Revista Espanola De Enfermedades Digestivas最新文献

{"title":"Demographic and survival characteristics of untreated hepatocellular carcinoma patients: insights into the natural history and prognostic determinants.","authors":"Helena González-Sánchez, Andrés Castaño-García, Miriam Celada-Sendino, Pablo Flórez-Díez, Marta García-Calonge, Manuel Rodríguez, Valentina Chiminazzo, María Varela Calvo","doi":"10.17235/reed.2025.11029/2024","DOIUrl":"https://doi.org/10.17235/reed.2025.11029/2024","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) patients with advanced symptoms or liver failure are often ineligible for transplantation, leading only to symptom control. Additionally, various factors lead to other HCC stage patients remaining in natural history.</p><p><strong>Objective: </strong>To describe the demographic of untreated HCC patients and to analyze survival-influencing factors.</p><p><strong>Methods: </strong>single-center retrospective observational study examining HCC patients diagnosed from 2015 to 2021 who received symptom control as their primary treatment. Baseline characteristics and survival data were collected and analyzed.</p><p><strong>Results: </strong>Of 685 HCC patients, 26% (n=181) remained in natural history, median age 71 years, 82% male patients, 93% with cirrhosis, 53% with previous decompensation. At a mean follow-up of 9.98 months, the mortality rate was 84%. While 49.8% of patients were BCLC-D stage, other reasons for remaining in natural history included frailty (25.4%) comorbidities (16%), and patient's treatment refusal (8%). Independent survival factors were BCLC stage, previous decompensation and diagnosis within the screening program, with 37% of untreated patients detected through surveillance.</p><p><strong>Conclusions: </strong>Liver function, BCLC stage and functional status influence survival in natural HCC history. A significant 37% diagnosed through screening indicates inclusion criteria refinement necessity to avoid overdiagnosis and optimize resources.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450060","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":"Virtual chromoendoscopy for the identification of colonic dysplasia in patients with inflammatory bowel disease. A systematic review.","authors":"Antonio López-Serrano, Luis Pretel","doi":"10.17235/reed.2025.9878/2023","DOIUrl":"https://doi.org/10.17235/reed.2025.9878/2023","url":null,"abstract":"<p><p>Patients with inflammatory bowel disease (IBD) in the colon have a higher risk for colorectal cancer (CRC). Virtual chromoendoscopy (VCE) allows identification and assessment of colonic dysplasia, which might displace dye-based chromoendoscopy (DCE) as the endoscopist's technique of choice for these patients within endoscopic surveillance programs.</p><p><strong>Objective: </strong>to analyze the best evidence available on the usefulness of VCE versus DCE for dysplasia identification in patients with long-standing colonic IBD.</p><p><strong>Material and methods: </strong>a qualitative, PRISMA 2020-based systematic review of the literature was carried out in the PubMed, Science Direct, and Scielo databases until June 2023. Clinical trials, case-control studies, comparative studies, and crossover studies in English or Spanish were included that directly compared DCE versus VCE for the screening of colonic dysplasia in patients with IBD. The Quality Assessment of Diagnostic Accuracy studies (QUADAS) 2 was used for assessing study quality. The selected studies were evaluated by 2 independent researchers, who entered their abstracted results into a database.</p><p><strong>Results: </strong>out of 141 identified studies 9 were selected that compared DCE with VCE (1131 patients included). Six studies are prospective, randomized, controlled trials; 2 are retrospective case-control studies; and 1 is a prospective comparative study. VCE showed a dysplasia detection ability similar to that of DCE, albeit with shorter examination times (8 studies; 985 patients). Factors associated with dysplasia identification included lesions in the right colon (3 studies; 581 patients); non-polypoid lesions (1 study; 210 patients) and/or lesions with Kudo's type III-V pit patterns (2 studies; 254 patients); and patient age (1 study; 129 patients).</p><p><strong>Conclusions: </strong>VCE may be an alternative to DCE for CRC screening in patients with long-standing IBD, with similar detection ability for colonic dysplasia and the benefit of shorter procedure times. Currently available evidence is limited in this regard given the small numbers of patients in the relevant studies, hence further research is necessary with greater numbers of included subjects.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450103","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":"Uncommon biliary strictures: diagnostic insights into biliary candidiasis.","authors":"Akihiro Maruyama, Takahiro Yamada, Makoto Kobayashi","doi":"10.17235/reed.2025.11113/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11113/2025","url":null,"abstract":"<p><p>We present a case of biliary candidiasis incidentally identified in a 71-year-old male who has the medical history of laparoscopic cholecystectomy performed 4 years ago. Laboratory examination revealed elevated biliary and liver enzyme levels. Abdominal contrast-enhanced computed tomography and endoscopic ultrasonography (EUS) revealed thickening of the common bile duct wall.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450099","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":"Colon ulcers and HIV: an image to remember.","authors":"Raquel Gómez Perosanz, Marta Quiñones Calvo","doi":"10.17235/reed.2025.11078/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11078/2025","url":null,"abstract":"<p><p>A 37-year-old HIV-positive male with a history of cutaneous Kaposi's sarcoma (KS) presented with chronic bloody diarrhea, abdominal pain, and weight loss despite an undetectable viral load and a CD4 count of 200 cells/mm³. Colonoscopy and gastroscopy revealed ulcers with erythematous-violaceous borders, and biopsies confirmed intestinal KS through HHV-8 positivity. Treated with paclitaxel, the patient showed significant clinical and endoscopic improvement. Visceral KS, though rare at higher CD4 counts, should be suspected in compatible cases. It often presents as diarrhea and abdominal pain, with or without skin lesions. Diagnosis requires HHV-8-positive biopsies, and treatment includes antiretroviral therapy and chemotherapy, such as paclitaxel or liposomal doxorubicin.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450029","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 future of artificial intelligence in Healthcare: smaller, more specialized language models.","authors":"Manuel Nevado Santos, Paula Nevado Álvarez","doi":"10.17235/reed.2025.11141/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11141/2025","url":null,"abstract":"<p><p>This letter discusses the shift from large proprietary AI models to smaller, specialized language models in healthcare. With advancements in fine-tuning techniques, such models can be adapted using affordable resources, ensuring data security and empowering smaller institutions. The letter emphasizes the importance of guiding AI development to complement human medical expertise.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450098","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":"Peptic perforation due to Candida spp.","authors":"Silvia Fernández Noël, Julia Gutiérrez de Prado, Óscar Caso Maestro, Carmelo Loinaz Segurola, Iago Justo Alonso","doi":"10.17235/reed.2025.11095/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11095/2025","url":null,"abstract":"<p><p>The incidence of peptic perforation has not decreased despite the successful management of Helicobacter pylori (HP), suggesting other mechanisms are involved in the pathological process. Our findings support the relevance of Candida spp. in these types of perforations. These findings provide insight into the management of peptic perforations complicated by fungal infections and highlight the importance of routinely performing peritoneal culture and biopsies in these patients. We propose that Candida coinfection be considered an independent risk factor in the mortality of patients with peritonitis, as shown by other studies.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450096","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":"Atypical hemolytic uremic syndrome triggered by acute pancreatitis.","authors":"Qing Yang, Qiang Geng, Shubei Chen, Ying Lin, Yong Ye","doi":"10.17235/reed.2025.11114/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11114/2025","url":null,"abstract":"<p><p>The clinical manifestations of atypical hemolytic uremic syndrome （aHUS） are hemolytic anemia, thrombocytopenia, and acute kidney injury. It is one of the Thrombotic microangiopathy (TMA), with triggers for activation of the complement bypass pathway, such as infection and pregnancy, present in 70-80% of patients. Treatment for this disease requires plasma exchange or eculizumab, we encountered a patient with aHUS induced by gallstone-pancreatitis, after the initial plasma exchange, the patient's condition was improved, but the subsequent incomplete treatment eventually led to severe sequelae. In a word, early, correct and adequate treatment is critical to the prognosis of these patients.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449974","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":"Visceral adiposity index as a key predictor of severity in acute pancreatitis - A large-scale retrospective cohort study.","authors":"Tingting Wang, Fei Cao, Jiajun He, Lei Zhu, Xiaoxi Yang, Shuli Ma, Quping Zhu, Yuanhao Li, Chuting Yang, Jun Liu, Chaowu Chen, Chen Weiwei","doi":"10.17235/reed.2025.10864/2024","DOIUrl":"https://doi.org/10.17235/reed.2025.10864/2024","url":null,"abstract":"<p><strong>Background and aims: </strong>Visceral adipose tissue has been indicated closely connected with the severity of acute pancreatitis (AP). Visceral adiposity index (VAI) is a mathematical model that consists of waist circumference, body mass index, triglyceride and high-density lipoprotein cholesterol, which has been demonstrated to be a better indicator of visceral fat than other traditional indices. This study aimed to evaluate the relationship between VAI and the severity of AP.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on a cohort of 1174 patients diagnosed with AP. These patients were categorized into two groups based on their VAI values: the normal VAI (NVAI) group and the elevated VAI (EVAI) group.</p><p><strong>Results: </strong>The EVAI group were much younger, mainly male and had higher incidence of severe acute pancreatitis (SAP) compared with the NVAI group (p < 0.001). The EVAI group developed higher incidences of persistent respiratory failure, acute peripancreatic fluid collection (APFC) and acute necrotic collection (ANC). The VAI level and the percentage of EVAI showed an increasing trend with the severity of AP (p < 0.001). EVAI was the most independent risk factor for persistent respiratory failure (OR = 6.405, 95% CI 2.317-17.705), APFC (OR = 2.093, 95% CI 1.255-3.578) and ANC (OR = 4.910, 95% CI 1.736-13.887).</p><p><strong>Conclusions: </strong>EVAI was strongly related to the severity of AP. It was the most independent risk factor of persistent respiratory failure, APFC and ANC.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450101","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":"Arterio-biliary fistula after TIPS placement: a rare but serious complication.","authors":"Elisa Antolinos Macho, Abel González Huete, Alberto Velasco Hernández, José Montilla","doi":"10.17235/reed.2025.11125/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11125/2025","url":null,"abstract":"<p><p>A 54-year-old male with cirrhosis and portal hypertension developed recurrent upper GI bleeding after transjugular intrahepatic portosystemic shunt (TIPS) placement. Severe anemia and hypotension ensued, with imaging revealing a hepatic artery pseudoaneurysm and arterio-biliary fistula. Arterio-biliary fistulas, though rare, are serious complications often linked to trauma or iatrogenic injury. This case highlights the importance of early recognition, imaging, and multidisciplinary management in high-risk post-TIPS patients to prevent catastrophic outcomes.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449968","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":"Ileal bile acid transport inhibitors - A new future in treatment of cholestatic diseases.","authors":"Amaia Salinas Uhalte, Ignacio Ros Arnal, Paula Casajús Pelegay, Enrique Medina Benítez, Ruth García Romero","doi":"10.17235/reed.2025.10600/2024","DOIUrl":"https://doi.org/10.17235/reed.2025.10600/2024","url":null,"abstract":"<p><p>We present a 14-year-old male with PFIC1 who required double liver transplant at five years old. Subsequently, liver function normalized, nevertheless, bowel habits and intestinal malabsorption worsened (10-12 daily and nocturnal stools, Bristol 6-7), with severe dehydration that required multiple hospitalizations, associating malnutrition and failure to thrive that required daily home parenteral nutrition(PN). At 14 years old, Odevixibat (40 mcg/kg/day) was initiated, leading to a marked improvement in bowel habits by the second day (1-2 daily stools, Bristol 2) and progressive weight gain, which allowed after 40 days of treatment discontinue PN following seven years.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450006","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}