Revista Espanola De Enfermedades Digestivas最新文献

Crohn's disease is a chronic inflammatory disorder which involves mainly the gut. It poses a continuous challenge for health care due to the lack of effective medical therapies. Given the situation of this refractory disease, surgery is indicated. However, the optimal moment to perform it stills unknown. Data from 38 patients who underwent elective ileal resection because of Crohn's disease between years 2019 and 2022 were collected. Early postoperative morbimortality, ileostomy rates, postoperative complications rates and postoperative recurrence rates were retrieved.

We report a case of a 48-year-old male with HIV and poor adherence to antiretroviral therapy, presenting with two months of abdominal pain and diarrhea. His latest CD4 count was 11/µL. Imaging and biopsy confirmed CMV enteritis with ulcerated lesions in the distal ileum. Despite prolonged antiviral therapy with ganciclovir and foscarnet, the patient's condition remained refractory, necessitating ileocaecal resection and ileostomy, followed by further resection and anastomosis. Post-surgery, the patient recovered well and was discharged. This case underscores the potential benefit of surgical intervention in CMV enteritis unresponsive to medical treatment in HIV patients.

We present the case of a 67-year-old male smoker with no medical history of interest. Admitted to Neurology for frontal headache, unsteady gait, temporospatial disorientation and vomiting. Laboratory tests (including vitamin B12, folic acid, lues) and cranial CT scan were normal, encephalogram compatible with diffuse encephalopathy and lumbar puncture with a finding of leptomeningeal carcinomatosis. In light of these findings, it was decided to look for occult tumor by thoracoabdominal-pelvic CT, which was negative for malignancy. In view of the results of the previous tests, it was decided to perform an endoscopic study. Colonoscopy reveals six 0-IIa Paris polyps in the left colon measuring 7-10 cm, which are removed. Gastroduodenoscopy shows a poorly distensible stomach, with erythematous gastric body mucosa and hard on biopsy. In addition, in the duodenum, three raised lesions with an excavated center (Fig. 1) of about 5 mm were identified and biopsied. Histology findings report mucosal and submucosal infiltration by poorly differentiated carcinoma. Immunohistochemistry positive for CK19, Glipican-3, weak positivity for CK7, conserved expression of MUC5AC and SMAD, negative for SF-1, inhibin, synaptophysin, INSM1, chromogramin, Gata-3 and S-100. The findings were suggestive of infiltration by poorly differentiated carcinoma of probable gastric origin. Unfortunately, during hospital admission the patient presented a progressive clinical deterioration and died two weeks later.

Dear Editor, We report a case of a 30-year-old woman with an 8-year diagnosis of eosinophilic esophagitis (EoE) treated with swallowed fluticasone propionate throughout this period. She presented to the emergency room with a two-day history of severe odynophagia, aphagia, retrosternal pain, and fever. The patient was febrile and hemodynamically stable, with no visible oropharyngeal lesions. She presented with elevated C-reactive protein (37 mg/L). An esophagogastroduodenoscopy was performed, which revealed white plaque-like lesions with "volcano-like" shallow ulcerations with raised edges on the distal esophagus (Figure 1aandb). Multiple biopsies were taken from both the center and edges of the lesions. The patient was empirically started on intravenous fluconazole due to the suspicion of candida esophagitis. However, the patient's symptoms worsened over the next two days, and acyclovir at a dose of 5 mg/kg was started. The initial work-up showed a positive titer for Herpes Simplex Virus (HSV)-2 IgM (1.6 U/L) and a negative titer for IgG (2.24 U/L), as well as a negative serological study for HSV-1, cytomegalovirus, and human immunodeficiency virus (HIV). Histological examination revealed multinucleated giant cells with nuclear molding and chromatin margination and cells with "ground glass" nuclei, along with typical Cowdry type A intranuclear inclusion bodies and immunohistochemical staining for HSV type 2, confirmed the diagnosis of herpetic esophagitis (Figure 1candd). The patient experienced rapid improvement and was discharged on oral acyclovir therapy at 400 mg/day, completing a total of 14 days of treatment with a total resolution of symptoms.

Bile acid malabsorption (BAM) is a common cause of chronic diarrhoea. Recent work has shown that it is probably an under-diagnosed entity. BAM is classified into 4 types depending on what conditions it. Type I involves organic involvement of the ileal mucosa. Type II is related to alterations in permeability in what is known as irritable bowel syndrome with a predominance of diarrhoea. Type III is related to other alterations of the digestive tract such as celiac disease, pancreatic insufficiency, cholecystectomy or bacterial overgrowth. Type IV is related to drugs that produce MAB as a side effect. There is a test for the detection of MAB with high sensitivity and specificity, non-invasive and with few associated complications, which is the 75Selenium and tauroselcholic acid scintigraphy (75SeHCAT®).

An increase in duodenal intraepithelial lymphocytes (IELs) is a characteristic finding in coeliac enteropathy. Flow cytometry analysis of this compartment, known as the 'duodenal IEL lymphogram', is a quick and simple technique that allows us to identify with high diagnostic accuracy the phenotype and distribution of the IEL subpopulations that characterise, in an almost pathognomonic way, the underlying celiac process. We contribute our experience as a pioneering group in the clinical implementation of this technique, adding certain reflections with the aim of harmonising minor discrepancies between laboratories when interpreting the parameters analysed.

The PRIVIDIGEST survey is an initiative of the Spanish Society of Digestive Pathology (SEPD) designed to analyse the reality of private practice in our specialty in Spain. It describes a sector undergoing profound change, where the traditional model of isolated consultation is disappearing in favour of a mixed practice, mainly integrated into more complex hospital and clinic structures. In the clinical and technological sphere, there are striking contrasts, as although specialists have modern, high-definition equipment, there is insufficient adherence to the monitoring of internationally required quality indicators. Similarly, there is a large gap between expectations and the actual use of artificial intelligence, as although it is considered a tool with great potential, its daily use is still minimal due to economic and organisational barriers. Finally, the analysis highlights significant gaps in non-clinical training. Specialists acknowledge a general lack of knowledge in the areas of business management, taxation and legal liability, and call on the SEPD to take a leading role in providing specific advice.

In patients with malignant distal biliary obstruction, drainage via Endoscopic Ultrasound-guided Choledochoduodenostomy (EUS-CDS) is indicated in clinical guidelines following a failed Endoscopic Retrograde Cholangiopancreatography (ERCP). However, current interest lies in evaluating its role as a first-line treatment. Through this letter, we present a case report that represents this clinical scenario, as well as a brief summary of the most recent literature supporting the use of EUS-CDS as a first-line treatment for malignant distal biliary obstruction.

Acute variceal bleeding is a life-threatening condition and a common cause of cirrhosis-related death, severe acute bleeding is difficult to treat and has a high mortality rate, drug treatment is often ineffective. We encountered a patient with cirrhosis with ruptured and bleeding gastroscopic varices requiring emergency endoscopic surgical treatment. However, in the routine left lateral position the treatment was interfered with by a fresh blood clot obscuring the gastric fundus. We were able to expose the gastric fundus by turning the patient to the right lateral position and eventually successfully treated the patient. This provides a new idea for the endoscopic treatment of acute gastric varices and may improve the success rate of treatment.

Leptospira interrogans is a spirochete excreted in the urine of various mammals. It can infect humans when contaminated water comes into contact with broken skin or mucous membranes. Leptospirosis may present as a mild febrile illness, with the classic features of Weil's syndrome (jaundice, conjunctival suffusion, and renal impairment), or progress to life-threatening forms such as acute liver failure or pulmonary hemorrhage.