Hacibe Hallal

Double-balloon enteroscopy: a descriptive study of 50 explorations

AIM To evaluate the utility of double-balloon enteroscopy for small-bowel disease. DESIGN A prospective study of 50 consecutive enteroscopies performed from December 2004 to July 2005 to analyze diagnoses and treatments. PATIENTS 44 patients (33 had undergone a previous capsule endoscopy) with indications for obscure digestive hemorrhage, angiodysplasia, Peutz-Jeghers syndrome, ulcer, suspected Crohns disease, tumors, and refractory celiac disease. RESULTS We carried out enteroscopy studies in 44 patients by the oral route and, in 6 additional patients, by both the oral and anal routes. We reached the ileon with the oral route in all cases but one (jejunal stenosis), and in 4 cases out of 7 with the anal route, with an average duration of 73 minutes. We found angiodysplasia in 19 cases, as well as NSAID-related enteropathy, Crohns disease, diverticulosis, and Waldenströms disease. We performed biopsies in 31% of cases with diagnoses of adenocarcinoma, lymphangiectasia secondary to tumor in celiac disease, and Whipples disease. We treated 19 patients with angiodysplasia (1 to 20 synchronous lesions) with argon, and 4 patients with polyps using polipectomy (sporadic polyps or Peutz-Jeghers syndrome). A retained capsule in one patient with stenosis was removed. CONCLUSIONS Double-balloon enteroscopy is a useful and effective technique in the diagnosis and treatment of small intestine diseases, thus complementing capsule endoscopy. More studies are needed to analyze its impact on the management of this condition.

A shortened, 2-hour rifampin test: a useful tool in Gilbert's syndrome.

INTRODUCTION Diagnosis of Gilberts disease often involves unnecessary testing and patient anxiety. Rifampin test can support the diagnosis; it has been described in short series and lacks standardization in dose, collection times, result presentation and interpretation. Our objective was to compare the response to oral rifampin in a series of patients with Gilberts disease, 2 and 4 h after drug administration. PATIENTS AND METHODS Eighty-nine patients with Gilberts disease (elevated total bilirubin with no hepatopathy or hemolysis) were recruited. After a basal blood collection, 900 mg rifampin were administered per os and new samples were drawn 2 and 4 h later. Total and esterified bilirubin were measured in every sample. Haptoglobin concentration was also analyzed. RESULTS When expressed as relative increase with respect to basal values, variations observed 2 h after rifampin intake were all above 15%. A significant correlation (r = 0.902; p = 0.000) was found between relative increases 2 and 4 h after drug administration. No significant variations were found in haptoglobin concentrations. CONCLUSION Rifampin test is useful in diagnosing Gilberts disease, but variations in total bilirubin concentrations (basal and post-rifampin) make that no absolute cut-off value can be used. Correlation between 2- and 4-h relative increases suggests that a shortened version could simplify the test.

Alteraciones gastrointestinales en una paciente con inmunodeficiencia variable común

Resumen Aportamos el caso de una paciente de 33 anos con diarrea intermitente de 8 anos de evolucion y diagnosticada de inmunodeficiencia variable comun. Nuestra paciente presento gastritis atrofica antral, atrofia parcial de vellosidades duodenales, hiperplasia nodular linfoide del intestino delgado y colitis linfocitica. Realizamos una revision de la bibliografia.

High Prevalence of Ibuprofen Drug-induced Liver Injury in Spanish and Latin-American Registries.

*Unidad de Gestión Clínica de Aparato Digestivo, Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Málaga, Spain; Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay; Unidad de Gestión Clínica de Aparato Digestivo Intercentros, Hospitales Universitarios Virgen Macarena-Virgen del Rocio, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Seville, Spain; kHospital Provincial del Centenario, Facultad de Medicina, Universidad Nacional de Rosario, Rosario, Argentina; Servicio de Aparato Digestivo, Hospital Morales Meseguer, Murcia, Spain; Department of Immunology, Complutense University School of Medicine, Madrid, Spain; **Hospital 12 de Octubre Health Research Institute (i+12), Madrid, Spain; Unidad de Investigación Clínica y Ensayos Clínicos Instituto de Investigación Biomédica de Málaga, Plataforma Spanish Clinical Research Network, Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Málaga, Spain