Helena Heras Salvat

Changing trends in acute upper-GI bleeding: a population-based study.

BACKGROUND Advances in medical practice in recent decades have influenced the etiology and management of acute upper-GI bleeding (UGIB), but their impact on the incidence and mortality is unclear. OBJECTIVE To analyze the time trends of UGIB in 2 different management eras. DESIGN Prospective observational study. SETTING General university-affiliated hospital. PATIENTS AND INTERVENTIONS A total of 587 patients who presented with UGIB during the 1983-to-1985 period were compared with 539 patient in the 2002-to-2004 period. RESULTS The overall incidence of UGIB decreased from 112.5 to 89.8 per 100,000/y, which corresponds to a 35.5% decrease after adjustment for age (95% CI, 24.2%-46.8%). The age standardized incidence of ulcer bleeding decreased by 41.6% (95% CI, 27.2%-56%); the decrease occurred only in people younger than 70 years of age. The rate of history of peptic ulcer disease decreased from 32.7% in the 1983-to-1985 period versus 19.5% in the 2002-to-2004 period (P < .001). The mean age increased from 61.0 to 68.7 years (P < .001), and the male:female ratio decreased from 2.7 to 1.8 (P = .002). The comorbidities increased from 69% to 75% (P = .01), the use of nonsteroidal anti-inflammatory drugs from 40.0% to 46.4% (P = .03), and the cases of bleeding occurring during hospitalization from 10.4% to 17.1% (P < .001). In the 1983-to-1985 cohort, the endoscopy was solely diagnostic, and antisecretory therapy consisted of H2-antagonists drugs. In the second period, 39.3% of patients underwent endoscopic therapy, whereas proton pump inhibitors were administered in 47%. Rebleeding rates decreased from 32.5% to 7.4% (P < .001) and surgery from 10.2% to 2.0% (P < .001). Overall mortality decreased from 17.1 to 8.2 per 100,000/y, which corresponded to a 60.8% decrease after adjustment for age (95% CI, 46.5%-75.1%). The age standardized mortality rate for ulcer bleeding decreased by 56.5% (95% CI, 41.9%-71.1%). LIMITATIONS A single-center study and a potential lack of generalizability. CONCLUSIONS From the 1983-to-1985 period to the 2002-to-2004 period, major changes occurred in the incidence of UGIB, features of patients, management, and outcomes. The incidence and mortality of UGIB overall and ulcer bleeding decreased significantly, and the decline of incidence occurred only in patients younger than 70 years old.

Comparison between different colon cleansing products for screening colonoscopy. A noninferiority trial in population-based screening programs in Italy.

BACKGROUND AND STUDY AIMS The high volume and poor palatability of 4 L of polyethylene glycol (PEG)-based bowel cleansing preparation required before a colonoscopy represent a major obstacle for patients. The aim of this study was to compare two low volume PEG-based preparations with standard 4 L PEG in individuals with a positive fecal immunochemical test (FIT) within organized screening programs in Italy. PATIENTS AND METHODS A total of 3660 patients with a positive FIT result were randomized to receive, in a split-dose regimen, 4 L PEG or 2 L PEG plus ascorbate (PEG-A) or 2 L PEG with citrate and simethicone plus bisacodyl (PEG-CS). The noninferiority of the low volume preparations vs. 4 L PEG was tested through the difference in proportions of adequate cleansing. RESULTS A total of 2802 patients were included in the study. Adequate bowel cleansing was achieved in 868 of 926 cases (93.7 %) in the 4 L PEG group, in 872 out of 911 cases in the PEG-A group (95.7 %, difference in proportions  + 1.9 %, 95 % confidence interval [CI]  - 0.1 to 3.9), and in 862 out of 921 cases in the PEG-CS group (93.6 %, difference in proportions  - 0.2 %, 95 %CI  - 2.4 to 2.0). Bowel cleansing was adequate in 95.5 % of cases when the preparation-to-colonoscopy interval was between 120 and 239 minutes, whereas it dropped to 83.3 % with longer intervals. Better cleansing was observed in patients with regular bowel movements (95.6 %) compared with those with diarrhea (92.4 %) or constipation (90.8 %). CONCLUSION Low volume PEG-based preparations administered in a split-dose regimen guarantee noninferior bowel cleansing compared with 4 L PEG. Constipated patients require a personalized preparation. TRIAL REGISTRATION EudraCT 2012 - 003958 - 82.

Mo1385 Role of the Colon Cancer Screening Programme on Inflammatory Bowel Disease New Diagnosis. One Year Experience in an Italian North-East Area

Entero-Urinary Fistulas in Crohns Disease: Prevalence and Clinical Manifestations Carlos Taxonera, Ignacio Fernandez-Blanco, Manuel Barreiro-de Acosta, Guillermo Bastida, Antonio Lopez-SanRoman, Olga Merino, Valle Garcia-Sanchez, Javier P. Gisbert, Ignacio Marin-Jimenez, Pilar Lopez-Serrano, Eva Iglesias Flores, Javier Martinez-Gonzalez, Maria Chaparro, Fernando Bermejo, Cristina Saro, Leticia Perez-Carazo, Rocio Plaza, David Olivares, Maria M. Canas, Juan L. Mendoza

Tu1181 Intermittent Versus Every-Day Mesalazine Therapy in Preventing Complications of Diverticular Disease: A Long-Term Follow-up Study

BACKGROUND : Mesalazine seems to be effective in preventing recurrence ofacuteuncomplicateddiverticulitis(AUD),but the optimal mesalazine scheme to achieve theseresultsisstilldebated. AIM: Toassesstheeffectivenessoftwodiffer- ent mesalazine-based treatments in preventing recurrence of AUD and the occurrence of other complications of diverticular disease (DD) dur - ingalong-termfollow-up. PATIENTS AND METHODS :We reviewed 311 patients suffer from recent episode of AUD and undergoingtomesalazinetreatment:207(group A, 105 males, median age 63 years, range 47-74 years)weretreatedwithmesalazine1.6gfor10 dayseachmonth,whilst104(groupB,55males, median age 65 years, range 50-72 years) were