Revista Española de Enfermedades Digestivas

Gastro-esophageal reflux disease and irritable bowel syndrome: why are they associated?

Heartburn and other related symptoms are independent of body mass index in irritable bowel syndrome

Background: increasing body mass index (BMI) is a risk factor for GERD but little is known about this association in the irritable bowel syndrome (IBS). Aims: to determine the presence of heartburn and other related symptoms in relation with BMI in IBS. Methods: volunteers (n = 483) answered the Rome II-Modular Questionnaire, and were divided into IBS and non-IBS (controls) groups. The frequency of heartburn, chest pain, epigastric pain, nausea, vomiting and belching was compared between the groups in the study sample and within three BMI categories. Results: the IBS (23.7%) and controls (76.3%) were similar in gender (females: 68.1%), age (32.2 ± 12.7 years), and BMI (25.4 ± 4.4). Raw associations analysis showed that heartburn: OR: 1.62 (95%CI: 1.04-2.53), chest pain: 1.77 (1.13-2.77), epigastric pain: 1.75 (1.03-2.98) and nausea: 2.45 (1.10-5.32) were more frequent in IBS vs. controls. Meanwhile, according to BMI, in those with obesity, heartburn was more frequent in IBS and among those with overweight, epigastric pain and nausea were also more frequent in IBS. However, in an adjusted log linear model, no significant interaction was found between BMI and any other studied symptom and heartburn was found to be independent of IBS: 1,4 (0.9, 4.7). Finally, a logistic regression model found no interaction between BMI and the presence of heartburn or IBS. Conclusions: while heartburn and other reflux-related symptoms are more frequent in IBS than in controls, these associations are independent of BMI.

Predictive baseline criteria of primary therapeutic failure in chronic hepatitis C genotype 1

Background and aims: more than half of patients with genotype 1 chronic hepatitis C (CHC) do not achieve a sustained viral response (SVR) to current antiviral therapy due to primary non-response, relapse or intolerance. Factors related to each of these unfavorable outcomes are different and the last two may be partially prevented. Our aim was to identify basal criteria to predict the risk of primary failure. Patients and methods: we included 251 consecutive patients (152 males) from a single centre, infected with HCV genotype 1 and not previously treated. SVR was achieved in 141 patients and primary failure in 110. Results: high vs. low viral load (> 400,000 IU/mL, OR = 6.17; 95% CI: 2.50-15.23), high serum GGT (> 60 IU/mL, OR = 4.25; 95% CI: 2.49-7.24), low serum cholesterol (< 178 mg/dL, OR = 2.93; 95% CI: 1.75-4.92) and older age (> 47 yrs., OR = 1.79; 95% CI: 1.08-2.96) were associated to the risk of primary failure in the lineal logistic regression analysis. From the 58 patients carrying all the first three negative criteria, 46 (79.3%) were primary non-responders. Conclusions: the negative basal profile identified in this study is based on easily available data and provides information about the risk of primary therapeutic failure, and may help to decide whether antiviral therapy should be offered to a single patient.

Management of colonic volvulus: Experience in 75 patients

Background: the diagnostic and therapeutic management of colonic volvulus remains nowadays controversial. The election of the type of surgery, its timing, or the use of non-operative decompression must be based on the experience of a multidisciplinary team, the clinical condition of the patient, and the type of volvulus. Objectives: the purpose of this study is to review our experience and results in the treatment of patients with colonic volvulus. Material and methods: we performed a retrospective study of patients diagnosed of colonic volvulus between January 1990 and September 2008 in our institution. Results: we included a total of 75 patients with a mean age of 72.7 years and, in most cases, with associated comorbidities and constipation. The most frequently involved segment was sigmoid colon (85.3%). A rectal tube insertion was used as the only therapeutic measure in 17 patients (22.4%), colonoscopic decompression in 17 (22.4%), and surgery in 41 patients (55.2%). Intestinal resection with primary anastomosis was the most common surgical option. Postoperative morbidity was 43%, being wound infections the most frequent complication. In the group of non-surgical treatment morbidity was 26.4%, albeit with a higher and early rate of recurrences. Conclusions: treatment of colonic volvulus present important morbidity and mortality rates, and its treatment must be individualized. Resective surgery with primary anastomosis in clinically stable patients is the most appropriate therapeutic option, offering the lower recurrence rates.

Introducción: el manejo diagnóstico-terapéutico del vólvulo de colon continúa siendo un tema controvertido en la actualidad. En base a la situación clínica del paciente, a la experiencia de un equipo multidisciplinar, deben elegirse el tipo de cirugía, momento de su realización y el empleo de otras opciones descompresivas. Objetivos: los objetivos del presente trabajo son revisar nuestra experiencia y resultados en el tratamiento de los pacientes con vólvulo de colon. Material y métodos: hemos realizado un estudio retrospectivo descriptivo de los pacientes diagnosticados de vólvulo de colon entre enero de 1990 y septiembre de 2008 en nuestro centro. Resultados: se han incluido un total de 75 pacientes, de edad media 72,7 años y, en su mayoría, con comorbilidades asociadas y estreñimiento. La zona de volvulación más frecuentemente implicada fue el sigma (85,3%). La sonda rectal fue utilizada como única medida terapéutica en 17 pacientes (22,4%), el tratamiento endoscópico en otros 17 (22,4%), y la cirugía en 41 (55,2%). La resección intestinal con anastomosis primaria fue la opción quirúrgica más empleada. La morbilidad postoperatoria fue del 43%, siendo las infecciones de herida la complicación más frecuente. En el grupo de tratamiento no quirúrgico la morbilidad fue del 26,4%, aunque con una mayor y más precoz tasa de recidivas. Conclusiones: el vólvulo de colon presenta una elevada tasa de morbimortalidad asociada, debiendo realizarse su tratamiento de forma individualizada. La cirugía resectiva con anastomosis primaria en pacientes clínicamente estables es la opción terapéutica definitiva más adecuada y con menores tasas de recidiva.

Sedation with propofol controlled by endoscopists during percutaneous endoscopic gastrostomy

Background: propofol is a hypnotic used with increasing frequency for sedation during endoscopic procedures. Most of the reports published related with its employment by non-anaesthesiologists, refers to basic endoscopy, with little reference to its use in advanced endoscopy. Objective: to evaluate the efficacy and safety of propofol sedation administered by endoscopists, while performing percutaneous endoscopic gastrostomy, an advanced technique that is usually performed in high anesthetic level risk patients. Material and methods: prospective study of a series of endoscopic gastrostomy performed consecutively in our department; the sedation was carried out exclusively with propofol. The staff in the room consisted of two medical gastroenterologists, a nurse and a nursing assistant. Propofol was administered by bolus doses adjusted to patient weight. Arterial oxygen saturation, heart rate and blood pressure were monitored; respiratory activity was monitored visually by observing respiratory excursions of the patient. Results: we included 47 patients, with an average age of 82 years. 87% were ASA III and the rest, ASA IV. The mean dose of propofol was 51 mgr. Complications were recorded: 8 cases of desaturation and two of hypotension, all of them minor and quickly reversible. All procedures were carried out successfully, at a median time of 8 minutes. Conclusion: the propofol sedation carried out by non-anaesthesiologist trained staff, seems to appear as a safe and effective procedure while performing percutaneous endoscopic gastrostomy.

Introducción: el propofol es un hipnótico usado cada vez con más frecuencia para la sedación durante procedimientos endoscópicos. La mayor parte de los trabajos publicados en relación con su empleo por personal no anestesista se refiere a exploraciones de endoscopia básica, siendo escasas las referencias a su empleo en endoscopia avanzada. Objetivo: valorar la eficacia y la seguridad de la sedación mediante propofol administrado por endoscopistas, durante la realización de gastrostomía endoscópica percutánea, técnica avanzada y generalmente aplicada sobre pacientes de riesgo anestésico alto. Material y métodos: estudio prospectivo de una serie de gastrostomías endoscópicas realizadas consecutivamente en nuestro servicio; las sedaciones se llevaron a cabo exclusivamente con propofol. El personal presente en la sala consistió en dos médicos gastroenterólogos, una enfermera y una auxiliar de enfermería. El propofol se administró en bolos, ajustando las dosis al peso de los pacientes. Se monitorizaron la saturación arterial de oxígeno, la frecuencia cardiaca y la tensión arterial. La actividad respiratoria se controló de forma visual mediante la observación de las excursiones respiratorias de los enfermos. Resultados: se incluyeron 47 pacientes, con una edad media de 82 años. El 87% fueron ASA III y el resto ASA IV. La dosis media de propofol fue de 51 mg. Como complicaciones se registraron 8 casos de desaturación y dos de hipotensión, todas leves y rápidamente reversibles. Todos los procedimientos se llevaron a cabo satisfactoriamente, en un tiempo medio de 8 minutos. Conclusión: la sedación mediante propofol llevada a cabo por personal entrenado no anestesista parece mostrarse como un método seguro y eficaz durante la realización de gastrostomía percutánea endoscópica.

Barrett´s esophagus: a review

Metastatic malignant melanoma of duodenum: the tip of the iceberg

Hernia diafragmática de Morgagni-Larrey como causa de obstrucción intestinal en una paciente con síndrome de Marfan

Intraabdominal hemophilic pseudotumor: case report

Porphiria hepatocutánea tarda

Giant fibroid inflammatory polyp

Co-existing primary intra-abdominal and pelvic myxoid liposarcomas: report of a case

Liver necrosis secondary to organophosphates intoxication

Cholestatic syndrome due to labetalol

Primary colonic angiosarcoma as a cause of massive lower gastrointestinal bleeding

Schwannoma of the rectum: report of a case and review of the literature