Gastroenterologia y hepatologia最新文献

Hepatitis B virus is a public health issue, with severe complications such as cirrhosis and liver cancer that impose significant economic, emotional, and psychosocial burdens. Despite the availability of a vaccine and oral treatments, effective management of this disease remains a challenge. Telemedicine and mobile applications have the potential to improve the management of chronic diseases; this study examines their utility in hepatitis B. A search was conducted in four databases in November 2024 following the PRISMA guidelines. Out of 216 articles, seven studies were included. These studies evaluated the use of mobile applications in providing access to information, detection and linkage to care, quality of life assessment, and vaccination promotion. The findings showed the usefulness of these tools, considering mobile applications as a helpful tool in the management and prevention of hepatitis B.

Introduction: subcutaneous (sc) vedolizumab is an alternative to intravenous (iv) vedolizumab for the treatment of patients with mild-to-moderate flares of inflammatory bowel disease (IBD).

Aims: to analyse the persistence rate of the sc vedolizumab and its pharmacokinetics in patients previously treated with iv vedolizumab; describing clinical and biochemical remission rates at one year, and comparing previous intravenous intensification regimens.

Methods: multicenter, descriptive, observational, and retrospective study of a cohort of 54 patients with IBD treated with iv vedolizumab for more than six months, who were switched to sc vedolizumab under a standard regimen, 32 patients (59%) with a diagnosis of ulcerative colitis (UC) and 22 patients (41%) with Crohn's disease (CD) Results: After one year of follow-up, 93% of the patients continued with vedolizumab, 100% were in clinical remission, and 86% achieved biochemical remission (calprotectin < 150). A progressive increase in vedolizumab levels was observed after switching to sc vedolizumab, with statistical significance (p < 0.05). 14 patients (25.9%) were on an intensified regimen before switching to sc vedolizumab. However, all patients remained on subcutaneous vedolizumab at a dose of 108 mg every two weeks without the need for intensification.

Conclusion: After switching to sc vedolizumab in patients with endovenous vedolizumab treatment, high persistence rate at one year of follow-up is achieved, with a greater tendency to biochemical remission, which is more pronounced in previously intensified patients without the need for subcutaneous vedolizumab intensification.

Objectives: Moderate to severe Crohn's disease (CD) treatment was revolutionized by introducing anti-tumor necrosis factor (TNF) agents, which is still a cornerstone of the treatment. It is speculated that adipose tissue may influence treatment response, especially for non-weight-adjusted agents.

Patients and methods: Research comparing the effectiveness of anti-TNFs between eutrophic and overweight patients may impact clinical management. We performed a retrospective analysis of a CD patient database. The primary endpoint was loss of response (LOR) after 54 weeks with infliximab (IFX) and adalimumab (ADA) in patients with body mass index (BMI) < 25 and ≥ 25. Secondary endpoints were steroid-free remission and endoscopic remission rate.

Results:  179 CD patients were evaluated; 48.9% had LOR after 54 weeks of anti-TNF therapy. Fifty-four patients had a BMI ≥ 25, with 51 receiving IFX and 28 receiving ADA. The univariate analysis identified LOR in 56.5% of the patients with IFX and 34.9% in the ADA group (p=0.009). In the 54-week multivariate analysis, loss of response in the IFX group with BMI ≥ 25 had a relative risk of 1.04 [CI 0,60-1.80 (p=0.891)] compared to patients with BMI < 25. Being overweight or obese led to a risk of 1.50 for LOR for ADA at 54 week time point [CI 0,60-3,74 (p=0.0387)]. Clinical remission at 54 weeks was similar between BMI groups.

Conclusions: Being overweight did not influence the LOR to treatment when IFX and ADA were compared, nor did it affect clinical and endoscopic remission after 54 weeks.

Objective: We aimed to determine the prevalence of intestinal and extra-intestinal symptoms according to depression severity in a large cohort of patients with irritable bowel syndrome (IBS).

Patients and methods: A consecutive series of patients with diagnosis of IBS according to Rome IV criteria undertaking a social-media based program (B15 program) were analyzed. The B15 program provides evidence-based dietary and non-pharmacological recommendations (i.e., mindfulness techniques and exercise) to improve gastrointestinal health. All patients completed the symptom-severity questionnaire (IBS-SSS) to determine severity of disease and the patient health questionnaire (PHQ9) to assess depressive symptoms. Patients' depression severity was stratified according to the PHQ9 score: none (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27). Demographics, IBS phenotype and prevalence of intestinal and extra-intestinal symptoms were compared among groups.

Results: A total of 15,675 patients with IBS were included; 895 (12.1%) with none, 5,709 (36.4%) with mild, 4,279 (27.3%) with moderate, 2,457 (15.7%) with moderately severe, and 1,335 (8.5%) with severe depression. Mean IBS-SSS score was significantly higher in patients with depressive symptoms (none 256.5 vs. severe 324.1, p<0.0001). IBS-M (mixed bowel habits alternating constipation and diarrhea) was more frequent in those with depression (p<0.0001). The presence of bloating, heartburn, dyspepsia, and belching were significantly more common in patients with higher levels of depression (p<0.0001). The prevalence and number of extra-intestinal symptoms were also associated with the severity of depression (p<0.0001).

Conclusions: The presence and severity of depression are strongly associated with the prevalence of intestinal and extra-intestinal symptoms in patients with IBS. Stratifying patients based on both their symptomatic and psychological profile could help targeting therapy.

Introduction: There is high variability in the follow-up of paediatric patients with coeliac disease (CD) in Europe. The aim of this study was to know the current reality of paediatric CD follow-up in Spain through professionals and the patients themselves and their families.

Patients and methods: A cross-sectional descriptive study was conducted using two anonymous web surveys, one aimed at paediatric gastroenterologists, and the other at members of CD patients' associations.

Results: A total of 96 responses from paediatricians and 4745 from patients (1362 <15 years) were analysed. Among the professionals, 84.4% carry out follow-up only at the hospital level. 80.2% lack a joint follow-up protocol with primary health care. The transition after the paediatric age is made to adult gastroenterologists by 56.2% of professionals (only 8.3% in a protocolized manner). 58.3% do not have a dietitian and 64.6% do not use quality of life questionnaires. The patients stated that they mainly performed follow-up visits in the hospital (68.8%). Only 15.7% ever consult a dietitian. Scheduled visits were more frequent in paediatric patients than in adults (95.1% vs. 63.5%, p <0.001). The variable most associated with attendance at follow-up visits was that the survey had been answered by the patient's parents (odds ratio 2.6, p <0.001).

Conclusions: In Spain, there is a lack of follow-up protocols for paediatric CD patients integrating hospitals and primary care, as well as protocols for the transition to adult professionals. The participation of dietitians is very low. Adult patients adhere less to follow-up visits.