ABSTRACT
No disponible
Subject(s)
Humans , Pregnancy , Middle Aged , Alendronate/adverse effects , Esophagitis/chemically induced , Osteoporosis/drug therapy , Gastroscopy/methods , Bone Density Conservation Agents/adverse effects , Deglutition Disorders/etiologyABSTRACT
INTRODUCCIÓN: Ustekinumab (UST) es un anticuerpo monoclonal frente a IL-12/23 aprobado en España (2017) para tratar el brote moderado/grave de enfermedad de Crohn. OBJETIVO: Evaluar la efectividad y seguridad en práctica clínica real en los pacientes tratados con UST en nuestro centro. MÉTODOS: Estudio prospectivo observacional unicéntrico incluyendo los pacientes que iniciaron UST desde el 1/08/2017 hasta el 28/02/2019 con seguimiento hasta esa fecha. Analizamos respuesta y remisión en semanas 16, 24 y 52, utilizando «Crohn's Disease Activity Index» (respuesta si descenso de 100 puntos y remisión si <150) y la «Valoración Global del especialista» traducción del «Physician's Global Assessment». RESULTADOS: Incluimos 61 pacientes con una mediana de duración de enfermedad de Crohn de 14,6 años (0-36). El 83,6% sin esteroides y el 73,8% sin inmunosupresores asociados. Previamente todos habían recibido anti-TNF y el 14,8%, además, vedolizumab. Observamos buena correlación entre Crohn's Disease Activity Index y Valoración Global del especialista (r = 0,89, p < 0,001). En la semana 16 (n = 45) un 75,6% de respuesta (57,8% remisión), en semana 24 (n = 35) 69,9% respuesta (45,7% remisión) y en semana 52 (n = 12) 75% respuesta (58,3% remisión). No se obtuvieron diferencias estadísticamente significativas en la tasa de respuesta/remisión en semana 16 ni 24 en función del motivo de inicio de UST o el número de biológicos previos. En 2 pacientes se retiró por toxicidad (artralgias/mialgias). CONCLUSIÓN: UST es un fármaco eficaz y seguro en práctica clínica real con altas tasas de remisión clínica en semana 16, 24 y 52 independientemente del orden de biológico utilizado y del motivo de inicio de UST
INTRODUCTION: Ustekinumab (UST) is a monoclonal antibody against IL-12/23 approved in Spain (2017) to treat moderate / severe Crohn's disease. OBJECTIVE: To evaluate the effectiveness and safety in real clinical practice in patients treated with UST in our center. METHODS: This is a prospective observational study including patients who started UST from 08/01/2017 to 02/28/2019 with follow-up up to that date. We analyze response and remission in weeks 16, 24 and 52, using "Crohn's Disease Activity Index" (response if 100 point decrease and remission if <150) and Physician's Global Assessment. RESULTS: We included 61 patients with a median duration of Crohn's disease of 14,6 years (0-36). The 83,6% of patients without steroids and 73,8% without associated immunosuppressors. Previously all patients had received anti-TNF and 14,8%, in addition, vedolizumab. We observed a good correlation between Crohn's Disease Activity Index and Physician's Global Assessment (r = 0,89, p <.001). In week 16 (n = 45) 75,6% response (57,8% remission), in week 24 (n = 35) 69,9% response (45,7% remission) and in week 52 (n = 12) 75% response (58.3% remission). There were no statistically significant differences in the response/remission rates at week 16 or 24 depending on the reason for the onset of UST or the number of previous biologics. In 2 patients it was withdrawn due to toxicity (arthralgia / myalgia). CONCLUSION: UST is an effective and safe treatment in real clinical practice with high rates of clinical remission at week 16, 24 and 52 regardless of the order of biological used and the reason for starting UST
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Ustekinumab/administration & dosage , Crohn Disease/drug therapy , Treatment Outcome , Prospective Studies , C-Reactive Protein/analysisABSTRACT
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Subject(s)
Humans , Female , Adult , Neutropenia/chemically induced , Adalimumab/adverse effects , Infectious Mononucleosis/diagnosis , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab/administration & dosage , Infectious Mononucleosis/drug therapy , Flow Cytometry/methods , Tumor Necrosis Factor-alpha/adverse effectsABSTRACT
INTRODUCTION: Ustekinumab (UST) is a monoclonal antibody against IL-12/23 approved in Spain (2017) to treat moderate / severe Crohn's disease. OBJECTIVE: To evaluate the effectiveness and safety in real clinical practice in patients treated with UST in our center. METHODS: This is a prospective observational study including patients who started UST from 08/01/2017 to 02/28/2019 with follow-up up to that date. We analyze response and remission in weeks 16, 24 and 52, using "Crohn's Disease Activity Index" (response if 100 point decrease and remission if <150) and Physician's Global Assessment. RESULTS: We included 61 patients with a median duration of Crohn's disease of 14,6 years (0-36). The 83,6% of patients without steroids and 73,8% without associated immunosuppressors. Previously all patients had received anti-TNF and 14,8%, in addition, vedolizumab. We observed a good correlation between Crohn's Disease Activity Index and Physician's Global Assessment (r = 0,89, p <.001). In week 16 (n = 45) 75,6% response (57,8% remission), in week 24 (n = 35) 69,9% response (45,7% remission) and in week 52 (n = 12) 75% response (58.3% remission). There were no statistically significant differences in the response/remission rates at week 16 or 24 depending on the reason for the onset of UST or the number of previous biologics. In 2 patients it was withdrawn due to toxicity (arthralgia / myalgia). CONCLUSION: UST is an effective and safe treatment in real clinical practice with high rates of clinical remission at week 16, 24 and 52 regardless of the order of biological used and the reason for starting UST.
Subject(s)
Crohn Disease/drug therapy , Ustekinumab/therapeutic use , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome , Ustekinumab/adverse effectsABSTRACT
Background: Capsule endoscopy was primarily designed for the investigation of the small bowel. However, it may also identify lesions in other segments of the gastrointestinal tract. The aim of the current study was to evaluate the incidence of gastroduodenal abnormalities during small bowel capsule endoscopy and its impact on patient diagnosis and management. Patients and methods: This study is a retrospective analysis of data from 2,217 consecutive capsule endoscopy procedures performed at a single tertiary-care center between January 2008 and February 2016. Patient baseline characteristics, gastroduodenal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was performed. Results: Two thousands and two hundred seventeen patients were finally included in the analysis. One thousand and seventy patients were male (48.2%) and the mean age was 56.1 ± 19.5 years (range: 12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Gastroduodenal abnormalities were detected by capsule endoscopy in 696 (31.4%) of 2,217 patients. The most common types of missed gastric and duodenal lesions found were gastric erosions (35.4%), findings suggestive of chronic gastritis (22.9%), duodenal erosions (28.1%) and duodenal erythema (23.5%). This information had a clinical or diagnostic impact of 26.2% and a therapeutic impact of 15.5%. Conclusion: Capsule endoscopy detects not only small bowel lesions but also some gastroduodenal lesions that may be overlooked during an initial gastroscopy. Therefore, all gastroduodenal images should be read during small bowel capsule endoscopy as it may provide relevant information that result in changes in patient management (AU)
No disponible
Subject(s)
Humans , Capsule Endoscopy/methods , Peptic Ulcer/diagnosis , Capsule Endoscopes/statistics & numerical data , Gastroscopy/methods , Intestine, Small/diagnostic imaging , Retrospective StudiesABSTRACT
BACKGROUND: Capsule endoscopy was primarily designed for the investigation of the small bowel. However, it may also identify lesions in other segments of the gastrointestinal tract. The aim of the current study was to evaluate the incidence of gastroduodenal abnormalities during small bowel capsule endoscopy and its impact on patient diagnosis and management. PATIENTS AND METHODS: This study is a retrospective analysis of data from 2,217 consecutive capsule endoscopy procedures performed at a single tertiary-care center between January 2008 and February 2016. Patient baseline characteristics, gastroduodenal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was performed. RESULTS: Two thousands and two hundred seventeen patients were finally included in the analysis. One thousand and seventy patients were male (48.2%) and the mean age was 56.1 ± 19.5 years (range: 12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Gastroduodenal abnormalities were detected by capsule endoscopy in 696 (31.4%) of 2,217 patients. The most common types of missed gastric and duodenal lesions found were gastric erosions (35.4%), findings suggestive of chronic gastritis (22.9%), duodenal erosions (28.1%) and duodenal erythema (23.5%). This information had a clinical or diagnostic impact of 26.2% and a therapeutic impact of 15.5%. CONCLUSION: Capsule endoscopy detects not only small bowel lesions but also some gastroduodenal lesions that may be overlooked during an initial gastroscopy. Therefore, all gastroduodenal images should be read during small bowel capsule endoscopy as it may provide relevant information that result in changes in patient management.
Subject(s)
Capsule Endoscopy/methods , Duodenal Diseases/diagnostic imaging , Stomach Diseases/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Child , Duodenal Diseases/diagnosis , Duodenal Diseases/therapy , Female , Gastroscopy , Humans , Incidence , Male , Middle Aged , Peptic Ulcer/diagnosis , Peptic Ulcer/diagnostic imaging , Peptic Ulcer/therapy , Retrospective Studies , Stomach Diseases/diagnosis , Stomach Diseases/therapy , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Melanoma/complications , Melanoma/diagnostic imaging , Biopsy , Rectal Neoplasms/diagnostic imaging , Melanoma/pathology , Rectal Neoplasms/pathology , Rectum/anatomy & histology , Rectum/pathology , Anus Neoplasms/pathology , PrognosisABSTRACT
The choledochocele is a cystic dilatation of the intraduodenal portion of the bile duct and corresponds to the type III biliary cysts in the Todani ´s classification. Eventhough the majority of patients remain asymptomatic they can be an atypical cause of abdominal pain or relapsing acute pancreatitis events. The risk of malignancy is lower than other choledochal cyst (<2,5%). The treatment is based on surgical or new endoscopic techniques of resection. In some of the cases an endoscopic sphincterotomy is the first approach.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Choledochal Cyst/diagnostic imaging , Endosonography , Pancreatitis/etiology , Acute Disease , Choledochal Cyst/complications , Choledochal Cyst/therapy , Humans , Middle Aged , RecurrenceABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/therapy , Cholecystectomy , Dilatation, Pathologic , Cholangiopancreatography, Endoscopic Retrograde , Sphincterotomy, Endoscopic , Pancreatitis, Acute Necrotizing , Endosonography/methods , Cholangiography , EndoscopyABSTRACT
A 28-year-old man diagnosed with Charge syndrome and no history of NSAIDs ingestion was referred due to the presentation in the previous 24 h of melenic stools with a negative upper endoscopy. Physical examination was unremarkable, although laboratory tests showed anemia. On the second day, significant painless rectal bleeding and the decrease of hematocrit levels responding to blood transfusion were observed, so colonoscopy was recommended but completely rejected by the patient. Therefore, capsule endoscopy was performed, identifying a saccular image in the terminal ileum suggestive of a Meckel's diverticulum.
Subject(s)
Capsule Endoscopy , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/etiology , Meckel Diverticulum/complications , Meckel Diverticulum/diagnostic imaging , Adult , CHARGE Syndrome/complications , Humans , Male , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage , Meckel Diverticulum/surgery , Meckel Diverticulum , Capsule Endoscopes , Double-Balloon Enteroscopy/trends , Double-Balloon Enteroscopy , Radionuclide Imaging , Sodium Pertechnetate Tc 99m/administration & dosageABSTRACT
Introducción: la inmunodeficiencia común variable (IDCV) conlleva un mayor riesgo de infecciones principalmente respiratorias y digestivas. Se asocia a enfermedades autoinmunes, manifestaciones granulomatosas y neoplasias. La clínica digestiva es muy frecuente, presentando hasta en el 60% de los pacientes diarrea crónica. Clínicamente puede confundirse con otras patologías en las que se incluye la enfermedad inflamatoria intestinal que es infrecuente (2-13%). Caso clínico: presentamos el caso de una paciente con IDCV con clínica digestiva a la que se diagnostica de enfermedad de Crohn-like con afectación ileal extensa. El tratamiento inicial de estos pacientes es igual al de una enfermedad de Crohn típica. Sin embargo en los casos más agresivos como este, el uso de inmunosupresores es imprescindible. La paciente que actualmente se encuentra en remisión con infliximab presentó una reacción adversa previa a adalimumab. Discusión: el número escaso de series hacen que el tratamiento con inmunomoduladores en esta inmunodeficiencia sea un reto diagnóstico y terapéutico (AU)
Common variable immunodeficiency (CVI) gives a major risk of principally respiratory and digestive infections. It is associated with autoimmune diseases, granulomatous process and neoplasias. The digestive clinic is common, in 10% of patients it is the only symptom, and 60 % present chronic diarrhea. Clinically it can be confused and related with other pathologies such as inflammatory bowel disease which is infrequent (2-13%). We present the case of a patient with CVI with digestive symptoms being diagnosed of Crohn-like disease with extent ileal affectation. The main treatment of these patients is the same as classical Crohn disease although in the most severe cases, as this one, the use of immunosupresors is necessary. At this time the patient remains on clinical remmision with infliximab. She presented a previous adverse reaction with adalimumab. The few case series in this pathology makes the treatment with immunomodulators in this immunodeficiency a real diagnostic and therapeutic challenge (AU)
Subject(s)
Humans , Female , Middle Aged , Autoimmune Diseases/complications , Autoimmune Diseases/immunology , Common Variable Immunodeficiency/complications , Common Variable Immunodeficiency/diagnosis , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/diagnosis , Adalimumab/adverse effects , Infliximab/therapeutic use , Immunologic Factors/therapeutic use , Diagnosis, Differential , Endoscopy , ColonoscopySubject(s)
Abdominal Pain/diagnosis , Ascariasis , Biliary Tract Diseases , Endoscopy, Gastrointestinal , Liver/diagnostic imaging , Adult , Animals , Ascariasis/diagnosis , Ascariasis/etiology , Ascariasis/physiopathology , Ascariasis/therapy , Ascaris lumbricoides/isolation & purification , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/parasitology , Biliary Tract Diseases/physiopathology , Biliary Tract Diseases/therapy , Diagnosis, Differential , Duodenoscopes , Endoscopy, Gastrointestinal/instrumentation , Endoscopy, Gastrointestinal/methods , Endosonography/methods , Female , Humans , Treatment OutcomeABSTRACT
Common variable immunodeficiency (CVI) gives a major risk of principally respiratory and digestive infections. It is associated with autoimmune diseases, granulomatous process and neoplasias. The digestive clinic is common, in 10% of patients it is the only symptom, and 60 % present chronic diarrhea. Clinically it can be confused and related with other pathologies such as inflammatory bowel disease which is infrequent (2-13%). We present the case of a patient with CVI with digestive symptoms being diagnosed of Crohn-like disease with extent ileal affectation. The main treatment of these patients is the same as classical Crohn disease although in the most severe cases, as this one, the use of immunosupresors is necessary. At this time the patient remains on clinical remmision with infliximab. She presented a previous adverse reaction with adalimumab. The few case series in this pathology makes the treatment with immunomodulators in this immunodeficiency a real diagnostic and therapeutic challenge.
