[Development of inflammatory bowel disease in a husband and wife]. / Desarrollo de enfermedad inflamatoria intestinal en ambos miembros de un matrimonio.

It is currently thought that chronic inflammatory bowel disease (IBD) may be due to the action of an as-yet unidentified external agent on genetically predisposed individuals. While genetic influence on the development of the disease has been widely studied, very little is known about the possible environmental agents that could influence its development. One example of the influence of environmental agents could be the development of chronic IBD in a husband and wife. We describe the case of a married couple; after more than 30 years of cohabitation, the wife developed fistulizing Crohn's disease and, 7 years later, the husband developed ulcerative proctosigmoiditis. Currently, approximately 70 cases have been described in the international literature but none have been reported in Spain. We discuss the characteristics of our patients compared with those described in published reports and stress the importance of describing these cases for the future identification of a possible external agent.

Cholelithiasic disease and associated factors in a Spanish population.

In order to analyze the factors associated with cholelithiasic disease, 1268 participants of a population sample were studied. On univariate analysis, 11 of the 23 variables included showed a statistically significant association (P < 0.05). Five of these variables, including obesity, triglyceride level, intake of hypolipidemic drugs, and a diet rich in cholesterol and saturated fats in women, and physical exercise in men, remained significantly associated after controlling for age. On multivariate analysis among women, a positive association was found with age (P < 0.001), obesity, and the use of hypolipidemic agents (P < 0.05) and a negative one with a diet rich in cholesterol and saturated fats (P < 0.05). Among men, the same analysis revealed there was a positive association with age (P < 0.001) and triglycerides (P < 0.05) and a negative one with physical exercise (P < 0.05). In conclusion, obesity and the use of hypolipidemic agents in women and triglycerides in men, were positively associated with cholelithiasic disease, independent of age, while negative associations included the intake of cholesterol and saturated fats in women and physical exercise in men.

[The prediction of the endoscopic diagnosis in the dyspepsia patient: the value of the predominating presenting symptom and the initial clinical presumption]. / Predicción del diagnóstico endoscópico en el paciente con dispepsia: valor del síntoma predominante de presentación y de la presunción clínica inicial.

AIM: To assess, in our patient population, whether upper gastrointestinal symptoms can be used to predict the presence of relevant pathology on endoscopy. PATIENTS AND METHODS: In the first retrospective phase, 311 gastroscopies, indicated for dyspeptic symptoms were selected. The gastroscopies were performed by the same endoscopist from April 1998 to March 1999. Patients were divided into four groups according to the main presenting symptom (epigastralgia, epigastralgia with pyrosis, pyrosis with nonspecific symptoms). The positive and negative predictive value, as well as the overall sensitivity and specificity of each group of symptoms for the presentation of a relevant pathology were calculated. In the second, prospective, phase an attempt was made, based on the clinical history taken in the initial consultation, to predict the results of the gastroscopies of 77 dyspeptic patients. There were four possibilities: normal or not relevant, esophagitis, ulcer and neoplasia. The positive predictive value, negative predictive value, sensitivity and specificity of the diagnostic hypothesis were calculated. RESULTS: a) Retrospective phase: the overall positive predictive value of dyspeptic symptoms to predict relevant pathology was 0.38. The highest positive predictive value corresponded to symptoms of pyrosis (0.48). Dividing the patients into groups according to age (older or younger than 45 years) did not improve the predictive value of symptoms. b) Prospective phase: the highest positive predictive value corresponded to "pathology without relevance" (0.7). The prediction of ulcer only gave a positive predictive value of 0.55. CONCLUSION: The main presenting symptom is not a good predictor of whether relevant pathology will be found on gastroscopy. The initial diagnostic hypothesis is not a sufficiently effective tool to accurately detect which patients will most benefit from gastroscopy.

[Prevalence of cholelithiasis in El Real-Gandia]. / Prevalencia de la enfermedad colelitiásica en El Real-Gandia.

The aim of this study was to know the prevalence of cholelithiasis (C) in the El Real-Gandia (Spain) as well as the degree of the response of the population. Health examinations were performed in 1,803 adults from El Real (2,000 inhabitants) and Gandia (54,000 inhabitants) using abdominal echography as the screening technique. Cholelithiasis was defined as the presence of biliary lithiasis (BL) or previous cholecystectomy (PC). Of 1,268 (70.3%) participants in the study, C was found in 126 cases (BL in 102 and P in 24) representing a standardized prevalence of around 15% in women and 5% in men. Cholelithiasis was more frequent in females (13.8%) than in males (5.7%) (p < 0.001) increasing linearly with age (p < 0.005). The proportion of PC was significantly higher in women (23.9%) than in men (5.9%) (p < 0.05) and in Gandia (34.4%) than in El Real (13.8%) (p < 0.02). The prevalence of biliary mud and polyps was of 0.3% and 1.1%, respectively. Working obligations (35.4%) and fear of hospitals (22.4%) were the most frequent causes for no response (NR). Males with more than primary a school education originating from outside the Valencian community (VC) were significantly associated with NR in multivariant analysis.