Revista Espanola De Enfermedades Digestivas最新文献

Core Outcome Sets (COS) provide standardized outcomes for randomized controlled trials (RCTs), enhancing consistency and comparability in research. In inflammatory bowel disease (IBD), the CORE-IBD Collaborators developed the first COS for RCTs, while the European Crohn's and Colitis Organisation (ECCO) later introduced a COS for real-world data, addressing key domains such as disease activity, patient-reported outcomes, and healthcare utilization. Emerging imaging techniques are also shaping IBD research, likely influencing future COS development. Integrating COS into studies can improve evidence synthesis and foster a more standardized, patient-centered approach in IBD research and care.

Gastric bypass is currently the most performed bariatric technique, with effective results in weight loss and resolution of comorbidities. However, it can have serious complications, such as gastric remnant neoplasms, rare tumors (mostly adenocarcinomas) that develop in the portion of the stomach excluded after surgery. The diagnosis of these neoplasms is often delayed due to the difficulty of endoscopic access to the gastric remnant and the nonspecificity of the initial symptoms -such as anemia, weight loss and dysphagia- which can be confused with common effects of the bypass. As a result, cases are often detected in advanced stages, with locally invasive or metastatic disease, complicating treatment and worsening prognosis. The case report describes a 56-year-old man who underwent gastric bypass surgery 11 years ago and presented with dysphagia, weight loss and anemia. Despite an initial gastroscopy without significant findings, a CT scan revealed an obstructing gastric tumor. He underwent robotic-assisted surgery, where peritoneal implants and ascites were found. After several postoperative complications - including jaundice and tumor stenosis of the gastrojejunostomy - prostheses and a catheter were placed to relieve symptoms, but the patient died 10 days after hospital discharge. This is the first case detected among more than 800 procedures since 2006. The uncommon nature of these neoplasms, together with their difficult diagnosis, highlights the need to keep a high index of suspicion and rigorous follow-up in patients with risk factors, given the associated poor prognosis.

There are potential advantages of domain-specific solutions, built by fine-tuning pretrained LLMs with healthcare data, but this approach has certain drawbacks: privacy, biases and accuracy.

Superior Mesenteric Artery Syndrome (SMAS) is a rare cause of proximal intestinal obstruction in young adults. This case series aims to describe the clinical presentation, diagnostic findings, and management outcomes in affected patients. We describe the information of eight patients diagnosed with SMAS. We collected clinical, laboratory, and radiological data and treatment approaches. The median age was 22 years (16-31), and a male predominance (62%). All patients had oral intake intolerance, with nausea (87%), dyspepsia (50%), and abdominal pain (37%) being the most common symptoms. The median Nutritional Risk Screening (NRS) score was 4. Imaging revealed a reduced aortomesenteric angle (median: 16.6°) and distance (median: 4 mm). Treatment varied based on severity, with 50% requiring surgical intervention. Two patients died due to unrelated complications. SMAS remains a challenging diagnosis due to its nonspecific and progressive symptoms. Early identification of risk factors and individualized management strategies are crucial for improving patient outcomes.

In patients with gastroesophageal reflux disease (GERD) and ineffective esophageal motility (IEM) who have surgical indication, there is controversy regarding the fundoplication to be performed, since Nissen fundoplication (NF) could increase the risk of postoperative dysphagia. Furthermore, studies that have evaluated NF for the treatment of GERD in patients with IEM are scarce. The aim of this study is to analyze the results of NF in patients with GERD and IEM. A retrospective study is carried out, whose study population consisted of patients with GERD and IEM who underwent NF between 2017 and 2023. Patients younger than 18 years, with paraesophageal hernias (II-IV), reinterventions and those with a follow-up of less than one year are excluded. Twenty-seven patients met the selection criteria. There were no complications (infection, bleeding or perforation), reinterventions or readmissions during the first 30 postoperative days. Moreover, 22,2% (n=6) had self-limited dysphagia that resolved in less than 3 months and 14,8% (n=4) had gas-bloat syndrome that resolved in the first 6 months. After 6 months, 18,5% (n=5) of the patients presented some degree of dysphagia, whose causes were: hiatal hernia in 3 cases, stenosis of the NF in one case and functional in another case. NF stenosis was resolved with endoscopic dilatations. After a mean follow-up of 53,1 ± 22,8 months, 22,2% (n=6) presented recurrence of GERD.

This letter is a comment on a recent article published in the Revista Española de Enfermedades Digestivas (REED). As the article serves as an update on the management of functional dispepsia involving primary care, clarification of the clinical modifications to the Rome IV criteria would be valuable to facilitate the work of primary care physicians. The letter references a relevant publication by the Rome Foundation on this topic.

A 54-year-old man with decompensated cirrhosis (Child-Pugh B8, MELD-Na 23) and a prior ileostomy was admitted with hemorrhage from the stoma. Initial hemostasis was achieved with mechanical suturing, but recurrent bleeding led to worsening anemia and hepatorenal syndrome. Contrast-enhanced CT identified peristomal varices without thrombosis. Endovascular cyanoacrylate embolization was performed successfully, with no further bleeding. This case highlights peristomal varices as a rare but serious complication in cirrhosis, requiring multidisciplinary management.

A 57-year-old male patient presenting with dysphagia two years following catheter ablation for atrial fibrillation was referred to our department. Upper gastrointestinal endoscopy and barium esophagography revealed no apparent abnormalities; however, high-resolution manometry demonstrated markedly abnormal contractions. The patient subsequently received treatment with gastroprokinetic agents, leading to symptomatic improvement. To date, only a limited number of reports have documented esophageal motility disorders as a complication of catheter ablation. This case, therefore, represents a novel clinical entity of significant relevance.

The initial approach to autoimmune hepatitis is based on the use of immunosuppressants and corticosteroids. The first-line immunosuppression options include azathioprine or mycophenolate mofetil. Long-term immunosuppression predisposes patients to the development of neoplastic diseases. In this case, chronic AIH treatment with mycophenolate mofetil was associated with the onset of primary cerebral lymphoma, which was treated with methotrexate and rituximab. Rituximab is an interesting therapy for AIH, and in this case, it was able to treat both conditions.

We thank ASENEM and SEMFYC for their comprehensive review on functional dyspepsia (FD), a prevalent condition with variable therapeutic responses. The review highlights the importance of thorough initial evaluation, including dietary habits, medical history, medication review, physical examination, Helicobacter pylori (Hp) testing, and empirical use of proton pump inhibitors (PPIs) or prokinetics. Endoscopy is reserved for refractory cases or those with alarm symptoms. This approach aligns with primary care practices, where time and access to specialized investigations are limited. Endoscopy is recommended for patients with alarm symptoms or symptom onset after 55-60 years. The review also suggests computed tomography (CT) for patients over 60 with unintentional weight loss to rule out pancreatic cancer, given its diagnostic accuracy for biliopancreatic, liver, and gastrointestinal malignancies. This is supported by the differing prevalence trends of gastric and pancreatic cancer in our country.