Actinomicosis orofaríngea complicada secundaria al tratamiento farmacológico / Complicated oropharyngeal actinomycosis secondary to pharmacotherapy

Anti-tumor necrosis factor (TNF)-α treatment is an effective therapeutic option in intestinal inflammatory chronic disease in cases of the ineffectiveness of other drugs, but it promotes the development of opportunistic infections in their severe forms, due to the profound suppression of T-cell mediated immunity it produces. Among the most frequent are bacterial granulomatous infections, such as mycobacteria (especially tuberculosis), and fungal infections. Actinomycosis is a rare suppurative granulomatous chronic opportunistic infection, which in states of immunosuppression, such as the one caused after treatment with TNF blockers, is complicated by more severe clinical pictures.We present the clinical case, not previously described, of cervicofacial actinomycosis complicated with pneumonia, secondary to treatment with adalimumab in a patient with Crohn's disease.

El tratamiento con anticuerpos anti-factor de necrosis tumoral (TNF) es una opción terapéutica efectiva en la enfermedad inflamatoria crónica intestinal, en casos de ineficacia a otros fármacos, pero favorece la aparición de infecciones oportunistas en sus formas graves, debido a la gran inmunodepresión de células T que produce. Entre las más frecuentes se encuentran las infecciones granulomatosas bacterianas, como las causadas por micobacterias (en la que se destaca la tuberculosis), y las fúngicas. La actinomicosis es una infección oportunista crónica, granulomatosa, supurativa e infrecuente que, en estados de inmunosupresión, como el provocado tras el tratamiento con anticuerpos monoclonales anti-TNF, puede complicarse con cuadros clínicos más graves. Se presenta el caso clínico, no descrito anteriormente, de actinomicosis cervicofacial complicada con neumonía, secundaria al tratamiento con adalimumab, en una paciente con enfermedad de Crohn.

Epidemiological study on the incidence of inflammatory bowel disease in Yinzhou District, Ningbo City from 2011 to 2020 / 北京大学学报(医学版)

OBJECTIVE@#To describe the distribution characteristics of inflammatory bowel disease among permanent residents in Yinzhou District, Ningbo City, and to understand the disease burden and development trend of inflammatory bowel disease in this area.@*METHODS@#Using the retrospective cohort design, we collected the registration information of all permanent residents in the residents' health files of the Yinzhou Regional Health Information Platform from 2010 to 2020, and used electronic medical records to follow up their inflammatory bowel disease visits. A one-year wash-out period was set, and the patients who were diagnosed with the primary diagnosis for the first time after one year of registration were re-garded as new cases. The incidence density and 95% confidence interval (CI) of inflammatory bowel disease were estimated by Poisson distribution.@*RESULTS@#From 2011 to 2020, a total of 1 496 427 permanent residents in Yinzhou District were included, of which 729 996 were male (48.78%). The total follow-up person-years were 8 081 030.82, and the median follow-up person-years were 5.41 [interquartile range (IQR): 5.29]. During the study period, there were 1 217 new cases of inflammatory bowel disease, of which males (624 cases, 51.27%) were more than females (593 cases, 48.73%). The total incidence density was 15.06/100 000 person-years (95%CI: 14.23, 15.93). Among all new cases, there were 1 106 cases (90.88%) of ulcerative colitis, with an incidence density of 13.69 per 100 000 person-years (95%CI: 12.89, 14.52); 70 cases (5.75%) of Crohn's disease, with an incidence density of 0.87 per 100 000 person-years (95%CI: 0.68, 1.09); and 41 cases (3.37%) of indeterminate colitis, with an incidence density of 0.51 per 100 000 person-years (95%CI: 0.36, 0.69). The median age of onset of ulcerative colitis was 50.82 years old (IQR: 18.77), with the highest proportion (15.01%) in the 45-49 years group. The incidence density of ulcerative colitis gradually increased with age, reaching a relatively high level in the 45-49 years group (20.53/100 000 person-years; 95%CI: 17.63, 23.78), followed by a slight increase. And the incidence density in the 65-69 years group was the highest (25.44/100 000 person-years; 95%CI: 20.85, 30.75), with a rapid decrease in the 75-79 years group. The median age of onset of Crohn's disease was 44.34 years (IQR: 33.41), with the highest proportion (12.86%) in the 25-29 years group. Due to the small number of new cases of Crohn's disease, the age distribution fluctuated greatly, with peaks both in young and old people. From 2011 to 2020, the incidence density of inflammatory bowel disease in Yinzhou District was at a low level from 2011 to 2013, and showed a rapid upward trend from 2014 to 2016, reaching a peak of 24.62 per 100 000 person-years in 2016 (95%CI: 21.31, 28.30), and slightly decreased in 2017-2020.@*CONCLUSION@#The incidence density of inflammatory bowel disease in Yinzhou District from 2011 to 2020 was at a relatively high level, and medical institutions and health departments need to pay attention to the burden of disease caused by it.

A rare cecal subepithelial tumor in a Crohn´s Disease patient

Appendiceal tumors comprise a variety of histologic types, including appendiceal mucinous neoplasms, which can be grouped as premalignant lesions, tumors of uncertain malignant potential, and malignant lesions. The appendiceal mucinous neoplasms are characterized by mucinous epithelial proliferation with extracellular mucin and pushing tumor margins, commonly an incidental finding during operative exploration. We report the case of a low-grade appendiceal mucinous neoplasm presenting as a subepithelial lesion in Crohn´s Disease patient. The diagnosis was not straightforward, and only surgical resection allowed an accurate diagnosis. Although Inflammatory Bowel Disease is a risk factor for the development of colorectal neoplasms, the absolute risk for appendiceal tumors is uncertain. The frequency of progression to malignancy remains to be determined.

Biosimilares en enfermedad inflamatoria intestinal: ¿será una alternativa útil en Chile? / Biosimilars for Inflammatory Bowel disease: would be an option in Chile?

Biological therapies have been essential for the management of inflammatory bowel disease; however, their high cost results in many patients being unable to access them. With time, commercial patents of many "original" biologics are reaching or almost in the point of reaching the expiration date of their licenses, which has allowed for the development of new agents known as biosimilars leading to a reduction of the cost of these therapies. The objective of this review is to explain what biosimilars are and show evidence of their effectiveness and safety.

Las terapias biológicas son parte fundamental en el manejo de la enfermedad inflamatoria intestinal, sin embargo los costos de éstas han hecho que muchos de los pacientes que tienen indicación de su uso, no puedan utilizarlas. Con el paso del tiempo, muchos biológicos "originales" están alcanzando o a punto de alcanzar el vencimiento de sus patentes, lo que ha llevado al desarrollo de nuevos agentes conocidos como biosimilares, determinando una disminución en los costos de estas terapias. Esta revisión tiene como objetivo explicar en qué consisten los biosimilares y la evidencia actual con respecto a su eficacia y seguridad.

Effects of Moxibustion on Colonic JNK Signaling Pathway in Crohn's Disease Model Rats / 世界科学技术-中医药现代化

Objective: To explore the anti-inflammatory immune mechanism in moxibustion treatment of Crohn.s disease (CD) from the perspective of c-Jun N-terminal kinase (JNK) signaling pathway, through observing the regulatory effect ofmoxibustion on colonic JNK, c-Jun, monocyte chemoattractant protein 1 (MCP-1) and cyclooxygenase 2 (COX2) in CDmodel rats. Method: Male Sprague-Dawley rats of clean grade were randomized into a normal group, a model group, amoxibustion group and a sham moxibustion group. CD model was developed by the mixture of 2, 4, 6 Trinitro-benzene-sulfonic acid (TNBS) and ethanol via enema. Hematoxylin-eosin (HE) staining was used to observe the morphologicalchanges in rat.s colon tissues for pathological scoring; enzyme-linked immunosorbent assay (ELISA) was used to detectthe contents of MCP-1, COX2, JNK, and c-Jun in colon tissues; real-time fluorescence quantitative PCR was adopted toexamine the mRNA expressions of JNK and c-Jun in rat.s colon. Result: Compared with the normal group, the modelgroup showed more significant colonic damage and thus had a higher colonic damage score (P ＜ 0.01), manifested astopical inflammation which involved the submucosa, fissuring ulcers and granuloma; the model group also showedincreased contents of protein MCP-1 and COX2, and elevated contents of JNK protein and mRNA in colon (all P ＜ 0.05), while the change in the content of c-Jun was insignificant (all P＞ 0.05) . Compared with the model group and shammoxibustion group, the colonic damage score was lower in the moxibustion group (P ＜ 0.01, P ＜ 0.05), with improvementin colonic structure and inflammation; the contents of MCP-1 and COX2 in colon tissues declined, so did the proteincontent and mRNA expression of JNK (all P ＜ 0.05), while the change in the content of c-Jun was insignificant (all P＞0.05) . There were no significant differences between the model group and sham moxibustion group comparing all theindexes (all P＞ 0.05) . Conclusion: Moxibustion down-regulates the expressions of JNK protein and mRNA in CD rat.scolon, as well as the contents of MCP-1 and COX2 in colon tissues, which is possibly one significant mechanism formoxibustion to ease intestinal inflammation and promote the repair of colon tissues in CD.

Body composition in patients with crohn's disease and ulcerative colitis / Composição corporal de pacientes com doença de Crohn e colite ulcerativa

ABSTRACT BACKGROUND The nutritional status of individuals with inflammatory bowel diseases is directly related to the severity of the disease and is associated with poor prognosis and the deterioration of immune competence. OBJECTIVE To assess the nutritional status and the body composition of outpatients with inflammatory bowel diseases. METHODS A cross-sectional study was conducted with clinical and nutritional assessment of patients with Crohn’s disease and ulcerative colitis. Patients were classified according to the clinical activity through Crohn’s Disease Activity Index and Mayo Score. Nutritional assessment consisted of anthropometric measurements of current weight, height, mid-arm circumference, triceps skinfold thickness and thickness of adductor policis muscle, with subsequent calculation of BMI, arm muscle circumference and the mid-arm muscle area (MAMA). The phase angle (PhA) and lean and fat mass were obtained with the use of electrical bioimpedance. Descriptive statistics, chi-square test or Fisher exact test, ANOVA and t-test. RESULTS We evaluated 141 patients of which 54 (38.29%) had Crohn’s disease and 87 (61.70%) ulcerative colitis. The mean age was 43.98 (±15.68) years in Crohn’s disease and 44.28 (±16.29) years for ulcerative colitis. Most of the patients were in clinical remission of the disease (Crohn’s disease: 88.89%; ulcerative colitis: 87.36%). Regarding the nutritional classification using BMI, it was found that 48.15% of Crohn’s disease patients were eutrophic and 40.74% were overweight or obese; among patients with ulcerative colitis, 52.87% were classified as overweight or obese. When considering the triceps skinfold, it was observed in both groups a high percentage of overweight and obesity (Crohn’s disease: 75.93%; ulcerative colitis: 72.42%). Crohn’s disease patients showed the most affected nutritional status according to the nutritional variables when compared to patients with ulcerative colitis (BMI: 24.88 kg/m² x BMI: 26.56 kg/m², P=0.054; MAMA: 35.11 mm x MAMA: 40.39 mm, P=0.040; PhA: 6.46° x PhA: 6.83°, P=0.006). CONCLUSION Patients with inflammatory bowel diseases have a high prevalence of overweight and obesity. Crohn’s disease patients had more impaired anthropometric and body composition indicators when compared to patients with ulcerative colitis.

RESUMO CONTEXTO O estado nutricional de indivíduos com doença inflamatória intestinal está diretamente relacionado à gravidade da doença e associado a mau prognóstico e deterioração da competência imune. OBJETIVO Avaliar o status e a composição corporal de pacientes ambulatoriais com doença inflamatória intestinal. METÓDOS Foi conduzido um estudo transversal com avaliação clínica e nutricional de pacientes com doença de Crohn e colite ulcerativa. Pacientes foram classificados de acordo com o índice de atividade clínica Crohn’s Disease Activity Index e escore de Mayo. Avaliação nutricional foi composta peso atual, estatura, circunferência do braço, dobra cutânea tricipital e espessura do músculo adutor do polegar. Posteriormente, foram calculados índice de massa corporal, circunferência muscular do braço e área muscular do braço corrigida. O ângulo de fase e massa magra e massa gorda foram derivadas da bioimpedância elétrica. Foram realizados análise descritiva, teste de qui-quadrado ou exato de Fisher, teste t e ANOVA. RESULTADOS Foram avaliados 141 pacientes, sendo 54 (38,29%) com doença de Crohn e 87 (61,70%) com colite ulcerativa. A idade média foi de 43,98 (±15,68) anos em pacientes com doença de Crohn e 44,28 (±16,29) anos em pacientes com colite ulcerativa. A maioria dos pacientes estava em remissão clínica da doença (doença de Crohn: 88,89%; colite ulcerativa: 87,36%). O estado nutricional de acordo com o IMC foi 48,15% eutrófico e 40,74% sobrepeso/obesidade para doença de Crohn; entre os indivíduos com colite ulcerativa, 52,87% foram classificados como sobrepeso/obesidade. Ao se considerar dobra cutânea do tríceps, observou-se obesidade em ambos os grupos (doença de Crohn 75,93%; colite ulcerativa: 72,42%). Pacientes com doença de Crohn apresentam maiores variações de composição corporal quando comparados com pacientes com colite ulcerativa (IMC: 24,88 kg/m² x IMC: 26,56 kg/m², P=0,054; área do músculo do braço: 35,11mm x área do músculo do braço: 40,39 mm, P=0,040; ângulo de fase: 6,46° x ângulo de fase: 6,83°, P=0,006). CONCLUSÃO Pacientes com doença inflamatória intestinal apresentaram alta prevalência de sobrepeso e obesidade. Indivíduos com doença de Crohn apresentaram parâmetros de composição corporal e de antropometria mais comprometidos, quando comparados com indivíduos com colite ulcerativa.

Neoplasias extra-colónicas en pacientes con enfermedad inflamatoria intestinal / Extra-intestinal malignancies in patients with inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) have shown to be at increased risk of developing extraintestinal malignancies. Immunomodulators (immunosuppressant and anti-tumor necrosis factor) diminish the mucosal inflammatory response changing the evolution of the disease, especially when these strategies are introduced earlier. However, therapies that alter the immune system may also promote carcinogenesis. Treatment of IBD in patients with prior malignancy is challenging and the final decision regarding therapeutic strategy should be made on a case-by-case basis. The purpose of this review is to show the characteristics of extra-colonic cancer in patients with IBD, including risks, pathogenesis and management of IBD after cancer diagnosis, the effect of neoplasm treatment on IBD, and the effect of IBD and its treatments on cancer outcomes.

Los pacientes con enfermedad inflamatoria intestinal (EII) presentan un mayor riesgo de desarrollar neoplasias extraintestinales. Los inmunomoduladores (inmunosupresores y terapia biológica anti-TNF) disminuyen la respuesta inflamatoria a nivel de la mucosa, modificando la evolución de la enfermedad, especialmente cuando son introducidos precozmente. Sin embargo, estas terapias pueden alterar el sistema inmune y promover la carcinogénesis. El tratamiento de la EII en pacientes con antecedentes de cáncer es un desafío y la decisión final sobre la estrategia terapéutica debe ser determinada caso a caso. Esta revisión tiene como objetivo mostrar las características de las neoplasias extra-intestinales en pacientes con EII, incluyendo los riesgos, patogénesis y manejo de la EII posterior al diagnóstico del cáncer, el efecto de la neoplasia sobre el tratamiento de la EII y el efecto de la EII y su tratamiento sobre el cáncer.

Educación al paciente con enfermedad inflamatoria intestinal: impacto de un equipo multidisciplinario / Education to IBD patients: impact of a multidisciplinary team

Inflammatory bowel disease (IBD) is a chronic, idiopathic disease characterized by inflammation of the gastrointestinal tract. It affects more than 5 million people worldwide and in Chile studies suggest that IBD incidence has increased in recent years. It is manifested by periods of remission and activity, requiring permanent pharmacological treatment. Both, the occurrence of a crisis episode and the need for lifetime medical treatment could affect the quality of life of IBD patients. Studies suggest that patients with IBD require education to develop self-management of their disease and adhere to treatment, thus reducing the risk of crisis episodes. The importance of this strategy or action is significant if we consider that studies have shown that the level of knowledge of IBD patients regarding their pathology is low. The purpose of this article is to review the effect of education on the management of IBD patients and the implications of a multidisciplinary team with an IBD specialist nurse.

La enfermedad inflamatoria Intestinal (EII) es una enfermedad crónica, idiopática, caracterizada por la inflamación del tracto gastrointestinal. Afecta a más de 5 millones de personas en el mundo y en Chile estudios sugieren que ha ido en aumento en los últimos años. Se manifiesta por períodos de remisión y actividad, siendo necesario un tratamiento farmacológico permanente. Tanto la presencia de crisis como la necesidad de un tratamiento médico de por vida, podrían afectar la calidad de vida de estos pacientes. Estudios sugieren que los pacientes con EII requieren de educación para poder desarrollar un buen autocuidado de su enfermedad, adherirse al tratamiento y disminuir así el riesgo de crisis. Esta estrategia o acción no deja de ser importante si consideramos que estudios han mostrado que el nivel de conocimiento de los pacientes con EII respecto a su patología es bajo. El propósito de este artículo es revisar el efecto de la educación en el manejo de los pacientes con EII, y las implicancias de un equipo multidisciplinario con una enfermera especialista en EII que realice el seguimiento de estos pacientes.

Impact of a low-to-middle dosage of glutamine-supplemented total parenteral nutrition on inflammatory markers in patients with inflammatory bowel disease / 中华临床营养杂志

Objective To evaluate the impact of total parenteral nutrition(TPN)on nutrition status and inflammatory markers in hospitalized fasted patients with inflammatory bowel disease(IBD).Methods A retrospective study was performed and 82 hospitalized fasted IBD patients [male/female=58/24,(39.4±14.5)years] who received TPN entered the study.Among them,38 patients had ulcerative colitis(UC)and 44 patients suffered from Crohn`s disease(CD).Clinical data(gender,age,duration of disease,history of disease,prednisone,immuno-suppressor,and antibiotics)were obtained from medical records.Nutritional parameters,C-creative protein(CRP),and erythrocyte sedimentation rate(ESR)before and after TPN were also obtained.Average caloric supplementation by TPN was(4 437.3±1 199.1)kJ/d and the nitrogen amount was(9.9±1.7)g/d.Median PN length was 15 days(7-54 days).67 IBD patients received a TPN formula with glutamine(≥14 d,25 patients vs.0-14 d,42 patients)and 15 IBD subjects received TPN without glutamine.Malnutrition was diagnosed by body mass index(BMI)and serum albumin level.Results The prevalence of undernutrition was 90.2％(74/82)in the study population.CD patients had a significantly longer history of disease [84(3-288)months vs.24(1-324)months,P<0.001] and a significantly lower BMI [(15.6±1.8)kg/m2 vs.(19.1±3.5)kg/m2,P<0.001] compared with those in UC patients.TPN improved nutritional parameters [serum albumin:(28.7±6.6)g/L before TPN vs.(31.7±5.8)g/L after TPN,P<0.001;pre-albumin:(174.1±85.5)mg/L before TPN vs.(227.2±82.8)mg/L after TPN,P<0.001].Conclusions TPN improves nutritional status in hospitalized fasted IBD patients.However,prospective randomized controlled trials are required to estimate the role of low-to-middle dosage of glutamine in IBD patients.

Mesotelioma benigno como causa de dolor abdominal inespecífico en un paciente con Enfermedad de Crohn / Benign multicystic peritoneal mesothelioma in a patient with Crohn disease

Benign multicystic peritoneal mesothelioma is an uncommon lesion arising from the peritoneal mesothelium. It is asymptomatic or presents with unspecific symptoms. Imaging techniques may reveal it, however the final diagnosis can only be made by histopathology. Surgery is the only effective treatment considering its high recurrence rate. We report a 19 years old male with Crohn’s disease. Due to persistent abdominal pain, an abdominal magnetic resonance imaging was performed, showing a complex cystic mass in the lower abdomen. The patient underwent surgery and the lesion was completely resected. The pathological study reported a benign multicystic peritoneal mesothelioma.

Hepatotoxicidad por isoniazida en un paciente con enfermedad de Crohn: Reporte de caso y revisión de la literatura / Hepatotoxicity due to Isoniazide in a Patient with Crohn’s Disease: Case Report and Literature Review

La isoniazida se utiliza para el tratamiento o profilaxis de la tuberculosis; sin embargo, su uso puede asociarse con reacciones hepáticas adversas. La hepatitis clínicamente manifiesta sucede en 0,5%-1% de los pacientes que reciben isoniazida como monoterapia. En este artículo se describe el caso de un paciente con enfermedad de Crohn que cursó con hepatotoxicidad grave por isoniazida, y se hace una revisión de la literatura al respecto

Isoniazid is used for treatment or prophylaxis of tuberculosis but may be associated with adverse hepatic reactions. Clinically manifest hepatitis occurs in 0.5%-1% of patients who receive isoniazid as monotherapy. This article describes the case of a patient with Crohn’s disease who experienced severe hepatotoxicity due to isoniazid. It also reviews the literature.

Enfermedad de Crohn fistulizante perianal, manejo médico-quirúrgico / Fistulizing perianal Crohn’s Disease, medical and surgical management

Crohn’s disease (CD) and ulcerative colitis (UC) are immunologically mediated chronic digestive diseases, with a trend to progressive damage, which generally have an onset at young age and a course characterized by remission and relapse. Its incidence and prevalence present a steady upward trend globally. CD is characterized by transmural inflammation in the digestive tract and it is a complex disease. The perianal involvement –“p”, abscesses or perianal fistulas– is considered a condition that is different from penetrating phenotype, a condition that indicates an aggressive behavior of CD. Early identification and proper treatment of fistulas, including correct diagnosis and classification are essential elements to establish an appropriate treatment plan. A multidisciplinary approach is essential including medical and surgical approach.

La Enfermedad de Crohn (EC) y la colitis ulcerosa (CU) son enfermedades digestivas crónicas, progresivas, mediadas inmunológicamente, que en general, tienen un inicio durante la edad adulta-joven y un curso que se caracteriza por remisión y recaída. Su incidencia y prevalencia ha presentado una tendencia constante de incremento a nivel global. La EC se caracteriza por comprimo transmural del tracto digestivo y por ser una patología compleja. El compromiso perianal –“p”, abscesos o fístulas perianales– se considera una condición diferente al fenotipo penetrante, señalándose en la actualidad como una variable modificadora del comportamiento de la patología y de gravedad. La identificación dirigida y precoz de trayectos fistulosos, su correcto diagnóstico y clasificación son elementos primordiales para poder establecer un plan terapéutico apropiado. Es imprescindible un abordaje multidisciplinario, en el cual exista integración médico-quirúrgica.

Experiencia del uso de terapia biológica en pacientes con enfermedad inflamatoria intestinal en un hospital público / Experience in the use of biological therapy in IBD patients in a public hospital

Biological therapy plays an important role in the treatment of inflammatory bowel disease (IBD). However, the use of these drugs is limited due to fears about their side effects. Aim: To report the experience with the use of infliximab/adalimumab in IBD patients in a public hospital. Material and Methods: Descriptive study of a historical cohort of IBD patients treated with infliximab and adalimumab between April 2012 and July 2014. The clinical response was considered favourable when general, intestinal and extra intestinal symptoms subsided after the induction therapy. In addition, endoscopic and/or imaging response was evaluated at three and six months of treatment. Results: Fifteen out of 162 patients, aged 17 to 52 years (7 women) were included. Seven had Crohn´s Disease, 7 had ulcerative colitis and one had non-classifiable IBD. Biological therapy was indicated due to conventional refractory disease in all patients. All patients received combined treatment with immunosuppressive medications. A favorable clinical response was observed in 93 percent after induction therapy and 73 percent showed endoscopic/imagining remission after 3-6 months. Only one patient experienced side effects associated to the biological therapy, which did not result in discontinuation or treatment interruption. Conclusions: In this cohort of IBD patients treated in a public hospital, the use of infliximab/adalimumab was associated with favorable clinical and endoscopic evolution, post induction therapy with no major side effects.

La terapia biológica tiene un papel fundamental en el tratamiento de la enfermedad inflamatoria intestinal (EII). Sin embargo, el uso de estos fármacos es escaso debido a los costos y los temores sobre los efectos secundarios. Objetivo: Dar a conocer la experiencia en el uso de infliximab/adalimumab en pacientes con EII atendidos en un hospital público de nuestro país. Material y Métodos: Estudio descriptivo de una cohorte histórica de pacientes con EII tratados con infliximab y adalimumab entre abril de 2012 y julio de 2014. La respuesta clínica fue considerada favorable cuando los síntomas generales, intestinales y extra-intestinales desaparecieron después de la terapia de inducción. Además se evaluó la respuesta endoscópica/radiológica a los 3 y 6 meses de tratamiento. Resultados: De un total de 162 pacientes con EII, 15 fueron tratados con terapia biológica, con edad entre 17-52 años (7 mujeres). Siete presentaban el diagnóstico de enfermedad de Crohn, siete colitis ulcerosa y uno EII no clasificable. En todos se inició terapia biológica debido a la presencia de refractariedad a la terapia convencional. Todos recibieron terapia combinada con inmunosupresores. Se observó una respuesta clínica favorable en 93 por ciento después de la terapia de inducción y 73 por ciento tuvo una mejoría endoscópica después de 3-6 meses. Sólo un paciente presentó un evento adverso a terapia biológica, el cual no motivó la interrupción del tratamiento. Conclusiones: En esta cohorte de pacientes con EII tratados en un hospital público, el uso de infliximab/adalimumab se asoció con mejoría clínica y endoscópica post terapia de inducción, sin mayores efectos secundarios.

Tratamiento exitoso con certolizumab pegol en un paciente con enfermedad de Crohn fistulizante compleja / Severe fistulizing crohn’s disease successfully treated with certolizumab pegol

Crohn’s disease (CD) is a type of inflammatory bowel disease that may involve every segment of the entire gastrointestinal tract and is characterized by transmural inflammation and formation of granulomas. Its classic presentation is evidenced by fever, abdominal pain and signs of intestinal obstruction, however these signs could vary among patients. Fistulizing CD (FCD) is a less frequent presentation. The clinical signs and symptoms of this form are not characteristic and usually have a more complicated outcome due to the development of sepsis. Certolizumab pegol is a recombinant humanized antibody, targeting the tumor necrosis factor alpha (TNF-alpha), which has been effective in patients with fistulizing CD. In this article, we report a patient with complicated FCD who required 21 month hospitalization due to the presence of multiple fistulae and malnutrition, but who had a successful management with certolizumab pegol.

La enfermedad de Crohn (EC) es un tipo de enfermedad intestinal inflamatoria, que puede comprometer cualquier segmento del tracto gastrointestinal caracterizado por inflamación transmural y formación de granulomas. Su presentación clínica clásica se caracteriza por fiebre, dolor abdominal y signos de obstrucción intestinal, aunque estos signos pueden variar entre cada paciente. La EC fistulizante (ECF) es un tipo de presentación menos frecuente. Los síntomas y signos clínicos no son fácilmente definidos y usualmente se asocian con el desarrollo de sepsis. El certolizumab pegol es un anticuerpo monoclonal recombinante contra el factor de necrosis tumoral alfa. En este artículo se describe la evolución clínica de un paciente con ECF con múltiples complicaciones y quien requirió una hospitalización prolongada durante 21 meses debido a la presencia de múltiples fístulas y desnutrición, quien respondió satisfactoriamente al tratamiento con certolizumab pegol.

Differential analysis of serum proteomics in Crohn’ s disease treated with infliximab / 中国病理生理杂志

AIM:To identify the serum proteins that might serve as biomarkers for predicting mucosal healing ( MH) in the patients with Crohn’ s disease ( CD) treated with infliximab ( IFX) .METHODS:We collected serum sam-ples before treatment (0 week, group A) and 14 weeks after treatment (group B) from 7 CD patients with IFX treatment who had achieved MH, as well as the serum samples from 7 CD patients who had not achieved MH (0 week, group C;14 weeks, group D) .Two-dimensional fluorescence difference gel electrophoresis was applied to analyze and compare the re-sults of serum profiles between groups A and B, C and D, A and C, B and D.Matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry and bioinformatics tools were utilized to preliminarily identify and figure out the dif-ferentially expressed proteins.RESULTS:(1) In total, there were 44 differentially expressed spots, 36, 3, 10 and 31 differentially expressed spots were detected while comparing A with B, C with D, A with C and B with D, respectively. (2) Among those spots, 17, 2, 2 and 15 proteins were identified, respectively.In total, there were 19 differentially ex-pressed proteins, including apolipoprotein E, apolipoprotein A-I, complement factor H, and so on.(3) Protein functional association networks were carried out based on STRING database.CONCLUSION: The serum protein profiles obviously change after IFX treatment in MH CD patients, and the serum protein profiles of MH patients are different from that of non-MH patients after IFX treatment.The 19 proteins we identified may serve as potential biomarkers for predicting MH in CD patients with IFX treatment.

Enfermedad de Crohn. Enfoque diagnóstico y terapéutico de las primeras visitas / Diagnostic and Therapeutic Approaches for First Visits of Patients with Crohn’s Disease

La enfermedad de Crohn (EC) es protagonista fundamental de la llamada enfermedad inflamatoria intestinal (EEI), término con el que se conocen varias entidades cuyo origen es multifactorial y se caracterizan por un fenómeno inflamatorio, crónico, recurrente con diferentes grados de afectación sobre el tubo digestivo; pero además con compromiso potencial de otros órganos. En la última década ha habido un renovado interés en dichas entidades, debido a un auge en medicamentos novedosos, a pesar de lo cual estas siguen siendo incurables. Lo anterior asociado a una incidencia creciente de dicha patología en nuestro país nos obliga tanto científica como moralmente a elaborar unos lineamientos básicos, prácticos con listas de chequeo adaptadas a nuestro medio para el enfoque diagnóstico y seguimiento a través de las primeras consultas del paciente con EC.

Crohn’s disease (CD) is the fundamental protagonist of so-called Inflammatory Bowel Disease (IBD). This is a term by which several entities are known. Its origin is multifactorial. It is characterized by chronic and recurrent inflammation with different degrees of involvement of the gastrointestinal tract, but also with potential commitment of other organs. In the last decade there has been a renewed interest in these entities due to a boom in innovative medicines. Despite these medications, CD and IBD remain incurable. The increasing incidence of CD in our country requires us both scientifically and morally to develop basic, practical guidelines with checklists adapted to our environment for the diagnosis and management of CD through the first consultations of patients.

T300A GENETIC POLYMORPHISM: a susceptibility factor for Crohn?s disease? / Polimorfismo genético T300A: fator de susceptibilidade para doença de Crohn?

Context Crohn’s disease is characterized by a chronic and debilitating inflammatory disorder of the gastrointestinal tract. Several factors may contribute to its development. From extensive studies of the human genome, the polymorphism T300A of the gene ATG16L1 (autophagy-related 16-like 1) has been related to increased risk of developing this disease. Objectives Analyze the role of polymorphism T300A (rs2241880) in patients with Crohn’s disease. Methods 238 samples from (control group) and 106 samples from patients with Crohn’s disease recruited at five Southern Brazilian reference centers were evaluated. The genotyping consisted of the amplification via Polymerase Chain Reaction of the genomic segment encompassing T300A, followed by Restriction Fragment Length Polymorphism analysis. The amplicons and fragments were separated by agarose gel electrophoresis and confirmed under ultraviolet light. Results The genotype AG was more prevalent among patients and controls (50% vs 44.8%), followed by genotypes AA (26.4% vs 35.1%) and GG (23.6% vs 20.1%). The frequency of the allele G of the polymorphism T300A was higher in the group of patients with Crohn’s disease (48.6%) than in controls (42.4%), although not reaching statistical significance. Conclusions It was not possible to confirm the increased susceptibility on development of Crohn’s disease conferred by polymorphism T300A. .

Contexto A doença de Crohn caracteriza-se por uma desordem inflamatória, crônica e debilitante do trato gastrointestinal. Diversos fatores contribuem para seu desenvolvimento. A partir da realização de estudos amplos do genoma, o polimorfismo T300A do gene ATG16L1 (autophagy-related 16-like 1) tem sido relacionado com aumento de susceptibilidade ao desenvolvimento desta doença. Objetivos Analisar a incidência do polimorfismo T300A (rs2241880) em pacientes com doença de Crohn. Métodos Foram analisadas 238 amostras de doadores de sangue (grupo controle) e 106 amostras de pacientes com doença de Crohn, procedentes de cinco centros. A genotipagem consistiu em amplificação do segmento gênico T300A, via reação em cadeia da polimerase, seguidos da análise de polimorfismo de comprimentos dos fragmentos de restrição. Os amplicons e fragmentos foram separados via eletroforese em gel de agarose e visualizados sob luz ultravioleta. Resultados O genótipo AG foi mais prevalente entre os pacientes e controles (50% vs 44,8%), seguido dos genótipos AA (26,4% vs 35,1%) e GG (23,6% vs 20,1%). A freqüência do alelo G do polimorfismo T300A foi maior no grupo de pacientes com doença de Crohn (48,6%) do que nos controles (42,4%), embora sem significância estatística. Conclusões Não foi possível confirmar o aumento de susceptibilidade à doença de Crohn conferido pelo polimorfismo T300A. .

Absceso del psoas en paciente con enfermedad de Crohn / Psoas abscess in a patient with Crohn's disease

La enfermedad de Crohn es una patología crónica que pertenece al grupo de las enfermedades inflamatorias intestinales. Su origen es desconocido, pero se cree que está asociada a un fenómeno inmunitario. Afecta principalmente el intestino delgado, la parte terminal o el íleon. Entre las complicaciones que se pueden presentar se encuentran el absceso del músculo psoas y de la pared intestinal. El absceso de psoas constituye una entidad rara, asociada a diferentes enfermedades, cuyo diagnóstico es realizado mediante tomografía computarizada (TAC) y su tratamiento consiste en el drenaje quirúrgico y administración de antibióticos.

Crohn’s disease is a chronic entity that belongs to the group of inflammatory bowel diseases. It’s etiology is unknown, but is believed to be caused by an immune component. Mainly, this disease affects the small intestine, primarily ileum. Among the complications that can occur, with intestinal manifestations of Crohn’s disease, are abscess in the psoas muscle and in the intestinal wall. Psoas abscess is a rare condition associated with different entities, whose diagnosis is made by CAT scan and its treatment involves surgical drainage and antibiotics.

Variación en el cuidado de pacientes con Enfermedad Inflamatoria Intestinal (EII): resultado de una encuesta / Survey results regarding variations in care of patients with inflammatory bowel disease

Objetivos: determinar, en Colombia, la variación en el cuidado de pacientes con enfermedad inflamatoria intestinal (EII) entre especialistas con experiencia en el manejo de esta entidad. La calidad en el cuidado de nuestros pacientes con EII es el principal mecanismo a través del cual podemos ofrecer un nivel adecuado de atención en salud a nuestra población.Métodos: se realizó un análisis estadístico descriptivo con las respuestas obtenidas de una encuesta con 13 preguntas relacionadas con calidad en el cuidado de pacientes con EII realizada durante el año 2011 a especialistas con interés en el manejo de pacientes con EII.Resultados: cincuenta y siete especialistas en gastroenterología y coloproctología contestaron el cuestionario de 13 preguntas. Dentro de los resultados más interesantes tenemos que 44% de los encuestados utiliza medicamentos 5-ASA tópico como monoterapia para el tratamiento de proctitis ulcerativa leve. 30% utiliza dosis correcta de azatioprina (2,0-2,5 mg/kg). Solo 47% de los especialistas prefieren la terapia biológica de inicio ("top down") en pacientes con Enfermedad de Crohn (EC) fistulizante. 54% realizan vacunación a sus pacientes con EII previo al inicio de terapia inmunosupresora. En cuanto al tabaquismo en EC, 67% consideran que deben suspenderlo pero 21% no dan recomendaciones al respecto. Solo 54% de los encuestados realizan tamizaje para osteoporosis en individuos con EII y uso crónico de esteroides. Por último, en cuanto a tamizaje de cáncer colorrectal en pacientes con EC, el 67% lo realiza similar a las recomendaciones para colitis ulcerativa (CU).Conclusión: existe una gran variabilidad en el manejo y en el cuidado preventivo de pacientes con EII en nuestro medio, esto representa una gran oportunidad para un mejoramiento continuo de nuestra práctica diaria. Es necesaria una mayor adherencia a las guías y recomendaciones internacionales por parte nuestra, para un adecuado manejo de los pacientes con EII.

Tratamiento de la fístula perianal en la enfermedad de Crohn a partir de una experiencia local / Treatment of perianal fistulae in Crohn´s disease: a local experience

Background: Perianal fistula (PF) may be present in 40 percent of patients with Crohn´s Disease (CD). Due to its complexity, its management should be multidisciplinary. Purpose: To describe clinical treatment in patients with CD and PF in our institution. Materials and Methods: This is a descriptive retroprospective study, using a registry of CD patients. We selected patients with PF and further characterized those patients that received their treatment at Clínica las Condes (CLC). Results: From a total of 74 patients with CD in the registry, 23 (31 percent) had PF, 61 percent male, median of 7 years of disease and half with colonic extension. Twelve patients were treated in CLC, from these, seven had concomitant proctitis. Optimal diagnostic study (magnetic resonance imaging/endorectal ultrasound plus examination under anesthetic) was performed in eleven (92 percent) patients. Ten (83 percent) patients received an optimal treatment (drainage and installation of a loose seton + start or optimization of medical therapy). Complete clinical response was achieved in more than half of the patients under optimal treatment within the first 6 months. Six (50 percent) patients had one or more recurrences of PF with similar study and management in a median of 13 months. With a median follow-up of 29 months, eight out of 12 patients had complete clinical response. There was one patient with unfavorable course who required a proctectomy and terminal diversion. Conclusion: Treatment of PF in CD is complex and in our population, the first-line treatment includes the installation of a loose seton and medical therapy to achieve clinical response even though fistulous tracts may persist.

Introducción: La fístula perianal (FP) puede presentarse hasta en 40 por ciento de los pacientes con Enfermedad de Crohn (EC). Dada su complejidad el tratamiento debe ser multidisciplinario. Objetivo: Describir el tratamiento de los pacientes portadores de EC con FP. Métodos: Estudio descriptivo, utilizando un registro de pacientes con EC. Se seleccionaron los pacientes con FP y se caracterizaron aquellos que recibieron el tratamiento en Clínica Las Condes (CLC). Resultados: De un total de 74 pacientes con EC, 23 (31 por ciento) presentaban FP asociada, 61 por ciento de sexo masculino, mediana de duración de enfermedad 7 años y la mitad con extensión colónica. Doce pacientes fueron tratados en CLC, de ellos, siete presentaban proctitis al momento de la FP. En 11 (92 por ciento) pacientes se realizó un estudio diagnóstico óptimo (resonancia magnética/ endosonografía transrrectal y exploración bajo anestesia). Diez (83 por ciento) pacientes recibieron tratamiento óptimo biasociado (drenaje e instalación de sedal no cortante + inicio u optimización de terapia médica). Siete pacientes con tratamiento óptimo presentaron mejoría clínica completa dentro de los primeros 6 meses. Seis (50 por ciento) pacientes presentaron una o más recurrencia de FP con estudio y manejo similar en una mediana de 13 meses. Con una mediana de seguimiento de 29 meses, ocho de los 12 pacientes obtuvieron mejoría clínica completa. Una paciente evolucionó desfavorablemente, requiriendo proctectomía y ostomía terminal. Conclusión: El manejo del FP en EC es complejo, en nuestra población el tratamiento biasociado (sedal + fármacos) fue de elección para lograr una mejoría clínica aun cuando persistieron los trayectos fistulosos.