Bismuth quadruple three-in-one single capsule three times a day increases effectiveness compared with the usual four times a day schedule: results from the European Registry on Helicobacter pylori Management (Hp-EuReg).

BACKGROUND: The recommended schedule for single capsule bismuth quadruple therapy (scBQT, Pylera) includes a proton pump inhibitor (PPI) two times a day and three scBQT capsules four times a day. Four times a day treatments are inconvenient and reduce adherence. In contrast, adherence improves with three times a day schedules. In clinical practice, many gastroenterologists use four capsule scBQT three times a day. However, the effectiveness and safety of this latter approach remain uncertain. AIM: To assess the effectiveness and safety of scBQT administered three times a day in the patients included in the European Registry on Helicobacter pylori Management (Hp-EuReg). METHODS: All Spanish adult patients registered in the Asociación Española de Gastroenterología Research Electronic Data Capture (REDCap) database from June 2013 to March 2021 receiving 10-day scBQT were analysed. Modified intention-to-treat effectiveness, adherence and the safety of scBQT given three times a day were calculated and compared with the four times a day schedule. A multivariate analysis was performed to determine independent factors predicting cure of the infection. RESULTS: Of the 3712 cases, 2516 (68%) were four times a day and 1196 (32%) three times a day. Mean age was 51 years, 63% were women and 15% had a peptic ulcer. The three times a day schedule showed significantly better overall cure rates than four times a day (1047/1112, 94%; 95% CI 92.7 to 95.6 vs 2207/2423, 91%; 95% CI 89.9 to 92.2, respectively, p=0.002). Adherence and safety data were similar for both regimens. In the multivariate analysis, three times a day dosage, first-line therapy, use of standard or high-dose PPIs and adherence over 90% were significantly associated with cure of the infection. CONCLUSIONS: ScBQT prescribed three times a day was more effective than the traditional four times a day schedule. No differences were observed in treatment adherence or safety.

Desarrollo de pie caído durante el tratamiento con adalimumab en enfermedad de Crohn / Foot drop during adalimumab therapy for Crohn disease

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Fully covered metal stents for the treatment of leaks after gastric and esophageal surgery.

OBJECTIVE: The use of fully covered metal stents (FCMS) for the treatment of benign conditions is increasing. The aim of our study was to assess the efficacy of FCMS in the management of post-operative leaks after gastric or esophageal surgery. MATERIAL AND METHODS: During a three year period (2011-2013), patients who underwent a surgery related with esophageal or gastric cancer and developed a postoperative anastomotic leak treated with FCMS were prospectively included. RESULTS: Fourteen patients were included (11 men, 3 women), with median age of 65 years. Placement of at least one stent was achieved in 13 patients (93% of cases), with initial closure of the leak in 12 of these 13 cases (92.3%). A final success (after removal of the stent) could be demonstrated in 9 cases (69.2%, intention to treat analysis); stent failed only in one case (7.7%) and there were 3 patients (23.1%) not evaluated because death before stent retrieval (not related with the endoscopic procedure). One stent were used in 9 cases (69.2%), and two in 4 (30.8%). Migration was observed in two cases (15.3%). There were no major complications related with the use of stents. There were no complications related with retrieval. CONCLUSIONS: The placement of FCMS to achieve the leak closure after esophageal or gastric surgery is an effective and probably safe alternative feasible with minor risks.

Fully covered metal stents for the treatment of leaks after gastric and esophageal surgery

OBJECTIVE: The use of fully covered metal stents (FCMS) for the treatment of benign conditions is increasing. The aim of our study was to assess the efficacy of FCMS in the management of post-operative leaks after gastric or esophageal surgery. MATERIAL AND METHODS: During a three year period (2011- 2013), patients who underwent a surgery related with esophageal or gastric cancer and developed a postoperative anastomotic leak treated with FCMS were prospectively included. RESULTS: Fourteen patients were included (11 men, 3 women), with median age of 65 years. Placement of at least one stent was achieved in 13 patients (93% of cases), with initial closure of the leak in 12 of these 13 cases (92.3%). A final success (after removal of the stent) could be demonstrated in 9 cases (69.2%, intention to treat analysis); stent failed only in one case (7.7%) and there were 3 patients (23.1%) not evaluated because death before stent retrieval (not related with the endoscopic procedure). One stent were used in 9 cases (69.2%), and two in 4 (30.8%). Migration was observed in two cases (15.3%). There were no major complications related with the use of stents. There were no complications related with retrieval. CONCLUSIONS: The placement of FCMS to achieve the leak closure after esophageal or gastric surgery is an effective and probably safe alternative feasible with minor risks

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Afectación colorrectal por cáncer de mama mestastásico / Colorectal involvement in metastatic breast carcinoma

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Seudomixoma peritoneal presentado como ascitis en paciente cirrótico / Peritoneal pseudomyxoma presenting as ascites in a patient with cirrhosis

Presentamos el caso de un paciente cirrótico con ascitis y gradiente de albúmina menor de 1,1g/dl. Tras la realización de pruebas endoscópicas, incluyendo ecoendoscopia alta con PAAF, se decide llevar a cabo una laparoscopia exploradora para esclarecer el diagnóstico, observándose mucina por toda la cavidad peritoneal y nódulos sobre el peritoneo parietal y elvisceral. Tras el estudio anatomopatológico se estableció seudomixoma peritoneal como diagnóstico. Esta infrecuente entidad, de pronóstico infausto en ausencia de tratamiento, suele generarse en tumores mucinosos apendiculares, y en segundo lugar desde tumores ováricos (AU)

We present the case of a cirrhotic patient with ascites and an albumin gradient of less than 1.1g/dl. After endoscopic tests, including upper gastrointestinal endoscopic ultrasound-guided fine-needle aspiration, exploratory laparoscopy was performed to provide the diagnosis, revealing mucin throughout the peritoneal cavity and nodules on the parietal and visceral peritoneum. Histopathological analysis established the diagnosis as peritoneal pseudomyxoma. This uncommon entity, which has a poor prognosis without treatment, is most frequently associated with mucinous tumors of the appendix, and secondly, with tumors of the ovary (AU)

[Peritoneal pseudomyxoma presenting as ascites in a patient with cirrhosis]. / Seudomixoma peritoneal presentado como ascitis en paciente cirrótico.

We present the case of a cirrhotic patient with ascites and an albumin gradient of less than 1.1 g/dl. After endoscopic tests, including upper gastrointestinal endoscopic ultrasound-guided fine-needle aspiration, exploratory laparoscopy was performed to provide the diagnosis, revealing mucin throughout the peritoneal cavity and nodules on the parietal and visceral peritoneum. Histopathological analysis established the diagnosis as peritoneal pseudomyxoma. This uncommon entity, which has a poor prognosis without treatment, is most frequently associated with mucinous tumors of the appendix, and secondly, with tumors of the ovary.

Inicio de la enfermedad celíaca tras curación de hepatitis aguda por el virus de la hepatitis B / Onset of celiac disease after acute hepatitis B infection

La enfermedad celíaca se caracteriza por el daño de la mucosa intestinal y la consiguiente malabsorción de nutrientes en individuos genéticamente predispuestos tras la ingesta de gluten. Es una enfermedad compleja, resultado de la interacción de un componente genético poligénico y varios factores ambientales. Se ha propuesto la teoría de que procesos infecciosos transitorios o aumentos en la permeabilidad de la barrera mucosa podrían facilitar el inicio de la enfermedad por los péptidos del gluten de la luz intestinal. Presentamos el caso de 2 pacientes que presentaron el inicio de la enfermedad tras la curación de una hepatitis aguda por virus de la hepatitis B. Se discute la fisiopatología de la enfermedad y se plantean hipótesis que expliquen esta asociación (AU)

Celiac disease is characterized by small intestinal mucosal injury and nutrient malabsorption in genetically susceptible individuals following dietary ingestion of gluten. The pathogenesis of the disease involves interactions between environmental, genetic, and immunologic factors. Transient infections or increased permeability of the mucosa may facilitate disease onset induced by the uptake of gluten peptides into a microenvironmental milieu in the small intestinal mucosa. We present two patients with onset of celiac disease after resolution of acute hepatitis B virus infection. The physiopathology of celiac disease is discussed and possible explanations for this association are proposed (AU)

[Onset of celiac disease after acute hepatitis B infection]. / Inicio de la enfermedad celíaca tras curación de hepatitis aguda por el virus de la hepatitis B.

Celiac disease is characterized by small intestinal mucosal injury and nutrient malabsorption in genetically susceptible individuals following dietary ingestion of gluten. The pathogenesis of the disease involves interactions between environmental, genetic, and immunologic factors. Transient infections or increased permeability of the mucosa may facilitate disease onset induced by the uptake of gluten peptides into a microenvironmental milieu in the small intestinal mucosa. We present two patients with onset of celiac disease after resolution of acute hepatitis B virus infection. The physiopathology of celiac disease is discussed and possible explanations for this association are proposed.