Enfermedad Inflamatoria Intestinal al Día最新文献

Introduction

An important percentage of patients with inflammatory bowel disease will require surgical treatment at some point. Despite technological progress in the surgical and anaesthetic fields, figures for postoperative morbidity are still high. This alone requires a comprehensive review of perioperative protocols that will allow better surgical results.

Objective

To update all organisational and therapeutic measures that have proven to be effective when it comes to optimising the perioperative period.

Methods

Review of literature related to postoperative morbidity, immunosupression, radiology, nutrition, multidisciplinary teams and multimodal rehabilitation protocols.

Results

Management of inflammatory bowel disease, especially during the perioperative period, requires the coordinated action of a multidisciplinary team with a specific dedication to this condition. The surgical decision must be agreed upon clinical criteria and reinforced by means of modern imaging techniques. Sepsis, malnutrition and prolonged corticoid therapy have shown to be the principal determining factors for morbimortality after surgery. The presence of an abscess requires percutaneous drainage followed by surgery. Malnutrition states require aggressive nutritional therapy before the surgery and, whenever possible, the corticoid dosage should be reduced. Compliance with the current ERAS multimodal rehabilitation protocols can help shorten the admission period after surgery and offer an efficient and viable alternative for improving the postoperative period and the quality of life for patients.

Inflammatory bowel disease (IBD) is a systemic chronic disease, which in some cases is associated with thromboembolic events. Although these events are uncommon, they are increased in patients with IBD and increase morbidity and mortality.While IBD is active there are modifications in the coagulation system, thus inducing a hypercoagulable state and a risk of developing thrombotic events which are not present in patients with inactive IBD.It is essential to identify which patients have a higher risk of developing a thrombotic event and establish appropriate prophylaxis as early as possible.We present some cases of patients diagnosed with IBD who developed vascular complications in the course of their disease and we review the existing literature.

The use of antibodies against tumor necrosis factor alpha (anti-TNF) increases the risk of tuberculosis (TB) in patients with inflammatory bowel diseases (IBD). The Spanish Working Group in IBD (GETECCU) developed the first guidelines for TB screening in IBD in 2003, and they were further reviewed in 2006. However, the widespread use in clinical practice of new diagnostic tools such as interferon-gamma release assays, the better knowledge of epidemiological and clinical features of TB in the setting of anti-TNF therapy, and the evidence that TB has decreased but still occurs despite the implementation of guidelines for the screening of latent TB infection, prompted a new revision of the GETECCU recommendations.

Although most patients with ulcerative colitis should be treated with topical treatment, different studies have shown that they are underused. The purpose of this article is to answer 10 specific questions about which drugs are available for topical use in the treatment of ulcerative colitis, and their characteristics in terms of formulation, dosage, presentation, application and proximal distribution of rectal-administered drugs. The efficacy of the available topical drugs and the benefits of combining different formulations and routes of administration, and their usefulness during disease remission is evaluated. Finally, some recommendations are given to better inform patients about the proper implementation and administration of topical treatment.

The use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) patients is very common. Complementary and alternative therapies might be effective for the treatment of IBD, although they might be as well potentially dangerous. Nowadays, the evidence and information about these types of therapies are not enough. However, alternative treatment strategies are limited and require extensive clinical testing before being optimized for use in patients. Therefore, physicians should know and increasingly inform IBD patients about benefits and limitations of CAM treatment. A review of clinical evidence available on the different types of CAM used in IBD is made.