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We read with great interest the ESGE and ESGENA Position Statement [1] on gastrointestinal endoscopy and the COVID-19 pandemic. We share the concerns listed in the suggested research agenda, particularly about enhancing procedural protection in the endoscopy unit to reduce risk of COVID-19 dissemination. We would like to bring attention to commercially available endoscopy masks that can be used to avoid aerosolizing spread of droplets during upper endoscopic procedures. These products seem to improve intra-procedure risk management and can serve as an alternative to a modified ventilation mask reported for this purpose by Marchese et al [2].

Objectives To assess the feasibility of gastrointestinal endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for histologic confirmation of cancer recurrence in women with gynecologic cancer. Methods This work was a retrospective cohort study comprising 46 consecutive women treated for gynecologic cancer and suspected of having a deep pelvic or abdominal recurrence on ultrasound imaging, computed tomography, positron emission tomography-computed tomography, or magnetic resonance imaging, evaluated at our institution from January 2010 to December 2017. Primary cancer was ovarian (n = 22), cervical (n = 13), endometrial (n = 4), sarcoma (n = 4), and other (n = 3). All women underwent EUS examinations for locating the lesion and guiding FNA. The results of FNA (benign/malignant) were assessed. Procedure-related complications were recorded. Results The patients' mean age was 57.8 years. A total of 66 procedures were performed. Eleven women underwent 2 procedures; 2 women underwent 3 procedures; and 1 woman underwent 6 procedures at different times during the study period. In 1 case, no lesion was detected on the EUS assessment, and in 2 cases, FNA was not successful. Most lesions were located in the retroperitoneum or involved the intestine. Fine-needle aspiration could be performed in 63 cases (94.5%). Cytologic samples were adequate in 62 of 63 (98.4%). Recurrence was confirmed in 56 cases (90.3%) and ruled out in 6 (9.7%). No patient had any complication related to the procedure. Conclusions Endoscopic ultrasound-guided FNA is a minimally invasive, feasible, and safe technique for confirming pelvic/abdominal recurrence of gynecologic cancer.

El estudio del vaciamiento gástrico se realiza generalmente mediante la escintigrafía. En los últimos años se han desarrollado métodos alternativos no radiactivos basados en la tecnología de los isótopos estables. Dichos procedimientos emplean fundamentalmente ácido 13C-octanoico para valorar el vaciamiento de sólidos y 13C-acetato de sodio para medir el de líquidos. El enriquecimiento de 13C en el aire espirado a lo largo del tiempo es un reflejo de la velocidad de vaciamiento gástrico. A partir de éste se pueden obtener unos parámetros cinéticos que permiten cuantificar el vaciamento gástrico. Las muestras se pueden obtener en un lugar alejado del centro de procesamiento. Dadas sus características, esta técnica es adecuada y segura para evaluar las patologías relacionadas con el vaciamiento gástrico, así como la eficacia del tratamiento.

Background and Aims It is known that sodium picosulfate–magnesium citrate (SPMC) bowel preparations are effective, well tolerated and safe, and that split-dosing is more effective for colon cleansing than previous-day regimens. Anesthetic guidelines consider that residual gastric fluid is independent of clear liquid fasting times. However, reluctance to use split-dosing persists. This may be due to limited data on residual gastric fluid volumes (RGFVs) and split-dosing bowel preparations, and that these may not be perceived as standard clear liquids. Furthermore, no studies are available on RGFV/residual gastric fluid pH (RGFpH) and SPMC. We aimed to evaluate the cleansing effectiveness and the RGFV/RGFpH achieved after an SPMC split-dosing regimen compared with a SPMC previous-day regimen. Methods This was a single-center observational study. A total of 328 outpatients scheduled for simultaneous EGD and colonoscopy and following a split-dosing or previous-day regimen of SPMC were included. We prospectively measured colon cleanliness by using the Ottawa Bowel Preparation Scale, RGFV, and RGFpH. Results Ottawa Bowel Preparation Scale scores for overall, right, mid-colon, and colon fluid were significantly better in the split-dosing group. In the split-dosing group, the 3- to 4-hour fasting time consistently achieved the best cleansing quality. RGFV was significantly lower in the split-dosing group (11.09 vs 18.62, P Conclusions Split-dosing SPMC provides higher colon cleansing quality with lower RGFVs than previous-day SPMC regimens. SPMC in split-dosing acts exactly as a standard clear liquid acts, and thus anesthetic guidelines on this issue may be applied with no concerns.

Resumen Introduccion Las nauseas y vomitos constituyen un sintoma frecuente en la practica clinica. Etiologia El espectro de posibilidades etiologicas es amplio e incluye no solamente afecciones gastrointestinales sino trastornos cerebrales, vestibulares y una amplia miscelanea de alteraciones sistemicas, hormonales y endocrinologicas. Diagnostico El protocolo diagnostico varia segun el tiempo de evolucion e incluye una anamnesis dirigida, un examen fisico completo y algunos datos basicos de laboratorio. Las pruebas complementarias deben orientarse en funcion del contexto clinico, y la definicion precisa de un trastorno motor puede requerir la intervencion de un equipo especializado. Tratamiento El tratamiento debe dirigirse no solo al control de los sintomas sino al de la causa subyacente y de las complicaciones asociadas. Algunas condiciones requieren un tratamiento especifico.

Resumen Indicaciones La endoscopia es la tecnica de eleccion cuando sospechamos patologia en el tracto digestivo superior, teniendo numerosas indicaciones tanto diagnosticas (urgentes y electivas) como terapeuticas. Contraindicaciones La unica contraindicacion absoluta es la negativa del paciente a su realizacion y existen contraindicaciones mayores y menores. Complicaciones Dado que es una tecnica invasiva, aunque infrecuentes, en ocasiones puede presentar alguna complicacion que conviene conocer, para que en el caso de que se presenten diagnosticarlas y tratarlas lo mas precozmente posible.

Resumen Introduccion La gastroenteritis aguda infecciosa es una entidad frecuente, en la que los agentes causales son multiples, siendo imposible e innecesario un diagnostico etiologico en muchos casos ya que frecuentemente es un proceso autolimitado. Valoracion diagnostica Una correcta actitud medica inicial puede evitar tanto el desarrollo de complicaciones como el gasto derivado de una hospitalizacion innecesaria. Manejo terapeutico Esta correcta actuacion medica incluye: prevenir y tratar precozmente la deshidratacion, conocer los criterios que implican gravedad y requieren iniciar una evaluacion medica (analitica y estudios de heces, tratamiento antibiotico, exploraciones complementarias), y conocer los datos que hacen aconsejable un ingreso hospitalario. El uso de antibiotico debe restringirse a los casos que pueden obtener un beneficio clinico con su administracion.

Resumen Introduccion El tracto gastrointestinal se ve afectado con frecuencia en numerosas enfermedades sistemicas, como son enfermedades reumatologicas y del colageno, vasculitis, neoplasias, enfermedades infiltrativas y enfermedades dermatologicas. En ocasiones la sintomatologia derivada de esta afectacion del tubo digestivo es la que lleva al paciente al medico y conduce a que se diagnostique la enfermedad. Colagenosis Artritis reumatoide, esclerodermia, lupus eritematoso sistemico, enfermedad mixta del tejido conectivo, dermatomiositis y sindrome de Sjogren, pueden presentar manifestaciones gastrointestinales. Vasculitis Poliarteritis nodosa, sindrome de Churg-Strauss, purpura de Schonlein-Henoch, papulosis atrofica maligna o sindrome de Kohlmeier-Degos, granulomatosis de Wegener y el sindrome de Behcet, son vasculitis con manifestaciones digestivas. Enfermedades dermatologicas Las principales dermopatias con manifestaciones digestivas son: sindrome del Blue-rubber-bleb-nevus, enfermedad de Rendu-Osler-Weber, sindrome de Klipel-Trenaunay-Weber, penfigos y penfigoide ampolloso, necrolisis epidermica toxica y sindrome de Stevens-Johnson y liquen plano. Neoplasias El tubo digestivo puede verse afectado por lesiones metastasicas de tumores procedentes de otros organos. El origen puede ser por invasion directa desde organos vecinos, por siembra intraperitoneal o por diseminacion hematogena o linfatica. Enfermedades infiltrativas La mastocitosis sistemica y la amiloidosis pueden tener expresion digestiva.

Vasculitides constitute a heterogeneous group of diseases characterized by inflammation of blood vessels. The skin is mainly affected, although the gastrointestinal tract mucosa can also be involved. The contribution of endoscopy in these cases has not been clearly determined. We report three cases of systemic vasculitis (polyarteritis nodosa, Schonlein-Henoch purpura and Behcet's disease) presenting with acute digestive bleeding. Endoscopy was an effective technique for completing the diagnosis and in establishing an effective nonsurgical therapeutic approach in these potentially lethal cases of gastrointestinal hemorrhage.

Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy.

La aspirina y otros antiinflamatorios no esteroideos (AINE) se han asociado a una reducción en el riesgo de desarrollar adenomas y cáncer colorrectal. Con la evidencia científica disponible, queda justificada la necesidad de más estudios que evalúen el efecto protector de la aspirina u otros AINE como medida preventiva del cáncer de colon, que definan la dosis mínima eficaz, la edad a la que comenzar el tratamiento, la duración más conveniente del mismo y las subpoblaciones para las que los beneficios de la quimioprofilaxis superan los posibles efectos adversos.

To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value.We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters in colorectal cancer with and without synchronous adenomas. Finally, we repeated the analysis after stratification of cancers in 2 groups according to pTNM staging: 0-I-II stage vs III-IV.We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 +/- 22.9 and 67.2 +/- 24.5 months (p = 0.55) respectively. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression : 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis: mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas.Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found in III-IV. The presence of synchronous adenomas doesn't influence prognosis.

capsule endoscopy (CE) allows for a new era in small-bowel examination. Nevertheless, physicians time for CE-interpretation remains longer than desirable. Alternative strategies to physicians have not been widely investigated. The aim of this study was to evaluate the accuracy of physician extenders in CE-interpretation.one CE-experienced gastroenterologist and two physician extenders reviewed independently 20 CE-procedures. Each reader was blinded to the findings of their colleagues. A consensus formed by the readers and a second CE-experienced gastroenterologist was used as gold standard. Number, type and location of images selected, character of CE-exams and their relationship with indications were recorded. Gastric emptying time (GEt), small-bowel transit time (SBTt) and time spent by readers were also noted.sensitivity and specificity for "overall" lesions was 79 and 99% for the gastroenterologist; 86 and 43% for the nurse; and 80 and 57% for the resident. All 34 "major" lesions considered by consensus were found by the readers. Agreement between consensus and readers for images classification and procedures interpretation was good to excellent (? from 0.55 to 1). No significant differences were found in the GEt and SBTt obtained by consensus and readers. The gastroenterologist was faster than physician extenders (mean time spent was 51.9 +/- 13.5 minutes versus 62.2 +/- 19 and 60.9 +/- 17.1 for nurse and resident, respectively; p0.05).physician extenders could be the perfect complement to gastroenterologists for CE-interpretation but gastroenterologists should supervise their findings. Future cost-efficacy analyses are required to assess the benefits of this alternative.

few data have been published regarding the causes of synchronous lesions in patients with colorectal cancer. The aim of our study was to identify potential factors that might be implicated in the development of multicentric lesions, since this knowledge could be useful for tailored follow-up once initial synchronous lesions have been removed.we retrospectively reviewed 382 colorectal cancer cases diagnosed by total colonoscopy and histological study of surgical specimens. We divided our population into 2 groups, based on whether they had synchronous lesions or otherwise. Several data related to personal and family history, habits, symptoms, and tumor characteristics were assessed. Univariate and multivariate statistical analyses were performed.208 (54.5%) patients had synchronous adenomas and 28 (7.3%) had synchronous cancer. A multivariate analysis showed that the following parameters were consistently related to the presence of multicentric lesions--male gender: OR = 1.97; CI = 1.13-3.45; p = 0.017; age = 59 years: OR = 2.57; CI = 1.54-4.29; p0.001; personal history of colonic adenomas: OR = 3.04; CI = 1.04-8.85; p = 0.042; and obstructive tumors: OR = 0.48; CI = 0.27-0.85; p = 0.012.our results show that several parameters that are easy to measure could be considered risk factors for the development of multicentric lesions. These factors need to be confirmed with follow-up studies analyzing their role in patients with and without metachronic lesions once all synchronous lesions have been removed.

Objetivo: en el cáncer colorrectal son poco conocidas las causas del frecuente desarrollo de lesiones neoplásicas sincrónicas. Pretendemos identificar posibles factores que pudieran influir en la multicentricidad lesional. Su conocimiento sería útil para, tras el tratamiento de las lesiones iniciales, optimizar el seguimiento en los pacientes que los presentaran. Pacientes y métodos: estudiamos retrospectivamente 382 cánceres colorrectales diagnosticados mediante colonoscopia completa y estudio de la pieza quirúrgica. Comparamos una serie de parámetros referentes a los antecedentes personales y familiares, hábitos, datos clínicos y del tumor entre los grupos con y sin lesiones neoplásicas sincrónicas, mediante análisis estadístico univariable y multivariable. Resultados: doscientos ocho (54,5%) pacientes presentaron adenomas sincrónicos y 28 (7,3%) carcinoma sincrónico. En el análisis multivariable el sexo masculino: OR = 1,97; IC = 1,13-3,45, p = 0,017; la edad superior a 59 años: OR = 2,57; IC = 1,54-4,29, p < 0,001; el antecedente personal de pólipo colónico: OR = 3,04, IC = 1,04-8,85, p = 0,042 y el carácter obstructivo del cáncer: OR = 0,48; IC = 0,27-0,85, p = 0,012 se asocian significativamente con la multicentricidad lesional. Conclusión: en los enfermos con cáncer colorrectal, nuestro estudio muestra una serie de parámetros, de fácil determinación, que podrían comportarse como factores de riesgo para el desarrollo de multicentricidad lesional. Estos factores deberán confirmarse mediante un estudio de seguimiento, analizando su comportamiento entre los pacientes que presenten o no lesiones metacrónicas tras la limpieza quirúrgico-endoscópica inicial.

Aim: To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value. Patients and methods: We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters in colorectal cancer with and without synchronous adenomas. Finally, we repeated the analysis after stratification of cancers in 2 groups according to pTNM staging: 0-I-II stage vs III-IV. Results: We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 ± 22.9 and 67.2 ± 24.5 months (p = 0.55) respectivelly. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression : 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis: mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas. Conclusions: Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found in III-IV. The presence of synchronous adenomas doesn’t influence prognosis.

Introducción y objetivos: la cápsula endoscópica (CE) ha supuesto una nueva era en el estudio del intestino delgado. No obstante, el tiempo empleado por el gastroenterólogo en este procedimiento es mayor del deseable y no se han evaluado completamente alternativas al personal especializado. El objetivo de este estudio es evaluar la precisión de personal no especializado en la interpretación de la CE. Material y métodos: un gastroenterólogo con experiencia en CE y personal no especializado revisaron independientemente 20 procedimientos. Los hallazgos de cada participante eran desconocidos por el resto. Un consenso formado por los participantes y un segundo gastroenterólogo fue empleado como gold standard. Se analizaron número, tipo y localización de las imágenes seleccionadas y tiempo de evacuación gástrica (tEG), tiempo de tránsito en intestino delgado (tTID) y tiempo empleado por los participantes. Resultados: la sensibilidad y la especificidad global fueron del 79 y 99% para el gastroenterólogo; del 86 y 43% para la enfermera; y del 80 y 57% para el residente. Las 34 lesiones "mayores" consideradas por consenso fueron detectadas por los tres participantes. El acuerdo entre consenso y participantes para clasificar e interpretar las imágenes fue de buena a excelente (κ de 0,55 a 1). No se encontraron diferencias estadísticamente significativas en el tEG y tTID obtenido por consenso y participantes. El gastroenterólogo fue el más rápido en revisar los procedimientos (51,9 ± 13,5 minutos versus 62,2 ± 19 y 60,9 ± 17,1 para enfermera y residente, respectivamente; p < 0,05). Conclusiones: el personal no especializado podría ser el complemento perfecto al gastroenterólogo en la interpretación de la CE, aunque este debería supervisar sus hallazgos. Los beneficios de esta alternativa deberían ser contrastados en el futuro por análisis coste-efectividad.

colonoscopy was not different in the Prepsystem (19 3 min) and the PEG (22 1 min) groups. Blood electrolytes were not significantly modified after bowel cleansing in both groups. Patient satisfaction was good to excellent in all cases in the Prepsystem group. Conclusion: The Prepsystem water infusion protocol appeared as effective as the splitted PEG protocol for bowel cleansing before colonoscopy. Patient tolerance of the Prepsystem was good. Further studies should evaluate the benefit of this protocole in patients with contraindications or poor tolerance to PEG cleansing or in ambulatory patients. Su1550 Establishing the Learning Curve for Achieving Competency in Performing Colonoscopy: a Systematic Review Neal Shahidi*, George Ou, Jennifer J. Telford, Robert a. Enns Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada Background: Training in colonoscopy (CSPY) is a difficult but an integral part of gastroenterology and surgical training programs. However, the number of procedures required to achieve competence is not well established, leading to significant heterogeneity among current guidelines. Aims: To assess the learning curve for achieving competency in performing CSPYs during gastroenterology and surgical training. Methods: Two investigators (NS and GO) independently searched MEDLINE (1946 June 2013) and the grey literature (bibliographies of included studies, pertinent review articles and guidelines) to identify relevant citations. Subsequently, after full-text review, studies meeting inclusion underwent data extraction with discrepancy among investigators resolved by consensus. A threshold of 90% independent cecal intubation rate (ICIR) was used as a minimum reference for competence. Results: 18 unique study populations, encompassing 38,000 CSPYs were included in our analysis. When stratifying by markers of competence: 10 studies used ICIR; 6 studies used ICIR with a cecal intubation time (CIT) limit; 1 study used ICIR with a procedural time limit; and 2 studies provided more comprehensive definitions of competence. Among the 10 studies that solely quantified ICIR, 4 studies were able to reach the reference competence estimate during analysis (90% ICIR), with trainees reaching competence between 140 to 305 CSPYs. In studies additionally setting a CIT (15 minutes 30 minutes) limit, competence was reached in 5 studies between 100 to 300 CSPYs. Of the 2 studies who provided more comprehensive estimates of competence, their reference competence thresholds were reached between 275 to 467 CSPYs. Conclusions: Our results suggest that as the definition of competence becomes more robust (i.e. acceptable for clinical practice) and incorporates more than just ICIR and CIT that the threshold to achieve competency continues to rise well above current recommendations. With newer levels of competence being promoted, present guidelines need to reassess the level of training required to adequately train endoscopists. Su1551 Split-Dose Sodium Picosulfate and Magnesium Citrate Preparation for Colonoscopy: Cleansing Effectiveness and Residual Gastric Volume and pH CeSar Prieto*, RAMoN AngoS, Maria Teresa BeteS, Susana De La Riva, Iago RodriGuez Lago, Cristina Carretero, Maite Herraiz, Alejandra Alzina Perez, Miguel a. MUnOz-Navas Gastroenterology, Clinica Universidad de Navarra, Pamplona, Spain Background: Split dose bowel preparations result in superior bowel cleanness. Although there is evidence that smaller residual gastric volumes (RGV) are obtained with fasting times of 2-4 hours when compared with more than 4 hours, and the relationship between fasting times for clear liquids and risk of pulmonary aspiration has not been demonstrated, there is still concern about the increased risk of aspiration when using a split-dosing regimen. Low-volume bowel preparation containing sodium picosulfate and magnesium citrate (PMC) has shown to be better tolerated, and at least as effective, as other cleansing agents. Aim: To compare the cleansing efficacy, RGV, gastric pH and tolerabilty between a PMC split-dose regimen and a traditional evening-before-procedurecomplete PMC regimen. Methods: Patients aged 18 to 80 ys. requiring elective gastroscopy (EGD) and colonoscopy in the same day were invited to participate. Exclusion criteria were: known gastroparesis, gastric outlet obstruction, hiatal herniaO4 cm, previous gastrointestinal resections excluding appendicectomy, renal insufficiency, active inflammatory bowel disease, and elevated anesthesic risk (ASA III-IV). Patients were distributed to split-dose group (1) or traditional regimen group (2) exclusively depending on the hour and date of medical visit. Group 1 patients were instructed to take a PMC sachet at 19:00 the evening before the procedure, and a second sachet 4 hours before the procedure. Group 2 patients were instructed to take 1 sachet at 15:00 and second sachet at 20:00 both the evening before the procedure. Tolerability was assesed by completing a questionnaire just before the procedure. Colonoscopy was performed immediately after EGD. Total gastric volume was suctioned off and collected in a graded AB318 GASTROINTESTINAL ENDOSCOPY Volume 79, No. 5S : 2014 specimen trap. Colon cleansing efficacy was assesed by Ottawa Bowel Preparation Scale (OBPS). Results: 206 patients were included (group 1: 116; group 2: 90). There were no significant differences in patient characteristics between the two groups. Mean time interval ( SD) between last reported ingestion was 3.63 hours ( 1.02) (range 2-6 hours) in the split-dosing group, and 11.59 ( 1.64) in the traditional regimen group. Mean RGV was significantly lower in group 1 than in group 2 (11.65 vs.17.50 ml; p!0.005). pH of RGV in group 1 was slightly higher than group 2 (2.06 vs.1.45; ns). Total, mid-colon and right-colon OBPS scores were significantly bettter in group 1 than in group 2 (3.47 vs 4.38, p!0.01; 1.18 vs 0.91, p!0.05; 1.16 vs 1.67 p!0.001, respectively). No significant differences in tolerabilty were found. No patient had evidence of aspiration. Conclusions: Patients receiving split-dose regimen of PMC have lower residual gastric volumes and superior cleansing levels, specially in right colon, than those receiving traditional regimen, suggesting an efficacy and safety adventage. SPLITDOSING (n[116) Mean (± SD) TRADITIONAL REGIMEN (n [ 90) Mean (± SD)

The study of gastric emptying is usually performed by scintigraphy. Over the last years alternative non radioactive methods have been developed based on the stable isotopes technology. Such techniques use 13C-octanoic acid to measure gastric emptying of solids and sodium 13C-acetate to measure liquids emptying. The enrichment of 13C in breath air along the time reflects the velocity of gastric emptying. Kinetic parameters can be obtained from this enrichment to quantify gastric emptying. Samples can be obtained outside the processing laboratory. Due to the characteristics of the method, it is adequate and safe to evaluate pathologies related to gastric emptying and the efficiency of the therapy.

We report the case of a patient in the Psychiatric Department who complained of progressive impairment of cerebral functions consistent with dementia, diarrhea and fecal incontinence in the last few months. His medical history included a Billroth II gastrectomy for gastric ulcer. Biochemical tests detected cobalamin deficiency, without megaloblastic anemia, and an abnormal Schilling test that was not due to intrinsic factor deficiency. Once other causes of cobalamin deficiency were ruled out, we considered it as a deficiency disease due to blind loop syndrome. Treatment with parenteral vitamin B complex and long term oral antibiotic therapy allowed the complete and permanent resolution of neurologic and digestive symptoms. We consider this case to be interesting because it shows the existence of curable dementias and the usefulness of taking into account bacterial overgrowth, usually underestimated, as an entity that can produce a variety of disorders.