Gastroenterologia y hepatologia最新文献

{"title":"Evaluation of the sensitivity and specificity of sigmoidoscopy in comparison to colonoscopy regarding the detection of intestinal inflammatory activity in the follow-up of patients with ulcerative colitis.","authors":"Paula Calderón, Paulina Núñez, Karin Herrera, Lilian Flores, Andrea Córdova, Francisca Carvajal, Rodrigo Quera","doi":"10.1016/j.gastrohep.2024.502232","DOIUrl":"10.1016/j.gastrohep.2024.502232","url":null,"abstract":"<p><strong>Introduction: </strong>Ulcerative colitis (UC) is a chronic disease characterized by periods of inflammatory activity and remission, which vary from the rectum to the proximal colon. Currently, mucosal healing is a long-term goal in the management of inflammatory bowel disease, with colonoscopy and sigmoidoscopy being the recommended tools for evaluation.</p><p><strong>Objective: </strong>To assess the effectiveness of both examinations in determining the presence of inflammatory activity in the follow-up of patients with UC.</p><p><strong>Methods: </strong>Retrospective observational study analyzing colonoscopies performed as part of the follow-up of UC patients between January 2021 and July 2023 by gastroenterologists from the Inflammatory Bowel Disease Program at the Clínica Universidad de los Andes. The study compared endoscopic and histological activity observed in the rectosigmoid region with that found in the rest of the colon. Sensitivity and specificity were determined using concordance and correlations tests.</p><p><strong>Results: </strong>A very good concordance and correlation were observed regarding endoscopic findings, with a Kappa index of 0.97 and a Spearman coefficient of 0.97. The Positive Predictive Value (PPV) of sigmoidoscopy for endoscopic activity was 1, and the Negative Predictive Value (NPV) was 0.96. In relation to histological activity, the concordance had a Kappa index of 0.93 and a Spearman coefficient of 0.93, with a PPV of sigmoidoscopy for histological activity being 1 and an NPV of 0.91.</p><p><strong>Conclusion: </strong>This cohort suggests that sigmoidoscopy is a cost-effective option for evaluating mucosal healing in UC patients in symptomatic and biomarker remission. However, complete colonoscopy should be considered in cases of discrepancies with the clinical picture or in colorectal cancer surveillance.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of severe hypertriglyceridemia through therapeutic plasma exchange in patients with acute pancreatitis or at risk of developing it.","authors":"Eva Marín-Serrano, Ana Kerguelen Fuentes, Rubén Fernández-Martos, José Mostaza Prieto, Aurora Viejo Llorente, Ana Barbado Cano, Pedro Luis Martínez Hernández, María Dolores Martín-Arranz","doi":"10.1016/j.gastrohep.2024.502229","DOIUrl":"10.1016/j.gastrohep.2024.502229","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>TPE drastically reduces serum triglyceride (sTG), but its role in the treatment of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) or at risk of developing it, is not well established. The objectives were to assess the effectiveness and safety of TPE in the treatment of severe HTG (sHTG), as well as to evaluate the severity of HTG-AP treated with TPE.</p><p><strong>Materials and methods: </strong>Observational-retrospective-single-center study, in which a descriptive analysis of sHTG treated with TPE was conducted, with the aim of treating HTG-AP or preventing its recurrence. TPE was performed if sTG≥ 1000 mg/dL after 24 hours of admission.</p><p><strong>Results: </strong>42 TPE were performed to treat 35 sHTG in 23 patients: 29 HTG-AP, and 6 sHTG with previous HTG-AP. Among the patients, 37% (13/55) were women, with 37 ± 14 years-old, 74.3% had normal BMI (25/35), 34% (12/35) were drinking > 40 g/alcohol/day and 54% (19/35) were diabetics. TPE significantly reduced the baseline sTG (4425 ± 2782 mg/dL vs. 709 ± 353 mg/dL, p < 0.001) in a single session, achieving a mean percentage reduction of 79 ± 13%; 20% (7/35) of sHTG cases required two TPE sessions to reduce sTG to < 1000 mg/dL. Adverse effects were reported in 4/42 TPE sessions (9,5%). sHTG-AP was observed in 3% of cases (1/29), and there were no deaths. sTG at 24 hours of admission showed no relation with the severity of APs.</p><p><strong>Conclusion: </strong>The treatment of sHTG with TPE, with the aim of treating HTG-AP or preventing its recurrence, reduces sTG quickly and safety.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strongyloides stercolaris hyperinfection syndrome in ulcerative colitis treated with corticotherapy: The importance of strongyloides screening.","authors":"Marc Vidal-Delso, Marta Fortuny, Laura González-González, Anna Pèlach, Laura Soldevila, Sílvia Roure-Díez, Míriam Mañosa, Eugeni Domènech","doi":"10.1016/j.gastrohep.2024.502230","DOIUrl":"10.1016/j.gastrohep.2024.502230","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric gallstone disease-Management difficulties in clinical practice.","authors":"Ana Losa, Gisela Silva, Sara Mosca, Berta Bonet, Helena Moreira Silva, Ermelinda Santos Silva","doi":"10.1016/j.gastrohep.2024.502228","DOIUrl":"10.1016/j.gastrohep.2024.502228","url":null,"abstract":"<p><strong>Background: </strong>Gallstone disease (GD) is no longer an exclusive condition of adulthood, and its prevalence is increasing in pediatric age. The management and the extent of the etiological investigation of GD in children and adolescents remains controversial. This study aimed to analyze the difficulties in the work-up and management of pediatric GD patients.</p><p><strong>Methods: </strong>A retrospective study performed in a single tertiary center enrolled sixty-five patients with GD followed from January 2014 to June 2021. Patients were categorized conveniently according to their age at diagnosis: Group A (<10years, n=35) and Group B (≥10years, n=30). We analyzed demographic, clinical and laboratory data, ultrasonographic findings at presentation, therapeutics and complications.</p><p><strong>Results: </strong>Symptoms were more frequent in patients >10years old (p=0.001). Cholecystectomy was performed in 31 patients (47.7%). A multivariate regression logistic model identified the age >10years (OR=6.440, p=0.005) and underlying entities (OR=6.823, p=0.017) as independent variables to perform surgery. Spontaneous resolution of GD was more common in children <2years old. A multivariate regression logistic model showed a trend for those >10years old to develop more complications. Two out of 18 patients were diagnosed with ABCB4 gene mutations in heterozygosity.</p><p><strong>Conclusions: </strong>Decision-making on cholecystectomy remains challenging in asymptomatic patients. Identifying predictive factors for the development of complications has proven difficult. However, we found a trend toward the development of complications in individuals older than 10years.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The phenotypic landscape of primary biliary cholangitis and autoimmune hepatitis variants.","authors":"Francesca Bolis, Giorgio Cazzaniga, Fabio Pagni, Pietro Invernizzi, Marco Carbone, Alessio Gerussi","doi":"10.1016/j.gastrohep.2024.502225","DOIUrl":"10.1016/j.gastrohep.2024.502225","url":null,"abstract":"<p><p>Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) stand as distinct diseases, yet occasionally intertwine with overlapping features, posing diagnostic and management challenges. This recognition traces back to the 1970s, with initial case reports highlighting this complexity. Diagnostic scoring systems like IAIHG and simplified criteria for AIH were introduced but are inherently limited in diagnosing variant syndromes. The so-called Paris criteria offer a diagnostic framework with high sensitivity and specificity for variant syndromes, although disagreements among international guidelines persist. Histological findings in AIH and PBC may exhibit overlapping features, rendering histology alone inadequate for a definitive diagnosis. Autoantibody profiles could be helpful, but similarly cannot be considered alone to reach a solid and consistent evaluation. Treatment strategies vary based on the predominant features observed. Individuals with overlapping characteristics favoring AIH ideally benefit from corticosteroids, while patients primarily manifesting PBC features should initially receive treatment with choleretic drugs like ursodeoxycholic acid (UDCA).</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-assisted identification and retrieval of chronic hepatitis C patients lost to follow-up in the health area of Pontevedra and O Salnés (Spain).","authors":"Pablo Parada Vázquez, Santiago Pérez-Cachafeiro, Belén Castiñeira Domínguez, Juan Manuel González-Pérez, José Manuel Mera Calviño, Raquel Souto-Rodríguez, Yolanda Falagán Cachafeiro, Indhira Pérez-Medrano, Nuria Vázquez-Temprano, Matilde Trigo, Alba Carrodeguas, José Luis González-Sánchez, Carmen Durán-Parrondo, Juan Turnes","doi":"10.1016/j.gastrohep.2024.502226","DOIUrl":"10.1016/j.gastrohep.2024.502226","url":null,"abstract":"<p><strong>Objective: </strong>Direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) infection offer an opportunity to eliminate the disease. This study aimed to identify and relink to care HCV patients previously lost to medical follow-up in the health area of Pontevedra and O Salnés (Spain) using an artificial intelligence-assisted system.</p><p><strong>Patients and methods: </strong>Active retrospective search of previously diagnosed HCV cases recorded in the Galician Health Service proprietary health information exchange database using the Herramientas para la EXplotación de la INformación (HEXIN) application.</p><p><strong>Results and conclusions: </strong>Out of 99 lost patients identified, 64 (64.6%) were retrieved. Of these, 62 (96.88%) initiated DAA treatment and 54 patients (87.1%) achieved a sustained virological response. Mean time from HCV diagnosis was over 10 years. Main reasons for loss to follow-up were fear of possible adverse effects of treatment (30%) and mobility impediments (21%). Among the retrieved patients, almost one in three presented advanced liver fibrosis (F3) or cirrhosis (F4) at evaluation. In sum, HCV patients lost to follow-up can be retrieved by screening past laboratory records. This strategy promotes the achievement of HCV elimination goals.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legal Aspects Related To The Use Of Artificial Intelligence In Medical Science.","authors":"Carlos Alventosa Mateu, Robert Giner Alventosa, María Lorena Tobar Peñaherrera","doi":"10.1016/j.gastrohep.2024.502227","DOIUrl":"10.1016/j.gastrohep.2024.502227","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Hepatitis Delta in Spain and the gaps in its management.","authors":"Sergio Rodríguez-Tajes, Adriana Palom, Álvaro Giráldez-Gallego, Antonio Moreno, Juan José Urquijo, Manuel Rodríguez, Marta Alvarez-Argüelles, Moisés Diago, María García-Eliz, Javier Fuentes, Ana María Martínez-Sapiña, Pilar Castillo, Marta Casado, Elena Pérez-Campos, Raquel Muñoz, Marta Hernández-Conde, Rosa María Morillas, Rafael Granados, Mireia Miquel, María Julia Morillas, Monserrat García-Retortillo, Jose Antonio Carrión, José María Moreno, Cristina Montón, Jesús Manuel González-Santiago, Sara Lorente, Joaquín Cabezas, Beatriz Mateos, Sergio Vázquez-Rodríguez, Fernando Díaz-Fontenla, José María Pinazo, Mercè Delgado, Domingo Pérez-Palacios, Diana Horta, Cristina Fernández-Marcos, Carmen López, José Luis Calleja, Inmaculada Fernández, Javier García-Samaniego, Xavier Forns, María Buti, Sabela Lens","doi":"10.1016/j.gastrohep.2024.502222","DOIUrl":"10.1016/j.gastrohep.2024.502222","url":null,"abstract":"<p><strong>Background and aims: </strong>Chronic hepatitis D (CHD) is a severe form of chronic viral hepatitis. The estimated hepatitis delta prevalence in Spain is around 5% of patients with hepatitis B. Reimbursement of new antiviral therapies (Bulevirtide, BLV) was delayed in our country until February 2024. We aimed to characterize the clinical profile of patients with HDV/HBV infection in Spain and current barriers in their management at the time of BLV approval.</p><p><strong>Method: </strong>Multicenter registry including patients with positive anti-HDV serology actively monitored in 30 Spanish centers. Epidemiological, clinical and virological variables were recorded at the start of follow-up and at the last visit.</p><p><strong>Results: </strong>We identified 329 anti-HDV patients, 41% were female with median age 51 years. The most common geographical origin was Spain (53%) and East Europe (24%). Patients from Spain were older and had HCV and HIV coinfection probably associated to past drug injection (p<0.01). HDV-RNA was positive in 138 of 221 assessed (62%). Liver cirrhosis was present at diagnosis in 33% and it was more frequent among viremic patients (58% vs 25%, p<0.01). After a median follow-up of 6 (3-12) years, 44 (16%) resolved infection (18 spontaneously and 26 after Peg-INF). An additional 10% of patients developed cirrhosis (n=137) during follow-up (45% had portal hypertension and 14% liver decompensation). Liver disease progression was associated to persisting viremia.</p><p><strong>Conclusion: </strong>One-third of the patients with CHD already have cirrhosis at diagnosis. Persistence of positive viremia is associated to rapid liver disease progression. Importantly, barriers to locally determine/quantify HDV-RNA were present.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Search for small-bowel capsule diagnostic yield optimization conducted through observational analysis.","authors":"Benito Velayos, Loreto Calleja, María Fe Muñoz, Antonella Rizzo, Ana Macho, Lourdes Olmo, Concepción García, Beatriz Antolín, Sandra Izquierdo, Luis Fernández","doi":"10.1016/j.gastrohep.2024.502223","DOIUrl":"10.1016/j.gastrohep.2024.502223","url":null,"abstract":"<p><strong>Objectives: </strong>To search for parameters susceptible to optimization when performing capsule endoscopy (CE) in a third level hospital with high volume and experience in this test.</p><p><strong>Patients and methods: </strong>Retrospective observational study, including 1325 CEs performed between 2017 and 2022. Overall diagnostic yield, effective diagnostic yield, by indication, place of request and waiting list, as well as complete examination rate and cleansing degree were analyzed.</p><p><strong>Results: </strong>The overall diagnostic yield was 70.99%, while the effective diagnostic yield was 72.7%. Diagnostic yields varied between 60.2% and 77.9% depending on the indication and between 64.7% and 74.3% depending on the requesting center. The mean waiting list was 101.15 days, with a tendency to worse results when the waiting list was longer. A total of 77.8% of the examinations were complete. Completion rates were lower in patients >70 years of age (p=0.001), as well as in those with gastric transit >60minutes (p=0.000). A total of 77.3% were clean, with debris that did not impede diagnosis being found in 16.9% and debris that did impede diagnosis in 5.8%. There was a relationship, although not significant, between cleansing degree and age.</p><p><strong>Conclusions: </strong>The diagnostic yields of CE in our center are in line with those previously reported. Differences were found according to the place of request. Waiting list could also influence diagnostic yield. Completion rates are lower in >70 years of age and when gastric transit is >60minutes. Cleansing degree achieved is acceptable.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptation and validation of an abbreviated version of the SIPAT integrated psychosocial risk scale in patients with liver cirrhosis candidates for liver transplantation (SIPAT-11).","authors":"Natalia García Morales, Sagrario Gutiérrez Morato, Carmen Castillo Cejas, Margarita Fernández de la Varga, Martín Menéndez Rodríguez, Victoria Aguilera, Salvador Benlloch, Luis Menéndez Rodríguez, Teresa Seoane Pillado, Joaquín Cubiella","doi":"10.1016/j.gastrohep.2024.502220","DOIUrl":"10.1016/j.gastrohep.2024.502220","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with liver cirrhosis who are candidates for liver transplantation must be evaluated both clinically and socially in order to obtain the optimal outcomes and avoid futile therapeutic measures. For the evaluation of the social aspects in these patients, no validated scale in Spanish is available. The SIPAT (Stanford Integrated Psychosocial Assessment for Transplantation) scale is an instrument that measures the social, family and psychological aspects in candidates for solid organ transplantation. The objective of this study is to adapt and validate an abbreviated version of the SIPAT scale in Spanish for patients with liver cirrhosis.</p><p><strong>Material and methods: </strong>Prospective observational study carried out in the Hepatology Unit of the La Fe Unversity Hospital in Valencia, by questionnaire validation methodology. To analyze the reliability of the questionnaire, the internal consistency of all variables was calculated, for variability an exploratory factor analysis, and for stability the test-retest test was carried out.</p><p><strong>Results: </strong>96 patients who were admitted for decompensated cirrhosis to the Hepatology Unit of the La Fe Hospital in Valencia between November 1, 2017 and January 31, 2017 were selected. 84% were men, the mean age was 60.01 (SD 10.12) years. In 73.2% of those admitted, the etiology of cirrhosis was alcoholic. 14.4% had a Child's stage A, 57.7% B and 27.8% C. The internal consistency of all variables reached a Cronbach's Alpha of 0.766. In the exploratory factor analysis, 6 dimensions of the questionnaire were identified that explain 84.27% of the total variability. To see the stability of the instrument, the measurement was repeated at 2 and 6 months of follow-up, obtaining in the test-retest a kappa agreement of 0.612 and 0.565 respectively.</p><p><strong>Conclusion: </strong>The SIPAT-11 questionnaire has good psychometric characteristics in cirrhotic patients who are candidates for liver transplantation. It is easy to complete and can be administered by professionals who are not specialists in the area of Mental Health.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}