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Resumen El abdomen agudo en la gestacion y el puerperio constituye un diagnostico complejo y un reto terapeutico. Nuestro objetivo es realizar una revision bibliografica de esta patologia a proposito de un caso de peritonitis secundaria a absceso tubarico con apendicitis por helmintos concomitante. Principalmente, su sintomatologia se resume en el dolor y la distension abdominal, las nauseas y/o los vomitos. Estos sintomas se encuentran presentes en el embarazo normal, dificultando el diagnostico diferencial. El abdomen agudo es relativamente infrecuente durante la gestacion y el puerperio, siendo la apendicitis aguda la principal causa de origen no obstetrico. Asocia una elevada morbimortalidad materno-fetal, que aumenta a medida que la gestacion avanza, requiriendo un manejo multidisciplinar para alcanzar un diagnostico precoz y un tratamiento efectivo. Fundamentalmente, el abordaje terapeutico es quirurgico debido, en gran medida, al diagnostico tardio con frecuente asociacion de complicaciones. Un manejo temprano sera primordial para minimizar riesgos para la madre y el feto.

Background: few studies have reported the onset and disappearance rates of gastroesophageal reflux symptoms (GERS) in the population. Aim: to assess the occurrence and disappearance rates of GERS in Spain, and their impact on health-related quality of life (HRQL). Participants and methods: participants were selected at random from the general population of Madrid in age and sex strata. They were interviewed at home twice, 6 months apart. Heartburn, acid regurgitation and consultation were assessed with the gastroesophageal reflux questionnaire, and HRQL with the SF-36. Results: 709 individuals were included, and 451 (63.6%) were re-interviewed 6 months later. Among the 325 individuals without GERS, 9 developed weekly symptoms (2.2% [95% CI: 0.8, 3.4%]); 2 (22%) consulted because of GERS. Among the 34 subjects reporting weekly GERS initially, 26 did not report them at 6-months. Onset of GERS was associated with worsening scores in the physical summary of SF-36 (delta = -6.6 [95% CI: -11.8, -1.42]), while disappearance with an improved score (delta = -3.0 [95% CI: 0.0, 5.9]). Conclusion: despite the lower prevalence of GERS in Spain, the occurrence rate is 2.2% in 6 months; however symptoms disappeared in more than half of subjects six months later. Developing GERS was associated with reduced HRQL, and their disappearance with improvement.

Objectives To estimate the impact of gastroesophageal reflux (GER) symptoms on the utilization of healthcare services and work absenteeism in Spain. Methods A cross-sectional study on 2,500 subjects representative of the Spanish population from 40 to 79 years of age. Data were collected via a telephone interview in January 2002 using Locke s questionnaire after its cross-cultural adaptation and validation for telephone use in Spain. Results GER is responsible for 296.8 doctor consultations (95% CI: 245.3-348.7) per 1,000 inhabitants per year, for 24 esophagogastrointestinal radiographic studies per 1,000 inhabitants per year (95% CI: 18-30), for 32.4 (95% CI: 25.5-39.3) high digestive endoscopies per 1,000 inhabitants per year, and for the loss of 201 (95% CI: 0-411.1) working days per 1,000 employed inhabitants with GER per year. In relation to medication intake, GER resulted in 4,092 (95% CI: 3,300-5,133) treatment days with H2 antagonists per 1,000 inhabitants per year, 9,030 (95% CI: 7,846-10,332) treatment days with proton pump inhibitors per 1,000 inhabitants per year, and 1,082 (95% CI: 519-1,549) treatment days with prokinetics per 1,000 inhabitants per year. Conclusions GER has a large impact on the utilization of healthcare resources and work absenteeism in Spain, in contrast to the widespread belief that it is an illness of little importance.

To measure the prevalence of gastro-oesophageal reflux symptoms and to identify associated factors in a representative sample of the Spanish population.A telephone survey of 2500 subjects was performed using a validated questionnaire. The association of gastro-oesophageal reflux symptoms (defined as the presence of heartburn or acid regurgitation) and their clinical characteristics with potential risk factors was summarized using the odds ratios (OR) obtained by multiple logistic regression.The response rate was 71.2%. The annual prevalence of gastro-oesophageal reflux symptoms was 31.6% [95% confidence interval (CI), 29.8-33.4] and the weekly prevalence was 9.8% (95% CI, 8.6-10.9). Gastro-oesophageal reflux symptoms were associated with excess weight (OR, 1.53; 95% CI, 1.23-1.92), obesity (OR, 1.74; 95% CI, 1.30-2.32), the psychosomatic symptom score (OR, 2.98; 95% CI, 2.41-3.67) and the presence of gastro-oesophageal reflux symptoms in a direct family member (OR, 1.61; 95% CI, 1.17-2.23). Gastro-oesophageal reflux symptoms ofor =10 years' duration were more frequent in obese subjects (OR, 1.92; 95% CI, 1.14-3.22) and those with a direct family member with gastro-oesophageal reflux symptoms (OR, 2.42; 95% CI, 1.44-4.06). Factors associated with gastro-oesophageal reflux symptoms ofor =1 year duration were a spouse with gastro-oesophageal reflux symptoms (OR, 2.33; 95% CI, 1.39-3.9) and the consumption of 1-5 aspirins/week (OR, 1.70; 95% CI, 1.01-2.86).The prevalence of frequent gastro-oesophageal reflux symptoms in Spain is lower than that observed in other Western populations. The psychosomatic symptom score is the factor most strongly associated with gastro-oesophageal reflux symptoms. Long-term gastro-oesophageal reflux symptoms are associated with certain genetic factors (obesity, family history of gastro-oesophageal reflux symptoms), whereas short-term gastro-oesophageal reflux symptoms are associated with factors of probable environmental nature.

To produce and validate for telephone use in Spain a cross-cultural adaptation of the gastroesophageal reflux questionnaire (GERQ) developed by Locke et al.The Spanish version of the questionnaire was developed through translation, assessment of comprehensibility, back translation, and appraisal of applicability. Subsequently, reproducibility was measured by a test-retest procedure in 125 patients, and concurrent validity was evaluated by comparing self-reported questionnaire data against a gastroenterologist's findings from clinical interviews with 50 patients.The Spanish version showed itself to be easily understandable and widely applicable. Reproducibility for the two cardinal symptoms of gastroesophageal reflux disease (heartburn and acid regurgitation) as measured by the kappa index (95% confidence interval), was 0.85 (0.73-0.97) and 0.81 (0.70-0.92), respectively. With respect to the process of concurrent validation, kappa values (95% confidence interval) for heartburn and acid regurgitation were 0.85 (0.68-1) and 0.91 (0.79-1), respectively. Median kappa for all questions on the questionnaire was 0.75 (range: 0.42 a 1) in the reproducibility analysis and 0.83 (range: 0.44 a 1) in the concurrent validity analysis.The reproducibility and concurrent validity of the Spanish version of the GERQ is excellent and comparable to that of the original English version.

Background few studies have reported the onset and disappearance rates of gastroesophageal reflux symptoms (GERS) in the population. Aim to assess the occurrence and disappearance rates of GERS in Spain, and their impact on health-related quality of life (HRQL). Participants and methods participants were selected at random from the general population of Madrid in age and sex strata. They were interviewed at home twice, 6 months apart. Heartburn, acid regurgitation and consultation were assessed with the gastroesophageal reflux questionnaire, and HRQL with the SF-36. Results 709 individuals were included, and 451 (63.6%) were re-interviewed 6 months later. Among the 325 individuals without GERS, 9 developed weekly symptoms (2.2% [95% CI: 0.8, 3.4%]); 2 (22%) consulted because of GERS. Among the 34 subjects reporting weekly GERS initially, 26 did not report them at 6-months. Onset of GERS was associated with worsening scores in the physical summary of SF-36 (delta = -6.6 [95% CI: -11.8, -1.42]), while disappearance with an improved score (delta = -3.0 [95% CI: 0.0, 5.9]). Conclusion despite the lower prevalence of GERS in Spain, the occurrence rate is 2.2% in 6 months; however symptoms disappeared in more than half of subjects six months later. Developing GERS was associated with reduced HRQL, and their disappearance with improvement.