Enfermedad Inflamatoria Intestinal al Día最新文献

Knowledge of the pathogenesis of inflammatory bowel disease has evolved over time. The most accepted hypothesis nowadays supports the fact that inflammatory bowel disease is the result of an aberrant immune response in a genetically susceptible host. The last 2 decades have signified a huge advance in this knowledge coming from different perspectives. The objective of this review is to explore studies that represent a qualitative breakthrough in this area, ranging from the influence of microbiota to advances in genetics and finally systems biology approach.

The WHO is advocating for the educational paradigm of self-care, led essentially by nursing professionals due to their clinical profile and training. There are few studies which value the role of the nurse in multidisciplinary units for patients with Inflammatory Bowel Disease (IBD). Our goal is to show the different views of the role and competencies of nursing in the IBD Unit at Vall d’Hebron Hospital.

A qualitative study, critical theory. The ethnographic method (microethnographic), from a descriptive focus. Semi-structured and registered personalised interviews through the use of webcams and voice registration. The codification and analysis of the information was undertaken manually. Of 10 participants, 8 collaborated. The connection to the UACC Unit is between one to twelve years.

Roles highlighted: case management, training, coordination, nurse availability and finally, the role of investigation, existing differences according to the link to the unit.

In analysis by competency we find: knowledge of inflammatory disease, chronic diseases, pharmacology and knowledge of the role of nursing. Skills: Communication, advocacy, management of chronic patients and stress, grouping, and empathy. Attitudes: listening, openness, calming, educational and receptive.

Knowing how nurses are considered permits opportunities for change, and this leads to setting out new lines of research which demonstrate the benefits of nurse management in IBD units.

Complex perianal disease frequently affects patients with Crohn's disease, and it is associated with high morbidity and a significant impairment in patients’ quality of life, both in adult and pediatric patients. It also constitutes a significant economic burden to the healthcare system due to its complexity and cost of treatment. The aim of this review is to provide an updated approach of this entity, reviewing aspects of its epidemiology, diagnosis and medical and surgical therapeutic alternatives. In addition, new emerging treatment options are discussed. A medical and surgical coordinated approach and a multidisciplinary assessment of these patients is mandatory.

Malnutrition is a common complication in patients with inflammatory bowel disease, especially in those with Crohn's, and it is associated with a negative impact on the patients’ prognosis. Enteral nutrition can induce a beneficial effect on nutritional status as well as on the disease's progression, throughout different mechanisms. Exclusive enteral nutrition is not considered a first-line therapy for the induction of remission in Crohn's disease. Its role in other clinical situations, such as clinical remission maintenance, is not well established. More controlled clinical trials are needed in order to clarify the clinical usefulness of enteral nutrition in inflammatory bowel disease in adults.

The treatment of paediatric Crohn's disease (CD) requires careful attention to optimising normal growth and bone health in addition to achieving mucosal healing. Reducing exposure to systemic corticosteroids can be a highly important first step to influence these medium-to-long-term disease-specific and general health outcomes. An effective alternative to induction therapy with corticosteroids is exclusive enteral nutrition (EEN) which is recommended as first-line therapy in paediatric CD. In this review, we discuss the rationale behind EEN, its putative mechanisms of action and novel, promising modifications to EEN for the future dietary management of paediatric CD.

Biological treatment with drugs targeting tumor necrosis factor-α (anti-TNF) has improved the therapeutic options for inflammatory bowel disease (IBD). These drugs have shown high clinical efficacy associated primarily with mucosal healing and improvement in the patient́s quality of life. However, a high percentage of patients do not respond to initial treatment or lose the achieved response over time. To prevent or attenuate anti-TNF failure, several strategies have been employed in an attitude known as treatment intensification. These strategies include: increasing anti-TNF dosage, shortening the intervals in administration, associating anti-TNF to an immunomodulator or, although not strictly an attitude of intensification, switching to another anti-TNF or biological drug (there are few alternatives in IBD). These strategies are usually applied empirically, based on the clinical condition of patients. Recently, the introduction of anti-TNF monitoring in clinical practice through the determination of drug serum levels and presence of antibodies to the drug, allows a more accurate selection of strategies. Nevertheless, there are certain aspects of the intensification of anti-TNF treatment that remain unresolved and patients with intensified treatment must be closely and thoroughly monitored because of the high risk of infection.

Introduction

In population-based studies, ulcerative proctitis (UP) accounts for more than 25% of ulcerative colitis (UC) patients and presents distinctive clinical outcomes and therapeutic approaches as compared to left-sided and extensive UC. Our aim was to describe the different therapeutic approaches and health resources used in patients with UP in clinical remission.

Material and methods

We performed a retrospective observational study including patients with UP that were followed in our Hospital Universitari Germans Trias i Pujol between 1989-2014. Clinical information and the different treatments for the maintenance of remission were recorded, including galenical formulation.

Results

A total of 101 patients with UP were included. Median time of follow up was 8 years (IQR 3-14). Most patients were treated with topical mesalazine (especially suppositories) (89%); followed by oral mesalazine (55%). The 33% of patients underwent combined therapy with oral and topical mesalazine. Another 12% were treated with topical steroids for maintenance therapy and 3% of patients required thiopurines. The 10% of patients attended to Emergency Service and 4% were hospitalized for disease activity within follow-up. None of them required colectomy.

Conclusions

Topical mesalazine is the most used maintenance treatment in UP patients in our clinical practice, suggesting both a good acceptance by patients and a high degree of confidence for doctors. UP is associated with a low requirement of health resources, although studies focused on the quality of life are needed.

Human papilloma virus, HPV, is the most common sexually transmitted disease in the world.

The incidence and prevalence of benign and malignant anogenital lesions induced by HPV are strongly increased by immunosuppression.

The case of 23 year-old man with extensive steroid-dependent ulcerative colitis, treated with azathioprine and prednisone, who developed perianal HPV lesions during the follow up.