DESCRIPCIÓN DE SUELOS REPRESENTATIVOS DE ÁREAS NATURALES CON PRESENCIA DE POBLACIONES DE CHILE CHILTEPIN / DESCRIPTION OF REPRESENTATIVE SOILS OF NATURAL AREAS WITH PRESENCE OF CHILEAN POPULATIONS CHILTEPIN

En el presente estudio se realizó una selección de cuatro sitios con alta presencia de poblaciones de chile silvestre en un área de 85 km2, correspondiente al municipio de Mocorito, Sinaloa, México. Mediante la observación en campo, se decidió realizar un perfil de suelo en cada uno de los sitios, el cual consistió en la descripción de campo, análisis físico-químico e hidrofísico y la clasificación de los diferentes tipos de suelo. De esta forma se logró identificar un tipo de suelo por cada población de chile silvestre, estos corresponden al tipo de suelo Vertisol, Fluvisol, Leptosol y Feozem.

A selection of four sites was performed with high presence of populations of wild chilli in an area of 85 km2, corresponding to the municipality of Mocorito, Sinaloa, Mexico. Through field observations, it was decided to conduct a soil profile on each of the sites, which consisted in the description field and hidrofísico physicochemical analysis and classification of differents types of soil. Thus was identified a type of soil per population of wild chilli, these correspond to soil type Vertisol, Fluvisol, Leptosol and Feozem.

Diagnostic and treatment recommendations on perianal Crohn's disease.

Treatment of perianal fistulas in Crohn's disease should be defined on an individual basis. A combined medical and surgical approach is the optimal treatment. Adequate management of perianal fistula disease is based on the presence or absence of active proctitis, anatomic location, and fistula type. Furthermore, the presence of perianal abscesses must be ruled out. This evaluation includes digital rectal examination, endoscopy, and examination under anesthesia combined with pelvic magnetic resonance imaging or anorectal endoscopy ultrasonography findings.

Recomendaciones en el manejo diagnóstico y terapéutico de la enfermedad de Crohn fistulosa perianal / Diagnostic and treatment recommendations on perianal Crohn’s disease

El tratamiento de la enfermedad fistulosa perianal (EFPA) en laenfermedad de Crohn (EC) debe de ser individualizado y combinarprocedimientos médicos y quirúrgicos. Los aspectos clave para unadecuado manejo de la EFPA son determinar la existencia o no deafectación rectal, las características anatómicas y tipo de fístulas, ydescartar la existencia de abscesos perianales. Para lograrlo es necesariauna aproximación diagnóstica que incluya inspección ytacto rectal, endoscopia y exploración bajo anestesia combinadocon resonancia magnética pélvica o ecografía anal

Treatment of perianal fistulas in Crohn’s disease should be definedon an individual basis. A combined medical and surgical approachis the optimal treatment. Adequate management of perianalfistula disease is based on the presence or absence of activeproctitis, anatomic location, and fistula type. Furthermore, thepresence of perianal abscesses must be ruled out. This evaluationincludes digital rectal examination, endoscopy, and examinationunder anesthesia combined with pelvic magnetic resonance imagingor anorectal endoscopy ultrasonography findings

Experience with granulocytapheresis in Crohn's disease.

OBJECTIVE: To describe our experience with granulocyte apheresis to induce remission in patients with active Crohn's disease refractory to conventional treatment. We summarize the results previously obtained with this technique. CONCLUSIONS: Granulocyte apheresis is a safe and well tolerated therapeutic modality that can be a valid therapeutic alternative in the induction of remission in inflammatory bowel disease, although controlled clinical trials must be conducted to define long-term efficacy, as well as to establish "optimal patient" selection, re-treatment interval, and number of sessions.

Predictors of response to infliximab in patients with fistulizing Crohn's disease.

OBJECTIVE: To evaluate the efficacy and toxicity of infliximab for the treatment of fistulizing Crohn's disease. METHODS: Consecutive patients with fistulizing Crohn's disease receiving infliximab were prospectively enrolled. Partial response was defined as a reduction of 50% or more from base-line in the number of draining fistulae. Complete response was defined as the closure of all fistulae. The influence of different variables on the efficacy of infliximab was evaluated. RESULTS: 108 patients were included. The disease was inflammatory plus fistulizing in 18% and only fistulizing in 82%. After the third infusion of infliximab the response was partial in 26% and complete in 57%. Response (%) rates (partial/complete) depending on fistula location were: enterocutaneous (25/68%), perianal (35/60%), rectovaginal (36/64%), and enterovesical (20/40%). None of the studied variables (including concomitant immunosuppressive therapy) correlated with efficacy of infliximab in the multivariate analysis. Incidence of adverse effects (21%) depending on the dose of infliximab was: first dose (5.6%), second (7.4%), and third (11.1%). CONCLUSIONS: Infliximab is an efficacious treatment for fistulizing Crohn's disease. Partial response was achieved in approximately one third of the patients, and complete response in more than half. No studied variable was predictive of response. Adverse effects were relatively infrequent and mild.

A continuous spectrum of neutrophilic dermatoses in Crohn's disease.

UNLABELLED: The inflammatory bowel disease is accompanied by cutaneous manifestations in approximately 10% of the cases. Neutrophilic dermatoses are located on the dermis and/or epidermis and are characterised on histological examination by the presence of an infiltrate that consists largely of neutrophils. The prototype of neutrophilic dematoses is Sweetacute;s syndrome; which is rarely associated with Crohns disease. CASE REPORT: A 63 year old woman was admitted to hospital with pyrexia, abdominal pain, episcleritis and skin lesions. She presented erythematous lesions on trunk, legs and arms, with tendency towards formation of plaques, nodules and vesicular pustular lesions. Both the colonoscopy and colonic biopsies confirmed the diagnosis of colonic Crohns disease. Cutaneous biopsies re-vealed an infiltrate consisting mainly of neutrophils. These biopsies, together with clinical details led to the diagnosis of Sweetacute;s syndrome. A methylprednisolone treatment rapidly improved the skin lesions and clinical symptoms. The different clinical forms of neutrophilic dermatosis are an extra intestinal manifestation of Crohns disease, and are some-times found concurrently in the same patient, which would indicate a common pathogenesis with different clinical presentations (spectrum of neutrophilic dermatoses).

Optimización en el tratamiento de formas complica das de la enfermedad inflamatoria intestinal. Enfermedad de Crohn fistulizante / Optimization in the management of complicated forms of the inflammatory bowel disease. Fistulas in Crohn's disease

No disponible

Epidemiología descriptiva de la enfermedad inflamatoria intestinal en España / Descriptive epidemiology of inflammatory bowel disease in Spain

No disponible

Prevalence of mutations of the NOD2/CARD15 gene and relation to phenotype in Spanish patients with Crohn disease.

BACKGROUND: We assessed the prevalence of R702W, G908R, and L1007fs coding mutations in the NOD2/CARD15 gene and the genotype-phenotype relation in Spanish patients with Crohn disease. METHODS: A cohort of 204 unrelated patients with Crohn disease and 140 healthy controls were studied. The phenotype was established before commencement of genotyping. Genotyping of the R702W, G908R, and L1007fs gene polymorphisms of NOD2/CARD15 was performed by two independent laboratories using different techniques. In the case of discordant results, specific sequencing of DNA strands was performed. RESULTS: At least one mutation was present in 32.8% of patients compared to 10.7% in controls (OR = 4.08, 95% CI 2.21 to 7.50). In patients with Crohn disease, the frequency of R702W, G908R, and L1007fs carriers was 13.7%, 8.3%, and 14.2%, respectively. Compound heterozygotes and homozygotes occurred in 3.4% and 2.9% of patients and in none of the controls. The correlation of genotype-Vienna classification showed a significant association with ileal disease (RR = 1.61, 95% CI 1.21-2.15, P = 0.001) and an inverse association with colonic localization (RR = 0.29, 95% CI 0.11-0.80, P = 0.007). There was a significant association between G908R carriership and previous appendectomy, surgical interventions, and stricturing behavior. A gene-dosage effect on phenotypic characteristics was not observed. CONCLUSIONS: In a Spanish population from Madrid, mutations of the NOD2/CARD15 gene were a marker of susceptibility to Crohn disease and were associated with ileal disease. Carriers of the G908R mutation showed a stricturing disease behavior, history of appendectomy, and surgical interventions over the course of the disease.

Infliximab treatment and prognostic factors for response in patients with Crohn's disease.

OBJECTIVE: The aim of this study is to report our experience with infliximab and analyse prognostic factors for response in Crohn's disease (CD). MATERIAL AND METHODS: Consecutive patients were prospectively enrolled in the study when referred for infliximab infusion. Data collected included indication for infusion, patient epidemiological characteristics, Vienna classification, previous surgery, previous medications and extra-intestinal manifestations. Adverse events and clinical response were tabulated separately for patients with luminal or fistulous Crohn's disease. RESULTS: 28 patients were treated (7 with inflammatory and 21 with fistulizing disease). Patients received a total of 116 infusions of infliximab: 57.1% (4 of 7) of patients with luminal disease had complete response within a median of 17.5 days (range 15-28 days), and 62% (13 of 21) of patients with fistulizing disease had complete response within a median of 9 days (range 6-51 days). All patients (5) without relapse received concomitant treatment with immune modifiers. The group of patients with previous resection or perianal fistula repair had complete response more frequently p = 0.03 (OR = 30; IC 95% = 1.47-119.8). CONCLUSIONS: Infliximab is safe and beneficial in clinical practice for Crohn's disease. The re-treatment regimen of infliximab is effective in maintaining clinical response. Immunosuppressant therapy may have a role in the duration of maintained clinical remission in patients with fistulizing disease. In patients with perianal fistulizing disease infliximab treatment is more effective when previous resection or fistula repair is present.

Tratamiento con infliximab y factores predictivos de respuesta en la enfermedad de Crohn / In fliximab treatment and prognostic factors for response in patients with Crohn's disease

Objetivo: describir nuestra experiencia con el infliximab y analizar la existencia de factores predictivos de respuesta en pacientes con enfermedad de Crohn (EC).Material y métodos: estudio longitudinal prospectivo donde se incluyeron consecutivamente a los pacientes tratados con infliximab. Se clasificaron según la indicación del tratamiento, características epidemiológicas, clasificación de Viena, antecedentes de cirugía, tratamientos concomitantes y manifestaciones extraintestinales. Se recogieron los efectos secundarios derivados del tratamiento y los resultados obtenidos durante el seguimiento clínico Resultados: se incluyeron 28 pacientes (7 con enfermedad intraluminal y 21 con enfermedad fistulosa) y se realizaron en total 116 infusiones de infliximab. En el grupo de enfermedad intraluminal respondieron 4 (57,1 por ciento), con una mediana de 17,5 días (15-28). En los enfermos con indicación por enfermedad fistulosa respondieron completamente 13 (62 por ciento) con una mediana de tiempo de 9 días (6-51). Los 5 pacientes en los que no se produjo la reapertura de la enfermedad fistulosa durante el seguimiento estaban concomitantemente con inmunosupresores. No encontramos factores predictivos de respuesta excepto en el grupo de enfermos con enfermedad perianal y antecedentes de cirugías prevías que presentaron con más frecuencia respuesta completa p=0,03 (OR=30; IC 95 por ciento= 1,47-119,8).Conclusiones: el tratamiento con infliximab benefició a un alto porcentaje de pacientes. Es un tratamiento seguro y eficaz. Tiene un importante papel en el mantenimiento de la respuesta en la EC. Los inmusupresores podrían tener un papel en la duración del mantenimiento de la respuesta en la enfermedad fistulizante. En la enfermedad fistulizante perianal se obtienen mejores resultados en la inducción, cuando se ha realizado cirugía previamente (AU)

Nuevas formas de complicaciones hepatobiliares en la enfermedad inflamatoria intestinal crónica / New types of hepatobiliary lesions in inflammatory bowel disease

No disponible

Amino acid polymorphism at residue 71 in HLA-DR beta chain plays a critical role in susceptibility to ulcerative colitis.

The association of ulcerative colitis with distinct HLA-DRB1 alleles has not been easy to ascertain. Recent studies show that among HLA-DR2 alleles, DRB1*15 but not DRB1*16, is associated with the disease. Similarly, in the HLA-DR1 group, only DRB1*0103 is increased in ulcerative colitis patients. The aim of our study was to identify critical DRB1 residues that might account for these differences. We typed 121 patients with ulcerative colitis and 275 controls using gene amplification and sequence-specific oligonucleotide probing for HLA-DRB1 and DRB3. We observed a strong negative association between HLA-DRB1 alleles that encode lysine at position 71 in their beta-chain and susceptibility to ulcerative colitis. Differences in the prevalence among other alleles differing only in the third hypervariable region suggested a hierarchy of susceptible and protective class II alleles related to the presence of an acidic, neutral, or basic amino acid residue at position 71. These data implicate most strongly the amino acid residues in the third hypervariable region of the DRbeta chain, especially DRbeta71, in the association between ulcerative colitis and HLA. However, this does not exclude the contribution of other parts of the molecule and other immunoregulatory genes.

Pancolitis and genetic markers in the Spanish population.

BACKGROUND: although the etiology of ulcerative colitis disease remains an enigma, the importance of the major histocompatibility complex genes has been described, as in many other autoimmune diseases. AIM: we investigated the contribution of HLA-DRB1, DQA1 and DQB1 genes (HLA region) in patients with pancolitis. METHODS: we studied a total of 89 patients diagnosed as having ulcerative colitis (34 pancolitis and 55 left colitis) and 275 healthy control subjects. Complete information on sex, age, family history, age of onset, localization, complications, surgery and treatment was obtained from all patients. DNA was extracted from peripheral blood leukocytes and all individuals were HLA-DRB1 genotyped. RESULTS AND CONCLUSIONS: there was an association between pancolitis and the presence of DR4-Val86 (p = 0.009; OR = 3.3) and DRB1*0103 (p = 0.02; OR = 5.1) alleles. In patients with left colitis an association with DRB1*1501 (p = 0.03; OR = 1.9) and DRB1*0103 alleles (p = 0.03; OR = 3.8) was observed. We conclude that a strong association between DR4-Val86 and pancolitis exists.

HLA-DR2 gene and Spanish patients with ulcerative colitis.

BACKGROUND: An association with class II MHC genes has been described in ulcerative colitis, as in other diseases with immunological pathogenesis. Heterogeneous results have been reported, depending on the studied population. OBJECTIVE: To study the importance of these genes in our population, mainly the alleles of group HLA DR2 (gene HLA-DRB1). PATIENTS AND METHODS: We studied a total of 107 patients diagnosed of ulcerative colitis and 200 unaffected controls. Complete information about sex, age, family antecedent, age of onset, localization, complications, surgery and treatment was obtained from these patients. DNA was extracted from peripheral blood leukocytes and all the individuals were HLA-DRB1 genotyping. RESULTS AND CONCLUSIONS: We conclude that a positive association exists between DR15 and ulcerative colitis (p < 0.05). This positive association was characterized and various clinical parameters were analyzed, being concluded that DR1501 is more frequent in this disease (p < 0.05) and in benign manifestations; the frequency of the allele DR1502 was also found to be elevated in severe manifestations.

Manometry and 24-hour ambulatory pH monitoring at two levels of the esophagus in patients with and without esophagitis.

OBJECTIVE: To define the relationship between esophageal dysmotility and severity of gastroesophageal reflux (GER) at the distal and proximal levels. METHODS: Two-level, 24-hour ambulatory pH monitoring and manometry of the esophagus were performed in 40 patients with abnormal distal acid exposure and in 20 healthy controls. Twenty patients with normal endoscopy or endoscopic evidence of grade I esophagitis were assigned to group 1 and 20 with grade II-III esophagitis were assigned to group 2. We used a dual-site pH probe with antimony electrodes spaced 15 cm apart. RESULTS: Patients had greater acid exposure than controls at both levels. The percentage of distal reflux episodes reaching proximal esophagus was significantly greater in group 1 than in the control group. The most marked reductions in the percentage of time of the pH remaining under 4 were detected in the patients with the most severe distal acid reflux and esophagitis (group 2). The mean lower esophageal sphincter pressure was significantly lower in group 2 than in group 1. The percentage of tertiary waves or nonperistaltic contractions was significantly higher in group 2 than in group 1 and the control group. Patients with milder distal reflux had significantly lower distal and middle esophageal wave amplitudes than controls. There were no significant differences between controls and patients with severe esophagitis in terms of the esophageal peristaltic wave amplitude in the middle third of the esophagus. CONCLUSIONS: No correlation was observed between episodes of distal reflux and proximal reflux in GER patients. Esophageal motor activity appears to be an important determinant of the severity and extension of GER in the proximal esophagus.