Immuno-mediated colitis induced by nivolumab that mimics endoscopically and histologically an ulcerative colitis.

Immunotherapy has revolutionized the management of oncological pathology, demonstrating effectiveness in treating various cancers by stimulating the immune system against tumor cells. Among the immunotherapy drugs are programmed cell death protein 1 (PD-1) inhibitors, such as Nivolumab, which, by blocking this receptor on the surface of T lymphocytes, enhance the immune response. Despite their significant benefits, these agents present specific adverse effects on healthy tissues that need to be understood. One of these effects is immune-mediated colitis, a potentially serious gastrointestinal disorder that may require the permanent discontinuation of the drug. Although it can occur with various immunotherapy regimens, it occurs more frequently with anti-CTLA4 agents like Ipilimumab, with its incidence much lower with anti-PD1 agents. We present the case of a 62-year-old male diagnosed with metastatic clear cell renal carcinoma treated with radical nephrectomy and subsequent palliative systemic treatment with Nivolumab. After the third cycle of immunotherapy, he developed abdominal pain and diarrhea. Colonoscopy revealed continuous mucosal inflammation up to the cecum, erosions, exudates, and loss of the vascular pattern. Biopsies showed signs of active colitis, cryptic abscesses, and focal cryptitis, all consistent with a case of immuno-mediated colitis induced by Nivolumab that mimics, both endoscopically and histologically, the findings found in ulcerative colitis.

Immunometabolic Profile Associated with Progressive Damage of the Intestinal Mucosa in Adults Screened for Colorectal Cancer: Association with Diet.

Environmental factors such as diet and lifestyle have been shown to influence the development of some intestinal mucosal lesions that may be precursors of colorectal cancer (CRC). The presence of these alterations seems to be associated with misbalanced immunological parameter levels. However, it is still unclear as to which immunological parameters are altered in each phase of CRC development. In this work, we aimed to study the potential relationships of immunological and metabolic parameters with diet in a CRC-related lesion context. Dietary information was obtained using an annual semi-quantitative food-frequency questionnaire (FFQ) from 93 volunteers classified via colonoscopy examination according to the presence of intestinal polyps or adenocarcinoma. Cytokines, chemokines, and adipokines were determined from serum samples. We observed a reduction in adiponectin according to the damage to the mucosa, accompanied by an increase and decrease in C-X-C motif chemokine ligand 10 (CXCL10) and resistin, respectively, in CRC cases. The presence of aberrant crypt foci (ACF) in the polyp group was associated with higher tumor necrosis factor-alpha (TNF-α) concentrations. Vegetables were directly correlated with adiponectin and resistin levels, while the opposite occurred with red meat. A bioactive compound, soluble pectin, showed a negative association with TNF-α. Future dietary strategies could be developed to modulate specific immunological parameters in the context of CRC.

Gastric lymphangioma. Diagnosis by endoscopic resection of a foreign entity.

The lymphangioma is a rare and very uncommon benign tumor at the gastric level. Its diagnosis typically involves imaging tests and endoscopy, and its treatment usually involves surgery. We present a case of an 82-year-old patient who presented with chronic anemia, with a large gastric polyp detected during the initial gastroscopy. Subsequently, an endoscopic resection was performed, confirming histologically that it was a lymphangioma.

Descriptive Study of the Different Tools Used to Evaluate the Adherence to a Gluten-Free Diet in Celiac Disease Patients.

Celiac disease (CD) is a genetically conditioned autoimmune process that appears in susceptible people. It can affect people of any age, and slightly predominates in females. It has a fairly homogenous global distribution, with an average prevalence of 1⁻2%, the frequency having increased in recent decades. The only effective treatment is a strict and permanent gluten-free diet (GFD), although the level of compliance is poor, at about 50% of cases. To monitor the effectiveness of the GFD, several procedures involving various approaches are employed: (a) Periodic visits by expert Nutritionists; (b) Clinical follow-up; (c) Serological time controls of specific antibodies; (d) Serial endoscopies with collection of duodenal biopsies; (e) Use of structured questionnaires; and (f) Determination of gluten peptides derived from gluten in faeces and/or urine. All of these procedures are useful when applied, alone or in combination, depending on the cases. Some patients will only need to consult to their doctors, while others will require a multidisciplinary approach to assess their compliance with the GFD. In children, normalization of duodenal mucosa was achieved in 95% of cases within two years, while it is more delayed in adults, whose mucosa take longer time (3⁻5 years) to heal completely.

[Irritable Bowel Syndrome; gut microbiota and probiotic therapy]. / Síndrome de Intestino Irritable; papel de la microbiota y probiótico-terapia.

Irritable bowel syndrome (IBS) is characterized by symptoms of abdominal pain and altered bowel habits. This common disorder is managed by varying clinical styles as no dominant therapeutic strategy has emerged. The pathophysiology of IBS remains unknown, but several lines of evidence link this disorder with the gut microbiota. Although controversy exists, gut microbiota is likely contributing to symptoms of IBS, at least in some patients, through an altered fermentation process, an impaired intestinal barrier function, a harmful modulation of enteric sensorimotor function, a promotion of low-grade inflammation without tissue damage, and a harmful modulation of the brain-gut axis. Probiotic therapy has a modest effect on IBS symptomatic relief, but the actual evidence is not strong enough to support a general recommendation of use. The best results are achieved, in children, with Lactobacillus rhamnusus GG, which moderately improves abdominal pain, while in adults the benefit appears to be greatest employing Bifidobacterium species.

El Síndrome de intestino irritable (SII) se define por síntomas de dolor abdominal, y alteración del hábito intestinal. Cuenta con diversos tratamientos disponibles, sin que hasta el momento haya destacado ninguna estrategia terapéutica en especial. La fisiopatología del SII permanece inexplicada, aunque diversas líneas de evidencia sugieren un papel de la microbiota intestinal. A pesar de que existe controversia, es probable que la microbiota contribuya a la generación de síntomas, al menos en algunos pacientes, a través de un proceso de fermentación alterado, de la modificación de la función de barrera intestinal, de la modulación inadecuada de la función sesorio-motora entérica y del eje cerebro-enteral. La probiótico-terapia produce un modesto alivio sintomático en SII, aunque la evidencia actual no es suficiente para la recomendación general de uso. Los mejores resultados se obtienen, en niños, con Lactobacillus rhamnosus GG, que mejora discretamente el dolor abdominal, mientras que en adultos el beneficio parece mayor empleando especies de Bifidobacterium.

[Transmission of hepatitis C virus in pregnant women]. / Transmisión del virus de la hepatitis C en gestantes.

BACKGROUND AND OBJECTIVE: Our goal was to determine the prevalence of hepatitis C virus infection in pregnant women from Asturias as well as the vertical transmission rate. PATIENTS AND METHOD: This was a prospective study of consecutive pregnant women from the 5th Health Area of Principado de Asturias (Northern Spain). We determined the prevalence of hepatitis C virus infection in the first trimester of pregnancy and the rate of mother-to-child transmission. Time period was August 1997-December 1998. Children were followed from birth to 18-24 months of age. Methods included anti-HVC, PCR-RNA-HVC, genotype and viral load at delivery of all positive women; and anti-HVC and PCR-RNA-HVC at birth, 3, 6, 12 and 18 months of age of their children. RESULTS: Out of 2442 consecutive pregnant women, 30 were anti-HVC positive (prevalence: 1.23% of pregnancies and 1.20% of women); 24 of them were PCR-RNA-HVC positive. There were 30 anti-HVC positive children. All but one lost their antibodies (vertical transmission rate 3.3%). CONCLUSIONS: The prevalence of hepatitis C virus infection was 1.20% of women from our Health Area. Vertical transmission rate was 3.3% among HVC infected, non-selected mothers.

[Varicella and parvovirus B19 immunity among pregnant women in Gijón, Spain]. / Prevalencia de inmunidad frente al virus de la varicela y al parvovirus B19 en gestantes de Gijón.

BACKGROUND: We aimed at determining the inmunological status regarding varicella and parvovirus B19 in pregnant women in Gijón, Spain, and its correlation with several clinical and epidemiological parameters. PATIENTS AND METHOD: Blood samples taken during the first trimester of pregnancy in the area of Gijón were analysed to determine the immunological status with respect to varicella and parvovirus B19. The study included 2 groups: 99 non-European (all tested for both varicella and parvovirus) and 2,188 Europeans (406 were randomly selected for varicella test and 287 for parvovirus test). All patients underwent a clinical-epidemiological survey. RESULTS: With regard to varicella, while 89% of pregnant women aged 14 to 35 years displayed immunity, this percentage reached 100% in those older than 35 years. Sensitivity was 73.8%, specificity 74.4%, positive predictive value 96.6% and negative predictive value was 22.6%. As for parvovirus B19, immunity was observed in 59.9% of Europeans and 67.7% of non-Europeans, without significant differences in the analysed parameters. CONCLUSIONS: Susceptibility to infection by varicella among pregnant women younger than 36 years reaches 10% in Gijón. Clinical surveys are useful to avoid a pre-vaccination serological study in an already immune population. Just over one third of these pregnant women are susceptible to infection by parvovirus B19.