Revista Espanola De Enfermedades Digestivas最新文献

{"title":"Challenging the gold standard: endohepatology in the diagnosis of presinusoidal portal hypertension.","authors":"Sofia Bragança, Pooja Khonde, Stephen D Zucker's, Marvin Ryou","doi":"10.17235/reed.2025.11480/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11480/2025","url":null,"abstract":"<p><p>We report a 52-year-old patient referred for evaluation of abnormal liver tests, with extensive etiological workup negative. Abdominal CT and MRI revealed hypertrophy of the left hepatic lobe, nodular liver contours, and ascites (SAAG 1.7; total protein 1.8 g/dL). Upper endoscopy showed no stigmata of portal hypertension. A dual interventional radiology procedure was performed. Transjugular liver biopsy (LB) (18G) was non-diagnostic, and hepatic venous pressure gradient (HVPG) was normal (HVPG 3 mmHg; wedged hepatic venous pressure [WHVP] 13 mmHg; free hepatic venous pressure [FHRVP] 10 mmHg). Given suspicion of pre-sinusoidal portal hypertension, endoscopic ultrasound (EUS) was performed (Arietta 850, Fujifilm Healthcare, Tokyo, Japan). EUS showed blunting of the left lobe tip, irregular contours, and ascites. Endoscopic \"palpation\" revealed an indentation of 2.0 mm (abnormal). Shear-wave-elastography (SWE) of the left lobe was normal at 6.04 kPa, but other areas showed 10.5-11.1 kPa (abnormal). No splenomegaly, but the mean SWE was 31.9 kPa (abnormal). EUS-guided portal pressure gradient (EUS-PPG), measured with EchoTip Insight™ FNB needle (Cook Medical, USA), was elevated (PPG 8 mmHg; mean hepatic vein pressure 4.0 mmHg; mean portal vein pressure [PVP] 12.0 mmHg). Targeted EUS-guided biopsy of the left lobe (Acquire™ 19G FNB needle, Boston Scientific, USA) showed vague liver nodular transformation with alternating regenerative and atrophic hepatocytes, consistent with nodular regenerative hyperplasia (NRH). Due to refractory ascites, TIPS placement was proposed. Pre-TIPS evaluation showed mildly elevated HVPG (6 mmHg), while immediate post-TIPS assessment revealed elevated HVPG (HVPG 11 mmHg; PVP 20 mmHg; FHRVP 9 mmHg). Ascites was controlled with TIPS.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"120 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186667","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":"Endoscopic submucosal dissection and postoperative radiotherapy for the treatment of esophagus adenoid cystic carcinoma.","authors":"Xinwei Hao, Yawei Bi, Xiao Lei, Jinyan Zhang, Ningli Chai","doi":"10.17235/reed.2025.11558/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11558/2025","url":null,"abstract":"<p><p>Adenoid cystic carcinoma (ACC) is a malignant tumor primarily originating from the salivary glands, with the parotid and submandibular glands being the most common sites, but is rare in the esophagus. The ESD resection of esophagus adenoid cystic carcinoma has been reported in recent years. However, no additional postoperative treatment has been performed. We reported a rare case of a patient with esophageal adenoid cystic carcinoma who underwent ESD resection and postoperative radiotherapy. During the 1-year follow-up period, no recurrence or metastasis of the disease was observed.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186684","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":"Associated factors and complementary strategies used in the indication of the intestinal patency capsule: a critical review.","authors":"Faviana Nicolette Soberon Montero, Karen Carlessi Saldaña Mendoza, Luz Campos Loza","doi":"10.17235/reed.2025.11476/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11476/2025","url":null,"abstract":"<p><p>The article by Ikegami et al., published in the Revista Española de Enfermedades Digestivas, explores clinical factors affecting the performance of the intestinal patency capsule (IPC). It identifies negative predictors for successful outcomes-such as past abdominal surgery, obstructive symptoms, and corticosteroid use-which can guide clinical decision-making. Complementing this, O'Hara et al. introduced a 72-hour extended protocol with a cut-off of 5 m/s, improving capsule excretion in high-risk cases, though it requires more resources. Vigorous physical activity combined with imaging (CT or MRI) boosts diagnostic accuracy and reduces false negatives. Delayed excretion of a non-retained IPC might also signal motor insufficiency, adding functional relevance. A Peruvian study in the Revista de Gastroenterología del Perú reinforces the safety and utility of the Agile capsule in detecting intestinal patency, especially in patients with undetected strictures, helping avoid capsule retention.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"120 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186707","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":"Vital ileoscopy: a step beyond colonoscopy in positive fecal occult blood test.","authors":"Andrés Mauricio Silva-Silva, Margarita Delgado Portela, Bartolomé López Viedma, Joaquín Rodriguez Sánchez-Migallón","doi":"10.17235/reed.2025.11554/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11554/2025","url":null,"abstract":"<p><p>Fecal occult blood testing (FOBT) is a key tool in colorectal cancer screening, typically followed by colonoscopy after a positive result. However, in patients with normal colonoscopy findings, further investigation may be warranted. We present the case of a 54-year-old asymptomatic male with a positive FOBT and normal colonoscopy, where terminal ileoscopy revealed a subepithelial ulcerated lesion causing significant luminal obstruction. Histological and immunohistochemical analyses confirmed an aggressive large B-cell non-Hodgkin lymphoma. Following surgical resection and pathological confirmation, the patient was referred for chemotherapy. This case underscores the diagnostic value of terminal ileoscopy in detecting occult pathology in patients with unexplained positive FOBT, emphasizing its role as a vital extension of standard colonoscopic evaluation.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186621","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":"First-line surgery in Crohn's disease: who benefits and when?","authors":"Alex Arenas, Diego Ruedi, Gustavo Walsen, Ignacio Catalán-Serra, Patricio Ibáñez","doi":"10.17235/reed.2025.11459/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11459/2025","url":null,"abstract":"<p><p>Crohn's disease (CD) patients often require surgery due to complications such as strictures or fistulas. While historically reserved as a last resort, emerging data suggest that early ileocecal resection (EICR) may provide long-term benefits in selected patients, including reduced need for biologics and lower relapse rates. Identifying which patients are ideal candidates for first-line surgery remains a clinical challenge, but recent studies point toward improved outcomes when surgery is performed in early, localized disease.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186642","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":"Prevalence of Hepatitis Delta Virus Infection in Galicia: Results of the Universal Implementation of Double Reflex Testing.","authors":"Raquel Carracedo Montero, María de Los Ángeles Cañizares, Sandra Cortizo, Matilde Trigo, Noelia Calvo, María José Gude, Patricia Ordóñez, Luz Moldes, Jorge Julio Cabrera, Noelia Parajó, Sara Pereira, Luis Rodríguez Otero, Antonio Aguilera","doi":"10.17235/reed.2025.11393/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11393/2025","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic hepatitis caused by the hepatitis Delta virus is the most severe form of viral hepatitis and carries the greatest risk of complications. The real prevalence of this infection remains unknown.</p><p><strong>Objectives: </strong>This study sought to determine the prevalence of both the antibodies and the active infection rates of hepatitis Delta in the Autonomous Region of Galicia, Spain.</p><p><strong>Materials and methods: </strong>A prospective study was conducted including all patients carrying the hepatitis B surface antigen who attended any hospital within the Galician Health Service between 2023 and 2024. These patients underwent serum testing for antibodies against the hepatitis Delta virus (LIAISON® XL MUREX Anti-HDV Assay; Diasorin Saluggia, Italia); the viral load was then assessed in those that tested positive (Hepatitis Delta Real Time PCR Kit; Vircell, Granada, Spain). The samples with a positive viral load were subsequently genotyped.</p><p><strong>Results: </strong>A total of 1,962 patients were included, 85 of whom had anti-HDV antibodies, and 20 of these (23.5%) had a detectable viral load. The prevalence obtained was 4.3% in carriers of the hepatitis B virus surface antigen, and 0.03 per 1,000 inhabitants. The most common genotype found in active infections was 1D.</p><p><strong>Conclusions: </strong>The seroprevalence obtained in this study confirmed the low circulation of the hepatitis Delta virus in our region. However, a significant proportion of affected patients have an active infection, and early diagnosis is essential to prevent disease progression and the development of complications. As expected, most of our patients are infected with strains of genotype 1D, which is predominant worldwide, including Europe. However, we also found three strains of genotype 5 in patients from West Africa.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186654","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":"Association of repeated endoscopic inflammation with dysplasia and colorectal cancer in ulcerative colitis.","authors":"Manuel Trigo, Lucia Jiménez Recio, Carlos Valdivia Krag, Carlos Mirabent, Lourdes González, José Manuel Benítez, Sandra Marín Pedrosa, Pilar Soto Escribano, Eva Iglesias-Flores, Beatriz Gros","doi":"10.17235/reed.2025.11522/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11522/2025","url":null,"abstract":"<p><strong>Background and aim: </strong>Ulcerative colitis (UC) confers an increased risk of dysplasia and colorectal cancer (CRC), largely driven by sustained mucosal inflammation. While inflammatory burden is a known risk factor, the specific impact of repeated endoscopic inflammation and contemporary therapies exposure warrant further investigation. We aimed to investigate the impact of cumulative inflammation in the risk of dysplasia and CRC development in UC.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adult UC patients diagnosed between 1975 and 2023 at a tertiary IBD center. Repeated colonoscopies were analyzed using the Andersen-Gill extension of the Cox proportional hazards model. Propensity score matching (1:2 ratio) was applied based on age at diagnosis, sex, smoking status, disease duration and extent to adjust for confounding.</p><p><strong>Results: </strong>A total of 571 patients and 1614 colonoscopies were included. There were 304 (53.2%) men, with a median age at diagnosis of 39.5 years (IQR 27.3-54.2) and a median follow-up of 7.1 years (IQR 3.7-13.3). At diagnosis, 147 patients (25.7%) had proctitis, 203 (35.6%) had left-sided colitis and 191 (33.5%) had extensive colitis. During follow-up 56 (9.8%) developed dysplasia or CRC. Advanced therapy was used in 152 patients (26.8%). In the propensity-matched cohort (n=123), repeated higher endoscopic inflammation measured by Mayo endoscopic score (adjusted HR: 1.600; 95% CI: 1.082-2.366; p = 0.019), family history of CRC (adjusted HR 1.518; 95% CI: 1.011-2.290, p=0.039) and exposure to advanced therapies (adjusted HR 2.048; 95% CI: 1.392-3.013, p<0.001) were associated with higher dysplasia/CRC risk.</p><p><strong>Conclusions: </strong>Our findings indicate that repeated endoscopic inflammation, a family history of CRC, and the use of advanced therapy are associated with an elevated risk of dysplasia and CRC in adult UC patients.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186672","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":"Monitoring inflammatory activity in inflammatory bowel disease: not too far, not too close.","authors":"Rodrigo Quera, Paulina Núñez, Francisca Carvajal, Gonzalo Pizarro","doi":"10.17235/reed.2025.11467/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11467/2025","url":null,"abstract":"<p><p>Treat-to-target in Inflammatory Bowel Disease aims to achieve symptomatic remission, normalization of biomarkers such as fecal calprotectin, and endoscopic remission within defined timeframes. Early recognition of inflammatory activity and timely therapeutic intervention are essential for improving the quality of life of patients with Inflammatory Bowel Disease.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"118 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186688","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":"GLP-1 receptor agonists and acute pancreatitis: fact or overstated risk?","authors":"Juan Enrique Domínguez Muñoz, José Lariño Noia, Yessica Domínguez Novoa, Julio Iglesias-García","doi":"10.17235/reed.2025.11499/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11499/2025","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for type 2 diabetes mellitus (T2DM) and weight management. These medications mimic the effects of the intestinal hormone GLP-1, thereby enhancing insulin secretion, reducing glucagon release, inducing satiety, and slowing gastric emptying. Their therapeutic scope now extends to cardiometabolic conditions and metabolic-associated steatotic liver disease (MASLD). Despite their clinical utility, GLP-1 RAs are frequently associated with gastrointestinal adverse effects-including nausea, vomiting, and diarrhoea-reported in up to 80% of patients, often in a dose-dependent manner. Concerns have also emerged regarding a potential association with acute pancreatitis.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186690","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":"Difficulty in Cannulation and Risk of Complications After ERCP According to the Type of Papilla of Vater in a Tertiary Center.","authors":"Renzo Pinto-Carta, Gustavo Adolfo Reyes Medina, Mariana Vásquez, Andrés Felipe Bejarano-Ramírez, María Alejandra Gómez-Gutiérrez, Fernando Sierra-Arango","doi":"10.17235/reed.2025.11475/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11475/2025","url":null,"abstract":"<p><p>Cannulation of the papilla of Vater is a critical step in endoscopic retrograde cholangiopancreatography (ERCP), with direct implications for procedural success and the risk of adverse events. Although endoscopist experience and anatomical variations are known contributors, the role of papillary morphology remains insufficiently explored in Latin America. This study aimed to assess the association between papilla type and cannulation difficulty or complications. Adults with a native major papilla undergoing ERCP at a tertiary center in Bogotá were prospectively enrolled. Papillary morphology was classified macroscopically, and difficult cannulation was defined according to ESGE criteria. Associations were analyzed using Fisher's exact test and odds ratios with 95% confidence intervals. Fifty-eight patients (mean age 59.9 years, 63.8% female) were included. The most common papilla was type 1 (63.8%), followed by type 3 (27.6%). Difficult cannulation occurred in 13.8% of procedures, mostly involving type 1, type 3, and the single type 4 case. Advanced cannulation techniques were required in 34.5% of cases and were associated with longer procedural times. Prophylactic measures were used in 60.3% of patients. Overall, 6.9% developed post-ERCP pancreatitis and 3.4% cholangitis. No significant association was found between papilla type and complication rate. Our findings suggest that type 1 and type 3 papillae are more frequently associated with cannulation difficulty, although complication rates did not differ significantly by morphology. Recognizing papilla morphology may enhance preprocedural planning and training strategies in advanced endoscopy units.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186692","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}