Revista Espanola De Enfermedades Digestivas最新文献

{"title":"HLA DQ2/DQ8 haplotypes and the clinical presentation of patients with celiac disease.","authors":"Alicia Antunes, Fabiana Andrade, Lorete Maria da Silva Kotze, Renato Nisihara","doi":"10.17235/reed.2025.11541/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11541/2025","url":null,"abstract":"<p><p>Celiac disease (CD) is a chronic condition triggered by gluten consumption in genetically predisposed individuals, with approximately 95% of CD patients carrying the HLA-DQ2 or DQ8 risk haplotypes. In addition to genetic susceptibility, recent evidence suggests that these haplotypes may influence the clinical presentation and severity of CD. However, evidence on this topic remains scarce, and the impact of HLA-DQ2 and DQ8 haplotypes on CD is not yet fully established. The present study investigated the relationship between HLA-DQ2 and DQ8 haplotypes and gastrointestinal symptoms in CD patients from Southern Brazil, treated in a private clinical setting. All patients were diagnosed with CD based on positive serological tests (anti-endomysial IgA) and confirmed by histological findings in duodenal biopsies (Marsh classification). The presence of haplotypes was determined by DNA typing using polymerase chain reaction (PCR), and clinical data were collected at the initial consultation, prior to the initiation of a gluten-free diet.</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":"145186644","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":"Multicenter Spanish study on vedolizumab intravenous to subcutaneous switch in patients with inflammatory bowel disease in clinical remission.","authors":"Beatriz Gros, Noemí Manceñido, José Manuel Benítez, Jordi Guardiola, Inmaculada Alonso Abreu, Iago Rodríguez-Lago, Rubén Alvarado, Ángel Ponferrada Díaz, Federico Argüelles, G Esther Rodríguez, Francisco Mesonero Gismero, Iván Guerra, Marisa Iborra, Pere Borrás, Fiorella Cañete, Lucía Madero Velázquez, Jesús Castro Poceiro, Antonio M Caballero-Mateos, Manuel Barreiro de Acosta, José María Huguet, Beatriz Castro Senosain, Eduard Brunet, Francisco López Romero-Salazar, Berta Caballol, Carles Suria, Erika Alfambra, Laura García García, Judit Orobitg, Sandra Marín Pedrosa, Pilar Soto Escribano, Yamile Zabana, Ana Gutiérrez, Eva Iglesias Flores","doi":"10.17235/reed.2025.11525/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11525/2025","url":null,"abstract":"<p><strong>Background and aims: </strong>Despite the established use of intravenous (IV) vedolizumab for treating inflammatory bowel disease, there's growing interest in exploring the advantages of the novel subcutaneous (SC) route. However, comprehensive real-world evidence regarding the extended safety and effectiveness of it remains scarce.</p><p><strong>Methods: </strong>IBD patients on IV vedolizumab treatment across 24 Spanish hospitals who were in clinical remission were given the option to transition to SC injections where this formulation was available or to remain on IV, while those in centers without access to SC vedolizumab remained on IV therapy. Data encompassing clinical disease activity, biochemical markers, adverse events, treatment persistence, and disease-related outcomes were retrospectively gathered from prospectively maintained clinical records at baseline, and at weeks 12, 24, and 48.</p><p><strong>Results: </strong>We identified 207 patients, with 23 excluded due to not being in clinical remission, resulting in a final inclusion of 184 patients. Of these, 53 (28.8%) remained on IV vedolizumab, while 131 (71.2%) transitioned to SC. There were 108 (58.7%) patients with ulcerative colitis and 76 (41.3%) with Crohn's disease. Both groups exhibited comparable demographic characteristics except for Crohn's disease behavior: non-inflammatory non-stricturing pattern (B1 Montreal classification) that was predominant among patients who transitioned to the SC (p=0.023). No differences were observed in drug persistence (log rank test p=0.82). Clinical, biochemical and fecal calprotectin remission at the different time-points were comparable at each time point with the exemption of clinical remission at week 12 favoring SC over IV. Drug intensification occurred in 24.5% of the patients on IV versus none on SC, p<0.0001. Safety was consistent with previously reported with no differences among groups 13 (8%) SC and IV 1 (2.1%), p=0.059; and most of them being mild in nature.</p><p><strong>Conclusions: </strong>Transitioning from IV to SC vedolizumab in patients with IBD in remission showed comparable effectiveness in maintaining disease remission and persistence. Patients on IV are more likely to need drug intensification during follow-up.</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":"145186677","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":"Challenges of using bevacizumab for hepatocellular carcinoma: incidence of adverse effects and mitigation strategies.","authors":"Marta García-Calonge, Andrés Castaño-García, Ana María Piedra Cerezal, Helena González Sánchez, Daniel Muíño Domínguez, Manuel Rodríguez, Valentina Chiminazzo, María Varela Calvo","doi":"10.17235/reed.2025.11540/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11540/2025","url":null,"abstract":"<p><p>Recent systemic treatment advances have transformed hepatocellular carcinoma (HCC) management, particularly with immunotherapy's superior outcomes over tyrosine kinase inhibitors, as demonstrated in trials like HIMALAYA, CheckMate 9DW and Imbrave-150. Atezolizumab and bevacizumab (AtezoBev) are now standard first-line treatments for advanced HCC. However, they present a risk of adverse events (AEs) that require careful monitoring, especially in patients with advanced chronic liver disease and related complications. This study investigates bevacizumab-related complications (B-AEs) in this population, emphasizing the importance of rigorous patient selection and management in achieving successful outcomes.</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":"145186680","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":"Comments on: \"Imaging features of Whipple's disease: fat-containing mesenteric lymphadenopathy and jejunal mucosal fold thickening\".","authors":"Akira Hokama","doi":"10.17235/reed.2025.11509/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11509/2025","url":null,"abstract":"<p><p>I read with interest the article by Dariva Machado et al., describing the case of Whipple's disease (WD), a systemic infection caused by Tropheryma whipplei that was initially misdiagnosed as sarcoidosis. I congratulate the authors on providing essential diagnostic clues and fully agree with their emphasis on the importance of radiologic findings in distinguishing WD from other granulomatous conditions. I would like to comment on another important differential diagnosis.</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":"145186710","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":"Reconnecting hepatitis C patients lost to follow-up ‒A targeted strategy.","authors":"Antonio Olveira, Raquel Domínguez-Hernández, Susana Cano, Irene Andaluz, Pilar Castillo, Miriam Romero, Javier García-Samaniego, Araceli García, Marta Abadía","doi":"10.17235/reed.2025.11527/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11527/2025","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C virus (HCV) infection remains a major contributor to liver-related morbidity and mortality worldwide. Although direct-acting antivirals (DAAs) achieve cure rates exceeding 95%, a substantial fraction of diagnosed patients never link to care.</p><p><strong>Objectives: </strong>To evaluate the effectiveness of a dual-modality retrieval strategy-mailed invitations followed by telephone outreach-in re-linking HCV-diagnosed patients lost to the health system within a defined health area.</p><p><strong>Methods: </strong>From 2010 to 2018, 4,816 anti-HCV serologies were reviewed and 677 patients (449 anti-HCV positive; 228 HCV RNA positive) were identified as lost to follow-up. An administrative team sent 436 personalized letters inviting patients to contact a dedicated phone line, then placed up to three calls (n = 363) to nonresponders during varied days and times. Respondents were offered expedited hepatology consultation (diagnostic confirmation, fibrosis staging) and DAA therapy.</p><p><strong>Results: </strong>Of 436 patients contacted, 260 (60%) responded (28% via letter and 72% via phone). Among these, 119 (47%) enrolled in follow-up (exclusion reasons: 65 declined further care, 51 were already treated/cured elsewhere, 13 had relocated, and 12 were deceased). A total of 119 patients attended hepatology consultation and underwent HCV RNA testing; 66 (55%, 66/119) initiated DAAs and all achieved sustained virological response at 12 weeks post-therapy completion, representing 10% of the original cohort, and 25% of contacts.</p><p><strong>Conclusions: </strong>Active retrieval combining mailed invitations and telephone outreach effectively re-links lost HCV patients to care, enabling DAA treatment and supporting national elimination goals.</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":"145186682","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":"Hepatic Myelopathy Improved by Embolization of Spontaneous Portosystemic Shunt and Partial Splenic Artery Embolization-A Case Report and Literature Review.","authors":"Fei Liu, Jiran Deng, Zhi Li, Zhong Huang","doi":"10.17235/reed.2025.11451/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11451/2025","url":null,"abstract":"<p><p>Hepatic myelopathy (HM) is a serious and debilitating complication associated with chronic liver disease. Currently, there is no definitive treatment; however, it is widely accepted that early liver transplantation and stent-restricted surgery may alleviate HM to some extent. We report a case of an adult male with a history of hepatitis B cirrhosis who developed a complex spontaneous shunt following portal vein occlusion, which resulted in recurrent hepatic encephalopathy and was later complicated by HM. We successfully relieved HM in this patient through embolization of the inferior mesenteric venous shunt and a portion of the splenic artery. This approach may offer a feasible alternative in selected patients not eligible for liver transplantation.</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":"145186647","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 diverticulotomy on Zenker's diverticulum with SB knife junior type endoscopic scissors. Safety profile in esophageal muco-myotomy.","authors":"Jorge Pérez Pérez, Jaime Escobar Ortiz, Francisco Garrido Gallego, Ángel Ponferrada Díaz","doi":"10.17235/reed.2025.11485/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11485/2025","url":null,"abstract":"<p><p>The Stag Beetle (SB) knife junior endoscopic scissors are commonly used in submucosal dissections. Its small size allows for more precise cuts that can be useful in diverticula with short, wide septa. In these types of septa, a Z-POEM technique may be considered, although its practicality is limited due to its complexity. We present the case of a 64-year-old man with symptoms of dysphagia, diagnosed with a 2 cm deep Zenker's diverticulum. It was therefore decided to perform an endoscopic muco-myotomy of the diverticulum.</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":"145186716","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 invisible burden - The challenge of untreated hepatocellular carcinoma.","authors":"José Luis Lledó Navarro","doi":"10.17235/reed.2025.11454/2025","DOIUrl":"10.17235/reed.2025.11454/2025","url":null,"abstract":"<p><p>This editorial explores the situation of patients with hepatocellular carcinoma (HCC) who, due to advanced frailty, multiple health conditions, personal choice, or terminal disease stage, are not candidates for active cancer treatment. Despite progress in early diagnosis, a notable percentage of these individuals receive only comfort-oriented care. The article reviews how their prognosis is largely determined by the severity of liver failure and overall health status, while tumor features such as extent and vascular invasion, along with high tumor markers, further diminish survival prospects. It also discusses the influence of social context and patient decisions on outcomes. The editorial advocates for a care model focused on alleviating symptoms, respecting patient preferences, and improving quality of life through palliative interventions. It calls for more inclusive research and healthcare strategies that address the specific needs of these patients, emphasizing the importance of compassion, respect, and tailored support during the final stages of illness.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":"487-489"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754148","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":"A review of the diagnosis and treatment of chronic pancreatitis-associated sarcopenia.","authors":"Pablo B Pedrianes Martín, Lourdes García Blasco, Pablo García Carbo, Mercedes Molares Pineiro, Cristina Viñolo Ubiña","doi":"10.17235/reed.2025.10592/2024","DOIUrl":"10.17235/reed.2025.10592/2024","url":null,"abstract":"<p><p>Chronic pancreatitis (CP) causes inflammation of the pancreas, resulting in structural damage and impaired exocrine and endocrine function. Chronic pain, nutritional deficiencies from nutrient maldigestion, and hyperglycemia cause a large number of consultations and hospital admissions, and a significant burden on the health care system. Intractable pain, alcoholism, and malabsorption place these patients at considerable risk of developing sarcopenia, with a prevalence of 17-62 %. While diagnostic methods have been developed to assess muscle mass in these patients, they still lack standardization and no specific drug regimen is available for the clinical management of sarcopenia. Nutritional assessment must be a key component of the initial approach to patients with CP. Our objective is to review the current knowledge on muscle mass status and the pathogenesis, diagnosis and management of sarcopenia in patients with CP.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":"513-520"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966967","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":"Reply to the comments on \"Coffee bean sign, steel pan sign and whirl sign in sigmoid volvulus\".","authors":"Akira Hokama, Atsushi Iraha, Kazuko Yamamoto","doi":"10.17235/reed.2024.10571/2024","DOIUrl":"10.17235/reed.2024.10571/2024","url":null,"abstract":"<p><p>We thank Prof. Atamanalp and colleagues for their interest and valuable comments on our article. The authors have highlighted important considerations in the diagnosis of sigmoid volvulus (SV). We would like to respond to their comments. Firstly, although we agree with their opinion that CT, MRI, and endoscopy are more reliable diagnostic tools than plain radiography, we still emphasize that diagnostic imaging for SV is initially based on plain radiography, as recommended by the WSES consensus guidelines. Since SV is the third most common cause of colonic obstruction worldwide, the accessibility of plain radiography is crucial. Among the many plain radiographic signs of SV, Levsky et al. reported that the most sensitive signs were absence of rectal gas, followed by inverted-U appearance and coffee bean sign. Understanding these signs may lead to early detection of SV and further CT evaluation for ischemia or perforation. Despite the high value of plain radiography, there is a global tend to use CT instead from the outset. Secondly, we agree with their opinion that endoscopy is not only a therapeutic, but also a diagnostic procedure to assess mucosal viability. In addition, we believe that endoscopy is also useful in ruling out other obstructive lesions, including colorectal neoplasia and complicated sigmoid diverticular disease. In the clinical setting, endoscopy is performed after the diagnosis of SV by plain radiography or CT and serves as the first line of decompression of SV when ischemia or perforation is not suspected. Finally, we congratulate Prof. Atamanalp and colleagues for their dedicated contribution to the large-scale SV studies in Eastern Anatolia, Turkey, where SV is endemic.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":"530-531"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318189","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}