BACKGROUND AND AIM:laparoscopic Nissen fundoplication (LNF) is the gold standard of antireflux surgery. Up to 30 % of patients experience symptoms after surgery, with insufficient information available. The main objective was to evaluate epidemiological, clinical, and functional factors associated with symptoms after LNF. METHODS:a retrospective case-control study was performed of 79 operated patients (2015-2024). The relationship between epidemiological data, functional tests, and imaging study results with the occurrence of symptoms after LNF was assessed. RESULTS:twenty-four asymptomatic and 55 symptomatic patients were included. Functional and imaging tests were normal in the majority of asymptomatic patients. integrated relaxation pressure over 4 seconds (IRP-4s) (95th percentile) in asymptomatic patients was 20.4 mmHg. Female gender (OR 4, 95 % CI: 1.1-14), preoperative dysphagia (OR 8.2, 95 % CI: 1.4-47.6), and IRP-4s (OR 1.2, 95 % CI: 1-1.3) were independent factors for postoperative dysphagia. Type III esophagogastric junction morphology on high-resolution manometry (OR 6.1, 95 % CI: 2.1-18.1) was independently associated with gastroesophageal reflux disease (GERD) symptoms. Acid exposure time (AET) showed a trend toward being an independent factor but did not reach statistical significance (OR 1.1, 95 % CI: 1-1.3). Hiatal hernia in the esophagogram was associated with reintervention (OR 5.5, 95 % CI: 1.6-19.1). CONCLUSIONS:asymptomatic patients mostly have normal functional tests after LNF, although IRP-4s normal value (95th percentile) is higher than proposed in the Chicago classification. Preoperative dysphagia and female gender are independent factors for postoperative dysphagia, which should be considered in the preoperative assessment. Functional and imaging tests are essential in evaluating patients with postoperative symptoms. Dysphagia is associated with higher IRP while GERD symptoms are related to type III esophagogastric junction (EGJ) on high resolution manometry (HRM). Similarly, a hiatal hernia on the esophagogram is associated with reintervention.

OBJECTIVE:Coffee ground vomiting is a classical symptom of upper gastrointestinal bleeding. However, the clinical usefulness is limited, due to the low positive predictive value. Our goal is to determine if whether an urgent endoscopy does modify our therapeutic management with a real impact on survival. PATIENTS AND METHODS:It is a retrospective, observational and descriptive study. We selected all patients that underwent a gastroscopy in our center for coffee ground vomiting over the last 4 years (2017-2021). Two groups were established: urgent endoscopy (first 24h) and scheduled (over 24h). Then we studied differences between both groups regarding survival, ICU admission, hospitalization days and rebleeding. RESULTS:Three hundred and fourteen patients were identified, from which 276 were included, with 176 belonging to the urgency group and 109 to the scheduled group. There were no differences in the ICU admission, hospitalization days, survival or rebleeding after 30 days. There were no differences either in the number of potentially bleeding lesions or the need of endoscopic therapeutic. CONCLUSIONS:Coffee ground vomiting, without any other data supporting upper gastrointestinal bleeding, does not represent a reliable indicator. Performing urgent endoscopy is not beneficial in terms of morbimortality. Therefore, a more conservative strategy would allow to differ endoscopy, decreasing risks and reducing costs, without affecting the prognosis.

Los vómitos en posos de café son un síntoma clásico de hemorragia digestiva alta. Sin embargo, tienen escasa validez semiológica, dado su conocido bajo valor predictivo positivo. Nuestro objetivo es determinar si realizar una gastroscopia urgente en estos pacientes modifica nuestra conducta terapéutica con impacto real en la morbimortalidad. Se trata de un estudio retrospectivo, observacional y descriptivo en el que se analizaron aquellos pacientes que se realizaron una gastroscopia en nuestro centro por vómitos en posos de café en los últimos 4 años (2017-2021). Se establecieron 2 grupos: endoscopia urgente (primeras 24 h) y programada (más de 24 h) y se evaluaron las diferencias entre ambos grupos en supervivencia, estancia en la UCI, días de ingreso hospitalario y tasa de resangrado. Se identificaron 314 pacientes, de los que finalmente se incluyeron 276, perteneciendo 176 al grupo de gastroscopia urgente y 109 al de diferida. No se identificaron diferencias en la tasa de ingreso en la UCI, días de estancia hospitalaria, supervivencia ni resangrado a los 30 días. Tampoco se objetivaron diferencias en la tasa de detección de lesiones potencialmente sangrantes ni en la necesidad de terapéutica endoscópica. Los vómitos en posos de café, sin otros datos clínicos de hemorragia digestiva, no son un indicador fiable de la misma, y la realización de una gastroscopia urgente no aporta beneficios en términos de morbimortalidad. Una estrategia conservadora en estos pacientes permitiría diferir endoscopias, evitando riesgos y ayudando al control de gastos sin incidir en el pronóstico del paciente. Coffee ground vomiting is a classical symptom of upper gastrointestinal bleeding. However, the clinical usefulness is limited, due to the low positive predictive value. Our goal is to determine if whether an urgent endoscopy does modify our therapeutic management with a real impact on survival. It is a retrospective, observational and descriptive study. We selected all patients that underwent a gastroscopy in our center for coffee ground vomiting over the last 4 years (2017-2021). Two groups were established: urgent endoscopy (first 24 h) and scheduled (over 24 h). Then we studied differences between both groups regarding survival, ICU admission, hospitalization days and rebleeding. Three hundred and fourteen patients were identified, from which 276 were included, with 176 belonging to the urgency group and 109 to the scheduled group. There were no differences in the ICU admission, hospitalization days, survival or rebleeding after 30 days. There were no differences either in the number of potentially bleeding lesions or the need of endoscopic therapeutic. Coffee ground vomiting, without any other data supporting upper gastrointestinal bleeding, does not represent a reliable indicator. Performing urgent endoscopy is not beneficial in terms of morbimortality. Therefore, a more conservative strategy would allow to differ endoscopy, decreasing risks and reducing costs, without affecting the prognosis.

INTRODUCTION Activation of mast cells causes alteration in epithelial and neuromuscular function, and is involved in visceral hypersensitivity and dysmotility in gastrointestinal functional disorders. OBJECTIVES Primary: Evaluate differences in basal serum tryptase (BST) between patients with irritable bowel syndrome (IBS) and healthy controls. Secondary: BST depending on IBS subtype (diarrhea: IBS-D; constipation: IBS-C), comorbidities and correlations with IBS severity and quality of life. MATERIAL AND METHODS Prospective control-case study in IBS patients (Rome IV criteria). BST was determined (ImmunoCAP-Phadia, Sweden®) IBS Severity Score (IBSSS), pain, bloating and flatulence analogue scales, IBS quality of life (IBSQOL) and patient health status (PHQ-9) were performed. BST is the primary variable in achieving the primary end-point. RESULTS Thirty-two patients, 21 (65.6%) IBS-D, 11 (34.4%) IBS-C and 32 controls were included. Mean IBSSSS: 326.6 (± 71.4), IBSQOL: 76 (± 20.3) and PHQ9: 10.2 (± 5.9). BST was 4.8 ± 2.6 in IBS and 4.7± 2.6 in controls (p=0.875). There was no difference in BST between IBS subtypes (4.7 ± 2.9 in IBS-D and 5± 1.8 in IBS-C; p =0.315) or IBS severity (p=0.662). However, BST was higher in patients with IBS and extraintestinal comorbidities compared to other patients and controls (p=0.029). This subgroup also has more severe bloating (p=0.021). There was no correlation between BST, quality of life (p=0.9260) and health status (p=0.3985). CONCLUSION BST does not discriminate between IBS patients and controls. However, BST was higher in patients with IBS with extraintestinal comorbidities which have more severe bloating. This finding is worthy of investigation.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered defecation, usually accompanied by abdominal bloating or distension. The integrated model of bidirectional interaction between the central, autonomic, enteric nervous system, the microbiome, and the gut barrier allows a better understanding of the pathophysiology of IBS, as well as consideration of potential therapeutic strategies. IBS with predominant diarrhea (IBS-D) represents a therapeutic challenge. Dietary changes or restrictions are most commonly used by patients in an attempt at symptom control. Therefore, a number of diets, especially low-FODMAP diet, have increasingly gained interest as a therapy for IBS-D or mixed IBS. However, this kind of diet, while effective, is not exempt of problems. It is therefore necessary that other therapeutic options be considered while bearing pathophysiological mechanisms and general symptom management in mind.

All HC seroconvert post complete vaccination with two vaccine doses [100%].A small proportion of patients with IBD failed to seroconvert [2%].Median anti-spike protein (SP) immunoglobulin (Ig)G levels post one vaccination and complete vaccination in our IBD cohort was significantly lower than HC [2,613 AU/mL versus 6,871 AU/mL, p=<0.001][Figure 1].A diagnosis of IBD was independently associated with lower anti-SP IgG levels [β coefficient -0.2, p = 0.001] whereas use of mRNA vaccines was independently associated with higher anti-SP IgG levels [β coefficient 0.25, p = < 0.001].Patients with IBD receiving anti-TNF therapy had significantly lower anti-SP IgG levels [2444.6AU/mL] than IBD patients not receiving these agents [3867.6AU/mL] [p = < 0.001].Patients with IBD not receiving TNF inhibitors still showed attenuated responses compared to HC receiving a similar vaccine [p = 0.001] [Figure 2].58 patients had an additional follow-up serology sample at a median of 12 weeks to complete vaccination to allow assessment of the durability of the response after their initial post-vaccination IgG level.There was a significant drop in IgG levels from 3952.85 AU/mL at the first timepoint checked post-complete vaccination to 921.1 AU/mL (343.1 -2102.7) on follow-up sampling (p = <0.001).Median anti-SP IgG levels were numerically lower in our cohort receiving anti-TNF therapy (794.8AU/mL) compared to those not receiving anti-TNF therapy (3136.9AU/mL) on final follow-up samples (p =0.28).HC participants with previous COVID-19 infection (n= 5) had significantly higher anti-SP IgG levels post complete vaccination ( 20,719.6 AU/mL) compared to IBD patients (n=4) with prior infection (3,938.2AU/mL) (p = < 0.001).Conclusions: Patients with IBD have attenuated serological responses to SARS-CoV-2 vaccination.Patients with IBD who do not seroconvert post-vaccination against COVID-19 are a particularly vulnerable cohort.Use of anti-TNF therapy negatively impacts anti-SP IgG levels.Impaired responses to vaccination in our study highlights the importance of booster vaccination programmes for patients with IBD.Differences in median IgG levels across three time points Differences in median anti-SP Levels dependent on medication for treatment of IBD.Su1495

Abstract Background This study aimed to compare the risk of COVID-19 in patients with IBD versus the general population, and to evaluate predictors of infection acquisition, progression to severe forms, and risk of developing persistent COVID-19. We also assess the differences between cases across the different COVID-19 pandemic waves in our target population. Methods This single-centre prospective, cohort study included consecutive IBD patients diagnosed of COVID-19 either by a positive polymerase chain reaction test and/or antigen test in nasopharyngeal swabs, or by anti-SARS-CoV-2 antibodies, and that they had a follow-up of at least 4 months. Using logistic regression, we evaluated cases versus IBD controls included in the IBD Unit database for predictors of COVID-19 acquisition. COVID-19 cases were distributed according to pandemic waves. Cox regression analysis was used for predictors of severe and persistent COVID-19. Results By May 31, 2021, 160 out of 1911 IBD patients (8.3%) were diagnosed with COVID-19. IBD patients had a similar adjusted incidence of COVID-19 (OR 0.94; 95% CI 0.86–1.02; P=0.42), and a similar associated mortality ratio (OR 0.83; 95% CI 0.6–1.06; P=0.48), compared to the general population. In multivariable analysis, treatment with biologics was associated with a higher risk (OR 2.22, P<0.001), and treatment with salicylates with a lower risk (OR 0.71, P=0.048) of contracting COVID-19.(Table 1) 62 COVID-19 cases were diagnosed during the first wave of pandemic (until the end of June 2020), and 54 and 44 cases during the second and third waves (until the end of December 2020 and May 2021, respectively).(Figure 1) In multivariate analysis, first wave cases were associated with a higher risk of progression to severe forms of infection (OR 4.76, 95% CI 1.83–12.37, P=0.001), and development of persistent COVID-19 (OR 2.4, 95% CI 1.16–4.95, P=0.018). 29 patients (18.1%) required hospitalisation and were classified as severe COVID-19, which was associated in multivariable analysis with age>48 (HR 3.68, P=0.007), cases diagnosed in the first wave (HR 6.04, P<0.001), and comorbidities (evaluated with Duke Severity of Illness Checklist [DUSOI], P<0.001).(Table 2) During a median follow-up of 8.4 months, 68 patients (42.5%) were diagnosed with persistent COVID-19. Multivariable analysis identified UC (P=0.053), comorbidities (P=0.090), and being diagnosed during the first wave (P=0.011) as risk factors for persistent COVID-19.(Table 3) Conclusion IBD patients have a similar risk of COVID-19 and associated mortality as the general population. Cases diagnosed during the first wave of the pandemic had severe and persistent forms of COVID-19 more frequently. Age and comorbidity were the main risk factors for severe forms of the disease.

Introducción: el papel del farmacéutico comunitario ha adquirido mayor relevancia en el contexto de las restricciones derivadas por la pandemia de COVID-19. Objetivo del estudio: identificar el resultado de la indicación farmacéutica ante la consulta por diarrea o estreñimiento durante este período. Material y métodos: estudio observacional, transversal, multicéntrico y nacional. Se invitó a participar a los farmacéuticos comunitarios registrados en la base de datos Medynet. Los seleccionados se estratificaron por comunidades autónomas y población rural o urbana. La población de estudio fueron los pacientes que acudieron a las farmacias comunitarias desde enero a junio de 2021 por estreñimiento o diarrea. Resultados: un total de 121 farmacéuticos de un máximo establecido de 120 reclutaron a 849 pacientes (49,7 % consultaron por diarrea y un 50,3 % por estreñimiento). Un 83,5 % de farmacéuticos consideraba haber atendido un mayor número de consultas por síntomas digestivos, pero sin llegar a ser el doble que antes de la pandemia. En los pacientes con diarrea, dieta (76,9 %) y suero oral (64,2 %) fueron las indicaciones más frecuentes, mientras que en los pacientes con estreñimiento destacaron el aumento de la ingesta de agua (86,9 %), la dieta (84,1 %) y la indicación de algún medicamento de prescripción libre (68,1 %). 4 de cada 5 consultas farmacéuticas por diarrea o estreñimiento fueron resueltas en la farmacia comunitaria sin precisar derivación al médico. Conclusión: el presente estudio refuerza el papel destacado del farmacéutico comunitario como profesional de primera línea, realizando indicaciones farmacéuticas personalizadas a pacientes con diarrea o estreñimiento, contribuyendo de forma sustancial a la eficiencia y sostenibilidad del sistema sanitario durante la pandemia de COVID-19.

Puntos para una lectura rápida•La ERGE es un reto diagnóstico y terapéutico en Atención Primaria debido a su cronicidad, expresión clínica heterogénea, alta prevalencia e impacto en la calidad de vida.•La endoscopia debe de indicarse en pacientes con síntomas de alarma, con ERGE de larga evolución y en no respondedores al tratamiento.•La pH-metría con o sin impedanciometría es la prueba de elección en el diagnóstico si no existe lesión en la endoscopia.•La manometría esofágica de alta resolución ayuda a comprender los mecanismos fisiopatológicos de la ERGE y es necesaria antes de plantear una cirugía antirreflujo.•Los inhibidores de la bomba de protones (IBP) siguen siendo los fármacos fundamentales en el tratamiento de la ERGE.•Los mucoprotectores y alginatos combinados con IBP pueden ayudar al control de los síntomas en pacientes no respondedores.•La funduplicatura es una opción válida en pacientes con reflujo ácido persistente a pesar de la optimización del tratamiento médico.•Nuevos fármacos bloqueadores de ácido competitivos con potasio como vonoprazán podrían mejorar la supresión de ácido en comparación con IBP.•Los procedimientos endoscópicos mínimamente invasivos parecen prometedores en pacientes seleccionados, pero requieren una evaluación adicional en la ERGE refractaria.

BACKGROUND:the impact of the COVID-19 pandemic has led to the interruption of most manometry or impedance-pH monitoring studies. The risk of restarting activities is unknown.OBJECTIVE:assess the risk of SARS-CoV-2 virus infection, both to patients and healthcare workers, in relation to esophageal and anorectal functional tests during the pandemic without protective measures.METHOD:a questionnaire was designed to determine whether patients and healthcare workers had COVID-19, confirmed by either a test or compatible symptoms, after functional studies were performed from January until March 2020.RESULTS:the survey was answered by 263 (92.9 %) patients. Four (1.52 %) patients had confirmed COVID-19 in the two weeks after the functional test (adjusted rate 8.34 cases per 1,000 [95 % CI -0.06-16.74], OR 0.84 [95 % CI: 0.83-0.85], p < 0.001) and no patient after anorectal manometry. Another five had only compatible symptoms, for a total of nine patients (3.42 %) (adjusted rate 27.50 cases/1,000 [95 % CI: 7.27-47.74], OR 2.84 [95 % CI: 2.81-2.87]). In the total study period, 18.25 % had confirmed COVID-19 or compatible symptoms. The average number of days between the procedure and the first day of symptoms was progressively shortened (January: 56 days, February: 33 days, March: 10.5 days). Two of ten healthcare workers (20 %) had confirmed COVID-19.CONCLUSIONS:the risk of COVID-19 infection when performing functional tests is low and more related to the evolution of the pandemic rather than to the procedure itself. The small number of healthcare workers included in the study does not allow a definitive conclusion to be drawn on their risk of infection.