Mercedes Amieva-Balmori

Model for end-stage liver disease-Na score or Maddrey discrimination function index, which score is best?

AIM To compare the ability of model for end-stage liver disease (MELD)-Na and Maddrey discrimination function index (DFI) to predict mortality at 30 and 90 d in patients with alcoholic hepatitis (AH). METHODS We prospectively assessed 52 patients with AH. Demographic, clinical and laboratory parameters were obtained. MELD-Na and Maddrey DFI were calculated on admission. Short-term mortality was assessed at 30 and 90 d. Receiver operating characteristic curve analysis was performed. RESULTS Thirty-day and 90-d mortality was 44% and 58%, respectively. In the univariate analysis, sodium levels was associated with mortality at 30 and 90 d (P = 0.001 and P = 0.03). Child stage, encephalopathy, ascites, or types of treatment were not associated with mortality. MELD-Na was the only predictive factor for mortality at 90 d. For 30-d mortality area under the curve (AUC) was 0.763 (95%CI: 0.63-0.89) for Maddrey DFI and 0.784 for MELD-Na (95%CI: 0.65-0.91, P = 0.82). For 90-d mortality AUC was 0.685 (95%CI: 0.54-0.83) for Maddrey DFI and 0.8710 for MELD-Na (95%CI: 0.76-0.97, P = 0.041). CONCLUSION AH is associated with high short-term mortality. Our results show that MELD-Na is a more valuable model than DFI to predict short-term mortality.

Consenso mexicano sobre estreñimiento crónico

INTRODUCTION Significant advances have been made in the knowledge and understanding of the epidemiology, pathophysiology, diagnosis, and treatment of chronic constipation, since the publication of the 2011 guidelines on chronic constipation diagnosis and treatment in Mexico from the Asociación Mexicana de Gastroenterología. AIMS To present a consensus review of the current state of knowledge about chronic constipation, providing updated information and integrating the new scientific evidence. METHODS Three general coordinators reviewed the literature published within the time frame of January 2011 and January 2017. From that information, 62 initial statements were formulated and then sent to 12 national experts for their revision. The statements were voted upon, using the Delphi system in 3 voting rounds (2 electronic and one face-to-face). The statements were classified through the GRADE system and those that reached agreement >75% were included in the consensus. RESULTS AND CONCLUSIONS The present consensus is made up of 42 final statements that provide updated knowledge, supplementing the information that had not been included in the previous guidelines. The strength of recommendation and quality (level) of evidence were established for each statement. The current definitions of chronic constipation, functional constipation, and opioid-induced constipation are given, and diagnostic strategies based on the available diagnostic methods are described. The consensus treatment recommendations were established from evidence on the roles of diet and exercise, fiber, laxatives, new drugs (such as prucalopride, lubiprostone, linaclotide, plecanatide), biofeedback therapy, and surgery.

Sa1392 The Use of Pictograms to Identify Postures Associated With Constipation

G A A b st ra ct s PHQ-9 (R=0.606, p=0.00358), PHQ-15 (R=0.466, p=0.03316) and GAD-7 (R=0.779, p= 0.00003) scores in constipated patients correlated strongly with SBS (Figure 1). Correlations between psychometric testing and SBS were not significant in controls, except for PHQ-15 (R=0.636, p=0.014). The prevalence of SBD in constipation was 52% compared to 14% in controls. No significant differences were found between HRAM parameters in constipated patients with and without a positive SBS (Table 1B). Unpaired T-tests confirmed PHQ-9 (p=0.038, CI 0.30-9.56), PHQ-15 (p=0.0004, 3.39-10.85), GAD-7 (p=0.025, CI 0.66-9.22) and SBS (p=0.024, CI 2.58-34.01) scores differed between the constipated and control groups.Conclusions: Severity of SBD correlates with the severity of depression, somatization, and anxiety. Symptoms of SBD were present in more than 50% of patients with chronic constipation. Constipated patients had similar HRAM profiles and rates of dyssynergy regardless of SBS status. Cognitive behavioral therapy, physical therapy and desensitization may be therapeutic for this population. Table 1. Results

881 Effects of Telmisartan in Anal Sphincter Physiology in Asymptomatic Volunteers and Patients With Anal Sphincter Hypertension With Chronic Proctalgia

Background. Small intestine contrast ultrasonography (SICUS) can detect intestinal damage in patients with Crohns disease (CD). We evaluated the diagnostic accuracy of SICUS in determining the site, extent, and complications of CD, compared with magnetic resonance (MR)-enterography as the standard. Methods. We performed a retrospective analysis of 52 patients with CD [(M=33; median age: 23, CD site: ileal 35 (67%), ileocolonic 13 (25%), jejuno-ileal, 3 (6%), colonic 1 (2%); behaviour: non-stricturing non-penetrating 8 (15%), structuring 27 (52%), penetrating 17 (33%); previous surgery 21 (40%); clinical indications: disease assessment 46 (89%), obstructive symptoms 6 (11%)] evaluated by SICUS and MRenterography 3 months apart, between January 2011 and October 2013. We evaluated disease site (based on bowel wall thickness), extent of lesions, presence of complications (stenosis, prestenotic dilation, abscess, or fistulas) using MR-Enterography as the standard. Sensitivity, specificity, and diagnostic accuracy were calculated. We determined the correlations in maximum wall thickness and disease extent in the small bowel between results from SICUS and MR-Enterography. Results. SICUS identified the site of small bowel CD with 96% sensitivity, 60% specificity, and 92% diagnostic accuracy; it identified the site of colon CD with 70% sensitivity, 92% specificity, and 87% diagnostic accuracy. Results from SICUS and MR-enterography correlated in determination of bowel wall thickness (rho=0.51) and disease extent (rho=0.72; P<.0001 for both). SICUS detected ileal stenosis with 90% sensitivity, 92% specificity, and 90% diagnostic accuracy, and pre-stenotic dilation with 66% sensitivity, 80% specificity, and 71% diagnostic accuracy. SICUS detected abscesses with 100% sensitivity, 100% specificity, and fistulas with 80% sensitivity, 81% specificity, and 81% diagnostic accuracy. Conclusion. SICUS identified lesions and complications in CD patients with high levels of sensitivity, specificity, and accuracy compared to MRenterography. SICUS might be used as an imaging tool as part of a focused diagnostic and follow up examination of patients with CD.