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Capsule endoscopy (CE) was first introduced in 2001 as a diagnostic tool to assess small bowel diseases. Its use has been widely recommended by clinical practice guidelines from the United States as well as European. Its higher diagnostic yield is found in obscure gastrointestinal bleeding (60%) and has demonstrated its efficacy in diagnosing other pathologies such as Crohn´s disease and polyposis syndromes. To enhance CE diagnostic yield, it is essential to have adequate mucosal visualization. It is not uncommon to detect intestinal content in some images that make this difficult to accomplish. With the final purpose to reduce this limitation, numerous investigation groups have proposed the use of different types of preparation to improve the quality of visualization and therefore improve the diagnostic efficacy of the procedure.One of the main issues in this regard is the absence of a validated grading scale or score that measures the quality of small bowel preparation. To avoid human dependant scores, computerized grading scales have been developed, withlimited efficacy and not entirely accurate. Our work aims to develop an automatic computer analysis tool (Endoclean) capable of measuring objectively the grade of cleanliness of CE procedures using a reproducible method. Oral communication presented in 40 Congreso de la Sociedad Española de Endoscopia Digestiva.

[EN] In recent years, localization for capsule endoscopy applications using Ultra-Wideband (UWB) technology has become an attractive field of study due to its potential benefits for patients. Performance analysis of RF-based localization techniques are very limited in literature. Most of the available studies rely on software simulations using digital human models. Nonetheless, no realistic studies based on in-vivo measurements has been reported yet. This paper investigates the performance of RSS-based technique for three-dimensional (3D) localization in the UWB frequency band. Impact of receivers selection as well as of the evaluated path loss model on the localization accuracy is investigated. Results obtained through CST-based simulations and from recently conducted in-vivo measurements are presented and compared., This work was supported by the European Union's H2020:MSCA:ITN program for the "Wireless In-body Environment Communication- WiBEC" project under the grant agreement no. 675353. This work was also funded by the Ministerio de Economia y Competitividad, Spain (TEC2014-60258-C2-1-R), by the European FEDER funds.

Background Rapid Urease Test (RUT) is a simple, cheap and relatively fast method for diagnosing Helicobacter pylori infection. It is therefore the preferred method used for patients undergoing gastroscopy. Most kits require 24 h to give results. The new Ultra-Rapid Urease Test (URUT) kit by Biohit® requires less than 1 h. Objective To determine URUT's diagnostic accuracy. Method Prospective, blind, multi-centre study involving dyspeptic patients. One corpus biopsy and three antral biopsies were obtained during gastroscopy for standard histological analysis, RUT and URUT. The URUT result was checked after 1 min, 5 min, 30 min and 60 min and the RUT was checked over the course of 24 h. Histology was used as the gold standard test. Results 144 patients were included, 68% female, with a mean age of 49 years old; 50% were H. pylori positive. RUT and URUT diagnoses were correct in 85.9% and 90% of the cases, respectively. The mean waiting time for a positive RUT result was 6 h. The sensitivity, specificity, and positive and negative predictive values for RUT were, respectively, 82%, 90%, 89% and 84%. The URUT's results were similar (85%, 94%, 94% and 87%). These figures improved when patients taking PPIs were excluded (RUT: 86%, 91%, 93% and 83%; URUT: 91%, 94%, 96% and 89%). No statistically significant differences were found when comparing RUT and URUT distributions of correct diagnoses (McNemar's Test, p = 0.3) but there was a tendency towards better results with the URUT. Conclusion The URUT is equivalent to (or slightly better than) the traditional RUT in diagnosing H. pylori infection, and provides results in less than an hour.

Liver abscesses are a relatively infrequent complication of inflammatory bowel disease. These abscesses are usually multiple and of polymicrobial origin. The development of primary sclerosing cholangitis in inflammatory bowel disease, although provoking alterations in biliary morphology and a higher incidence of infections, does not predispose patients to the development of liver abscesses. We describe a new case of primary sclerosing cholangitis and Crohn's disease with multiple fungal liver abscesses caused by Candida albicans. The patient had developed a duodenal-biliary fistula. Antibiotic therapy produced clinical response and surgery was performed to repair the fistula.

Although acute cholecystitis in the context of acute hepatitis A virus (HAV) infection is extremely rare, previous cases have been reported. However, this manifestation of HAV infection is little known. In the present article, we briefly review previously documented cases and present a new case. We report the case of a 39-year-old woman with fever, abdominal pain and moderately elevated transaminase levels who developed jaundice and peritoneal irritation. Diagnosis of acute cholecystitis was given by abdominal ultrasound and magnetic resonance imaging. The patient underwent surgery. In the postoperative period, positive IgM antibody titers for HAV were obtained, confirming the diagnosis of HAV infection.

Protein-losing enteropathy is characterized by excessive leaking of serum proteins into the gastrointestinal tract, as a result of disease progression in several diseases. We report the case of a 17-year-old-woman with hypoproteinemia, generalized edema and serosal effusions diagnosed as protein-losing enteropathy due to right ventricular failure secondary to previous surgical damage. All previously described therapies were ineffective in curing or relieving the disease or its symptoms, and the patient was listed for heart transplantation. During the 7-month period on the waiting list, the patient was managed as an outpatient, with fortnightly albumin infusions and intravenous furosemide administration, which allowed her a better quality of life during that period, avoiding further admissions.

Although acute cholecystitis in the context of acute hepatitis A virus (HAV) infection is extremely rare, previous cases have been reported. However, this manifestation of HAV infection is little known. In the present article, we briefly review previously documented cases and present a new case. We report the case of a 39-year-old woman with fever, abdominal pain and moderately elevated transaminase levels who developed jaundice and peritoneal irritation. Diagnosis of acute cholecystitis was given by abdominal ultrasound and magnetic resonance imaging. The patient underwent surgery. In the postoperative period, positive IgM antibody titers for HAV were obtained, confirming the diagnosis of HAV infection.

Introduccion Azatioprina (AZA) y 6-mercaptopurina (6MP) son efectivas en el tratamiento de la enfermedad inflamatoria intestinal (EII). Su mayor inconveniente es el desarrollo de efectos adversos que obligan a su retirada. Uno de los efectos secundarios mas frecuentes es el desarrollo de intolerancia gastrointestinal. Objetivos Valorar la incidencia de intolerancia gastrointestinal en pacientes tratados con AZA, valorar variables clinicas asociadas a su aparicion y evaluar prospectivamente la utilidad de la 6MP en esta situacion. Material y metodos Se incluyeron prospectiva y consecutivamente todos los pacientes con EII que iniciaron tratamiento con AZA y se siguieron durante 12 meses. Se determino la actividad de la tiopurina metiltransferasa (TPMT) antes del inicio. Todos recibieron AZA segun el mismo protocolo: inicio con 50 mg/dia y a los 15 dias en caso de tolerancia aumento a dosis plenas (2.5 mg/Kg). En caso de intolerancia gastrointestinal se intento una reintroduccion de AZA mas lenta. En caso de nueva toxicidad gastrointestinal se retiro la AZA y se inicio 6MP (1,5 mg/Kg). Se recogio el motivo de retirada de AZA, el tiempo de aparicion, la medicacion concomitante en ese momento y la tolerancia a 6MP. Resultados Se incluyeron 92 pacientes (68 enfermedad de Crohn y 24 Colitis Ulcerosa), edad media 36,8 (DE 10,97) anos. Valor medio de TPMT 19,65 (DE 4,6) U/mL (rango 6,6–35,7). Se dieron efectos secundarios en 58 pacientes (63%) tras 3,42 meses de media, los mas frecuentes fueron la intolerancia gastrointestinal 30 (33%) y la leucopenia 8 (9%). Abandonaron el tratamiento por efectos secundarios 25 (27%) pacientes tras 1,5 meses de media, rango 0,36 a 6,51. La intolerancia gastrointestinal aparecio tras 2,1 meses de media, rango 0,4–12. Los factores asociados a su aparicion fueron el sexo femenino, OR 2,83, IC95% (1,29–6,2), valores de TPMT (P=0,04) y el tratamiento con infliximab OR 5,8, IC95% (1,1–32). Quince (50%) de los 30 pacientes toleraron la reintroduccion de AZA mas lentamente, en el resto de suspendio la AZA. Las variables asociadas a la retirada de AZA fueron los niveles de TPMT (P=0,04) y el tratamiento concomitante con 5-ASA, OR 1,4, IC95% (1,01–1,9). El area bajo la curva para predecir la retirada de AZA en funcion de los niveles de TPMT fue de 0,7 CI95% (0,5–0,9) con una sensibilidad del 73% y una especificidad del 67%. Se le ofrecio cambio a 6MP a todos los pacientes intolerantes a AZA, aceptaron 14 de 15. Cinco, (38%) por protocolo y 36% por intencion de tratar toleraron el tratamiento con 6MP. La tolerancia a 6MP no se asocio a ninguna de las variables estudiadas. Conclusiones La incidencia de intolerancia gastrointestinal es un hecho relevante durante el tratamiento con AZA. En caso de intolerancia se debe contemplar el tratamiento con 6MP. La asociacion con los niveles de TPMT podria reflejar el papel de los nucleotidos de 6-metilmercaptoprurina en su patogenesis.

El cumplimiento de las expectativas de los pacientes es clave para mejorar los resultados en salud. Objetivo Conocer las expectativas de los pacientes con acalasia esofagica y su cumplimiento tras la dilatacion neumatica (DN). Metodos Estudio prospectivo realizado en una serie consecutiva de pacientes con acalasia que iban a ser tratados con DN. En una visita anterior a la DN se administro a los pacientes un listado con 15 items relativos a los siguientes dominios:relacion medico-paciente (RMP), diagnostico (Dx) y tratamiento (Tx) de su enfermedad.Se les pidio que eligieran 5 en orden de prioridad y que anadieran cualquier otra expectativa no incluida en el listado, que consideraran de importancia. Las expectativas se analizaron globalmente y segun la edad, sexo y tratamiento previo.Dos meses tras la DNse pidio a los pacientes que valoraran el cumplimiento de cada una de las expectativas mediante una escala Likert de 5 puntos (nulo/escaso/medio/importante/total), considerandose cumplidas si se eligio importante o total. El cumplimiento se valoro globalmente y en funcion de la eficacia del tratamiento. La DNse considero eficaz si el paciente estaba asintomatico o padecia sintomas que no interferian con las actividades cotidianas. Resultados En 74 pacientes (37 mujeres; edad media 52 anos, limites 16 y 82 anos) se evaluo las expectativas en 122 ocasiones (1 vez en 38 casos; 2, en 24; y 3, en 12). 1) La expectativa mas frecuente fue: “que el tratamiento sea eficaz para mi enfermedad y pueda hacer una vida normal” seleccionada en primer lugar en 42 casos (34%) y en cualquier lugar en 106 (87%). Ningun paciente anadio ninguna expectativa a las incluidas en la lista. Las expectativas elegidas en primer lugar fueron RMP: 25%; Dx: 27%; Tx: 48%. Las elegidas en cualquier lugar fueron RMP: 32%; Dx: 23%; Tx: 45%. Las mujeres eligieron con mas frecuencia que los hombres expectativas del dominio de Tx 50% vs 39%) y con menos frecuencia, las del grupo de RMP (26% vs 39%). No hubo diferencias en relacion con la edad. El fracaso previo de la DNse asocio a un incremento en las expectativas relacionadas con el Tx (40% vs 53%) y a una disminucion de las relacionadas con la RMP (37% vs 24%). 2) Se valoro el cumplimiento en 98 de los 122 casos (80%). Se cumplieron el 69% de las expectativas elegidas en primer lugar y el 77% de las elegidas en cualquier lugar. Agrupandolas, se cumplieron el 93% de las expectativas de RMP; el 83% de las de Dx; y el 54% de las de Tx. La DN fue eficaz en 35 (36%) e ineficaz en 63 (64%) de los 98 casos. La eficacia de la DNno influyo en el cumplimiento de las expectativas de RMP (98% vs 92%); ni en las de Dx (78% vs 82%), pero si en las de Tx (92% vs 36%) (eficaz vs no eficaz). Conclusiones Las expectativas mas importantes para los pacientes con acalasia se relacionan con la eficacia del tratamiento, especialmente en mujeres y si ha habido una DN previa ineficaz. La eficacia de la DN no influye en el cumplimiento de las expectativas relacionadas con la RMP y con el Dx.