Revista Espanola De Enfermedades Digestivas最新文献

Background: The epidemiology of inflammatory bowel disease (IBD) among migrant populations in southern Spain has been scarcely explored. This study analyses the incidence, prevalence, and severity of IBD among native and migrant populations in Granada over a decade.

Methods: A retrospective, multicenter, population-based study (2012-2022) including 2,764 IBD patients. A subset of 144 cases (111 natives, 33 migrants) was selected using age-, sex-, and disease-type matching. Multivariate logistic regression identified independent predictors of severe disease.

Results: Most migrant patients originated from Africa (57.5%), followed by Latin America (27.3%) and Central Europe (15.2%). Migrants were diagnosed at a younger age than Spaniards (38.8 ± 12.1 vs 47.7 ± 15.0 years; p = 0.002). Prevalence increased among natives (295/100,000) but remained stable among migrants (41/100,000). Incidence was higher in natives (6.49 vs 1.32 per 100,000/year). Severe IBD affected 34% of all patients, being more frequent among Spaniards (37.8%) than migrants (21.2%). Independent predictors of severity included Crohn's disease (OR 2.36; 95% CI 1.00-5.40), ≥3 colonoscopies (OR 7.02; 95% CI 2.35-20.98), ≥3 hospitalizations (OR 7.75; 95% CI 2.27-26.47), and Spanish nationality (OR 3.24; 95% CI 1.00-10.49).

Conclusions: The prevalence and incidence of IBD in Granada have increased over the last decade but remain lower than those in northern Europe. Migrant populations exhibit lower disease severity. The Mediterranean diet and universal healthcare access may mitigate differences in disease progression.

Background: The impact of metabolism-related genes on inflammatory bowel disease remains unclear. This study aimed to identify the causal relationships between metabolism-related genes and inflammatory bowel disease.

Methods: We performed summary-data-based Mendelian randomization analysis to investigate the associations of metabolism-related genes with inflammatory bowel disease.

Results: In the first priority, genetically predicted SORD (CD: odds ratio [OR], 0.716, 95% confidence interval [CI], 0.647-0.791; UC: OR, 0.720, 95% CI, 0.647-0.802), NDUFB2 (CD: OR, 0.814, 95% CI, 0.765-0.866; UC: OR, 0.820, 95% CI, 0.778-0.864), HS2ST1 (CD: OR, 0.765, 95% CI, 0.687-0.853; UC: OR, 0.781, 95% CI, 0.711-0.859), and SDHC (CD: OR, 0.896, 95% CI, 0.857-0.936; UC: OR, 0.908, 95% CI, 0.874-0.943) expression were associated with decreased CD and UC risk. Conversely, genetically predicted higher expression of SRD5A3 (CD: OR, 1.175, 95% CI, 1.118-1.235; UC: OR, 1.134, 95% CI, 1.074-1.197), CDO1 (CD: OR, 1.202, 95% CI, 1.126-1.284; UC: OR, 1.264, 95% CI, 1.162-1.375), and FADS2 (CD: OR, 1.127, 95% CI, 1.072-1.184; UC: OR, 1.189, 95% CI, 1.114-1.268) were associated with increased CD and UC risk. In the second priority, we found MOCOS (OR: 1.174, 95% CI: 1.108-1.244) was presumptively associated with CD, the NAGA (OR: 0.812, 95% CI: 0.744-0.886) and ATP6V1D (OR: 1.236, 95% CI: 1.123-1.362) were associated with UC.

Conclusion: This study provides genetic support for a potential causal relationship between metabolism-related genes and the risk of inflammatory bowel disease. Our findings should be interpreted with caution given the inherent limitations of Mendelian randomization analysis, and further research is warranted to validate these results.

Background: The global incidence of pediatric inflammatory bowel disease (IBD) is increasing steadily. Children with IBD under 6 years present unique clinical characteristics.

Objective: To compare very early-onset IBD (VEO-IBD) and late-onset IBD (LO-IBD) across clinical, endoscopic, and transcriptomic profiles.

Methods: We retrospectively analyzed clinical data from 76 children (2010-2025) and leveraged the transcriptomic dataset GSE57945 (20 VEO-IBD vs. 260 LO-IBD).

Result: VEO-IBD patients showed significantly higher rates of hematochezia (RR=1.552, 95% CI:1.099~2.191, P=0.032), fever (RR=1.696, 95% CI:1.093~2.631, P=0.034), decreased serum creatinine (RR=1.588, 95% CI:1.251~2.016, P=0.004), and higher Mayo scores (t=2.232, 95% CI:1.852~3.407, P=0.030). Transcriptomics revealed significant downregulation of collagen genes (COL12A1, COL1A1, COL7A1) in VEO-IBD, confirmed by qRT-PCR.

Conclusion: VEO-IBD exhibits a more aggressive phenotype than LO-IBD, which may be associated with distinct clinical severity and collagen-related barrier dysfunction. These findings suggest a novel pathophysiological hypothesis linking extracellular matrix impairment to disease severity in VEO-IBD.

Introduction: Body mass index (BMI) is widely used to diagnose obesity, but it has limitations in assessing abdominal adiposity. Recently, it has been proposed to complement it with the waist-to-height ratio (WtHR) for the diagnosis of obesity. This study evaluates the impact of using WtHR in the diagnosis of obesity in patients seen in gastroenterology outpatient consultations.

Methods: Observational study in a tertiary hospital between December 2023 and April 2025. A total of 253 patients referred from primary care were included. Clinical and anthropometric variables and comorbidities were collected. Obesity was defined as a BMI ≥ 30 kg/m² and a WtHR ≥ 0.5 in patients with a BMI between 25-30 kg/m² and associated comorbidities. Changes in the diagnosis of obesity using WtHR, the presence of metabolic syndrome, and the prevalence of obesity according to the reason for consultation were studied.

Results: 21.7% (55/253) of patients were obese according to BMI, while 54.9% (139/253) were diagnosed as obese when the WtHR criterion was included. In men, the change in the diagnosis of obesity went from 22.6% (26/115) to 67% (77/115). A prevalence of metabolic syndrome of 17.4% (44/253) was observed. Dyspepsia was the main reason for consultation, with obesity present in 18% (11/61); when applying the criterion that includes WtHR, 47.5% (29/61) were obese.

Conclusions: The use of WtHR in gastroenterology consultations allows for better identification of abdominal obesity, especially in patients with digestive and metabolic comorbidities. Its systematic incorporation alongside BMI can improve the clinical and therapeutic approach to these patients.

Study Background and Aim: Peroral endoscopic myotomy (POEM) is a primary treatment for achalasia. Traditionally, oral feeding is initiated after an X-ray contrast study excludes the post-procedure leak. However, since major adverse events (AEs) are rare and typically symptomatic, the need for routine postprocedural X-ray studies is uncertain. Our center initially used routine X-raycontrast studies, but from late 2018 we adopted a clinical decision-based approach, starting oral feeding on postoperative day 2 unless complications were suspected. This study compares both strategies regarding complication rates and hospital stay.

Methods: We performed a retrospective analysis of POEM procedures between 2015 and 2023 in our tertiary center. Patients were divided into an "X-ray subgroup" (feeding after negative X-ray contrast study on the 1st postoperative day) and a "clinical decision subgroup (feeding on the 1st or 2nd postoperative day based on a clinical judgment). Primary outcomes were the rate of major and minor AEs and length of hospital stay.

Major results: A total of 271 POEM procedures were analyzed (129 males, 142 females; mean age 52.6 ± 16.1 years). X-ray contrast was performed in 106 (39.1%) patients (March 2015 - December 2018), while in 165 (60.9%) patients (December 2018 - December 2023) the initiation of oral intake was based on a clinical evaluation. Adverse events occurred in 16 patients (15.1%) and 25 patients (15.2%) in the X-ray group and in the clinical decision group, respectively (p=NS). Major adverse events occurred in 4 (3.8%) and 2 (1.2%) in X-ray subgroup and clinical decision subgroup, respectively (p=NS). Hospital stay was shorter in the clinical decision group. (6.6 ± 1.5 vs. 7.2 ± 2.9 days, p=0.05 95% CI [0.0, 1.2]).

Conclusions: Severe complications after POEM are rare. Routine X-ray contrast study after POEM does not lead to decreased rate of adverse events.

The indication for liver transplantation in liver metastases from neuroendocrine tumors is to improve overall survival and disease-free survival in these patients. The selection criteria for candidates are strict, and although few patients can benefit, it should be offered in indicated cases and patients should be referred to centers with experience in transplantation and in this type of tumor.

A 7-year-old girl, coming from a rural area in Cameroon, presented to the emergency department with a 3-months history of abdominal pain. Her family also reported vomiting and minimal food intake for two weeks. Physical examination showed a palpable and mobile abdominal mass. An ultrasound showed a large intrabdominal multicystic lesion of about 10cm, close to the intestine and with no solid lesions in other organs. A laparotomy was scheduled and a mobile mass dependent on the jejunum was found. The mass caused an intestinal obstruction and was composed of several large cysts with whitish fluid. Excision of the mass and resection of a short segment of small bowel were performed. Intestinal cystic lymphangioma is a rare congenital malformation that normally presents with abdominal pain and distension. Abdominal ultrasonography is the procedure of choice for the diagnosis. Intestinal resection and anastomosis (while the cyst is normally intimate attached to the bowel) is an effective treatment.

A 25-year-old male with tachycardia and right heart enlargement was diagnosed with atrial-ventricular nodal reentrant tachycardia (AVNRT) and successfully treated with radiofrequency ablation. Cardiac MRI confirmed right heart enlargement but ruled out cardiomyopathy. Further imaging revealed a rare congenital absence of the portal vein (CAPV) with an associated portosystemic shunt. This case highlights the importance of considering CAPV in unexplained cardiac symptoms and structural heart changes.

We present the case of a 72-year-old male who was admitted to the Digestive Unit due to an increase in the number of stools (>40 per day) and a change in stool characteristics. Initially a neoplastic lesion of the colon was suspected, and finally the diagnosis was colonic infiltration due to chronic lymphocytic leukemia (CLL).

An 82-year-old woman presented with painless hematochezia. Colonoscopy revealed a submucosal tumor-like mass in the cecum. The appendiceal orifice was identified in the center of the prominence, showing the volcano sign. The yellowish mucus was discharged from the orifice like a lava flow, the so-called mucus outflow. She underwent laparoscopic appendectomy based on the diagnosis of appendiceal mucinous neoplasm. The pathological diagnosis was low grade appendiceal mucinous neoplasm, that is a clinical entity characterized by absence of infiltrative growth or destructive invasion. The differential diagnosis includes appendiceal polyps, lipomas, neuroendocrine neoplasms, and endometriosis. Our case underscores the importance of the volcano sign and the mucus outflow for the preoperative diagnosis of appendiceal mucinous neoplasm.