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Publicado el número extraordinario de 2019 de la RAPD online #50SAPD https://t.co/mgMumVwwCp https://t.co/1YIJWy5z4q

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RT @redaccionmedica: .@sapdes recomienda poner en marcha una comisión de seguimiento del Programa de Detección Precoz de Cáncer Colorrectal…

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RT @sepdigestiva: ¡Felicidades @sapdes! Desde aquí os deseamos, por lo menos, otros cincuenta más 😊 Os estaremos acompañando en la próxima…

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RT @drapereza: @sapdes Lo queremos compartir con todas las sociedades cientificas q nos han acompañado en nuestro cumpleaños @aegastro @AEE

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RT @jgarciacano1: Enhorabuena a @sapdes por haber celebrado su 50 aniversario. En estos momentos de déficits importantes en la financiación…

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Despedida de la #50SAPD. Hasta la próxima edición en Jaén 2020. https://t.co/VRWCH7bIfw

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La Dra. Ángeles Pérez Aisa @drapereza, presidenta de la SAPD y el Dr. Manuel Romero Gómez @mromerogomez, presidente… https://t.co/NrlqPQvQ0K

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RT @mromerogomez: El Dr Suarez de HU de Valme presenta su última comunicación oral en #50SAPD. Retirar antivirals en hepatitis B puede ser…

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¿Hay algún factor de respuesta a vedolizumab en la enfermedad inflamatoria intestinal? @HUVMacarena #50SAPD https://t.co/ilyX3gvQEc

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RT @drapereza: Todo el mundo participando hasta el final en la reunion #50SAPD ...entrega maxima...gracias https://t.co/IJvseIOPuk

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Suspensión del tratamiento con análogos de nucleótidos (AN) en pacientes con hepatitis crónica por VHB (HCB) HBEAG… https://t.co/y1Fhja5vWn

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Registro europeo del manejo de h. pylori (HP-EUREG): análisis intermedio de los tratamientos de primera línea en an… https://t.co/e8dfYKCcl7

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Marcapasos y desfibriladores automáticos implantables en la realización de cápsula endoscópica: seguridad y eficaci… https://t.co/3t17CqMIh3

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Evaluación de nuevos biomarcadores potenciales para el daño hepático inducido por fármacos @_ibima @DestiNAGenomichttps://t.co/lh6YLMFEsi

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Última Sesión Plenaria de Comunicaciones Orales, moderada por el Dr. Manuel Rodríguez Téllez @DigestivoTellezhttps://t.co/8N6u2QXLPr

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RT @mromerogomez: @clparrac de @HospitalUVRocio dicta la conferencia de clausura en #50SAPD ciencia de datos e inteligencia artificial, her…

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En la celebración de nuestro 50 aniversario queremos compartir con todos vosotros nuestro video conmemorativo… https://t.co/PTSgpxp7tm

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RT @RosalesDigestiv: Conferencia de clausura del #50SAPD con D. Carlos Parra, moderado por @mromerogomez sobre la ciencia de datos y la int…

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Conferencia de Clausura: “La ciencia de datos y la inteligencia artificial en la práctica clínica” moderada por el… https://t.co/J1bwrnioQA


RAPD 2011
VOL 34
N5 Septiembre - Octubre 2011

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Datos de la publicación


XLII MEETING OF THE ANDALUSIAN SOCIETY OF DIGESTIVE DISEASES. JAEN 2011. Oral Comunications, Table 5


Oral Comunications, Table V

1. RESCUE TREATMENT EFFICACY WITH OMEPRAZOLE, AMOXICILLIN AND LEVOFLOXACIN IN THE ERADICATION OF H. PYLORI

Cano-medel, C.; Ampuero, J.; Millán-domínguez, R.; Lamas, E.; Pabon, M.; Larraona, J.; Romero-gómez, M.; Castrofernández, M.

VALME HOSPITAL, DIGESTIVE DISEASES SERVICE. SEVILLE. SEVILLE.

Introduction

The combination of omeprazole, amoxicillin and levofloxacin has become the treatment of choice in the eradication of H. pylori when triple therapy with omeprazole, clarithromycin and amoxicillin (OCA) fails. In a recent national multicenter study that counted with the participation of our hospital and 1000 patients, it was stated that it is a very effective treatment, with a high rate of compliance and without serious adverse effects.

Aim of this study

To evaluate the treatment efficiency in the last few years of omeprazole, amoxicillin and levofloxacin when administered for 10 days in our health area in the eradication of H. pylori after failure of first treatment with OCA.

Patients and approaches

Design of the study: a single-center, observational and prospective study was carried out. Study Period: 2006-2010. Patients: 100 consecutive patients (62 women) whose average age was 48 (18-78) were included in the study. 81 of them were diagnosed with functional or non-investigated dyspepsia and 19 with gastroduodenal ulcer, with H. pylori infection. They strictly complied with treatment with levofloxacin (500 mg/12h), amoxicillin (1 g/12h) and omeprazole (20 mg/12h) for 10 days or other PPI at equivalent dose after failure of a first eradication treatment with OCA during 10 days. Treatment compliance was checked by questioning. Variable: Rate of eradication of H. pylori confirmed by C13-urea breath test, performed 8 weeks after stopping treatment.

Results

H. pylori eradication was achieved in 75% of patients (it was eradicated in 78% of patients with dyspepsia and in 69% of patients with gastroduodenal ulcer).

Conclusions

The 10 days rescue treatment with omeprazole, amoxicillin and levofloxacin showed a high efficacy in eradicating H. pylori, and it must be considered the treatment of choice when the initial treatment with OCA fails and probably after failure of the quadruple therapy with omeprazole, clarithromycin, amoxicillin and metronidazole, which is becoming increasingly recommended as first-line eradication therapy.

2. FACTORS IN THE EMERGENCE OF ERYTHEMA NODOSUM AND PYODERMA GANGRENOSUM IN INFLAMMATORY BOWEL DISEASE IN A COHORT OF 331 PATIENTS

Ampuero, J.; Cano-medel, C.; Rojas-feria, M.; Millán-lorenzo, M.; Castro-fernández, M.; Romero-gómez, M.

VALME HOSPITAL, DIGESTIVE DISEASES SERVICE. SEVILLE.

Aims of this study

To evaluate the factors associated with the presence of major dermatological disorders ((erythema nodosum-EN) and (pyoderma gangrenosum-PG)) in inflammatory bowel disease (IBD).

Approach

The study included 331 patients with IBD, divided into Crohn's disease (CD) (n = 247, 74.8%) and ulcerative colitis (UC) (n = 84, 25.2%), under study from 2003. There were 172 men (52%) and 159 women (48%), with an age at diagnosis of 31.7 ± 13.8 and follow-up of 10 ± 6.4 years. Variables analyzed: smoking and drinking habit, activity, pattern, size, family history, previous surgery, other extraintestinal manifestations, previous biological and immunosuppressive treatments, response to corticosteroids and presence of fistulas. Statistical Method: Chi-square distribution, Kaplan-Meier and T-student methods. Results 35 dermatological disorders were found (26 EN and 9 PG), which represents a prevalence of 10.6%. There were 23 EN in patients with IBD and 8 PG in patients with CD (88.5%) and 3 EN and 1 PG in patients with UC (11.5%). A relationship was found between these pathologies and being a woman (p = 0.001), the presence of other extraintestinal manifestations (p = 0.004), CD (p = 0.034), as well as with the age at diagnosis (p = 0.037). Women (log rank 9.77, p = 0.002) and the presence of other extraintestinal manifestations (log rank 7.75, p = 0.005) showed to be related in the survival analysis.

Conclusions

Being a woman, the presence of extraintestinal manifestations, Crohn's disease and age at diagnosis are associated with erythema nodosum and pyoderma gangrenosum. Prospective studies with larger cohorts are needed to confirm these results.

3. UTILITY OF INFLIXIMAB IN THE TREATMENT OF AUTOIMMUNE HEMOLYTIC ANEMIA ASSOCIATED WITH ULCERATIVE COLITIS

Leo Carnerero, E.; Trigo Salado, C.; de La Cruz Ramirez, M.; Herrera Justiniano, J.; Marquez Galan, J.

VIRGEN DEL ROCIO HOSPITAL, CLINICAL MANAGEMENT UNIT, GASTROENTEROLOGY SERVICE. SEVILLE.

Aim of this study

Communicating the utility of infliximab in the treatment of ulcerative colitis (UC) associated with autoimmune hemolytic anemia (AIHA), after the failure of a therapy with steroids and immunosuppressants. Except for the first of our cases, there is no other rescue literature with infliximab.

Patients and method

We present the case of two women with UC who developed AIHA when they were 24 and 35 years old respectively. Both women were being treated with azathioprine; the first case was associated with a case of moderate to severe left sided colitis, the second woman suffered a case of severe pancolitis. Hemoglobin (HB) was 64 and 60 g/l respectively with signs of hemolysis, and no improvement took place with steroids. We recorded the patients' response to infliximab.

Results

Treatment commenced with infliximab at standard doses and intervals. HB after 7 and 30 days was 85 and 105 and 68 and 104 g/l respectively. Although in the second case the patient had recurrence of colitis after the decrease of the 3 induction dose, HB values finally normalized in both women (> 115 g/l). Clinical remission and endoscopic improvement of UC occurred in parallel. HB remained normal after treatment for 3 and 1 year. Conclusions Infliximab is an effective alternative in the treatment of AIHA associated with UC, and should be tried before surgery. Control of colonic inflammation is the mainstay of treatment for anemia, as no antibodies against red blood cells are formed. This justifies the main difficulty to control the second case, as it extends more widely and is more severe than colitis.

4. UTILITY OF TUMOR M2 PYRUVATE KINASE IN PLASMA AND STOOL FOR THE DETECTION OF COLORECTAL CANCER

Fernández Suárez, A.1; Fatela Cantillo, D.1; Aguilar Benítez, J.2; Marín Moreno, M.3; Puente Gutiérrez, J.3; Bernal Blanco, E.3; Díaz Iglesias, J.1

1ALTO GUADALQUIVIR HOSPITAL, ANDUJAR, BIOTECHNOLOGY UNIT. JAEN. 2ALCALA LA REAL HOSPITAL, ALCALA LA REAL, LABORATORY. JAEN. 3ALTO GUADALQUIVIR HOSPITAL, ANDUJAR, GASTROENTEROLOGY SERVICE. JAEN.

Aims of this study

To determine the usefulness of tumor M2 pyruvate kinase (M2-PK) in plasma and stool samples for early detection of colorectal cancer (CRC), and to establish the relationship of this enzyme in both types of sample.

Approach

All patients were prospectively included (April 2008 to July 2010) undergoing diagnostic colonoscopy for suspected colorectal disease. The EDTA plasma and stool samples were collected before the colonoscopy. The M2-PK levels in plasma and stools were analyzed by means of an immunoenzymatic assay (ScheBo Biotech AG, Giessen, Germany).

Results

180 cases were studied; 39 patients were diagnosed with CRC, 35 with polyps, 70 with other diseases and in 36 cases there was no evidence of disease. The M2-PK levels in plasma and stools correlated significantly (Spearman rho 0.246, p = 0.001). The areas under the ROC curves (95% CI) in the detection of CRC for the M2-PK levels in plasma and stools were 0.696 (0.595-0.797) and 0.708 (0.612-0.805) respectively. The optimal cutoff point obtained for the M2-PK in stool and plasma was 8.46 U/mL and 20.50 U/mL, providing sensitivity figures of 76.9% and 61.5% with a specificity of 62.4% and 77.3% respectively. The combination of both markers showed a sensitivity and specificity of 84.62% and 51.77%, with a negative predictive value of 92.41%.

Conclusions

The determination of the M2-PK in stools is far more sensitive than measurement on plasma, which in turn is more specific. A negative result of both markers allow to rule out with a high probability the presence of CRC.

5. COMPARISON OF PLASMA TUMOR M2-PK AGAINST CEA, CA 19.9 AND TPS IN THE DIAGNOSIS OF COLORECTAL CANCER

Fernández Suárez, A.1; Fatela Cantillo, D.1; Marín Moreno, M.2; Domínguez Jiménez, J.2; Bernal Blanco, E.2; Díaz Iglesias, J.1; Puente Gutiérrez, J.2

1ALTO GUADALQUIVIR HOSPITAL, ANDUJAR, BIOTECHNOLOGY UNIT. JAEN. 2ALTO GUADALQUIVIR HOSPITAL, ANDUJAR, GASTROENTEROLOGY SERVICE. JAEN.

Aims of this study

To compare the diagnostic efficacy of the concentrations of plasma tumor M2 pyruvate kinase (M2-PK) in the detection of colorectal cancer (CRC) versus serum CEA, CA 19.9 and TPS in patients undergoing diagnostic colonoscopy.

Approach

The study included a cohort of patients (from April 2008 to July 2010) with suspected colorectal disease. EDTA-plasma and serum samples were collected before colonoscopies. Markers were analyzed by ELISA (M2-PK; ScheBo Biotech AG, Giessen, Germany) and automated testing (CEA in Cobas 6000, Roche Diagnostics, CA 19.9 in Centaur XP and TPS in Immulite 1000, Siemens Healhtcare Diagnostics).

Results

170 patients were included in the study; anatomic pathology confirmed the CRC diagnosis in 38 patients; colonoscopy showed the presence of polyps in 34 patients; the 98 remaining cases showed other pathologies or it was not possible to find evidences of other disease. The areas under the ROC curves (95% CI) in the detection of CRC for M2-PK, CEA, CA 19.9 and TPS, were 0.751 (0.611-0.841), 0.703 (0.610-0.796), 0.666 (0.570-762) and 0.624 (0.524-0.723), respectively. When the concentrations of markers were analyzed in the three groups, M2-PK showed statistical differences between the cancer group and the other groups (polyps, p = 0.01; other cases, p = 0.038); CEA and CA 19.9 only showed significant differences between the CRC group and the remaining 98 cases; TPS showed no difference in levels between any group. Conclusions M2-PK shows a greater diagnostic yield than the other markers studied.

6. EVOLUTION OF THE EFFECTIVENESS OF OCA AS FIRST LINE TREATMENT FOR THE ERADICATION OF HELICOBACTER INFECTION OVER A TEN YEAR PERIOD

Romero Ordoñez, A.1; González Bárcenas, M.1; López Vega, M.2; Rivera Irigoin, R.1; Fernández Moreno, N.1; Moreno Garcia, A.1; Pérez Aísa, A.1; Navarro Jarabo, J.3

1COSTA DEL SOL HEALTH AGENCY. GASTROENTEROLOGY SERVICE. MARBELLA. 2COSTA DEL SOL HEALTH AGENCY. GASTROENTEROLOGY SERVICE. MARBELLA. 3COSTA DEL SOL HEALTH AGENCY. GASTROENTEROLOGY SERVICE AND CIBERESP. MARBELLA.

Introduction

The eradication of Helicobacter pylori (Hp) infection is still today a priority health problem. Treatment success depends on two factors: treatment adherence, and resistance of bacteria to antibiotics. In recent years Hp is developing an increased resistance to clarithromycin, which is the standard antibiotic in the first-line treatments. Clinical guidelines consider a first-line treatment to be effective when it offers an eradication of around 80%.

Aims of this study

We intend to analyze whether there were differences in our eradication rates over a 10 year period. Material and approaches The study analyzed first-line treatments (in naïve patients) treated with OCA. Information on the results of the period 2000-2002 was available from our historical record which analyzed the effectiveness of all treatment regimens controlled by the Breath Test. The records selected to be studied were those obtained in the first months of 2011 from the breath test records available in our service. Variables which might influence the final result such as age, sex, type of injury, and treatment duration were analyzed. The information was extracted by reviewing medical records in the computerized management system of our hospital records.

Results

386 patients were studied in the first period (2000-2001); 373 of them were treated with OCA, with a 77.2% overall efficiency. In the current period, 351 out of 365 patients were treated with OCA. 156 patients of the patients treated with OCA were men and 209 women. 120 patients were treated for a peptic ulcer.

Conclusions

In the last 10 years no significant changes in the rate of eradication of Helicobacter pylori infection have taken place with first-line OCA treatment regimens. We have increased our tendency to use long regimens of 10 days. The eradication values obtained are considered acceptable according to clinical guidelines agreed by consensus, and therefore changes should not be considered in our clinical practice.

7. ASSESSMENT OF THE CLINICAL IMPACT OF GASTROINTESTINAL TRACT MRIs IN THE MANAGEMENT OF PATIENTS WITH CROHN'S DISEASE: EXPERIENCE IN OUR HOSPITAL

Naveas Polo, C.1; Triviño Tarradas, F.2; García Sánchez, V.3; Iglesias Flores, E.1; Escribano Fernández, J.2; Marín Pedrosa, S.1; García Caparrós, C.1; Gómez Camacho, F.1

1REINA SOFIA UNIVERSITY HOSPITAL, GASTROENTEROLOGY SERVICE. CORDOVA 2REINA SOFIA UNIVERSITY HOSPITAL, RADIOLOGY SERVICE. CORDOVA. 3REINA SOFIA UNIVERSITY HOSPITAL, GASTROENTEROLOGY SERVICE. CORDOVA

Introduction

Gastrointestinal tract MRIs are nowadays very important for diagnosis purposes, Crohn's Disease (CD) extension and activity studies and for the detection of complications, which may influence the therapeutic strategy.

Aims of this study

Evaluate the impact of Gastrointestinal tract MRIs in the management of patients in clinical practice. Approach Retrospective study of 74 patients with CD or suspected of it, explored by means of a Gastrointestinal tract MRI. We analyzed the indications, findings, the correlation with endoscopic findings in case the patient had undergone a colonoscopy and the clinical impact on therapeutic management.

Results

The study included 74 patients (41 men) whose average age was 36, the most common indication being the assessment of the activity and severity of an outbreak in diagnosed patients (31%). In 20 of the patients, the examination was normal. Fistulas were found in 5 of the patients, stenosis in 34, masses in 2 and abscesses in 8 of them. 6 patients were diagnosed with suspected CD (33%). In 27 patients (36%), the assessment caused changes in the pattern or location of the disease. 15% of the patients underwent a colonoscopy before the MRI. In 87% of the cases there was agreement between the results shown by the two scans. In 42 patients (57%) the therapeutic strategy was changed: 12 were chosen for surgery, 9 undiagnosed patients started treatment, 10 patients started being treated with immunosuppressants, 13 patients started biological treatment and in 4 pretreatment was optimized.

Conclusions

Gastrointestinal tract MRIs influence therapeutic decision making, helping in the diagnosis and definition of the extent and behavior of the disease, showing good correlation with colonoscopy.

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