Revista Espanola De Enfermedades Digestivas最新文献

Caustic ingestion in adults is an infrequent but potentially life-threating condition, commonly associated with intentional ingestion and severe gastrointestinal injury. Data describing the clinical and endoscopic characteristics of adult caustic ingestion in Hispanic population are limited. The aim of this study was to describe the epidemiological, clinical, and endoscopic characteristics of adult patients with caustic ingestion and to explore associations between clinical presentation and endoscopic severity. We conducted a retrospective observational study including adults admitted with caustic ingestion at tertiary referral center in northern Mexico between January 2016 and July 2025. Demographic, clinical, and endoscopic data were obtained from medical records. Upper endoscopy was performed within the first 24 hours whenever feasible, and lesions were classified according to Zargar classification. Thirty-five patients were included, with a median age of 27 years and male predominance. Most ingestions were intentional, and acid agents were the most frequently involved substances. Esophageal lesions were identified in most patients, followed by gastric and duodenal involvement. The most frequent esophageal injuries corresponded to moderate and severe grades. Clinical findings such as sialorrhea and aspiration of secretions and need for orotracheal intubation were associated with gastric involvement. In-hospital mortality was 5.7%, and only one (2.8%) patient developed an esophageal stricture. In this Hispanic cohort, adult caustic ingestion predominantly affected young men and was mainly intentional. Severe esophageal injury was frequent, and specific clinical findings at presentation were associated with advanced endoscopic damage, supporting their role as early indicators of severity and the need for prompt endoscopic evaluation.

Multiple biliary hamartomas (Von Meyenburg complexes) are benign biliary duct malformations usually detected incidentally. Although magnetic resonance imaging is the diagnostic reference, abdominal ultrasound is typically the first imaging modality performed. We present a case of isolated GGT elevation in which ultrasound revealed a characteristic "starry sky" pattern, allowing suspicion of the diagnosis later confirmed by computed tomography. Recognizing these sonographic features is essential in daily gastroenterology practice.

Recently ustekinumab biosimilar has been aproved for the treatment of patients with Crohn's Disease. This retrospective bicentric study aimed to evaluate the short- and medium-term effectiveness and safety of UB in ustekinumab-naïve patients and after switching from the originator.

Liver transplantation is a life-saving procedure for patients with end-stage liver disease. Although immunosuppressive therapy has markedly improved transplant outcomes, its long-term use is associated with significant adverse effects, including infections, metabolic complications and malignancies. Achieving operational tolerance, defined as stable graft function in the absence of immunosuppressive therapy, represents a major goal in liver transplantation. MicroRNAs have emerged as promising biomarkers due to their stability and their association with immune-regulatory processes. We conducted a prospective study including forty-five liver transplant recipients undergoing a controlled immunosuppressive drug withdrawal protocol. Patients were classified as tolerant or non-tolerant according to their ability to remain free of immunosuppressive therapy without rejection for at least twelve months. Liver tissue biopsies were obtained at baseline, and microRNA expression was analyzed using microarray profiling and quantitative polymerase chain reaction. Differential expression and pathway enrichment analyses were performed. Three microRNAs, namely microRNA-4284, microRNA-4286 and microRNA-7977, were upregulated in non-tolerant patients compared with tolerant patients. Functional enrichment analysis indicated that genes targeted by these microRNAs were enriched in pathways related to T cell proliferation, inflammatory immune responses, cellular metabolism and apoptosis. Notably, intra-graft microRNAs expression levels were positively associated with baseline tacrolimus concentrations. In conclusion, intra-graft microRNAs expression patterns are linked to tolerance outcome and associated with immunosuppressive drug exposure. These findings suggest that intra-graft microRNAs expression may capture composite biological signals reflecting both graft immune state and pharmacological immunosuppression intensity, supporting their potential utility for patient stratification in immunosuppression withdrawal strategies.

A 55-year-old woman presented with vomiting and abdominal pain. Physical examination revealed abdominal tenderness, but no rebound tenderness. A computed tomography (CT) scan revealed a distended small intestine called the flower bouquet sign, as well as the fat notch sign. These findings supported the suspicion of adhesive small bowel obstruction (SBO). Emergency surgery confirmed the presence of an adhesive band formed and it was resected. The patient recovered uneventfully. Most cases of SBO are caused by adhesions, followed by internal hernias and volvulus. CT scanning is essential for diagnosing adhesive SBO, which exhibits characteristic signs such as the beak sign, fat notch sign, small bowel feces sign, and flower bouquet sign. The flower bouquet sign refers to the distended small bowel segments arranged radially within a closed loop, resembling flowers and stretched mesenteric vessels that converge toward the transition zone, resembling stems. The fat notch sign indicates extraluminal compression of the bowel by an adhesive band at the transition zone. This case underscores the importance of recognizing adhesive SBO early on through characteristic imaging signs to mitigate the risk of life-threatening complications, such as ischemia or perforation.

Introduction: Current measuring tools for disability related to inflammatory bowel disease (IBD) rely mostly on patient-reported disability perception. It may, therefore, largely depend on patients' subjectivity, thus hindering objective evaluation. In the present study, we aimed to identify clinical plausibly objectifiable variables related to disability and to develop and validate a long-term disability index based on them.

Methods: Answering an online survey, IBD patients reported their officially recognised degree of general and work disability plus several long-term disability-related clinical variables. Responses were randomly allocated to a training or a validation dataset. Multiple logistic regression tests were performed in the training set. Variables statistically or clinically related to disability were used to model an Unweighted-IBD Objective Disability Index (U-IBDODI) -where all variables had the same weight- and a Weighted- Index (W-IBDODI), where variables were weighted according to the regression results. Both scores were subsequently validated.

Results: The analysis included 930 questionnaires. Patients' mean age was 41±11, 642 (65.4%) were women, and 582 (59.3%) had Crohn's Disease. The training dataset included 665 surveys. In the validation set (n=265), U-IBDODI mean values were 3.7+/-1.3 for patients with work disability and 2.3+/-1.4 for patients without (p<0.001). U-IBDODI AUROCs for predicting work and general disability were 0.839 and 0.675, respectively. The corresponding W-IBDODI values were 10.9+/-3.7 and 6.9+/-3.7 (p<0.001), 0.837 and 0.606.

Conclusions: Predictive values of IBDODI scores were good for work disability and moderate for general disability. These indexes may provide a more objective evaluation of permanent disability, complementing existing indexes.

Introduction: Sump formation can occur in end-stage esophageal achalasia or following esophagectomy and is associated with severe esophageal dilatation, luminal stasis, increased aspiration risk, and malnutrition. Peroral plication of the esophagus (POPE) is a novel endoscopic technique designed to remodel the esophageal lumen; however, current evidence remains limited. This systematic review assesses the available evidence on POPE in patients with end-stage achalasia and delayed gastric conduit emptying (DGCE) after esophagectomy.

Methods: This systematic review was conducted across four databases. Case series and case reports describing POPE in patients with achalasia or postesophagectomy were included to evaluate feasibility, clinical outcomes, and safety. Conference abstracts were included only when sufficient data on key outcomes could be extracted. The main analysis was limited to full-text publications, with a secondary analysis incorporating conference abstracts. Certainty of evidence was assessed using an adapted GRADE approach based on full-text studies.

Results: Nine studies were included, comprising 59 patients (four case series, three case reports, and two conference abstracts). The primary analysis, including 39 patients, revealed technical success and symptom improvement in 39/39 (100%) and 31/39 patients (79.5%), respectively. A new session of POPE (re-POPE) was performed in 12/39 patients (30.8%). No intraprocedural adverse events occurred, and 5/39 cases exhibited postprocedural adverse events (12.8%). When conference abstracts (59 patients) were included, technical success was reported in all patients (100%), with symptom improvement in 51/59 (86.4%). The secondary analysis demonstrated that re-POPE was performed in 13/59 patients (22.0%).

Conclusions: POPE appears to be a feasible intervention with an acceptable safety profile based on published case reports and series and may provide symptomatic benefit in selected patients. However, current evidence is limited and heterogeneous. Prospective studies and multicenter registries with standardized results are needed to confirm its efficacy and durability.

Autoimmune hemolytic anemia (AIHA) is an autoimmune destruction of red blood cells, usually mediated by immunoglobulin G (IgG) and/or immunoglobulin M (IgM). We present the case of a 75-year-old woman diagnosed with Crohn's disease (CD) who developed AIHA while receiving treatment with vedolizumab. We think that this report is important to add evidence of this possible association and most of all, underscores the importance of maintaining a high index of suspicion in patients with severe anemia and IBD undergoing treatment with novel therapies.

The advent of artificial intelligence (AI) is revolutionizing today's clinical practice, particularly in gastroenterology, where capsule endoscopy (CE) positions itself as one of the most impacted and benefited areas. Interpreting a video capsule endoscopy procedure, which may involve over 50,000 images per study, is an error-prone, complex process that demands experience and sustained focus. AI, through deep learning models (DL) and convolutional neural networks (CNN), has optimized this reading procedure, demonstrating high sensitivity and specificity in the detection of lesions and providing diagnostic support in pathologies such as Crohn's disease and celiac disease, in addition to significantly reducing reading times. The use of AI as a first-reading tool stands out for its ability to select relevant images, speeding up the review of videos. Tools such as TOP100, already available in clinical practice, have proven effective in reducing reading times, facilitating prioritization in urgent scenarios. However, it faces significant challenges, such as the presence of false negatives. In its role as a second-reading tool, AI can confirm initial findings, detect unseen lesions, and serve as a training tool for physicians in training without compromising diagnostic accuracy. In addition to its impact on reducing reading time, AI has shown potential in detecting intestinal lesions, locating them, and assessing intestinal cleanliness. Despite advances, its widespread adoption requires overcoming significant challenges such as lack of standardization and medico-legal issues. Future prospective, multicenter studies will help AI revolutionize CE interpretation, improving its accuracy and efficiency in clinical practice.

Background: SETD8, a histone methyltransferase catalyzing H4K20 monomethylation (H4K20me1), is crucial for epigenetic regulation, yet its role in gastric cancer (GC) progression remains unclear. This study investigated whether SETD8 promotes epithelial-mesenchymal transition (EMT) and GC progression by regulating MCM7.

Methods: expression and clinical relevance of SETD8 and MCM7 were analyzed using TCGA and GEO databases, and validated in GC cell lines and normal gastric epithelial cells. SETD8 knockdown and inhibitor UNC0379 were used to assess its functions. Proliferation, apoptosis, invasion, migration, EMT and stemness were evaluated by CCK-8, flow cytometry, Transwell, wound healing, immunofluorescence and sphere formation assays. ChIP-qPCR measured H4K20me1 enrichment and SETD8 binding at the MCM7 promoter. Rescue experiments were performed by overexpressing MCM7 in SETD8-knockdown cells. Supplementary single-cell and immunotherapy cohort analyses were also conducted.

Results: SETD8 and MCM7 were overexpressed in GC tissues and cell lines, correlating with advanced stage and poor prognosis. SETD8 knockdown suppressed proliferation, migration, invasion and stemness, induced apoptosis, and reversed EMT (downregulating Snail, N-cadherin, Vimentin; upregulating E-cadherin). Mechanistically, SETD8 knockdown reduced global H4K20me1 and MCM7 expression. H4K20me1 was enriched at the MCM7 promoter, while direct SETD8 binding was not detected, suggesting a non-canonical regulatory mode. MCM7 overexpression rescued the malignant phenotypes inhibited by SETD8 knockdown.

Conclusion: SETD8 promotes EMT and GC progression primarily by upregulating MCM7 expression, likely via an H4K20me1-dependent epigenetic mechanism. MCM7 acts as a key downstream effector. The SETD8/MCM7 axis represents a novel driver and potential therapeutic target in GC.