Search PubMed⌕ Search

Biomedical subjects

E Brullet

Publications and source records attributed to E Brullet.

At least 37 records · Page 2Linked to original sources
PubMed1999

Identification of factors that influence tolerance of upper gastrointestinal endoscopy.

OBJECTIVE: Unsedated gastroscopy is unpleasant for some patients. The identification of factors related to tolerance would permit the selection of patients for sedation. The aim of the present study was to identify these factors. METHODS: Five hundred and nine patients underwent diagnostic gastroscopy after the administration of topical pharyngeal anaesthesia, without sedation. Patients were grouped as to whether they had undergone prior examinations or not. Tolerance was assessed with a visual analogue scale and a questionnaire. RESULTS: Two hundred and seventy-three (54%) patients underwent gastroscopy for the first time, and 236 (46%) patients had prior experience. Patient tolerance was poor in 84 of 273 (31%) patients undergoing gastroscopy for the first time, and in 61 of 236 (26%) patients with prior experience. Logistic regression analysis identified the following variables related to poor tolerance: (a) in patients undergoing gastroscopy for the first time: presence of gag reflex (odds ratio (OR) = 3.42, 95% confidence interval (CI) 1.90-6.17), apprehension (OR = 2.57, CI 1.33-4.95), young age (OR = 0.95, CI 0.93-0.98) and high level of anxiety (OR = 1.91, CI 0.96-3.89); (b) in patients with prior experience: apprehension (OR = 4.21, CI 1.93-9.20), poor tolerance of prior examinations (OR = 4.92, CI 1.93-12.5) and female (OR = 2.23, CI 1.09-4.57). CONCLUSIONS: The above-mentioned factors are predictive of poor tolerance, and may enable the identification of those patients who might benefit more from sedation for gastroscopy.

Adolescent↗
PubMed1998

[Epidemiological study on the incidence of inflammatory bowel disease in 4 Spanish areas. Spanish Group on the Epidemiological Study of Inflammatory Bowel Disease].

BACKGROUND: The incidence of inflammatory bowel disease (IBD) shows marked geographical variations. The aim of this study was to determine and compare the incidence of IBD in four Spanish areas: Sabadell (Northeast), Vigo (Northwest), Mallorca island and Motril (South). PATIENTS AND METHODS: Prospective survey based on inception cohorts over a two-years period (1 October 1991 to September 1993). Subjects were the patients resident in these areas and diagnosed of IBD according to a standard protocol for case ascertainment and definition. RESULTS: Altogether 328 cases were identified, of whom 191 were diagnosed as ulcerative colitis (UC), 135 as Crohn's disease (CD) and 2 as indeterminate colitis. The overall adjusted incidence rate per 100,000 persons between ages 15-64 years of UC and CD were respectively 9.8 and 5.2 in Sabadell, 7.7 and 5.0 in Vigo, 7.8 and 5.8 in Mallorca and 4.3 and 6.5 in Motril. The Incidence rate ratio showed no significant differences for either conditions among these areas. The global adjusted incidence rate of UC in Spanish areas (8.0; IC 95%: 6.3-9.7) was significantly lower to that of Northern European countries while that of CD (5.5; IC 95%: 4.1-6.9) was between that of Northern and Southern Europe with no significant differences. CONCLUSIONS: The incidence of IBD did not show differences among the Spanish areas, and rates are between 2 and 6 times higher than those previously reported. The incidence of UC is significantly lower than that observed in the North of Europe, while for CD the incidence is between that of Northern and Southern Europe.

Adolescent↗
PubMed1998

Transnasal gastroscopy compared to conventional gastroscopy: a randomized study of feasibility, safety, and tolerance.

BACKGROUND AND STUDY AIMS: Gastroscopy is often an unpleasant procedure for the patient. Sedation improves the tolerance, but it causes inconvenience both for patients and for endoscopy units. The aim of the present study was to compare the feasibility, safety, and tolerance of transnasal gastroscopy using a thin endoscope with conventional oral gastroscopy. PATIENTS AND METHODS: One hundred eighty-one consecutive outpatients referred for diagnostic gastroscopy were randomized to undergo transnasal or oral conventional gastroscopy. The tolerance (discomfort, retching, throat pain, and desire for sedation in any further procedures) and examination difficulty (intubation, examination, aspiration, and visibility) were assessed by the patients and the endoscopists, respectively, using visual analogue scales and a questionnaire. RESULTS: Endoscope insertion failed in six patients (four transnasal, two conventional). The tolerance was significantly better with transnasal gastroscopy in comparison to conventional oral gastroscopy. Only 3% of patients undergoing transnasal gastroscopy desired sedation in any further examinations, compared to 15% in the conventional oral gastroscopy group (P = 0.01). The examination time was longer in the transnasal group (5 min 25 sec +/- 1 min 46 sec vs. 3 min 22 sec +/- 1 min 9 sec, P < 0.001). Visualization capability and aspiration using the thin endoscope were considered more difficult by the endoscopists. CONCLUSIONS: Nasal introduction of thin endoscopes is better tolerated by patients than conventional gastroscopy, minimizing the need for sedation. However, technical improvements in thin endoscopes (a wider working channel, increased length and better image quality) would increase their usefulness.

Adolescent↗
PubMed1998

Two-day quadruple therapy for cure of Helicobacter pylori infection: a comparative, randomized trial.

OBJECTIVE: We sought to compare a 2-day quadruple therapy with a 14-day triple therapy in the treatment of Helicobacter pylori infection. METHODS: Eighty-one consecutive patients with an endoscopically diagnosed peptic ulcer and demonstrated infection by H. pylori were included in the study. Patients were randomized to receive omeprazole 40 mg b.i.d., amoxicillin 2.5 g once daily, metronidazole 500 mg t.i.d., and bismuth subcitrate 360 mg t.i.d. for 2 days, followed by omeprazole 20 mg once daily for 6 additional days (Group 1) or a 14-day course of omeprazole 20 mg b.i.d., amoxicillin 1 g t.i.d., and metronidazole 500 mg t.i.d. (Group 2). Eradication was evaluated by antral biopsy and rapid urease test at 2 months after therapy and by C13-urea breath test after a year. RESULTS: Two patients were lost to follow-up at 2 months. Intention-to-treat analysis showed that H. pylori infection was cured in 29 of 42 patients (69%; 95% CI: 53-82%) in Group 1 versus 36 of 39 (92%; 95% CI: 78-98%) of patients in Group 2 (p = 0.009). Per-protocol analysis showed a cure rate of 71% (95% CI: 55-84%) (29/41 patients) and 95% (95% CI: 81-99%) (36/38 patients), respectively (p = 0.007). Fifty-five of 65 cured patients returned 1 year after treatment (26 in Group 1, 29 in Group 2). All but one in Group 2 remained cured. There were no significant differences in compliance (88% in Group 1 versus 92% in Group 2) or in the presence of side effects (27%; 95% CI: 15-43% versus 41%; 95% CI: 26-58%; ns). CONCLUSION: Two-day quadruple therapy is significantly less effective than 2-wk triple treatment.

Adolescent↗
PubMed1998

Epidemiology of peptic ulcer disease in cirrhotic patients: role of Helicobacter pylori infection.

OBJECTIVE: The aim of this study was to investigate the clinical and epidemiological factors associated with the appearance of peptic ulcer in patients with cirrhosis and, in particular, the role of Helicobacter pylori infection. METHODS: A total of 201 of 220 consecutive patients included in a prospective study that aimed to evaluate the effect of dietary intervention on cirrhotic complications and survival underwent upper gastrointestinal endoscopy. At entry, an epidemiological and clinical questionnaire was completed and the presence of peptic ulcer disease or esophageal varices at endoscopy was prospectively collected. Sera were obtained and stored at -70 degrees C until analyzed, being tested afterward for Helicobacter pylori antibodies using a commercial ELISA kit. RESULTS: Eleven of 201 patients had borderline anti-Helicobacter pylori IgG titers and were excluded from further analysis. In the remaining 190 patients, point prevalence of peptic ulcer was 10.5% and lifetime prevalence 24.7%. Multivariate analysis selected male sex (OR 2.3; 95%CI 1.09-4.89) and Helicobacter pylori seropositivity (OR: 1.7, 95%CI 1.02-2.81) as the variables independently related to peptic ulcer disease. CONCLUSIONS: Male sex and seropositivity for Helicobacter pylori are the major risk factors for peptic ulcer in cirrhosis.

Female↗
PubMed1997

Seroprevalence and epidemiology of Helicobacter pylori infection in patients with cirrhosis.

BACKGROUND: Helicobacter pylori infection is the major pathogenic factor for peptic ulcer disease. Its epidemiology is not fully known; few data are available in patients with chronic liver disease. AIMS: To investigate the seroprevalence and factors associated with Helicobacter pylori infection in a series of liver cirrhosis patients. METHODS: Two hundred and twenty consecutive patients were prospectively included in a study aimed to evaluate the effect of dietary intervention on cirrhosis complications and survival. At inclusion, an epidemiological and clinical questionnaire was completed. Sera were obtained and stored at -70 degrees C until analyzed. They were tested for Helicobacter pylori antibodies using a commercial ELISA kit. RESULTS: Eleven out of 220 patients had borderline anti-Helicobacter pylori IgG titers. Of the remaining 209 patients, 105 (50.2%) showed positive titers of Helicobacter pylori IgG. Univariate analysis showed that Helicobacter pylori infection was more frequent in older patients, those born outside Catalonia, and in patients with a low educational level. Past ethanol consumption and current smoking correlated negatively with Helicobacter pylori infection. Multivariate analysis selected age (OR 3.1. 95% CI 1.46-6.45), educational level (OR 2.2. 95% CI 1.18-4.2) and alcohol consumption (OR 0.7. 95% CI 0.45-0.99) as the variables independently related to Helicobacter pylori infection. CONCLUSIONS: Helicobacter pylori infection in cirrhosis has the same epidemiological pattern as in the general population. Suggestions that the etiology or the severity of the liver disease could be related to Helicobacter pylori infection were not confirmed by our study.

Adult↗
PubMed1996

Factors predicting failure of endoscopic injection therapy in bleeding duodenal ulcer.

BACKGROUND: The aim of this study was to assess the factors that may cause failure of endoscopic injection in patients bleeding from a duodenal ulcer. METHODS: One hundred twenty patients admitted for a bleeding duodenal ulcer with active arterial hemorrhage or a nonbleeding visible vessel were included. RESULTS: Endoscopic injection was not feasible in 14 of 120 (11.6%) patients because of inaccessibility or massive hemorrhage. The remaining 106 patients underwent endoscopic therapy by injection of adrenaline and polidocanol. The efficacy (achievement of definitive hemostasis) of endoscopy therapy was 83% (88 of 106). Univariate analysis showed that failure of endoscopic injection was related to age, presence of shock, ulcer size greater than 2 cm, and hemoglobin level. Multivariate analysis showed that ulcer size greater than 2 cm (p = 0.005) and the presence of shock (p = 0.03) were factors predictive of endoscopic treatment failure. Failure to achieve hemostasis (p < 0.001) and poor physical status measured by American Society of Anesthesiology classification (p = 0.02) were significantly related to mortality. CONCLUSIONS: Ulcer size and severity of hemorrhage are predictive of endoscopic injection failure in patients bleeding from high-risk duodenal ulcers. Survival is determined by clinical status and associated diseases.

Aged↗
PubMed1996

Gastric ulcer perforation into the heart.

Penetration of the pericardium and heart is a very rare complication of benign peptic ulcer. The case is reported here of a 76-year-old woman with advanced senile dementia, who was admitted due to melena. Endoscopy revealed a large gastric ulcer located in a giant hiatal hernia. The ulcer base was protruding and strongly pulsatile, and seemed to be mobile and free in relation to the ulcer margins. This effect was particularly obvious during the pulsatile movements. Endoscopic findings suggested ulcer perforation to the pericardium. The patient's relatives denied consent to surgery. She was therefore treated with conservative measures, including parenteral nutrition, ranitidine, and antibiotics. The patient remained in a relatively stable condition, and she was discharged three weeks later. One month later, however, she was admitted with massive bleeding and hypovolemic shock. In spite of resuscitation measures, she died. The autopsy study showed a gastric ulcer penetrating through the pericardium and myocardium into the left ventricle.

Aged↗
PubMed1996

Factors related to the failure of endoscopic injection therapy for bleeding gastric ulcer.

BACKGROUND: Although endoscopic injection therapy is effective in controlling initial haemorrhage from peptic ulcer, between 10% to 30% of patients suffer rebleeding. AIM: To assess the factors that may predict the failure of endoscopic injection in patients bleeding from high risk gastric ulcer. SUBJECTS: One hundred and seventy eight patients admitted for a gastric ulcer with a bleeding or a non-bleeding visible vessel were included. METHODS: Patients received endoscopic therapy by injection for adrenaline and polidocanol. Twelve clinical and endoscopic variables were entered into a multivariate logistic regression model to ascertain their significance as predictive factor of therapeutic failure. RESULTS: Eighty seven per cent (155 of 178) of patients had no further bleeding after endoscopic therapy. Endoscopic injection failed in 23 (13%) patients: 20 (12%) continued to bleed or rebleed, and three (1%) patients could not be treated because of inaccessibility of the lesion. Logistic regression analysis showed that therapeutic failure was significantly related to: (1) the presence of hypovolaemic shock (p = 0.09, OR 2.38, 95% CI: 0.86, 6.56), (2) the presence of active bleeding at endoscopy (p = 0.02, OR 2.98, 95% CI: 1.12, 7.91), (3) ulcer location high on the lesser curvature (p = 0.04, OR 2.79, 95% CI: 1.01, 7.69), and (4) ulcer size larger than 2 cm (p = 0.01, OR 3.64, 95% CI: 1.34, 9.89). CONCLUSION: These variables may enable identification of those patients bleeding from gastric ulcer who would not benefit from injection therapy.

Aged↗
PubMed1996

[Prognostic factors of early mortality in the 1st episode of hemorrhage caused by esophageal varices].

AIM: To assess the prognostic factors of early mortality in cirrhotic patients with the first variceal bleeding episode. PATIENTS AND METHODS: Fifty-five cirrhotic patients with endoscopic evidence of variceal bleeding treated with sclerotherapy during emergent endoscopy were included. RESULTS: Permanent hemostasis was obtained in 36 patients (65.5%). Fourteen (25.4%) patients died within six weeks of the bleeding episode. Twenty-four variables obtained at admission and in the following days were compared between patients who survived (n = 41), and died (n = 14). In the univariate analysis the following variables were related to early mortality: prothrombin ratio (p = 0.04), the presence of ascites (p = 0.004) and encephalopathy (p = 0.06), albumin (p = 0.01), Child-Pugh score (p = 0.0003), hemostasis during endoscopy (p = 0.002), absence of rebleeding at 24 hours (p = 0.01) and early rebleeding (within five days after the bleeding episode) (p = 0.006). Multiple logistic regression identified the Child-Pugh score (OR 11.86, CI 95% 2.54-55.48; p = 0.001) and early rebleeding (OR 6.27, CI 95% 1.29-30.44; p = 0.02) as prognostic independent factors of early mortality. CONCLUSIONS: The degree of hepatic failure and early rebleeding are prognostic independent factors of early mortality in cirrhotic patients after the first variceal bleeding episode.

Analysis of Variance↗