Revista Espanola De Enfermedades Digestivas最新文献

Introduction: chronic hepatitis caused by the hepatitis delta virus is the most severe form of viral hepatitis and carries the greatest risk of complications. The real prevalence of this infection remains unknown.

Objectives: this study sought to determine the prevalence of both the antibodies and the active infection rates of hepatitis delta in the Autonomous Region of Galicia, Spain.

Materials and methods: a prospective study was conducted including all patients carrying the hepatitis B surface antigen who attended any hospital within the Galician Health Service between 2023 and 2024. These patients underwent serum testing for antibodies against the hepatitis delta virus (LIAISON® XL MUREX Anti-HDV Assay; Diasorin Saluggia, Italia); the viral load was then assessed in those that tested positive (Hepatitis Delta Real Time PCR Kit; Vircell, Granada, Spain). The samples with a positive viral load were subsequently genotyped.

Results: a total of 1,962 patients were included, 85 of whom had anti-HDV antibodies, and 20 of these (23.5 %) had a detectable viral load. The prevalence obtained was 4.3 % in carriers of the hepatitis B virus surface antigen, and 0.03 per 1,000 inhabitants. The most common genotype found in active infections was 1D.

Conclusions: the seroprevalence obtained in this study confirmed the low circulation of the hepatitis delta virus in our region. However, a significant proportion of affected patients have an active infection, and early diagnosis is essential to prevent disease progression and the development of complications. As expected, most of our patients are infected with strains of genotype 1D, which is predominant worldwide, including Europe. However, we also found three strains of genotype 5 in patients from West Africa.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for type 2 diabetes mellitus (T2DM) and weight management. These medications mimic the effects of the intestinal hormone GLP-1, thereby enhancing insulin secretion, reducing glucagon release, inducing satiety, and slowing gastric emptying. Their therapeutic scope now extends to cardiometabolic conditions and metabolic-associated steatotic liver disease (MASLD). Despite their clinical utility, GLP-1 RAs are frequently associated with gastrointestinal adverse effects-including nausea, vomiting, and diarrhoea-reported in up to 80% of patients, often in a dose-dependent manner. Concerns have also emerged regarding a potential association with acute pancreatitis.

We present the clinical case of a 39-year-old woman with a medical history of juvenile idiopathic arthritis and uveitis, evaluated for abdominal pain and distension, difficulty gaining weight, and diarrhea. Blood tests were requested, including antibodies which were negative and common genetic markers, showing positivity for HLA DQ 7.5. A gastroscopy with duodenal biopsies revealed findings consistent with stage 3b of the modified Marsh classification. Due to diagnostic uncertainty, an IEL study was performed, showing a characteristic CD pattern, leading to the initiation of a strict gluten-free diet (GFD). During follow-up, the patient showed partial improvement, with persistent digestive symptoms. A repeat endoscopic study revealed persistent atrophy, but refractory disease type 2 was ruled out. During a flare of rheumatologic disease, Tocilizumab was initiated by Rheumatology, resulting in improvement of duodenal atrophy.

A 52-year-old male was diagnosed with primary liver cancer in June 2021 after experiencing abdominal pain and bloating. He had previously undergone resection for a Merkel cell tumor in March 2021, with no metastasis found. Three months later, imaging suggested a liver mass consistent with liver cancer. Lab tests showed elevated hepatitis B surface antigen (>130 IU/ml) and alpha-fetoprotein (24.54 IU/ml), and the imaging features resembled hepatocellular carcinoma (HCC).Finally,it was diagnosed as liver metastasis of Merkel cell carcinoma by pathology.

Schistosoma japonicum, which has been endemic for a long time, associated colon abnormality has also been sporadically reported. The majority of patients with Schistosomiasis japonicum infected may mainly presented as acute manifestation or become chronic complication, known as schistosomiasis liver change, intestinal tract lesions and other system involved. Interestingly, both states could be observed in this patient. Acute infection presented as systemic hypersensitivity reaction, characterized by elevated eosinophils and intestinal symptom.

We present the Clinical Trial results of the first Spanish intragastric balloon manufactured: the Stella® balloon (SwanMedical, Barcelona). As a peculiarity, it has a double lumen in the introducer system. The first one is intended for the passage of a guidewire to insert the balloon quickly and safely, which also requires prior gastroscopy. The second lumen allows for regular filling. Therefore, Stella® accepts all current IGB indications, adding specific applicability for endoscopists in training and for some pharyngo-oesophageal anatomical alterations that could make the placement of another IGB model difficult or impossible. In conclusion, preliminary results suggest that Stella® could have efficacy and safety values comparable to those of the leading currently approved intragastric balloons. Final certification and market release of the device is expected by the end of 2024.

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.

Introduction: incidental cystic pancreatic lesions are increasingly detected in the aging population, with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) being the most common. This study aimed to evaluate the benefits of implementing a surveillance program in patients diagnosed with presumed BD-IPMN at the age of 75 years or older.

Methods: a retrospective analysis was conducted using a prospective registry of patients diagnosed incidentally with presumed BD-IPMN at ≥ 75 years of age. Patients were categorized into two groups: group A, who underwent clinical and imaging follow-up, and group B, with no surveillance. Clinical records were reviewed to assess pancreatic cancer incidence, overall survival, and mortality.

Results: among 434 patients with BD-IPMN, 93 met inclusion criteria (42 in group A; 51 in group B). The mean age was 77 years in group A and 79.2 years in group B (p = 0.016). The mean cyst size was 15.6 mm in group A and 14.6 mm in group B (p = 0.56). No cases of pancreatic cancer were identified in group A, while one case occurred in group B (p = 1.0). Five patients died in each group (p = 1.0). Overall survival was comparable between groups (HR 0.8; 95 % CI: 0.22-2.94; p = 0.74).

Conclusions: presumed incidental BD-IPMNs diagnosed at ≥ 75 years of age rarely progress to pancreatic cancer. In patients with cysts < 2 cm and without high-risk features, surveillance does not appear to confer a survival benefit and may therefore be unnecessary.

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.

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.