Long-term follow-up of 1,000 patients cured of Helicobacter pylori infection following an episode of peptic ulcer bleeding.

OBJECTIVES: To evaluate the effect of Helicobacter pylori (H. pylori) eradication on ulcer bleeding recurrence in a prospective, long-term study including 1,000 patients. METHODS: Patients with peptic ulcer bleeding were prospectively included. Prior non-steroidal anti-inflammatory drug (NSAID) use was not considered exclusion criteria. H. pylori infection was confirmed by rapid urease test, histology, or (13)C-urea breath test. Several eradication therapies were used. Subsequently, ranitidine 150 mg o.d. was administered until eradication was confirmed by (13)C-urea breath test 8 weeks after completing therapy. Patients with therapy failure received a second, third, or fourth course of eradication therapy. Patients with eradication success did not receive maintenance anti-ulcer therapy and were controlled yearly with a repeat breath test. NSAID use was not permitted during follow-up. RESULTS: Thousand patients were followed up for at least 12 months, with a total of 3,253 patient-years of follow-up. Mean age 56 years, 75% males, 41% previous NSAID users. In all, 69% had duodenal ulcer, 27% gastric ulcer, and 4% pyloric ulcer. Recurrence of bleeding was demonstrated in three patients at 1 year (which occurred after NSAID use in two cases, and after H. pylori reinfection in another one), and in two more patients at 2 years (one after NSAID use and another after H. pylori reinfection). The cumulative incidence of rebleeding was 0.5% (95% confidence interval, 0.16-1.16%), and the incidence rate of rebleeding was 0.15% (0.05-0.36%) per patient-year of follow up. CONCLUSION: Peptic ulcer rebleeding virtually does not occur in patients with complicated ulcers after H. pylori eradication. Maintenance anti-ulcer (antisecretory) therapy is not necessary if eradication is achieved. However, NSAID intake or H. pylori reinfection may exceptionally cause rebleeding in H. pylori-eradicated patients.

[Cost effectiveness study on the use of somatostatin for reduction of acute pancreatitis after ERCP]. / Estudio de coste-efectividad del empleo de somatostatina para la disminución de pancreatitis agudas post-CPRE.

OBJECTIVES: Recent studies show that intravenous injection of somatostatin before endoscopic retrograde cholangiopancreatography (ERCP) is associated with a significant reduction in the rate of post-ERCP acute pancreatitis. The lack of data in our environment led us to study the possible economic benefits of somatostatin administration, obtained through the reduction of costs due to post-ERCP acute pancreatitis. MATERIAL AND METHODS: Theoretical study of the direct costs of post-ERCP acute pancreatitis using Markov's tree decisions. The costs of the group pre-treated with intravenous administration of 3 mg of somatostatin were compared with those of the control group. Post-ERCP rates of pancreatitis of 10% were accepted in the control group and rates of 3% were accepted in the somatostatin group. The costs of the different types of pancreatitis were as follows: costs with and without complications and with surgical intervention were based on the diagnosis related group-weights applied by the Ministry of Health in the Contract-program of the Health Service of Navarre for 1999. A sensitivity analysis was carried out to determine the rate of post-ERCP pancreatitis from which an economic benefit would be obtained in the group pre-treated with somatostatin. RESULTS: Mean theoretical cost per procedure was 121,640 pesetas for the control group and 105,539 for the group pre-treated with somatostatin. Saving per patient was 13.26% (16,101 pesetas). The sensitivity analysis revealed that in the control group premedication produced an economic benefit starting from a pancreatitis rate of 4.2%. CONCLUSIONS: Independently of the clinical benefit signifying the reduction of post-ERCP pancreatitis, somatostatin administration led to a saving of 16,101 pesetas per patient. Accepting that the pancreatitis rate in the treated group was proportionately reduced, the sensitivity analysis showed that premedication produced an economic benefit starting from a pancreatitis rate of 4.2% in the control group.

[Eosinophilic esophagitis: an underdiagnosed entity?]. / Esofagitis eosinofílica: Una entidad infradiagnosticada?

Eosinophilic esophagitis is an exceptional entity, although the number of published cases has increased three times during the last 3 years. We report the case of an 18-year-old male with a long esophageal stenosis due to eosinophilic esophagitis. Clinical, radiologic, endoscopic and manometric outcome was satisfactory after prednisone therapy. Although isolated esophageal involvement may occur, disseminated eosinophilic esophago-gastro-intestinal disease is more frequent. The disease is usually diagnosed in young male patients, presenting with dysphagia and, to a lesser extent, chest pain. Previous allergic conditions are reported in 80% of cases and peripheral eosinophilia is present in 80% of patients. Esophageal stenosis is present in 72% of cases and manometric alterations are found in 47% of patients. Radiographic findings are nonspecific and include stenosis and rigidity. Endoscopic features are not specific either, but diagnosis may be achieved by endoscopic biopsy. Corticosteroids and sodium chromoglycate have proved to be useful, with good therapeutic response being reported in 90% of patients with this underestimated disease.

[Results of an anthropometric study of the adult Canarian population from 1985 to 1987]. / Resultados del estudio antropométrico de la población canaria adulta 1985-1987.

Presentation of the results of an anthropometric study conducted among the population of the province of Tenerife from 1985-1987. Tables of the parameters by age groups and sex were attached: these parameters included weight, height, triceps fold, circumference of arm, muscular and fatty areas of arm. A table of weights according to sex for each centimetre of height was also attached. Likewise, percentile graphs and their evolution throughout different decades of age were attached. Lastly, comments were made on the differences between this and other anthropometric studies.

[Ultrasound diagnosis of abdominal aortic aneurysm. Review of five cases (author's transl)]. / La ecografia abdominal en el diagnóstico del aneurisma aórtico. A propósito de cinco casos.

Five patients with aneurysms occuring in the abdominal aorta have been studied by means of arteriographic and echographic examinations. Suggestive clinical symptoms (pulsatile abdominal mass) were present in two cases, while the remaining three patients had doubtful symptomatology. Echography achieved and accurate diagnosis in all cases. Aortograms were useful in four cases, but a definite diagnosis was not obtained in the fifth case due to the presence of aortic fibrosis. Advantages of echographic procedure as a simple, useful, non-surgical and lower-cost method are mentioned.