[Evaluation of the utility and efficacy of a day hospital in a gastroenterology department]. / Valoración de la utilidad y eficacia de un hospital de día en un servicio de patología digestiva.

Because public health funds are limited, full advantage should be taken of the resources available. Consequently, hospital stay should be reduced with no loss of health care quality. In our Gastroenterology Department, investigations or treatment requiring a short hospital stay are carried out in a day hospital. Between March 1998 and March 2000, 2,169 patients were treated: 1,862 outpatients and 307 patients referred from another hospital. A total of 95.2% of the outpatients were discharged. Hospital stay was prolonged in 4.8% (91/1,862): 13 due to incomplete investigations, 29 because of worsening of their underlying disease before the procedure and 49 due to complications. The overall complication rate was 2.8% (62/2,169). Six complications developed after discharge; of these two appeared within 24 hours. After the opening of the day hospital, the mean hospital stay in the Gastroenterology Department was reduced from 9.05 days to 6.07 days (p = 0.001). In conclusion, the use of a day hospital in a gastroenterology department is useful, effective, safe and profitable.

[Functional dyspepsia, gastric emptying of solids, and Helicobacter pylori infection]. / Dispepsia funcional, vaciado gástrico de sólidos e infección por Helicobacter pylori.

UNLABELLED: The origin of functional dyspepsia (FD) is unknown, however, abnormal gastric emptying and infection by H. pylori have been suggested as possible causes. OBJECTIVE: The aim of this study was to test the hypothesis that infection by H. pylori could be related to alterations in gastric emptying of solids and play a role in the pathophysiology of dyspepsia. METHODS: Studies were performed on 12 controls: 6 males, 6 females, age 40 +/- 13, and on 45 FD patients: 15 males and 30 females, age 43.5 +/- 12. Clinical criteria for FD diagnosis were post-prandial epigastric pain, nausea, vomiting or epigastric bloating, with normal blood test, upper endoscopy and abdominal ultrasound. Diagnosis of H. pylori infection was either by growth positive on culture of antral biopsy or by all of the following: on Gram stain, urease test positive and visualization of microorganisms in the antral biopsy. Gastric emptying of solids was studied with a radio-nuclide technique. Patients were prospectively classified in 4 groups according to the main symptom: reflux-like, ulcer-like, dysmotility, and non-specific. RESULTS: H. pylori infection was observed in 21/32 (66%) FD patients. No significant differences in the gastric emptying of solids between the control group and patients with FD (tl/2 80 +/- 17 minutes vs 75 +/- 16 min). The presence of H. pylori infection did not influence gastric emptying rates (78 +/- 16 minutes in infected patients vs 73 +/- 15 min in non infected patients). Gastric emptying times were similar among the four subgroups of FD patients. CONCLUSIONS: No significant differences in gastric emptying of solids were found in H. pylori infected persons as compared with the controls. These findings suggest that H. pylori infection and/or changes in gastric emptying of solids do not play a role in the pathophysiology of FD.

[Morphology of chronic gastritis associated with Campylobacter pylori infection]. / Morfología de la gastritis crónica asociada a infección por Campylobacter pylori.

Recently, a close relation has been found between infection of the gastric mucosa by Campylobacter pylori and chronic gastritis. To establish the possible existence of characteristic morphologic changes in this disease, which can be differentiated from other unrelated forms of gastritis, we analyzed the antral biopsies obtained from 75 patients, 35 with duodenal peptic ulcer and 40 with nonulcerous dyspepsia. The diagnosis of C. pylori infection is based on positive biopsy culture or, if not, when following three requirements are met: positive urease test before 24 hours, identification of the germ by Gram stain and visualization in the tissue of microorganisms with morphology similar to that of C. pylori. We found that 85.5% of the 55 patients with C. pylori infection present active chronic gastritis with lymphoid nodes (GCA + NL), while this morphology is only found in 5 of the 20 uninfected patients. The association of GCA + NL with C. pylori infection is highly significant (p less than 0.0001). We think that it could be a local immunologic response to the stimulus of the bacterial antigen, and that it has sufficient morphologic entity to differentiate it from other inflammatory processes of the gastric mucosa of still unknown etiology.