Revista Espanola De Enfermedades Digestivas最新文献

{"title":"From Baveno VII to Baveno VIII: key innovations in risk stratification and personalized care for portal hypertension.","authors":"Luis Téllez, Jesús Donate Ortega, José Ignacio Fortea, Anna Baiges, Edilmar Alvarado-Tapias, Agustín Albillos Martínez","doi":"10.17235/reed.2026.12213/2026","DOIUrl":"https://doi.org/10.17235/reed.2026.12213/2026","url":null,"abstract":"<p><p>Portal hypertension is a major determinant of disease progression and clinical outcomes in cirrhosis. The Baveno consensus has progressively moved its focus from the treatment of established complications towards earlier risk stratification, prevention of decompensation and modification of the natural history of the disease. Baveno VIII consolidates and extends this approach across the different stages of advanced chronic liver disease. Non-invasive assessment of clinically significant portal hypertension is refined through the incorporation of spleen stiffness measurement and probabilistic models, while longitudinal assessment emphasizes the importance of updating risk according to the most recent evaluation. In compensated disease, prevention of first decompensation remains centred on aetiological treatment and carvedilol in patients with clinically significant portal hypertension, together with management of relevant modifiable factors. In decompensated cirrhosis, greater emphasis is placed on preventing further decompensation and considering transjugular intrahepatic portosystemic shunt (TIPS) earlier in the disease course, with individualized patient selection, stent diameter and strategies to prevent and manage post-TIPS hepatic encephalopathy. Management of acute portal hypertension-related bleeding is further refined, particularly regarding the timing of pre-emptive TIPS and the treatment of gastric varices and vascular gastric lesions. Finally, updated criteria for hepatic recompensation establish durable clinical recovery as a meaningful therapeutic goal. These advances support a more individualized approach to portal hypertension, integrating disease stage, risk of progression and response to treatment throughout the course of cirrhosis.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149272855","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":"Faecal urgency in Crohn's disease: associations with disease location and activity, psychobiological burden and adverse outcomes.","authors":"Carlos Borges Chaves, Inês Azevedo Silva, Diogo Feijó, Maria José Temido, Mariana Sant'Anna, Andrea Silva, Margarida Ferreira, Sandra Lopes, Pedro Figueiredo, Francisco Portela","doi":"10.17235/reed.2026.12223/2026","DOIUrl":"https://doi.org/10.17235/reed.2026.12223/2026","url":null,"abstract":"<p><strong>Background: </strong>Faecal urgency (FU) is a frequent and disabling symptom in inflammatory bowel disease, although evidence in Crohn's disease (CD) remains limited. We aimed to evaluate the prevalence and severity of FU in CD and assess its association with disease location, inflammatory activity, psychobiological factors, quality of life (QoL), work productivity, and adverse clinical outcomes after 52 weeks.</p><p><strong>Methods: </strong>We conducted a single-centre observational study including adult patients with CD recruited between July-September 2024. Participants completed the Faecal Urgency Numeric Rating Scale (FU NRS), WPAI-GH, SIBDQ, and HADS questionnaires. Disease activity was assessed clinically, biochemically, endoscopically, and ultrasonographically. Patients were followed for 52 weeks for emergency room (ER) admissions, hospitalization, corticosteroid requirement, treatment escalation, surgery, and death.</p><p><strong>Results: </strong>A total of 158 patients were included, of whom 109 (69.0%) reported clinically relevant FU (FU NRS ≥2). In the primary analysis, neither distal disease nor rectal involvement were significantly associated with clinically relevant FU (p=0.46 and 0.83, respectively). FU severity was not significantly correlated with inflammatory measures. Conversely, FU severity correlated with anxiety, depressive symptoms, impaired work productivity, and poorer QoL (all p<0.001). In multivariate models, FU was associated with overall work productivity loss and reduced SIBDQ scores. In an exploratory analysis, greater FU severity was associated with higher odds of ER admissions after 52 weeks (p=0.007).</p><p><strong>Conclusions: </strong>In this CD cohort, FU was significantly associated with psychobiological burden, impaired QoL, and healthcare utilization, supporting the multifactorial nature of this symptom.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138167","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":"Use of subcutaneous infliximab biosimilar CT-P13 in the Common Variable Immune Deficiency associated enteropathy.","authors":"Rodrigo Quera, Christian von Muhlenbrock, Paulina Núñez, Luis Contreras","doi":"10.17235/reed.2026.12239/2026","DOIUrl":"https://doi.org/10.17235/reed.2026.12239/2026","url":null,"abstract":"<p><p>Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency in adults; non-infectious gastrointestinal involvement may be present in up to 50% of patients, with the small intestine and colon being the most frequently affected areas. Studies have evaluated the effectiveness of biological therapy in this setting. Experience with infliximab is limited, and to the best of our knowledge, there are no published reports on the use of the subcutaneous infliximab biosimilar CT-P13. We describe the clinical, endoscopic, and histological findings of a 55-year-old man with a history of CVID-associated enteropathy involving the small intestine and colon, who has shown a satisfactory clinical, endoscopic, and histological response after three years of treatment with infliximab.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138265","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":"Heterogeneity in current guidelines for the management of gallbladder polyps ‒ A systematic review.","authors":"Luis Enrique Expósito Portales, Jorge Gerardo Pereira Fraga, Rafael de la Caridad Torres Peña, Hiram de Zacarías Rodríguez Blanco, Lisandra de la Caridad Rodríguez Gutierrez","doi":"10.17235/reed.2026.12024/2026","DOIUrl":"https://doi.org/10.17235/reed.2026.12024/2026","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder polyps are elevated lesions of the gallbladder mucosa that protrude into its lumen. Their prevalence in the general population ranges from 0.3% to 9.5%. Guidelines regarding surgical indications and follow-up remain controversial due to regional differences in the development of malignancy. Hence, this systematic review was performed to assess the heterogeneity in current international guidelines for the management of gallbladder polyps.</p><p><strong>Methods: </strong>In accordance with the PRISMA guidelines, a comprehensive search of the literature was conducted from PubMed and Google Scholar (from January 2020 to April 2026; in Spanish and English) for official clinical practice guidelines and updated consensus statements issued by scientific societies. The methodological quality of the included studies was evaluated using the AGREE II instrument.</p><p><strong>Results: </strong>A total of five guidelines were included in the review. The divergent aspects evaluated were: the size threshold for surgical treatment regardless of other malignancy risk factors (≥10 mm or ≥15 mm); the definition of significant growth (≥2-4 mm or unequivocal size increase upon visual assessment since the last follow-up); and the use of abdominal Doppler ultrasonography for risk stratification.</p><p><strong>Conclusion: </strong>Guidelines governing the management of gallbladder polyps vary. The best recommendation is to select the most appropriate guideline based on the behavior of this condition as observed in studies of the specific population receiving medical care.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138248","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":"Giant hepatic angiomylipoma presenting with painful hepatomegaly.","authors":"Helena Moreira-González, Pablo Romo de Arriba, Sergio Pérez Rodríguez, Sergio Farrais Villalba, Michelle Casanova Cabral","doi":"10.17235/reed.2026.12241/2026","DOIUrl":"https://doi.org/10.17235/reed.2026.12241/2026","url":null,"abstract":"<p><p>Hepatic angiomyolipoma (HAML) is a rare mesenchymal neoplasm belonging to the perivascular epithelioid cell tumor (PEComa) family. Although usually asymptomatic and incidentally detected, large lesions may cause symptoms and pose diagnostic challenges. We report the case of a 69-year-old man presenting with painful hepatomegaly. Computed tomography revealed a 12-cm, predominantly fat-containing hepatic mass. Percutaneous biopsy demonstrated characteristic morphological features and an immunohistochemical profile showing HMB-45 and Melan-A positivity, with negative S100 and smooth muscle actin staining in the epithelioid tumor cells. Surgical resection was performed, with a favorable postoperative course. This case highlights the importance of integrating radiological and histopathological findings for accurate diagnosis and individualized management of giant hepatic angiomyolipoma.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138174","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":"Jejunal Dieulafoy's lesion: challenging diagnosis and treatment, and an even greater challenge for clinical pathways.","authors":"Ana Chicano Ros, Alejandro Pérez Fernández, Marina García García, Enrique Pérez-Cuadrado Martínez","doi":"10.17235/reed.2026.12230/2026","DOIUrl":"https://doi.org/10.17235/reed.2026.12230/2026","url":null,"abstract":"<p><p>Regarding the article by João Carlos Gonçalves et al. on a rare case of Dieulafoy's lesion in an atypical jejunal location, we would like to highlight the potential of real-time capsule viewing, integrated into a dedicated clinical pathway allowing early device-assisted enteroscopy. The identification of an active bleeding during within the first hour after pyloric passage of emergency real-time capsule may help select the most appropriate approach for emergency enteroscopy, usually the oral route in this setting, and may increase the diagnostic yield and endoscopic therapy. Once the patient has been hemodynamically stabilized, such a strategy requires a dedicated and streamlined clinical pathway for emergency DAE, including prompt access to a specialized endoscopy unit, appropriately trained staff, and the resources required for deep sedation or general anesthesia. The same pathway should also anticipate early rebleeding after endoscopic therapy. In our experience, rebleeding may occur in up to 25% of cases, most frequently within the first 48 hours.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138313","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":"Cost-effectiveness of opportunistic age-based hepatitis C screening using pooled HCV RNA testing in Galicia, Spain.","authors":"Antonio Aguilera, Raquel Carracedo, Adrián Domínguez-Lago, Luz Moldes, Jorge Julio Cabrera, Matilde Trigo, María José Gude, Noelia Calvo, Patricia Ordóñez, María de Los Ángeles Cañizares, Sandra Cortizo, Santiago Martínez García, Ana Fuentes, Marta Piñeiro-Sotelo, Raquel Domínguez-Hernández, Juan Turnes, Carmen Durán-Parrondo, Federico Garcia","doi":"10.17235/reed.2026.12096/2026","DOIUrl":"https://doi.org/10.17235/reed.2026.12096/2026","url":null,"abstract":"<p><strong>Background: </strong>Targeted hepatitis C virus (HCV) screening, particularly in age groups with a higher prevalence of infection, may improve case detection and accelerate progress towards HCV elimination. This study evaluated the cost-effectiveness of opportunistic age-based HCV screening among individuals aged 50-60 years in Galicia, Spain, using a pooled HCV RNA testing strategy.</p><p><strong>Methods: </strong>HCV RNA testing was performed using a previously validated sample-pooling strategy. A validated lifetime Markov model of chronic HCV infection was adapted to compare three scenarios: (1) pooling-based screening versus no intervention; (2) pooling-based screening versus standard testing, defined as anti-HCV antibody testing followed by HCV RNA confirmation; and (3) standard testing versus no intervention. The model incorporated Spanish epidemiological and clinical data, sustained virological response rates with direct-acting antivirals, and official healthcare costs. Analyses were conducted from the perspective of the Spanish National Health System, using a lifetime horizon and a 3% annual discount rate for costs and health outcomes.</p><p><strong>Results: </strong>Among 157,606 screened individuals, 221 were identified as HCV RNA positive. Compared with no intervention, pooling-based screening was projected to reduce the lifetime incidence of liver-related complications and mortality by 64%-72%. Although the strategy increased initial screening and diagnostic costs by €181,716, it generated savings of €2,328,496 in the management of liver-related complications and was therefore a dominant strategy, providing better health outcomes at a lower overall cost. Compared with standard testing, pooling-based screening achieved equivalent clinical outcomes but reduced costs by €663 per diagnosed viraemic patient. Standard testing was cost-effective compared with no intervention.</p><p><strong>Conclusions: </strong>Opportunistic age-based HCV screening among individuals aged 50-60 years was dominant compared with no intervention. Pooled HCV RNA testing provides equivalent clinical effectiveness to standard testing at a lower cost per diagnosed viraemic patient and represents a scalable approach to support HCV elimination in low-prevalence settings.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138197","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":"Ischemic colitis associated with oral semaglutide with recurrence upon rechallenge.","authors":"Sofía Aranda Rojas, Yali Chen Wang, Eduardo Tavío Hernández, Sofía Parejo Carbonell, Estefanía Romío de Las Heras, Agustín Albillos Martínez","doi":"10.17235/reed.2026.12187/2026","DOIUrl":"https://doi.org/10.17235/reed.2026.12187/2026","url":null,"abstract":"<p><p>Ischemic colitis associated with glucagon-like peptide-1 (GLP-1) receptor agonists is an exceptionally rare condition, with only a few cases reported in the literature. We present the case of a 46-year-old woman treated with oral semaglutide (Rybelsus®) for weight loss who experienced three episodes of abdominal pain and hematochezia temporally associated with drug exposure. The third episode, which occurred after semaglutide was reintroduced, led to a confirmed diagnosis based on computed tomography, rectosigmoidoscopy, and histopathological findings consistent with ischemic colitis. Permanent discontinuation of semaglutide was followed by complete clinical resolution without further recurrence. The temporal relationship, improvement after drug withdrawal, and recurrence upon rechallenge support a probable causal association. This case highlights the need to consider ischemic colitis as a potential rare adverse effect of semaglutide.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138346","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":"Incidence and delayed diagnosis of hepatitis C: unexpected findings in times of elimination.","authors":"Esteban Gabriel Torres Martel, Melisa Hernández-Febles, Miriam Serrano Fuentes, Blas Labrador Vázquez, Raquel Zaragozá González, Rafael Granados Monzón, Ildefonso Quiñones Morales, Ana Bordes Benítez, María José Pena López","doi":"10.17235/reed.2025.11603/2025","DOIUrl":"10.17235/reed.2025.11603/2025","url":null,"abstract":"<p><strong>Introduction: </strong>chronic hepatitis C virus (HCV) infection remains a public health concern. Late diagnosis and barriers to treatment hinder progress toward elimination goals. In Spain, although prevalence has declined, a hidden burden of infection persists. This study analyzed the incidence of newly diagnosed HCV cases in a region of Gran Canaria during 2023-2024, the frequency of late presentation, and access to antiviral treatment.</p><p><strong>Patients and methods: </strong>clinical-epidemiological, observational, descriptive, and retrospective study of newly diagnosed hepatitis C patients, whether identified through clinical request or opportunistic screening. \"Late presentation\" was defined as fibrosis ≥ F3.</p><p><strong>Results: </strong>a total of 87 cases were diagnosed (13.2 and 11.1 per-100,000 people in 2023 and 2024, respectively); 69 of them chronic cases (79.3 %) and 18 acute cases (20.7 %, with 38.9 % reinfections). Among chronic hepatitis cases, 50.8 % presented late, with a one-year mortality of 11.6 %. Screening led to diagnosis in 34.5 % of cases, and more than 30 % of chronic cases had no identifiable risk factors. Acute infections predominantly affected HIV-positive men who have sex with men (88.9 %). Direct referral from the laboratory enabled most patients to access treatment within one year.</p><p><strong>Conclusions: </strong>in this descriptive, and retrospective study, the incidence of new HCV diagnoses exceeded the World Health Organization (WHO) elimination targets, with a high proportion of late-stage diagnoses and active transmission amongst vulnerable populations. There is a need to intensify screening strategies, optimize care coordination, and strengthen preventive interventions.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":"572-577"},"PeriodicalIF":4.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542090","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":"Refractory gastrointestinal bleeding caused by splenic artery pseudoaneurysm rupture.","authors":"Eri Nishikawa, Tetsuya Yoshizaki, Takashi Toyonaga, Yuzo Kodma","doi":"10.17235/reed.2024.10854/2024","DOIUrl":"10.17235/reed.2024.10854/2024","url":null,"abstract":"<p><p>A 64-year-old man was admitted for hematemesis. Esophagogastroduodenoscopy revealed a gastric ulcer with a visible vessel on the posterior wall of the gastric body. After admission, the patient developed multiple episodes of massive hematemesis. During emergent esophagogastroduodenoscopy, he developed hemodynamic instability due to spurting bleeding. On day 18 of hospitalization, hemostasis was achieved using hemostatic forceps; however, contrast-enhanced computed tomography performed on the same day revealed a small splenic artery pseudoaneurysm (SAP) that had not been previously detected. To prevent fatal re-bleeding, interventional radiology was performed, and coil embolization was applied proximal to the pseudoaneurysm. The patient recovered without further hematemesis. One month later, exposed coils were observed from the healing ulcer, and celiac trunk angiography confirmed splenic artery thrombosis. Despite multiple attempts at endoscopic intervention, the patient developed recurrent hematemesis, suggesting that the gastric ulcer had eroded into the splenic artery, forming the SAP and causing significant hemorrhage. Although SAPs secondary to gastric ulcers are extremely rare, early recognition is critical because they carry a high risk of rupture and mortality. Endoscopic procedure alone may be insufficient, and an endovascular approach is a standard treatment to prevent life-threatening re-bleeding.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":"591-593"},"PeriodicalIF":4.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142627128","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}