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La fisiopatología del síndrome de rumiación es mal conocida. Por ello, el objetivo del estudio es determinar las características clínicas, fisiológicas y psicopatológicas de los pacientes con rumiación respecto a un grupo de dispepsia funcional. Se estudiaron ambos grupos de forma prospectiva durante dos años, realizándose manometría gastrointestinal y esofágica, vaciamiento gástrico, barostato gástrico y valoración psipatológica. Concluimos que el síndrome de rumiación se presenta en pacientes con características funcionales de dispepsia funcional, sin evidenciarse diferencias en la patología psiquiátrica pero con una mejor percepción de la enfermedad respecto al grupo de dispépticos. La fisiopatologia de la síndrome de rumiació és mal coneguda. Per això, l'objectiu de l'estudi és determinar les característiques clíniques, fisiològiques i psicopatològiques dels pacients amb rumiació respecte a un grup de dispèpsia funcional. Es van estudiar ambdós grups de forma prospectiva durant dos anys, realitzant-se manometria gastrointestinal i esofàgica, buidament gàstric, baròstat gàstric i valoració psicopatològica. Concloem que la síndrome de rumiació es presenta en pacients amb característiques funcionals de dispèpsia funcional, sense evidenciar-se diferències en la patologia psiquiàtrica, però amb una millor percepció de la malaltia respecte al grup de dispèptics.

Gastrointestinal involvement affects 30-40% of the patients with chronic Chagas disease. Esophageal symptoms appear once the structural damage is established. Little is known about the usefulness of high resolution manometry to early identification of esophageal involvement. We performed a cross-sectional study at the Vall d'Hebron University Hospital (Barcelona, Spain) between May 2011 and April 2012. Consecutive patients diagnosed with Chagas disease in the chronic phase were offered to participate. All patients underwent a structured questionnaire about digestive symptoms, a barium esophagogram (Rezende classification) and an esophageal high resolution manometry (HRM). A control group of patients with heartburn who underwent an esophageal HRM in our hospital was selected. 62 out of 73 patients that were included in the study fulfilled the study protocol. The median age of the Chagas disease group (CG) was 37 (IQR 32-45) years, and 42 (67.7%) patients were female. Twenty-seven (43.5%) patients had esophageal symptoms, heartburn being the most frequent. Esophagogram was abnormal in 5 (8.77%). The esophageal HRM in the CG showed a pathological motility pattern in 14 patients (22.6%). All of them had minor disorders of the peristalsis (13 with ineffective esophageal motility and 1 with fragmented peristalsis). Hypotonic lower esophageal sphincter was found more frequently in the CG than in the control group (21% vs 3.3%; p

OBJECTIVE: The aim of this study was to analyze the outcomes of a long-term intraductal papillary mucinous neoplasm (IPMN) registry and evaluate new guidelines. METHODS: A prospectively maintained IPMN registry involving 6 centers in Europe and the United States was used to collect the data. Patients with more than 1-year follow-up and no malignancy diagnosed within the first 3 months of surveillance were included. RESULTS: From 1999 to 2014, 620 patients were included. The median follow-up time was 3 years. Thirty-seven (6%) patients developed malignancy with a median time from IPMN diagnosis to malignancy of 10.3 months. The 1-, 5-, and 10-year actuarial rates of disease-free survival were 97%, 93%, and 92% respectively. Four hundred thirty-one patients met criteria for low-risk branch duct IPMN consisting of cyst size less than 3 cm, with no solid component or main duct dilation. Eight malignancies were diagnosed in this subgroup, all of them within the first 5 years. From this subcohort, 112 patients had a follow-up time of more than 5 years, and no malignancy was diagnosed. CONCLUSIONS: In IPMN lesions with low-risk features at baseline, the risk of progression to malignancy after the first 5 years of follow-up was minimal. Furthermore, the main cyst characteristics remained unchanged during their surveillance.

Objectives The aim of this study was to determine the accuracy of cytology, carcinoembryonic antigen (CEA), and amylase levels in the preoperative diagnosis of intraductal papillary mucinous neoplasms (IPMNs). Methods An international registry was started in 2005 and included patients with clinically suspected IPMNs. Those who underwent surgery and had preoperative endoscopic ultrasonography fine-needle aspiration were selected for the study. Results One hundred eighty patients were included. Cytological analysis for neoplastic cells in IPMNs showed high specificity (87.8%) but low sensitivity (39.4%). The median CEA level was 525.5 ng/mL (n = 78) in IPMNs versus 9.7 ng/mL in nonmucinous cysts (n = 6), showing an area under the receiver operating characteristic curve (AUC) of 0.87. The optimal cutoff CEA value for distinguishing IPMN from nonmucinous cysts was 129 ng/mL. At this level, the sensitivity was 76.9%, and specificity was 83.3%, yielding a positive predictive value of 95.9% and a negative predictive value of 41.9%. Carcinoembryonic antigen was a poor predictor of neoplasia in IPMNs (AUC = 0.55). Amylase did not distinguish IPMNs from mucinous cystadenomas (MCAs) (median, 3759 U/L [n = 28 IPMNs] and 497 U/L [n = 3 MCAs], AUC = 0.65). Conclusions Cytology has a limited role because of its lack of sensitivity. Carcinoembryonic antigen modestly differentiated between mucinous and nonmucinous lesions. Amylase did not distinguish IPMNs versus MCAs.

a b s t r a c t Background: Intraductal papillary mucinous neoplasms of the pancreas are increasingly diagnosed. Due to their malignant potential, greater understanding of their nature is required. Aims: Define risk factors for malignancy in intraductal papillary mucinous neoplasms. Methods: An international, multicentre study was performed in Europe and the United States. Clinical databases were reviewed for patients with intraductal papillary mucinous neoplasms diagnosis. Results: Of 1126 patients, 84 were diagnosed with invasive carcinoma/high-grade dysplasia and were compared to the rest of the cohort. Multivariate logistic analysis showed a statistically significant associ- ation between cancer/high-grade dysplasia and the variables smoking history (OR 1.9, 95% CI (1.1-3.1)), body mass index (OR 1.1, 95% CI (1-1.1)), symptoms (OR 3.4, 95% CI (1.9-6)), jaundice (OR 0.1, 95% CI (0-0.3)), and steatorrhea (OR 0.3, 95% CI (0.1-0.8)). Univariate analysis showed no association between malignancy and the cyst number/location (p = 0.3 and p = 0.5, respectively) although a strong association was shown for cyst size (p < 0.001). The presence and size of nodules (p < 0.01) and main duct involvement (p < 0.001) were also strongly related with malignancy. Conclusion: The presence of jaundice and steatorrhea, smoking, high body mass index, and imaging fea- tures such as cyst size, main duct involvement, and the presence and size of mural nodules are associated with high-grade neoplasia in intraductal papillary mucinous neoplasms.