Revista Espanola De Enfermedades Digestivas最新文献

Background: constipation is a common gastrointestinal disorder closely associated with obesity. Relative fat mass (RFM) is a newer anthropometric index that offers a more precise reflection of body fat distribution than traditional methods. Despite its advantages, the potential link between RFM and the likelihood of experiencing constipation has not been thoroughly examined. This study was therefore designed to explore the association between RFM and constipation Methods: data were obtained from the 2005-2010 cycles of the National Health and Nutrition Examination Survey (NHANES). Constipation was defined using the Bristol Stool Form Scale and questionnaire responses. Weighted multivariable logistic regression models were employed to evaluate the association between RFM and constipation. Propensity score matching (PSM) was used to balance baseline covariates between groups. Analyses were conducted both before and after PSM to test the robustness of the findings. Smooth curve fitting and threshold effect analyses were conducted to explore potential nonlinear relationships. Subgroup analyses and interaction tests were used to assess possible heterogeneity across different population strata.

Results: a total of 11,380 participants were included in the final analysis, among whom 1,206 were classified as having constipation. Logistic regression revealed that in the fully adjusted model, each one-unit increase in RFM was associated with a 2.9 % reduction in the odds of constipation (OR = 0.971, 95 % CI: 0.956-0.986, p = 0.0011). Furthermore, PSM analyses confirmed the robustness of the results. The inverse association between RFM and constipation was more pronounced among individuals aged > 45 years, those with hypertension, and those who did not consume alcohol (all p for interaction < 0.05). Smooth curve fitting and threshold effect analysis indicated a nonlinear relationship, with an inflection point at an RFM of 36.06.

Conclusion: our study suggests a significant inverse association between RFM and constipation. Further prospective studies are warranted to validate this relationship.

This is a case report of a patient with a history of liver transplant who developed interstitial pneumonitis due to immunosuppressive treatment. Everolimus-induced pneumonitis in liver transplant recipients is a rare condition. This observation aims to highlight the significance of being aware of this condition, being suspicious of it, and getting a proper diagnosis and treatment.

Introduction: self-expanding metal stents (SEMS) are widely used for the palliation of malignant esophageal conditions, including strictures, fistulas, and extrinsic compression. Placement may be guided by fluoroscopy, direct endoscopy, or both. However, few studies have directly compared the outcomes of these techniques.

Objective: to compare the safety and efficacy of SEMS placement under endoscopic versus fluoroscopic control in a real-world clinical setting.

Methods: we conducted a retrospective observational study of adult patients who underwent esophageal SEMS placement between January 2011 and December 2023. Patients were assigned to either the endoscopic control (EC) or fluoroscopic control (FC) group based on fluoroscopy availability. Outcomes included technical success, complication rates (early and late), and overall survival.

Results: a total of 103 patients were included (mean age 69.4 years; 79 % male), with 43 receiving SEMS under EC and 60 under FC. The primary indication was malignant esophageal stricture (91.3 %). Technical success was achieved in 97 % of EC cases and 100 % of FC cases. Early complications occurred in 53 % of EC and 49 % of FC patients (p = 0.70), including chest pain (40.7 %), vomiting (22.3 %), and stent migration (5.8 %). Late complications occurred in 28 % of EC and 31 % of FC cases (p = 0.74), most commonly tumor overgrowth (14.6 %) and stent migration (10.7 %). Thirty-day mortality was 2.3 % in the EC group and 0 % in the FC group (p = 0.31). Median survival was 102 days (EC) versus 113 days (FC) (p = 0.44).

Conclusions: SEMS placement under both endoscopic and fluoroscopic control is safe and effective, with no significant differences in complication rates, technical success, or survival. Endoscopic guidance may be a viable alternative to fluoroscopy in experienced hands, particularly in resource-limited settings.

Introduction: cannulation of the papilla of Vater is a critical step in endoscopic retrograde cholangiopancreatography (ERCP), with direct implications for procedural success and the risk of adverse events. Although endoscopist experience and anatomical variations are known contributors, the role of papillary morphology remains insufficiently explored in Latin America. This study aimed to assess the association between papilla type and cannulation difficulty or complications.

Materials and methods: adults with a native major papilla undergoing ERCP at a tertiary center in Bogotá were prospectively enrolled. Papillary morphology was classified macroscopically, and difficult cannulation was defined according to the European Society of Gastrointestinal Endoscopy (ESGE) criteria. Associations were analyzed using Fisher's exact test and odds ratios with 95 % confidence intervals. Fifty-eight patients (mean age 59.9 years, 63.8 % female) were included.

Results: the most common papilla was type 1 (63.8 %), followed by type 3 (27.6 %). Difficult cannulation occurred in 13.8 % of procedures, mostly involving type 1, type 3, and the single type 4 case. Advanced cannulation techniques were required in 34.5 % of cases and were associated with longer procedural times. Prophylactic measures were used in 60.3 % of patients. Overall, 6.9 % developed post-ERCP pancreatitis and 3.4 % cholangitis. No significant association was found between papilla type and complication rate.

Conclusion: our findings suggest that type 1 and type 3 papillae are more frequently associated with cannulation difficulty, although complication rates did not differ significantly by morphology. Recognizing papilla morphology may enhance preprocedural planning and training strategies in advanced endoscopy units.

Acute acalculous cholecystitis (AAC) of infectious origin represents a small percentage of all cases of cholecystitis. According to the literature, the most common pathogens include Salmonella typhii and Epstein-Barr virus (EBV). However, AAC has also been described as a rare complication in the context of other viral hepatitis infections, with only a few reported cases attributed to hepatitis A virus (HAV) infection. We present the case of a patient with AAC secondary to HAV infection, which resolved favorably with conservative management. We report the case of a 29-year-old male presenting with jaundice, abdominal pain, and fever lasting three days. Laboratory results revealed elevated transaminase levels with a cholestatic pattern and hyperbilirubinemia, predominantly direct bilirubin. Abdominal ultrasound showed a gallbladder with a thickened, heterogeneous, poorly defined, and disorganized wall, along with multiple enlarged perihilar lymph nodes and a positive Murphy's sign. Serological testing for hepatopathy revealed positive IgM antibodies for HAV, confirming the diagnosis of hepatitis A. Seven days later, follow-up testing demonstrated normalization of both laboratory parameters and ultrasound findings following resolution of the viral illness.

Graft-versus-host disease (GVHD) is a significant complication of allogeneic hematopoietic cell transplantation, an immune response against the host's tissues, resulting in inflammation and intestinal damage. GVHD is one of the leading causes of morbidity and mortality in this group of people, with an incidence of approximately 29.9% to 36% in acute grade II-IV gastrointestinal cases. Thus, the following is a report of a GVHD case where radiological findings were essential for diagnosis and treatment.

Cystic pancreatic lesions (CPL) represent a growing challenge in gastroenterology, as their detection becomes more prevalent, and their management is increasingly complex. While many CPLs are benign and require only observation, others carry a significant risk of malignant transformation. The key to effective management relies in an accurate risk stratification, which can guide decisions regarding surveillance and treatment. As we move towards more personalized, patient-centered approaches, it is crucial to balance the benefits of early detection and intervention with the risks of overtreatment and the psychological burden on patients. Advances in molecular diagnostics and imaging, combined with improved patient education and shared decision-making, will be essential in shaping the future of CPLs management. The goal is not only to improve patient outcomes but also to ensure that care is compassionate, cost-effective, and aligned with individual patient needs.

Hepatocellular carcinoma (HCC) treatment increasingly involves liver transplantation (LT), often after downstaging therapies. Atezolizumab, a PD-L1 inhibitor, combined with bevacizumab, an anti-VEGF agent, is widely used, showing high response rates pre-transplant. However, bevacizumab impairs angiogenesis and can significantly increase the risk of wound dehiscence, infection, and delayed healing after major surgery, including LT.

Brunner's gland hyperplasia or Brunneroma is a rare benign proliferative lesion of the small intestine. It is often incidentally discovered during endoscopy or imaging studies. The endoscopic presentation can be nodular, polypoid, or a diffuse glandular proliferation with thickening of the duodenal wall, which can be mistaken for malignant neoplasia. It rarely causes gastrointestinal bleeding. Is presented a case of a 25-year-old man who presented with melena and anemia secondary to Brunner's gland hyperplasia.

A 71-year-old male patient with a history of bladder neoplasia underwent Bricker-type surgery, during which an iatrogenic rectal injury occurred. During surgery, an unsuccessful suture attempt was made, leading to the appearance of fecaluria after 48 hours. A computed tomography scan revealed a small continuity defect in the rectal wall, accompanied by a 25-mm adjacent collection. Percutaneous drainage was placed in an attempt to achieve spontaneous closure, but this was unsuccessful. A rectoscopy was performed, identifying a wall defect in the mid-rectum. A review with a paediatric gastroscope confirmed communication to a cavity drained by urethra (recto-urethral fistula). Endoscopic vacuum therapy (EVT) (Endo-SPONGE®, B.Braun; Melsungen, Hesse, Germany) was initiated, achieving negative pressures (KCI Acelity V.A.C.® ATS® Negative Pressure Wound Therapy Unit; -100 mmHg). An endoscopic review after 72 hours confirmed the appearance of granulation tissue and the initiation of cavity closure. After three replacements (a total of four sponges), cavity collapse was achieved, but complete closure of the orifice was not attained. An over-the-scope clip (OTSC® 11.5-14 mm type-t, Ovesco; Tübingen, Baden-Wurttemberg, Germany) was placed, but fecaluria persisted, albeit with lesser intensity. Ultimately, successful closure was achieved by placing a second over-the-scope clip, two conventional hemoclips (Novaclip-R3 16 mm, Vytil; Hangzhou, Zhejiang, China), and instilling endoscopic biodegradable cyanoacrylate adhesive (Glubran® 2, GEM; Viareggio, Lucca, Italy).