Pub Date : 2024-05-07DOI: 10.1016/j.gastrohep.2024.502200
Iago Rodríguez-Lago, Beatriz Gros, Kristy Sánchez, Daniel Arumí, M Del Pilar Fortes, Ana Cábez, Francisco Mesonero Gismero
Objective: To analyse the characteristics and use of digital health tools (DHT) in inflammatory bowel disease (IBD).
Methods: We performed a qualitative study based on a narrative literature review, a questionnaire and on the opinion of 3 expert gastroenterologists. Several searches were carried out until September 2022 through Medline to identify articles on the use of DHT in IBD by healthcare professionals. A structured questionnaire was designed to be answered by health professionals involved in the care of patients with IBD. The experts generated a set of recommendations.
Results: There are multiple DHT for IBD with different characteristics and contents. We received 29 questionnaires. Almost 50% of the participants were 41-50 years old, the majority were women (83%) and 90% were gastroenterologists. A total of 96% reported the use of several DHT, but 20% used them occasionally or infrequently. Web pages were found the most used (62%). DHT are mostly used to get information (80%), followed by clinical practice issues (70%) and educational purposes (62%). G-Educainflamatoria website is the best known and most used HDS (96% and 64%, respectively). The main barriers to the use of DHT in IBD were the lack of time (55%), doubts about the benefit of DHT (50%) and the excess of information (40%).
Conclusions: Healthcare professionals involved in the care of patients with to IBD frequently use DHT, although actions are needed to optimize their use and to guarantee their efficient and safe use.
{"title":"Use of digital health tools in inflammatory bowel disease.","authors":"Iago Rodríguez-Lago, Beatriz Gros, Kristy Sánchez, Daniel Arumí, M Del Pilar Fortes, Ana Cábez, Francisco Mesonero Gismero","doi":"10.1016/j.gastrohep.2024.502200","DOIUrl":"10.1016/j.gastrohep.2024.502200","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the characteristics and use of digital health tools (DHT) in inflammatory bowel disease (IBD).</p><p><strong>Methods: </strong>We performed a qualitative study based on a narrative literature review, a questionnaire and on the opinion of 3 expert gastroenterologists. Several searches were carried out until September 2022 through Medline to identify articles on the use of DHT in IBD by healthcare professionals. A structured questionnaire was designed to be answered by health professionals involved in the care of patients with IBD. The experts generated a set of recommendations.</p><p><strong>Results: </strong>There are multiple DHT for IBD with different characteristics and contents. We received 29 questionnaires. Almost 50% of the participants were 41-50 years old, the majority were women (83%) and 90% were gastroenterologists. A total of 96% reported the use of several DHT, but 20% used them occasionally or infrequently. Web pages were found the most used (62%). DHT are mostly used to get information (80%), followed by clinical practice issues (70%) and educational purposes (62%). G-Educainflamatoria website is the best known and most used HDS (96% and 64%, respectively). The main barriers to the use of DHT in IBD were the lack of time (55%), doubts about the benefit of DHT (50%) and the excess of information (40%).</p><p><strong>Conclusions: </strong>Healthcare professionals involved in the care of patients with to IBD frequently use DHT, although actions are needed to optimize their use and to guarantee their efficient and safe use.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.1016/j.gastrohep.2024.502198
Eva Marín-Serrano, Ana Barbado Cano, Rubén Fernández Martos, Marta Abadía Barno, Antonio Olveira Martín, Maria Dolores Martín Arranz
Introduction: Transabdominal ultrasound (TU) pancreatic 2D-SWE elastography is a developing technique that needs to be protocolized.
Objectives: Establish a protocol for image acquisition and measurement of TU pancreatic - 2D-SWE elastography and estimate the minimum number of measurements to be performed.
Materials and methods: Ten measurements of pancreatic elasticity were taken in healthy volunteers using TU-2D-SWE, following a strict protocol for image acquisition and measurement.
Results: The 70% of the participants were women, with an average age, weight, and BMI of 49.5±15.7 years, 65.9±11.9kg, and 24.5±4.2kg/m2, respectively. Measurements were taken from the body (70%), tail (16.7%), and pancreatic head (13.3%). The median mean velocity and elasticity were 1.46±0.25cm/sec and 6.46±2.87KPa, respectively. The ROI depth was 4.12±1cm and the SP-ROI distance was 5.2mm on average. There were no statistically significant differences between the 10 measurements. The reliability analysis of the measurements showed high internal consistency and repeatability. Taking 5-6 measurements ensured high concordance with the ten reference measurements. The measurements were significantly lower when the SP-ROI values were intermediate (0.3-0.6cm). The measurement accuracy was higher when performed at a depth less than 4.8cm.
Conclusion: To measure pancreatic elasticity using TU-2D-SWE, we propose a strict protocol for image acquisition and measurement, taking a minimum of 5 measurements in the best visualized and accessible pancreatic portion, and preferably at a depth of less than 4.8cm.
{"title":"Protocol for acquisition of images and measurement of transabdominal ultrasound pancreatic two-dimensional shear wave elastography (2D-SWE).","authors":"Eva Marín-Serrano, Ana Barbado Cano, Rubén Fernández Martos, Marta Abadía Barno, Antonio Olveira Martín, Maria Dolores Martín Arranz","doi":"10.1016/j.gastrohep.2024.502198","DOIUrl":"10.1016/j.gastrohep.2024.502198","url":null,"abstract":"<p><strong>Introduction: </strong>Transabdominal ultrasound (TU) pancreatic 2D-SWE elastography is a developing technique that needs to be protocolized.</p><p><strong>Objectives: </strong>Establish a protocol for image acquisition and measurement of TU pancreatic - 2D-SWE elastography and estimate the minimum number of measurements to be performed.</p><p><strong>Materials and methods: </strong>Ten measurements of pancreatic elasticity were taken in healthy volunteers using TU-2D-SWE, following a strict protocol for image acquisition and measurement.</p><p><strong>Results: </strong>The 70% of the participants were women, with an average age, weight, and BMI of 49.5±15.7 years, 65.9±11.9kg, and 24.5±4.2kg/m<sup>2</sup>, respectively. Measurements were taken from the body (70%), tail (16.7%), and pancreatic head (13.3%). The median mean velocity and elasticity were 1.46±0.25cm/sec and 6.46±2.87KPa, respectively. The ROI depth was 4.12±1cm and the SP-ROI distance was 5.2mm on average. There were no statistically significant differences between the 10 measurements. The reliability analysis of the measurements showed high internal consistency and repeatability. Taking 5-6 measurements ensured high concordance with the ten reference measurements. The measurements were significantly lower when the SP-ROI values were intermediate (0.3-0.6cm). The measurement accuracy was higher when performed at a depth less than 4.8cm.</p><p><strong>Conclusion: </strong>To measure pancreatic elasticity using TU-2D-SWE, we propose a strict protocol for image acquisition and measurement, taking a minimum of 5 measurements in the best visualized and accessible pancreatic portion, and preferably at a depth of less than 4.8cm.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.1016/j.gastrohep.2024.502199
Rafael Esteban, Raquel Domínguez-Hernández, Helena Cantero, Miguel Ángel Casado
Objective: Direct-acting antivirals for the treatment of hepatitis C virus (HCV) represented a paradigm shift. In 2017, sofosbuvir/velpatasvir (SOF/VEL-Epclusa®) was approved, which showed a high cure rate in all patient, contributing to HCV elimination. The analysis aimed to quantify the clinical and economic value of SOF/VEL in HCV chronic patients since its approval in Spain.
Methods: An economic evaluation was elaborated adapting a Markov model that simulated the lifetime disease progression in of all HCV chronic patients treated with SOF/VEL (30,488 patients) since its launch (5-years), compared to previous therapies. Patients entered the model and were distributed between the fibrosis states (F0-to-F4) in treated and untreated. All patients (100%) were treated with SOF/VEL regardless of their fibrosis, and 49% with previous therapies in ≥F2. The average sustained viral response (SVR) rates 98.9% SOF/VEL versus 61.0% previous therapies. All parameters for the analysis were obtained from real-life data and literature. Only direct healthcare costs associated with disease management were included. The SOF/VEL value was measured as the number of hepatic complications avoided and their associated cost, and hepatic mortality compared to previous therapies. National Health System perspective and a 3% discount rate was applied.
Results: SOF/VEL decreased the number of liver complications, avoiding 92% decompensated cirrhosis, 80% hepatocellular carcinomas, and 87% liver transplants, as well as 85% liver-related mortality. Their cost associated was reduced, amounting to savings of 197M€.
Conclusion: SOF/VEL adds relevant value to the HCV treatment, reducing the clinical and economic disease burden and contributing to HCV elimination in Spain.
{"title":"Evaluation of the clinical and economic value of sofosbuvir/velpatasvir (SOF/VEL) in patients with chronic hepatitis C in Spain during the last 5 years.","authors":"Rafael Esteban, Raquel Domínguez-Hernández, Helena Cantero, Miguel Ángel Casado","doi":"10.1016/j.gastrohep.2024.502199","DOIUrl":"10.1016/j.gastrohep.2024.502199","url":null,"abstract":"<p><strong>Objective: </strong>Direct-acting antivirals for the treatment of hepatitis C virus (HCV) represented a paradigm shift. In 2017, sofosbuvir/velpatasvir (SOF/VEL-Epclusa®) was approved, which showed a high cure rate in all patient, contributing to HCV elimination. The analysis aimed to quantify the clinical and economic value of SOF/VEL in HCV chronic patients since its approval in Spain.</p><p><strong>Methods: </strong>An economic evaluation was elaborated adapting a Markov model that simulated the lifetime disease progression in of all HCV chronic patients treated with SOF/VEL (30,488 patients) since its launch (5-years), compared to previous therapies. Patients entered the model and were distributed between the fibrosis states (F0-to-F4) in treated and untreated. All patients (100%) were treated with SOF/VEL regardless of their fibrosis, and 49% with previous therapies in ≥F2. The average sustained viral response (SVR) rates 98.9% SOF/VEL versus 61.0% previous therapies. All parameters for the analysis were obtained from real-life data and literature. Only direct healthcare costs associated with disease management were included. The SOF/VEL value was measured as the number of hepatic complications avoided and their associated cost, and hepatic mortality compared to previous therapies. National Health System perspective and a 3% discount rate was applied.</p><p><strong>Results: </strong>SOF/VEL decreased the number of liver complications, avoiding 92% decompensated cirrhosis, 80% hepatocellular carcinomas, and 87% liver transplants, as well as 85% liver-related mortality. Their cost associated was reduced, amounting to savings of 197M€.</p><p><strong>Conclusion: </strong>SOF/VEL adds relevant value to the HCV treatment, reducing the clinical and economic disease burden and contributing to HCV elimination in Spain.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.1016/j.gastrohep.2024.502202
Francisca Isabelle da Silva E Sousa, Raiza Lima Silva, Cezar Nilton Rabelo Lemos Filho, Maria Tereza Oliveira Pereira Santos, Luiz Eduardo Soares Martins, Thais Carvalho de Abreu, Leonardo Freire Alves Nogueira, Sâmya Correia Marques, Marcellus Henrique Loiola Ponte de Souza, Lucia Libanez Bessa Campelo Braga
Objective: To assess adherence to and the adverse effects of the SARS-COV vaccine in patients with inflammatory bowel disease (IBD).
Patients and methods: This is an observational, analytical, cross-sectional study. Sociodemographic and clinical data, SARS-COV vaccine data, medications for IBD with use during the vaccination period, and adverse events during the vaccination period were collected. Carried out logistic regressions with robust variance estimation to estimate the odds ratio with the respective 95% confidence intervals (95%CI) to assess the factors associated with non-serious adverse effects following vaccine doses as outcome variables.
Results: 194 patients participated, with vaccine compliance of 78.3% for three doses of any vaccine (n=152). Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. The first dose of the SARS-COV vaccine with AstraZeneca had a higher percentage of patients with vaccine symptoms. AstraZeneca vaccine increased the chance of non-serious adverse effects in IBD patients by 2.65 times (95% CI: 1.38-5.08; p=0.003), regardless of age, gender, physical activity, excess weight, use of disease-modifying drugs, immunobiological and corticosteroids. CoronaVac vaccine was associated with asymptomatic patients at the first dose and reduced the chance of adverse effects by 0.28 times (OR: 0.284; 95%CI: 0.13-0.62; p=0.002).
Conclusion: Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. Using CoronaVac in the first dose reduced the chances of adverse effects, while AstraZeneca increased the risk of adverse effects.
{"title":"Vaccine adherence and adverse events of the SARS-COV vaccine in patients with inflammatory bowel disease.","authors":"Francisca Isabelle da Silva E Sousa, Raiza Lima Silva, Cezar Nilton Rabelo Lemos Filho, Maria Tereza Oliveira Pereira Santos, Luiz Eduardo Soares Martins, Thais Carvalho de Abreu, Leonardo Freire Alves Nogueira, Sâmya Correia Marques, Marcellus Henrique Loiola Ponte de Souza, Lucia Libanez Bessa Campelo Braga","doi":"10.1016/j.gastrohep.2024.502202","DOIUrl":"10.1016/j.gastrohep.2024.502202","url":null,"abstract":"<p><strong>Objective: </strong>To assess adherence to and the adverse effects of the SARS-COV vaccine in patients with inflammatory bowel disease (IBD).</p><p><strong>Patients and methods: </strong>This is an observational, analytical, cross-sectional study. Sociodemographic and clinical data, SARS-COV vaccine data, medications for IBD with use during the vaccination period, and adverse events during the vaccination period were collected. Carried out logistic regressions with robust variance estimation to estimate the odds ratio with the respective 95% confidence intervals (95%CI) to assess the factors associated with non-serious adverse effects following vaccine doses as outcome variables.</p><p><strong>Results: </strong>194 patients participated, with vaccine compliance of 78.3% for three doses of any vaccine (n=152). Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. The first dose of the SARS-COV vaccine with AstraZeneca had a higher percentage of patients with vaccine symptoms. AstraZeneca vaccine increased the chance of non-serious adverse effects in IBD patients by 2.65 times (95% CI: 1.38-5.08; p=0.003), regardless of age, gender, physical activity, excess weight, use of disease-modifying drugs, immunobiological and corticosteroids. CoronaVac vaccine was associated with asymptomatic patients at the first dose and reduced the chance of adverse effects by 0.28 times (OR: 0.284; 95%CI: 0.13-0.62; p=0.002).</p><p><strong>Conclusion: </strong>Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. Using CoronaVac in the first dose reduced the chances of adverse effects, while AstraZeneca increased the risk of adverse effects.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140897831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1016/j.gastrohep.2024.502196
Francisco José Fernández-Pérez, Nuria Fernández-Moreno, Estela Soria-López, Francisco Javier Rodriguez-González, Francisco José Fernández-Galeote, Ana Lifante-Oliva, Concepción Ruíz-Hernández, Elisabeth Escalante-Quijaite, Francisco Rivas-Ruiz
Introduction: Granulocyte and monocyte adsorptive apheresis (GMA) removes neutrophils and monocytes from peripheral blood, preventing their incorporation into the inflamed tissue also influencing cytokine balance. Published therapeutic efficacy in ulcerative colitis (UC) is more consistent than in Crohn's disease (CD). We assessed clinical efficacy of GMA in UC and CD 4 weeks after last induction session, at 3 and 12 months, sustained remission and corticosteroid-free remission.
Patients and method: Retrospective observational study of UC and CD patients treated with GMA. Partial Disease Activity Index-DAIp in UC and Harvey-Bradshaw Index-HBI in CD assessed efficacy of Adacolumn® with induction and optional maintenance sessions.
Results: We treated 87 patients (CD-25, UC-62), 87.3% corticosteroid-dependent (CSD), 42.5% refractory/intolerant to immunomodulators. In UC, remission and response were 32.2% and 19.3% after induction, 35.5% and 6.5% at 12 weeks and 29% and 6.5% at 52 weeks. In CD, remission rates were 60%, 52% and 40% respectively. In corticosteroid-dependent and refractory or intolerant to INM patients (UC-41, CD-14), 68.3% of UC achieved remission or response after induction, 51.2% at 12 weeks and 46.3% at 52 weeks, and 62.3%, 64.3% and 42.9% in CD. Maintained remission was achieved by 66.6% in CD and 53.1% in UC. Up to 74.5% of patients required corticosteroids at some timepoint. Corticosteroid-free response/remission was 17.7% in UC and 24% in CD.
Conclusions: GMA is a good therapeutic tool for both in UC and CD patients. In corticosteroid-dependent and refractory or intolerant to INM patients it avoids biological therapy or surgery in up to 40% of them in one year.
{"title":"Granulocyte and monocyte adsorptive apheresis (GMA) in patients with inflammatory bowel disease: A useful therapeutic tool not just in ulcerative colitis but also in Crohn's disease.","authors":"Francisco José Fernández-Pérez, Nuria Fernández-Moreno, Estela Soria-López, Francisco Javier Rodriguez-González, Francisco José Fernández-Galeote, Ana Lifante-Oliva, Concepción Ruíz-Hernández, Elisabeth Escalante-Quijaite, Francisco Rivas-Ruiz","doi":"10.1016/j.gastrohep.2024.502196","DOIUrl":"10.1016/j.gastrohep.2024.502196","url":null,"abstract":"<p><strong>Introduction: </strong>Granulocyte and monocyte adsorptive apheresis (GMA) removes neutrophils and monocytes from peripheral blood, preventing their incorporation into the inflamed tissue also influencing cytokine balance. Published therapeutic efficacy in ulcerative colitis (UC) is more consistent than in Crohn's disease (CD). We assessed clinical efficacy of GMA in UC and CD 4 weeks after last induction session, at 3 and 12 months, sustained remission and corticosteroid-free remission.</p><p><strong>Patients and method: </strong>Retrospective observational study of UC and CD patients treated with GMA. Partial Disease Activity Index-DAIp in UC and Harvey-Bradshaw Index-HBI in CD assessed efficacy of Adacolumn® with induction and optional maintenance sessions.</p><p><strong>Results: </strong>We treated 87 patients (CD-25, UC-62), 87.3% corticosteroid-dependent (CSD), 42.5% refractory/intolerant to immunomodulators. In UC, remission and response were 32.2% and 19.3% after induction, 35.5% and 6.5% at 12 weeks and 29% and 6.5% at 52 weeks. In CD, remission rates were 60%, 52% and 40% respectively. In corticosteroid-dependent and refractory or intolerant to INM patients (UC-41, CD-14), 68.3% of UC achieved remission or response after induction, 51.2% at 12 weeks and 46.3% at 52 weeks, and 62.3%, 64.3% and 42.9% in CD. Maintained remission was achieved by 66.6% in CD and 53.1% in UC. Up to 74.5% of patients required corticosteroids at some timepoint. Corticosteroid-free response/remission was 17.7% in UC and 24% in CD.</p><p><strong>Conclusions: </strong>GMA is a good therapeutic tool for both in UC and CD patients. In corticosteroid-dependent and refractory or intolerant to INM patients it avoids biological therapy or surgery in up to 40% of them in one year.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1016/j.gastrohep.2024.502189
Cándido Alcázar, Juan Jesús Rubio, Víctor Cristóbal, José M Ramia
{"title":"Septated gallbladder.","authors":"Cándido Alcázar, Juan Jesús Rubio, Víctor Cristóbal, José M Ramia","doi":"10.1016/j.gastrohep.2024.502189","DOIUrl":"10.1016/j.gastrohep.2024.502189","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1016/j.gastrohep.2024.502190
Jeannine Suárez Terán, Francisco Guarner Aguilar
Small intestinal bacterial overgrowth (SIBO) is a clinical entity recognized since ancient times; it represents the consequences of bacterial overgrowth in the small intestine associated with malabsorption. Recently, SIBO as a term has been popularized due to its high prevalence reported in various pathologies since the moment it is indirectly diagnosed with exhaled air tests. In the present article, the results of duodenal/jejunal aspirate culture testing as a reference diagnostic method, as well as the characteristics of the small intestinal microbiota described by culture-dependent and culture-independent techniques in SIBO, and their comparison with exhaled air testing are presented to argue about its overdiagnosis.
{"title":"Small Intestinal Bacterial Overgrowth (SIBO), a clinically overdiagnosed entity?","authors":"Jeannine Suárez Terán, Francisco Guarner Aguilar","doi":"10.1016/j.gastrohep.2024.502190","DOIUrl":"10.1016/j.gastrohep.2024.502190","url":null,"abstract":"<p><p>Small intestinal bacterial overgrowth (SIBO) is a clinical entity recognized since ancient times; it represents the consequences of bacterial overgrowth in the small intestine associated with malabsorption. Recently, SIBO as a term has been popularized due to its high prevalence reported in various pathologies since the moment it is indirectly diagnosed with exhaled air tests. In the present article, the results of duodenal/jejunal aspirate culture testing as a reference diagnostic method, as well as the characteristics of the small intestinal microbiota described by culture-dependent and culture-independent techniques in SIBO, and their comparison with exhaled air testing are presented to argue about its overdiagnosis.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1016/j.gastrohep.2024.502197
Cristina Suárez Ferrer, Francisco Mesonero Gismero, Berta Caballol, Maria Pilar Ballester, Iria Bastón Rey, Andrés Castaño García, Jose Miranda Bautista, Rosa Saiz Chumillas, Jose Manuel Benitez, Laura Sanchez-Delgado, Alicia López-García, Cristina Rubin de Celix, Inmaculada Alonso Abreu, Luigi Melcarne, Rocío Plaza Santos, Miquel Marques-Camí, Antonio Caballero Mateos, César Gómez Díez, Margalida Calafat, Horacio Alonso Galan, Pablo Vega Vilaamil, Beatriz Castro Senosiain, Andrea Guerro Moya, Carmen Yolanda Rodriguez Diaz, Katerina Spicakova, Noemi Manceñido Marcos, Gema Molina, Luisa de Castro Parga, Andres Rodriguez Angulo, Lidia Cuevas Del Campo, Maria Del Carmen Rodriguez Grau, Fernando Ramirez, Barbara Gomez Pastrana, Irene Gonzalez Partida, Belen Botella Mateu, Elena Peña Gonzalez, Eduardo Iyo, Alfonso Elosua Gonzalez, Empar Sainz Arnau, Luis Hernandez Villalba, Pablo Perez Galindo, Leyanira Torrealba Medina, Sara Monsalve Alonso, Jose Antonio Olmos Perez, Carmen Dueñas Sadornil, Laura Garcia Ramirez, María Dolores Martín-Arranz, Antonio López Sanroman, Agnès Fernández, Victor Merino Murgui, Cristina Calviño Suárez, Pablo Flórez-Diez, María Elena Lobato Matilla, Beatriz Sicilia, Pilar Soto Escribano, Carlos Maroto Martin, Míriam Mañosa, Manuel Barreiro-De Acosta
Introduction: Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population.
Methods: Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus).
Results: A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab.
Conclusions: Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.
{"title":"Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort.","authors":"Cristina Suárez Ferrer, Francisco Mesonero Gismero, Berta Caballol, Maria Pilar Ballester, Iria Bastón Rey, Andrés Castaño García, Jose Miranda Bautista, Rosa Saiz Chumillas, Jose Manuel Benitez, Laura Sanchez-Delgado, Alicia López-García, Cristina Rubin de Celix, Inmaculada Alonso Abreu, Luigi Melcarne, Rocío Plaza Santos, Miquel Marques-Camí, Antonio Caballero Mateos, César Gómez Díez, Margalida Calafat, Horacio Alonso Galan, Pablo Vega Vilaamil, Beatriz Castro Senosiain, Andrea Guerro Moya, Carmen Yolanda Rodriguez Diaz, Katerina Spicakova, Noemi Manceñido Marcos, Gema Molina, Luisa de Castro Parga, Andres Rodriguez Angulo, Lidia Cuevas Del Campo, Maria Del Carmen Rodriguez Grau, Fernando Ramirez, Barbara Gomez Pastrana, Irene Gonzalez Partida, Belen Botella Mateu, Elena Peña Gonzalez, Eduardo Iyo, Alfonso Elosua Gonzalez, Empar Sainz Arnau, Luis Hernandez Villalba, Pablo Perez Galindo, Leyanira Torrealba Medina, Sara Monsalve Alonso, Jose Antonio Olmos Perez, Carmen Dueñas Sadornil, Laura Garcia Ramirez, María Dolores Martín-Arranz, Antonio López Sanroman, Agnès Fernández, Victor Merino Murgui, Cristina Calviño Suárez, Pablo Flórez-Diez, María Elena Lobato Matilla, Beatriz Sicilia, Pilar Soto Escribano, Carlos Maroto Martin, Míriam Mañosa, Manuel Barreiro-De Acosta","doi":"10.1016/j.gastrohep.2024.502197","DOIUrl":"10.1016/j.gastrohep.2024.502197","url":null,"abstract":"<p><strong>Introduction: </strong>Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population.</p><p><strong>Methods: </strong>Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus).</p><p><strong>Results: </strong>A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab.</p><p><strong>Conclusions: </strong>Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1016/j.gastrohep.2024.502192
María Del Mar Calvo Bernal, Elena Pérez Campos, Adrián Aparicio Mota, Álvaro Hernández Martínez
Introduction: Ulcerative colitis (UC) and Crohn's disease (CD) are diseases that cause a significant impact on patients' quality of life. The aim of this study is to assess the impact of inflammatory bowel disease (IBD) on health-related quality of life (HRQoL).
Material and methods: Observational, descriptive, cross-sectional study, carried out at Torrecárdenas Hospital (Almería). Patients over 14 years of age diagnosed with CD or UC were included. For the assessment of HRQoL, the reduced 9-item IBDQ-9 questionnaire was used.
Results: 106 patients with a mean age of 44 years were included, with a female predominance. Forty-five percent of the patients in the sample had UC compared to 55% with CD. Of the patients, 69.8% were in clinical remission. The median questionnaire score was 60.8 points out of 100. Statistically significant differences were observed between sexes, with worse HRQoL for females. No differences were observed between patients with UC and CD. Differences were also detected between patients who underwent surgery and those who did not. A negative association was observed between the number of flares and the questionnaire score.
Conclusions: In our study population, there is an acceptable HRQoL, with no differences observed between CD and UC. Female sex, absence of clinical remission, number of previous outbreaks, and surgery have a negative association with HRQoL.
{"title":"Assessment of the quality of life of patients with inflammatory bowel disease.","authors":"María Del Mar Calvo Bernal, Elena Pérez Campos, Adrián Aparicio Mota, Álvaro Hernández Martínez","doi":"10.1016/j.gastrohep.2024.502192","DOIUrl":"10.1016/j.gastrohep.2024.502192","url":null,"abstract":"<p><strong>Introduction: </strong>Ulcerative colitis (UC) and Crohn's disease (CD) are diseases that cause a significant impact on patients' quality of life. The aim of this study is to assess the impact of inflammatory bowel disease (IBD) on health-related quality of life (HRQoL).</p><p><strong>Material and methods: </strong>Observational, descriptive, cross-sectional study, carried out at Torrecárdenas Hospital (Almería). Patients over 14 years of age diagnosed with CD or UC were included. For the assessment of HRQoL, the reduced 9-item IBDQ-9 questionnaire was used.</p><p><strong>Results: </strong>106 patients with a mean age of 44 years were included, with a female predominance. Forty-five percent of the patients in the sample had UC compared to 55% with CD. Of the patients, 69.8% were in clinical remission. The median questionnaire score was 60.8 points out of 100. Statistically significant differences were observed between sexes, with worse HRQoL for females. No differences were observed between patients with UC and CD. Differences were also detected between patients who underwent surgery and those who did not. A negative association was observed between the number of flares and the questionnaire score.</p><p><strong>Conclusions: </strong>In our study population, there is an acceptable HRQoL, with no differences observed between CD and UC. Female sex, absence of clinical remission, number of previous outbreaks, and surgery have a negative association with HRQoL.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1016/j.gastrohep.2024.502195
Iago Rodríguez-Lago, Claudia Herrera-deGuise, Maia Boscá-Watts, Cristina Rodríguez, Eduardo Leo-Carnerero, María Calvo Íñiguez, Fiorella Cañete, Silvia Chacón, Camila Cuarán, Ainara Elorza, Elena Guerra-Del-Río, Eva Iglesias, Damián Sánchez, Manuel Barreiro-de Acosta, Daniel Ginard, José Luis Cabriada
Objective: Granulocyte-monocyte apheresis (GMA) has shown to be safe and effective in ulcerative colitis (UC), also in combination with biologics, mainly with anti-TNF. The aim of this study was to evaluate the efficacy and safety of combining GMA after primary non-response (PNR) or loss of response (LOR) to ustekinumab (UST) in patients with UC.
Patients and methods: A retrospective study was performed in 12 IBD Units, including all patients with refractory UC or unclassified IBD (IBD-U) who received combined GMA plus UST. The number and frequency of GMA sessions, filtered blood volume and time of each session were registered. Efficacy was assessed 1 and 6 months after finishing GMA by partial Mayo score, C-reactive protein (CRP) and fecal calprotectin (FC). Descriptive statistics and non-parametric tests were used in the statistical analysis.
Results: Seventeen patients were included (15 UC, 2 IBD-U; median age 47 years [IQR, 35-61]; 59% male; 53% E3). Most patients (89%) had prior exposure to anti-TNF agents and 53% to vedolizumab; 65% were also receiving steroids at baseline. Median partial Mayo score at baseline was 6 (IQR, 5-7) and it significantly decreased after 1 and 6 months (p=0.042 and 0.007, respectively). Baseline FC significantly decreased after 6 months (p=0.028) while no differences were found in CRP. During follow-up, 18% patients started a new biologic therapy and 12% required surgery; 64% of patients under steroids were able to discontinue them. Adverse events were reported in one patient.
Conclusion: GMA can recapture the response to UST in selected cases of UC after PNR or LOR to this drug.
{"title":"Combination of granulocyte-monocyte apheresis and ustekinumab: Multicentre and retrospective study.","authors":"Iago Rodríguez-Lago, Claudia Herrera-deGuise, Maia Boscá-Watts, Cristina Rodríguez, Eduardo Leo-Carnerero, María Calvo Íñiguez, Fiorella Cañete, Silvia Chacón, Camila Cuarán, Ainara Elorza, Elena Guerra-Del-Río, Eva Iglesias, Damián Sánchez, Manuel Barreiro-de Acosta, Daniel Ginard, José Luis Cabriada","doi":"10.1016/j.gastrohep.2024.502195","DOIUrl":"10.1016/j.gastrohep.2024.502195","url":null,"abstract":"<p><strong>Objective: </strong>Granulocyte-monocyte apheresis (GMA) has shown to be safe and effective in ulcerative colitis (UC), also in combination with biologics, mainly with anti-TNF. The aim of this study was to evaluate the efficacy and safety of combining GMA after primary non-response (PNR) or loss of response (LOR) to ustekinumab (UST) in patients with UC.</p><p><strong>Patients and methods: </strong>A retrospective study was performed in 12 IBD Units, including all patients with refractory UC or unclassified IBD (IBD-U) who received combined GMA plus UST. The number and frequency of GMA sessions, filtered blood volume and time of each session were registered. Efficacy was assessed 1 and 6 months after finishing GMA by partial Mayo score, C-reactive protein (CRP) and fecal calprotectin (FC). Descriptive statistics and non-parametric tests were used in the statistical analysis.</p><p><strong>Results: </strong>Seventeen patients were included (15 UC, 2 IBD-U; median age 47 years [IQR, 35-61]; 59% male; 53% E3). Most patients (89%) had prior exposure to anti-TNF agents and 53% to vedolizumab; 65% were also receiving steroids at baseline. Median partial Mayo score at baseline was 6 (IQR, 5-7) and it significantly decreased after 1 and 6 months (p=0.042 and 0.007, respectively). Baseline FC significantly decreased after 6 months (p=0.028) while no differences were found in CRP. During follow-up, 18% patients started a new biologic therapy and 12% required surgery; 64% of patients under steroids were able to discontinue them. Adverse events were reported in one patient.</p><p><strong>Conclusion: </strong>GMA can recapture the response to UST in selected cases of UC after PNR or LOR to this drug.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}