Revista Espanola De Enfermedades Digestivas最新文献

The indication for liver transplantation in liver metastases from neuroendocrine tumors is to improve overall survival and disease-free survival in these patients. The selection criteria for candidates are strict, and although few patients can benefit, it should be offered in indicated cases and patients should be referred to centers with experience in transplantation and in this type of tumor.

Intestinal pneumatosis is a relatively rare condition, and its association with the use of cetuximab, a monoclonal antibody used in the treatment of certain types of cancer, is even less common. Documenting rare cases is important for expanding clinical knowledge and providing references for future similar cases. Publishing this case may alert clinicians to this potential complication, improving early detection and appropriate management of the condition.

Inflammatory fibroid polyps (IPF), also called Vanek tumors, are rare, benign lesions of mesenchymal origin. They can affect both sexes with a majority incidence between 50-70 years. We present the case of a 53-year-old woman with an outpatient clinic due to severe iron deficiency anemia, gastroscopy and colonoscopy without relevant findings. A study with capsule endoscopy identify an ulcerated polypoid mass, which caused a slight stenosis of the lumen, allowing the passage of the capsule endoscopy compatible with Vanek's tumor.

Introduction and aim: although generative language models have been extensively studied in the field of digestive diseases, further progress requires addressing underexplored aspects such as linguistic bias, the evaluation of clinical reasoning underlying model responses, and the use of realistic clinical material in non-English-speaking contexts. The aim of this study was to evaluate the accuracy of GPT-4o to answer clinical questions in Spanish and to qualitatively analyze its errors.

Methods: we used the most recent official board examination for specialist in Gastroenterology (Spain, 2023), focusing on its practical section, which includes 18 real clinical cases described through text and images, totaling 50 multiple-choice questions (200 options in total). Forty-nine valid questions were analyzed, excluding one withdrawn by the organizing committee. GPT-4o answered 39 questions correctly (79.6 %). No significant differences were observed between questions with clinical images (22/29 correct) and those without images (17/20 correct).

Results: twenty percent of the answers were incorrect. In those cases, the model was prompted to provide its reasoning, which was then qualitatively analyzed by a team of experts. Errors were associated with inappropriate therapeutic generalizations, confusion regarding diagnostic or therapeutic sequencing, poor integration of contextual information, unawareness of contraindications, and omission of key temporal criteria in clinical decision-making.

Conclusions: clinical images did not increase the error rate; however, the observed failures revealed that the model tends to omit information already provided (such as clinical context or temporal criteria), thereby compromising the quality of its reasoning.

Pneumatosis intestinalis is a rare disorder that can be secondary to a variety of causes among which includes oncological treatment. Most cases due to oncological treatment are reported with targeted therapy but there is growing number of cases secondary to tyrosin kinase inhibitors that includes Lenvatinib which it can be used in the treatment of hepatocarcinoma.

This paper reported a rare case of achalasia patient postoperatively experiencing a series of neurologic symptoms, diagnosed as severe B vitamin deficiencies caused by central and peripheral damage.

A 64-year-old man was admitted to the hospital due to "recurrent abdominal pain for 8 months" and had a history of multiple episodes of pancreatitis. CT scan showed an enlarged pancreas with no normal pancreatic tissue . Contrast enhancement scan in the arterial phase displayed moderate enhancement in the solid portion, while the cystic necrosis area showed no enhancement. It was suspected to be pancreatic cancer, and laparoscopic exploration of the pancreas followed by partial pancreatectomy was performed. Finally, it was confirmed as pancreatic squamous cell carcinoma by immunohistochemistry (P63 (+), CK5/6 (+)). Seven days after the operation, F18-FDG PET/CT showed multiple soft tissue density masses in the upper abdominal wall along the laparoscopic trajectory with increased uptake.

Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by malformed and dilated intestinal lymphatic vessels, resulting in impaired drainage and leakage of lymph fluid into the gastrointestinal lumen. This leads to protein-losing enteropathy, causing chronic diarrhea, peripheral edema, weight loss, and hypoalbuminemia due to loss of proteins, lymphocytes, and lipids. Diagnosis relies on endoscopic visualization of pathognomonic white mucosal plaques (representing dilated lymphatics) and histopathological confirmation of lymphatic dilation, after excluding secondary causes like malignancy, surgery, or inflammatory conditions.

Hepatic myelopathy (HM) is a serious and debilitating complication associated with chronic liver disease. Currently, there is no definitive treatment; however, it is widely accepted that early liver transplantation and stent-restricted surgery may alleviate HM to some extent. We report a case of an adult male with a history of hepatitis B cirrhosis who developed a complex spontaneous shunt following portal vein occlusion, which resulted in recurrent hepatic encephalopathy and was later complicated by HM. We successfully relieved HM in this patient through embolization of the inferior mesenteric venous shunt and a portion of the splenic artery. This approach may offer a feasible alternative in selected patients not eligible for liver transplantation.

Background: Oral health has a well-established impact on physical and psychological aspects of quality of life. However, evidence on oral health-related quality of life (OHRQoL) in patients with cirrhosis remains limited, and whether differences in country-level socioeconomic context influence patients' perceptions has not yet been investigated.

Objective: The aim of this cross-sectional study was to analyse the impact of OHRQoL and country-level socioeconomic context on patients with cirrhosis.

Methods: This cross-sectional, matched case-control study included 454 patients from Brazil (n=386) and Spain (n=68), comprising patients with cirrhosis (study group-SG) and controls without cirrhosis (CG). Data collection included medical history, clinical oral examination, the decayed, missing and filled teeth (DMFT) index, simplified oral hygiene index (SOHI), gingival index (GI), periodontal status, and the Oral Health Impact Profile-14 (OHIP-14).

Results: SG patients showed unsatisfactory SOHI (65.20%), gingivitis (75.33%) and periodontal disease (53.37%). Brazilian patients had a higher DMFT (18±6.32) compared to Spanish ones (10.2±8.86) (P<0.001) as well as a higher OHIP-14 score (p=0.006). SG patients scored higher than the controls in all domains of OHIP-14 (P<0.001), except for physical pain. Psychological discomfort (1.046±1.277) and psychological disability (0.863±1.112) were the domains most impacting the patients.

Conclusions: Patients with cirrhosis reported poorer OHRQoL than matched controls, with a predominantly psychological pattern of impact. Differences between countries suggest that broader contextual factors may shape how oral health problems are perceived and reported. These findings support greater awareness, routine screening, and integration of oral health assessments into multidisciplinary care.