Revista Española de Enfermedades Digestivas

Clinical value of gene NOD2/CARD15 mutations in Crohn's disease

Association of NOD2/CARD15 mutations with previous surgical procedures in Crohn's disease

Objective: the aim of this study is to assess the importance of NOD2/CARD15 gene mutations as prognostic factors for surgical indications in Crohn's disease. Patients and experimental design: a total of 165 Crohn's disease patients were studied, considering previous surgery related to Crohn´s disease. We analyzed for previous surgery in global procedures as well as separately for the two main surgical indications: ileal resection and fistula treatment. The need for appendectomy was also studied. All patients were genotyped for the three CARD15 mutations, and association studies were developed using Chi-square statistics and Fisher's exact test whenever appropriate. Results: carriers of the G908R or 1007fs mutation needed surgery more frequently, both for ileal resection and fistula repair. In contrast, appendectomy was not associated with CARD15 mutations. Conclusions: as previously reported in this population, the R702W mutation does influence parameters of disease or need of surgery. The need for Crohn's disease-related surgery is higher in carriers of the G908R or 1007fs CARD15 mutation in the Galician population. Nevertheless, the frequency of these mutations does not allow their use to predict the course of disease.

Objetivo: conocer la influencia de las principales mutaciones descritas en el gen NOD2/CARD15 en la cirugía asociada a la enfermedad de Crohn. Pacientes y diseño experimental: se estudió un total de 165 pacientes con enfermedad de Crohn, analizándose los antecedentes de cirugía de estos pacientes en relación con su enfermedad, se analizaron los antecedentes de cirugía en global e, individualmente, de las dos formas principales de cirugía, resección ileal y cirugía de las fístulas. Se estudió también la necesidad de apendicectomía. Todos los pacientes fueron genotipados para las tres mutaciones del gen CARD15 y se llevaron a cabo estudios de asociación mediante el empleo de test Chi cuadrado o test exacto de Fisher cuando este fue necesario. Resultados: individuos portadores de las mutaciones G908R o 1007fs requieren cirugía con mayor frecuencia, tanto sea esta considerada de forma global como en resección ileal y cirugía de fístulas individualmente. Por el contrario la apendicectomía no aparece asociada significativamente al gen CARD15. Conclusiones: la necesidad de cirugía asociada a enfermedad de Crohn, es mayor en pacientes que portan las mutaciones G908R o 1007fs del gen CARD15. Sin embargo, la mutación R702W parece no influir en población gallega. La influencia de esas dos mutaciones no es, sin embargo, suficiente como para que puedan ser utilizadas con fines predictivos.

Reliability of the Spanish version of a brief questionnaire on patient satisfaction with gastrointestinal endoscopy

Background: there has not been a validated questionnaire available in Spanish to evaluate patient satisfaction with gastrointestinal endoscopy. Our aim was to evaluate the external validity and internal consistency of the Spanish version of a questionnaire on patient satisfaction with gastrointestinal endoscopy elaborated by the American Society for Gastrointestinal Endoscopy. Design: prospective questionnaire validation study. Patients and methods: a total of 485 consecutive patients referred to two different hospitals for endoscopy were interviewed by telephone. Internal consistency was studied using Cronbach's alfa test and corrected item-total correlations (CITC). External validity was determined using a mailed questionnaire completed by 185 patients -correlations between telephone and postal responses were calculated, as well as the correlation with the total score obtained. Results: Cronbach´s alfa was 0.82 and mean CITC was 0.59. Weighted kappa values for the same questionnaire items performed by telephone or mail varied between 0.51 and 0.81. Total score correlation was 0.78. Internal consistency and external validity were not affected by differences in the administration of the questionnaire (mail or by telephone), different interviewers, type of endoscopy, or source of patients. Conclusions: the Spanish version of the ASGE questionnaire on satisfaction with endoscopy is valid, reliable, and reproducible.

Objetivos: no se dispone en castellano de un cuestionario validado para la valoración de la satisfacción del paciente en endoscopia digestiva. Evaluar la validez externa y la consistencia interna de la versión en castellano del cuestionario recomendado por la American Society for Gastrointestinal Endoscopy sobre satisfacción en endoscopia. Diseño experimental: estudio de validación de un cuestionario, recogida de datos prospectiva. Pacientes y métodos: cuatrocientos ochenta y cinco pacientes consecutivos remitidos para endoscopia a dos hospitales diferentes fueron entrevistados telefónicamente. La validez interna se estudió mediante alfa de Cronbach y correlación total inter-ítem media. Para estimar la validez externa se remitió un cuestionario anónimo a 185 pacientes y se calcularon las correlaciones entre las respuestas dadas telefónicamente y por correo, así como la correlación en la puntuación global obtenida mediante la suma de los valores para las siete cuestiones del cuerpo principal del cuestionario. Resultados: la alfa de Cronbach fue de 0,82 y la CTITM de 0,59. La kappa ponderada entre las mismas cuetiones en los cuestionarios administrados telefónica o anónimamente variaron entre 0,51 y 0,81. La correlación en la puntuación total fue de 0,78. La validez interna y externa no se vio afectada por diferencias en la administración del cuestionario (correo o telefónico), los diferentes entrevistadores, el tipo de endoscopia o la procedencia de los pacientes. Conclusiones: la versión en castellano del cuestionario recomendado por la ASGE sobre satisfacción en endoscopia es válida, fiable y reproducible.

Total gastrectomy with or without abdominal drains. A prospective randomized trial

The most common postoperative complications of total gastrectomy are esophagojejunal anastomotic leakage and subphrenic abscess. These complications are a cause of morbility and mortality, relaparotomy, and longer postoperative stay. The use of abdominal drains is useful for the early diagnosis and management of anastomotic leaks. The aim of this study was to analyze our experience with total gastrectomy for gastric cancer in patients with and without abdominal drains, and to evaluate the results regarding postoperative morbidity, postoperative hospital stay, postoperative days for oral intake, relapatorotomy and mortality. This prospective and randomized study examines the results in 60 consecutive patients (43 males and 17 females) with gastric cancer who underwent total gastrectomy in the Regional Clinical Hospital of Concepción, Chile, between 2000 and 2003. Patients were divided into two groups: group I (without drains) and group II (two drains). We found 31 patients in group I and 29 patients in group II. The mean length of postoperative stay was 12.9 days in group I and 18.8 days in group II (p = 0.0242, s.). Morbidity was 9.7% in group I and 37.9% in group II (p = 0.0242, s.). Re-explorations were more frequent in group II (24.1%) versus group I (9.7%) (p = 0.1239, n.s.). Postoperative days for oral intake were 9.4 in group I and 12.8 in group II (p = 0.0514, n.s.) Mortality was 0% in group I and 3.4% in group II (p = 0.4833, n.s.). In our experience, morbidity and postoperative hospital stay were statistically higher in the group of patients with abdominal drains.

Probiotics in arthralgia and spondyloarthropathies in patients with inflammatory bowel disease: Prospective randomized trials are necessary

Arthralgias and spondyloarthropathies of the peripheral and axial joints are common in inflammatory bowel disease. Evidence for a strong association between these clinical manifestations and diseases of the joints has been provided by several clinical and epidemiological studies. Immunological studies have shown the presence of shared inflammatory cells both in the gut and the synovium in spondyloarthropathies. Genetic factors play a crucial role in the pathogenesis of spondyloarthropathies and inflammatory bowel disease. The role of the ubiquitous bacterial flora and pathogenic microorganisms present in the intestinal lumen may induce these joint diseases in patients with inflammatory bowel disease. In this review we will focus on the pathogenesis of spondyloarthropathies and arthralgia in patients suffering from inflammatory bowel disease. Based on preliminary clinical observations in patients with arthralgia and IBD, we put forward the hypothesis that probiotics may be helpful in the management of common extraintestinal manifestations such as arthralgia in patients with ulcerative colitis and Crohn's disease.

IL-6 and extracellular matrix remodeling

Bruising of the esophagus as a cause of gastrointestinal bleeding in a case of heatstroke

Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC) after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.

Las alteraciones de la coagulación son una complicación frecuente en el golpe de calor grave, y pueden ser causa de hemorragia digestiva. Presentamos el caso de un varón de 26 años que fue admitido en nuestro hospital por un cuadro de hipertermia, asociado con encefalopatía y coagulación intravascular diseminada tras exposición solar prolongada. Presentó hematemesis por la que fue diagnosticado de múltiples hematomas esofágicos que ocupaban los tercios superior e inferior del órgano, en ausencia de otras lesiones en estómago y duodeno. Tras el tratamiento de soporte y la resolución de la patología subyacente, desaparecieron las lesiones endoscópicas, normalizándose la mucosa esofágica.

Tracheo-esophageal fistula in a patient with esophageal cancer and stent

Colitis ulcerosa

Spontaneous bacterial peritonitis by Listeria monocytogenes in a patient with liver cirrhosis

Fecal incontinence and female's pelvis floor: a need for a complete diagnosis

Recurrent gastric inarceration in long-term umbilical hernia

A new multilocular ciliated hepatic foregut cyst: A report review

Familiar penetrancy of HFE gene: four brothers of the same family affected by hereditary haemochromatosis