Enfermedad Inflamatoria Intestinal al Día最新文献

Inflammatory bowel disease (IBD) is a chronic condition and establishing a relationship of trust with the patient is key in facilitating treatment adherence. 70% of specialists are aware of the fact that good communication with patients encourages adherence to treatment but only one in ten professional admit to having received specific training.

Motivational interviewing (MI) is an easy-to-learn method. Its use in various medical disciplines is associated with better adherence and a change in unhealthy habits. This paper provides a brief review of the strategic principles of MI and how it can be applied to daily practice for IBS.

There has been renewed interest in the recent years, in the epidemiology of inflammatory bowel diseases. The aim of this article is present a review of the epidemiological method and the epidemiological studies, showing the strengths and limitations of each of them, with examples in the field of inflammatory bowel diseases in order to understand and analyse these types of studies.

Many high quality articles were published in 2016 regarding Crohn's disease (CD) and ulcerative colitis (UC). The importance of diet and microbes in inflammatory bowel disease (IBD), the burden of IBD on patient quality of life are some of the relevant topics. The role of calprotectin or the possibility of using PET for follow-up is also highlighted.

IBD treatment has been the focus of numerous clinical trials, which have consolidated infliximab (suggesting levels in week 2), adalimumab, and golimumab as front-line treatment. The use of ustekinumab in CD is supported, with methotrexate being left as a last resort, except in the case of arthropathy. Other treatments investigated that are worth mentioning were stem cells, other biosimilar, and new drugs.

Introduction

Neurological manifestations in patients with inflammatory bowel disease are more frequent than previously believed. In some cases the neurological symptoms can precede the diagnosis of inflammatory bowel disease. An early and correct diagnosis of these problems is important, since they can be serious and irreversible. Cerebrovascular involvement is rare, being more frequent in ulcerative colitis, and is favoured by a multifactorial hypercoagulability state.

Patients and methodology

The case is presented on a paediatric patient with refractory Crohn's disease who developed cerebral venous thrombosis three years after onset of the bowel disease. A review is also presented on all the cases described in the literature and a comparative study with our case was performed.

Results

The review found a total of 18 paediatric age patients diagnosed with inflammatory bowel disease who suffered thrombosis of the cerebral venous sinuses. Most of the patients had ulcerative colitis (61.1%). An analysis was made of the presence of the most common risk factors such as thrombocytosis or iron-deficiency anaemia, as well as genetic coagulation disorders. The treatment used in the most of the cases included heparin and oral anticoagulants. The outcome of the neurological manifestations was favourable in more than 75% of the cases.

Conclusion

Cerebrovascular involvement is rare, but an early diagnosis and treatment are essential for a favourable outcome.

Following the notification from the FDA on the risk of hepatosplenic T-cell lymphoma after using thiopurines, it has found a growing trend of prescribing MTX in paediatric inflammatory bowel disease, becoming the first-line immunomodulator in up to 60% of PIBD patients in 2010. The basic mechanism of action by which MTX acts in IBD and rheumatologic diseases is currently unknown, but it seems not to be exclusively by inhibiting the metabolism of folates. Side effects (nausea/vomiting, hypertransaminasaemia, leukopenia and thrombocytopenia) of treatment with MTX are currently the major factor that has conditioned the widespread use of MTX in PIBD. The purpose of this manuscript is to describe the pharmacological aspects of MTX, review the effectiveness of MTX in paediatric CD and UC in both mono and combination therapy, and highlight the most important aspects in terms of side effects and their management.

Inflammatory bowel disease is a chronic disease that primarily affects the gastrointestinal tract. Extraintestinal manifestations are frequent and can affect any organ, but those that affect the respiratory tract are uncommon. In these cases, the lower respiratory tract tends to be affected, usually with bronchiectasis and chronic bronchitis. It has been more often described in patients with ulcerative colitis.

We herein report the cases of two patients with inflammatory bowel disease with upper respiratory tract involvement treated in our hospital. Both cases were treated with systemic corticotherapy and required a tracheostomy. The first case presented with subglottic stenosis requiring dilation with a Foley catheter. We have conducted a review on the evidence available of the main characteristics of these manifestations, as well as its diagnosis and treatment according to the available case series.

The presence of activity of inflammatory bowel disease during pregnancy can affect the course of the pregnancy. Therefore, the best advice is that conception occurs when the disease is in remission. A flare-up during pregnancy requires treatment as quickly as possible to induce remission and thus avoid any complications.

We report the case of a woman, who being treated with adalimumab, becomes pregnant and presents with a flare-up that requires a scale-up of treatment until the end of pregnancy. The end of pregnancy and childbirth occur without maternal and foetal complications.

Hereditary haemochromatosis (HH) is an autosomal recessive genetic disease related to iron overload due to a mutation of the HFE gene located in chromosome 6. This chromosome is located on locus HL-DR, which is the same as ulcerative colitis. This could mean that patients who have HH have a greater predisposition to suffer an inflammatory bowel disease. In addition, both diseases increase the risk of infections by intracellular bacteria, such as Listeria monocytogenes.

Patients with inflammatory bowel disease and concomitant perianal disease may present with urgency and/or faecal incontinence due to both the underlying inflammatory process and possible abnormalities in anorectal function, or by affecting rectal compliance. Anorectal function studies show that in Crohn's disease anal resting pressure and squeeze pressure are decreased in patients with previous surgery on the perianal region. In ulcerative colitis there is no published data on the capacity of the anal sphincter in patients with ulcerative colitis and perianal disease. Anal pressures are normal in patients with ulcerative colitis even during flare-ups with a dramatic decrease in rectal compliance contributing to urgency and incontinence in these patients. Likewise, increased fatigability of the striated sphincter muscle, observed in both patients with Crohn's disease and with ulcerative colitis, is associated with faecal urgency or incontinence. In conclusion, it might be useful to evaluate anorectal function in those patients who will be operated on due to injury in the perianal region and prior to bowel transit restorative surgery.

In spite of the best possible optimisation of the available drugs in inflammatory bowel disease (IBD), an important group of patients will require new therapeutic alternatives. Fortunately, there are already new drugs such as vedolizumab or ustekinumab, but, there are many more that will be available in a near future. In this article, a review is made of the evidence and the possible uses of these alternatives. Some of them are drugs that inhibit white cell adhesion, the JAK-kinase inhibitors, the anti-cytokines (especially, ustekinumab), and mongersen.