Emilio Varela

Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias.

BACKGROUND Angiodysplasia is a frequent cause of GI bleeding. Argon plasma coagulation has been shown to arrest bleeding, but its efficacy for prevention of recurrent bleeding has not been thoroughly evaluated. This study assessed the effectiveness and the safety of argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias. METHODS A total of 60 patients with GI bleeding caused by angiodysplasia were included. The endoscopic intervention was considered successful if there was no further overt bleeding and if the Hb level stabilized. Recurrent bleeding was defined as any detectable bleeding episode (hematemesis, melena, or hematochezia) or a decrease in Hb level. RESULTS Overt bleeding was resolved, and the Hb level stabilized without transfusion or supplemental iron therapy in 50 of the 60 patients (83%) at a median follow-up of 18 months (range 6-38 months). In the subgroup of patients with anemia, mean Hb level increased from 8.6 g/dL (range 5.1-12.2 g/dL) to 12 g/dL (range 8.0-15.2 g/dL) ( p < 0.01). The estimated probability of remaining free of recurrent bleeding at 1- and 2-year follow-up was 86%: 95% CI [73%, 93%] and 80%: 95% CI [64%, 89%], respectively. Among 72 procedures, only two were associated with a complication (2.8%). CONCLUSIONS Endoscopic argon plasma coagulation is both effective and safe for prevention of recurrent bleeding from GI angiodysplasia.

M1038 Prevalence of Celiac Disease in a Community Hospital Health Maintenance Organization

INTRODUCTION: Celiac disease (CD) is a gluten-sensitive enteropathy characterized by a chronic injury in the small bowel, caused by gluten intolerance in genetically predisposed individuals. CDs different forms of presentation resemble more a multisystem disorder than a primary gastrointestinal disease, frequently remaining underdiagnosed by primary care physicians. OBJECTIVE: To determine the prevalence of CD diagnosis within an heath maintenance organization (HMO) population composed, predominantly, of middle-class individuals who live in an urban area. MATERIAL AND METHODOLOGY: A cross sectional analysis of the electronic medical record system (EMR) of our HMO population between 1999 and 2006 was carried out. All patients in our adult population with clinical problems related to CD were identified by primary care physicians or specialists. People tested for IgA antitransglutaminasa antibodies (TG-ab) during the period were analyzed as well. The criteria used to define the case was based on a diagnosis of CD in the EMR and/or a TGab value >15U. RESULTS: According to these criteria, out of a total enrollment of 128,626 individuals in the HMO, 276 patients with CD diagnosis were identified. The prevalence of CD was 0.21%. The mean age of this group of people was of 40.8 years, of which 76.8% were female. The age distribution of the CD population was as follows: 26% under 18 years old, 50% between 18 and 60, and 24% over 60. DISCUSSION AND CONCLUSIONS: In a previous study made in one of the largest urban areas of Argentina (La Plata city) using TG-ab as a detection method in blood samples of prenuptial tests, the serologic prevalence of CD was 1 in 143 individuals. In our HMO, using secondary databases we found the frequency of CD diagnosis to be 1 in 470. The rate between the assumed serological prevalence of CD in this urban population and the clinical diagnosis carried out in our center was 3 to 1. Although this level of diagnosis is among the highest rates published, there would still be 2/3 of the patients left without diagnosis. CD, thus, appears to be a widespread public health problem. An increased level of awareness and clinical suspicion is needed and physicians must learn how to recognize the various clinical presentations of CD.