Revista Espanola De Enfermedades Digestivas最新文献

Hydatidosis is a zoonosis caused by Echinococcus granulosus that typically affects the liver and lungs, with splenic involvement being rare. This case refers to a complication in the form of colonic fistulization of a splenic hydatid cyst, which required both medical and surgical treatment.

A 32-year-old man with a background of schizophrenia presented to gastroenterology outpatient clinic with upper abdominal discomfort and abnormal behavior for 1 day. The physical examination was characterized by a lack of cooperation. Computed tomography of the abdomen showed a rectangular-like metallic foreign body in the stomach without gastrointestinal perforation. The patient denied swallowing any foreign bodies. Owing to the large size of the metallic foreign body (13.0 by 4.7 by 3.7 cm), endoscopic removal was not attempted. Laparoscopic removal was attempted; however, conversion to an open procedure was performed, and two strings of magnets, approximately 60 pieces, were successful retrieved from the stomach, with no residual foreign bodies detected. At 1-month follow-up, he was without any discomfort.

Background and aim: malnutrition, caused by malabsorption and maldigestion, affects nutrient intake and utilization. Early detection and interventions, such as oligomeric enteral formulas, are key to improving outcomes. This study explored healthcare professionals' experiences with oligomeric supplements in Spain's public healthcare system, focusing on clinical practices, patient adherence, tolerability, and benefits.

Methods: the S-QUEST study was an observational, multicenter, cross-sectional investigation conducted in real-world clinical settings. Healthcare providers, mainly physicians from various specialties, were surveyed electronically using an ad hoc questionnaire on nutritional screening practices for malnourished patients prescribed oligomeric supplements. Data were analyzed using SPSS® (version 25.0), with significance set at p < 0.05.

Results: a total of 259 healthcare providers from 41 Spanish hospitals completed the survey. Nutritional screening was reportedly performed by 75 % of respondents, with endocrinologists and gastroenterologists indicating more frequent use (p < 0.001) and a broader range of methods. Oligomeric formulas were prescribed by 67.6 % of participants, mainly in cases involving oncology, inflammatory bowel disease, and diarrhea-related malnutrition. A self-reported adherence rate of 85 % was noted, with higher compliance perceived by endocrinologists and gastroenterologists. Additionally, 95 % of participants perceived oligomeric formulas as beneficial, particularly in relation to weight, stool consistency, and albumin levels.

Conclusions: this study explored healthcare providers' perceptions of oligomeric formulas in malnutrition management. Respondents, particularly endocrinologists and gastroenterologists, reported frequent use and perceived patient benefits. High self-reported adherence suggests good acceptance. Further research is needed to objectively assess outcomes and guide clinical practice and training.

A 54-year-old male underwent a low anterior resection in 2015 for rectal adenocarcinoma. He presented to the emergency department with a two-week history of fever, perianal pain, an erythematous, warm, and actively draining mass. Physical examination revealed a perianal abscess in the left posterior gluteal region, with a palpable internal fistulous orifice 3 cm from the anal margin. Abdominal and pelvic CT and MRI demonstrated a discontinuity in the distal sigmoid colon pre-anastomotic, communicating with a perirectal abscess and an extrasphincteric fistulous tract towards the left ischioanal fat. Despite initial antibiotic therapy with amoxicillin/clavulanic and poor clinical response, colonoscopy revealed a 10 mm, erythematous, and friable fistulous orifice at the anastomosis. Histopathology did not reveal any adenomatous or dysplastic tissue. Vacuum-assisted closure was attempted but was unsuccessful due to technical difficulties and the small size of the cavity. Given the characteristics of the fistula, we proceeded with continuous manual suturing after argon application, achieving complete closure of the fistulous opening. However, after two weeks, there was a sluggish evolution. A follow-up colonoscopy showed persistence of the fistulous orifice with suture material, although radiologically there was a clear decrease in the abscess. Finally, after one month of hospitalization with a stable fistula but no definitive resolution, a planned surgical intervention was decided.

We report the case of a 32-year-old female patient who presented with worsening symptoms of bloody diarrhea, abdominal pain, and fever. Based on the clinical presentation, colonoscopy findings, and CT imaging, the patient underwent colectomy for suspected intestinal perforation. Histopathological examination and immunohistochemistry analysis of the resected specimen ultimately led to the diagnosis of primary intestinal NK/T-cell lymphoma.

Background: approximately one-third of patients with inflammatory bowel disease (IBD) do not achieve disease control despite the incorporation of new advanced therapies in recent years. The combination of two advanced therapies (AT) can overcome this therapeutic ceiling; therefore, these therapies have been empirically tested in real-life clinical practice, but evidence is lacking on how and when to combine them.

Methods: a multicenter retrospective study was designed, reviewing cases treated with dual advanced therapy (DAT). We examine its characteristics, effectiveness and adverse effects, and explore potential variables associated with its effectiveness.

Results: a total of 29 DAT regimens were documented in 24 patients, with a median duration of seven months (IQR 0.5-43 months). Overall clinical remission was 41.1 % (36 % when DAT was indicated for refractory IBD, and 60 % when indicated for immune-mediated inflammatory diseases (IMID) and IBD. Endoscopic/radiological response was observed in 31.6 % of the evaluated patients (n = 19). In 17 cases (58.6 %), DAT was discontinued, three of them due to deep remission. The median survival without discontinuation due to inefficacy or adverse events was 20 months. No differences in effectiveness were observed based on the combined mechanisms of action, or on the strategy of adding new versus recycled AT.

Conclusions: empirical use of DAT in refractory IBD may lead to clinical remission in approximately one-third of patients. Remission rates appeared more effective when DAT was used to simultaneously treat IBD and an IMID. However, further data are needed before specific recommendations can be made regarding type or timing strategy for DAT.

We present the case of a 52-year-old woman with grade III obesity, type II diabetes, sleep apnea, and severe myasthenia gravis. Due to prolonged corticosteroid treatment, she had gained weight and experienced difficulty moving. To improve her condition, a laparoscopic gastric bypass was performed with good results. Myasthenia gravis is a rare autoimmune neuromuscular disease that primarily affects women. Although it is uncommon for it to be associated with obesity, weight loss has been shown to improve the symptoms of this condition, owing to the resolution of metabolic syndrome and the optimization of acetylcholine receptors after weight loss.

A 24-year-old young female presented to our hospital with gastrointestinal bleeding for four days. The patient had no family history of polyps or cancer. There were no pigment spots on her skin, lips, or oral mucosa. For diagnostic purposes gastroscopy and colonoscopy were all performed. Gastroscopy revealed a pedunculated polyp with a size of approximately 2.5 * 2.5cm in the gastric body. Colonoscopy showed normal. Then the polyp was excised by electrocoagulation with a snare. After the polyp was excised, the bleeding stopped. Histopathological analysis revealed that the polyp was a Peutz-Jeghers-type polyp (PJP) .

Background: microscopic colitis (MC), a chronic intestinal inflammatory disorder characterised by persistent watery diarrhoea, is categorised into collagenous and lymphocytic subtypes. Recent studies suggest that appendectomy influences the risk of MC, although the evidence remains inconclusive. This meta-analysis of available research was conducted to clarify the relationship between appendectomy and MC risk.

Methods: in accordance with the PRISMA guidelines, a comprehensive search was conducted in the Web of Science, EMBASE, and PubMed up to January 2024, focusing on studies that explored the association between appendectomy and MC. Quality was assessed using the Newcastle-Ottawa Scale, with data synthesis using the DerSimonian and Laird random-effects model. Heterogeneity and potential biases were evaluated; subgroup analyses were performed to investigate specific associations.

Results: six studies were analysed, including one cohort and five case-control studies involving 85,845 participants. The combined analysis showed no significant link between appendectomy and MC risk (OR: 1.20, 95 % CI: 0.91-1.58), despite moderate heterogeneity (I² = 59 %). Subgroup analyses indicated potential associations in specific contexts. Notably, significant associations were found in subgroups based on MC subtypes (CC: OR 1.59, 95 % CI: 1.20-2.10; LC: OR 1.45, 95 % CI: 1.34-1.58), unadjusted ORs (OR 1.42, 95 % CI: 1.17-1.73), healthy control groups (OR 1.51, 95 % CI: 1.38-1.67) and studies using medical records for appendectomy history (OR 1.50, 95 % CI: 1.28-1.75). Other subgroup analyses did not yield significant results.

Conclusion: this meta-analysis did not support a significant association between appendectomy and increased risk of MC. These findings highlight the need for further large-scale, prospective studies to explore this relationship in greater detail, considering the potential for nuanced interactions and the impacts of various confounding factors.

We present the case of an 18-year-old male who was diagnosed at age 15 with extensive ileal and colonic Crohn's disease with rectal involvement and an associated perianal fistula. The patient received different treatments with biologics without achieving response, thus, combination therapy with subcutaneous Infliximab and Risakizumab was attempted. The patient showed improvement fter the second week, achieving both analytical, clinical and endoscopic response.