Peptic Ulcer Bleeding Risk. The Role of Helicobacter Pylori Infection in NSAID/Low-Dose Aspirin Users.

OBJECTIVES: Helicobacter pylori (H. pylori) infection and NSAID/low-dose aspirin (ASA) use are associated with peptic ulcer disease. The risk of peptic ulcer bleeding (PUB) associated with the interaction of these factors remains unclear. The objective of this study was to determine the risk of PUB associated with the interaction between H. pylori infection and current nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose ASA use. METHODS: This was a case-control study of consecutive patients hospitalized because of PUB. Controls were matched by age, sex, and month of admission. H. pylori infection status was determined in all cases and controls by serology. Drug use was determined by structured questionnaire. Adjusted relative risk (RR) associated with different factors, and the interaction between NSAID/ASA and H. pylori infection was estimated by logistic regression analysis. RESULTS: The study included 666 cases of PUB and 666 controls; 74.3% cases and 54.8% controls (RR: 2.6; 95% confidence interval (CI): 2.0-3.3) tested positive for H. pylori infection; 34.5% of cases had current NSAID use compared with 13.4% of controls (RR: 4.0; 95% CI: 3.0-5.4). Respective proportions for low-dose ASA use were 15.8 and 12%, respectively (RR: 1.9; 95% CI: 1.3-2.7). The RR of PUB for concomitant NSAID use and H. pylori infection suggested an additive effect (RR: 8.0; 95% CI: 5.0-12.8), whereas no interaction was observed with ASA use (RR: 3.5; 95% CI: 2.0-6.1). CONCLUSIONS: NSAID, low-dose ASA use, and H. pylori infection are three independent risk factors for the development of PUB, but there were differences in the interaction effect between low-dose ASA (no interaction) or NSAID (addition) use and H. pylori infection, which may have implications for clinical practice in prevention strategies.

Can red flowers be conspicuous to bees? Bombus dahlbomii and South American temperate forest flowers as a case in point.

It has been argued that trichromatic bees with photoreceptor spectral sensitivity peaks in the ultraviolet (UV), blue and green areas of the spectrum are blind to long wavelengths (red to humans). South American temperate forests (SATF) contain a large number of human red-looking flowers that are reported to be visited by the bumblebee Bombus dahlbomii. In the present study, B. dahlbomii's spectral sensitivity was measured through electroretinogram (ERG) recordings. No extended sensitivity to long wavelengths was found in B. dahlbomii. The spectral reflectance curves from eight plant species with red flowers were measured. The color loci occupied by these flowers in the bee color space was evaluated using the receptor noise-limited model. Four of the plant species have pure red flowers with low levels of chromatic contrast but high levels of negative L-receptor contrast. Finally, training experiments were performed in order to assess the role of achromatic cues in the detection and discrimination of red targets by B. dahlbomii. The results of the training experiments suggest that the bumblebee relies on achromatic contrast provided by the L-receptor to detect and discriminate red targets. These findings are discussed in the context of the evolutionary background under which the relationship between SATF species and their flower visitors may have evolved.

Phylogenetic analysis of floral integration in Schizanthus (Solanaceae): does pollination truly integrate corolla traits?

To assess whether floral integration patterns result from the action of pollinator selection on functionally related traits, we compared corolla integration patterns in eight Schizanthus species differing in pollination systems and in their degree of pollinator dependence across a molecular phylogeny. Integration patterns differed among species and these differences were not related to their phylogenetic relatedness. When the putative original function of some corolla traits was lost in pollinator-dependent species, the integration among nonfunctional characters and the rest of the corolla traits was disrupted. This pattern was not presented in species adapted for late autonomous selfing, which exhibited higher corolla integration than their pollinator-dependent relatives. These results suggest that corolla integration in pollinator-dependent species was shaped by pollinator-mediated selection. Decoupling of nonfunctional traits in these species may result from a relaxation of correlational selection or from selection acting against a default covariation provided by genetic and developmental connections.

Relationship between seed bank expression, adult longevity and aridity in species of Chaetanthera (Asteraceae) in central Chile.

BACKGROUND AND AIMS: Broad surveys have detected inverse relationships between seed and adult longevity and between seed size and adult longevity. However, low and unpredictable precipitation is also associated with seed bank (SB) expression in semi-arid and arid areas. The relationship between adult longevity, SB formation, seed mass and aridity is examined in annual and perennial herbs of Chaetanthera (Asteraceae) from the Chilean Mediterranean-type climate and winter-rainfall desert areas over a precipitation range of one order of magnitude. METHODS: Seeds of 18 species and subtaxa (32 populations) were buried in field locations, and exhumed after two successive germination periods. Seeds not germinating in the field were tested in a growth chamber, and remnant intact seed tested for viability. Seed banks were classed as transient or persistent. The effect of life form, species, population and burial time on persistent SB size was assessed with factorial ANOVA. Persistent seed bank size was compared with the Martonne aridity index (shown to be a surrogate for inter-annual variation in precipitation) and seed size using linear regression. ANCOVA assessed the effect of life-form on SB size with aridity as covariate. KEY RESULTS: Three species had a transient SB and 15 a persistent SB. ANOVA revealed a significant effect of life-form on SB size with annuals having larger SB size and greater capacity to form a persistent SB than perennials. Significant inter-population variation in SB size was found in 64% of cases. Seed mass was negatively correlated with persistent SB size. Persistent seed bank size was significantly correlated with the Martonne aridity index in the perennial and annual species, with species from more arid areas having larger persistent SBs. However, when aridity was considered as a covariate, ANCOVA revealed no significant differences between the annual and perennial herbs. CONCLUSIONS: Persistent seed bank size in Chaetanthera appears to reflect environmental selection rather than any trade-off with adult longevity.

Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations.

BACKGROUND: The risks and benefits of coxibs, non-steroidal anti-inflammatory drugs (NSAIDs), and aspirin treatment are under intense debate. OBJECTIVE: To determine the risk of peptic ulcer upper gastrointestinal bleeding (UGIB) associated with the use of coxibs, traditional NSAIDs, aspirin or combinations of these drugs in clinical practice. METHODS: A hospital-based, case-control study in the general community of patients from the National Health System in Spain. The study included 2777 consecutive patients with endoscopy-proved major UGIB because of the peptic lesions and 5532 controls matched by age, hospital and month of admission. Adjusted relative risk (adj RR) of UGIB determined by conditional logistic regression analysis is provided. RESULTS: Use of non-aspirin-NSAIDs increased the risk of UGIB (adj RR 5.3; 95% confidence interval (CI) 4.5 to 6.2). Among non-aspirin-NSAIDs, aceclofenac (adj RR 3.1; 95% CI 2.3 to 4.2) had the lowest RR, whereas ketorolac (adj RR 14.4; 95% CI 5.2 to 39.9) had the highest. Rofecoxib treatment increased the risk of UGIB (adj RR 2.1; 95% CI 1.1 to 4.0), whereas celecoxib, paracetamol or concomitant use of a proton pump inhibitor with an NSAID presented no increased risk. Non-aspirin antiplatelet treatment (clopidogrel/ticlopidine) had a similar risk of UGIB (adj RR 2.8; 95% CI 1.9 to 4.2) to cardioprotective aspirin at a dose of 100 mg/day (adj RR 2.7; 95% CI 2.0 to 3.6) or anticoagulants (adj RR 2.8; 95% CI 2.1 to 3.7). An apparent interaction was found between low-dose aspirin and use of non-aspirin-NSAIDs, coxibs or thienopyridines, which increased further the risk of UGIB in a similar way. CONCLUSIONS: Coxib use presents a lower RR of UGIB than non-selective NSAIDs. However, when combined with low-dose aspirin, the differences between non-selective NSAIDs and coxibs tend to disappear. Treatment with either non-aspirin antiplatelet or cardioprotective aspirin has a similar risk of UGIB.

Estudio comparativo de los inhibidores de la bomba de protones en la hemorragia digestiva alta / Proton pump inhibitors

El medio ácido disminuye la agregación plaquetaria y la formación del coágulo. El beneficio de los fármacos antisecretores en la hemorragia digestiva por enfermedad péptica (HDA-EP) se alcanzará, de forma ideal, al mantener un pH intragástrico superior 6 de forma constante. Los antagonistas H2 pierden su potencia antisecretora a partir del tercer día de tratamiento. Los inhibidores de la bomba de protones tienen una mayor capacidad antisecretora y más mantenida y han demostrado su eficacia en la prevención de la recidiva, necesidad de cirugía y mortalidad en la HDA-EP. Existen estudios demostrando la superioridad de omeprazol y pantoprazol frente a placebo, especialmente después de tratamiento endoscópico. Esomeprazol por vía intravenosa ha demostrado tener una mayor capacidad para inhibir la secreción ácida y elevar el pH intragástrico. Se recomienda un bolo de 80 mg, seguido de una infusión constante de 8 mg/hora durante tres días (AU)

In an acid environment platelet aggregation and clotting formation are reduced. Ideally, highest benefits in peptic disease- related digestive hemorrhages (PDRDH) could be reached if intragastric pH was continuously maintained above 6. The H2 antagonists lose their antisecretory potential after a three day treatment. The proton pump inhibitors have a higher and maintained antisecretory potential in comparison to H2 antagonists in PDRDH; their efficiency in the prevention of recurrent disease, reduction of surgery and mortality has been also demonstrated. Several studies have reported the superiority of omeprazole and pantoprazole compared to placebo, specially after endoscopic treatment. Intravenous esomeprazole has shown benefit preventing acid secretion and increasing intragastric pH. A bolus of 80 mg is the dose preferred, followed by constant infusion of esomeprazole 8 mg/hour throughout three days (AU)

Fabrication of SU-8 multilayer microstructures based on successive CMOS compatible adhesive bonding and releasing steps.

This paper describes a novel fabrication process based on successive wafer-level bonding and releasing steps for stacking several patterned layers of the negative photoresist EPON SU-8. This work uses a polyimide film to enhance previous low temperature bonding technology. The film acts as a temporary substrate where the SU-8 is photopatterned. The poor adhesion between the polyimide film and SU-8 allows the film to be released after the bonding process, even though the film is still strong enough to carry out photolithography. Using this technique, successive adhesive bonding steps can be carried out to obtain complex 3-D multilayer structures. Interconnected channels with smooth vertical sidewalls and freestanding structures are fabricated. Unlike previous works, all the layers are photopatterned before the bonding process yielding sealed cavities and complex three-dimensional structures without using a sacrificial layer. Adding new SU-8 layers reduces the bonding quality because each additional layer decreases the thickness uniformity and increases the polymer crosslinking level. The effect of these parameters is quantified in this paper. This process guarantees compatibility with CMOS electronics and MEMS. Furthermore, the releasing step leaves the input and the output of the microchannels in contact with the outside world, avoiding the usual slow drilling process of a cover. Hence, in addition to the straightforward integration of electrodes on a chip, this fabrication method facilitates the packaging of these microfluidic devices.

[Surgery at follow-up in an incidence cohort of patients with Crohn's disease in Aragon (Spain): etiology, type of surgery and associated epidemiological factors]. / Cirugía de una cohorte incidente de pacientes con enfermedad de Crohn en Aragón: indicaciones, tipo de cirugía y factores de riesgo asociados.

INTRODUCTION: Few population-based studies have been published on predictive factors in the clinical course of Crohn's disease (CD). The only constant risk factor for postsurgical recurrence is smoking. The aim of this study is to describe surgical need, etiology and characteristics, and the distinct clinical variables that act as risk or protective factors for the indication of surgery in an incidence cohort of patients with a diagnosis of CD in Aragon. MATERIAL AND METHODS: Based on the results of a population-based, prospective study reporting the incidence of inflammatory bowel disease in Aragon, 88 patients with a diagnosis of CD were included in the present study. The patients medical records were reviewed and data on the following clinical variables from diagnosis (1992-1995) to February 2001 were gathered: surgery, type of surgery and etiology, anatomic distribution, number of relapses, remission, clinical course, death, smoking, oral contraceptive intake, and hospitalization. Descriptive and bivariate analyses were performed to investigate the association between these variables and surgery during follow-up. RESULTS: Eighty-eight patients with at least 6 months of follow-up were included (88/103; 85%), with a mean follow-up of 77 months (range, 6-110 months). Some kind of surgery during follow-up was required by 20.5% of our patients; in nearly 50% of these, surgery was indicated for intestinal obstruction. A second surgical intervention was required in 10.2% due to fistula and/or abscess or ileostomy for subsequent reconstruction of intestinal transit. Although ileal localization was more frequently associated with surgery, this association was not statistically significant. No association was found between surgery during follow-up and sex, age at diagnosis or oral contraceptive intake. Factors positively associated with surgery were a chronic clinical course and a greater number of hospitalizations. We found no positive or negative association with smoking, non-smoking or time free of smoking, but the total time of smoking was positively associated with surgery. CONCLUSIONS: Risk factors for surgery in patients with CD were a chronic clinical course, the number of hospitalizations and total time of smoking. Ileal localization was more frequently associated with surgery but this association was not statistically significant.

[Ulcerative pancolitis predicts the need for colectomy: study of an incident cohort of patients with ulcerative colitis in Aragón (Spain)]. / La afectación pancolónica inicial en la colitis ulcerosa predice la necesidad de colectomía: estudio poblacional basado en una cohorte incidente de pacientes en Aragón.

INTRODUCTION: Population-based studies show pancolitis as the only risk factor for colectomy in patients with ulcerative colitis (UC). AIM: To evaluate surgical need, its etiology and characteristics, and the distinct clinical variables that act as risk and/or protective factors for the indication for surgery in an incident cohort of patients with UC in Aragón. PATIENTS AND METHOD: Based on the results of a population-based, prospective study reporting the incidence of inflammatory bowel disease in Aragón, 168 patients with a diagnosis of UC were included in the present study. The patients' medical records were reviewed and the following clinical variables were collected from the time of diagnosis (1992-1995) to February 2001: surgery, type of surgical intervention and etiology, anatomic distribution, number of relapses, remissions, clinical course, death, smoking, oral contraceptives and hospitalizations. To investigate the association between these variables and surgery during follow-up, descriptive and bivariate analyses were performed. RESULTS: Of 204 patients diagnosed with UC, 168 (82.3%) with a follow-up of at least 6 months were included. The mean follow-up was 77 months (range: 6-110 months). Some type of surgery was required by 6.5% of our patients during follow-up and 3.6% needed a second surgical intervention. Surgery was indicated for various etiologies. Most patients underwent colectomy and ileostomy with subsequent surgical reconstruction of the intestinal tract. Pancolitis was a clear independent risk factor for colectomy in our patient cohort. No association was found between sex, age at diagnosis, and oral contraceptive intake with surgery during follow-up. Patients who underwent surgery had previously shown more than one relapse and several hospitalizations but did not necessarily show a chronic clinical course. We found no positive or negative association with any smoking-related variables: smoker, non-smoker, years of smoking or years free of smoking. CONCLUSION: Ulcerative pancolitis at diagnosis is a predictive factor for surgery in the short term in patients with a diagnosis of UC in Aragón. We found no other significant associations with the remaining epidemiological factors studied.

La afectación pancolónica inicial en la colitis ulcerosa predice la necesidad de colectomía: estudio poblacional basado en una cohorte incidente de pacientes en Aragón / Ulcerative pancolitis predicts the need for colectomy: study of an incident cohort of patients with ulcerative colitis in Aragón (Spain)

INTRODUCCIÓN: Sobre la base de estudios poblacionales, la única variable clínica consistente y predictiva de un determinado curso clínico que se ha descrito es el mayor riesgo decolectomía en los pacientes con pancolitis ulcerosa. OBJETIVO: Valorar la necesidad de cirugía, su etiología y sus características, así como las distintas variables clínicas que actúan como factores de riesgo o protectores respecto de la indicación quirúrgica de una cohorte incidente de pacientes con diagnóstico de colitis ulcerosa (CU) en Aragón. PACIENTES Y MÉTODO: Basados en los resultados de un estudio poblacional y prospectivo incidente en Aragón, incluimos en el estudio a 168 pacientes diagnosticados de CU; se revisaron sus historias clínicas y se recogieron las distintas variables clínicas desde su diagnóstico (1992-1995) hasta febrero de 2001: cirugía, tipos de intervención quirúrgica y etiología, localización anatómica, número de brotes e ingresos, remisión, curso crónico, fallecimiento, exposición al tabaco, anticonceptivos orales e ingresos. Se realizó un análisis descriptivo y un análisis bivariante para investigar la asociación de estas variables con la cirugía durante el seguimiento. RESULTADOS: Hemos obtenido información durante 6 meses de seguimiento de 168 pacientes (168/204) (82,3%), con un seguimiento medio de 77 meses (rango, 6-110 meses). Durante el seguimiento, el 6,5% de los pacientes precisó algún tipo de intervención quirúrgica y el 3,6%, una segunda cirugía. La indicación quirúrgica es variable; en la mayoría de los casos se realizó colectomía e ileostomía, y fue necesaria una segunda cirugía para la reconstrucción del tránsito intestinal. La pancolitis ulcerosa se comporta como un factor de riesgo independiente para la necesidad de cirugía. En nuestros pacientes, el sexo, la edad al diagnóstico y la toma de anticonceptivos no se asociaron a la presencia de cirugía. Los pacientes que precisaron cirugía durante el seguimiento habían presentado previamente un curso clínico de más de un brote y un mayor número de ingresos, pero no necesariamente un curso crónico. No objetivamos una asociación positiva ni negativa con las variables: expuesto, no fumador, tiempo libre de exposición al tabaco ni tiempo global de exposición. CONCLUSIÓN: La pancolitis ulcerosa al diagnóstico es un factor que se relaciona con la necesidad a corto plazo de la cirugía en los pacientes con diagnóstico inicial de CU en Aragón; no se objetivó ninguna otra asociación entre otros factores epidemiológicos estudiados

INTRODUCTION: Population-based studies show pancolitis as the only risk factor for colectomy in patients with ulcerative colitis (UC).AIM: To evaluate surgical need, its etiology and characteristics, and the distinct clinical variables that act as risk and/or protective factors for the indication for surgery in an incident cohort of patients with UC in Aragón. PATIENTS AND METHOD: Based on the results of a population based, prospective study reporting the incidence of inflammatory bowel disease in Aragón, 168 patients with a diagnosis of UC were included in the present study. The patients’ medical records were reviewed and the following clinical variables were collected from the time of diagnosis (1992-1995)to February 2001: surgery, type of surgical intervention andetiology, anatomic distribution, number of relapses, remissions, clinical course, death, smoking, oral contraceptives and hospitalizations. To investigate the association between these variables and surgery during follow-up, descriptive and bivariate analyses were performed. RESULTS: Of 204 patients diagnosed with UC, 168 (82.3%)with a follow-up of at least 6 months were included. Theme an follow-up was 77 months (range: 6-110 months). Some type of surgery was required by 6.5% of our patients during follow-up and 3.6% needed a second surgical intervention. Surgery was indicated for various etiologies. Most patients underwent colectomy and ileostomy with subsequent surgical re- construction of the intestinal tract. Pancolitis was a clear independent risk factor for colectomy in our patient cohort. No association was found between sex, age at diagnosis, and oral contraceptive intake with surgery during follow-up. Patients who underwent surgery had previously shown more than one relapse and several hospitalizations but did not necessarily show a chronic clinical course. We found no positive or negative association with any smoking related variables: smoker, non-smoker, years of smoking or years free of smoking. CONCLUSION: Ulcerative pancolitis at diagnosis is a predictive factor for surgery in the short

Risk of upper gastrointestinal bleeding in patients taking low-dose aspirin for the prevention of cardiovascular diseases.

BACKGROUND: Most patients with vascular-occlusive diseases benefit from low-dose aspirin (75-325 mg/day). However, they have an increased risk of upper gastrointestinal bleeding (UGIB). AIMS: To analyse the incidence and factors influencing the occurrence of UGIB in patients taking low-dose aspirin for the prevention of cardiovascular diseases outside clinical trials. METHODS: We studied 903 consecutive patients discharged on low-dose aspirin from the Cardiology Department of a general hospital. Data were collected from medical charts and structured telephone interviews. RESULTS: Forty-one patients (4.5%) presented with UGIB requiring hospitalization during follow-up (45 +/- 22 months). The incidence of UGIB was uniform during follow-up (1.2 UGIB per 100 patient years). Multivariate analysis showed that a history of peptic ulcer or UGIB [risk ratio: 3.1, 95% CI: (1.5-6.5)] and aspirin dose (per 100 mg/day) [1.8 (1.5-2.9)] was associated with higher risk of UGIB. On the other hand, antisecretory [0.22 (0.07-0.75)] and nitrovasodilator drugs [0.73 (0.55-0.96)] were associated with a decreased risk. CONCLUSIONS: Cardiovascular patients on long-term low-dose aspirin have a stable risk of major UGIB, which is higher than published controlled clinical trials. Antisecretory and nitrovasodilator drugs protect from UGIB, whereas previous peptic ulcer or UGIB and higher doses of aspirin increase the risk.

[Antisecretory drugs and prophylaxis of secondary gastrointestinal effects associated with the consumption of non steroid anti-inflammatory drugs]. / Fármacos antisecretores y profilaxis de los efectos secundarios gastrointestinales graves asociados al consumo de antiinflamatorios no esteroides.

BACKGROUND: To evaluate the available evidence on the efficacy of antisecretory drugs in the prevention of serious upper gastrointestinal adverse events associated with the use of nonsteroidal antiinflammatory drugs (NSAID). METHODS: All studies published and abstracted in the MEDLINE from 1970 to 1999 were reviewed. Only randomized, double-blind and placebo-controlled studies with a follow-up longer than 4 weeks were selected. The variables upper gastrointestinal complications, gastric ulcer, duodenal ulcer and side effects in both primary and secondary prophylaxis were analyzed by meta-analysis techniques. RESULTS: No studies were available regarding the effects of antisecretory drugs in the prevention of upper gastrointestinal bleeding associated with NSAID use. Ten studies were identified in the prevention of both gastric and duodenal ulcers. The effect of these agents was found to be especially useful in the prevention of duodenal ulcers, in secondary prophylaxis and in the long-term use of NSAID. The most consistent effect was seen with omeprazole for both duodenal ulcer prevention (OR [95% CI] = 0.12 [0.06-0.23]) and gastric ulcer prevention (OR = 0.20 [0.13-0.31)]. However, H2-receptor, antagonists were not significantly associated with gastric ulcer prevention in all the scenarios analyzed. CONCLUSIONS: Prescription of antisecretory drugs are justified in the prevention of both gastric and duodenal ulcers in patients taking NSAID. The best benefit is achieved with omeprazole.

Prevention and healing of experimental indomethacin-induced gastric lesions: effects of ebrotidine, omeprazole and ranitidine.

BACKGROUND: Ebrotidine is a new H2 receptor antagonist that potentiates the gastric mucosal barrier. AIM: To compare ebrotidine with other anti-secretory drugs in the prevention and healing of indomethacin-induced gastric lesions. METHODS: Three different models of indomethacin-induced gastric lesions were used. (1) Fasted rat model: indomethacin was intra-gastrically administered in rats pre-treated with different doses of the anti-secretory drugs. (2) Re-fed rat model: rats orally treated with different doses of anti-secretory drugs had free access to chow pellets and were then treated with parenteral indomethacin. (3) Healing model: either oral or parenteral anti-secretory drugs were given after indomethacin administration. Computer-assisted analysis of the area of damage was expressed as ulcer index. Gastric secretion was evaluated in the pylorus-ligated rat model. RESULTS: Inhibition of acid secretion was in the order omeprazole > ebrotidine = ranitidine. Ebrotidine at the highest dose used (100 mg/kg) and omeprazole, but not ranitidine, significantly prevented indomethacin-induced corpus (fasted rat) and antrum (re-fed rat) gastric lesions. In the ulcer healing model, oral administration of omeprazole and both ranitidine and ebrotidine at the highest dose used improved the ulcer index. The parenteral administration of these drugs had a lesser effect than the oral route and was in the order ebrotidine > omeprazole > ranitidine. CONCLUSIONS: Ebrotidine is effective in both the prevention and healing of indomethacin-induced experimental gastric lesions. In these models, the effect of ebrotidine is comparable to omeprazole and more effective than ranitidine.

Aspirin related gastrointestinal bleeders have an exaggerated bleeding time response due to aspirin use.

BACKGROUND: Gastrointestinal bleeding is related to non-steroidal anti-inflammatory drug (NSAID) use, especially aspirin, but only a small subset of users bleed. AIM: To look for risk factors or mechanisms whereby aspirin may promote gastrointestinal bleeding. PATIENTS: Sixty one patients with previous aspirin related upper gastrointestinal bleeding and 61 matched controls. METHODS: Patients and controls were given 375 mg of aspirin and sequential skin bleeding time and blood aspirin levels were measured. Additional studies included platelet lumiaggregation, von Willebrand factor, Factor VIII, and coagulation studies. RESULTS: Baseline skin bleeding time was similar in bleeders and controls, but bleeders had a more prolonged skin bleeding time after aspirin use. Hyper-response was more frequent in bleeders (30% v 9.3%; p < 0.01) and was associated with more than one previous separate bleeding event and a lower packed cell volume during the preceding bleeding episode. No differences were found in other factors studied. Logistic regression analysis identified prolonged skin bleeding time after aspirin use as an independent factor contributing to aspirin related gastrointestinal bleeding (RR = 5.4; 95% CI: 1.8 to 17.1). CONCLUSIONS: 30% of patients with a history of aspirin related gastrointestinal bleeding have an exaggerated prolongation of skin bleeding time in response to aspirin, which may be a risk factor for bleeding. This intrinsic defect or to subclinical von Willebrand disease or different aspirin metabolism.

Effect of parenteral omeprazole and ranitidine on gastric pH and the outcome of bleeding peptic ulcer.

The pharmacotherapy of bleeding peptic ulcer is directed at attempting to keep the gastric pH above the proteolytic range for pepsin. In this randomized, prospective, open clinical trial we have compared the effects and outcome of omeprazole versus ranitidine in patients with bleeding peptic ulcer. Of 219 consecutive patients with upper gastrointestinal bleeding, 51 (23.2%) had an ulcer with endoscopic predictors of rebleeding at the time of diagnosis. These 51 patients were selected at random to receive either omeprazole (80 mg bolus and 40 mg/12 h i.v.) or ranitidine (50 mg/4 h i.v.). No endoscopic therapy was performed at the time of diagnosis. Twenty of these patients with duodenal ulcer (n = 10 omeprazole, n = 10 ranitidine) underwent 24-h gastric pH monitoring. Both groups were homogeneous in all clinical and endoscopic parameters. No differences in blood transfusion units, time of hospitalization, the lowest hematocrit measured, and mortality rates were observed between the groups. However, omeprazole reduced the number of rebleeding episodes (p = 0.1) and the need for surgery (3.8% vs. 22.7%; p = 0.05). Omeprazole also reduced the amount of time the gastric pH was < 6 (15.3 +/- 5.9% vs. 61.8 +/- 5.6%, p < 0.0001). We conclude that parenteral omeprazole is much more effective than ranitidine in keeping the gastric pH above the proteolytic range for pepsin in bleeders and that this might explain a better outcome in a subset of patients with bleeding peptic ulcers treated with parenteral omeprazole.

[Diarrhea, protein-losing enteropathy and sarcoidosis]. / Diarrea, enteropatía proteinorreica y sarcoidosis.

A case of inactive sarcoidosis associated with protein-losing enteropathy, severe hypoalbuminemia and diarrhea is reported. 99mTc-labeled human serum albumin was performed to show protein loss. There was no abnormal upper gastrointestinal mucosa as shown by peroral duodenal and jejunal biopsies. However, a CT scan showed the presence of multiple calcified intra and retroperitoneal lymph nodes, which might explain the presence of lymphatic ectasia and protein-losing enteropathy in this case. A brief literature review of gastrointestinal sarcoidosis is included.