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Biomedical subjects

V Garrigues

Publications and source records attributed to V Garrigues.

At least 19 recordsLinked to original sources
PubMed2007

Change over time of bowel habit in irritable bowel syndrome: a prospective, observational, 1-year follow-up study (RITMO study).

BACKGROUND: Evolution of bowel habit in irritable bowel syndrome (IBS) is not well known. AIM: To evaluate the change over time of bowel habit in IBS patients followed-up during 1 year. METHODS: Five hundred and seventeen patients with IBS were prospectively included in an observational study with five evaluations over a 1-year period. Symptoms were recorded daily in diary cards during four 4-week periods along the study. Bristol Stool Scale (BSS) was used to define bowel habit. RESULTS: Four-hundred patients completed the study. Rome II showed low-moderate agreement (42%) with BSS to define bowel habit. Frequency of constipation and diarrhoea showed little changes throughout the study. Over 50% of the patients had the same bowel habit when each diary was compared with the next one. A third of patients maintained the same habit throughout the study. Most changes occurred from/to mixed or unsubtyped IBS. Only 14% of cases changed from constipation to diarrhoea or vice versa. This change was associated to female gender (OR: 2.65). CONCLUSIONS: The frequency of constipation and diarrhoea remains relatively stable over time. Changes in IBS subtypes are common, but changes between constipation and diarrhoea are rare. Alternating IBS is more frequent in women.

Adolescent↗
PubMed2006

Healthcare seeking for constipation: a population-based survey in the Mediterranean area of Spain.

BACKGROUND: The use of healthcare resources for the management of constipation is not well-known. AIM: To analyse healthcare seeking for constipation, defined by three different criteria, and its related factors and to assess the frequency of use of laxatives, suppositories and enemas for the treatment of constipation. METHODS: A cross-sectional study in the general community. A questionnaire comprising 21-items was developed and delivered by mail to a random sample of 506 subjects aged 18-65 years, and belonging to a Spanish population. RESULTS: Seeking of health care was high in the sample (16%) and was similar for all definitions of constipation (over 40% of constipated subjects). It was associated with female gender, a higher educational level and two symptoms, such as prolonged defecation and abdominal pain. A 14% of the sample used laxatives, and about a 25% of constipated subjects used laxatives at least once a week. Utilization was more frequent in women, with no differences by age group. CONCLUSIONS: Chronic constipation is a problem that causes an important consumption of resources in our setting, derived from laxative use and the seeking of medical help to combat the problem. The use of these resources is higher in women.

Adolescent↗
PubMed2006

Predictive factors of irritable bowel syndrome improvement: 1-year prospective evaluation in 400 patients.

BACKGROUND: The natural history of the irritable bowel syndrome is poorly understood. AIM: To assess the clinical course of the irritable bowel syndrome and the factors that might predict it. METHODS: An observational prospective study, involving 400 irritable bowel syndrome patients meeting Rome II criteria. Symptoms were recorded in a diary over four non-consecutive months (1, 4, 7 and 10). Demographic data, associated disorders, psychological status and health-related quality of life were obtained. RESULTS: At 1-year follow-up, half of the patients and half of their physicians considered irritable bowel syndrome to have improved, but improvement was minor. Diary data showed that, according to the type of symptom, improvement was small and quite different: diarrhoea in 19% of patients, abdominal pain frequency in 26%, constipation in 33% and abdominal pain intensity in 60%. Factors related to improvement at one year were: severe symptoms and poor health-related quality of life at first visit, irritable bowel syndrome-constipation, good improvement at 3 months, anxiety/depression, stress, symptoms related to meals and absence of comorbidity. By multivariate logistic regression, predictors were: severe basal symptoms and good improvement at 3 months (OR:CI 95%, 1.32:1.09-1.59 and 4.44:2.81-7.05). CONCLUSIONS: At 1-year follow-up, half the patients and their physicians considered the irritable bowel syndrome to have had some improvement but, symptom diaries demonstrated that improvement was small and heterogeneous. Severe basal symptoms and improvement at 3 months were related to better prognosis.

Abdominal Pain↗
PubMed2004

[Factors influencing the decision to administer systemic corticosteroids in Crohn's disease].

INTRODUCTION: Crohn's disease shows periods of exacerbation and remission. Corticosteroids are the most frequently used drugs in exacerbations of disease activity. The objective of this study is to determine which clinical and laboratory parameters are associated with the therapeutic decision to administer corticosteroids during the course of the disease. MATERIAL AND METHOD: Two-hundred seven consecutive visits made by 62 patients with Crohn's disease were selected from a database. Data from visits in which corticosteroid administration was initiated (n = 65) were compared with those from visits in which this decision was not made (n = 142). Univariate and multivariate (logistic regression) analyses were performed. The results are expressed as odds ratio (OR) with 95% confidence interval (95% CI). RESULTS: In the univariate analysis statistically significant differences were found between groups in localization, maintenance treatment, Crohn's Disease Activity Index (CDAI) score, the presence of abdominal pain, mass, perianal disease, extraintestinal manifestations and all laboratory parameters (leukocytes, platelets, fibrinogen, erythrocyte sedimentation rate, C-reactive protein). In the multivariate analysis (with corticosteroid administration as the dependent variable) a statistically significant positive association was found between the decision to administer corticosteroids and mild (OR = 31.9; 95% CI, 6.6-154.1), moderate or severe (OR = 49.7; 95% CI, 6.1-401.3) CDAI, ileocolic localization (OR = 4.8; 95% CI, 1-22.1) and the presence of perianal disease (OR = 7.4; 95% CI, 1.5-35.9), while a negative association was found with maintenance treatment with immunosuppressant drugs (OR = 0.05; 95% CI, 0.30-0.008). The laboratory variables positively associated with corticosteroid administration were C-reactive protein and leukocyte count. CONCLUSION: The variable with greatest predictive value for corticosteroid prescription is the CDAI score, although other clinical and laboratory variables not included in this index are also associated with corticosteroid administration. There is a negative association between the use of immunosuppressive drugs and corticosteroid prescription.

Adolescent↗
PubMed2003

[Dynamic ultrasonography in the diagnosis of gallbladder dysfunction: reliability of a simple method with easy clinical application].

AIMS: Although the results of dynamic ultrasonography (DUS) are similar to those of dynamic cholescintigraphy (DCS) in the study of gallbladder function, the methodology required for this technique is laborious and sometimes complex. The aim of this study was to investigate the reliability of a simple method of DUS to evaluate gallbladder function using DCS as a reference. PATIENTS AND METHODS: Gallbladder function was studied using DUS and DCS in 80 consecutive patients with clinical findings compatible with gallbladder dysfunction. For DUS the ellipsoid method was used with measurement of three gallbladder diameters (transversal, longitudinal and anteroposterior) in basal conditions and after applying a cholecystokinetic stimulus (meal test); gallbladder emptying of less than 50% was considered abnormal. In DCS intravenous cholecystokinin (CCK) (0.40 IDU/kg in 20 minutes) was used as stimulus and an ejection fraction < or = 40% was considered abnormal. RESULTS: In 15 patients (19%; 95% CI, 11-29%) abnormal gallbladder response was found using DUS. The ejection fraction in the entire group of patients studied was 48 26.2%. Ejection fraction was abnormal in 41 patients (51%; 95% IC, 40-63%) with a value of 25 8.5% and was normal in 39 patients (49%; 95% IC, 40-63%) with a value of 71.5 14.5%. The correlation coefficient between the values of gallbladder emptying calculated with DUS and the ejection fraction obtained with DCS was 0.199 (p = 0.079). When patients were divided according to gallbladder emptying measured by DUS and the ejection fraction obtained with DCS the concordance was very low (k = 0.065; EE = 0.085). CONCLUSIONS: DUS performed using a simple technique lacks diagnostic value in gallbladder dysfunction when DCS is taken as a reference test

Adult↗
PubMed2003

Cough reflex testing with inhaled capsaicin in the study of chronic cough.

OBJECTIVES: To assess the utility of capsaicin test in the differential diagnosis of non-productive causes of chronic cough and to examine the effects of treatment on this reflex. PARTICIPANTS: 86 healthy volunteers and 101 patients with chronic cough: asthma (n: 54) gastroesophageal reflux (n: 35) and post-nasal drip syndrome (n: 12). DESIGN: Prospective intervention trial. Spirometry, bronchoprovocation test with histamine (PC20), and cough challenge with ascending concentrations of capsaicin (0.49-500 microM) were initially performed in all subjects. Patients were treated for 3 months according to the origin of the cough. Concentrations that elicited two (C2) and five or more coughs (C5) were determined before and after treatment. RESULTS: In healthy subjects, cough sensitivity to capsaicin was not influenced by gender or smoking status; however, women with chronic cough were more sensitive to cough challenge than men. C2 and C5 were significantly lower in patients with asthma or gastroesophageal reflux than in post-nasal drip syndrome. No significant correlation was observed between the capsaicin cough threshold and PC20. Cough sensitivity did not improve significantly in most patients with asthma or gastroesophageal reflux despite adequate medical treatment during 3 months. Discriminative value of capsaicin test to differentiate healthy subjects from patients with asthma or reflux was poor. CONCLUSIONS: Cough sensitivity to inhaled capsaicin is a safe and reproducible tool in the study of chronic cough. However, its usefulness for the management and differential diagnosis is limited.

Administration, Inhalation↗
PubMed2003

Diagnostic value of symptoms in patients with suspected upper digestive tract disease.

OBJECTIVE: to develop a predictive model based on clinical data for patients with suspected upper digestive tract disease. PATIENTS AND METHODS: forty-seven clinical data were obtained before endoscopy from 283 patients with suspected upper digestive disease (153 men; mean age 55 years, limits 17-92 years). A clinical prediction of diagnosis was made before endoscopy. On the basis of the endoscopic findings, the patients were divided into three diagnostic groups: absence of significant disease (group I), significant benign disease (group II) and malignant disease (group III). The probability rate of belonging to each one of the three groups was obtained for each patient by using Bayes' theorem. RESULTS: the endoscopic findings were classified according to their clinical importance: 121 patients (43%) belonged to group I, 137 (48%) were included in group II; and 25 (9%) in group III. The clinical prediction correctly classified 61% of the patients (group I: 56%, group II: 62% and group III: 76%) The coincidence between prediction obtained using Bayes' theorem and the actual diagnosis was 61% (group I: 65%, group II: 51%, group III: 92%). The predictive model was useful to confirm or not the clinical prediction. CONCLUSION: objective analysis of clinical data can be useful to support clinical judgment, mainly in patients with neoplasia. However, the model is not adequate to improve indication of upper endoscopy since many patients are misclassified.

Adolescent↗
PubMed2001

Adverse effects of azathioprine in the treatment of inflammatory bowel disease.

OBJECTIVE: To know the type, frequency and time course for the occurrence of adverse events in our series of patients with inflammatory bowel disease treated with azathioprine or 6-mercaptopurine. PATIENTS AND METHOD: 92 consecutive patients were treated with azathioprine. 70 of them (55 Crohn's disease, 14 ulcerative colitis and 1 undetermined colitis) were suitable for analysis. RESULTS: We observed 23 adverse reactions in 21 patients. Adverse events were as follows: haematological 11.4%, digestive intolerance 11.4%, infection 7.1%, and pancreatitis 2.8%. The prevalence was increased among ulcerative colitis patients (57.8 vs. 21.8%) (p = 0.02). There were no statistical differences in the prevalence of adverse events respective of the age, gender or location of disease. Digestive intolerance and pancreatitis occurred within the first 6 months of therapy, whereas haematological side effects occurred between 3 months and 4 years after therapy onset. Early occurrence (but not late occurrence) was associated with thiopurine methyltransferase (TMPT) activity levels. All infections took place between 8 months and 5 years of treatment. Azathioprine was definitively withdrawn due to side effects in 9 cases (12.8%). CONCLUSIONS: The frequency of adverse events in our study is similar to that reported in previous studies. Azathioprine withdrawal is required in almost half of the cases because of toxicity. Frequency of side effects is increased in patients with ulcerative colitis. The variability in time course makes clinical-biological monitoring mandatory.

Adult↗
PubMed2000

Prevalence of gastroesophageal reflux in asthma.

A high prevalence of gastroesophageal reflux disease (GER) in asthma patients has been shown in several reports from North America and Europe. However, no data from Southern Europe are available. This paper evaluates the prevalence of abnormal reflux in asthmatics, the pattern of acid reflux when present, and the relationship between asthma and GER. Eighty-one consecutive ambulatory patients with clinically stable asthma (41 women; median age 40 years, range 17-69 years) were prospectively evaluated. All patients had a thorough digestive history; baseline pulmonary function studies, including bronchoprovocation methacholine test; and ambulatory 24-hr esophageal pH monitoring. Reflux symptoms were present in 40 patients (49%). Twelve patients had abnormal GER as defined by pH testing, giving a prevalence rate of 15% (95% confidence interval 8%-24%). The presence of acid reflux was not associated with a more severe respiratory disease. Abnormal GER seems not to be a clinically significant problem in many patients with asthma in our area.

Adult↗
PubMed1999

Efficacy and safety of cardiomyotomy in patients with achalasia after failure of pneumatic dilatation.

In patients with achalasia, it has been suggested that pneumatic dilatation could make cardiomyotomy more difficult to perform, diminishing its efficacy and safety. Our aim was to evaluate the efficacy and safety of elective cardiomyotomy after failure of pneumatic dilatation in achalasia. During 14 years, 32 of 276 consecutive patients with achalasia have been operated on because of failure of dilatation therapy. Twenty patients have been followed-up for at least one year after surgery. After failure of dilatation, Heller's cardiomyotomy and 180 degrees anterior fundoplication were performed. Clinical status was evaluated before and after surgery. Lower esophageal sphincter pressure and esophageal body basal pressure were measured by manometry, esophageal diameter by barium meal, and gastroesophageal reflux by endoscopy and 24-hr esophageal pH monitoring. No technical difficulties were found during operation. Postoperative morbidity was infrequent and mortality was absent. Cardiomyotomy improved clinical status in 19 of 20 patients. The results of surgery were considered excellent or good in 16 patients (80%; CI: 56-94%). The pressure of the lower esophageal sphincter was significantly reduced, falling in most patients to under 10 mm Hg. Gastroesophageal reflux appeared after surgery in eight patients, four of them with endoscopic esophagitis, but it was controlled in all patients with medical therapy. In conclusion, cardiomyotomy is a safe and effective therapy in achalasia after failed pneumatic dilatation.

Adult↗
PubMed1999

Normal esophageal function after myotomy in a patient with idiopathic diffuse esophageal spasm.

A 52-year-old man with idiopathic diffuse esophageal spasm and hypertensive lower esophageal sphincter presented with dysphagia for several years. After unsuccessful therapy with forceful pneumatic dilation of the cardia, a myotomy of the cardia and distal esophagus was performed. The patient became asymptomatic, lower esophageal sphincter pressure diminished to less than 10 mm Hg, and esophageal body motor activity was normalized. This situation remains unchanged 6 years after the operation.

Cardia↗
PubMed1999

[Treatment with omeprazole, clarithromycin and amoxicillin over 6 days in patients with Helicobacter pylori-infected duodenal ulcer].

OBJECTIVE: To investigate the eradication rate of Helicobacter pylori with omeprazole, amoxicillin and clarithromycin during 6 days in patients with duodenal ulcer. To compare the reliability of the analysis of the eradication with urea-13C breath test performed one month and 3 months after therapy. To evaluate the one-year reinfection rate. PATIENTS AND METHODS: Prospective study including 99 patients with duodenal ulcer (65 with acute disease and 34 in maintenance treatment) infected by Helicobacter pylori (urease rapid test and urea-13C breath test positive). Patients were treated with omeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1 g, b.i.d., during 6 days. The infection status was investigated 1 and 3 months after treatment by urea-13C breath test. The one-year reinfection rate was investigated using the same test. RESULTS: Per protocol eradication rates were 76% (95%-CI: 66-84) one month and 73% (95%-CI: 63-81) 3 months after treatment. In the intention to treat analysis, eradication rates were 74% (95%-CI: 64-82) and 70% (95%-CI: 60-79), respectively. Side effects were mild and uncommon. The rate of false negative urea-13C breath test results one month after therapy with respect to 3 months was 4.2% (95%-CI: 0.8-11.7). One-year reinfection rate determined in 56 patient was absent. CONCLUSIONS: The eradication of Helicobacter pylori with triple therapy for 6 days in patients with duodenal ulcer is not satisfactory. To investigate Helicobacter pylori infection with urea-13C breath test one month after treatment overestimates the results of the eradication. One-year reinfection rate is clinically irrelevant.

Adolescent↗
PubMed1998

[Study of gastric emptying by dual isotopes. Corrections due to contamination].

The evaluation of gastric emptying by the double isotope technique involves some methodologic conditioning. Among them contamination correction or interference in the energy windows of the activity of the two isotopes used in the marking of the solids and fluids of the test food are important. The results of an experiment in which a phantom was used to evaluate the contamination between indio 111 (DTPA-Ca111In) and technecium 99m (colloid99mTc). Three test studies were posteriorly performed in healthy volunteers and 27 studies in a control group (13 males, mean age of 33 years, mean body mass index 39.02 kg/m). In these studies the contamination was corrected with the acquisition, following an initial swallow of juice marked with 111In, of activity in the windows of both isotopes. The contamination of 111In (isotope of greatest radiation energy) in the window of 99mTc was 24% in the phantom and 20%, 23% and 26% in the three initial study tests. The mean contamination in the control group was of 22% with limits of 19% to 29% and a standard deviation of 3%. Despite the comparable results, the usefulness of the individualized contamination calculation in the studies of gastric emptying with dual isotope to minimize the methodologic errors of this technique is discussed.

Adult↗
PubMed1997

Analysis of the predictive value of clinical data in patients with suspected colonic disease.

OBJECTIVE: To develop guidelines for predicting colonic disease on the basis of clinical parameters. EXPERIMENTAL DESIGN: A prospective study of the clinical data prior to colonoscopy. On the basis of the endoscopic findings, the patients were divided into three diagnostic groups: absence of significant disease, significant benign disease and malignant disease. The patient population was divided randomly into two subgroups. The clinical data from one of them was used to build a database which, using Bayes' theorem, was compared with the variables from the other subgroup to predict the diagnosis for each patient. PATIENTS: A total of 336 patients (170 males and 166 females; mean age: 58 years; range: 15 to 87 years) were evaluated. RESULTS: When the endoscopic findings were grouped on the basis of their clinical importance, 211 patients (63%) belonged to the group without significant disease, 60 patients (18%) had significant benign disease and 65 (19%) presented a neoplastic disease. Of the 21 variables selected for use in the database, 6 showed statistically significant differences in terms of the absence or presence of malignant disease: age, absence of previous similar episodes, weight loss, rectal bleeding, lack of improvement and the presence of a mass on digital rectal examination. The predictive model differentiated patients with neoplasm from those without malignant disease, but was not capable of identifying differences among the latter. The model was useful for assessing the risk of malignant disease for each patient. CONCLUSIONS: The predictive model obtained is a useful tool for establishing the diagnosis and the priority in the performance of colonoscopy.

Adolescent↗
PubMed1996

Individual prediction of response to pneumatic dilation in patients with achalasia.

During nine years, 157 consecutive patients with achalasia have been dilated in our unit. First, the long-term effect of dilation on clinical status was evaluated. The probability of being in clinical remission eight years after first dilation was 51%. The pressure of the LES measured after dilation was highly predictive of the long-term clinical evolution. Second, a predictive model of the individual response to pneumatic dilation was developed and simplified. Therapy was effective in 80% of the patients, after one to four dilations. Younger age was the only factor significantly associated with ineffective therapy. Depending on the prognosis of the outcome calculated with the predictive model, patients were classified in groups of risk that showed a different rate of ineffective, therapy. In the simplified model, age < or = 20 years, male gender, esophageal body diameter < or = 3 cm, esophageal body basal pressure > 15 mm Hg, and pressure of the lower esophageal sphincter > 30 mm Hg were predictors of a poor response to dilation. We conclude that pneumatic dilation is an effective therapy for achalasia. A predictive model was useful to classify the patients in groups with a different risk for ineffective dilation. A simplification of this model could be used to predict the response to dilation.

Adolescent↗