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.
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.
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).
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).
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.
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.
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.
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).
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%.
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.
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).
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.
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.
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.
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
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.
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.