Impact and risk factors of non-adherence to 5-aminosalicylates in quiescent ulcerative colitis evaluated by an electronic management system.

BACKGROUND AND OBJECTIVE: To determine the impact of non-adherence to 5-Aminosalicylates (5-ASA) on the risk of flares and to identify risk factors of non-adherence. METHODS: Observational, cohort study of ulcerative colitis (UC) patients in clinical remission at least 6 months on 5-ASA monotherapy maintenance prescribed by an electronic management program. Adherence was considered when 80% of the prescribed 5-ASA had been dispensed at the pharmacy. The study analyzed the existence and degree of 5-ASA adherence, disease course, UC phenotypic expression, and 5-ASA dose and regimen, and consumption of non-UC chronic drugs during 2-year follow-up. RESULTS: The study included 274 patients, 49% males with a median age of 38 (27-49) years old. Overall, 41% of patients were non-adherent to 5-ASA. Risk of flares was reduced in the adherent group (36% vs 54%; OR = 0,484; p = 0,004), mainly the mild ones (26% vs 38%; OR = 0,559; p = 0,031). Non-adherence was associated with younger age at diagnosis (32 (26-45) vs 41.5 (21-50), p = 0.000) and no-consumption of other chronic treatments (1.1 vs 2.1; OR = 1709; p = 0,048). CONCLUSION: Non-adherence to 5-ASA evaluated by the pharmaceutical management system was at 41% with a higher risk of relapse. Younger patients and patients who do not receive non-UC chronic treatments showed lower adherence rate.

Phenotype and natural history of elderly onset inflammatory bowel disease: a multicentre, case-control study.

BACKGROUND: Onset during old age has been reported in upto 10% of total cases of inflammatory bowel disease (IBD). AIM: To evaluate phenotypic characteristics and the use of therapeutic resources in patients with elderly onset IBD. METHODS: Case-control study including all those patients diagnosed with IBD over the age of 60 years since 2000 who were followed-up for >12 months, identified from the IBD databases. Elderly onset cases were compared with IBD patients aged 18 to 40 years at diagnosis, matched by year of diagnosis, gender and type of IBD (adult-onset). RESULTS: One thousand three hundred and seventy-four elderly onset and 1374 adult-onset cases were included (62% ulcerative colitis (UC), 38% Crohn's disease (CD)). Among UC patients, elderly onset cases had a lower proportion of extensive disease (33% vs 39%; P < 0.0001). In CD, elderly onset cases showed an increased rate of stenosing pattern (24% vs 13%; P < 0.0001) and exclusive colonic location (28% vs 16%; P < 0.0001), whereas penetrating pattern (12% vs 19%; P < 0.0001) was significantly less frequent. Regarding the use of therapeutic resources, there was a significantly lower use of corticosteroids (P < 0.0001), immunosuppressants (P < 0.0001) and anti-TNFs agents (P < 0.0001) in elderly onset cases. Regarding surgery, we found a significantly higher surgery rate among elderly onset UC cases (8.3% vs 5.1%; P < 0.009). Finally, elderly onset cases were characterised by a higher rate of hospitalisations (66% vs 49%; P < 0.0001) and neoplasms (14% vs 0.5%; P < 0.0001). CONCLUSIONS: Elderly onset IBD shows specific characteristics and they are managed differently, with a lower use of immunosuppressants and a higher rate of surgery in UC.

Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study.

OBJECTIVES: The aims of this study were to assess the risk of relapse after discontinuation of anti-tumor necrosis factor (anti-TNF) drugs in patients with inflammatory bowel disease (IBD), to identify the factors associated with relapse, and to evaluate the overcome after retreatment with the same anti-TNF in those who relapsed. METHODS: This was a retrospective, observational, multicenter study. IBD patients who had been treated with anti-TNFs and in whom these drugs were discontinued after clinical remission was achieved were included. RESULTS: A total of 1,055 patients were included. The incidence rate of relapse was 19% and 17% per patient-year in Crohn's disease and ulcerative colitis patients, respectively. In both Crohn's disease and ulcerative colitis patients in deep remission, the incidence rate of relapse was 19% per patient-year. The treatment with adalimumab vs. infliximab (hazard ratio (HR)=1.29; 95% confidence interval (CI)=1.01-1.66), elective discontinuation of anti-TNFs (HR=1.90; 95% CI=1.07-3.37) or discontinuation because of adverse events (HR=2.33; 95% CI=1.27-2.02) vs. a top-down strategy, colonic localization (HR=1.51; 95% CI=1.13-2.02) vs. ileal, and stricturing behavior (HR=1.5; 95% CI=1.09-2.05) vs. inflammatory were associated with a higher risk of relapse in Crohn's disease patients, whereas treatment with immunomodulators after discontinuation (HR=0.67; 95% CI=0.51-0.87) and age (HR=0.98; 95% CI=0.97-0.99) were protective factors. None of the factors were predictive in ulcerative colitis patients. Retreatment of relapse with the same anti-TNF was effective (80% responded) and safe. CONCLUSIONS: The incidence rate of inflammatory bowel disease relapse after anti-TNF discontinuation is relevant. Some predictive factors of relapse after anti-TNF withdrawal have been identified. Retreatment with the same anti-TNF drug was effective and safe.

Pancreatitis autoinmune: pseudotumor inflamatorio, afectación multifocal, hipertensión portal y evolución a largo plazo / No disponible

La pancreatitis autoinmune es una enfermedad recientementecaracterizada y que en la actualidad constituye un reto diagnósticoespecialmente su diferenciación con el cáncer de páncreas. Suevolución a largo plazo es poco conocida, presentándose un casoestudiado a lo largo de 14 años y mostrando su evolución clínica,bioquímica y morfológica.Paciente mujer de 54 años que debuta con un cuadro de ictericiaobstructiva y molestias abdominales inespecíficas y constataciónen la TAC de un aumento de la cabeza del páncreas, todoello sugestivo de neoplasia de páncreas. Fue intervenida evidenciándoseun aumento difuso de todo el páncreas descartándosemalignidad intraoperatoriamente, realizando únicamente colecistectomíay coledocoduodenostomía, quedando diagnosticada entoncescomo pancreatitis crónica. Durante los años posterioresfueron apareciendo diferentes procesos autoinmunes como asma,sialoadenitis y colangitis esclerosante secundaria, así como episodiosrecurrentes de ictericia e insuficiencia pancreática endocrinay exocrina. La aparición de estas complicaciones y la detección deniveles séricos elevados de IgG4 y de anticuerpos antianhidrasacarbónica II condujo a la reevaluación de la histología inicial concluyendofinalmente con el diagnóstico de pancreatitis autoinmuneal evidenciarse una infiltración linfocitaria y plasmacitariaIgG4+, así como fibrosis y flebitis obliterativa. En los últimos añosse ha añadido a las anteriores complicaciones una fibrosis retroperitonealcon hipertensión portal, varices esofágicas y esplenomegalia

Autoimmune pancreatitis is a recently characterized diseasethat still constitutes a diagnostic challenge, especially regarding differentialdiagnosis from neoplasia. Long-term outcome is poorlyknown. We herein report a case of a patient with autoimmunepancreatitis and 14 years of follow-up, and show its clinical, biochemical,and morphological characteristics.A 54-year-old female presented with obstructive jaundice andabdominal tenderness, as well as a mass at the pancreatic head ona CT scan, suggestive of pancreatic neoplasia. Surgery showed anincrease of the whole pancreas, malignancy was intraoperativelyruled out, and a cholecystectomy and choledochoduodenostomywere carried out. The diagnosis was chronic pancreatitis. Over thefollowing years different autoimmune complications developed, includingasthma, salivary gland swelling, and sclerosing cholangitis,as well as recurrent episodes of jaundice, and exocrine and endocrinepancreatic failure. The development of these complicationscombined with the demonstration of high serum levels ofIgG4 and carbonic anhydrase II led to a re-evaluation of the initialhistology of the pancreas, leading to a final diagnosis of autoimmunepancreatitis: IgG4+ lymphoplasmacytic infiltrates, fibrosis,and obliterative phlebitis. New complications developed during thelast few years: retroperitoneal fibrosis with portal hypertension,esophageal varices, and splenomegaly

[Autoimmune pancreatitis: inflammatory pseudotumor, multifocal fibrosclerosis, portal hypertension, and long-term outcome]. / Pancreatitis autoinmune: pseudotumor inflamatorio, afectación multifocal, hipertensión portal y evolución a largo plazo.

Autoimmune pancreatitis is a recently characterized disease that still constitutes a diagnostic challenge, especially regarding differential diagnosis from neoplasia. Long-term outcome is poorly known. We herein report a case of a patient with autoimmune pancreatitis and 14 years of follow-up, and show its clinical, biochemical, and morphological characteristics. A 54-year-old female presented with obstructive jaundice and abdominal tenderness, as well as a mass at the pancreatic head on a CT scan, suggestive of pancreatic neoplasia. Surgery showed an increase of the whole pancreas, malignancy was intraoperatively ruled out, and a cholecystectomy and choledochoduodenostomy were carried out. The diagnosis was chronic pancreatitis. Over the following years different autoimmune complications developed, including asthma, salivary gland swelling, and sclerosing cholangitis, as well as recurrent episodes of jaundice, and exocrine and endocrine pancreatic failure. The development of these complications combined with the demonstration of high serum levels of IgG4 and carbonic anhydrase II led to a re-evaluation of the initial histology of the pancreas, leading to a final diagnosis of autoimmune pancreatitis: IgG4+ lymphoplasmacytic infiltrates, fibrosis, and obliterative phlebitis. New complications developed during the last few years: retroperitoneal fibrosis with portal hypertension, esophageal varices, and splenomegaly.

Clinical evaluation of drug-induced hepatitis.

OBJECTIVE: To ascertain the epidemiological characteristics, clinical symptoms, and evolution of drug-induced hepatitis over the last 22 years. EXPERIMENTAL DESIGN AND SUBJECTS: An observational, retrospective study between 1982 and 1993, and prospective study between 1994 and 2003. All patients in our department diagnosed with having drug-induced hepatitis were studied analyzing epidemiological (age, sex, cases per year, hospitalization) and clinical features (previous liver disease, hepatic symptoms, laboratory results), and follow-up (complete recovery or chronicity). RESULTS: A total of 61 patients were diagnosed as having drug-induced hepatitis, 26 men and 35 women (57%), mean age 52.4 years +/- 17 years, of which 72.2% were older than 40 years. A total of 43% were admitted to hospital. In 87% of cases, two or more drugs were involved, the most frequent being antituberculosis (19 cases), psychotropic (26 cases), and non-steroidal anti-inflammatory drugs (45 cases). Evolution showed that 94% of patients recovered after the withdrawal of suspected causal drugs. CONCLUSIONS: The incidence of drug-induced hepatitis is higher in patients over 40 years of age, it being more common in females. Non-steroidal anti-inflammatory, psychotropic, and anti-tuberculosis agents were the main drugs involved. Most patients made a complete recovery after withdrawal of the suspected causal drug.

Evaluación clínica de las hepatitis producidas por fármacos / Clinical evaluation of drug-induced hepatitis

Objetivo: conocer las características epidemiológicas, manifestaciones clínicas y la evolución de las hepatitis producidas por fármacos en los últimos 22 años. Diseño experimental y pacientes: estudio observacional, retrospectivo entre 1982 y 1993 y prospectivo entre 1994 y 2003, donde incluimos todos los pacientes atendidos en nuestro Servicio que fueron diagnosticados de hepatitis por fármacos. Analizamos los factores epidemiológicos -edad, sexo, número de casos por año, ingresos hospitalarios-, clínicos -antecedentes de enfermedad hepática, manifestaciones clínicas-, analíticas y evolutivos -evolución a curación o cronicidad. Resultados: diagnosticamos un total de 61 pacientes con hepatitis por fármacos, 26 hombres y 35 mujeres, con edad media 52.4 ± 17 años y edades superiores a los 40 años en el 72,2%. Se produjo ingreso hospitalario en el 43% de los casos. En la mayoría de los pacientes (87%) existían dos o más fármacos siendo los antiinflamatorios no esteroideos, neurofármacos y antituberculosos, los que con más frecuencia encontramos implicados en la aparición de la enfermedad hepática. La evolución a curación se produce en el 94% de los casos. Conclusiones: las hepatitis por fármacos se presentan más frecuentemente en edades superiores a los 40 años (72%) y en mujeres (57%), siendo los fármacos más frecuentemente implicados los antiinflamatorios (45 casos), neurofármacos (26 casos) y antituberculosos (19 casos). La mayoría de los casos evolucionó a la curación

Objective: to ascertain the epidemiological characteristics, clinical symptoms, and evolution of drug-induced hepatitis over the last 22 years. Experimental design and subjects: an observational, retrospective study between 1982 and 1993, and prospective study between 1994 and 2003. All patients in our department diagnosed with having drug-induced hepatitis were studied analyzing epidemiological (age, sex, cases per year, hospitalization) and clinical features (previous liver disease, hepatic symptoms, laboratory results), and follow-up (complete recovery or chronicity). Results: a total of 61 patients were diagnosed as having drug-induced hepatitis, 26 men and 35 women (57%), mean age 52.4 years ± 17 years, of which 72.2% were older than 40 years. A total of 43% were admitted to hospital. In 87% of cases, two or more drugs were involved, the most frequent being antituberculosis (19 cases), psychotropic (26 cases), and non-steroidal anti-inflammatory drugs (45 cases). Evolution showed that 94% of patients recovered after the withdrawal of suspected causal drugs. Conclusions: the incidence of drug-induced hepatitis is higher in patients over 40 years of age, it being more common in females. Non-steroidal anti-inflammatory, psychotropic, and anti-tuberculosis agents were the main drugs involved. Most patients made a complete recovery after withdrawal of the suspected causal drug