El cumplimiento del protocolo de seguimiento postquirúrgico en pacientes con poliposis adenomatosa familiar puede evitar el ulterior desarrollo de cáncer colorrectal / Adherence to a postoperative follow-up protocol in patients with familial adenomatous polyposis may prevent colorectal cancer development

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Impact of nocturnal heartburn on quality of life, sleep, and productivity: the SINERGE study.

The aim of the SINERGE study was to assess the impact of nocturnal heartburn on quality of life, sleep, and productivity. Ambulatory patients >/=18 years old and classified as defined cases of nocturnal heartburn (n=337), nonnocturnal heartburn (n=139), uncontrolled hypertension (n=198), and symptomatic depression (n=104) were included in this cross-sectional study. Information on age, gender, body mass index, and comorbidity was collected and the following validated questionnaires were applied: SF-12, Pittsburgh Sleep Quality Index, and Work Productivity and Activity Impairment questionnaire. The prevalence of primary care consultation for heartburn and nocturnal heartburn was 4.7% and 1.9%, respectively. Health-related quality of life, sleep, and productivity were significantly impaired in patients with frequent nocturnal heartburn symptoms as compared with those of the patients without nocturnal symptoms or patients with hypertension. Nocturnal heartburn poses a considerable burden for the sufferer because of the impact on quality of life, sleep, and daily activities.

[Colonoscopic follow-up of patients undergoing curative resection of colorectal cancer]. / Seguimiento colonoscópico de los pacientes intervenidos de carcinoma colorrectal con intención curativa.

AIM: To investigate the role of colonoscopy in the follow-up of patients undergoing curative resection of colorectal cancer. MATERIAL AND METHODS: A prospective study was performed of 102 patients with colorectal cancer who underwent surgery with curative intention. Postoperative colonoscopic follow-up was a minimum of 5 years. RESULTS: There were 62 males and 40 females. The mean duration of follow-up was 73.4 months. Synchronous polyps were found in 44.1% (114 in 45 patients) and metachronous polyps in 33.4% (64 in 34 patients). Synchronous carcinoma was detected in 7.8% (9 in 8 patients), metachronous carcinoma in 1.9% (2 in 2 patients) and suture recurrence in 4.9% (5 in 5 patients). Metachronous polyps developed in 55.5% of the patients with synchronous polyps and in only 15.8% of those with no synchronous polyps (p < 0.00005); the odds ratio was 6.67. Colonoscopy diagnosed 92 synchronous polyps and 64 metachronous polyps; of these, 34 were found to be significant(in 22 patients). Colonoscopy diagnosed 5 synchronous carcinomas; in 3 of these (polyps with non-invasive carcinoma) polypectomy constituted definitive therapy and in the remaining 2, curative resection was achieved. Colonoscopy diagnosed 2 stage C2 metachronous carcinomas at 63 and 94 months. Curative resection was achieved in both cases. Colonoscopic follow-up diagnosed 2 suture recurrences and resection was potentially curative. CONCLUSIONS: Colonoscopy was found to play an essential role in 30% of the patients. The technique allowed the early diagnosis of synchronous carcinomas and curative treatment of metachronous carcinomas and demonstrated that the presence of synchronous polyps increases the risk of developing metachronous polyps.

[Treatment with omeprazole, clarithromycin and amoxicillin over 6 days in patients with Helicobacter pylori-infected duodenal ulcer]. / Tratamiento con omeprazol, claritromicina y amoxicilina durante 6 días en pacientes con úlcera duodenal infectados por Helicobacter pylori.

OBJECTIVE: To investigate the eradication rate of Helicobacter pylori with omeprazole, amoxicillin and clarithromycin during 6 days in patients with duodenal ulcer. To compare the reliability of the analysis of the eradication with urea-13C breath test performed one month and 3 months after therapy. To evaluate the one-year reinfection rate. PATIENTS AND METHODS: Prospective study including 99 patients with duodenal ulcer (65 with acute disease and 34 in maintenance treatment) infected by Helicobacter pylori (urease rapid test and urea-13C breath test positive). Patients were treated with omeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1 g, b.i.d., during 6 days. The infection status was investigated 1 and 3 months after treatment by urea-13C breath test. The one-year reinfection rate was investigated using the same test. RESULTS: Per protocol eradication rates were 76% (95%-CI: 66-84) one month and 73% (95%-CI: 63-81) 3 months after treatment. In the intention to treat analysis, eradication rates were 74% (95%-CI: 64-82) and 70% (95%-CI: 60-79), respectively. Side effects were mild and uncommon. The rate of false negative urea-13C breath test results one month after therapy with respect to 3 months was 4.2% (95%-CI: 0.8-11.7). One-year reinfection rate determined in 56 patient was absent. CONCLUSIONS: The eradication of Helicobacter pylori with triple therapy for 6 days in patients with duodenal ulcer is not satisfactory. To investigate Helicobacter pylori infection with urea-13C breath test one month after treatment overestimates the results of the eradication. One-year reinfection rate is clinically irrelevant.

[Do patients with duodenal ulcer transmit Helicobacter pylori to their relatives?]. / Los pacientes con úlcera duodenal transmiten el Helicobacter pylori a sus familiares?

The prevalence of IgG antibodies to Helicobacter pylori was determined with an enzyme-linked immunosorbent assay in 80 families who lived together with 40 duodenal ulcer patients in whom Helicobacter pylori had been cultured from a gastric biopsy (34 spouses, 31 children, 10 parents, 4 sisters and 1 brother) and in 112 controls from the same habitat and with similar age. The antibodies were positive in 38.4% of the relatives and in 36.6% of the controls, the difference was not significant. Among spouses of patients, 38.4% of those aged 25-39 years and 66.6% of those aged 40-67 years were positive, whereas controls showed a 29.2% and a 58.3% of positives respectively. The differences between both groups were not significant. Among children, 17.2% were positive and in parents 50%, whereas among controls with a similar age 26.3% and 62.5% respectively were positive. The differences between relatives and controls were not significant. We conclude that in our environment among consanguineous families living together and between spouses, person-to-person spread of Helicobacter pylori does not usually occur or it happens uncommonly.

[Substances harmful for the gastric mucosa]. / Sustancias nocivas para la mucosa gástrica.

Gastroduodenal mucosa has a self-defense capacity against a wide range of potentially harmful exogenous and endogenous agents. It has been proven that certain diet compounds damage gastric mucosa, which explains--at lest partially--the regional variations in the incidence of peptic ulcer. Ethanol blocks the defense mechanisms of gastric mucosa and induces the onset of acute lesions, but there is no definite proof to show that ethanol ingestion helps produce the onset of peptic ulcer. It has been confirmed that tobacco negatively affects the healing and relapse of ulcers. From an epidemiological point of view, the controversy of the relationship between tobacco abuse and peptic ulcer genesis is still ongoing. Non-steroid anti-inflammatory non-acid soluble produces lesions acute and chronic) in gastroduodenal mucosa. They can reactivate old lesions and increased the risk of complications. Aspirin is the most harmful compound in this pharmacologic group. Paracetamol is the compound which has the safest spectrum. The harmfulness of steroids is still being discussed, however, it is accepted that they have a rapid effect on gastric mucosa in relation to dosage and duration of treatment.

[Defense mechanisms of the gastroduodenal mucosa]. / Mecanismos de defensa de la mucosa gastroduodenal.

A better knowledge of the mechanisms implicated in maintaining the integrity of gastroduodenal mucosa, suggests that apart from gastric acid, other--maybe equally important--factors are implicated in the genesis of acute and chronic lesions. Several intra and extracellular mechanisms have been identified which play a role in the "cytoprotection" phenomenon. More recently, the importance of the enteric nervous system, immune-mucosal system and motility of gastrointestinal tract, in all processes of defense and cellular restitution, has been pointed out. The effects on treatment derived from this knowledge are evident, even though the majority of them are hypothesis. They are an important line of pharmacology research. Further definition of the role in prevention and treatment of peptic ulcer disease of selective vasodilators, immunomodulators and mitotic agents as the epidermal growth factor needs to be carried out.

[Hepatic activity of glutathione transferase and bromsulphalein metabolism]. / Actividad hepática de la glutatión transferasa y metabolismo de la bromosulfotaleína.

The gluthatione transferase activity has been studied in liver biopsies from patients suffering with different hepatic lesion and related to the bromsulphalein (BSP) maximal transport (MT) and the conjugated dye present in serum. Results prove that the MT of BSP is independent of the enzyme activity, but is correlated to the conjugated BSP present in serum during the first perfusion. The enzyme activity, the MT of BSP and BSP conjugated rare in serum are not related to the liver lesion stage. From the analysis of our results we conclude that in the beginning the BSP conjugated proportion is determined by the enzyme activity which is not a restrictive factor of the BSP maximal transport.

[A comparative study of the oral and rectal ammonium overload test in liver cirrhosis]. / Estudio comparativo del test de sobrecarga amónica por vía oral y rectal en la cirrosis hepática.

The ammonium loading test has been realized in 66 patients, 8 of them without clinical or laboratory data of hepatic disease and 58 diagnosed of hepatic cirrhosis (HC). In 40 patients with HC and 8 patients without liver disease the ammonium was administered by rectum and in the remaining 18 patients with HC it was administrated orally. In each case, non stagnant venous blood was drawn at 0, 30, 45, 60 and 75 minutes after the administration of ammonium and plasmatic levels were measured. The results show that in patients with HC there are no significant differences between rectal and oral administration although the rectal way presented less secondary effects and is better tolerated. The test is discriminatory when comparing patients with HC and patients without liver disease as well as between patients with HC and portal hypertension and those without clinical signs of portal hypertension.

Prevalence of liver disease and infection by hepatitis B, delta virus, and human immunodeficiency virus in two Spanish penitentiaries.

We studied the prevalence of liver disease and the carrier state for hepatitis B (HBV), delta virus (HDV) and HIV-1 infection in two Valencian penitentiaries, one for males and the other for females. Serological results were correlated with history of intravenous drug addiction, alcohol abuse, homosexuality or prostitution (high-risk groups), and duration and number of internments. A high prevalence of increased transaminase levels (52.2%) and serological markers for HBV infection (66.5%) was observed amongst the inmates, figures being higher amongst high-risk individuals and inmates confined for more than 6 months. No signs of HDV or HIV-1 infection were found amongst the prison staff. Anti-HIV-1 positivity was observed most frequently amongst individuals combining both drug abuse and homosexuality/and prostitution.

Effect of L-carnitine upon ammonia tolerance test in cirrhotic patients.

In a group of liver cirrhosis (LC) patients subjected to a rectal ammonium overload test, the effect of L-carnitine on ammoniemia and on the type A numerical connection and star clock psychomotor tests has been evaluated. On comparing 40 LC patients given L-carnitine with 40 control cirrhotics given a placebo, no significant differences were observed in ammonium levels after performing the overload test in both groups. However, on studying the patients with the greatest liver involvement, those given L-carnitine showed smaller elevations in ammoniemia and better responses to the psychometric tests than those receiving the placebo. The results obtained emphasize the need to continue testing the effect of L-carnitine using either similar tests or carrying out long-term evaluations to determine its protective effect in the appearance of hepatic encephalopathy, perhaps even including its evaluation in the treatment of established encephalopathy.

[Action of domperidone on dopamine-induced inhibition of gastric secretion]. / Acción de la domperidona sobre la inhibición de la secreción gástrica provocada por la dopamina.

The inhibitory action of dopamine on basal gastric secretion and that stimulated by pentagastrin with previous administration of domperidone in 26 male patients, between 18 and 48 years of age, suffering duodenal ulcer has been studied. The administration of domperidone (0.25 mg/kg) produces a significant reduction of the inhibitory action of dopamine on basal gastric secretion and that stimulated by pentagastrin at dose 0.15 microgram/kg/h. Besides dopamine shows a minor, non significant, inhibitory action on acid gastric secretion stimulated by maximal doses of pentagastrin, while showing no differences against the group without administration of domperidone.