[Three prognostic scales; clinical utility and prediction of intrahospital survival in alcoholic hepatitis]. / Utilidad clínica y predicciónde supervivencia intrahospitalaria de 3 escalas pronósticas en hepatitis alcohólica.

BACKGROUND: Alcoholic hepatitis is a serious clinical problem; opportune detection is transcendental for treatment and survival improvement. The aim of this study was to evaluate clinical utility of in-hospital mortality prediction of 3 alcoholic hepatitis scores and to assess survival prediction fitting them to the best cut-off points. MATERIAL AND METHODS: Retrospective, observational study. All patients with diagnosis of alcoholic hepatitis from January 2002 to January 2005 were included.Clinical and laboratory variables were analyzed for the different prognostic scores (MELD, GAHS and the Discriminate Function Maddrey's index) calculation. Evaluation of clinical utility scores was done with ROC curves and expressed by c-statistics. After fitting best cut-off points, survival prediction was assessed by Kaplan-Meier's method. RESULTS: Of 120 patients with alcoholic hepatitis, 48 fulfilled the admission criteria. The c-statistics of MELD was of 0.72, GAHS 0.75 and Maddrey's index 0.64. Survival analysis of the 3 prognostic scales showed statistical significance (log rank < 0.05) with the adjusted cut-off point to our population. CONCLUSION: The prediction of in hospital survival of GAHS, MELD and Maddrey's index after fitting best cut-off points are similar. The clinical utility for in-hospital mortality prediction of GAHS and MELD are superior to Maddrey's index in this Mexican cohort.

Alteraciones en la motilidad del cuerpo esofágico en pacientes con enfermedad por reflujo gastroesofágico / Esophageal motility disturbances in patients with gastro-esophageal reflux

Estudiamos manométricamente a 65 pacientes con sintomatología de esofagitis por reflujo gastroesofágico (ERGE), de ellos 36 tuvieron evidencia de reflujo endoscópicamente (21 masculinos y 15 femeninos). Las alteraciones encontradas en el cuerpo fueron ausencia de peristalsis efectiva en 20 por ciento y ondas no transmitidas en 75 por ciento con hipotomía y sin relajación apropiada 16 por ciento. Concluimos que no puede aseverarse si el reflujo es debido a las alteraciones o estas lo producen