[Effect of Helicobacter pylori eradication on patients with functional dyspepsia]. / Efecto del tratamiento erradicador para Helicobacter pylori en pacientes con dispepsia funcional.

OBJECTIVE: This study evaluated Helicobacter pylori eradication therapy in terms of symptomatic response in patients with functional dyspepsia. On the other hand, we analyzed the importance of histologic findings as a predictor of treatment response. In particular, we studied whether antral gastritis (which is associated with peptic ulcer) may predict a greater symptomatic response to Helicobacter pylori eradication in functional dyspepsia. PATIENTS AND METHODS: This prospective, randomized, single-center trial included 48 patients with functional dyspepsia and Helicobacter pylori infection (27 women and 21 men, mean age 37 +/- 13.5 years). Twenty-seven patients received a 10-day course of rabeprazole, amoxicillin, and clarithromycin (eradication group), followed by 20 mg of rabeprazole for 3 months. Twenty-one patients received 20 mg of rabeprazole for 3 months (control group). Patients were followed up over a 1-year period. All patients completed the Dyspepsia-Related Health Scale Questionnaire, which studies four dimensions: pain intensity, pain disability, non-pain symptoms, and satisfaction with dyspepsia-related health. RESULTS: There was significant symptomatic improvement (p < 0.002) after 6 and 12 months, which was similar with both treatments. In the multivariate analyses, eradication therapy and less severe symptoms before treatment were the only independent factors. The symptomatic response to Helicobacter pylori eradication after 6 months was significantly greater as compared to control therapy (p = 0.01) in patients with antral gastritis and in the non-pain symptoms dimension of the questionnaire. CONCLUSIONS: Both treatments proved to be clinically beneficial in patients with functional dyspepsia. We observed a tendency to greater symptomatic benefit with Helicobacter pylori eradication therapy when compared to control treatment in patients with functional dyspepsia and in a population with a high prevalence of this infection. There is a tendency to symptomatic benefit with Helicobacter pylori eradication therapy in patients with antral gastritis.

Efecto del tratamiento erradicador para Helicobacter pylori en pacientes con dispepsia funcional / No disponible

Objetivo: este estudio ha tenido un doble objetivo: por unlado, evaluar el efecto del tratamiento erradicador para Helicobacterpylori en la respuesta sintomática de pacientes diagnosticadosde dispepsia funcional y, por otro, determinar si los hallazgoshistológicos podían servir como predictor de la efectividad dela terapia. En particular, se trató de averiguar si la presencia degastritis antral (la que se asocia a la enfermedad ulcerosa péptica)podría predecir una mayor respuesta sintomática al tratamientoerradicador en los pacientes con dispepsia funcional e infecciónpor Helicobacter pylori.Pacientes y métodos: estudio prospectivo, monocéntrico yaleatorizado, que incluyó a 48 pacientes con dispepsia funcional einfección por Helicobacter pylori (27 mujeres y 21 hombres, conedad media de 37 ± 13,5 años). Veintisiete pacientes recibieronel tratamiento erradicador (rabeprazol, claritromicina y amoxicilinadurante 10 días, seguido de 20 mg/día de rabeprazol 3 meses)y 21 el tratamiento control (20 mg/día de rabeprazol 3 meses).Los pacientes fueron seguidos durante un año. Todos rellenaronel Cuestionario de calidad de vida asociada a dispepsia, queevalúa cuatro apartados: intensidad de los síntomas habituales, intensidaddel dolor de estómago, incapacidad debida al dolor y satisfaccióncon la salud.Resultados: existió una mejoría significativa (p < 0,002) enlos síntomas de los pacientes, tanto a los 6 como a los 12 mesestras el inicio del tratamiento, que además fue común a las dospautas de tratamiento. En el análisis de regresión lineal múltiple,los efectos del tratamiento erradicador y de tener una sintomatologíamenos intensa antes de recibir el tratamiento, fueron los dosúnicos factores independientes de forma significativa. La respuestaal tratamiento erradicador a los 6 meses fue significativamentemayor que con el tratamiento control (p = 0,01) en los pacientescon gastritis de predominio antral y en el apartado concreto de lossíntomas habituales. Conclusiones: ambos tratamientos producen una mejoríasintomática significativa en los pacientes con dispepsia funcional.Se observa una tendencia hacia un beneficio sintomático mayorcon el tratamiento erradicador respecto al control en pacientescon dispepsia funcional y en un medio con elevada prevalencia deinfección por Helicobacter pylori. Existe una tendencia hacia lamejoría sintomática con el tratamiento erradicador en los pacientesque tienen una gastritis de predominio antral

Objective: this study evaluated Helicobacter pylori eradicationtherapy in terms of symptomatic response in patients withfunctional dyspepsia. On the other hand, we analyzed the importanceof histologic findings as a predictor of treatment response.In particular, we studied whether antral gastritis (which is associatedwith peptic ulcer) may predict a greater symptomatic responseto Helicobacter pylori eradication in functional dyspepsia.Patients and methods: this prospective, randomized, single-center trial included 48 patients with functional dyspepsiaand Helicobacter pylori infection (27 women and 21 men,mean age 37 ± 13.5 years). Twenty-seven patients received a10-day course of rabeprazole, amoxicillin, and clarithromycin(eradication group), followed by 20 mg of rabeprazole for 3months. Twenty-one patients received 20 mg of rabeprazole for3 months (control group). Patients were followed up over a 1-year period. All patients completed the Dyspepsia-RelatedHealth Scale Questionnaire, which studies four dimensions:pain intensity, pain disability, non-pain symptoms, and satisfactionwith dyspepsia-related health.Results: there was significant symptomatic improvement (p <0.002) after 6 and 12 months, which was similar with both treatments.In the multivariate analyses, eradication therapy and lesssevere symptoms before treatment were the only independent factors.The symptomatic response to Helicobacter pylori eradicationafter 6 months was significantly greater as compared to controltherapy (p = 0.01) in patients with antral gastritis and in thenon-pain symptoms dimension of the questionnaire.Conclusions: both treatments proved to be clinically beneficialin patients with functional dyspepsia. We observed a tendencyto greater symptomatic benefit with Helicobacter pylori eradicationtherapy when compared to control treatment in patients withfunctional dyspepsia and in a population with a high prevalence of this infection. There is a tendency to symptomatic benefit withHelicobacter pylori eradication therapy in patients with antralgastritis

Sarcoidosis cutaneopulmonar durante el tratamiento con interferón pegilado y ribavirina / Cutaneopulmonary sarcoidosis during pegylated interferon plus ribavirin therapy

No disponible

[Gastrointestinal anisakiasis. Study of a series of 25 patients]. / Anisakiasis gastrointestinal. Estudio de una serie de 25 pacientes.

INTRODUCTION: Infection with the parasite Anisakis simplex is common in Japan and northern European countries. The number of reported cases in Spain has increased since the first description in 1991. The aim of the present study was to evaluate the incidence, clinical patterns, histopathological lesions, treatment, and outcome of Anisakis simplex infection in our environment. MATERIAL AND METHOD: Cases of gastrointestinal anisakiasis diagnosed in our center from December 1999 to January 2002 were studied. Only patients with detection of the parasite in oral endoscopy or the surgical specimen and those with elevated levels of specific IgE to Anisakis simplex, a clinical picture compatible with anisakiasis, or a history of raw fish intake were included. Epidemiological, clinical and laboratory data, as well as diagnostic, histopathologic and therapeutic features, and outcome in these patients were recorded. RESULTS: Twenty-five cases of gastrointestinal anisakiasis were diagnosed during the study period, representing an incidence of 3.87 cases per 100 000 inhabitants/year. All the patients had ingested raw anchovies. Two groups were observed. The first group was composed of 10 patients with a gastric form of the infection, in which the main symptom was epigastralgia (90%). Oral endoscopy was performed in all patients and the parasite was detected in five (50%). The second group was composed of 15 patients with intestinal involvement in which the main manifestations were symptoms mimicking appendicitis (80%). The most frequent finding of laparotomy and/or imaging tests (abdominal ultrasonography, intestinal transit, abdominal CAT) was terminal ileitis (80%). Seven patients underwent surgery: intestinal resection was performed in four with detection of Anisakis simplex in three. Eosinophilic infiltration was found in all surgical specimens. Treatment was symptomatic in most of the patients and outcome was favorable in all. CONCLUSIONS: Infection with Anisakis simplex should be investigated in patients with abdominal pain after intake of raw fish, ileitis of unclear origin, or eosinophilic gastroenteritis.

[Hepatic granulomas in a patient with acquired hypogammaglobulinemia]. / Granulomas hepáticos en una paciente con hipogammaglobulinemia adquirida.

The case of a young female diagnosed with an IgG deficit and hepatic granulomas is presented. After 6 years of follow up the patient remains asymptomatic without treatment and with moderate biochemical cholestasis. The tests performed did not lead to a definitive etiologic diagnosis, therefore, according to a review of the literature, we believe that the granulomatous reactions are related with the hypogammaglobulinemia itself.

[Recombinant alfa-2 interferon treatment of a patient with chronic hepatitis B and ulcerative colitis]. / Tratamiento con interferón alfa-2 recombinante en un paciente con hepatitis crónica por virus B y colitis ulcerosa.

The case of a patient ulcerative colitis involving an autoimmune base who was treated with recombinant alpha-2 interferon for concomitantly presenting chronic hepatitis B in the replicative phase is reported. With this therapy unreplicative seroconversion of the disease was achieved without modification of the course of the chronic inflammatory intestinal disease (CIID) during treatment or over the posttreatment follow up period. A brief review of the literature was performed concerning the role of autoimmunity in ulcerative colitis, treatment with alpha-interferon in chronic hepatitis B and the exacerbation of autoimmune phenomena which may lead to interferon treatment. According to the evolution of this case and the review of the literature, the authors conclude that the existence of CIID does not contra-indicate the use of recombinant alpha-2 interferon in patients with chronic viral hepatitis, although special control of the disease should be carried out during the treatment period.

[Solitary ulcer of the rectum and granulomatous appendicitis, a casual association?]. / Ulcera solitaria de recto y apendicitis granulomatosa, una asociación casual?

We report a case of solitary rectal ulcer (SRU) in a patient who had been previously diagnosed of granulomatous appendicitis. Both entities were histologically confirmed. The patient is asymptomatic after appendectomy done one and a half years ago, demonstrating the low recurrence rate of granulomatous appendicitis and the silent course of solitary rectal ulcer in many patients. Both entities may be related.

[Epidemiologic aspects of 116 acute pancreatitis prospectively studied]. / Aspectos epidemiológicos de 116 pancreatitis agudas estudiadas prospectivamente.

OBJECTIVE: To gather epidemiological data about acute pancreatitis (A.P.) in our environment. EXPERIMENTAL DESIGN: A prospective analysis of a series of patients in whom A.P. was diagnosed. PATIENTS: 116 patients with abdominal pain, elevation of pancreatic enzymes and absence of other acute abdominal pathology. RESULTS: These patients made up 2.8% of all emergency admissions to medical departments. Frequency of A.P. was 331 cases per million inhabitants/year. The biliary etiology was the most frequent (70.7%) followed by idiopathic forms (19.8%) and those deriving from alcohol abuse (7.8%). Mean patient age was 64.88 + 15.82 years, while patients with alcoholic A.P. were significantly younger than the other two groups. Women predominated in cases with biliary etiology, while men did so in alcoholic A.P. In cases of biliary A. P. amilasemia levels were significantly higher on admission (2598) than for other groups (1132 in alcohol related cases and 1692 in idiopathic ones). The overall rate of complications was 18.1%. Finally, overall mortality was 5.1%. CONCLUSIONS: Although the mean age of our patients was advanced, morbidity and mortality rates were low.