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BACKGROUND AND AIMS: This study sought to determine the prevalence of malnutrition in patients with inflammatory bowel disease, to analyse the dietary beliefs and behaviours of these patients, to study their body composition, to evaluate their muscular strength and to identify the factors associated with malnutrition in these patients. METHODS: This was a prospective, multicentre study. Crohn's disease and ulcerative colitis patients from 30 Spanish centres, from the outpatient clinics, were included. A questionnaire of 11 items was applied to obtain data from patients' dietary behaviour and beliefs. Patients who accepted were evaluated to assess their nutritional status using Subjective Global Assessment and body mass index. Body composition was evaluated through bioelectrical impedance. RESULTS: A total of 1271 patients were included [51% women, median age 45 years, 60% Crohn's disease]. Of these, 333 patients underwent the nutritional evaluation. A total of 77% of patients declared that they avoided some foods to prevent disease relapse. Eighty-six per cent of patients avoided some foods when they had disease activity because of fear of worsening the flare. Sixty-seven per cent of patients modified their dietary habits after disease diagnosis. The prevalence of malnutrition was 16% [95% confidence interval = 12-20%]. In the multivariate analysis, history of abdominal surgery, active disease and avoidance of some foods during flares were associated with higher risk of malnutrition. CONCLUSIONS: The prevalence of malnutrition in inflammatory bowel disease patients was high. We identified some predictive factors of malnutrition. Most of the patients had self-imposed food restrictions, based on their beliefs.

Introduccion: La preparacion de la colonoscopia en dosis fraccionadas (DF) mejora la calidad de la limpieza. Objetivo: Comparar la preparacion para colonoscopias de manana con picosulfato sodico/citrato de magnesio (Citrafleet®) en DF con su administracion el dia previo. Material y metodos: Pacientes consecutivos fueron aleatorizados a Citrafleet® el dia anterior o en DF administrandose la segunda mitad individualizadamente con un intervalo de 2 a 6 h antes del procedimiento, sin bisacodilo. La sedacion fue realizada con propofol, definiendose una limpieza adecuada si ? 6 (escala de Boston), sin ninguna puntuacion 0/1. Resultados: Se incluyeron 193 pacientes. La calidad de la limpieza fue significativamente mejor en el grupo DF de manera global (7 vs. 5,2, p

Background: Using quadruple clarithromycin-containing regimens for Helicobacter pylori eradication is controversial with high rates of macrolide resistance. Aim: To evaluate antibiotic resistance rates and the efficacy of empirical and tailored nonbismuth quadruple (concomitant) therapy in a setting with cure rates

Beclometasone dipropionate (BDP) is a relatively new topically acting oral steroid to treat mild to moderately active ulcerative colitis (UC). We estimate that 20,000 patients have received oral BDP in Spain in the last two years. Our aim was to evaluate the efficacy and safety of oral BDP in clinical practice.Retrospective and multicenter study that included 434 patients with active UC treated with BDP. The partial Mayo Clinic score (pMS, 0-9) was used to measure disease activity. Remission was defined as post-treatment pMS of 0 or 1; response as a decrease in pMS of 3 points or 2 points and30%, and failure as lack of remission or response.BDP dose was 5 mg/day in 88% of patients and mean treatment duration was 6.2 weeks. BDP achieved remission in 44.4%, response in 22.3% and failed in 33.2% of patients. Mean pMS decreased from 4.9 ± 1.3 to 2.4 ± 2.3 (p0.0001). Remission rate was higher in mild and moderate than in severe UC (p0.043) and tended to be higher in left-sided and extensive UC than in proctitis (p0.06). Failure was less frequent in patients treated for4 weeks (p0.02). Mild adverse events were reported in 7.6% of patients.BDP induces response or remission in two thirds of active UC patients, with a good safety profile. Patients with mild to moderate, left-sided or extensive UC, receiving BDP for more than 4 weeks are most likely to benefit from this treatment.

Background: non-anesthesiologist administration of propofol (NAAP) using continuous infusion systems may achieve a more sustained sedative action. Aim: to compare intermittent boluses (IB) with pump continuous infusion (PCI) for NAAP, targeted to moderate sedation, for colonoscopy. Methods: 192 consecutive outpatients were randomized to receive IB (20 mg propofol boluses on demand) or PCI (3 mg/ kg/h plus 20 mg boluses on demand). Sedation could be stopped at cecal intubation at the discretion of the endoscopist. Satisfaction rates of the patient, nurses and endoscopist, propofol doses, depth of sedation (at the beginning, at cecal intubation and at the end), recovery times, complications and were collected. Results: there were no differences between groups regarding patient, nurse or endoscopist satisfaction rates with procedural sedation. Propofol doses (mg) were significantly higher during the induction phase (86 [30-172] vs. 78 [30-160], p 0.03) and overall (185 [72-400] vs. 157 [60-460], p = 0.003) for PCI group. 81 % of assessments of the depth of sedation were moderate. The level of sedation (O/AAS scale) was borderline significantly deeper at cecal intubation (2.38 vs. 2.72; p = 0.056) and at the end of the procedure (4.13 vs. 4.45; p = 0.05) for PCI group, prolonging thus early recovery time (6.3 vs. 5.1 minutes, p = 0.008), but not discharge time. Complications, all of them in minors, were non-significantly more frequent in the PCI group (9 vs. 7 %, p = 0.07). Conclusions: NAAP for colonoscopy was safely administered with comparable satisfaction and complication rates with either IB or PCI.

Background: In eosinophilic esophagitis (EoE), eosinophils invade the esophagus where they degranulate and release very cytotoxic proteins, including major basic protein (MBP-1). Currently the diagnosis of EoE necessitates endoscopy with biopsy that characterizes less than 2% of the esophagus. Furthermore, the inflammation is patchy, necessitating numerous biopsies to ensure that the involved area has been adequately sampled. Improved methods are needed to characterize the eosinophil density throughout the esophagus and to thoroughly understand this disease. Aim: To prepare the first MBP-1 specific ultrasound contrast agents to facilitate the detection of EoE associated inflammation by tethering EoE specific antibodies to their surfaces and demonstrating the binding of these agents to eosinophil proteins on ex vivo monkey esophagi. Method: The contrast agent was synthesized by preparing 2 mg/ mL of insulin in HCl (pH 1.6) at 65C for 12 hours. The resulting particles were incubated withmaleimide activated streptavidin. Purified antibodies specific to MBP-1 were biotinylated and reacted with the streptavidin functionalized fibers to form an insulin aggregate-steptavidin-biotin antibody complex. This complex comprises the MBP-1 specific ultrasound contrast agent. A Macaca monkey esophagus, incubated overnight in MBP-1, was filled with this solution. Ultrasound images were taken before and after washing at 15 MHz. Results: Insulin aggregates were observed using ultrasound. Incubating the insulin complex in monkey esophagi coated with MBP-1 yields an extra contrast layer at the inner wall of the esophagus, demonstrating the specific binding of these agents to eosinophil granule proteins. No such layer is visualized in control samples (not treated with MBP-1). Discussion: This is the first reported use of insulin particles as contrast agents for ultrasound. These findings indicate that insulin aggregates provide clear ultrasound contrast in liquid environments. When coupled with disease specific antibodies, these novel agents have the potential to be used for detection, minimizing the need for anesthesia or radiation associated with other diagnostic or imaging modalities. This finding is important because it provides a new avenue for clinical detection of EoE.