Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding.

OBJECTIVE: We analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. METHODS: We retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. RESULTS: Capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. CONCLUSIONS: The performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.

Medida del tamaño de las lesiones con cápsula endoscópica: un problema por resolver / No disponible

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Public opinion survey after capsule endoscopy: patient s point of view on its utility.

AIM: When programming a medical test such as capsule endoscopy (CE), finding the closest point between the patient's experience and his/her expectation is essential to improve any further explorations. For this purpose we designed a form which tries to collect the information required. MATERIAL AND METHODS: From December 2003 to January 2005 we examined the small intestine of 98 patients with the help of CE. Later they were sent an anonymous questionnaire in July 2005, which included 10 questions upon the origin and previous knowledge of the patient about this technique, their tolerance to it, and the value they attached to it with regard to finding a new diagnosis and assigning different treatments, and also the incidence in the positive or negative evolution of their disease in particular and of medicine in general. RESULTS: Answer rate reached 58% and was slightly higher among women and people over 70 years; 80% of repliers had been informed about CE by a physician, while nearly all the rest had received previous information from the media; 37% had had symptoms for more than 12 months, while only 17% had suffered them for one month before the exploration. A bit over 30% did not know what the specific diagnostic field of the test was (most of them women and young people), although most of them were not surprised by the procedure. Over 75% showed "acceptable" or "excellent" tolerance, while 5.5% (most of them young people) found it hard to bear. The opinion about its utility in the diagnosis was 37%, and although 70% thought that CE had revealed nothing new about their pathology, over 60% declared feeling better after the test; 84% pointed out that it had achieved a breakthrough for their quality of life (most of them men and very old people), and only 13% thought it was worthless. However, nearly all the answers agreed in that CE was an "important" or "very important" diagnostic device. CONCLUSIONS: After the test using CE, the diagnostic benefit detected by the patient is not the same as that shown by technical studies. Nevertheless, the test can be highly satisfactory for the patient in particular, and also in an overall view. CE is a well-tolerated test, applied in our setting to chronic diseases and that, contrary to what we supposed, is explained to patients mainly by a physician. Most of them are not familiar with its specific indications.

Encuesta de opinión tras estudio con cápsula endoscópica: percepción de su utilidad por el enfermo / Public opinion survey after capsule endoscopy: patient s point of view on its utility

Objetivo: a la hora de programar la realización de una pruebacomo la cápsula endoscópica, la máxima aproximación entre laexperiencia que le supuso al enfermo y sus expectativas es vitalpara mejorar en futuras exploraciones.Con este fin, hemos diseñado un formulario que trata de recogeresta información.Material y métodos: de diciembre del 2003 a enero del2005 se estudió el intestino delgado mediante cápsula endoscópicaen 98 enfermos. Se les envió un cuestionario anónimo de 10preguntas en julio del 2005 que incidía en aspectos relacionadoscon el origen y la información previa del paciente respecto a latécnica, el tiempo de presencia de sus síntomas, la tolerancia y elvalor atribuido en cuanto al hallazgo de nuevos diagnósticos, instauraciónde tratamientos diferentes y la evolución positiva o node su enfermedad y de la medicina en general.Resultados: la tasa de respuesta llegó al 58%, siendo algo superioren mujeres y mayores de 70 años. El 80% de los respondedoreshabían conocido la cápsula endoscópica por un médico especialista,mientras que en la casi totalidad del resto fue a travésde los medios de comunicación. Un 37% tenía síntomas desde hacíamás de 12 meses, refiriendo menos de un 17% haberlos padecidosólo durante el mes previo a la exploración. Algo más de un30% no sabían cuál era el campo diagnóstico específico de laprueba (sobre todo mujeres y jóvenes), aunque la mayoría no sesorprendió por el procedimiento de ejecución. Más del 75% manifestaronuna tolerancia buena o muy buena, encontrándola durade soportar sólo un 5,5% (jóvenes principalmente). La percepciónde utilidad diagnóstica se sitúa en un 37%, y, aunque el 70%creían que la cápsula endoscópica no había conseguido ningunanovedad en el abordaje de su patología, algo más del 60% reconocíanencontrarse mejor tras su realización. El 84% señaló quehabía supuesto un paso importante o muy importante en su calidadde vida (sobre todo varones y edades extremas), con sólo un13% que calificó su valor como nulo. Sin embargo, casi la totalidadde las respuestas apuntaron que veían a la cápsula endoscópicacomo un método diagnóstico importante o muy importante enel arsenal tecnológico médico.Conclusiones: tras la ejecución de una cápsula endoscópica,la rentabilidad diagnóstica percibida por el enfermo no coincidecon la reflejada en estudios de competencia técnica. Sin embargo,la prueba es capaz de originar una amplia adherencia y satisfacciónen el paciente de manera personal y en una visión general.La cápsula endoscópica es una exploración bien tolerada, aplicadaen nuestro medio en el estudio de entidades crónicas y que,al contrario de lo presumido, llega a ser conocida en los sujetossobre los que se realiza sobre todo a través de un médico especialista.Un gran porcentaje desconoce su indicación específica

Aim: when programming a medical test such as capsule endoscopy(CE), finding the closest point between the patient’s experienceand his/her expectation is essential to improve any furtherexplorations.For this purpose we designed a form which tries to collect theinformation required.Material and methods: from December 2003 to January2005 we examined the small intestine of 98 patients with thehelp of CE. Later they were sent an anonymous questionnaire inJuly 2005, which included 10 questions upon the origin and previousknowledge of the patient about this technique, their toleranceto it, and the value they attached to it with regard to findinga new diagnosis and assigning different treatments, and also theincidence in the positive or negative evolution of their disease inparticular and of medicine in general.Results: answer rate reached 58% and was slightly higheramong women and people over 70 years; 80% of repliers hadbeen informed about CE by a physician, while nearly all the resthad received previous information from the media; 37% had hadsymptoms for more than 12 months, while only 17% had sufferedthem for one month before the exploration. A bit over 30% didnot know what the specific diagnostic field of the test was (most ofthem women and young people), although most of them were notsurprised by the procedure. Over 75% showed “acceptable” or“excellent” tolerance, while 5.5% (most of them young people)found it hard to bear. The opinion about its utility in the diagnosiswas 37%, and although 70% thought that CE had revealed nothingnew about their pathology, over 60% declared feeling betterafter the test; 84% pointed out that it had achieved a breakthroughfor their quality of life (most of them men and very oldpeople), and only 13% thought it was worthless. However, nearlyall the answers agreed in that CE was an “important” or “very important”diagnostic device.Conclusions: after the test using CE, the diagnostic benefitdetected by the patient is not the same as that shown by technicalstudies. Nevertheless, the test can be highly satisfactory for thepatient in particular, and also in an overall view.CE is a well-tolerated test, applied in our setting to chronic diseasesand that, contrary to what we supposed, is explained to patientsmainly by a physician. Most of them are not familiar with itsspecific indications

Fístula colédoco-renal en colangiocarcinoma localmente avanzado / Choledocho-renal fistula in locally advanced cholangiocarcinoma

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Patrón de ingesta en un grupo de pacientes con síndrome de intestino irritable; relación de la ingesta de fibra con los síntomas / Dietary intake of a group of patients with irritable bowel syndrome; relation between dietary fiber and symptoms

Objetivos: El objetivo de nuestro estudio fue evaluar la ingesta de un grupo de pacientes con síndrome de intestino irritable y compararla con las ingestas internacionales recomendadas. Pacientes y métodos: Se incluyeron un total de 53 pacientes con síndrome de intestino irritable seleccionados con un muestreo no probabilístico consecutivo. Los pacientes habían sido diagnosticados de síndrome de intestino irritable (SII) siguiendo los Criterios de Roma II. A todos los pacientes se les determinó el peso, talla, índice de masa corporal, encuesta dietética de 3 días y un test de evaluación de síntomas. Resultados: Los 53 pacientes pesentaban una edad media de 45,67+13,6 años y una distribución por sexo de (22 varones/31 mujeres). La ingesta calórica total fue adecuada en valores absolutos y al corregir por peso del paciente. La distribución de calorías fue un 41,5 por ciento en forma de carbohidratos, un 19,8 en proteinas y un 38,7 por ciento en lípidos, estos datos muestran un claro exceso en el consumo de grasas y defecto en el consumo de hidratos de carbono. Existió una baja ingesta de vitaminas A y D. La ingesta de vitamina B12, vitamina C y niacina fue superior que las recomendaciones internacionales. Con respecto a los minerales, existió un claro déficit de la ingesta de calcio, magnesio, yodo y zinc. Al realizar el análisis en fibra soluble e insoluble, la primera fue inferior (fibra soluble 1,46 ± 0,74 g/día) (19 por ciento), la fibra insoluble representó 6,21 ± 2,67 g/día (71 por ciento). La ingesta corregida de fibra por calorías fue baja 4,5 ± 1,2 por cada 1.000 calorías. En el análisis de correlación sólo se correlacionó la fibra insoluble (r=-0,46; p < 0,05) y la fibra soluble (r=0,42; p < 0,05) con el factor general del sistema de puntuación y no existieron relaciones significativas con el resto de factores del sistema de puntuación. Conclusiones: Los pacientes con síndrome de intestino irritable presentan una desviación de las ingestas de algunos minerales y vitaminas. La ingesta de fibra es pobre, existiendo una correlación entre la baja ingesta y la severidad de los síntomas generales de la enfermedad (AU)

[Dietary intake of a group of patients with irritable bowel syndrome; relation between dietary fiber and symptoms]. / Patrón de ingesta en un grupo de pacientes con síndrome de intestino irritable; relación de la ingesta de fibra con los síntomas.

OBJECTIVES: The aim of our study was to evaluate the oral dietary intake of a group of patients with irritable bowel syndrome and to compare with international recommendations. PATIENTS AND METHODS: A total of 53 patients with irritable bowel syndrome was enrolled in a non-propabilistic sample. Patients were diagnose with Roma II criteria. In all patients were determined, weight, height, body mass index, dietary intake of 3 days and a symptoms scoring system. RESULTS: The average age of 53 patients was 45.67+/-13.6 years with a distribution of sex (22 males/31 females). Caloric intakes was right in absolute terms and corrected by weight. Distribution of calories was 41.5% of carbohydrates, a 19.8% of proteins, and a 38.7% of lipids, showing a high intake of lipids and low of carbohydrates. A low intake of vitamin A and D was detected. High intake of vitamin B12, vitamin C and niacine was observed. A low intake of calcium, magnesium, yodo and zinc was detected. Intake of soluble fiber was lower than insoluble fiber (1.46+/-0.74 g/day) (19%) vs 6.21+/-2.67 g/day (71%). Intake of fiber corrected by calories was low 4.5+/-1.2 g/1000 calories. In correlation analysis, insoluble fiber (r=0.46; p < 0.05) and soluble fiber (r=0.42; p < 0.05) were inverse correlated with general symptoms. CONCLUSIONS: Patients with irritable bowel syndrome showed a deviation of mineral and vitamin dietary. Fiber intake is low, a correlation between fiber intake and general symptoms was detected.