[Patient-Related Factors Affecting Bowel Preparation Prior to Colonoscopy.] / Factores relacionados al paciente que afectan la limpieza del colon previo a la colonoscopia.

INTRODUCTION: Colorectal cancer is a major health problem worldwide because it is the third most common cancer and the third leading cause of cancer mortality in western countries. Screening for colorectal cancer in asymptomatic patients is crucialfor reducing the incidence and colonoscopy is one of the methods of choice. The ability of colonoscopy in detecting small lesions is clearly influenced by the quality of the colonic preparation. OBJECTIVES: To know which are the variablesrelating to the patient and the type ofpreparation that affect the quality of colonic cleansing. MATERIALS AND METHODS: It was designed a cross-sectional study. It was administered a questionnaire for the enrolled subjects to assess the presence offactors that could affect the quality of colonic cleansing. Then they underwent a colonoscopy. The different variables between subjects with adequate or inadequate colonic cleansing were compared. RESULTS: We evaluated 277 subjects. In multivariate analysis the only variables that showed significant differences are split dose [OR 0.45 (0.21 to 0.99)] and age [OR 1.02 (1-1.05)]. Obesity showed no significant differences in multivariate analysis [OR 1.84 (0.9-3.78)]. CONCLUSIONS: Age and split-dose were the only variables significantly associated with the quality of bowel preparation prior to colonoscopy. Not so constipation or the presence ofdiverticula, so these patients do not require special preparation regimes.

[Pilot test for Helicobacter pylori detection with ammonia breath test]. / Prueba piloto para la detección de Helicobacter pylori con test de amoníaco en aire espirado.

BACKGROUND: In Argentina we have little access to the more sensitive and specific non-invasive diagnostic methods for the detection of Helicobacter pylori (HP), such as the urea breath test. The upper gastrointestinal videoendoscopy, with biopsy for histological analysis and rapid urease test remains as the usual method in our country, but the cost is high and the accessibility is also limited. For this reason we propose to develop a new fast, accurate, accessible and inexpensive method for measuring the concentration of expired NH in order to achieve a diagnosis of active infection. OBJECTIVE: To determine the utility of a non-invasive method for detecting HP through the measurement of ammonia in the breathing. MATERIALS AND METHODS: We studied 3 patients older than 21 years, attending the Gastroenterology clinic. All patients who meet the inclusion criteria were evaluated with an upper gastrointestinal videoendoscopy and gastric biopsies (antrum, body and incisura angularis). Samples were analyzed by histopathological examination and urease test. The subjects with both negative tests (non-infected) or positive (infected) were selected for ammonia measurement in exhaled air. RESULTS: The prevalence of HP infection was 60.9% (14 patients). Ten of these patients had significant differences between the baseline ammonia and the ammonia after urea ingestion, yielding a specifcity of 88.9% and a sensitivity of 71.43%, with a Jouden index higher than 50%. CONCLUSION: Although the experience must be carried forward, the results of this pilot study suggest that the measurement of ammonia in breath test after ingestion of unmarked urea would be applicable as a diagnostic test for HP, taking into account its low cost and easy management compared to conventional non-invasive methods.

[Pancreatic intraductal papillary mucinous neoplasm: Case report and review of the literature]. / Neoplasia mucinosa intraductal papilar del páncreas: Comunicación de un caso y revisión de la literature.

Pancreatic intraductal papillary mucinous neoplasias (IPMN) are increasingly detected in medical diary practice because of increased awareness of their existence and because of increased use of cross-sectional imaging studies. IPMN are diagnosed incidentally in most cases and are classified as branch-duct IPMN, main-duct IPMN and combined-type IPMN. The last two types show a more aggressive biological behavior and surgery is recommended. Moreover, there are four subtypes of neoplastic epithelium in these tumours (intestinal, pancreatobiliary, gastric and oncocytic), which determine differences in the natural history of these neoplasms and this also seems to have prognostic relevance. We report a case of a patient who underwent a pancreatoduodenectomy due to a combined-type IPMN and whose anatomopathological study revealed an intestinal subtype IPMN with high grade dysplasia and colloid carcinoma. We also review the literature and describe the main aspects of this particular type ofcystic pancreatic tumours.

HELICOBACTER PYLORI PREVALENCE IN PATIENTS WITH CELIAC DISEASE: results from a cross-sectional study.

BACKGROUND: Some previously published studies have suggested an inverse relationship between celiac disease and Helicobacter pylori, raising the possibility of the protective role Helicobacter pylori could have against celiac disease development. Nevertheless, this association is inconclusive. OBJECTIVES: To determine the prevalence of Helicobacter pylori infection in celiac subjects. METHODS: Between January 2013 and June 2014, patients over 18 years old undergoing upper endoscopy who required both gastric and duodenal biopsies were included for analysis. Enrolled subjects were divided in two groups: those with a diagnosis of celiac disease and those without a celiac disease diagnosis. Helicobacter pylori infection prevalence was compared between groups. Among celiac patients, endoscopic markers of villous atrophy as well as histological damage severity were compared between those with and without Helicobacter pylori infection. RESULTS: Overall, 312 patients were enrolled. Seventy two of them had a diagnosis of celiac disease. Helicobacter pylori infection prevalence among celiac disease patients was 12.5%, compared to 30% in non-celiac patients [OR=0.33 (0.15-0.71)]. There was not a significant difference in terms of the severity of villous atrophy in patients with Helicobacter pylori infection compared to those without it. There was a slight increase in the prevalence of endoscopic markers in those Helicobacter pylori-negative celiac subjects. CONCLUSION: Helicobacter pylori infection seems to be less frequent in celiac patients; among those celiac subjects with concomitant Helicobacter pylori infection, histological damage degree and presence of endoscopic markers suggesting villous atrophy seem to be similar to those without Helicobacter pylori infection.

HELICOBACTER PYLORI PREVALENCE IN PATIENTS WITH CELIAC DISEASE: results from a cross-sectional study / Prevalência do Helicobacter pylori em pacientes com doença celíaca: resultados de um estudo transversal

Background Some previously published studies have suggested an inverse relationship between celiac disease and Helicobacter pylori, raising the possibility of the protective role Helicobacter pylori could have against celiac disease development. Nevertheless, this association is inconclusive. Objectives To determine the prevalence of Helicobacter pylori infection in celiac subjects. Methods Between January 2013 and June 2014, patients over 18 years old undergoing upper endoscopy who required both gastric and duodenal biopsies were included for analysis. Enrolled subjects were divided in two groups: those with a diagnosis of celiac disease and those without a celiac disease diagnosis. Helicobacter pylori infection prevalence was compared between groups. Among celiac patients, endoscopic markers of villous atrophy as well as histological damage severity were compared between those with and without Helicobacter pylori infection. Results Overall, 312 patients were enrolled. Seventy two of them had a diagnosis of celiac disease. Helicobacter pylori infection prevalence among celiac disease patients was 12.5%, compared to 30% in non-celiac patients [OR=0.33 (0.15-0.71)]. There was not a significant difference in terms of the severity of villous atrophy in patients with Helicobacter pylori infection compared to those without it. There was a slight increase in the prevalence of endoscopic markers in those Helicobacter pylori-negative celiac subjects. Conclusion Helicobacter pylori infection seems to be less frequent in celiac patients; among those celiac subjects with concomitant Helicobacter pylori infection, histological damage degree and presence of endoscopic markers suggesting villous atrophy seem to be similar to those without Helicobacter pylori infection. .

Contexto Alguns estudos publicados anteriormente sugerem uma relação inversa entre a doença celíaca e Helicobacter pylori, levantando a possibilidade do papel protetor que o Helicobacter pylori poderia ter contra o desenvolvimento de doença celíaca. No entanto, esta associação é inconclusiva. Objetivos Determinar a prevalência da infecção por Helicobacter pylori em indivíduos celíacos. Métodos Entre janeiro de 2013 e de 2014 junho, foram incluídos para análise pacientes com mais de 18 anos de idade submetidos a endoscopia para necessárias biópsias gástricas e duodenais. Os pacientes foram divididos em dois grupos: aqueles com diagnóstico de doença celíaca e aqueles sem um diagnóstico de doença celíaca. A prevalência da infecção por Helicobacter pylori foi comparada entre os grupos. Entre os pacientes celíacos, os marcadores endoscópicos de atrofia das vilosidades, bem como a gravidade do dano histológico foram comparados entre aqueles com e sem infecção pelo Helicobacter pylori. Resultados De um total de 312 pacientes, 72 deles tiveram diagnóstico da doença celíaca. A prevalência de infecção pelo Helicobacter pylori entre pacientes com doença celíaca foi de 12,5%, em comparação com 30% em pacientes não-celíacos [OR=0,33 (0,15-0,71)]. Não houve diferença significativa em termos da gravidade da atrofia das vilosidades em pacientes com infecção pelo Helicobacter pylori em comparação com aqueles sem ele. Houve um ligeiro aumento na prevalência de marcadores endoscópicos nos indivíduos celíacos com Helicobacter pylori-negativo. Conclusão A infecção pelo Helicobacter pylori parece ser menos frequente em pacientes celíacos; entre esses indivíduos celíacos com concomitante infecção por Helicobacter pylori, o grau de dano histológico e a presença de marcadores endoscópicos sugerindo atrofia vilosa, parecem ser semelhantes com os sem infecção. .

Risk of infertility in patients with celiac disease: a meta-analysis of observational studies.

CONTEXT: Celiac disease is an autoimmune disorder of the small intestine associated with several extra-intestinal features, such as reproductive disorders. The relationship between celiac disease and infertility has been previously assessed, with conflicting results. OBJECTIVES: We seek to determine the relationship between celiac disease and infertility. METHODS: Data was extracted from case-control or cohort design studies from 1966 to December 2013 using the MEDLINE-Pubmed, EMBASE, LILACS and Cochrane Library databases. We analyzed two kinds of trials: those assessing the risk of infertility in subjects with already diagnosed celiac disease, and those evaluating the prevalence of undiagnosed celiac disease in subjects with a diagnosis of infertility. RESULTS: The search yielded 413 potentially relevant studies for revision, 12 of which were finally included for analysis. A significant association was found between women with a diagnosis of infertility and undiagnosed celiac disease [OR 3.09 (95% CI 1.74-5.49)]. When considering those studies assessing the occurrence of infertility in subjects with already-diagnosed celiac disease, no difference was found between celiac disease patients and control subjects [OR 0.99 (0.86-1.13)]. CONCLUSIONS: Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients.

RISK OF INFERTILITY IN PATIENTS WITH CELIAC DISEASE: a meta-analysis of observational studies / Risco de infertilidade em pacientes com doença celíaca: uma meta-análise de estudos observacionais

Context Celiac disease is an autoimmune disorder of the small intestine associated with several extra-intestinal features, such as reproductive disorders. The relationship between celiac disease and infertility has been previously assessed, with conflicting results. Objectives We seek to determine the relationship between celiac disease and infertility. Methods Data was extracted from case-control or cohort design studies from 1966 to December 2013 using the MEDLINE-Pubmed, EMBASE, LILACS and Cochrane Library databases. We analyzed two kinds of trials: those assessing the risk of infertility in subjects with already diagnosed celiac disease, and those evaluating the prevalence of undiagnosed celiac disease in subjects with a diagnosis of infertility. Results The search yielded 413 potentially relevant studies for revision, 12 of which were finally included for analysis. A significant association was found between women with a diagnosis of infertility and undiagnosed celiac disease [OR 3.09 (95% CI 1.74-5.49)]. When considering those studies assessing the occurrence of infertility in subjects with already-diagnosed celiac disease, no difference was found between celiac disease patients and control subjects [OR 0.99 (0.86-1.13)]. Conclusions Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients. .

Contexto A doença celíaca é uma doença auto imune do intestino delgado associada a manifestações extra-intestinais, tais como distúrbios reprodutivos. A relação entre a doença celíaca e a infertilidade foi previamente avaliada, com resultados conflitantes. Objetivos Procuramos determinar a relação entre a doença celíaca e a infertilidade. Métodos Utilizou-se dados extraídos de estudos de projeto de caso-controle ou coorte de 1966 à dezembro de 2013 utilizando o MEDLINE-Pubmed, EMBASE, LILACS e Cochrane Library. Foram analisados dois tipos de ensaios: os que avaliam o risco de infertilidade em pacientes com doença celíaca já diagnosticados e, os que avaliam a prevalência da doença celíaca não diagnosticada em indivíduos com diagnóstico de infertilidade. Resultados A busca resultou em 413 estudos potencialmente relevantes para a revisão, 12 dos quais foram finalmente incluídos para análise. Foi encontrada uma associação significativa entre as mulheres com diagnóstico de infertilidade e doença celíaca não diagnosticada [TR 3,09 (IC 95% 1,74-5,49)]. Ao considerar esses estudos avaliando a ocorrência de infertilidade em pacientes com doença celíaca já diagnosticada, não foi encontrada diferença entre os pacientes com doença celíaca e controles [TR 0,99 (0,86-1,13)]. Conclusões A falta de diagnóstico para a doença celíaca é um fator de risco para a infertilidade. As mulheres que procuram o conselho médico para esta condição particular, devem ser examinados para a doença celíaca. A adoção de uma dieta sem glúten pode ter um impacto positivo sobre a fertilidade neste grupo de pacientes. .

[Influence of proton pump inhibitors on intestinal fermentative profile: a case-control study]. / Impacto del uso de inhibidores de la bomba de protones sobre el perfil fermentativo intestinal: Un estudio de tipo caso-control.

INTRODUCTION: Proton pump inhibitors could have an impact on the results of breath tests performed in patients with irritable bowel syndrome. This impact could be due to the development of small intestine bacterial overgrowth. OBJECTIVE: To compare the prevalence of fermentative profile alterations of irritable bowel syndrome patients exposed and not-exposed to proton pump inhibitor therapy. MATERIAL AND METHODS: Subjects with irritable bowel syndrome were enrolled. A validated questionnaire assessing symptom severity as well as proton pump inhibitor treatment was delivered. A lactulose breath test was undertaken by each enrolled subject. Fermentative profile (area under the curve of hydrogen excretion/time) was compared between proton pump inhibitors consumers and non-consumers. Furthermore, small intestine bacterial overgrowth prevalence was compared. RESULTS: Two hundred and twenty five patients were enrolled. No significant differences were found on the fermentative profile between groups [AUC mediana 3,776 (rango 2,124-5,571) vs 4,347 (rango 2,038-5,481), P = 0.3]. Small intestine bacterial overgrowth prevalence was similar as well [33% vs 27.5%]. These differences remained non-significant after adjusting for proton pump inhibitor dose and treatment time. Surprisingly, symptom score was significantly higher in those patients under proton pump inhibitor therapy [28.5 (23-26) vs 23 (15-29), P = 0.01]. CONCLUSION: Proton pump inhibitors have no significant influence on lactulose breath tests, regardless of the dosage and time of administration.

Risk of colorectal neoplasia in patients with celiac disease: a multicenter study.

BACKGROUND AND AIMS: The association of celiac disease with colorectal neoplasia is controversial. The aim of this study was to determine the risk of colorectal neoplasia among patients with celiac disease. METHODS: We carried out a multicenter, retrospective case-control study, within four community hospitals. Celiac disease patients with a complete colonoscopy were regarded as cases and those without celiac disease as controls. For each case, two controls matched for age, sex, indication for colonoscopy and colorectal cancer family history, were randomly selected. The main outcome evaluated was risk of colorectal polyps, adenomas, advanced neoplastic lesions and cancer. RESULTS: We identified 118 patients with celiac disease and 236 controls. The risk of polyps, adenomas and advanced neoplastic lesions was similar in both groups (OR 1.25, CI 0.71-2.18, p=0.40; OR 1.39, CI 0.73-2.63, p=0.31; and OR 1.00, CI 0.26-3.72, p=1.00, respectively). On multivariate analysis, age >75 years old, and first-grade CRC family history were associated with adenomas (OR 2.68 CI 1.03-6.98, OR 6.68 CI 1.03-47.98 respectively) and advanced neoplastic lesions (OR 15.03, CI 2.88-78.3; OR 6.46 CI 1.23-33.79, respectively). With respect to celiac disease characteristic, a low adherence to a gluten free diet was independently associated with the presence of adenomas (OR 6.78 CI 1.39-33.20 p=0.01). CONCLUSIONS: Celiac disease was not associated with an increased risk of colorectal neoplasia. Nonadherence to a strict gluten free diet was associated with the presence of adenomas. Further studies addressing celiac disease characteristics are needed to confirm this observation.

A controlled pilot study on the efficacy of a low dose antibiotic for the treatment of chronic constipation in patients receiving a high fiber diet.

BACKGROUND AND AIMS: In a previous uncontrolled experiment, oral vancomycin improved the symptoms (S) of chronic constipation (CC). The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet. METHODS: On days 0-to-10, patients were randomized to 500 mg oral lincomycin + high fiber (L + F) or to placebo + high fiber (P + F). Participants and patients were blinded. From days 10-to-21, patients were continued solely on the high fiber diet. The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale (VAS) calibrated from 0 = severe S to 10 = asymptomatic. RESULTS: The means of all S were significantly improved by L + F but not by P + F. A significant higher proportion of L + F patients increased the VAS > or = 3 points. CONCLUSIONS: The initial course of L facilitated the effect of F probably by its effect on the colon flora. This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs.

A controlled pilot study on the efficacy of a low dose antibiotic for the treatment of chronic constipation in patients receiving a high fiber diet / A controlled pilot study on the efficacy of a low dose antibiotic for the treatment of chronic constipation in patients receiving a high fiber diet.

BACKGROUND AND AIMS: In a previous uncontrolled experiment, oral vancomycin improved the symptoms (S) of chronic constipation (CC). The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet. METHODS: On days 0-to-10, patients were randomized to 500 mg oral lincomycin + high fiber (L + F) or to placebo + high fiber (P + F). Participants and patients were blinded. From days 10-to-21, patients were continued solely on the high fiber diet. The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale (VAS) calibrated from 0 = severe S to 10 = asymptomatic. RESULTS: The means of all S were significantly improved by L + F but not by P + F. A significant higher proportion of L + F patients increased the VAS > or = 3 points. CONCLUSIONS: The initial course of L facilitated the effect of F probably by its effect on the colon flora. This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs.