Autochthonous cultures to improve the quality of PGI Castellano cheese: Impact on proteolysis, microstructure and texture during ripening.

The aim of this research was to find out the effect of different combinations of starter and non-starter cultures on the proteolysis of Castellano cheese during ripening. Four cheese batches were prepared, each containing autochthonous lactobacilli and or Leuconostoc, and were compared with each other and with a control batch, that used only a commercial starter. To achieve this, nitrogen fractions (pH 4.4-soluble nitrogen and 12 % trichloroacetic acid soluble nitrogen, polypeptide nitrogen and casein nitrogen), levels of free amino acids and biogenic amines were assessed. Texture and microstructure of cheeses were also evaluated. Significant differences in nitrogen fractions were observed between batches at different stages of ripening. The free amino acid content increased throughout the cheese ripening process, with a more significant increase occurring after the first 30 days. Cheeses containing non-starter lactic acid bacteria exhibited the highest values at the end of the ripening period. Among the main amino acids, GABA was particularly abundant, especially in three of the cheese batches at the end of ripening. The autochthonous lactic acid bacteria were previously selected as non-producers of biogenic amines and this resulted in the absence of these compounds in the cheeses. Analysis of the microstructure of the cheese reflected the impact of proteolysis. Additionally, the texture profile analysis demonstrated that the cheese's hardness intensified as the ripening period progressed. The inclusion of autochthonous non-starter lactic acid bacteria in Castellano cheese production accelerated the proteolysis process, increasing significantly the free amino acids levels and improving the sensory quality of the cheeses.

Association between Variables of Eating Habits and Gastric Trophic Changes in a Gastroenterology Institution in Medellín, Colombia

Aim: To establish the relationship between consuming foods considered risk factors for gastric cancer and trophic changes in gastric mucosa. Materials and methods: Cross-sectional study. We included patients older than 18 admitted for upper GI endoscopy with biopsies who adequately answered a survey of personal history and eating habits. Those with a history of gastric cancer or gastric surgical resection for any reason were excluded. The association between feeding variables and trophic changes in the gastric mucosa was estimated. Results: In a population of 1,096 patients, the average age was 51 years (standard deviation [SD]: 15.5), and 59% were women. Trophic changes in the gastric mucosa were identified in 173 patients (15.8%). No statistical association was found between the independent variables of eating habits, obesity, and positive Helicobacter pylori versus the variable "trophic changes," unlike the variable "family history of gastric cancer" (odds ratio [OR]: 1.49 95% confidence interval [CI]: 1.03-2.17, p = 0.036). One case of high-grade dysplasia was detected in the study population (0.91 cases in 1,000 patients). Conclusions: No association was established between eating habits and trophic changes in the gastric mucosa in the studied population. A family history of gastric cancer is a statistically significant risk factor for developing atrophy, metaplasia, or dysplasia changes.

Objetivo: establecer la relación entre el consumo de alimentos considerados como factores de riesgo para cáncer gástrico y la presencia de cambios tróficos de la mucosa gástrica. Materiales y métodos: estudio de corte transversal. Se incluyeron los pacientes mayores de 18 años admitidos para realización de endoscopia digestiva superior con toma de biopsias que respondieron adecuadamente una encuesta de antecedentes personales y hábitos de alimentación. Se excluyeron aquellos con antecedente de cáncer gástrico o resección quirúrgica gástrica por cualquier motivo. Se estimó la asociación entre las variables de alimentación y la presencia de cambios tróficos de la mucosa gástrica. Resultados: en una población de 1096 pacientes, el promedio de la edad fue 51 años (desviación estándar [DE]: 15,5), y correspondió en un 59% a mujeres. Se identificaron cambios tróficos de la mucosa gástrica en 173 pacientes (15,8%). No se obtuvo asociación estadística entre las variables independientes de hábitos de alimentación, obesidad y Helicobacter pylori positivo frente a la variable "cambios tróficos", a diferencia de la variable "antecedente familiar de cáncer gástrico" (odds ratio [OR]: 1,49; intervalo de confianza [IC] 95%: 1,03-2,17; p = 0,036). Se obtuvo 1 caso de displasia de alto grado en la población estudiada (0,91 casos en 1000 pacientes). Conclusiones: no se estableció una asociación entre los hábitos de alimentación y la presencia de cambios tróficos de la mucosa gástrica en la población estudiada. El antecedente familiar de cáncer gástrico se muestra como un factor de riesgo estadísticamente significativo para el desarrollo de cambios de atrofia, metaplasia o displasia.

Incidence and characterization of colorectal adenomas in the area of influence of a specialized institution / Incidencia y caracterización de adenomas colorrectales en el área de influencia de una institución especializada

Abstract Aim: To locate and characterize colorectal adenomas endoscopically and histologically in a cohort of patients undergoing colonoscopy in Medellín, Colombia. Materials and methods: Descriptive cross-sectional study. We included patients older than 18 years who underwent colonoscopy between February and July 2020 at a specialized center in Medellín, Colombia. We determined the incidence of adenomas, their location in different segments of the colon, their endoscopic and histological characteristics, and cases of colorectal cancer (CRC) and high-grade dysplasia (HGD). Results: 992 colonoscopies were performed, finding colorectal polyps in 266 patients, of which 208 had adenomas. We resected 461 polyps, of which 336 were adenomas (72 %). The histological type with the highest representation was tubular (78 %). The location of adenomas was 37 % in the right colon, 25 % in the transverse colon, and 38 % in the left colon. CRC cases were nine per 1,000 patients, including advanced carcinoma and carcinoma in situ (HGD). Conclusions: Given the incidence of adenomas in the right and transverse colon, rectosigmoidoscopy is discouraged as a screening study for CRC. Tubular adenomas, sessile in appearance and tiny, predominated in the population studied. We recommend screening in the population over 40 years of age and the search for precursor lesions as strategies to reduce morbidity and mortality rates due to CRC.

Resumen Objetivo: localización y caracterización endoscópica e histológica de los adenomas colorrectales en una cohorte de pacientes sometidos a colonoscopia en Medellín, Colombia. Materiales y métodos: estudio descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años sometidos a colonoscopia entre febrero y julio de 2020 en un centro especializado de Medellín, Colombia. Se determinó la incidencia de adenomas, su localización en los diferentes segmentos del colon, sus características endoscópicas e histológicas, así como también los casos de cáncer colorrectal (CCR) y displasia de alto grado. Resultados: se realizaron 992 colonoscopias y se encontraron pólipos colorrectales en 266 pacientes, de los cuales 208 tenían adenomas. En total se resecaron 461 pólipos, de los cuales 336 fueron adenomas (72 %). El tipo histológico con mayor representación fue el tubular (78 %). La localización de adenomas fue del 37 % en el colon derecho, 25 % en el transverso y 38 % en el colon izquierdo. La cantidad de casos de CCR fue de 9 por 1000 pacientes, que incluyen carcinoma avanzado y carcinoma in situ (DAG). Conclusiones: dada la incidencia de adenomas en el colon derecho y transverso, no se recomienda la rectosigmoidoscopia como estudio de tamizaje para CCR. En la población estudiada fueron predominantes los adenomas tubulares, de aspecto sésil y tamaño diminuto. Se recomienda el tamizaje en la población mayor de 40 años y la búsqueda de lesiones precursoras como estrategias para disminuir las tasas de morbimortalidad por CCR.

Can We Use the Indication for a Colonoscopy as a Predictor of the Adenoma Detection Rate? / ¿Podemos utilizar la indicación de colonoscopia como predictor de la tasa de detección de adenomas?

Abstract Aim: To determine the adenoma detection rate (ADR) and identify the indications for a colonoscopy that predict adenomas. Materials and methods: Cross-sectional study. We included patients older than 18 years who underwent colonoscopy between February and July 2020 at a specialized center in Medellín, Colombia. We estimated the ADR and identified the indications for a colonoscopy, considered predictors for finding adenomas. Results: The overall adenoma detection was 21 % (n = 992) and ADR in the screening population was 25 %. The range of 40-49 years contributed 12 % of the total number of adenomas detected, and the male population had a higher incidence (OR 1.73; 95 % CI 1.25-2.38; p < 0.001). Personal history of polyps (OR 1.86; 95 % CI 1.25-2.78; p = 0.002) and fecal occult blood (OR 2.67; 95 % CI 1.12-6.35; p 0.026) are deemed predictors for finding adenomas. LCI filters showed better results in detecting lesions (OR 1.43; 95 % CI 1.02-2.0). Conclusions: The indications for a colonoscopy can predict the probability of detecting adenomas. Male gender, a personal history of polyps, fecal occult blood, and the search for adenomas after the age of 40 are the variables that increase the probability of finding adenomas. The use of LCI filters increases lesion detection. The suggested age to start CRC screening is 40 years.

Resumen Objetivo: determinar la tasa de detección de los adenomas (TDA) e identificar las indicaciones de colonoscopia que predicen su hallazgo. Materiales y métodos: estudio de corte transversal. Se incluyeron pacientes mayores de 18 años sometidos a colonoscopia entre febrero y julio de 2020 en un centro especializado de Medellín, Colombia. Se estimó la TDA y se identificaron las indicaciones de colonoscopia, que se consideran predictores para el hallazgo de adenomas. Resultados: la detección general de adenomas fue del 21 % (n = 992) y la TDA en la población de tamizaje fue del 25 %. El rango de 40 a 49 años aportó el 12 % del total de adenomas detectados y la población masculina tuvo mayor incidencia (OR 1,73; IC 95 % 1,25-2,38; p < 0,001). El antecedente personal de pólipos (OR 1,86; IC 95 % 1,25-2,78; p = 0,002) y la presencia de sangre oculta en heces (OR 2,67; IC 95 % 1,12-6,35; p 0,026) se consideran predictores para el hallazgo de adenomas. El uso de filtros LCI mostró mejores resultados en la detección de las lesiones (OR 1,43; IC 95 % 1,02-2,0). Conclusiones: las indicaciones de la colonoscopia pueden predecir la probabilidad de detección de adenomas. El género masculino, el antecedente personal de pólipos, la presencia de sangre oculta en heces y la búsqueda de adenomas a partir de los 40 años son las variables que aumentan la probabilidad de encontrar adenomas. El uso de filtros LCI aumenta la detección de lesiones. La edad sugerida para el inicio del tamizaje de CCR es a partir de los 40 años.

2021 Guidelines on Helicobacter pylori. Coincidences and divergences between the Spanish and World Gastroenterology Organisation (WGO) guidelines.

This editorial summarizes and discusses the most relevant aspects of the latest WGO guidelines on Helicobacter pylori infection, while considering the recently reported Spanish consensus on its management.

Efectividad y tolerabilidad de tres tipos de productos de preparación para colonoscopia / Effectiveness and tolerability of three types of colonoscopy preparation products

Resumen Objetivo: establecer las diferencias entre tres tipos de productos de preparación para colonoscopia, en cuanto a efectividad y tolerabilidad. Materiales y métodos: estudio de corte transversal, analítico, prospectivo, ciego para el evaluador de la escala de Boston. Se incluyeron pacientes adultos, mayores de 18 años con requerimiento de colonoscopia y diligenciamiento de la encuesta sobre el tipo de preparación realizada para la limpieza del colon. Resultados: se evaluaron 3 grupos de productos (polietilenglicol, picosulfatos, sales de sulfato) en 907 pacientes, se aplicó la escala de Boston total y por segmentos, sin encontrar diferencias estadísticamente significativas entre ellos (Odds ratio [OR]: 1,10; intervalo de confianza [IC] 95 %: 0,6-1,8; p = 0,728). El 60 % de la población fueron mujeres y la edad promedio 52 años. Se observó el cumplimiento de la dieta en el 99 % de los participantes. La preparación dividida tuvo mejores resultados en la escala de Boston (OR: 5,06; IC 95 %: 3,2-8,01; p = 0,001). Los picosulfatos tuvieron mayor aceptabilidad (OR: 15,8; IC 95 %: 8,83-28,3; p = 0,001) y menores efectos secundarios como distensión abdominal (OR: 0,59; IC 95 %: 0,3-0,9; p = 0,033) y vómito (OR: 0,25; IC 95 %: 0,07-0,82; p = 0,015). Se observó mejor resultado cuando se realizó el examen antes de 6 horas de finalizada la preparación (OR: 6,38; IC 95 %: 3,84-10,6; p = 0,001). Conclusiones: los productos evaluados no presentaron diferencias entre sí con respecto a su efectividad. Los picosulfatos tuvieron menores efectos secundarios y mejor aceptabilidad. Se obtuvo una mejor preparación del colon con preparación dividida y si el examen es hasta 6 horas de finalizada la preparación.

Abstract Objective: To establish the differences between three types of colonoscopy preparation products in terms of effectiveness and tolerability. Materials and methods: An analytical, prospective, blind, cross-sectional study of the Boston Bowel Preparation Scale was carried out. Adult patients over 18 years of age with a requirement for colonoscopy and completion of the survey on the type of preparation carried out for colon cleansing were included. Results: Three groups of products (polyethylene glycol, picosulfates, and sulfate salts) were evaluated in 907 patients. Total and segment Boston Bowel Preparation Scale was applied, without finding statistically significant differences between them (OR 1.10; 95%CI: 0.6-1.8; p = 0.728). 60% of the population were women and the average age was 52 years. Compliance with the diet was observed in 99% of the participants. Split-dose bowel preparation performed best on the Boston scale (OR 5.06; 95%CI; 3.2-8.01; p= 0.001). Picosulfates had greater acceptability (OR 15.8; 95%CI: 8.83-28.3; p= 0.001) and fewer side effects such as abdominal distension (OR 0.59; 95%CI: 0.3-0.9; p= 0.033) and vomiting (OR 0.25; 95%CI: 0.07-0.82; p= 0.015). The best result was observed when the test was performed within 6 hours of completion of preparation (OR 6.38; 95%CI: 3.84-10.6; p = 0.001). Conclusions: The products evaluated did not show differences between them regarding their effectiveness. Picosulfates had fewer side effects and better acceptability. Split-dose and testing up to 6 hours after preparation resulted in better bowel preparation.

[Serological diagnosis of Fasciola hepatica infection: a systematic review]. / Diagnóstico serológico de la infección por Fasciola hepática: una revisión sistemática.

INTRODUCTION: Fascioliasis is a disease caused by the parasite Fasciola hepatica, according to its clinical picture, it can be classified into two phases: acute and chronic, currently the diagnosis is made during the chronic phase, however, early detection would allow to provide an effective treatment and timely. Objetive: This study is carried out with the objective of evaluating the diagnostic validity of serological tests for the timely diagnosis of hepatic fascioliasis. MATERIALS AND METHODS: a systematic search of the literature was carried out in Embase, MedLine, Cochrane Library and LILACS. Study selection was performed by pairs of reviewers, diagnostic test studies were selected using: ELISA, indirect ELISA, rapid ELISA, Fas2 ELISA, Arco2 compared to sedimentation techniques for the diagnosis of hepatic fascioliasis in adults. The studies were evaluated using the QUADAS-2 tool. RESULTS: Seven studies were identified that answer the PICO question, with a total of 1,317 human serum samples, the tests reported high sensitivity and specificity, FhTA, ELISA, number of studies and participants identified, summary estimators with the corresponding confidence intervals / credibility, and the ranking of treatments. DISCUSSION: In general, the specificity of the serological tests was slightly higher than the sensitivity, there is evidence of moderate to low quality that reports their performance, however, the quality of the evidence and the heterogeneity between the studies do not allow determining its usefulness during the acute phase of the disease. More studies are needed in this regard. The studies were clinically heterogeneous between them.

Diagnóstico serológico de la infección por Fasciola hepática: una revisión sistemática / Serological diagnosis of Fasciola hepatica infection: a systematic review

RESUMEN Introducción: La fascioliasis es una enfermedad causada por el parásito Fasciola hepática, según su cuadro clínico puede clasificarse en dos fases: aguda y crónica, actualmente el diagnóstico se realiza durante la fase crónica, sin embargo, la detección temprana permitiría brindar un tratamiento eficaz y oportuno. Objetivo: Este estudio se realiza con el objetivo de evaluar la validez diagnóstica de las pruebas serológicas para el diagnóstico oportuno de fascioliasis hepática. Materiales y métodos: se realizó una búsqueda sistemática de la literatura en Embase, MedLine, Cochrane Library y LILACS. La selección de estudios se realizó mediante pares de revisores, se seleccionaron estudios de pruebas diagnósticas utilizando: ELISA, ELISA indirecto, ELISA rápido, Fas2 ELISA, Arco2 comparada con técnicas de sedimentación para el diagnóstico de fascioliasis hepática en adultos. Los estudios fueron evaluados mediante la herramienta QUADAS-2. Resultados: Se identificaron siete estudios que responden a la pregunta PICO, con un total de 1317 muestras de suero humano, las pruebas reportaron alta sensibilidad y especificidad, FhTA, ELISA, número de estudios y participantes identificados, estimadores resumen con los correspondientes intervalos de confianza/credibilidad, también se puede discutir el ranking de tratamientos. Discusión: en general la especificidad de las pruebas serológicas fue ligeramente superior que la sensibilidad, existe evidencia de moderada a baja calidad que reporta su rendimiento, sin embargo, la calidad de la evidencia y la heterogeneidad entre los estudios no permite determinar su utilidad durante la fase aguda de la enfermedad. Se necesitan más estudios al respecto. Los estudios fueron clínicamente heterogéneos entre ellos.

ABSTRACT Introduction: Fascioliasis is a disease caused by the parasite Fasciola hepatica, according to its clinical picture, it can be classified into two phases: acute and chronic, currently the diagnosis is made during the chronic phase, however, early detection would allow to provide an effective treatment and timely. Objetive: This study is carried out with the objective of evaluating the diagnostic validity of serological tests for the timely diagnosis of hepatic fascioliasis. Materials and methods: a systematic search of the literature was carried out in Embase, MedLine, Cochrane Library and LILACS. Study selection was performed by pairs of reviewers, diagnostic test studies were selected using: ELISA, indirect ELISA, rapid ELISA, Fas2 ELISA, Arco2 compared to sedimentation techniques for the diagnosis of hepatic fascioliasis in adults. The studies were evaluated using the QUADAS-2 tool. Results: Seven studies were identified that answer the PICO question, with a total of 1,317 human serum samples, the tests reported high sensitivity and specificity, FhTA, ELISA, number of studies and participants identified, summary estimators with the corresponding confidence intervals / credibility, and the ranking of treatments. Discussion: In general, the specificity of the serological tests was slightly higher than the sensitivity, there is evidence of moderate to low quality that reports their performance, however, the quality of the evidence and the heterogeneity between the studies do not allow determining its usefulness during the acute phase of the disease. More studies are needed in this regard. The studies were clinically heterogeneous between them.

Treating Helicobacter pylori infection in the face of growing antibiotic resistance.

Helicobacter pylori eradication cures most peptic ulcers and non-atrophic chronic gastritis, and may potentially prevent over 70% of gastric cancers. In the late 1980s, shortly after the discovery of H. pylori, eradication therapy was established based on the use of two antibiotics (amoxicillin and clarithromycin) and one proton-pump inhibitor for 7 or 10 days (OCA7, OCA10). This therapy, recommended during the first Maastricht Consensus Conference, obtained eradication rates above 90%, and was equally effective everywhere around the world. However, over time, H. pylori has developed resistance to several antibiotics.

El tratamiento de la infección por Helicobacter pylori en un entorno de resistencia creciente a los antibióticos / Treating Helicobacter pylori infection in the face of growing antibiotic resistance

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Tailored Helicobacter pylori eradication based on prior intake of macrolide antibiotics allows the use of triple therapy with optimal results in an area with high clarithromycin resistance

Background: the previous intake of macrolide antibiotics is associated with a failure to eradicate Helicobacter pylori (H. pylori) with clarithromycin-containing regimens. However, the standard triple therapy achieves eradication rates of over 90% in patients without a previous use of macrolides in our health area. The aim of this study was to evaluate the efficacy of an H. pylori eradication strategy based on the intake of macrolides by the patient during the previous years. Methods: one hundred and sixty-nine patients with H. pylori infection were prospectively included in the study. The electronic medical record of each patient was reviewed at the time of inclusion. Depending on their previous intake of macrolides, patients were assigned to one of two eradication regimens: group A) patients without a previous intake of macrolides received an optimized triple therapy for 14 days; and group B) patients with a previous intake of macrolides received bismuth quadruple therapy for ten days. Results: ninety-one patients (53.84%) without a previous intake of macrolides received an optimized triple therapy (group A) and 78 patients (46.15%) with a previous intake of macrolides received bismuth quadruple therapy (group B). In group A, the H. pylori eradication rates were 90.11% in the intention-to-treat and 95.35% in the per-protocol analysis. In group B, the H. pylori eradication rates were 85.89% in the intention-to-treat and 98.5% in the per-protocol analysis. The overall eradication rates obtained using this strategy were 88.16% (95% CI: 82.32-92.02%) in the intention-to-treat and 96.75% (95% CI: 92.59-98.94%) in the per-protocol analysis. Conclusions: an H. pylori eradication strategy based on the intake of macrolides during the previous years achieves overall eradication rates close to 90% and allows the use of standard triple therapy in more than half of the patients from a health area with a high level of clarithromycin resistance

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Tailored Helicobacter pylori eradication based on prior intake of macrolide antibiotics allows the use of triple therapy with optimal results in an area with high clarithromycin resistance.

BACKGROUND: the previous intake of macrolide antibiotics is associated with a failure to eradicate Helicobacter pylori (H. pylori) with clarithromycin-containing regimens. However, the standard triple therapy achieves eradication rates of over 90% in patients without a previous use of macrolides in our health area. The aim of this study was to evaluate the efficacy of an H. pylori eradication strategy based on the intake of macrolides by the patient during the previous years. METHODS: one hundred and sixty-nine patients with H. pylori infection were prospectively included in the study. The electronic medical record of each patient was reviewed at the time of inclusion. Depending on their previous intake of macrolides, patients were assigned to one of two eradication regimens: group A) patients without a previous intake of macrolides received an optimized triple therapy for 14 days; and group B) patients with a previous intake of macrolides received bismuth quadruple therapy for ten days. RESULTS: ninety-one patients (53.84%) without a previous intake of macrolides received an optimized triple therapy (group A) and 78 patients (46.15%) with a previous intake of macrolides received bismuth quadruple therapy (group B). In group A, the H. pylori eradication rates were 90.11% in the intention-to-treat and 95.35% in the per-protocol analysis. In group B, the H. pylori eradication rates were 85.89% in the intention-to-treat and 98.5% in the per-protocol analysis. The overall eradication rates obtained using this strategy were 88.16% (95% CI: 82.32-92.02%) in the intention-to-treat and 96.75% (95% CI: 92.59-98.94%) in the per-protocol analysis. CONCLUSIONS: an H. pylori eradication strategy based on the intake of macrolides during the previous years achieves overall eradication rates close to 90% and allows the use of standard triple therapy in more than half of the patients from a health area with a high level of clarithromycin resistance.

Development and validation of a scoring index to predict the presence of lesions in capsule endoscopy in patients with suspected Crohn's disease of the small bowel: a Spanish multicenter study.

BACKGROUND: Capsule endoscopy (CE) is the first-line investigation in cases of suspected Crohn's disease (CD) of the small bowel, but the factors associated with a higher diagnostic yield remain unclear. OBJECTIVE: Our aim is to develop and validate a scoring index to assess the risk of the patients in this setting on the basis of biomarkers. PATIENTS AND METHODS: Data on fecal calprotectin, C-reactive protein, and other biomarkers from a population of 124 patients with suspected CD of the small bowel studied by CE and included in a PhD study were used to build a scoring index. This was first used on this population (internal validation process) and after that on a different set of patients from a multicenter study (external validation process). RESULTS: An index was designed in which every biomarker is assigned a score. Three risk groups have been established (low, intermediate, and high). In the internal validation analysis (124 individuals), patients had a 10, 46.5, and 81% probability of showing inflammatory lesions in CE in the low-risk, intermediate-risk, and high-risk groups, respectively. In the external validation analysis, including 410 patients from 12 Spanish hospitals, this probability was 15.8, 49.7, and 80.6% for the low-risk, intermediate-risk, and high-risk groups, respectively. CONCLUSION: Results from the internal validation process show that the scoring index is coherent, and results from the external validation process confirm its reliability. This index can be a useful tool for selecting patients before CE studies in cases of suspected CD of the small bowel.

Macrolide use in the previous years is associated with failure to eradicate Helicobacter pylori with clarithromycin-containing regimens.

BACKGROUND: There is some evidence that prior use of macrolide antibiotics is a useful predictor of the likelihood of standard triple therapy failure in Helicobacter pylori eradication. In this study, we have evaluated whether previous intake of macrolides correlates with failure to eradicate H. pylori using two different first-line clarithromycin-containing regimens. MATERIALS AND METHODS: Retrospective study of 212 patients with H. pylori infection treated with one of two first-line clarithromycin-containing regimens: 108 patients treated with triple therapy for 10 days and 104 patients treated with concomitant therapy for 10 days. The intake of macrolides (clarithromycin, azithromycin, and other macrolides) prior to the eradication therapy was obtained from the electronic medical record, which contains information regarding all the medication prescribed to the patients since the year 2004. RESULTS: One hundred of 212 patients (47.2%) had received at least one treatment with macrolides during the years prior to the eradication therapy. H. pylori eradication rates were significantly lower in patients with previous use compared to patients without previous use of macrolides, both with triple therapy (60.8% vs 92.9%; P < .0001) and with concomitant therapy (85.7% vs 98.2%; P = .024). CONCLUSIONS: Previous use of macrolides correlates with a low H. pylori eradication rate with triple and concomitant clarithromycin-containing regimens. In addition, our study shows that in patients without previous use of macrolides, triple therapy achieves per-protocol eradication rates over 90%.

Role of capsule endoscopy in alarm features and non-responsive celiac disease: A European multicenter study.

BACKGROUND AND AIM: The role of capsule endoscopy (CE) in established celiac disease (CD) remains unclear. Our objective was to analyze the usefulness of CE in the suspicion of complicated CD. METHODS: This was a retrospective multicenter study. One hundred and eighty-nine celiac patients (mean age: 46.6 ± 16.6, 30.2% males) who underwent CE for alarm symptoms (n = 86, 45.5%) or non-responsive CD (n = 103, 54.5%) were included. Diagnostic yield (DY), therapeutic impact and safety were analyzed. RESULTS: Capsule endoscopy was completed in 95.2% of patients (small bowel transit time: 270.5 ± 100.2 min). Global DY was 67.2%, detecting atrophic mucosa (n = 92, 48.7%), ulcerative jejunoileitis (n = 21, 11.1%), intestinal lymphoma (n = 7, 3.7%) and other enteropathies (n = 7, 3.7%, six Crohn's disease cases and one neuroendocrine tumor). The DY of CE was significantly higher in patients presenting with non-responsive disease compared to patients with alarm symptoms (73.8% vs 59.3%, P = 0.035). The new findings of the CE modified management in 59.3% of the cases. There were no major complications. CONCLUSION: Capsule endoscopy may be a moderately helpful and safe diagnostic tool in the suspicion of complicated CD, modifying the clinical course of these patients.

Role of capsule endoscopy in suspected celiac disease: A European multi-centre study.

AIM: To analyze the diagnostic yield (DY), therapeutic impact (TI) and safety of capsule endoscopy (CE). METHODS: This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I, n = 19), seropositive CD without atrophy (Group-II, n = 39), contraindication to gastroscopy (Group-III, n = 6), seronegative CD without atrophy, but with a compatible context (Group-IV, n = 99). DY, TI and the safety of CE were analysed. RESULTS: The overall DY was 54% and the final diagnosis was villous atrophy (n = 65, 39.9%), complicated CD (n = 12, 7.4%) and other enteropathies (n = 11, 6.8%; 8 Crohn's). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3% vs 49.2%, P = 0.034) and older age (P = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3% vs 45.3%, P < 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention (0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated CD. CONCLUSION: CE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.

A proposed reference change value for an IgA anti-tissue transglutaminase immunoassay to improve interpretation of serial results in celiac patients.

BACKGROUND: Celiac disease (CD) is an autoimmune disorder caused by an inappropriate immunological response to gluten ingestion in genetically susceptible individuals. IgA anti-tissue transglutaminase (tTG) antibodies have been widely employed as a specific biochemical marker for CD. Recent studies have also shown its usefulness in evaluating patient compliance with a gluten-free diet. METHODS: A group of 28 subjects with CD was selected for the study. Each fulfilled the requirement of a gluten-free diet for more than one year. IgA anti-tTG determination was performed every two months for half a year. These data were used to estimate the biological variation (BV) of IgA anti-tTG in celiac patients and to calculate the reference change value (RCV). RESULTS: The within-subject biological variation (CVI) and between-subject biological variation (CV(G)) were 19.2% and 75.6%, respectively, and the index of individuality was 0.25. The RCV calculated using these data together with our analytical imprecision (5.7%) was 55.5% for a 95% level of significance. CONCLUSIONS: We have determined for the first time the BV and the RCV for IgA anti-tTG in a celiac population. This value and the probability curve generated from our data could be a valuable tool for monitoring patients' adherence to dietary treatment.

Fontan operation for patients with complex anatomy: the intra-atrial conduit technique.

The extracardiac conduit type of total cavopulmonary connection (TCPC) is the most common variation of the modified Fontan operation in current use. For patients with some forms of complex anatomy (eg, dextrocardia in situs solitus or asplenia syndrome), we have adopted a different technique: interposition of an intra-atrial conduit between the inferior vena cava (IVC) and the superior vena cava-right pulmonary artery (SVC-RPA) connection. We report our experience with six patients.

Amyloidosis and Crohn´s disease.

Secondary amyloidosis is a rare but serious complication of inflammatory bowel disease that may influence the prognosis even more than the underlying disease. Due to a better knowledge of the association of secondary amyloidosis to inflammatory bowel disease, early diagnosis of this complication is becoming more frequent, but its treatment continues to pose a challenge. We report 4 cases of patients with Crohn´s disease and amyloidosis diagnosed in the inflammatory bowel disease Units of Toledo and Ciudad Real, which represent 0.68% of the patients with Crohn´s disease of our health areas. There have been not cases of amyloidosis in patients with ulcerative colitis. In our 4 patients the secondary amyloidosis was clearly related to Crohn´s disease,which was often of fistulising type. The predominant clinical picture of amyloidosis was nephrotic syndrome. The patients responded to medical and surgical treatment of Crohn´s disease and colchicine, which improved renal function in all cases except in one who required kidney transplantation.