Gastroenterologia y hepatologia最新文献

Coeliac disease is a chronic immune-mediated enteropathy triggered by gluten intake, which affects the small intestine in genetically susceptible individuals (HLA-DQ2 and/or HLA-DQ8). This disease, which occurs in both children and adults, is among the most common genetically determined disorders in Western countries. It is characterized by the presence of very varied and often nonspecific clinical manifestations (primarily digestive symptoms and signs of intestinal malabsorption), as well as the presence of specific antibodies (tissue transglutaminase and endomysium) and enteropathy. Currently, the only treatment for coeliac disease is a strict gluten-free diet for life. The main objective of the NATURCEL (NATURal history, epidemiological, clinical, diagnostic and therapeutic aspects of CoELiac disease and noncoeliac enteropathies) registry is to collect selected variables on different aspects of the disease (epidemiological, clinical, genetic, immunological, etc.) for a subsequent shared analysis for scientific and translational purposes.

Objective: Ulcerative proctitis (UP) usually presents a milder course, but some patients develop significant symptom burden, severe forms, or refractory UP (RUP). Our objective was to characterise RUP and generate recommendations for daily practice.

Methods: A systematic review (SR) was conducted to analyze epidemiological, clinical, and pharmacological treatment aspects of RUP. The results were discussed in a nominal focus group meeting composed of seven gastroenterologists specialized in the management of inflammatory bowel disease, a nurse, and a patient. Several statements on the management of PU were proposed and voted to achieve agreement.

Results: The SR included 43 articles of low to moderate quality. Nearly 30% of patients presented RUP, and the impact of the disease on their quality of life was highly significant. Different gaps of knowledge related to the clinical characteristics and course of the disease, efficacy, safety, and selection of pharmacological treatments were identified. The experts proposed 13 practical statements that reached the established level of agreement. These address the diagnosis of UP and RUP, their therapeutic goals and treatment selection, monitoring, treatment response, and the role of the nurse.

Conclusions: RUP is common and can have a significant impact on patients. More research is needed to characterize RUP and the long-term efficacy of available treatments. The proposed statements aim to address the knowledge gaps related to RUP.

Modulation of sphingosine-1-phosphate receptors represents a relatively recent approach in the treatment of inflammatory bowel disease, although these modulators have been approved since 2010 for other inflammatory conditions such as multiple sclerosis. Etrasimod is a sphingosine-1-phosphate receptor (S1PR) modulator that binds to S1PR1, S1PR4 and S1PR5 receptors, and its efficacy has been demonstrated in the treatment of moderately to severely active ulcerative colitis. It is a small molecule and synthetic drug administered orally, with a proper bioavailability and a fast elimination rate, predictable pharmacokinetics and lack of immunogenicity, which are convenient characteristics for both efficacy and safety. This article reviews the pharmacological characteristics of etrasimod and its safety profile.

Aim: To evaluate the potential acceptance of Hot-Spaxus in routine practice through a subjective technical assessment by expert endoscopists, and to assess its short-term efficacy and safety.

Patients and methods: Observational multicenter study based on a prospective database of the first cases of EUS-guided therapeutic drainage of on-label targets (pancreatic fluid collections [PFC] and gallbladder drainage [GD]) using Hot-Spaxus© doing by 6 expert endoscopist. After the endoscopic procedure, experts completed two questionnaires with 9 items each: one assessing technical difficulty and another evaluating preference for Hot-Spaxus, Hot-Axios, or no preference/similar.

Results: Twelve patients were included (4 PFC / 8 GD); 66% were women, with a median age of 84.8 years (IQR 71.7-89.4). In the questionnaire on perceived difficulty, most items were rated as easy or moderate, while the "very difficult" category was reported infrequently. Endoscopists preferred Hot-Axios© over Hot-Spaxus© regarding position control during deployment (58.3%) and management of the delivery system (58.3%). Technical and clinical success rates were 91.7% and 90.9%, respectively. One case of bleeding was reported as an adverse event (8.3%).

Conclusions: Deployment system friction, endoscope channel friction, and guidewire passage through the delivery system were perceived as less complex. In contrast, penetration, position control, and LAMS deployment were considered more challenging and were rated less favorably compared with Hot-Axios©.