Position statement of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis on sexuality and inflammatory bowel disease. / Documento de posicionamiento. Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa sobre sexualidad y enfermedad inflamatoria intestinal.

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.

El trasplante de microbiota fecal es un tratamiento sencillo, efectivo y seguro en el manejo de la infección por C. difficile en la práctica clínica diaria / Faecal microbiota transplantation is a simple, effective and safe treatment in the management of C. difficile infection in daily clinical practice

Introducción: El trasplante de microbiota fecal (TMF) es un tratamiento avalado por evidencia científica amplia y muy efectivo en el manejo de la infección por Clostridioides difficile (CD). El objetivo de este estudio es analizar su efectividad y seguridad en un ámbito de práctica clínica real. Métodos: Estudio observacional retrospectivo, unicéntrico y descriptivo, en el que se recogieron todos los TMF realizados entre mayo de 2016 y diciembre de 2020. Se definió como éxito técnico la administración exitosa del preparado fecal en el tracto gastrointestinal del receptor y éxito clínico la desaparición de la diarrea en las primeras 72 h tras el procedimiento y ausencia de recidiva a las ocho semanas. Resultados: Se realizaron 15 TMF a 13 pacientes. La edad media de los pacientes fue de 73 ± 19,4 años (rango: 40 a 98 años); siendo el 60% mujeres. La indicación del TMF fue la colitis recidivante por CD en el 84,6%. Todos los TMF se realizaron por colonoscopia y de donantes emparentados. Con un primer procedimiento, el TMF fue efectivo en 11 de 13 pacientes (84,61%; IC 95%; 54,55-98,07). El tiempo hasta la resolución de los síntomas fue menos de 48 h en todos los casos. El seguimiento postrasplante fue de 25,66 ± 17,5 meses. No se registraron complicaciones precoces ni tardías significativas en el seguimiento. Conclusión: El TMF es un procedimiento sencillo, eficaz y seguro en la infección por CD, incluso en pacientes de edad muy avanzada o con grandes comorbilidades.(AU)

Introduction: Faecal microbiota transplantation (FMT) is a treatment supported by wide scientific evidence and proved to be very effective in the management of Clostridioides difficile (CD) infection. The objective of this study is to analyze its effectiveness and safety in a real clinical practice setting. Methods: Retrospective, single-center and descriptive observational study in which all FMT performed between May 2016 and December 2020 were included. Technical success was defined as the successful administration of the fecal preparation in the patient's gastrointestinal tract and clinical success the disappearance of diarrhea in the first 72 h after the procedure with no relapse within the following 8 weeks after the therapy was started. Results: 15 FMT were performed in 13 patients. The mean age of the patients was 73 ± 19,4 years (range: 40–98 years); being 60% women. The indication for FMT was relapsing colitis due to CD in 84.6%. All FMTs were performed by colonoscopy and from related donors. With a first procedure, the TMF was effective in 11 of 13 patients (84.61%; 95% CI; 54.55–98.07). Time until resolution of symptoms was less than 48h in all cases. Post-transplant follow-up was 25.66 ± 17.5 months. No significant short or long-term complications were recorded at follow-up. Conclusion: TMF is a simple, effective and safe procedure in CD infection, even in elderly patients or those with great comorbidities.(AU)

Treatment With Adalimumab 80 mg Every Other Week in Inflammatory Bowel Disease: Results of Treatment Intensification in Clinical Practice.

Background: Loss of response to anti-tumor necrosis factor drugs in patients with inflammatory bowel disease (IBD) is frequent and, in case of low drug levels, treatment intensification is recommended. In addition, in cases in which clinical response without attainment of remission (clinical, endoscopic, or radiological), intensification could be justified since higher drug levels are associated with better outcomes. For adalimumab (ADA), the standard intensification regimen is 40 mg every week (ew). Availability of ADA 80 mg prefilled pens has enabled every other week (eow) intensification. We assessed the clinical efficacy of intensification with ADA 80 mg eow. Methods: This retrospective study was conducted at a tertiary hospital in Spain. Patients with IBD receiving maintenance ADA 80 mg eow with clinical, biomarker, and drug-level assessments were included. Demographics and clinical, biological, and endoscopic evaluation of the disease before and after ADA intensification, and pharmacokinetic assessments, were collected. Results: Eighty-seven patients (72 Crohn's disease, 15 ulcerative colitis; average age 50 years) were included. Reasons for ADA intensification were: low ADA levels-<5 µg mL-1-(17%), low ADA levels-<5 µg mL-1-without clinical response (63%), clinical response without clinical remission (15%) and active disease on objective evaluation (including colonoscopy, magnetic resonance imaging, capsule endoscopy, and/or intestinal ultrasound; 5%). Following treatment intensification to ADA 80 mg eow, 75 patients (86%) were in clinical remission and 69 (79.3%) were in biologic remission (clinical remission and normalization of biomarkers). After a median follow-up of 19 months (interquartile range 13-25), 63 patients (72%) remained on treatment and in clinical remission. There were no serious infections, hospitalizations, or deaths. Drug costs did not increase with the 80 mg eow regimen versus a standard intensification regimen. Conclusions: ADA intensification to 80 mg eow was safe, effective, and did not increase drug costs versus standard intensification to 40 mg ew in our experience.

Clinical characteristics and prognostic factors for Crohn's disease relapses using natural language processing and machine learning: a pilot study.

BACKGROUND: The impact of relapses on disease burden in Crohn's disease (CD) warrants searching for predictive factors to anticipate relapses. This requires analysis of large datasets, including elusive free-text annotations from electronic health records. This study aims to describe clinical characteristics and treatment with biologics of CD patients and generate a data-driven predictive model for relapse using natural language processing (NLP) and machine learning (ML). METHODS: We performed a multicenter, retrospective study using a previously validated corpus of CD patient data from eight hospitals of the Spanish National Healthcare Network from 1 January 2014 to 31 December 2018 using NLP. Predictive models were created with ML algorithms, namely, logistic regression, decision trees, and random forests. RESULTS: CD phenotype, analyzed in 5938 CD patients, was predominantly inflammatory, and tobacco smoking appeared as a risk factor, confirming previous clinical studies. We also documented treatments, treatment switches, and time to discontinuation in biologics-treated CD patients. We found correlations between CD and patient family history of gastrointestinal neoplasms. Our predictive model ranked 25 000 variables for their potential as risk factors for CD relapse. Of highest relative importance were past relapses and patients' age, as well as leukocyte, hemoglobin, and fibrinogen levels. CONCLUSION: Through NLP, we identified variables such as smoking as a risk factor and described treatment patterns with biologics in CD patients. CD relapse prediction highlighted the importance of patients' age and some biochemistry values, though it proved highly challenging and merits the assessment of risk factors for relapse in a clinical setting.

Los servicios de digestivo en el Sistema Nacional de Salud del siglo XXI. Estándares de organización y funcionamiento para un servicio centrado en el paciente / No disponible

La Sociedad Española de Patología Digestiva ha elaborado un documento de consenso sobre los estándares y recomendaciones que considera fundamentales en la organización de las unidades de digestivo para desarrollar sus actividades con eficiencia y calidad. Se han definido cuatro grupos de procesos clave: la atención al paciente adulto agudamente enfermo, la endoscopia digestiva ambulatoria, la consulta e interconsulta en patología digestiva y la asistencia integral del paciente con patología digestiva crónica compleja. Como procesos de soporte se han identificado la estructura y el funcionamiento de las unidades de digestivo y, como procesos estratégicos, la formación e investigación. Se han elaborado, asimismo, los estándares para algunas unidades funcionales y monográficas de digestivo: Unidad de Endoscopia Digestiva, Unidad de Hepatología y Unidad Multidisciplinar de Enfermedad Inflamatoria Intestinal, así como para determinados procedimientos: colangiopancreatografía retrógrada endoscópica, colonoscopia y gastroscopia. Los estándares serán ampliados a otras unidades y procedimientos en la medida en que se vayan desarrollando. Los estándares elaborados deben ser revisados en el plazo máximo de cinco años

No disponible

Digestive units in the National Health System of the 21st century. Organizational and management standards for a patient-centered service.

The Spanish Society of Digestive Pathology has set a consensus document on the standards and recommendations for gastroenterology units (GU). These standards are considered as relevant in the organization and management of the unit to develop their activities with efficiency and quality. Four key groups of processes have been identified: a) care for the acutely ill adult patient; b) outpatient digestive endoscopy; c) in-hospital support to other services and outpatient clinics; and d) management of patients with chronic complex digestive pathology. Standards for organization and management of the unit were classified within the group of support processes, and training and research as strategic processes. Standards have also been developed for some functional and monographic units such as endoscopy, hepatology and inflammatory bowel disease; as well as for certain procedures including endoscopic retrograde cholangiopancreatography, colonoscopy and gastroscopy. The standards will be set for other units and procedures as they are developed. The standards developed must be reviewed within a maximum period of five years.

Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Española de Patología Digestiva.

INTRODUCTION: In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. OBJECTIVE: The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use. MATERIAL AND METHODS: A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. RESULTS: Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. CONCLUSIONS: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.

Idiopathic portal hypertension regarding thiopurine treatment in patients with inflammatory bowel disease.

INTRODUCTION: The possibility of developing idiopathic portal hypertension has been described with thiopurine treatment despite compromises the prognosis of these patients, the fact its true prevalence is unknown. MATERIAL AND METHODS: A cross-sectional study was conducted in a cohort of inflammatory bowel disease (IBD) patients followed at our unit, to determine the prevalence of diagnosis of idiopathic portal hypertension (IPH) and its relationship with thiopurine treatment. RESULTS: At the time of the analysis, 927/1,419 patients were under treatment with thiopurine drugs (65%). A total of 4 patients with IBD type Crohn's disease with idiopathic portal hypertension probably related to the thiopurine treatment were identified (incidence of 4.3 cases per 1,000). Seventy-five percent of patients started with signs or symptoms of portal hypertension. Only one patient was asymptomatic but the diagnosis of IPH because of isolated thrombocytopenia is suspected. However, note that all patients had thrombocytopenia previously. Abdominal ultrasound with fibroscan, hepatic vein catheterization and liver biopsy were performed on all of them as part of the etiology of portal hypertension. In the abdominal ultrasound, indirect portal hypertension data were observed in all patients (as splenomegaly) cirrhosis was also ruled out. The fibroscan data showed significant liver fibrosis (F2-F3). CONCLUSION: Idiopathic portal hypertension following thiopurine treatment in IBD patients is a rare occurrence, but it must be borne in mind in the differential diagnosis for early diagnosis, especially in patients undergoing thiopurine treatment over a long period. The presence of thrombocytopenia is often the only predictor of its development in the preclinical stage.

Hipertensión portal idiopática secundaria a tratamiento tiopurínico en pacientes con enfermedad inflamatoria intestinal / Idiopathic portal hypertension regarding thiopurine treatment in patients with inflammatory bowel disease

Introducción: entre los efectos adversos hepáticos secundarios al tratamiento tiopurínico en pacientes con enfermedad inflamatoria intestinal (EII), se ha descrito la posibilidad de desarrollar hipertensión portal idiopática. Esta patología de etiología y prevalencia real inciertas puede comprometer el pronóstico de estos pacientes, por lo que se debe tener un alto grado de sospecha para su diagnóstico precoz. Material y métodos: se ha llevado a cabo un estudio transversal en una cohorte de pacientes con EII en seguimiento en nuestra unidad para determinar la prevalencia del diagnóstico de HTP idiopática (HTPI) y su relación con el tratamiento tiopurínico. Resultados: en nuestro centro, en el momento del análisis había 1.419 pacientes en seguimiento por enfermedad inflamatoria intestinal. De estos, 927 pacientes se encuentran bajo tratamiento con fármacos tiopurínicos (o lo han estado durante la evolución de su enfermedad), lo que supone el 65,3% de la población: 689 pacientes con azatioprina (74,3%) y 238 con 6-mercaptopurina (25,7%). En total, se identificaron 4 pacientes con EII tipo enfermedad de Crohn con hipertensión portal idiopática en probable relación con el tratamiento tiopurínico, lo que supuso un 4,3% del total, es decir, una incidencia de 4,3 casos por cada 1.000 pacientes con EII tratados con tiopurínicos. Las características basales de los pacientes se describen en la tabla I. El 75% de los pacientes debutó con signos o síntomas de hipertensión portal: 1 paciente con encefalopatía hepática y 2 pacientes con hemorragia digestiva por varices esofágicas. Solo un paciente se encontraba asintomático, pero se sospechó el diagnóstico de HTP por trombopenia aislada. No obstante, cabe destacar que todos los pacientes presentaban trombopenia previamente aunque no se había sospechado el diagnóstico de HTP a pesar de un exhaustivo estudio. A todos los se realizó ecografía abdominal con fibroscan, cateterismo de venas suprahepáticas, así como biopsia hepática como parte del estudio etiológico de hipertensión portal. En la ecografía abdominal se objetivaron datos indirectos de HTP en todos los pacientes (como esplenomegalia), descartándose asimismo cirrosis hepática. El fibroscan mostraba datos de fibrosis hepática significativa (F2-F3). Además, a todos los pacientes se les realizó una angiorresonancia en la que se descartó trombosis del eje esplenoportal como causa de HTP. Por último, la anatomía patológica de la biopsia hepática descartó la presencia de cirrosis hepática, apoyando el diagnóstico de HTP idiopática (Tabla II). Conclusiones: la hipertensión portal idiopática secundaria a tratamiento tiopurínico en pacientes con enfermedad inflamatoria intestinal es un fenómeno poco frecuente, pero ha de ser tenido en cuenta en el diagnóstico diferencial para un diagnóstico precoz, principalmente en pacientes con tratamiento tiopurínico de larga evolución. La presencia de trombopenia es a menudo el único factor predictor de su desarrollo en fases preclínicas (AU)

Introduction: The possibility of developing idiopathic portal hypertension has been described with thiopurine treatment despite compromises the prognosis of these patients, the fact its true prevalence is unknown. Material and methods: A cross-sectional study was conducted in a cohort of inflammatory bowel disease (IBD) patients followed at our unit, to determine the prevalence of diagnosis of idiopathic portal hypertension (IPH) and its relationship with thiopurine treatment. Results: At the time of the analysis, 927/1,419 patients were under treatment with thiopurine drugs (65%). A total of 4 patients with IBD type Crohn’s disease with idiopathic portal hypertension probably related to the thiopurine treatment were identified (incidence of 4.3 cases per 1,000). Seventy-five percent of patients started with signs or symptoms of portal hypertension. Only one patient was asymptomatic but the diagnosis of IPH because of isolated thrombocytopenia is suspected. However, note that all patients had thrombocytopenia previously. Abdominal ultrasound with fibroscan, hepatic vein catheterization and liver biopsy were performed on all of them as part of the etiology of portal hypertension. In the abdominal ultrasound, indirect portal hypertension data were observed in all patients (as splenomegaly) cirrhosis was also ruled out. The fibroscan data showed significant liver fibrosis (F2-F3). Conclusion: Idiopathic portal hypertension following thiopurine treatment in IBD patients is a rare occurrence, but it must be borne in mind in the differential diagnosis for early diagnosis, especially in patients undergoing thiopurine treatment over a long period. The presence of thrombocytopenia is often the only predictor of its development in the preclinical stage (AU)

Risk factors for Clostridium difficile diarrhea in patients with inflammatory bowel disease.

BACKGROUND: Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors. METHOD: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. RESULTS: Three cases (20%) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67%) received treatment with proton pump inhibitors (PPIs) versus 2 (13%) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in one (14%). Fourteen (93%) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of community-acquired infection (13 patients, 87%), immunosuppressive treatment (7 patients, 47%) and less patients had received previous antibiotic treatment (3 patients, 20%) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66% and 80%, respectively p = 0.266). CONCLUSIONS: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable.

Factores de riesgo de diarrea por Clostridium difficile en pacientes con enfermedad inflamatoria intestinal / Risk factors for Clostridium difficile diarrhea in patients with inflammatory bowel disease

INTRODUCCIÓN: a pesar de la incidencia creciente de diarrea por Clostridium difficile (DCD) en pacientes con enfermedad inflamatoria intestinal (EII) disponemos de un conocimiento limitado de factores de riesgo. MÉTODO: estudio retrospectivo comparando casos de DCD en pacientes con EEI con pacientes portadores de EEI que no desarrollaron DCD. También se realizó una comparación con pacientes que desarrollaron DCD, pero que no padecían EII. RESULTADOS: tres casos (20 %) con EII y DCD habían recibido antibióticos durante los tres meses previos frente a ninguno de los controles (EEI sin DCD, p = 0,22). Diez casos (67 %) estaban recibiendo tratamiento con un inhibidor de la bomba de protones (IBP) frente a dos (13 %) entre los controles (EEI sin DCD, p = 0,001). Se visualizaron pseudomembranas en uno (14 %) de los siete casos en los que se hizo colonoscopia. Hubo respuesta favorable a metronidazol en 14 pacientes (93 %). Los pacientes con EEI y DCD presentaron menor edad (36 ± 10 años), mayor grado de adquisición comunitaria de la infección (13 pacientes, 87 %) y tratamiento inmunosupresor (7 pacientes, 47 %) junto a menos pacientes con tratamiento antibiótico previo (3 pacientes, 20 %) que los pacientes con DCD pero sin EII. La proporción de pacientes que recibían tratamiento con un IBP era similar (66 % y 80 %, respectivamente; p = 0,266). CONCLUSIONES: los casos de DCD en portadores de EEI se caracterizan por afectar a pacientes más jóvenes, mayoritaria adquisición comunitaria (y menor nosocomial), guardar más relación con el tratamiento previo con IBP que con el tratamiento antibiótico y presentar evolución clínica favorable

BACKGROUND: Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors. METHOD: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. RESULTS: Three cases (20 %) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67 %) received treatment with proton pump inhibitors (PPIs) versus 2 (13 %) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in ne (14 %). Fourteen (93 %) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of communityacquired infection (13 patients, 87 %), immunosuppressive treatment (7 patients, 47 %) and less patients had received previous antibiotic treatment (3 patients, 20 %) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66 % and 80 %, respectively p = 0.266). CONCLUSIONS: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable

Utilidad y coste de la cápsula endoscópica. Tres años de experiencia de nuestro centro / Utility and cost of the endoscopic capsule. Three years’ experience in our center

INTRODUCCIÓN: Nuestro objetivo fue evaluar el impacto clínico y la seguridad, así como estimar el gasto de la cápsula endoscópica (CE) en nuestro centro. RESULTADOS: Se analizaron retrospectivamente los estudios realizados en nuestro centro desde el año 2009 hasta 2012. Las indicaciones más frecuentes fueron el estudio de anemia (39%),el estudio de la hemorragia digestiva de origen incierto (HDOO) (19%) y de la enfermedad inflamatoria intestinal (EII) (18%). Se encontraron hallazgos positivos en un 51% de los casos, lo que tuvo impacto clínico en el 36,5%. La EII fue la indicación en la que la CE tuvo mayor impacto clínico (74,5%, p < 0,001). El impacto clínico de la CE en la HDOO o la anemia fue del 41 y el 26%, respectivamente. Una aproximación al gasto de las exploraciones recogidas supone una inversión de al menos 132.600 €; dado que el 63,5% de las exploraciones no tuvo impacto clínico quiere decir que la inversión de hasta 84.200 € no tuvo repercusión en el manejo de los pacientes. En aquellos pacientes que recibieron CE por un cuadro de HDOO se relacionó la realización precoz de la prueba (< 7 días) con la presencia de hallazgos patológicos y de impacto clínico. No se encontraron otros factores epidemiológicos, clínicos o analíticos capaces de predecir la presencia del impacto clínico de la CE en las diferentes indicaciones. CONCLUSIONES: En nuestra experiencia, la realización de la CE tuvo mayor impacto clínico en el estudio de la EII, y de la HDOO si se realiza de forma precoz; por el contrario, sería necesario un esfuerzo en mejorar las indicaciones de CE en el estudio de anemia para conseguir un mayor impacto clínico en este contexto

INTRODUCTION: T he aim of this study was to evaluate the safety, clinical impact and costs associated with capsule endoscopy (CE) in our center. RESULTS: We retrospectively analyzed the CE procedures carried out in our center from 2009 to 2012. The most frequent indications were investigation of anemia (39%), obscure gastrointestinal bleeding (OGIB) (19%) and inflammatory bowel disease (IBD)(18%). Findings were positive in 51% of the patients, which had a clinical impact in 36.5%. The indication in which CE had the greatest clinical impact was IBD (74.5%, p < 0,001). The clinical impact of CE in OGIB and anemia was 41% and 26%, respectively. The procedures performed represented an investment of at least 132 600€; since 63.5% of the procedures had no clinical impact, an investment of 84 200€ had no effect on patient management. In patients who underwent CE for OGIB, early performance of the procedure (< 7 days) was related to the presence of pathological findings and clinical impact. We found no other epidemiological, clinical or analytic factors able to predict the clinical impact of CE in the various indications

[Utility and cost of the endoscopic capsule. Three years' experience in our center]. / Utilidad y coste de la cápsula endoscópica. Tres años de experiencia de nuestro centro.

INTRODUCTION: The aim of this study was to evaluate the safety, clinical impact and costs associated with capsule endoscopy (CE) in our center. RESULTS: We retrospectively analyzed the CE procedures carried out in our center from 2009 to 2012. The most frequent indications were investigation of anemia (39%), obscure gastrointestinal bleeding (OGIB) (19%) and inflammatory bowel disease (IBD)(18%). Findings were positive in 51% of the patients, which had a clinical impact in 36.5%. The indication in which CE had the greatest clinical impact was IBD (74.5%, p<0,001). The clinical impact of CE in OGIB and anemia was 41% and 26%, respectively. The procedures performed represented an investment of at least 132 600€; since 63.5% of the procedures had no clinical impact, an investment of 84 200€ had no effect on patient management. In patients who underwent CE for OGIB, early performance of the procedure (<7 days) was related to the presence of pathological findings and clinical impact. We found no other epidemiological, clinical or analytic factors able to predict the clinical impact of CE in the various indications. CONCLUSIONS: In our experience, CE had the greatest impact in the study of IBD and, if performed early, in OGIB. However, the indications for CE in the study of anemia should be most precisely defined to achieve a greater clinical impact in this disorder.

Riesgo de fenómenos tromboembólicos en pacientes con enfermedad inflamatoria intestinal / Risk of thromboembolic phernoma in patients with inflammatory bowel disease

La enfermedad inflamatoria intestinal (EII) es un factor de riesgo independiente para presentar fenómenos tromboembólicos (FTE). Evaluamos la prevalencia y los posibles factores de riesgo asociados a presentar FTE en pacientes con EII en nuestro centro. Material y métodos Se recogieron los datos de forma retrospectiva desde enero de 1995 hasta diciembre de 2011, obteniendo un total de 23 pacientes. Un 61% había sido diagnosticado de enfermedad de Crohn (EC) y un 39% de colitis ulcerosa (CU) según los criterios habituales. Resultados Utilizando la clasificación de Montreal, el 58% de los pacientes con EC tenía un patrón inflamatorio (B1), el 25% un patrón estenosante (B2) y el 17% un patrón fistulizante (B3). Respecto a la localización, la mitad de los pacientes tenían afectación ileocólica (L3), un tercio afectación cólica (L2) y el resto afectación ileal (L1). Entre los pacientes con CU según la clasificación de Montreal, el 78% sufría una colitis extensa (E3), el 11% tenía afectación de colon izquierdo (E2) y el 11% (..) (AU)

Inflammatory bowel disease (IBD) is an independent risk factor for thromboembolic phenomena (TEP). We evaluated the prevalence and the possible risk factors associated with developing TEP in patients with IBD in our center. Material and methods: Data were retrospectively collected from January 1995 to December2011 from 23 patients. A total of 61% were diagnosed with Crohn’s disease (CD) and 39% with ulcerative colitis (UC) according to routine criteria. Results: When the Montreal classification was used, 58% of the patients with CD had an inflammatory pattern (B1), 25% a stenosing pattern (B2) and 17% a fistulizing pattern (B3). Half the patients had ileocolic involvement (L3), one-third had colonic involvement (L2) and the remainder had ileal involvement (L1). Among patients with UC according to the Montreal classification,78% had extensive colitis (E3), 11% had left colonic involvement (E2) and 11% had proctocolitis (E1). During the event, almost half the patients with UC had severe inflammatory activity (S3;44%), 33% had mild-moderate activity (S1: 22%, S2: 11%) and only 22% were in remission (S0).Overall, at the time of the TEP, 48% of the patients had mild-moderate activity and 22% had severe activity. Likewise, 44% were hospitalized at the time of the event. In UC, an increase in the prevalence of TEP was found in admitted patients (66%). None of the patients had a family history of TEP, two patients (9%) had associated thrombophilia and 26% were active smokers (..) (AU)

[Risk of thromboembolic phenomena in patients with inflammatory bowel disease]. / Riesgo de fenómenos tromboembólicos en pacientes con enfermedad inflamatoria intestinal.

INTRODUCTION: Inflammatory bowel disease (IBD) is an independent risk factor for thromboembolic phenomena (TEP). We evaluated the prevalence and the possible risk factors associated with developing TEP in patients with IBD in our center. MATERIAL AND METHODS: Data were retrospectively collected from January 1995 to December 2011 from 23 patients. A total of 61% were diagnosed with Crohn's disease (CD) and 39% with ulcerative colitis (UC) according to routine criteria. RESULTS: When the Montreal classification was used, 58% of the patients with CD had an inflammatory pattern (B1), 25% a stenosing pattern (B2) and 17% a fistulizing pattern (B3). Half the patients had ileocolic involvement (L3), one-third had colonic involvement (L2) and the remainder had ileal involvement (L1). Among patients with UC according to the Montreal classification, 78% had extensive colitis (E3), 11% had left colonic involvement (E2) and 11% had proctocolitis (E1). During the event, almost half the patients with UC had severe inflammatory activity (S3; 44%), 33% had mild-moderate activity (S1: 22%, S2: 11%) and only 22% were in remission (S0). Overall, at the time of the TEP, 48% of the patients had mild-moderate activity and 22% had severe activity. Likewise, 44% were hospitalized at the time of the event. In UC, an increase in the prevalence of TEP was found in admitted patients (66%). None of the patients had a family history of TEP, two patients (9%) had associated thrombophilia and 26% were active smokers. There were no TEP during pregnancy. Only one patient was taking contraceptive pills when the event occurred. The most frequent forms of TEP were deep vein thrombosis of the legs (55%) followed by pulmonary thromboembolism (25%). CONCLUSIONS: TEP are relatively frequent in patients with IBD, with a strong impact on morbidity and mortality. In our series, risk factors for these events were more extensive involvement (any of the groups) and severe inflammatory activity. No significant association between classical risk factors such as the use of contraceptives, pregnancy, coagulation disorders or smoking and the risk of TEP were found.