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the current indicated first-line treatment for Helicobacter pylori (H. pylori) infection is the quadruple therapy with bismuth (Pylera®), or the quadruple concomitant therapy without bismuth. The triple therapy was abandoned due to its low eradication rates, partly derived from an increase in antibiotic resistance. The aim of this study was to compare the H. pylori eradication rates guided by antibiotic susceptibility testing (AST) versus Pylera®.a specimen was taken prospectively for culture and antibiotic susceptibility testing (AST) from all patients diagnosed with H. pylori infection using gastroscopy, and they were randomized to receive triple therapy depending on the results of the AST, or quadruple therapy with Pylera®. The eradication rates of both groups were analyzed using fecal antigen. The adherence and side effects of the treatment were also analyzed.of the 108 patients with H. pylori infection, 55 received Pylera® and 53 AST-guided triple therapy. The eradication rates were 92.7 % with Pylera® and 90.6 % in the AST-guided group, and the difference was statistically significant. There were also no differences found in adherence or side effects.the treatment of H. pylori with AST-guided triple therapy is effective, especially in regions with high rates of antibiotic resistance.

A 41-year-old patient presented to the Dermatology clinic with a papular rash on the trunk and orange-colored maculopapular lesions on the soles of both feet. This was associated with general symptoms including myalgia, fatigue, epigastric pain, nausea and vomiting. The patient had been taking omeprazole and cinitapride with little improvement.

Introduccion: actualmente, el tratamiento indicado como primera linea en la infeccion por Helicobacter pylori (H. pylori) es la cuadruple terapia con bismuto (Pylera®) o la cuadruple concomitante sin bismuto, abandonandose la triple terapia por sus bajas tasas de erradicacion debido, en parte, a un incremento de las resistencias antibioticas. El objetivo de nuestro estudio es comparar las tasa de erradicacion de H. pylori con triple terapia guiada por antibiograma frente a Pylera®. Metodos: de forma prospectiva en todos los pacientes diagnosticados de infeccion por H. pylori a traves de gastroscopia, se tomo muestra para cultivo y antibiograma y fueron aleatorizados a recibir triple terapia en funcion del resultado del antibiograma o cuadruple terapia con Pylera®. Se analizaron las tasas de erradicacion de ambos grupos a traves de antigeno fecal. Tambien se analizaron la adherencia y los efectos secundarios del tratamiento. Resultados: se incluyeron 108 pacientes con infeccion por H. pylori, 55 recibieron Pylera® y 53, triple terapia guiada por antibiograma. Las tasas de erradicacion fueron del 92,7 % con Pylera® y del 90,6 % en el grupo guiado por antibiograma, sin mostrar diferencias estadisticamente significativas. Tampoco se encontraron diferencias en adherencia y efectos secundarios. Conclusiones: el tratamiento de H. pylori con triple terapia guiada por antibiograma es un tratamiento eficaz, especialmente en regiones con altas tasas de resistencia antibiotica.

espanolIntroduccion: la sedacion profunda con propofol controlada por endoscopista en las diferentes unidades de endoscopia ha sido un tema de continua controversia a lo largo de los ultimos anos, origen de conflictos de intereses entre las distintas sociedades cientificas de Anestesiologia y Gastroenterologia. Numerosos estudios han demostrado ya la eficacia, eficiencia y escasa aparicion de complicaciones en la sedacion controlada por un endoscopista formado frente al anestesiologo. Material y metodos: hemos revisado en nuestra base de datos el porcentaje de complicaciones cardiorrespiratorias graves en nuestra unidad, en el periodo comprendido entre 2011 y 2016, en las distintas exploraciones endoscopicas que realizamos (gastroscopia, colonoscopia, colangiopancreatografia retrograda endoscopica [CPRE] y ecoendoscopia [USE]) y cuya sedacion es controlada por un endoscopista. Resultados: se llevo a cabo el analisis de 33.195 exploraciones durante el periodo de estudio. Obtuvimos un 0,13% de complicaciones cardiorrespiratorias, la mayor parte de ellas desaturaciones graves (la mayoria respondieron a la apertura de la via aerea asociada a la interrupcion de la infusion del farmaco, precisando la necesidad de ambu en contadas ocasiones). No existieron diferencias estadisticamente significativas entre los diferentes grupos excepto en edad media, riesgo por tipo de exploracion y riesgo ASA, donde la CPRE presento una p EnglishIntroduction: deep sedation with propofol monitored by an endoscopist in different endoscopy units is a controversial subject and the source of conflicts of interest between the various scientific societies of Anesthesiology and Gastroenterology. Many studies have already demonstrated the efficacy, efficiency and low incidence of complications associated with sedation when under the control of a trained endoscopist vs an anesthesiologist. Material and methods: the rate of severe cardiorespiratory complications during various endoscopic examinations (gastroscopy, colonoscopy, endoscopic retrograde cholangiopancreatography [ERCP] and endoscopic ultrasound [EUS]) where sedation was controlled by an endoscopist within our unit, from 2011 to 2016, was reviewed. Results: during the study period, 33,195 examinations were analyzed. The rate of cardiorespiratory complications was 0.13% and the majority were severe desaturations. Most cases responded to an opening in the airway associated with the interruption of drug infusion and an ambu bag was required in a few cases. There were no statistically significant differences between the different groups, except for mean age, risk by type of examination and ASA risk, where the difference between ERCP and the rest of examinations was statistically significant. Conclusion: there is a high level of evidence in the scientific literature suggesting that sedation controlled by a trained endoscopist is safe, effective and efficient. However, further prospective studies are required in order to confirm this conclusion due to the fact that the majority of studies to date are retrospective