ABSTRACT
Resumen Los pacientes con colitis ulcerosa (CU) y enfermedad de Crohn (EC) presentan un mayor riesgo de cáncer colorrectal (CCR), debido a la inflamación crónica, la susceptibilidad genética y los factores de riesgo ambientales. Sin embargo, las neoplasias no epiteliales son infrecuentes. Presentamos el caso de un varón de 83 años con una CU de larga evolución, que presenta una lesión polipoide. Una vez resecada, se diagnosticó de un leiomiosarcoma de alto grado. En la literatura, únicamente se han publicado tres casos previos de leiomiosarcoma en pacientes con CU, por lo que este reporte representaría el cuarto caso. La asociación directa de la CU y el leiomiosarcoma no ha sido bien establecida. No obstante, se sugiere que la inmunosupresión y la inflamación crónica son factores de riesgo.
Abstract Ulcerative colitis (UC) and Crohn's disease (CD) patients present an increased risk of colorectal cancer (CRC) due to chronic inflammation, genetic susceptibility and environmental risk factors. In contrast, non-epithelial neoplasms are uncommon. We discuss the case of an 83-year-old male with a long-standing UC, presenting with a polypoid lesion. Once resected, the lesion was identified as a high-grade leiomyosarcoma. A review of the literature revealed that only three previous cases of leiomyosarcoma among patients with UC have been published. Thus, this one would represent the fourth case where this rare non-epithelial neoplasm was detected in a patient with UC. The direct association of UC and leiomyosarcoma has not been well established; however, immunosuppression is suggested to be a risk factor for leiomyosarcoma in the literature.
Subject(s)
Humans , Male , Aged, 80 and over , Colitis, Ulcerative , Leiomyosarcoma , Colorectal Neoplasms , Crohn Disease , Genetic Predisposition to DiseaseABSTRACT
BACKGROUND: The diagnostic accuracy of the Gaxilose test (GT) for hypolactasia diagnosis has already been proved. The objectives of this clinical trial were to demonstrate the noninferiority of the GT compared to the hydrogen breath test (HBT) on the impact on diagnostic thinking and patient management, to evaluate the GT reproducibility with urine accumulated from 0 to 4âhours and from 0 to 5âhours and to assess test safety. METHODS: We conducted a randomized, parallel, noninferiority clinical trial. Patients with clinical symptoms suggestive of lactose intolerance were screened for inclusion and randomly assigned to the GT arm or the HBT arm of the study. The impact on diagnostic thinking and patient management was analyzed with pretest and posttest questionnaires in which the investigators indicated their estimated probability of hypolactasia diagnosis and the intended management before and after the GT or the HBT (noninferiority margin: -10%). The primary outcome of the study was the impact on diagnostic thinking, expressed as the mean of the absolute values of the differences between the pretest and posttest probabilities of hypolactasia diagnosis. Patients randomized to the GT arm performed also the retest to evaluate the reproducibility of the GT. RESULTS: A total of 147 patients were included in the intend-to-treat (ITT) population. Among them, 74 performed the HBT and 73 performed the GT. The results proved the noninferiority of the GT compared to the HBT on the impact on diagnostic thinking (ImpactGTâ=â31.74â±â23.30%; ImpactHBTâ=â24.28â±â19.87%; ΔGT-HBTâ=â7.46%; 95% confidence interval of ΔGT-HBT: 1.55%, infinite) and on patient management. The test-retest reproducibility was better for the GT with urine accumulated from 0 to 5âh: the intraclass correlation coefficient (ICC) was 0.5761, and the Kappa coefficient was 0.7548, indicative of substantial agreement between both tests. No serious adverse events were reported during the study. CONCLUSIONS: The GT has an impact on diagnostic thinking and patient management noninferior to that of the HBT, is reproducible and well tolerated. These results prove the clinical benefit of its use in the clinical practice (ClinicalTrials.gov identifier: NCT02636413).
