Revista Espanola De Enfermedades Digestivas最新文献

Background: anti-TNF drugs have revolutionized the treatment of Crohn's disease (CD) and have set new therapeutic targets. A direct correlation between anti-TNF trough levels and endoscopic healing in inflammatory bowel disease (IBD) patients has been established, but the association between drug levels and transmural healing assessed by ultrasound is not yet clearly defined.

Aims: to evaluate the correlation between the serum concentration of adalimumab (ADA) and sonographic transmural healing in CD patients at different times during follow-up.

Methods: in this retrospective, cross-sectional study, all patients with CD who were undergoing treatment with ADA in our center were included. Intestinal ultrasound (IUS) was performed before the initiation of the drug and for response monitoring. ADA serum-trough levels were compared between patients with and without transmural healing at different periods of time.

Results: ninety-two patients were included, and all patients showed signs of inflammatory activity in the baseline IUS. During IUS monitoring of the response to ADA, 34 (34.8 %) patients presented transmural healing. Among patients in the first year of treatment, those with sonographic healing showed higher median levels than patients without transmural healing (12.0 µg/ml vs 9.3 µg/ml, respectively; p = 0.007). There was no correlation between ADA levels and sonographic healing in patients undergoing treatment for over a year.

Conclusions: higher ADA trough levels correlated with transmural healing with ultrasound during the first year of treatment. This correlation was not found after one year of treatment.

We report a case of fatal HBV reactivation in a patient with chronic hepatitis B infection HBeAg-, who was withdrawn from antiviral therapy.. We think that it may be a warning of risks that this clinical decision may entail.

Ustekinumab (UST) is a human IgG1 monoclonal antibody that targets to the share p40 subunit of interleukin-12(IL-12) and IL-23. Evidence has shown that UST therapy is well tolerated and effective in inducing clinical response in refractory CD(Crohn's disease) and dose escalation is effective in recapturing response in over half of the patients. However, no predictive factor has been reported to be helpful for UST treatment in clinical practice. Additionally, there were few reports about therapeutic drug monitoring (TDM) of UST administration in China due to its late launch time in Chinese market and lack of experience in clinical use. Herein, we establish and validate the first UST-trough concentrations (TCs) -related nomogram in China for predicting endoscopic remission in refractory CD to facilitate clinical decision making.

A 55-year-old male swallowed fish bone accidentally and subsequently developed retrosternal pain. He underwent chest computed tomography at his local hospital on October 23, 2023, showing esophageal foreign body with suspected esophageal rupture. One day later, he underwent endoscopy at our department, showing a fish bone penetrated into the esophageal wall. After consultation with cardiothoracic surgeons, endoscopy-guided removal of this foreign body was performed under anesthesia. An esophageal ulcer with a length of 2cm was left with overflowing air bubbles, and was closed by three metal clips. Two days later, retrosternal pain disappeared. A tube was intubated to duodenal distal segment under endoscopy, via which enteral nutritional suspension was given. Then, he was discharged.

Introduction: the early diagnosis of achalasia requires a high degree of clinical suspicion, and delays in diagnosis are frequent. High-resolution esophageal manometry (HRM) is the gold standard for its diagnostic confirmation. There are two HRM systems, perfusion and solid-state, which allow its classification into three subtypes: I, or classical; II, or with pan-esophageal pressurization; and III, or spastic.

Objective: to determine the clinical and manometric characteristics of the three subtypes with high-resolution perfusion and solid-state equipment and the time of evolution until diagnosis.

Methods: this was a multicenter, observational, retrospective study of patients from the INTEGRA database of the Spanish Association of Neurogastroenterology and Motility who were diagnosed with primary achalasia confirmed by HRM, who fell under the Chicago Classification v3.0, and who had not been treated.

Results: the study included 110 patients (subtype I, n = 14; subtype II, n = 73; subtype III, n = 23). The HRM equipment was perfusion for 49 and solid-state for 61. The mean age was 61.8 ± 14 years (age range 44-81), the age was lower in subtype II, and sex distribution was similar. The time of clinical evolution until diagnosis was > 12 months (51.6 %), subtype II being the one that was diagnosed earlier and the most often (66.3 %). Dysphagia was the most frequent symptom (90.5 %). According to the comparative analysis by high-resolution perfusion and solid-state esophageal manometry equipment, the baseline pressure of the lower esophageal sphincter was higher in the solid-state esophagus, but the difference was not statistically significant. The median integrated relaxation pressure at four seconds (IRP4) was similar (21 mmHg) between the perfusion and solid-state measurements. We describe the ranges of IRP4 in achalasia patients with both systems and confirm the possibility of achalasia even when IRP4 is within the normal range.

Conclusions: achalasia in our environment has a significant diagnostic delay. No significant differences were observed in the esophagogastric junction between the two groups diagnosed with perfusion and solid-state equipment.

Although most esophagus subepithelial tumors are benign, the possibility of malignancy cannot be completely ruled out and it can gradually increase, leading to symptoms such as dysphagia, so removal is still recommended. The narrow cavity and thin walls of the upper esophagus, as well as movement caused by breathing and heartbeat, makes it difficult to perform operation by endoscopy or surgery. Cold snare pulpectomy may been used to remove subepithelial tumors of the upper third of the esophagus due to a low risk of adverse events and short procedure time.

A 65-year-old woman was diagnosed with an exogenous submucosal tumor located in the fornix of the stomach, on the basis of the endoscopic ultrasound and enhanced CT findings. She refused surgery and referred for EFTR. It is difficult to perform EFTR at the gastric fornix and suture the large surgical defect. Therefore, we created technique of triangular pulley traction combined with pre-closure.

Gastrointestinal fistulas can be a complication of severe acute pancreatitis, and their incidence is low and sporadically reported in the literature. The most frequently reported site is in the colon, followed by duodenal fistulas. Psoas abscess is a rare condition. Iliopsoas abscesses are classified as primary or secondary. Secondary abscesses develop by spreading infection from contiguous anatomical structures, such as the gastrointestinal tract. We present the case of a recurrent left psoas abscess secondary to a duodenal fistula as a late complication of necrotizing pancreatitis resolved by endoscopic treatment.

Symptomatic splenic cyst is usually managed by surgical resection or ultrasound-guided percutaneous sclerotherapy. In the present case, we demonstrated the safety and feasibility of endoscopic ultrasound-guided sclerotherapy for treatment of splenic cyst. As far as we known. This is the first case report concerning EUS-guided sclerotherapy for splenic cyst.

Endoscopic retrograde cholangio-pancreatography (ERCP) is a diagnostic, therapeutic technique for the management of pancreato-biliary conditions. Technical contraindications include the presence of intraluminal foreign bodies precluding endoscope passage. Intragastric balloon (IGB) is a bariatric procedure that provides sensations of early fullness and satiety from intragastric occupation, thus leading to weight loss. While, according to guidelines, choledocholithiasis and cholangitis do not represent an indication for IGB removal in contrast to moderate-severe pancreatitis, where need for an ERCP and the procedure's technical difficulty most commonly require it. We report the case of a female patient with an IGB where ERCP was indicated. CASE REPORT: A 47-year-old woman visited the emergency room for epigastric abdominal pain radiating to her back. She had jaundice without pyrexic symptoms. At the ER an ultrasonogram revealed cholelithiasis and a dilated common bile duct (11 mm in diameter), no cause being then identified. Lab tests rule out pancreatic involvement and associated infection. The patient had an IGB (Photo 1a) implanted 5 months before the present episode. She was admitted to the gastroenterology ward with choledocholithiasis as suspected diagnosis. The study was completed by endoscopic ultrasound (EUS), which confirmed a dilated hepatocholedochal duct at 15.3 mm in diameter (Photo 1b), secondary to multiple choledochal stones. A direct ERCP procedure was initiated where the IGB precluded rectification and proper placement, which forced the use of a double-guidewire technique for cannulation (Photo 1c)5. Sphincterotomy and sphincteroplasty to 10 mm ensued, and 8 stones were removed using a balloon and then a basket catheter (Photo 1d). The patient was discharged at 24 hours after the procedure with no complications. DISCUSSION: No prior studies are available that describe the possibility of therapeutic ERCP for choledocholithiasis in IGB-carrying patients; in most cases IGB removal is taken for granted because of the procedure's technical difficulty. Our case report may well show a safe alternative to IGB removal by using less conventional cannulation techniques without higher complication rates. However, further cases are needed in order to draw significant conclusions regarding their widespread use.