Revista Espanola De Enfermedades Digestivas最新文献

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.

Introduction: the comprehensive diagnosis of viral hepatitis is an advance towards its elimination, but not all Spanish hospitals performed this diagnosis in 2022. Our objective was to evaluate the situation of the comprehensive diagnosis after the publication of the guidelines and evaluate the degree of implementation in the centers that responded to both surveys.

Methods: a descriptive cross-sectional study was conducted among 79 hospitals that had participated in the initial survey. They were reinvited to respond via Google Forms (sent 23/12/2024).

Results: the response rate was 91 % (72/79). Compared to the previous year, reflex testing increased by 3 %, with notable increases for hepatitis B virus (HBV) (33 %), hepatitis C virus (HCV) (2 %), hepatitis D virus (HDV) (45 %) and dual HBV-HDV (79 %). Anti-HDV and HDV-RNA testing increased by 18 % and 21 %, respectively. Alerts to specialist physicians rose by 24.1 % for HBV and 52.9 % for HDV. Automated appointment systems and referral mechanisms also expanded. Hepatitis A virus (HAV) testing was integrated in 38 % of centers, human immunodeficiency virus (HIV) testing in 50 %, and sexually transmitted infections (STI) testing in 56 %.

Conclusions: awareness and implementation of integrated diagnostics, particularly for hepatitis D, have improved. Nonetheless, further progress is needed to ensure broader coverage and to contribute towards World Health Organization (WHO) elimination goals.

We present the case of a 27-year-old man, with no previous diseases, who was referred to the Department of Otorhinolaryngology in May 2023 for a 2-cm right submandibular lymphadenopathy of two month's evolution. He did not report fever or night sweats, and no oral or genital ulcers were observed. He presented eosinophilia in the analysis performed and a maculopapular exanthema on the left leg and malleolus areas, which was initially treated with topical antibiotic and corticosteroids. A soft tissue ultrasound revealed two right laterocervical lymphadenopathies at levels I and II. Given the suspicion of a primary hematological tumor, a PET-CT scan was conducted to complete the study, which revealed hypermetabolic laterocervical bilateral lymphadenopaties. In June 2023, a programmed cervicotomy was conducted, with complete excision of the right main lymphadenopathy in the Ib region, which showed a histological result of reactive lymphadenitis with intense eosinophilia, vascular proliferation, and fibrosis. These findings suggest Kimura disease as the first possibility. Due to sporadic episodes of choking that were not associated with specific food, persistent elevated IgE levels and eosinophilia in peripheral blood tests, and skin alterations, the study was completed with a gastroscopy to rule out the presence of eosinophilic esophagitis, which showed erosive duodenitis, with villous shortening and increased lymphoplasmacytic cellularity of the lamina propria, findings consistent with celiac disease, which was afterwards confirmed with the presence of positive anti-endomysial and transglutaminase antibodies, and the presence of HLA-DQ8 positive in homozygosis in the genetic study. The patient started systemic treatment with corticosteroids and gluten-free diet, which he continues to take at present.

We present a rare case of ruptured pancreatic carcinosarcoma in a 56-year-old male who underwent radical surgery and adjuvant chemotherapy. Despite the typical poor prognosis associated with this aggressive tumor, the patient achieved an overall survival of 20 months postoperatively. This case emphasizes the challenges in diagnosing and managing pancreatic carcinosarcoma and highlights the potential benefits of aggressive surgical and chemotherapeutic interventions in achieving extended survival.

This pilot study evaluates the presence of potential unrecognized steatotic liver disease with moderate alcohol consumption (MetALD) in patients diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD) using the ALD/NAFLD index (ANI) score. A retrospective single-center study was conducted on 85 patients attending Digestive Diseases consultations in May and June 2024. MASLD was defined by hepatic steatosis with limited alcohol intake (<20 g/day for women and <30 g/day for men) and at least one cardiovascular risk factor. The ANI score identified 21.2% of patients as having a potential probability of MetALD, with higher alcohol consumption (10-30 g/day) and increased liver fibrosis observed in this group, though the latter did not reach statistical significance. Even though the ANI score is not validated to distinguish MetALD from MASLD, our findings highlight its potential utility in improving diagnostic accuracy by addressing underreported alcohol consumption.

Chemical burns of the rectum are so rare that there are few cases reported about this situation. In fact, chemical burns of the rectum can cause severe serious consequence, such as bleeding, perforation and necrosis, even developing to persistent rectal stricture. Here we present a case report of a 12-year-old child with rectal stenosis who imitates the use of corkage and inserts rust remover into the rectum unsupervised by family members. He underwent endoscopic balloon dilation followed by submucosal injection of bleomycin at the stenosis point.

Clinical decision-making in patients with pancreatic neuroendocrine tumors is complex. The absence of effective biomarkers and the reliance on morphological criteria underlying current predictive models expose patients to a substantial risk of overdiagnosis and overtreatment. The implementation of non-invasive tools that improve the precision of prognostic estimates remains an unmet clinical need.

Background: Constipation, a widespread global issue, prompted an investigation into the intricate relationship between dietary factors and this condition. This study delves into the association between carbohydrate-to-fiber (CF) ratio and constipation, employing data from the National Health and Nutrition Examination Survey (NHANES) and a comprehensive meta-analysis.

Methods: Utilizing NHANES data (2005-2010) from 7752 adults, constipation was defined based on stool type (Bristol Stool Form Scale types 1 or 2). The CF ratio was calculated, revealing an L-shaped, non-linear association with constipation. A meta-analysis of 16 studies (1626 participants) confirmed a positive effect of dietary fiber on constipation, emphasizing the robustness of the findings.

Results: Among participants, constipation prevalence stood at 13.98%. The CF ratio exhibited a turning point at 26.92/day, with adjusted odds ratios for constipation indicating a decrease with higher CF ratios. Meta-analysis results supported these findings, demonstrating a significant positive effect of dietary fiber on constipation.

Conclusion: This study illuminates a nuanced relationship between CF ratio and constipation, suggesting a critical turning point at 26.92/day. These findings underscore the importance of dietary assessment, offering valuable insights for clinicians and individuals. Further prospective research is warranted to validate the CF ratio as a robust dietary assessment tool.

Plummer-Vinson syndrome (PVS) is a rare disorder characterized by a triad of iron-deficiency anemia, cervical dysphagia, and post-cricoid esophageal webs. The exact relationship between anemia and web formation remains unclear, with current hypotheses lacking strong evidence. Although treating anemia generally resolves dysphagia, some cases require endoscopic intervention. PVS is considered a precancerous condition due to its association with squamous cell carcinoma of the hypopharynx or upper esophagus. We present the case of a 53-year-old woman with psoriatic arthritis who exhibited iron-deficiency anemia unresponsive to oral iron and persistent dysphagia. Gastroscopy revealed esophageal narrowing, and she underwent successful balloon dilation following iron therapy. The patient is now asymptomatic. While the etiopathogenesis of PVS remains unknown, autoimmune conditions may play a role. Due to its potential link to neoplastic lesions, recognizing and managing PVS is critical. Further research is required to improve understanding and identify those at risk.

Histoplasmosis is an opportunistic infection originating from endemic regions. Current factors such as immigration and immunosuppression associated with new therapeutic approaches increase the likelihood of disease dissemination. Hepatic involvement is uncommon and leads to an extensive differential diagnosis, potentially delaying diagnosis and resulting in a fatal outcome. We present the case of a male patient with human immunodeficiency virus (HIV) infection, whose clinical onset occurred in the context of disseminated histoplasmosis with hepatic involvement.