS-D and IBS-M, respectively, p = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS-D and 27.9% IBS-M, p = 0.0001). Patients with IBS-D showed a significantly higher prevalence of food intolerance perception (9.5%, p = 0.03), history of cholecystectomy (17.8%, p = 0.03), and fecal incontinence (36.2%, p = 0.0001) as compared to the other groups. Patients with IBS-M had significantly higher mean PHQ-9 score (12.7 vs. 11.1 IBS-D and 10.5 IBS-C, p = 0.001) and prevalence of depressive symptoms (80.0%, p = 0.01). Patients with IBS-M also had higher prevalence of extra-intestinal symptoms such as arthralgia (62.4%, p = 0.0001), extremity numbness (64.5%, p = 0.0001), atopic dermatitis (28.2%, p = 0.02), and chronic cervicalgia (81.0%, p = 0.01). CONCLUSIONS & INFERENCES: The prevalence of most extra-intestinal symptoms is higher among patients with IBS-M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.

Effectiveness of Colonoscopy in Reducing Incidence of Late-stage Colorectal Cancer Within an Opportunistic Screening Program.

BACKGROUND: The effectiveness of colonoscopy in preventing colorectal cancer (CRC) within opportunistic screening programs has not been clearly established. The aim of this study was to analyze the effectiveness of colonoscopy within an opportunistic screening program using nested case-control study. METHODS: Subjects who received a diagnosis of CRC (CG) between the ages of 50 and 90 years were included and matched by age and gender in a 1:5 ratio with patients without CRC diagnosis (COG) during the period 2015 to 2023. Using conditional regression analyses, we tested the association between screening colonoscopy and CRC. Subgroup analyses were then performed for CRC location, endoscopist specialty, and colonoscopy quality. RESULTS: Of the 134 patients in CG, 19 (14.18%) had a colonoscopy in the preceding 5 years compared with 258 out of 670 (38.51%) in COG (AOR, 0.24; 95% CI: 0.14-0.41). Any colonoscopy was strongly associated with decreased odds for left-sided CRC (AOR, 0.09; 95% CI: 0.04-0.24) but not for right-sided CRC (AOR, 0.58; 95% CI: 0.29-1.17). Only complete colonoscopy (AOR, 0.41; 95% CI: 0.19-0.89) and colonoscopy with satisfactory bowel preparation (AOR, 0.38; 95% CI: 0.15-0.98) were associated with decreased odds for right-sided CRC. No significant differences in colonoscopy outcomes were found when stratifying by endoscopist specialty. CONCLUSIONS: In the setting of an opportunistic screening program, exposure to any colonoscopy significantly reduced left-sided CRC incidence; however, only high-quality colonoscopy was associated with a lower incidence of right-sided CRC. Therefore, every possible effort should be made to optimize the quality and cost-effectiveness of colonoscopy within an opportunistic screening program.

[Colorectal cancer screening with colonoscopy]. / La colonoscopia en la pesquisa de cáncer colorrectal.

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.

[Celiac disease and risk of colorectal neoplasia]. / Riesgo de cáncer colorrectal en pacientes con enfermedad celíaca.

BACKGROUND: Although small bowel and esophagus neoplasia are recognized to occur more frequently in patients with celiac disease, the association with colorectal cancer is still controversial. OBJECTIVE: To determine the risk of colorectal neoplasia among patients with celiac disease. METHODS: A case-control study was conducted using the gastroenterology and endoscopy unit electronic data base. Patients with celiac disease and colonoscopy were regarded as cases and those without celiac disease and colonoscopy as controls. Patients were matched for age, sex, colonoscopy purpose and family history of colorectal cancer. The main outcome was the risk of colorectal polyps, adenomas, advanced lesions and cancer. The risk was expressed as odds ratio (OR) with the respective 95% confidence intervals (95% CI). RESULTS: Out of 178 celiac disease patients, 44 were included as cases. Eighty-eight non-celiac patients were included as controls. In cases, the presence of polyps, adenomas and advanced colonic lesions was 20%, 16% and 4.5%, respectively. In controls, it was 15%, 9% and3.4%, respectively. The risk of polyps, adenomas and advanced colonic lesions was similar in both groups: OR 1.48 (95% CI 0.59-3.73), OR 1.89 (95% CI 0.66-5.42) and OR 1.34 (95% CI 0.26-7.05). No colorectal cancer was identified. CONCLUSION: The risk of colorectal neoplasia within this cohort of patients with celiac disease was similar to the control population.

[Prevalence of serrated adenomas of the colon and association with synchronic and metachronic neoplastic lesions]. / Prevalencia de adenomas serratos de colon y asociación con lesiones neoplásicas sincrónicas y metacrónicas.

OBJECTIVE: To determine the prevalence of serrated adenomas (SA), the frequency of high grade dysplasia (HGD) and adenocarcinoma in these polyps, and the association with synchronic (SNL) and metachronic neoplastic lesions (MNL). METHODS: Reports from patients undergoing colonoscopy and polypectomy from January 2003 to April 2010, were obtained from our electronic database. SA were reanalyzed by two pathologists and classified on the basis of Snover's diagnostic criteria. The prevalence of these polyps and the clinical and endoscopic features were determined. SNL were defined by adenomas, cancer or advanced neoplastic lesions (ANL) (> 1 cm, HGD and/or >75% of villous component) in the same colonoscopy. MNL were identified in patients who underwent surveillance colonoscopies. An univariate and multivariate analysis was performed, looking for independent predictors of HGD/ cancer, SNL and MNL in patients with SA. RESULTS: The prevalence of SA was 0.87%. The mean age was 60 years old and 50.5% of patients were women. Most of the polyps were sessile (67%), small (63%) and located in ceco-ascending colon (47%). We found HGD in 4.4% ofSA and no adenocarcinoma. SNL was found in 31% ofpatients: 46% adenomas, 40.5% ANL and 13.5% adenocarcinoma. MNL was found in 29% of patients: 25% SA, 31% adenomas, 44% ANL and 0% adenocarcinoma. Age over 60 years old was significantly associated with MNL [Odds ratio 3.7 (95% confidence interval 1.16-11.8)] and polyp's size higher than 1 cm with sessile SA histology [Odds ratio 8 (95% confidence interval 1.28-49.4)]. CONCLUSION: The prevalence of SA was low. We found an association with neoplastic lesions. Therefore, it is important to establish specific guidelines for the management of these polyps.

PULSE-HF: A Simple Clinical and Geriatric Score to Predict Systolic Dysfunction in the Elderly Without Heart Failure.

To develop a clinical score to determine preclinical predictors of systolic dysfunction in an outpatient elderly population without a diagnosis of heart failure (HF). PULSE-HF is a cross-sectional study in elderly at-risk (coronary artery disease, diabetes or hypertension) outpatients without a diagnosis of heart failure (HF). The objective in this population was to develop a clinical score to determine preclinical predictors of systolic dysfunction. Clinical and geriatric variables were analyzed; independent predictive factors in the logistic regression analysis were included for the score calculation. Of the 722 subjects enrolled, 47 (6.5%) had a left ventricular ejection fraction (LVEF) < 50%, and 15 (2.1%) a LVEF < 40%. Mean age was 76.5 years (5.18) and 445 (61.6%) were female. Multiple logistic regression analysis identified abnormal Q waves (odds ratio [OR]: 4.36; P = 0.003), cardiomegaly (OR: 3.32; P < 0.001), right bundle branch block (OR: 2.84; P = 0.011), cognitive dysfunction (OR: 2.14; P = 0.027) and NT-proBNP (OR 5.43; P < 0.001) as independent predictors of LVEF < 50%. Two prediction scores were built, without and with NT-proBNP inclusion; the area under ROC curves were 0.70 and 0.76, respectively. As the score increased, the sensitivity decreases but increases specificity, and accuracy (97.17% and 91.64% respectively in ≥6 points). NT-proBNP was associated with an increment in the performance (accuracy of 93.18% for score ≥10). We conclude that a simple score using clinical information might be useful to predicting asymptomatic systolic dysfunction in the elderly.

[Role of antibodies in celiac disease after one year of treatment to predict the adherence to gluten-free diet]. / Rol de los anticuerpos en la enfermedad celíaca luego de un año de tratamiento para predecir la adherencia a la dieta libre de gluten.

INTRODUCTION: The celiac disease (CD) is characterized by a permanent sensitivity to gluten. The treatment for this disease is the life-long strict compliance with a gluten-free diet (GFD). The average of compliance with GFD ranges between 15% and 80%. Antibodies' role in the follow up of these patients regarding the adherence to the GFD is not well established. Objective. To determine the relationship between the antibodies for CD and the adherence to the GFD in patients with over a year of treatment. MATERIAL AND METHODS: Patients with CD with a minimum of one year of GFD were prospectively included They were asked to complete a self-survey regarding to the compliance to GFD and the level of adherence was determined: low (no compliance or more than 2 gluten intakes per week), medium (1 or 2 gluten intakes per week or 2 or 3 gluten intakes per month), or high (1 gluten intake per month or less than 3 intakes per year). The follow up was performed by their general practitioners. From one year of GFD onwards, the results of the available antibodies at the time of the last follow up were assessed: antigliadine IgA (AGA) and IgG (AGG), anti-endomysium IgA (EMA) and IgG (EMG), anti-transglutaminase (ATG), and deaminated peptides of gliadine IgA and IgG, considering them as positive or negative. Through an univariate analysis, the above-mentioned antibodies were correlated (independent variables) in order to identify predicting factors of high and low adherence to the GFD (dependent variables). RESULTS: Ninety patients were analyzed, age 43.6 +/- 15.3 years old, 89% women, 58% classic celiacs. The average time of GFD was 7.9 years and 63% had been on a GFD for over 3 years. A 71% of patients (95% CI 69%-80%) showed high adherence to the GFD, and a 67% (95% CI 2%-13%) showed low adherence. GFD of less than 3 years was a determining factor for low adherence [relative risk (RR) 2.41 (95% CI 1.2-2.89)]. The predictive antibodies for GFD high adherence were: (1) negative EMA [RR 1.27 (95% CI 1.03-1.54)], (2) negative ATG [RR 1.62 (95% CI 1.12-2.47)], and (3) all negative requested ones [RR 1.60 (95% CI 1.17-2.18)]. The predictive antibodies for GFD low adherence were: (1) positive AGA [RR 15.5 (95% CI 2.29-105)], (2) positive EMA [RR 10.2 (95% CI 2.19-47.7)], (3) positive ATG [RR 9.63 (95% CI 1.53-63.4)], and 4) all negative requested ones [RR 0.11 (95% CI 0.018-0.71)]. CONCLUSION: After one year of treatment, the negativity of EMA or ATG antibodies had a significant correlation with the high adherence to GFD and the positivity of AGA, EMA or ATG antibodies had a significant correlation with a low adherence.

[Diffuse gastric cancer associated with Ménétrier's disease]. / Adenocarcinoma gástrico difuso asociado a enfermedad de Ménétrier.

BACKGROUND: Ménétrier's disease is a rare disease of the stomach generally described as hypertrophic gastropathy. Its etiology is unknown and its malignant potential is controversial. Only a few reports supporting its association with gastric cancer have been found. We present a case of gastric cancer associated with Ménétrier's disease. CASE REPORT: We present a 72 year-old-male with epigastric pain and early satiety during the last 5 months. He had been treated with proton pump inhibitors with unfavorable response and began with loss of weight and asthenia. An upper digestive endoscopy showed an erythematous nodular gastric mucosa, with enlarged folds. An abdominal CT scan demonstrated a circumferential parietal thickening of the gastric wall and adenopathies. A gastric macrobiopsy done by endoscopic mucosal resection evidenced a mucin infiltrating adenocarcinoma with invasion of the lamina propria. Subtotal gastrectomy was done. The histology showed a stomach with changes compatible with Ménétrier's disease and diffuse infiltration by a highly undifferentiated adenocarcinoma (plastic linitis). CONCLUSION: A patient with diffuse gastric adenocarcinoma and Ménétrier's disease is reported.

[Surveillance colonoscopy before scheduled: is it worthwhile?]. / Vigilancia colonoscópica antes de Lo estipulado: tiene alguna utilidad?

OBJECTIVE: To determine de incidence of colonic polyps in colonoscopies performed before scheduled and to identifY the clinical and endoscopic features that predicted this finding. METHODS: All patients who underwent at least two complete colonoscopies less than three years apart were retrospectively identified in our computerized database. We excluded patients with high risk of colonic neoplasm requiring a new colonoscopy in less than three years. We analyzed the incidence of polyps before the first and third year after the first study, and the clinical and endoscopic features related to this finding by means of multivariate logistic regression. RESULTS: 378 paired colonoscopies fulfilled criteria, 129 were performed less than one year apart (group 1), and 249 less than three years apart (group 2). Regarding surveillance colonoscopies, 19% of patients presented adenomas and 1.5% high grade dysplasia (HGD) in group 1, and 21% presented adenomas and 2% HGD in group 2. In group 1 fair preparation (P = 0.03), and prolonged colonoscopy (P = 0.02) on the first study were independent predictors to find any polyp on the second study before scheduled. In group 2 fair cleansing (P = 0.04), history of sessile polyps (P = 0.01) and 3 or more polyps in the first study (P = 0.01) were independent predictors to find any polyp, while more than 5 polyps in the first study predicate adenomas. CONCLUSION: During the first year incident polyps related to difficult procedures (missed polyps?) while at 3 years the history of previous polyps was also important.

Usefulness of a mobile app to improve performance of specialists in responding correctly to CRC screening and surveillance clinical scenarios.

Background and study aims The adherence to and knowledge of physicians about colorectal cancer (CRC) screening and surveillance guidelines is still suboptimal, threatening the effectiveness of CRC screening. This study assessed the usefulness of a mobile decision support system (MDSS) to improve physician ability to recommend proper timing of and intervals for CRC screening and surveillance. Patients and methods This was a binational, single-blinded, randomized clinical trial including gastroenterologists and colorectal surgeons from Argentina and Uruguay. The specialists were invited to respond to a questionnaire with 10 CRC screening and surveillance clinical scenarios, randomized into two groups, with and without access to a dedicated app (CaPtyVa). The main outcome measure was the proportion of physicians correctly solving at least 60 % of the clinical cases according to local guidelines. Results A total of 213 physicians were included. The proportion of physicians responding correctly at least 60 % of the vignettes was higher in the app group as compared to the control group (90 % versus 56 %) (relative risk [RR] 1.6 95 % confidence interval [CI] 1.34-1.91). The performance was also higher in the app group for both vignette categories: CRC screening (93 % vs 75 % RR 1.24, 95 %CI 1.01-1.40) and surveillance (85 % vs 47 % RR 1.81 95 %CI 1.46-2.22), respectively. Physicians considered the app easy to use and of great utility in daily practice. Conclusions A MDSS was shown to be a useful tool that improved specialist performance in solving CRC screening and surveillance clinical scenarios. Its implementation in daily practice may facilitate the adherence of physicians to CRC screening and surveillance guidelines.