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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.

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.