Pouchitis: Treatment dilemmas at different stages of the disease.

Pouchitis is a frequent complication in ulcerative colitis patients after proctocolectomy with ileal pouch-anal anastomosis. It is an unspecific inflammation of the pouch with unknown aetiology. First-line treatment for acute and chronic pouchitis is antibiotics. Some cases of severe chronic refractory pouchitis may benefit from biological treatment. Anti-tumour necrosis factor should be recommended as the first option, leaving the new biologicals for multirefractory patients. Permanent ileostomy may be an option in severe cases, after failure of medical treatment. Prophylaxis therapy with a probiotic mixture is recommended after the first episode of pouchitis, whereas it is not clear whether probiotics are useful for all patients after surgery. Here, we present a case report and review the treatment options in different forms of pouchitis.

Latest advances in chronic pancreatitis. / Últimos avances en pancreatitis crónica.

This article summarizes some of the recent and clinically relevant advances in chronic pancreatitis. These advances mainly concern the definition of the disease, the etiological diagnosis of idiopathic disease, the correlation between fibrosis degree and pancreatic secretion in the early stages of chronic pancreatitis, the treatment of the disease and of pain, the clinical relevance of pancreatic exocrine insufficiency, and the diagnosis of autoimmune pancreatitis. A new mechanistic definition of chronic pancreatitis has been proposed. Genetic testing is mainly of help in patients with relapsing idiopathic pancreatitis. A significant correlation has been shown between the degree of pancreatic fibrosis as evaluated by elastography and pancreatic secretion of bicarbonate. New data supports the efficacy of antioxidants and simvastatin for the therapy of chronic pancreatitis. The pancreatoscopy-guided intraductal lithotripsy is an effective alternative to extracorporeal shock wave lithotripsy in patients with chronic calcifying pancreatitis. The presence of pancreatic exocrine insufficiency in patients with chronic pancreatitis is associated with a significant risk of cardiovascular events. Fine needle biopsy and contrast enhanced harmonic endoscopic ultrasonography are of help for the diagnosis of autoimmune pancreatitis and its differential diagnosis with pancreatic cancer.

Últimas novedades presentadas en gastroenterología / No disponible

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Pancreatitis crónica / Chronic pancreatitis

El papel de la elastografía en el diagnóstico de la pancreatitis crónica, las consecuencias de un estado nutricional deficiente en estos pacientes y los riesgos que esta enfermedad confiere en términos de morbimortalidad han sido los campos en los que se han producido avances más relevantes en relación al conocimiento de la pancreatitis crónica. La elastografía pancreática permite la cuantificación del grado de fibrosis pancreática y puede jugar un papel relevante en el diagnóstico de la pancreatitis crónica. La insuficiencia pancreática exocrina secundaria a pancreatitis crónica se asocia frecuentemente a déficit de vitamina B12 y anemia. Además, un deficiente estado nutricional conlleva una peor evolución de la enfermedad en términos de dolor abdominal y necesidad de ingreso hospitalario. La pancreatitis crónica y sus complicaciones multiplican por 4 el riesgo de muerte, básicamente como consecuencia de enfermedades digestivas, neoplásicas y cardiovasculares (AU)

Major advances have been recently reported on the role of elastography for the diagnosis of chronic pancreatitis, the consequences of a deficient nutritional status in these patients, and the risk of morbi-mortality in patients with chronic pancreatitis. The degree of pancreatic fibrosis in the context of chronic pancreatitis can be quantified by pancreatic elastography. This technique may therefore play a relevant role in the diagnosis of the disease. The presence of anemia and vitamin B12 deficiency has been reported in a relevant proportion of patients with chronic pancreatitis-related pancreatic exocrine insufficiency. In addition, a deficient nutritional status in these patients has been associated to more frequent abdominal pain episodes and to more frequent hospital admissions due to the pancreatic disease. Chronic pancreatitis and its complications cause a 4-fold increase of death, mainly secondary to digestive diseases, tumors and cardiovascular events (AU)

[Chronic pancreatitis]. / Pancreatitis crónica.

The present article summarizes some of the most important results with potential clinical impact on the diagnosis and management of chronic pancreatitis presented at the last meeting of Digestive Disease Week. Endoscopic ultrasound (EUS) is currently the method of choice for the diagnosis of chronic pancreatitis in clinical practice. However, some new studies suggest that the Rosemont classification is not useful for diagnosis of this disease in the early stages, whereas others show that, in patients with abdominal pain, chronic pancreatitis cannot be excluded even when there are less than three EUS criteria of the disease. In contrast, new studies support the usefulness of endoscopic ultrasound for the diagnosis of autoimmune pancreatitis in the presence of pancreatic ductitis. From the therapeutic point of view, a notable contribution at the congress was a new randomized placebo-controlled clinical trial showing the efficacy of pregabalin for the treatment of pain in chronic pancreatitis.

Modified rapid urease test for detection of Helicobacter pylori infection.

BACKGROUND: The rapid urease test is the most widely used standard procedure for the detection of Helicobacter pylori infection. This is because it is a simple, reliable and inexpensive test, which provides results rapidly. AIM: The aim of the present study was the evaluation of a modified rapid urease test (HUT-test) in comparison with the standard CLO-test. In addition, it was questioned whether the performance of the rapid urease test in two biopsy samples from antrum and gastric body would increase the sensitivity of the test. METHODS: One hundred and fifteen consecutive patients undergoing oesophagogastroduodenoscopy were studied. Diagnosis of H. pylori infection was based on histological examination of biopsy samples from antrum and gastric body. The HUT-test was performed in two biopsy specimens from antrum and body, respectively, and the CLO-test in one antral biopsy sample. The time to positivity and the stability of the HUT-test kit at different storage temperatures were previously optimized by adapting the type and concentration of buffer and indicators. RESULTS: Sixty patients (52%) were diagnosed as being infected with H. pylori. Sensitivity of the rapid urease tests in biopsy samples from the antrum was 90% for the HUT-test and 88% for the CLO-test, with a specificity of 100% for both tests. Combining biopsies from the antrum and corpus increased the diagnostic sensitivity of the HUT-test to 93%, but the specificity decreased to 98%. In patients with H. pylori infection, the HUT-test gave positive results more rapidly than the CLO-test (104 +/- 21 min compared with 195 +/- 49 min, respectively, P < 0.02). CONCLUSION: Application of the HUT-test to a simple biopsy from the antrum can establish the diagnosis of H. pylori infection with high accuracy, similar to that of the standard CLO-test. Compared with the CLO-test, the HUT-test has a significantly faster reaction time, which is an obvious clinical advantage. An additional biopsy from the distal gastric body did not add to the diagnostic efficacy in untreated patients, but may be needed in specific circumstances, such as following treatment.

Clinical and laboratory diagnosis of acute pancreatitis.

Determination of serum pancreatic enzymes remains the gold standard for the diagnosis of acute pancreatitis. Clinical symptoms and signs are of major importance in suspecting the disease, but they are not accurate enough to confirm the diagnosis. Among pancreatic enzymes, total amylase, pancreatic isoamylase and lipase are preferred, since simple, rapid and unexpensive enzymatic methods are commercially available. More expensive and cumbersome methods (e. g. ELISA for pancreatic elastase) are required if a significant delay to hospital admission occurs. In that case, other serum enzymes are usually normal or only lightly increased. To early define the etiology of acute pancreatic serum pancreatic enzymes lack of value. With this purpose, determination of AST, bilirubin and alkaline phosphatase may allow to distinguish between biliary and non-biliary origin of the disease.