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Aim: To identify those clinical and nutritional factors associated with plasma lipid unsaturation deficiency in cirrhosis. Methods: Fatty acid profiles of plasma phospholipids (PL) and cholesteryl esters (CE) were measured in 101 inpatients with advanced cirrhosis and in 44 age- and sex-matched healthy controls. Double-bond index (DBI) was calculated for each fraction and binarily categorized in each patient using the 5th percentile of the control group as the cut-off limit. The association of 12 routine clinical, biological, and nutritional variables with derangement of each DBI was multivariately assessed by means of stepwise logistic regression analysis. Results: The DBI of PL and CE were below the 5th percentile of the control group in 60 and 68 of 101 cirrhotic patients, respectively. After multivariate analyses, the variables found to be independent predictors of impaired unsaturation were: 1) The presence of moderate/severe malnutrition (odds ratio: 1.3-8.0 (95% Cl); p < 0.05) and serum τ-GT > 1 µkat/L (odds ratio: 0.2-1.0; NS) for plasma PL and 2) the presence of moderate/severe malnutrition (odds ratio: 1.8-17.4; p. &lt 0.05), serum bilirubin > 50 µmol/L (odds ratio 1.7-14.5; p < 0.05) and serum τ-GT < 1 µkat/L (odds ratio 0.1-1.1; NS) for CE. Conclusion: Malnutrition appears to be a major factor for impaired lipid unsaturation in advanced cirrhosis. Thus, the possibility of improving plasma lipid unsaturation in these patients by means of nutritional support should be further investigated. [ABSTRACT FROM AUTHOR]

A correction to the article "Prevalence and Factors Related to Hepatitis B and C in Inflammatory Bowel Disease Patients in Spain: A Nationwide, Multicenter Study" that was published in the previous issue is presented.

Neuroendocrine tumors of the gastrointestinal tract are highly infrequent. We report the case of a 57-year-old woman who presented with toxic syndrome, vomiting and a 3-month history diarrhea, with a final diagnosis of poorly-differentiated neuroendocrine tumor. Based on this case, we review the clinical characteristics, diagnostic procedures, prognostic factors and therapeutic possibilities in this type of tumor. Neuroendocrine tumors should be considered in the diagnosis of colonic tumors with hyperechoic liver metastases., (Copyright © 2011 Elsevier España, S.L. y AEEH y AEG. All rights reserved.)

Objective: To evaluate the resources available in Catalan regional hospitals for the emergency care of upper gastrointestinal hemorrhage., Methods: We analyzed a survey sent to 32 hospitals on the availability, composition and resources of a duty endoscopy service for the year 2009., Results: Responses were obtained from 24 centers, covering 3,954,000 inhabitants. Duty endoscopists were available in 12 hospitals. A total of 1,483,000 inhabitants were unable to access a duty endoscopist in the referral center. Centers with duty endoscopists had more beds and had a larger catchment area. Duty services were composed of 4.5 endoscopists (range 2-11), covering 82.1 (33.2-182.5) duty shifts/year. Seventeen centers reported 1,571 episodes (51%, range: 3-280, 39.68/100,000 inhabitants). Centers with a duty service reported a greater number of cases (76 vs. 43, p=0.047). Centers without this service referred a greater number of patients (147 vs. 17, p=0.001). Patients in the emergency department were under the care of the internal medicine department in four centers, the surgery department in 14 centers and under the care of both departments in six. Admitted patients were under the care of the gastroenterology department in only six hospitals. The most widely used procedures were ligation of varicose bleeding and injection therapies in non-varicose bleeding. Twenty-one percent of centers did not perform combined treatment., Conclusions: A significant proportion of the population does not have access to a duty endoscopist in referral centers. Duty shifts represent significant workload in regional hospitals. Coordination among health professionals and centers would allow the efficient application of therapeutic resources and a duty endoscopy service to be established in centers lacking this resource., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

We report the case of a 40-year-old man with underlying alcoholic liver disease who presented with prolonged fever, jaundice and liver failure associated with Coxiella burnetii infection. After diagnosis and appropriate antibiotic treatment, the patient made a complete recovery. We describe aspects of this case and provide a practical review of the literature on the topic. We also discuss the importance of this infection and the need for its inclusion in the differential diagnosis of this clinical picture., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background and Objectives: Collaboration between general practitioners (GPs) and specialists is considered crucial to provide high-quality healthcare. The objective of this study was to analyze the relationship between gastroenterologists and GPs in regional hospitals and their referring primary care centers in Catalonia (Spain)., Materials and Methods: A descriptive, observational, cross-sectional study was carried out using anonymous questionnaires between January and April 2008., Results: A total of 314 surveys were administered (261 GPs and 53 gastroenterologists). The overall relationship was considered highly deficient or insufficient by 62.3% of gastroenterologists (95% CI, 47.9-74.9) and by 55.6% of GPs (95% CI, 49.3-61.7). More than half (56.6%) of the gastroenterologists did not know any GPs, or only a very few, and the situation was the same for 80.4% of GPs. Sixty-four percent of gastroenterologists considered that the quality of care for digestive diseases in primary care was highly deficient or insufficient while 21.1% of GPs considered that the care provided by gastroenterologists was highly deficient or insufficient. The perception of healthcare in both primary and specialized settings was substantially better when there was good interaction between gastroenterologists and GPs., Conclusions: Practitioners acknowledge that the degree of interaction between different levels of healthcare is insufficient. Moreover, gastroenterologists consider that the management of digestive diseases in primary care is deficient. Establishing a personal relationship between the two types of practitioners substantially improves mutual assessment., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background and Objective: Predictive symptomatic scoring models have been proposed to select patients with dyspepsia, who may be candidates to endoscopy. In a previous study performed by gastroentrologists from our group, we obtained three scales of symptoms to predict organic dyspepsia, peptic ulcer and esophagitis, respectively. Here we analyze the reproducibility of those scoring models of symptoms when used either by other gastroenterologists or general practitioners., Patients and Method: It was a clinical prospective study of 230 patients from the Viladecans hospital area (120 from primary healthcare and 110 from the gastroenterologist's consultation). The three validation scales were performed in each patient. Then, we performed a diagnostic gastroscopy which allowed to classify patients into those with organic dyspepsia (ulcer, esophagitis, cancer) or those with functional dyspepsia. We calculated the overall predictive accuracy for the gastroenterologist and the general practitioner and for the three diagnoses (organic dyspepsia, ulcer or esophagitis) using the C statistic., Results: Discriminative capacities were 0.75 and 0.82 for organic dyspepsia, 0.78 and 0.86 for ulcer disease, and 0.78 and 0.82 for esophagitis, for the general practitioner and the gastroenterologist, respectively. In this validation study, the best cut-off value, namely the one combining good sensitivity and specificity, was found to be 7., Conclusions: A correct predictive capacity of the symptomatic score models when used by other gastroenterologists or by primary healthcare practioners confirms its reproducibility and transferability. The use of predictive symptomatic score models in everyday clinical practice can allow to rationalize the referral for endoscopy in our local setting.