ABSTRACT
It is widely acknowledged that inflammatory bowel disease (IBD) is associated with a high prevalence of sexual dysfunction (SD). However, there is a notable paucity of specific literature in this field. This lack of information impacts various aspects, including the understanding and comprehensive care of SD in the context of IBD. Furthermore, patients themselves express a lack of necessary attention in this area within the treatment of their disease, thus creating an unmet need in terms of their well-being. The aim of this position statement by the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) is to provide a review on the most relevant aspects and potential areas of improvement in the detection, assessment, and management of SD in patients with IBD and to integrate the approach to sexual health into our clinical practice. Recommendations are established based on available scientific evidence and expert opinion. The development of these recommendations by GETECCU has been carried out through a collaborative multidisciplinary approach involving gastroenterologists, gynecologists, urologists, surgeons, nurses, psychologists, sexologists, and, of course, patients with IBD.
ABSTRACT
Antecedentes y objetivo: Las guías clínicas de colitis ulcerosa (CU) recogen la mejor evidencia disponible, aunque no todas las situaciones clínicas quedan respondidas, por lo que su manejo puede ser motivo de controversia. El objetivo de este estudio es identificar las situaciones de la CU leve a moderada susceptibles de controversia y evaluar el grado de acuerdo o desacuerdo a propuestas concretas. Métodos: Mediante reuniones de debate de expertos en enfermedad inflamatoria intestinal (EII) se identificaron criterios, actitudes y opiniones respecto al manejo de la CU. A continuación se elaboró un cuestionario Delphi con 60 aseveraciones relativas a antibióticos, salicilatos y probióticos, corticoides locales, sistémicos y tópicos e inmunosupresores. Resultados: Se alcanzó consenso en 44 aseveraciones (73,3%); 32 en el acuerdo (53,3%) y 12 en el desacuerdo (20,0%). Algunos de ellos fueron: no es necesario el uso sistemático de antibióticos a pesar de la gravedad del brote, quedando reservados ante la sospecha de infección o toxicidad sistémica; ante un brote leve-moderado de CU y en pacientes que no responden a aminosalicilatos es adecuado utilizar una dosis de beclometasona de 10mg/día durante un mes y 5mg/día durante otro mes; se aconseja que la dosis de azatioprina se administre en una única dosis. Conclusiones: Los expertos en EII coinciden en la mayoría de las propuestas identificadas para manejar la CU leve a moderada y se constata la necesidad de evidencia científica en algunas situaciones concretas en las que conocer la opinión de expertos puede resultar de ayuda. (AU)
Background and objective: Ulcerative colitis (UC) clinical guidelines include the best available evidence, although not all clinical situations are answered, so their management can be controversial. The aim of this study is to identify the situations of mild to moderate UC susceptible to controversy and to evaluate the degree of agreement or disagreement with specific proposals. Methods: Inflammatory bowel disease (IBD) expert discussion meetings were used to identify criteria, attitudes and opinions regarding the management of UC. A Delphi questionnaire was then developed with 60 items regarding antibiotics, salicylates and probiotics; local, systemic and topical corticosteroids; and immunosuppressants. Results: Consensus was reached in 44 statements (73.3%); 32 in agreement (53.3%) and 12 in disagreement (20.0%). Some of them were: it is not necessary the systematic use of antibiotics despite the severity of the outbreak, being reserved when there is suspicion of infection or systemic toxicity; when faced with a mild-moderate outbreak of UC and in patients who do not respond to aminosalicylates, it is appropriate to use a dose of beclomethasone of 10mg/day for one month and 5mg/day for another month; it is advised that the dose of azathioprine be administered in a single dose. Conclusions: IBD experts agree on most of the proposals identified for managing mild to moderate UC and there is a need for scientific evidence in some specific situations where expert opinion may be helpful. (AU)
Subject(s)
Humans , Inflammatory Bowel Diseases , Colitis, Ulcerative/drug therapy , Anti-Bacterial Agents/therapeutic use , Delphi Technique , ConsensusABSTRACT
BACKGROUND AND OBJECTIVE: Ulcerative colitis (UC) clinical guidelines include the best available evidence, although not all clinical situations are answered, so their management can be controversial. The aim of this study is to identify the situations of mild to moderate UC susceptible to controversy and to evaluate the degree of agreement or disagreement with specific proposals. METHODS: Inflammatory bowel disease (IBD) expert discussion meetings were used to identify criteria, attitudes and opinions regarding the management of UC. A Delphi questionnaire was then developed with 60 items regarding antibiotics, salicylates and probiotics; local, systemic and topical corticosteroids; and immunosuppressants. RESULTS: Consensus was reached in 44 statements (73.3%); 32 in agreement (53.3%) and 12 in disagreement (20.0%). Some of them were: it is not necessary the systematic use of antibiotics despite the severity of the outbreak, being reserved when there is suspicion of infection or systemic toxicity; when faced with a mild-moderate outbreak of UC and in patients who do not respond to aminosalicylates, it is appropriate to use a dose of beclomethasone of 10mg/day for one month and 5mg/day for another month; it is advised that the dose of azathioprine be administered in a single dose. CONCLUSIONS: IBD experts agree on most of the proposals identified for managing mild to moderate UC and there is a need for scientific evidence in some specific situations where expert opinion may be helpful.
Subject(s)
Colitis, Ulcerative , Inflammatory Bowel Diseases , Humans , Colitis, Ulcerative/drug therapy , Consensus , Delphi Technique , Anti-Bacterial Agents/therapeutic useABSTRACT
The model for approaching inflammatory bowel disease (IBD) has been modified, and a paradigm has been established with terms that define new strategies and perceptions. The present issue of Revista Española de Enfermedades Digestivas exemplifies this by recording the primary initiatives that have led to changes: new goals, patient at the center of the care model, and sensitivity to patient limitations.
Subject(s)
Inflammatory Bowel Diseases/therapy , Patient-Centered Care , Health Surveys , Humans , Inflammatory Bowel Diseases/pathology , Inflammatory Bowel Diseases/psychology , Patient Reported Outcome MeasuresABSTRACT
The Susac's syndrome is a rare disorder that was first described in 1979 and is characterized by a classic triad consisting in encephalopathy, visual impairment and sensorineural hearing loss. However, the etiology of the disease is still unclear. We report the case of a 29-year-old with ulcerative colitis treated with mercaptopurine, six months before to her admission started with personality changes attributed to symptoms of depression who subsequently present neurological symptoms characteristic of Susac's Syndrome. In the literature there is no clear association between inflammatory bowel disease and Susac's -syndrome, but this case is presented in order to emphasize the simultaneous presentation of these two diseases with a tendency to vasospasm and an autoimmune pathogenesis.
Subject(s)
Colitis, Ulcerative/complications , Susac Syndrome/complications , Adult , Female , Hearing Loss, Sensorineural/etiology , Humans , Magnetic Resonance Imaging , Susac Syndrome/diagnosis , Susac Syndrome/drug therapyABSTRACT
La infusión continua de levodopa/carbidopa intraduodenal es un tratamiento eficaz que mejora las complicaciones motoras y la calidad de vida de los pacientes con enfermedad de Parkinson avanzada. Sin embargo, no está exento de complicaciones. Éstas pueden presentarse en el postoperatorio de la cirugía (gastrostomía) o a largo plazo durante el seguimiento, y pueden estar relacionadas con la medicación (levodopa/carbidopa), el estoma, la gastrostomía o el dispositivo (bomba, sonda enteral, piezas del sistema FREKA). El objetivo de la presente revisión es describir el manejo de las complicaciones que pueden presentar los pacientes con enfermedad de Parkinson avanzada tratados con infusión continua de levodopa/carbidopa intraduodenal (AU)
Continuous infusion of intraduodenal levodopa/carbidopa is an effective treatment that improves the motor complications and the quality of life of patients in the advanced stages of Parkinsons disease. However, it is not free of complications. These may present in the post-operative period following surgery (gastrostomy) or in the long-term during the follow-up period and can be related with the medication (levodopa/carbidopa), the stoma, the gastrostomy or the device (pump, enteral tube, parts of the FREKA system). The aim of this review is to report on the management of the complications that can be observed in patients with advanced Parkinsons disease treated with continuous infusion of intraduodenal levodopa/carbidopa (AU)
Subject(s)
Humans , Parkinson Disease/drug therapy , Levodopa/administration & dosage , Gastrostomy/adverse effects , Carbidopa/administration & dosage , Postoperative Complications/epidemiology , /epidemiology , Infusion Pumps/adverse effectsABSTRACT
Continuous infusion of intraduodenal levodopa/carbidopa is an effective treatment that improves the motor complications and the quality of life of patients in the advanced stages of Parkinson's disease. However, it is not free of complications. These may present in the post-operative period following surgery (gastrostomy) or in the long-term during the follow-up period and can be related with the medication (levodopa/carbidopa), the stoma, the gastrostomy or the device (pump, enteral tube, parts of the FREKA system). The aim of this review is to report on the management of the complications that can be observed in patients with advanced Parkinson's disease treated with continuous infusion of intraduodenal levodopa/carbidopa.
TITLE: Manejo de las complicaciones relacionadas con la infusion intraduodenal de levodopa/carbidopa en pacientes con enfermedad de Parkinson.La infusion continua de levodopa/carbidopa intraduodenal es un tratamiento eficaz que mejora las complicaciones motoras y la calidad de vida de los pacientes con enfermedad de Parkinson avanzada. Sin embargo, no esta exento de complicaciones. Estas pueden presentarse en el postoperatorio de la cirugia (gastrostomia) o a largo plazo durante el seguimiento, y pueden estar relacionadas con la medicacion (levodopa/carbidopa), el estoma, la gastrostomia o el dispositivo (bomba, sonda enteral, piezas del sistema FREKA). El objetivo de la presente revision es describir el manejo de las complicaciones que pueden presentar los pacientes con enfermedad de Parkinson avanzada tratados con infusion continua de levodopa/carbidopa intraduodenal.
