Acta Gastroenterologica Latinoamericana最新文献

{"title":"From Intravenous to Subcutaneous Infliximab: the Same but Different? Real-World Evidence from a Tertiary Center.","authors":"María José Temido, Andrea Silva, Sandra Lópes, Ana Margarida Ferreira, Sofía Mendes, Manuela Ferreira, Pedro Figueiredo, Francisco Portela","doi":"10.52787/agl.v54i1.364","DOIUrl":"10.52787/agl.v54i1.364","url":null,"abstract":"<p><strong>Introduction: </strong>\u0000 <i>Recently, a subcutaneous formulation of infliximab was approved. The switch from intravenous infliximab to subcutaneous infliximab may improve convenience, but data on pharmacokinetics and immunogenicity are limited. We aimed to compare the efficacy and tolerability of subcutaneous infliximab and to assess whether the formulation results in higher plasma levels of infliximab.</i>\u0000 </p><p><strong>Methods: </strong>\u0000 <i>Retrospective, single-center cohort study. Patients with Crohn's disease or ulcerative colitis, 18 years of age or older, clinically stable, receiving intravenous infliximab (5mg/kg every eight weeks) for more than 6 months were switched. Subcutaneous infliximab (120 mg) was administered every 2 weeks. Clinical and analytical evaluations were performed on day 0, week 2, week 8, and week 16. Plasma levels of infliximab and anti-drug antibodies were measured at these time points.</i>\u0000 </p><p><strong>Results: </strong>\u0000 <i>41 patients included (27 with Crohn's disease and 14 with ulcerative colitis. Azathioprine was administered concomitantly in 47.6%. All patients remained in clinical remission. Analytical biomarkers remained stable. Treatment persistence: 95.1%. Median plasma levels of infliximab at day 0, week 2, week 8, and week 16: 4.89 (3.25 - 7.27), 9.17 (7.89 - 12.6), 19.91 (15.02 - 21.64) and 21.55 (17.18 - 29.57) ug/mL, respectively. Statistically significant difference of plasma levels of infliximab in day 0 vs. week 2 and week 2 vs week 8. Azathioprine resulted in a statistically significant difference in plasma levels of infliximab only at day 0 (not at week 2, week 8, or week 16). Plasma levels of infliximab at week 2, week 8, and week 16, but not at baseline, were statistically associated with body mass index. No anti-drug antibodies were detected. No severe adverse effects. Three patients developed injection site reactions. Three patients developed arthralgia of undetermined significance.</i>\u0000 </p><p><strong>Conclusions: </strong>\u0000 <i>Switching from intravenous infliximab to subcutaneous infliximab maintained clinical response. Plasma levels of infliximab at week two were still lower than expected, considering the results at week eight. A possible advantage of subcutaneous infliximab may be the diminished necessity for concomitant immunomodulators.</i>\u0000 </p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"54 1","pages":"56-64"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Role of Imaging in Autoimmune Pancreatitis].","authors":"Diego Haberman, Sandra Basso, Mariano Volpacchio, Analía Gubitosi, María Cristina Nazar, Paola Visbal, María Florencia Ranero","doi":"10.52787/agl.v54i1.392","DOIUrl":"10.52787/agl.v54i1.392","url":null,"abstract":"<p><p>Autoimmune pancreatitis is a specific form of chronic recurrent pancreatitis whose etiopathogenesis involves immunological mechanisms. Historically, two varieties of the disease have been described, each with clinical, biochemical and histological particularities. Recently, a third subtype has been described as a consequence of the adverse effects associated with immunotherapy, which is increasingly indicated for several tumors. The diagnosis of autoimmune pancreatitis is a challenge for professionals, in part because of its heterogeneous clinical presentation, which includes obstructive jaundice in type 1 autoimmune pancreatitis and abdominal pain in type 2, and can mimic more serious pathologies such as pancreatic ductal adenocarcinoma. Serum biomarkers (IgG4) play an important role in the diagnosis, but they can sometimes be normal, especially in type 2 autoimmune pancreatitis, or be elevated in other pathologies. Non-invasive imaging techniques, in particular magnetic resonance cholangiopancreatography with intravenous contrast, play a central role in the diagnostic process of the disease. In this article, we review the imaging aspects of autoimmune pancreatitis and the extrapancreatic manifestations of systemic IgG4 disease, the features that differentiate it from pancreatic cancer and we evaluate the radiological criteria for response to corticosteroid treatment.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"54 1","pages":"14-30"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[[Key Concepts in Pretest Probability Estimation]].","authors":"Walter Masson","doi":"10.52787/agl.v54i1.385","DOIUrl":"10.52787/agl.v54i1.385","url":null,"abstract":"","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"54 1","pages":"8-10"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Esophageal Granular Cell Tumor Methodology and Differential Diagnosis: A Case Report].","authors":"Guillermo Carnevale, Sergio Mauricio Rubel Cohen, Guillermo D'Ottavio, Jordana De Melo, Daniel Pozzi, Federico Bucciarelli, Juan Cardona","doi":"10.52787/agl.v54i1.342","DOIUrl":"10.52787/agl.v54i1.342","url":null,"abstract":"<p><p>Granular cell tumor is a neoplasm that originates from Schwann cells. Esophageal localization is rare. Although certain endoscopic features characterize these lesions, endoscopic ultrasound together with histopathological examination with immunohistochemical analysis are essential for their correct diagnosis.</p><p><strong>Case report: </strong>A 56-year-old male consulted for dysphagia and pyrosis. Endoscopic examination revealed an elevated subepithelial lesion in the lower third of the esophagus with areas of mucosal erosion. Echoendoscopy showed a hypoechogenic lesion with defined borders located on the muscularis mucosae layer. The lesion was removed using an endoscopic submucosal dissection technique. Finally, after the use of immunohistochemistry, the diagnosis of granular cell tumor was reached, with positive expression of S100 protein and CD68 marker.</p><p><strong>Conclusion: </strong>Granular cell tumor is a rare cause of esophageal subepithelial lesion. Its main differential diagnosis is stromal tumor. Echoendoscopy and histopathologic analysis with the use of immunohistochemistry are essential for its correct diagnosis and subsequent treatment.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"54 1","pages":"98-102"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prevalence of Motility Disorders in Patients with Esophageal Symptoms].","authors":"Adriana Tevez, Harumi Hashimoto, María M Piskorz, Tatiana Uehara, Esteban González Ballerga, Jorge A Olmos","doi":"10.52787/agl.v53i4.363","DOIUrl":"10.52787/agl.v53i4.363","url":null,"abstract":"<p><strong>Introduction: </strong>\u0000 <i>. Patients with esophageal motility disorders may present different symptoms. Dysphagia is the most common symptom, but it may also present with reflux symptoms (mainly regurgitation) and/or chest pain. Data on the prevalence of esophageal motility disorders, according to the different presenting symptoms in the Argentine population, are scarce.</i>\u0000 </p><p><strong>Aim: </strong>\u0000 <i>To describe the symptom profile and determine the prevalence of esophageal motility disorders based on each symptom.</i>\u0000 </p><p><strong>Material and methods: </strong>\u0000 <i>Retrospective analysis of prospectively conducted studies. Patients with esophageal symptoms who underwent high-resolution esophageal manometry from January 2009 to December 2020 were included. High-resolution manometry was performed with a system of 36 circumferentially sensitive solid-state sensors and patients were classified using the Chicago Classification v3.0.</i>\u0000 </p><p><strong>Results: </strong>\u0000 <i>Of the 861 patients studied (mean age 57 +/- 16 years; 71.2% women), 304 had dysphagia, 462 had gastroesophageal reflux symptoms, 89 had chest pain, and 6 had a combination of symptoms. Among patients with dysphagia, 38.16% had achalasia. Among patients with gastroesophageal reflux symptoms, 63.2% had normal esophageal motility and 18% had ineffective esophageal motility. Among patients with chest pain, 67% had normal esophageal motility and 13% had ineffective esophageal motility. The odds ratio for achalasia in patients with dysphagia was 38 (95% CI 19-86, p = 0.000).</i>\u0000 </p><p><strong>Conclusion: </strong>\u0000 <i>Gastroesophageal reflux symptoms were the most common presentation, followed by dysphagia. Achalasia was the most common manometric finding in patients with dysphagia and ineffective esophageal motility in patients with gastroesophageal reflux and chest pain. This study highlights the high prevalence of achalasia in patients with dysphagia and ineffective esophageal motility in patients with gastroesophageal reflux and chest pain.</i>\u0000 </p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"347-354"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Findings in Candidate Patients for Bariatric Surgery.","authors":"Nicolás Airaldi, Manuel García, Agustín R Gigena, Fernando Martínez Lascano, Carlos M Esquivel","doi":"10.52787/agl.v53i4.360","DOIUrl":"10.52787/agl.v53i4.360","url":null,"abstract":"<p><strong>Introduction: </strong>. Obesity is a risk factor for gastrointestinal diseases such as gastroesophageal reflux disease, erosive esophagitis, and hiatal hernia, among others. The presence of some of these diseases during the preoperative bariatric study may condition the surgical technique to be performed.</p><p><strong>Materials and methods: </strong>. We conducted a retrospective, descriptive, cross-sectional study from a prospectively collected database of patients with obesity treated with bariatric surgery between January 2016 and June 2022 who systematically underwent preoperative upper gastrointestinal endoscopy.</p><p><strong>Results: </strong>. We evaluated 704 patients who were candidates for bariatric surgery. The mean age of the patients was 40 years, predominantly female (71.6%). The most frequent endoscopic findings were gastropathies, which appeared in 98.9% (n: 696) of the patients, followed by esophageal disorders in 11.6% (n: 82). The prevalence of erosive esophagitis was 9.8% (n: 69). In adittion, 19.7% of the endoscopic findings required preoperative medical treatment and in 4% of the patients the surgical decision was determined by the endoscopic finding.</p><p><strong>Conclusion: </strong>. Given the high relationship between obesity and diseases of the upper digestive tract, and the interference that these diseases can have in the postoperative evolution of a bariatric patient, we consider that upper gastrointestinal endoscopy should be routinely included in the preparation of the patient who is a candidate for bariatric surgery.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"361-368"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divertículo esofágico inusual en un paciente anciano.","authors":"Laura Juliana Jaime Ardila, Jorge Carmelo Martínez, Juan Sebastián Frías Ordoñez, Carlos Mauricio Martínez, Oscar Fernando Ruiz Morales, Martín Alonso Gómez Zuleta","doi":"10.52787/agl.v53i4.368","DOIUrl":"10.52787/agl.v53i4.368","url":null,"abstract":"","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"346"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Experience in the Use of Tofacitinib in the Treatment of Ulcerative Colitis in Two Pediatric Patients: Two Case Reports].","authors":"Karen Velásquez Vanegas, Carlos Augusto Cuadros Mendoza, María José Daniels García, Viviana Parra Izquierdo","doi":"10.52787/agl.v53i4.331","DOIUrl":"10.52787/agl.v53i4.331","url":null,"abstract":"<p><strong>Introduction: </strong>. In this report, the experience using tofacitinib in two pediatric patients diagnosed with ulcerative colitis at the International Hospital of Colombia is described. A review of the current state of the art is also carried out.</p><p><strong>Cases: </strong>. Both patients had already undergone conventional management without an adequate response for almost two years. In case 1, clinical remission was achieved one month after initiating sustained treatment with tofacitinib. In case 2, clinical and endoscopic remissions were achieved two months after initiating treatment.</p><p><strong>Discussion: </strong>. Studies have demonstrated its efficacy as induction and maintenance therapy for moderate to severe active ulcerative colitis, with an acceptable safety profile. However, information about the use of tofacitinib within the treatment arsenal is limited in the pediatric age group.</p><p><strong>Conclusion: </strong>. Tofacitinib is a promising alternative for the treatment of ulcerative colitis with no response or loss of response to conventional treatment. We present the experience of two adolescent patients in whom clinical remission of the disease was achieved earlier than expected, also documenting endoscopic and histologic remission in one of them.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"395-400"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Von Meyenburg Complexes or Biliary Hamartomas: A Case Report].","authors":"Rosángela Ramírez Barranco, Carmen Yanette Suárez Quintero, Fredy Ávila Almanza","doi":"10.52787/agl.v53i4.323","DOIUrl":"10.52787/agl.v53i4.323","url":null,"abstract":"<p><strong>Introduction: </strong>. Von Meyenburg complexes or biliary hamartomas are a rare benign congenital anomaly of the intrahepatic bile ducts. They are usually asymptomatic and incidentally found on imaging studies but can cause jaundice, abdominal pain, and cholangitis.</p><p><strong>Case report: </strong>. An 80-year-old male patient was admitted to the emergency department due to progressive jaundice associated with pruritus, with an altered hepatogram and a cholestasis pattern. Imaging studies were performed in which there were no alterations in the liver parenchyma or bile ducts. A liver biopsy was performed, which revealed perivenular canalicular cholestasis and the presence of von Meyenburg complexes. The patient was treated with ursodeoxycholic acid with normalization of cholestasis at outpatient follow-up.</p><p><strong>Conclusion: </strong>. The diagnosis of biliary hamartomas should be considered in patients with intrahepatic cholestasis in whom the etiology is not identified by initial studies. They represent a diagnostic challenge as they are not always seen in imaging studies.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"390-394"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Retrospective Study: Comparison of AIMS65, Rockall and Glasgow Blatchford Scores for Upper Gastrointestinal Bleeding].","authors":"Virgilio Alvarado Gallo, Jimmy Arias Crespo, María Cepeda Mullo, Silvia Campoverde Duchitanga, Víctor Vera Gordillo, Jorge López Pinto, Rita Pico Rodríguez, Paúl Chamba Molina","doi":"10.52787/agl.v53i4.371","DOIUrl":"10.52787/agl.v53i4.371","url":null,"abstract":"<p><strong>Introduction: </strong>Upper gastrointestinal bleeding constitutes a primary emergency for emergency services world wide. It has varied etiology and broadther apeutics, so the use of prognostic scalesis necessary to establish the patient's risk.</p><p><strong>Objectives: </strong>. Determine which of the four scales studied has a greater capacity to discriminate between cases of low and high risk for rebleeding, need for blood transfusion and death.</p><p><strong>Materials and methods: </strong>. A retrospective cohort study was carried out using the data base of the Guasmo Sur General Hospital from 2020 to 2022, comparing scores obtained by applying the scales to patients diagnosed with upper gastrointestinal bleeding and the irevolution to know their potential prognosis.</p><p><strong>Results: </strong>. In predicting mortality, the following had better AUC: pre-endoscopic Rockall and AIMS65 with 0.701 and 0.689, respectively; the most useful are Rockall and pre-endoscopic Rockall with sensitivity 95% and NPV 98.3%, with cut-off points of 4 and 3, respectively. In predicting rebleeding, the score with the best AUC was GBS with 0.700, at a cut-off point of 9, it had a sensitivity of 92.3% and a NPV of 95.1%. In predicting the need for transfusion, the one with the best AUC was GBS with 0.766, and a cut-off point of 5, it is the most useful with sensitivity 97.1% and NPV 82.6%.</p><p><strong>Conclusion: </strong>. The most useful scales for the different outcomes measured were Rockall, pre-endoscopic Rockall and GBS.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"369-377"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}