Diagnostic yield and therapeutic impact of rectal retroflexion: a prospective, single-blind study conducted in three centers.

BACKGROUND/AIMS: No clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination. METHODS: A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included. RESULTS: A total of 934 patients (542 women, 58%) were included. The mean age was 57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact. CONCLUSIONS: Rectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.

[Serum levels of beta2 microglobulin and ultrasensitive c-reactive protein as markers of histological activity in ulcerative colitis]. / Niveles de beta2 microglobulina y proteína C reactiva ultrasensible como marcadores de actividad histológica en pacientes con colitis ulcerativa crónica idiopática.

BACKGROUND: There is currently increasing interest in research focused on new, non-invasive biochemical markers with better efficacy for evaluating endoscopic activity in patients with inflammatory bowel disease (IBD). In the present study, we determined the diagnostic utility of high sensitive C-reactive protein (hs CRP) and beta2 microglobulin (beta2M) levels and analyzed their correlation with the histological activity of ulcerative colitis (UC). METHODS: A total of 60 consecutive patients with UC were studied. Truelove-Witts index, histological activity, and beta2M and CRP levels were determined. Patients were grouped as non-active, mild, moderate, or severe following Riley's classification. Statistical analysis was performed using descriptive statistics. RESULTS: The mean age of the patients was 41.3 +/- 14.5 years. Thirty patients were women (50%). Twenty-one patients had distal UC (35%). The correlations between serum hsCRP and beta2M with histological activity showed coefficients of 0.39 (p = 0.01) and 0.33 (p = 0.02), respectively. The diagnostic utility was determined by ROC curves, which showed that the cutoff with the greatest area under the curve (AUC) for hsCRP and beta2M were > or = 0.36 (AUC = 0.73) and > or = 1.3 (AUC = 0.69), respectively. CONCLUSIONS: In patients with UC, hsCRP and beta2M levels are positively correlated with histological activity.

Niveles de beta2 microglobulina y proteína C reactiva ultrasensible como marcadores de actividad histológica en pacientes con colitis ulcerativa crónica idiopática / Serum levels of beta2 microglobulin and ultrasensitive c-reactive protein as markers of histological activity in ulcerative colitis

Antecedentes: Recientemente hay interés en investigar nuevos marcadores bioquímicos no invasivos con mayor eficacia para evaluar la actividad endoscópica en pacientes con enfermedad inflamatoria intestinal. El objetivo de esta investigación fue evaluar la correlación de los valores séricos de proteína C reactiva ultrasensible (PCR-us) y beta-2 microglobulina (β2M) con la actividad histológica en pacientes con colitis ulcerosa crónica idiopática. Métodos: Se estudiaron 60 pacientes con diagnóstico confirmado de colitis ulcerosa crónica idiopática. Se determinó el Índice de Truelove-Witts, los valores séricos de β2M y PCR-us, así como el grado de actividad histológica. Resultados: 30 pacientes fueron mujeres (50 %) con edad promedio de 41.3 ± 14.5 años. Al evaluar la correlación entre los valores séricos de PCR-us y β2M con la actividad histológica, se documentó un coeficiente de correlación de 0.39 (p = 0.01) y 0.33 (p = 0.02), respectivamente. En un análisis por subgrupos se determinó la utilidad diagnóstica de la PCR-us y β2M. Las curvas ROC mostraron que la mayor área bajo la curva (AUC) para PCR-us y β2M correspondió a los puntos de corte de ≥ 0.36 (AUC = 0.73) y ≥ 1.3 (AUC = 0.69), respectivamente. Conclusiones: Los valores séricos de PCR-us y β2M correlacionaron positivamente con el grado de actividad histológica en pacientes con colitis ulcerosa crónica idiopática.

BACKGROUND: There is currently increasing interest in research focused on new, non-invasive biochemical markers with better efficacy for evaluating endoscopic activity in patients with inflammatory bowel disease (IBD). In the present study, we determined the diagnostic utility of high sensitive C-reactive protein (hs CRP) and beta2 microglobulin (beta2M) levels and analyzed their correlation with the histological activity of ulcerative colitis (UC). METHODS: A total of 60 consecutive patients with UC were studied. Truelove-Witts index, histological activity, and beta2M and CRP levels were determined. Patients were grouped as non-active, mild, moderate, or severe following Riley's classification. Statistical analysis was performed using descriptive statistics. RESULTS: The mean age of the patients was 41.3 +/- 14.5 years. Thirty patients were women (50%). Twenty-one patients had distal UC (35%). The correlations between serum hsCRP and beta2M with histological activity showed coefficients of 0.39 (p = 0.01) and 0.33 (p = 0.02), respectively. The diagnostic utility was determined by ROC curves, which showed that the cutoff with the greatest area under the curve (AUC) for hsCRP and beta2M were > or = 0.36 (AUC = 0.73) and > or = 1.3 (AUC = 0.69), respectively. CONCLUSIONS: In patients with UC, hsCRP and beta2M levels are positively correlated with histological activity.

Factors that influence outcome in non-invasive and invasive treatment in polycystic liver disease patients.

AIM: To evaluate the factors that influence outcome of both non-invasive and invasive treatment of polycystic liver disease. METHODS: Analysis of clinical files of patients with complete follow-up from July 1986 to June 2006. RESULTS: Forty-one patients (male, 7; female, 34), 47.8 +/- 11.9 years age, and 5.7 +/- 6.7 years follow-up, were studied. Alkaline phosphatase (AP) elevation (15% of patients) was associated with the requirement of invasive treatment (IT, P = 0.005). IT rate was higher in symptomatic than non-symptomatic patients (65.4% vs 14.3%, P = 0.002), and in women taking hormonal replacement therapy (HRT) (P = 0.001). Cysts complications (CC) were more frequent (22%) in the symptomatic patients group (P = 0.023). Patients with body mass index (BMI) > 25 (59%) had a trend to complications after IT (P = 0.075). Abdominal pain was the most common symptom (56%) and indication for IT (78%). Nineteen patients (46%) required a first IT: 12 open fenestration (OF), 4 laparoscopic fenestration (LF) and 3 fenestration with hepatic resection (FHR). Three required a second IT, and one required a third procedure. Complications due to first IT were found in 32% (OF 16.7%, LF 25%, FHR 66.7%), and in the second IT in 66.7% (OF 100%). Follow-up mortality rate was 0. CONCLUSION: Presence of symptoms, elevated AP, and CC are associated with IT requirement. HRT is associated with presence of symptoms and IT requirement. Patients with BMI > 25 have a trend be susceptible to IT complications. The proportions of complications are higher in FHR and second IT groups. RS is more frequent after OF.