Gastroenterologia y hepatologia最新文献

Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideline aims to respond to its main challenges, both in terms of disease burden and complexity. To this end, recommendations have been proposed to experts through the Delphi method. The consensus was optimal in recommendations regarding type 2 diabetes as a risk factor (1.5.1, 4.5.1), in which cases early detection of MetHS should be carried out (4.5.2). Its results also emphasize the importance of the use of non-invasive tests (FIB-4, NFS, HFS) for the exclusion of significant fibrosis in patients with suspected MetHS (2.3.1, 2.3.3). Diagnosis should be carried out through the sequential combination of non-invasive indices and transient elastography by FibroScan® for its risk stratification (2.3.3). A nearly unanimous consensus was reached regarding the role of early prevention in the impact on the quality of life and survival of patients (5.1.2), as well as on the effectiveness of the Mediterranean diet and physical exercise in relation to the improvement of steatosis, steatohepatitis and fibrosis in MetHS patients (5.2.2) and on the positive results offered by resmiterom and semaglutide in promoting fibrosis regression (5.4.1). Finally, a great consensus has been reached regarding the importance of multidisciplinary management in MetHS, for which it is essential to agree on multidisciplinary protocols for referral between levels in each health area (6.2.1), as well as ensuring that referrals to Hepatology/Digestive and Endocrinology or Internal Medicine services are effective and beneficial to prevent the risk of disease progression (6.2.3, 6.3.1).

Aim: Eosinophilic esophagitis (EoE) is a chronic and progressive inflammatory disease with increasing prevalence and incidence worldwide. The objective was to determine the differences in epidemiological, clinical, and treatment characteristics between pediatric and adult patients with EoE in Colombia.

Patients and methods: A cross-sectional comparative study was conducted with two independent cohorts of pediatric and adult patients at multiple Colombian centers.

Results: 286 patients with EoE were analyzed, 143 children and 143 adults, with a predominance of males (61.9%). Regarding symptom onset and time to diagnosis, adults sought medical attention earlier than children (<6 months: 42.0% vs. 22.8%, p = 0.014). Adults presented with more dysphagia (70.0% vs. 32.2%, P < 0.001) and food impaction (21.0% vs. 2.8%, P < 0.001), and less weight loss (4.2% vs. 25.7%, P < 0.001), compared to children. Regarding treatment, adults received more proton pump inhibitors (87.4% vs. 41.1%, p < 0.001) and more topical steroids (29.4% vs. 16.1%, p = 0.07) than children. The use of systemic corticosteroids was very low in both groups (1.4% vs. 2.8%, p = 0.684). There were no significant differences in dietary treatment (40.0% vs. 32.9%, p = 0.797).

Conclusions: Eosinophilic esophagitis in Colombia affects both children and adults and shows clear differences in allergic history, clinical presentation, and treatment strategies. These findings highlight variability in clinical practice between pediatric and adult gastroenterologists within the national context.

Background and objective:  Helicobacter pylori (H. pylori) colonizes the gastric mucosa in approximately half of the global population and is a well-established risk factor for peptic ulcer disease and gastric adenocarcinoma. Data on the effectiveness of levofloxacin-based eradication regimens in Argentina remain scarce. The objective of the study was to evaluate the eradication efficacy of a 14-day levofloxacin-containing triple therapy regimen in treatment-naïve patients with H. pylori infection.

Patients and methods:  This single-center retrospective study included treatment-naïve adult patients with histologically confirmed H. pylori infection between 09/2020-07/2023. Patients received a 14-day regimen consisting of amoxicillin 1 g twice daily, levofloxacin 500 mg once daily, and pantoprazole 40 mg twice daily. Eradication was assessed by ¹³C-urea breath test performed at least 4 weeks following treatment completion.

Results:  The study included 277 patients (median age 57 years; 60.6% female). The eradication rate was 76.2% evaluated through modified intention to treat analysis. Eradication rates did not differ by age, sex, body mass index, or other baseline clinical characteristics. Treatment-related adverse events occurred in 11 (4%) patients and 6 (2.2%) patients did not complete the prescribed treatment regimen due to adverse events.

Conclusion:  The 14-day levofloxacin-based triple therapy regimen achieved a suboptimal H. pylori eradication rate, falling below the internationally recommended threshold above 90%. These results indicate this regimen should not be considered as first-line therapy in our region, and alternative regimens with higher efficacy should be prioritized.

Objective: Approximately 20% of the patients with Crohn's disease (CD) undergo intestinal resection within the first five years from diagnosis. Postoperative recurrence (POR) occurs in many even if preventive therapies are started early after surgery. In this scenario, treatment escalation is recommended; although scarce data are available, faecal calprotectin (FC) has been proposed as the best non-invasive monitoring tool. The aim of this study is to explore the utility of FC for monitoring the treatment response of endoscopic POR (ePOR).

Patients and methods: A single-centre retrospective study of patients with CD treated because of ePOR and from whom baseline and follow-up FC measurements as well as an ileocolonoscopic assessment were available. Primary endpoint was endoscopic improvement (decrease in the Rutgeerts'endoscopic score [RES] ≤2b).

Results: Twenty-two patients with ePOR in whom treatment escalation was started were included. ePOR was treated with anti-TNF in 13 patients (59%), thiopurines in 4(15%), ustekinumab in 3(13%) and vedolizumab in 2 (10%). After a median clinical follow-up of 23 months, endoscopic improvement was observed in 68% (n=15). At baseline, 14 patients (64%) had FC levels >200μg/g; endoscopic improvement was observed in 11(73%) of these and 7(65%) reduced FC values <200 μg/g. All patients with persistence of mucosal lesions remained with FC values >200 μg/g. FC levels <250 μg/g immediately before endoscopic assessment showed 70% sensitivity and 100% specificity (when baseline FC>200 μg/g) for the prediction of endoscopic improvement.

Conclusions: FC after treatment escalation for ePOR shows potential as a monitoring tool for endoscopic response, but requires validation in larger cohorts.

Introduction: Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated infectious diarrhea and is associated with significant morbidity and mortality, primarily due to its high recurrence rate. For this reason, the Catalan Society of Gastroenterology commissioned the development of a position paper aimed at providing practical recommendations, grounded in scientific evidence and expert consensus, on the diagnosis and management of CDI.

Methods: This position paper was developed by specialists in Gastroenterology, Infectious Diseases and Microbiology. It was based on a non-systematic review of the scientific evidence. Recommendations were formulated through expert consensus.

Results: The document presents a structured approach to the diagnosis and treatment of CDI, emphasizing individualized management and strategies to reduce recurrence rates. Key components include the role of fecal microbiota transplantation and a therapeutic algorithm informed by disease severity and by whether the episode is initial or recurrent.

Conclusions: This position paper aims to serve as a practical, evidence-based guide for healthcare professionals involved in the clinical management of CDI, promoting the implementation of optimal therapeutic strategies and addressing the main challenges associated with this infection.