Colonoscopy quality assessment.

AIM: Colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. MATERIAL AND METHOD: This is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30) was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. RESULTS: Indicators results are: quality of bowel preparation (87%), kappa 0.74 (95% CI: 0.48-0.99); cecal intubation rate (90%) 0.74 (95% CI: 0.49-0.99); adenoma detection and removal rate (96%), kappa: 0.78 (95% CI: 0.53-0.99); withdrawal time: 13.36 min (95% CI: 10.48-16.11). Kappa: 0.78 (95% CI: 0.49-0.99). CONCLUSIONS: Quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice.

Valoración de la calidad en la práctica de la colonoscopia / Colonoscopy quality assessment

Objetivo: la colonoscopia constituye la técnica exploratoria del colon más importante en la actualidad. Su uso, cada vez más frecuente conlleva la aparición de problemas en su aplicación. Es necesario medir la calidad en la realización de esta técnica, para ello es preciso definir indicadores válidos que permitan la realización de ciclos de evaluación de la calidad. En este estudio se presenta la aplicación de algunos de estos indicadores. Los indicadores propuestos en este estudio son: nivel de limpieza, intubación cecal, indicador de pólipos y tiempo de retirada. Pacientes y método: estudio prospectivo de 12 meses de las colonoscopias realizadas en un programa de cribado de cáncer colorrectal en el área de salud VI de la Región de Murcia. En este estudio se incluyen todos los pacientes con resultado positivo al test de sangre oculta en heces (SOH) desde febrero de 2006 a febrero de 2007 (n: 609). Se extrae una muestra de 30 pacientes para evaluar la fiabilidad de los indicadores y realizar un análisis preliminar de los resultados. Resultados: los resultados preliminares obtenidos de cumplimiento para cada indicador fueron los siguientes: indicador de nivel de limpieza (87%). Índice de kappa 0,74 (IC del 95%: 0,48-0,99); intubación cecal (90%) 0,74 (IC del 95%: 0,49-0,99); indicador de pólipos (96%), índice de kappa de 0,78 (IC del 95%: 0,53-0,99); tiempo de retirada: 13,36 min (IC del 95%: 10,48-16,11). Índice kappa de 0,78 (IC del 95%: 0,49-0,99). Conclusiones: la definición y aplicación de indicadores de calidad en la práctica de la colonoscopia es posible. Se precisan más estudios para definir el papel de estos indicadores en la práctica asistencial(AU)

Aim: colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. Material and method: this is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30) was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. Results: indicators results are: quality of bowel preparation (87%), kappa 0.74 (95% CI: 0.48-0.99); cecal intubation rate (90%) 0.74 (95% CI: 0.49-0.99); adenoma detection and removal rate (96%), kappa: 0.78 (95% CI: 0.53-0.99); withdrawal time: 13.36 min (95% CI: 10.48-16.11). Kappa: 0.78 (95% CI: 0.49-0.99). Conclusions: quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice(AU)

Peritonitis bacteriana espontánea de causa atípica / Spontaneous bacterial peritonitis of atipical origin

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Hemorragia digestiva de causa poco frecuente / Digestive haemorrhage of rare origin

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[Idiopathic cholestasis associated with bloody diarrhea as the first manifestation of Hodgkin's lymphoma]. / Colestasis idiopática asociada a diarrea sanguinolenta como primera manifestación de linfoma de Hodgkin.

Jaundice in Hodgkin's disease occurs in 3-13% of the cases reported in the medical literature and can be due to several causes. Cholestatic jaundice associated with ductopenia may be a consequence of an associated paraneoplastic process and can occur several months before the development of Hodgkin's disease. When there is a finding of jaundice of unknown etiology associated with ductopenia, the possible existence of Hodgkin's disease should be investigated. We describe a case of cholestatic jaundice associated with Hodgkin's disease. The first clinical and laboratory manifestations were symptoms of bloody diarrhea months before the development of Hodgkin's disease. We discuss the differential diagnoses considered, given the complexity of the case.

Colestasis idiopática asociada a diarrea sanguinolenta como primera manifestación de linfoma de Hodgkin / Idiopathic cholestasis associated with bloody diarrhea as the first manifestation of Hodgkin’s lymphoma

La ictericia asociada a la enfermedad de Hodgkin (EH) aparece entre un 3 y un 13% de los casos comunicados en la bibliografía médica y puede deberse a diversas causas. Por otro lado, la ictericia colestásica asociada a ductopenia puede ser consecuencia de un proceso paraneoplásico y aparecer varios meses antes del desarrollo de la EH. Ante el hallazgo de ictericia de origen no filiado con presencia de ductopenia se propone la investigación de la existencia de una posible EH. Describimos un caso de ictericia colestásica asociada a EH que se presentó tras un cuadro de diarrea sanguinolenta como primera manifestación clínica y analítica varios meses antes del desarrollo de la EH. Se comentan los diferentes diagnósticos diferenciales planteados ante la complejidad del cuadro clínico

Jaundice in Hodgkin's disease occurs in 3-13% of the cases reported in the medical literature and can be due to several causes. Cholestatic jaundice associated with ductopenia may be a consequence of an associated paraneoplastic process and can occur several months before the development of Hodgkin's disease. When there is a finding of jaundice of unknown etiology associated with ductopenia, the possible existence of Hodgkin's disease should be investigated. We describe a case of cholestatic jaundice associated with Hodgkin's disease. The first clinical and laboratory manifestations were symptoms of bloody diarrhea months before the development of Hodgkin's disease. We discuss the differential diagnoses considered, given the complexity of the case

Ictericia obstructiva por neoformación de conducto hepático común / Obstructive jaundice caused by a common bile duct neoplasia

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Paciente con esclerosis tuberosa y angiomiolipomas renales bilaterales gigantes / Patient with tuberous sclerosis and giant renal angiomyolipomas

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Fallo hepático agudo por el virus de la hepatitis C en el puerperio / Acute liver failure caused by hepatitis C virus in the puerperium

La infección por el virus de la hepatitis C (VHC) es un problema de salud global en nuestros sistemas sanitarios. La prevalencia de pacientes infectados en la población general es de alrededor del 2%. En el subgrupo de pacientes embarazadas el porcentaje de pacientes infectadas oscila entre el 1 y el 3% de los casos. Varios estudios han descrito la relación entre el embarazo y la hepatitis crónica C y la mayoría de las veces se ha observado que los valores séricos de transaminasas se normalizan mientras que los valores de ARN del VHC aumentan durante el segundo y el tercer trimestres de gestación. La influencia de las hormonas maternas después del alumbramiento en la evolución natural de la infección por el VHC no ha sido suficientemente estudiada y permanece por ello en controversia. En esta nota clínica se describe la peculiar evolución de una paciente con hepatitis crónica por el VHC en el puerperio

Hepatitis C virus (HCV) infection is a global problem in our health systems. The prevalence of infected patients in general population is about 2%. In the subgroup of pregnant woman the percentage of infected patients ranges from 1-3%. Several studies have described the relationship between pregnancy and chronic HCV infection, and in most cases serum transaminases levels return to normal values while HCV-RNA levels increase during the second and third trimester. The influence of maternal hormones after delivery in the natural history of HCV infection has not been sufficiently studied and consequently remains controversial. This case report shows the peculiar clinical course of a patient with chronic HCV infection in the puerperium

[Acute liver failure caused by hepatitis C virus in the puerperium]. / Fallo hepático agudo por el virus de la hepatitis C en el puerperio.

Hepatitis C virus (HCV) infection is a global problem in our health systems. The prevalence of infected patients in general population is about 2%. In the subgroup of pregnant woman the percentage of infected patients ranges from 1-3%. Several studies have described the relationship between pregnancy and chronic HCV infection, and in most cases serum transaminases levels return to normal values while HCV-RNA levels increase during the second and third trimester. The influence of maternal hormones after delivery in the natural history of HCV infection has not been sufficiently studied and consequently remains controversial. This case report shows the peculiar clinical course of a patient with chronic HCV infection in the puerperium.

[Lactose malabsorption in patients with inflammatory bowel disease without activity: would it be necessary to exclude lactose products in the diet of all patients?]. / Malabsorción de lactosa en pacientes con enfermedad inflamatoria intestinal inactiva: ¿ está justificado excluir los productos lácteos a todos los pacientes?

INTRODUCTION: There are inflammatory bowel disease (IBD) patients avoid lacteal products without evidence of lactose malabsorption, probably because of incorrect patient perceptions and arbitrary advice from physicians and diet books. AIM: To evaluate the prevalence of lactose malabsorption in patients with IBP. METHOD: In 18 patients with Crohns disease and 24 with ulcerative colitis and 25 controls the prevalence of lactose intolerance, as measured by lactose breath hydrogen tests. RESULTS: Observed deficiencies of absorption of the lactose in 7 (16.6%) patients with IBP and 5 (20%) subjects control. CONCLUSIONS: Not all the patients with IBD are intolerant to the lactose by the suppression of the lacteal produts must not be generalized in the diet of these patients.

[Amebic colitis in an immunocompetent host]. / Colitis amebiana en pacientes inmunocompetente.

Amebic colitis is a low prevalence illness in developed countries. Its diagnosis is infrequent and is usually made in certain groups of risk. Images studies are not useful in differential diagnosis with other illnesses as Inflammatory Bowel Disease (IBS). Next clinical note shows the problems in the diagnosis of amebic colitis in an immunocompetent host without risk factors.

Malabsorción de lactosa en pacientes con enfermedad inflamatoria intestinal inactiva: ¿está justificado excluir los productos lácteos a todos los pacientes? / Lactose malabsorption in patients with inflammatory bowel disease without activity: it would be necessary to exclude the lactose products in their diet to all the patients?

Introducción: Muchos pacientes con enfermedad inflamatoria intestinal (EII) sin evidencia de malabsorción de lactosa, evitan tomar productos lácteos, basándose en percepciones erróneas y consejos equivocados de médicos y libros de dietética. Objetivo: Evaluar la frecuencia de malabsorción de lactosa en pacientes EII. Método: Se estudia la frecuencia de intolerancia a la lactosa en 18 pacientes con enfermedad de Crohn, 24 pacientes con colitis ulcerosa y 25 controles sanos, realizando un test de hidrógeno espirado. Resultados: Se observaron deficiencias de absorción de la lactosa en 7 (16,6 por ciento) pacientes con EII y 5 (20 por ciento) sujetos control. Conclusiones: No todos los enfermos con EII son intolerantes a lactosa, por lo que no debe generalizarse la supresión de los lácteos en la dieta de estos enfermos (AU)

Colitis amebiana en paciente inmunocompetente / Amebic colitis in an immunocompetent host

La colitis amebiana es una entidad de baja prevalencia en el mundo occidental. Su diagnóstico es infrecuente y se halla restringido a ciertos grupos de riesgo. Los hallazgos de imagen resultan ,en ocasiones, indistinguibles a los obtenidos en otras patologías tales como la Enfermedad Inflamatoria Intestinal Crónica (EIIC). En el siguiente caso se pone de manifiesto la dificultad para realizar el diagnóstico de colitis amebiana en un sujeto inmunocompetente y sin hábitos de riesgo conocidos (AU)

Pólipo gigante esofágico / Giant polyp of the esophagus

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