Revista Espanola De Enfermedades Digestivas最新文献

Over the past decades, the fight against hepatitis C has become one of the most remarkable public health successes of our time. Once a disease with profound clinical, social, and economic consequences, hepatitis C is now approaching elimination in countries like Spain. This achievement reflects the powerful convergence of scientific innovation, effective health policies, and a sustained collective effort by healthcare professionals, affected individuals, institutions, and civil society. It stands as a compelling demonstration that when scientific knowledge, political will, and civic engagement align, transformative and enduring progress is not only possible, it is inevitable.

We report a 52-year-old patient referred for evaluation of abnormal liver tests, with extensive etiological workup negative. Abdominal CT and MRI revealed hypertrophy of the left hepatic lobe, nodular liver contours, and ascites (SAAG 1.7; total protein 1.8 g/dL). Upper endoscopy showed no stigmata of portal hypertension. A dual interventional radiology procedure was performed. Transjugular liver biopsy (LB) (18G) was non-diagnostic, and hepatic venous pressure gradient (HVPG) was normal (HVPG 3 mmHg; wedged hepatic venous pressure [WHVP] 13 mmHg; free hepatic venous pressure [FHRVP] 10 mmHg). Given suspicion of pre-sinusoidal portal hypertension, endoscopic ultrasound (EUS) was performed (Arietta 850, Fujifilm Healthcare, Tokyo, Japan). EUS showed blunting of the left lobe tip, irregular contours, and ascites. Endoscopic "palpation" revealed an indentation of 2.0 mm (abnormal). Shear-wave-elastography (SWE) of the left lobe was normal at 6.04 kPa, but other areas showed 10.5-11.1 kPa (abnormal). No splenomegaly, but the mean SWE was 31.9 kPa (abnormal). EUS-guided portal pressure gradient (EUS-PPG), measured with EchoTip Insight™ FNB needle (Cook Medical, USA), was elevated (PPG 8 mmHg; mean hepatic vein pressure 4.0 mmHg; mean portal vein pressure [PVP] 12.0 mmHg). Targeted EUS-guided biopsy of the left lobe (Acquire™ 19G FNB needle, Boston Scientific, USA) showed vague liver nodular transformation with alternating regenerative and atrophic hepatocytes, consistent with nodular regenerative hyperplasia (NRH). Due to refractory ascites, TIPS placement was proposed. Pre-TIPS evaluation showed mildly elevated HVPG (6 mmHg), while immediate post-TIPS assessment revealed elevated HVPG (HVPG 11 mmHg; PVP 20 mmHg; FHRVP 9 mmHg). Ascites was controlled with TIPS.

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.

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®).

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.

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.

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.

We presented a 66-year-old woman with T2DM who had a liver mass discovered incidentally during hospitalization. She was asymptomatic with a right upper abdominal mass that was smooth, mobile, and non-tender. Hepatitis virus markers and tumor markers were normal. The computed tomography (CT) images showed a 4.7×4.0 cm lesion in the left liver lobe with indistinct borders. Further magnetic resonance imaging (MRI) revealed low T1 and high T2 signal intensity with ring-shaped enhancement following contrast administration. Surgical resection was performed, and histology confirmed hepatic angioleiomyoma with thick-walled vessels and spindle cell proliferation. Immunohistochemistry was positive for SMA, desmin, caldesmon, CD31, and CD34. The patient had no recurrence during 5 years follow-up.