Revista Espanola De Enfermedades Digestivas最新文献

Objectives: The objective of this review is to identify key clinical lessons and highlight diagnostic and therapeutic strategies derived from case reports and recent literature. Particular attention is given to recognising overlapping presentations, optimising multimodal imaging and endoscopic evaluation, and promoting multidisciplinary collaboration between gastroenterologists, gynaecologists, radiologists, and pathologists to enhance diagnostic accuracy and guide patient-centred management.

Methods: A case series was conducted at Hospital Universitari Germans Trias i Pujol (2019-2024), including patients with confirmed inflammatory bowel disease and histologically or radiologically verified endometriosis. A literature review was performed using PubMed and Scopus databases (1990-2024) with search terms: "endometriosis," "inflammatory bowel disease," "Crohn's disease," "ulcerative colitis," "diagnosis," and "multidisciplinary management.

Case presentation: Case one involved a 35-year-old pregnant woman with Crohn's disease presenting acute abdominal pain initially considered as appendiceal plastron; endometriosis was subsequently confirmed postpartum following laparoscopic appendectomy. Case two concerned a 68-year-old woman with Crohn's disease and rectovesical fistula complications, where histopathological analysis of resected sigmoid tissue revealed concurrent deep infiltrating endometriosis. Case three presented a 36-year-old woman with ileal Crohn's disease experiencing persistent pelvic pain initially misattributed to inflammatory bowel pathology before definitive endometriosis diagnosis. Case four involved a 43-year-old woman with Crohn's disease and axial spondylitis, whose chronic pelvic symptoms were ultimately attributed to deep infiltrating endometriosis.

Conclusions: The coexistence of endometriosis and IBD presents significant diagnostic and therapeutic challenges requiring multidisciplinary evaluation. Early recognition and targeted imaging strategies are fundamental for preventing delayed diagnoses and optimising patient outcomes.

Introduction: Joint extraintestinal manifestations (EIMs) are a frequent complication in patients with inflammatory bowel disease (IBD). The effectiveness of vedolizumab in this context remains uncertain, with conflicting results reported. Some studies have even suggested a potential worsening of joint manifestations during treatment.

Methods: We conducted a meta-analysis of observational studies reporting joint EIM outcomes in patients with Crohn's disease or ulcerative colitis treated with vedolizumab. New-onset and worsening of existing joint manifestations were analysed separately from improvement or clinical response. A systematic search was performed in EMBASE, PubMed, and MEDLINE in June 2023, with the final search conducted on 15 June 2023. Grey literature, including preprints and conference abstracts, was excluded. The primary outcomes were the pooled incidence of joint EIMs and the rate of clinical response.

Results: Twelve studies including a total of 7,296 patients met the inclusion criteria. The pooled was 8.7% (95% CI, 4.3-13%) for incidence of joint EIMs was and 31.9% for worsening. The pooled clinical response rate was 35% (95% CI, 22-48%), with a response rate of 32% for arthritis/arthralgia and 23% for spondyloarthritis. All analyses demonstrated high heterogeneity.

Conclusions: Vedolizumab treatment appears to be associated with a relatively low incidence of new or worsening joint EIMs. However, its effectiveness in improving joint manifestations is limited.

Polycystic kidney diseases are linked to a myriad of hepatobiliary diseases. Patients with such diseases have a higher risk of admission. Clinical manifestations and complementary testing differ from healthy controls leading to suboptimal care. This review focuses on the different hepatobiliary diseases linked to polycystic kidney diseases, their diagnosis, clinical manifestations and management.

Background and aim of the study: Thiopurines are cornerstone immunosuppressants for maintenance therapy in inflammatory bowel disease, but their use is limited by potentially serious adverse events. The aim of this study is to characterize severe adverse events associated with thiopurine therapy in a cohort of inflammatory bowel disease patients treated at a tertiary care center.

Methods: A retrospective observational study was conducted including adult inflammatory bowel disease patients who developed clinically significant adverse events while on thiopurine therapy. Demographic, disease-related, treatment, and outcome variables were collected. Quantitative variables were expressed as means and standard deviations; categorical variables as percentages with 95% confidence intervals. Statistical significance was defined as p < 0.05.

Main results: Among 722 inflammatory bowel disease patients treated with thiopurines, 81 (11.2%) experienced at least one severe adverse event. Of these, 24 (30%) required hospitalization, and 2 deaths (2.5%) were attributed to thiopurine-associated malignancies. The most frequent adverse events were acute pancreatitis in 31 patients (38.3%), myelotoxicity in 19 (23.4%), malignancies in 13 (16.0%), and hepatotoxicity in 6 (7.4%). Infections and fever of unknown origin were less common, with 3 cases each (3.7%). No statistically significant associations were observed between adverse events occurrence and sex (p = 0.36), IBD subtype (p = 0.21), or thiopurine type (azathioprine vs. 6-mercaptopurine; p = 0.09).

Conclusions: Thiopurine therapy in inflammatory bowel disease is associated with a notable incidence of severe adverse events, particularly acute pancreatitis and myelotoxicity. No consistent demographic or clinical predictors of toxicity were identified, highlighting the importance of universal monitoring strategies during thiopurine treatment.

Background and aims: Prospective data on non-cirrhotic hepatocellular carcinoma (NC-HCC) are scarce, mainly in Western countries. Characteristics, evolution, prognostic factors and outcomes were analyzed.

Method: One hundred and forty-one NC-HCC diagnosed by histology were included in a Spanish multicenter prospective registry (2018-2023) involving 23 centers. Liver cirrhosis was excluded by histology, transient elastography or level 2 Mittal criteria.

Results: Underlying chronic liver disease was present in 77% of patients, mainly MASLD/MetALD and viral. Using the aMAP risk score less than 10% of patients were classified in the low-risk group. Fibrosis stage was 0-1 in 53%. A single nodule was detected in 75%. The BCLC stage was 0 in 6.5%, A in 63.8%, B in 17.7%, C in 11.3% and D in 0.7%. Initial treatment was surgical resection in 63.9%, ablation in 4.2%, TACE/TARE in 13.5%, systemic therapy in 14.9%, and symptomatic treatment in 3.5%. Median follow-up was 34.1 (IQR: 15.5-49.5) months. Median overall survival was 47.9 months (95% CI: not assessable), and global 1-, 3- and 5-year survival rate were 85%, 62.4% and 49.1%, respectively. AFP level (<20/≥20ng/ml) [HR: 2.63 (1.3-5.3), p=0.007] was an independent predictor of survival. In surgically treated patients, the 5-year recurrence rate and 5-year survival rate were 55.1% and 59.1%, respectively. Active lifestyle (HR 0.27 [95% CI: 0.09-0.8]) and microvascular invasion and/or satellite nodules (HR 3.03 [95% CI: 1.18-7.75]) were independent predictors of mortality.

Conclusions: Despite the lack of routine screening, most patients with NC-HCC were diagnosed at early stages and treated with surgery. The main underlying etiology was MASLD/MetALD and a sedentary lifestyle was associated with mortality, so interventions to improve this aspect are essential.

Objective: This study aims to assess the therapeutic advantages of PD-1 and PD-L1 inhibitors for gastric cancer (GC) patients and determine which of the two agents confers greater benefits.

Methods: A total of 17 randomized controlled trials (RCTs) were included. The primary outcomes included pathological complete response(pCR), objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and ≥grade 3 treat-related adverse events (TRAEs). Direct meta-analysis and network meta-analysis (NMA) were used to assess the efficacy and safety of PD-1/PD-L1 inhibitors in locally advanced and advanced GC patients.

Results: For locally advanced GC, the direct results indicated that PD-1/PD-L1 inhibitors improved patients' pCR [ORPD-1=5.43 (3.25,9.05) and ORPD-L1=2.60 (1.86,3.65)]. Additionally, the NMA found that PD-1 inhibitors achieved a higher pCR than PD-L1 [OR=2.17 (1.12, 3.93)]. In advanced GC, direct results revealed that PD-1/PD-L1 inhibitors improved ORR [OR=1.48 (1.33, 1.65)] and reduced the risk of death [HR = 0.79 (0.74, 0.83)] and disease recurrence [HR = 0.75 (0.70, 0.80)] in first-line therapy. However, this study not found PD-1/PD-L1 improved the ORR, TRAE, PFS and OS in the later-line therapy. Subsequently, an exploring NMA on specific treatment regimens in first-line therapy for advanced GC was conducted, the results revealed Nivolumab plus chemotherapy enhanced the ORR while having the lowest TRAE, whereas Sintilimab plus chemotherapy provided the greatest benefit in PFS and OS.

Conclusion: The study suggested that PD-1/PD-L1 enhanced anti-tumor efficacy in neoadjuvant therapy and first-line of advanced GC, whereas no benefit was observed in the later-line treatment. And the efficacy of PD-1 was superior to PD-L1 in neoadjuvant treatment.

Introduction: Endoscopic treatment improves the outcomes of patients with acute peptic ulcer bleeding (APUB). Epinephrine injection is a frequently used treatment. There is no consensus, however, on the optimal volume of epinephrine injection. Primary aim was to compare the efficacy and safety of endoscopic injection using different volumes of epinephrine for APUB treatment in a systematic review and meta-analysis.

Methods: Systematic searches were performed for full papers published from 1986 until January 2025 in multiple databases. We included randomized controlled trials (RCT) comparing different epinephrine volumes injection. Primary outcome was permanent haemostasis defined as achieved initial haemostasis and not rebleeding during admission. Secondary outcomes were adverse events, need for rescue treatment and mortality. We estimated the OR and 95%CI using random-effects models.

Results: Four RCT including 556 patients were analyzed. No studies comparing different doses of epinephrine in combination therapy were found. In studies comparing different doses of epinephrine alone, permanent haemostasis was more frequently achieved in the large-volume injection groups (91% vs 77%, OR:2.90; 95%CI:1.72-4.86, p<0.0001). Adverse events (AE) were also more frequent in the large-volume groups (33% vs 3%, OR: 21.02; 95%CI:6.51-67.87, p<00001). Abdominal pain was the most frequent AE. Bowel perforation appeared only when injection volumes exceeded 35 cc.

Conclusion: Endoscopic injection of large volumes of epinephrine up to 30cc appear safe and improve rates of permanent haemostasis when compared to lower injection volume in patients with APUB. Trials assessing the use of larger epinephrine volume in combination endoscopic hemostatic therapy are needed.

Lymphocytic esophagitis is a little-known entity whose cause is not fully established, and which basically presents with dysphagia. It is characterized by the presence of an infiltrate mainly formed by lymphocytes and other signs of epithelial damage in the absence of other granulocytes. The lack of knowledge about this pathology as well as standardized diagnostic criteria complicates its diagnosis. We present the case of an 84-year-old male with dysphagia and pathological findings compatible with lymphocytic esophagitis, requiring several lines of treatment and even endoscopic dilation with subsequent clinical improvement.

A 38-year-old man came to our outpatient department with abdominal pain. The computed tomography (CT) scan shows no obvious abnormalities. The colonoscopy showed a submucosal eminence about 0.6cm in diameter in ascending colon, with a yellow surface color and moderate motion. Subsequently, we performed endoscopic mucosal dissection (ESD) surgery on the patient. The postoperative pathology revealed a submucosal granular cell tumor (GCT) of the ascending colon with a diameter of about 4mm. The immunohistochemistry suggestsed CD117 (-), Desmin (mucosal muscle +), S-100 (+++), CD68 (++), SOX-10 (++), Syn (+), CgA (-) , and Ki-67 (approximately 5%+).

A 54-year-old woman was admitted to the hospital due to unexplained weight loss Physical examination revealed a significant abdominal mass. CT scanning revealed a large mixed-density mass in the abdomen closely associated with the liver.