T. Arranz

Patrón de ingesta en un grupo de pacientes con síndrome de intestino irritable: relación de la ingesta de fibra con los síntomas

Objectives: The aim of our study was to evaluate the oral dietary intake of a group of patients with irritable bowel syndrome and to compate with international recommendations. Patients and methods: A total of 53 patients with irritable bowel syndrome was enrolled in a non-propabilistic sample. Patiens were diagnose with Roma II criteria. In all patients were determined, weight, height, body mass index, dietary intake of 3 days and a symptoms scoring system. Results: The average age of 53 patients was 45.67±13.6 years with a distribution of sex (22 males/31 females). Caloric intakes was righ in absolut terms and corrected by weight. Distribution of calories was 41.5% of carbohidrates, a 19.8% of proteins, and a 38.7% of lipids, showing a high intake of lipids and low of carbohidrates. A low intake of vitamin A and D was detected. High intake of vitamin B12, vitamin C and niacine was observed. A low intake of calcium, magnesium, yodo and zinc was detected. Intake of soluble fiber was lower than insoluble fiber (1.46±0.74 g/day) (19%) vs 6.21±2.67 g/day (71%). Intake of fiber corrected by calories was low 4.5±1.2 g/1000 calories. In correlation analysis, insoluble fiber (r=0.46; p < 0.05) and soluble fiber (r=0.42; p < 0.05) were inverse correlated with general symptoms. Conclusions: Patients with irritable bowel syndrome showed a desviation of mineral and vitamin dietary . Fiber intake is low, a correlation between fiber intake and general symptoms was detected.

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

OBJECTIVE We analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. METHODS We retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. RESULTS Capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. CONCLUSIONS The performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.

Choledocho-renal fistula in locally advanced cholangiocarcinoma

as complications of cholangiocarcinoma. We report a new kind of biliary fistula as a result of cholangiocarcinoma. A 56-year-old man underwent ERCP because of progressive jaundice. He had no urinary or other symptoms. His only relevant medical history was a cholecystectomy performed one year before because of acute cholecystitis; operatory cholangiography was normal. Cannulation revealed a normal pancreatogram. Intrahepatic ducts were markedly dilated, with an irregular tapering in the middle of the common bile duct with a malignant in appearance (Fig. 1). A few seconds afterwards, the radiological image showed the right renal pelvis and ureter filled with the non-absorptive contrast (iohexol) we used. A sphincterotomy was performed, and samples for citology were obtained with a brush. Then, a 8.5 French and a 10-cm wire-guided stent was placed through the stricture (Fig. 2). The left renal system worked properly and was never filled with contrast. Further films confirmed this finding. Jaundice improved. Computerized tomography and urine tests showed no alterations. A cytologic diagnosis of cholangiocarcinoma was made. The patient went under expected curative surgery. The tumor, with a 3-cm-long fistulous tract towards the right kidney, was confirmed and then removed by surgery. Carcinomatous cells were found in the excised biliary tract, and in the tissue around it. Although biliary tumors usually grow slowly and seldom involve adjacent organs, they may sometimes, through circular size increases, affect neighboring tissues by compression, infiltration or fistulation. These are usually end stages, and treatment is usually endoscopic with biliary stents (5). Surgical treatment can be useful in selected cases. 1130-0108/2005/97/10/750-751 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright

Esófago en arañazo de gato: ¿una nueva entidad por describir?

We report the case of an 84 years old man without significant medical history. He consulted for rapidly progressive dysphagia for solids and liquids and loss of weight. The gastroscopy showed a dilated esophagus but no trace of food in it. The esophageal mucosa had superficial and linear tears that followed the long axis from the middle to the cardias (Fig. 1). The endoscopic view remembered that would cause a cat scratching on a tubular fabric. Among the mucosal flaps we could see an entire and erythematous submucosa with its microvasculature respected (Fig. 2). Endoscopic progression, which was not traumatic, diagnosed a cardiac tumor that was generating an incomplete stenosis at that level. Histology showed a squamous stratified epithelium.