Medición de la absorción de los ácidos biliares en el diagnóstico inicial de la diarrea crónica / Measurement of 75Se-SeHCAT abdominal retention in the initial diagnosis of Bile Acid Absorption (BAM)

Objetivo. Evaluar la utilidad de la prueba del 75SeHCAT en el diagnóstico precoz del síndrome diarreico (SD). Se evaluaron prospectivamente 37 pacientes con SD de un mes de evolución. Método. Se midió la retención abdominal (RA) de 75SeHCAT 4 y 7 días post-administración de 0,01 mCi de 75SeHCAT antes del tratamiento y a los tres meses en los pacientes con estudio basal positivo. La prueba se consideró positiva si la RA era: < 25% el 4.° y < 10% el 7.° días. Los pacientes fueron visitados a los tres meses. Según la respuesta se distinguió: a) respuesta completa: normalización del ritmo deposicional; b) respuesta parcial, disminución de la frecuencia/consistencia, y c) no respuesta. Resultados. Grupo A: la RA fue normal en 21 pacientes. El diagnóstico fue: 6 divertículos colónicos, 8 síndrome de intestino irritable, 1 colitis linfocitaria, 1 síndrome post-gastroenteritis, 1 enfermedad celíaca, 1 estenosis de cardias y 4 continuan en estudio. Grupo B: la RA disminuyó en 16 pacientes; todos mostraron una RA baja a los 7 días y solo uno a los 4 días. Tras la administración de resina de colestiramina, 8 (50%) presentaron respuesta parcial y 8 (50%) respuesta completa. A los tres meses, la RA había aumentado en tres pacientes al 4.° día y en 9 al 7.° día. Conclusión. La medición de la RA de 75Se-SEHCAT permite el diagnóstico precoz de la malabsorción de sales biliares en el 43% de pacientes con SD. La medición a los 7 días parece más precisa que la de los 4 días(AU)

Aim. To evaluate the usefulness of the 75SeHCAT abdominal retention (AR) measurement in the early diagnosis of diarrhea syndrome (DS). Methods. Thirty-seven patients with diarrhea syndrome within the first month of evolution were prospectively evaluated. The 75Se-SeHCAT abdominal retention was measured 4 and 7 days post-administration of 0.01 mCi of 75SeHCAT. The test was performed prior to treatment and at 3 months when the baseline study was positive. The test was considered positive if the RA was <25% at 4th and <10% on the 7th day. The patients were visited at 3 months. Depending on the response, 3 groups were established: a) complete response: normalization of stool frequency, b) partial response, decrease of frequency or c) no response. Results. Group A: The AR of 75Se-SEHCAT was normal in 21 patients. Six were diagnosed of colonic diverticulosis, 8 of irritable bowel syndrome, 1 of lymphocytic colitis, 1 of post-gastroenteritis syndrome, 1 of celiac disease and 1 of stenosis of the cardia. Four are still under study. Group B: The AR of 75Se-SEHCAT decreased in 16 patients. All showed abnormal AR at day 7 and all but 1 at day 4. Following administration of cholestyramine resin, 8 (50%) presented partial response and 8 (50%) complete response. At 3 months, AR had increased at day 4 and 9 at day 7. Conclusion. The measurement of 75SEHCAT abdominal retention allows the early diagnosis of bile acid malabsorption in 43% of the patients with DS. Measurement at 7 days seems more accurate than that at 4 days(AU)

[Measurement of 75Se-SeHCAT abdominal retention in the initial diagnosis of Bile Acid Absorption (BAM)]. / Medición de la absorción de los ácidos biliares en el diagnóstico inicial de la diarrea crónica.

AIM: To evaluate the usefulness of the (75)SeHCAT abdominal retention (AR) measurement in the early diagnosis of diarrhea syndrome (DS). METHODS: Thirty-seven patients with diarrhea syndrome within the first month of evolution were prospectively evaluated. The (75)Se-SeHCAT abdominal retention was measured 4 and 7 days post-administration of 0.01 mCi of (75)SeHCAT. The test was performed prior to treatment and at 3 months when the baseline study was positive. The test was considered positive if the RA was <25% at 4(th) and <10% on the 7th day. The patients were visited at 3 months. Depending on the response, 3 groups were established: a) complete response: normalization of stool frequency, b) partial response, decrease of frequency or c) no response. RESULTS: Group A: The AR of (75)Se-SEHCAT was normal in 21 patients. Six were diagnosed of colonic diverticulosis, 8 of irritable bowel syndrome, 1 of lymphocytic colitis, 1 of post-gastroenteritis syndrome, 1 of celiac disease and 1 of stenosis of the cardia. Four are still under study. Group B: The AR of (75)Se-SEHCAT decreased in 16 patients. All showed abnormal AR at day 7 and all but 1 at day 4. Following administration of cholestyramine resin, 8 (50%) presented partial response and 8 (50%) complete response. At 3 months, AR had increased at day 4 and 9 at day 7. CONCLUSION: The measurement of (75)SEHCAT abdominal retention allows the early diagnosis of bile acid malabsorption in 43% of the patients with DS. Measurement at 7 days seems more accurate than that at 4 days.

Usefulness of reagent strips for checking cure in spontaneous bacterial peritonitis after short-course treatment.

BACKGROUND: The usefulness of reagent strips to check cure of spontaneous bacterial peritonitis have not been evaluated to date. AIM: To assess the usefulness of ascitic fluid analysis by means of reagent strips to check cure after a 5-day antibiotic course. METHODS: We prospectively included all cirrhotic patients diagnosed with spontaneous bacterial peritonitis. On day 5, conventional and reagent strip ascitic fluid analyses were performed. RESULTS: Fifty-three episodes of spontaneous bacterial peritonitis in 51 cirrhotic patients were included. Five patients died before the fifth day and in two patients, the control paracentesis yielded no ascitic fluid. In nine out of 46 cases (19.6%), spontaneous bacterial peritonitis had not resolved by day 5. In 32 out of 33 cases in which the ascitic fluid polymorphonuclear count was <250/microL at day five, the reagent strips was negative. The negative predictive value of the reagent strip at fifth day was 97% and the LR- 0.13. CONCLUSIONS: Almost 20% of episodes of spontaneous bacterial peritonitis do not resolve with a short-course of antibiotic treatment. In view of the high negative predictive value and low likelihood ratio for a negative test, reagent strips analysis may be an alternative to conventional cytology if a 5-day antibiotic therapy is planned.