Revista Espanola De Enfermedades Digestivas最新文献

Early liver transplantation for severe alcohol-associated hepatitis represents a transformative therapeutic approach that can significantly improve survival and achieves standard survival after LT compared to other indications. Early evaluation and an adequate selection of candidates, including organic and psychosocial criteria, are essential. Multidisciplinary management, including the addiction team for the treatment of alcohol use disorder, decreases the risk of alcohol relapse after liver transplantation and is associated with improved outcomes.

Protein-losing enteropathy is a relatively uncommon syndrome characterized by excessive loss of proteins into the intestinal lumen. It can be caused by various etiologies. Inflammatory bowel disease (IBD) is the first condition we think of when we meet a patient with intestinal ulcers and hypoproteinemia. However, there are many other complicated and relatively novel etiologies, which we must be aware of in order to perform an appropriate differential diagnosis, such as the one we present.

We present the case of a 64-year-old male diagnosed with corticosteroid-dependent ulcerative colitis in 1999, who underwent total proctocolectomy with a J-pouch in 2005. Three years later, he developed recurrent histologically confirmed pouchitis, with clinical worsening. Several therapies were tried, including Infliximab, which provided stability for six years, until the development of antibodies led to moderate pouchitis in the rectal stump. Attempts with Adalimumab, Vedolizumab, and Ustekinumab failed, leading to worsening cuffitis, pouchitis, and anastomotic stenosis. Tofacitinib was started at 10 mg/12h, leading to a >50% reduction in fecal calprotectin and a PDAI drop from 4 to 0 within four weeks. After reducing the dose to 5 mg/12h, disease control was maintained, and the patient remains asymptomatic after two years and seven months, with normal colonoscopy findings showing complete mucosal healing. Despite advances in treatment, around 15% of ulcerative colitis patients require surgery, and 30-50% of those develop acute or chronic cuffitis or pouchitis. Tofacitinib, a JAK inhibitor, is approved for ulcerative colitis but has shown inconsistent results in treating pouchitis and cuffitis. While some studies report a lack of efficacy, others show potential responses in refractory cases. More research with larger patient cohorts is needed to better understand the role of JAK inhibitors in this context.

Endoscopic fragmentation or removement of gastric bezoar is the simplest, most cost-effective approach, while the traditional endoscopic device include foreign body forceps, polypectomy snare, laser lithotripsy, and electrohydraulic lithotripsy. For bezoar < 3 cm, traditional snares are preferred. But for some giant or hard bezoars, traditional snares are too easily deformed to be used continuously and can be embedded in the bezoar causing direct damage to the stomach , Therefore, a handy and effective snare-like approach is needed, especially for elderly patients who have a high surgical risk. The lithotriptic device should be evaluated according to the size and texture of the gastroliths before lithotripsy. For some relatively hard gastroliths, which are easy to damage the endoscope, the use of transparent caps is a wise choice, which can protect the mirror body well. In this case, the bezoar was oversized (6 cm) and traditional snare was failed to capture the bezoar. Laser lithotripsy and electrohydraulic lithotripsy were lacking supplies and were not promptly available in our hospital. Therefore, we chose a yellow zebra guide wire to make this large snare for lithotripsy completely and removed with the assistance of gastric bezoar basket. The case highlights the importance of regular endoscopic instruments.

Crohn's disease (CD) is a relapsing-remitting inflammatory bowel disease (IBD) affecting the gastrointestinal tract. Its symptoms are nonspecific, with weight loss, diarrhea, and abdominal pain being classic, though their diagnostic utility is controversial (2). We evaluated the clinical-pathological association of different symptoms in CD through an analytical study of patients under 15 years of age who underwent esophagogastroduodenoscopy and ileocolonoscopy in a pediatric hospital between 2015-2022 due to suspected IBD.

Early diagnosis of abdominal actinomycosis is challenging due to its atypical presentation as an abdominal mass, which may mimic colon cancer. Initial clinical suspicion is crucial to guide treatment and prevent further complications.

Introduction: The PillCam™ patency capsule is useful in preventing capsule endoscope retention; however, visual confirmation of patency capsule excretion is challenging for many patients.

Objective: We investigated the factors related to the patency capsule remaining in the colon after 33 h and the factors hindering the visual confirmation of its excretion.

Methods: We retrospectively analyzed 498 patients with intestinal patency who underwent patency capsule examination. Patients were categorized into the "excretion group" and "colon group," depending on whether the capsule was excreted or remained in the colon after 33 h, respectively. Patients were further classified into self-confirmed and unself-confirmed groups within the excretion group. Univariate and multivariate logistic regression analyses were used to analyze the factors associated with the colon and unself-confirmed groups.

Results: Overall, 49% of patients visually confirmed capsule excretion within 33 h, whereas 51% did not and required radiological examination. Among those without capsule excretion, 34% of patients had a detectable capsule in the colon, whereas 16% had no detectable capsule. In the excretion group, 75% and 25% of patients were self-confirmed and unself-confirmed, respectively. Female sex, inpatient status, constipation, and capsule in the colon during the previous examination were the independent factors associated with the colon group. Male sex and younger age were the independent factors associated with the unself-confirmed group.

Conclusions: Our findings highlight the need for new approaches to facilitate patency capsule excretion to avoid radiation exposure, especially in females, inpatients, those with constipation, and capsule remaining in the colon on the previous examination.

We present the case of a 73-year-old male, recipient of a liver transplant a year ago, with migration of a "Be-Graft" stent used in a pre-transplant transjugular intrahepatic portosystemic shunt towards the pulmonary artery. The stent was incidentally discovered via imaging tests during hospitalization due to acute cholangitis.

Celiac disease (CD) is an autoimmune disorder triggered by gluten in genetically predisposed individuals, often diagnosed by detecting anti-tTG2 antibodies. First-degree relatives of CD patients are at high risk and require careful evaluation. We conducted a prospective study to validate CeliacDetect, a rapid immunochromatographic test that detects anti-tTG2 IgA antibodies in capillary blood within 10 minutes. Involving 95 first-degree relatives, the study showed that CeliacDetect had 100% sensitivity, specificity, positive predictive value, and negative predictive value. These results suggest CeliacDetect is a highly accurate, non-invasive screening tool for early CD detection.

Dehiscence following esophagectomy for cancer has a mortality rate of 10-40%, prolongs hospital stay, and reduces survival. To prevent it, proper patient selection and surgical techniques that minimize tension and ischemia are essential. Procedures such as ERAS protocols and the use of indocyanine green have improved the detection of well-vascularized areas, but the leak rate still exceeds 10%. In a series of 12 patients who underwent robotic esophagectomy, 45.4% received a prophylactic stent. These patients had a mean hospital stay of 16 days, compared to 53.5 days for those who experienced dehiscence. Early endoscopy and the placement of a prophylactic stent proved to be safe and effective in reducing complications.