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1.
Am J Gastroenterol ; 2024 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-39008547

RESUMEN

BACKGROUND: The coexistence of human immunodeficiency virus (HIV) infection and inflammatory bowel disease (IBD) is uncommon. Data on the impact of HIV on IBD course and its management is scarce. AIM: To describe the IBD phenotype, therapeutic requirements and prevalence of opportunistic infections (OI) in IBD patients with a coexistent HIV infection. METHODS: Case-control, retrospective study including all HIV positive patients diagnosed with IBD in the ENEIDA registry. Patients with positive HIV serology (HIV-IBD) were compared to controls (HIV seronegative), matched 1:3 by year of IBD diagnosis, age, gender and type of IBD. RESULTS: A total of 364 patients (91 HIV-IBD and 273 IBD controls) were included. In the whole cohort, 58% had ulcerative colitis (UC), 35% had Crohn's disease (CD) and 7% were IBD unclassified. The HIV-IBD group presented a significantly higher proportion of proctitis in UC and colonic location in CD but fewer extraintestinal manifestations than controls. Regarding treatments, non-biological therapies (37.4% vs. 57.9%; P=0.001) and biologicals (26.4% vs. 42.1%; P=0.007), were used less frequently among patients in the HIV-IBD group. Conversely, HIV-IBD patients developed more OI than controls regardless of non-biological therapies use. In the multivariate analysis, HIV infection (OR 4.765, 95%CI 2.48-9.14; P<0.001) and having ≥1 comorbidity (OR 2.445, 95%CI 1.23-4.85; P=0.010) were risk factors for developing OI, while CD was protective (OR 0.372, 95%CI 0.18-0.78;P=0.009). CONCLUSIONS: HIV infection appears to be associated with a less aggressive phenotype of IBD and a lesser use of non-biological therapies and biologicals but entails a greater risk of developing OI.

2.
Am J Gastroenterol ; 118(6): 1036-1046, 2023 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-36516073

RESUMEN

INTRODUCTION: The prevalence of penetrating complications in Crohn's disease (CD) increases progressively over time, but evidence on the medical treatment in this setting is limited. The aim of this study was to evaluate the effectiveness of biologic agents in CD complicated with internal fistulizing disease. METHODS: Adult patients with CD-related fistulae who received at least 1 biologic agent for this condition from the prospectively maintained ENEIDA registry were included. Exclusion criteria involved those receiving biologics for perianal disease, enterocutaneous, rectovaginal, anastomotic, or peristomal fistulae. The primary end point was fistula-related surgery. Predictive factors associated with surgery and fistula closure were evaluated by multivariate logistic regression and survival analyses. RESULTS: A total of 760 patients from 53 hospitals (673 receiving anti-tumor necrosis factors, 69 ustekinumab, and 18 vedolizumab) were included. After a median follow-up of 56 months (interquartile range, 26-102 months), 240 patients required surgery, with surgery rates of 32%, 41%, and 24% among those under anti-tumor necrosis factor, vedolizumab, or ustekinumab, respectively. Fistula closure was observed in 24% of patients. Older patients, ileocolonic disease, entero-urinary fistulae, or an intestinal stricture distal to the origin of the fistula were associated with a higher risk of surgery, whereas nonsmokers and combination therapy with an immunomodulator reduced this risk. DISCUSSION: Biologic therapy is beneficial in approximately three-quarters of patients with fistulizing CD, achieving fistula closure in 24%. However, around one-third still undergo surgery due to refractory disease. Some patient- and lesion-related factors can identify patients who will obtain more benefit from these drugs.


Asunto(s)
Enfermedad de Crohn , Fístula , Fístula Rectal , Adulto , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/cirugía , Ustekinumab/uso terapéutico , Resultado del Tratamiento , Terapia Biológica , Necrosis , Estudios Retrospectivos , Fístula Rectal/etiología , Fístula Rectal/terapia
3.
Rev Esp Enferm Dig ; 111(2): 129-133, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30421955

RESUMEN

INTRODUCTION: cases of hepatitis B virus (HBV) reactivation have been reported in patients with hepatitis C virus (HCV) treated with direct antiviral agents (DAA). OBJECTIVES AND METHODS: the main objectives of the present study are: a) to determine the prevalence of HBV/HCV coinfection in HCV patients treated with DAAs in the Autonomous Community of Madrid (CM) and also to determine the incidence and clinical relevance of HBV reactivation; and b) to determine the HBV screening rates in HCV patients in our region. For that purpose, 1,337 HCV patients were consecutively treated with DAAs in two hospitals located in South CM between January 2015 and June 2017. RESULTS: nine of the 1,337 (0.67%) participants were HBsAg positive and 356 (26.6%) had previous HBV infection markers. Two of the four (50%) HBsAg positive patients with untreated HBV developed a virological reactivation, but not a biochemical reaction. Of the 356 patients with previous HBV infection markers, all had normal transaminases at the end of treatment and during follow-up. The HBV screening rate amounted to 92.9% of the cohort. CONCLUSIONS: the prevalence of HBV (HBsAg positive) infection in patients with chronic hepatitis C in the southern area of the CM is low. HBV reactivation in HBsAg positive patients treated with DAAs is common, although without clinical relevance. In our region, there is a high rate of HBV screening in patients with HCV that are likely treated with DAAs.


Asunto(s)
Coinfección/virología , Virus de la Hepatitis B/fisiología , Hepatitis B Crónica/virología , Hepatitis C Crónica/virología , Activación Viral , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/uso terapéutico , Biomarcadores/sangre , Femenino , Antígenos de Superficie de la Hepatitis B/análisis , Virus de la Hepatitis B/inmunología , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/inmunología , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , España , Adulto Joven
4.
Rev Esp Enferm Dig ; 110(4): 262-263, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29620411

RESUMEN

Although sedation in endoscopy is increasingly used and contributes to the quality of procedures, its role in upper gastrointestinal endoscopy (UGE) is not as well defined as in other procedures. For this reason, we conducted a prospective pilot study where the patient, once informed of the different options, decided whether or not to undergo sedation for UGE. Remarkably, almost 60% preferred not to undergo sedation, with a high degree of satisfaction and no adverse effects in any of the groups (Ferrer Rosique JA, et al. XXXIX Congreso SEED, Toledo 2017).


Asunto(s)
Sedación Consciente , Endoscopía Gastrointestinal/métodos , Satisfacción del Paciente , Humanos , Hipnóticos y Sedantes , Pacientes , Propofol
5.
Dig Liver Dis ; 2024 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-38876834

RESUMEN

BACKGROUND: some patients with inflammatory bowel disease (IBD) treated with antiTNF develop drug-induced psoriasis (antiTNF-IP). Several therapeutic strategies are possible. AIMS: to assess the management of antiTNF-IP in IBD, and its impact in both diseases. METHODS: patients with antiTNF-IP from ENEIDA registry were included. Therapeutic strategy was classified as continuing the same antiTNF, stopping antiTNF, switch to another antiTNF or swap to a non-antiTNF biologic. IP severity and IBD activity were assessed at baseline and 16, 32 and 54 weeks. RESULTS: 234 patients were included. At baseline, antiTNF-IP was moderate-severe in 60 % of them, and IBD was in remission in 80 %. Therapeutic strategy was associated to antiTNF-IP severity (p < 0.001). AntiTNF-IP improved at week 54 with all strategies, but continuing with the same antiTNF showed the worst results (p = 0.042). Among patients with IBD in remission, relapse was higher in those who stopped antiTNF (p = 0.025). In multivariate analysis, stopping antiTNF, trunk and palms and soles location were associated with antiTNF-IP remission; female sex and previous surgery in Crohn´s disease with IBD relapse. CONCLUSION: skin lesions severity and IBD activity seem to determine antiTNF-IP management. Continuing antiTNF in mild antiTNF-IP, and swap to ustekinumab or switch to another antiTNF in moderate-severe cases, are suitable strategies.

7.
Rev. esp. enferm. dig ; Rev. esp. enferm. dig;111(2): 129-133, feb. 2019. tab, graf
Artículo en Español | IBECS (España) | ID: ibc-182195

RESUMEN

Introducción: se han comunicado casos de reactivación de virus de la hepatitis B (VHB) en pacientes con virus de la hepatitis C (VHC) tratados con agentes antivirales directos (AAD). Objetivos y métodos: los objetivos del presente estudio son: a) conocer la prevalencia de la coinfección VHB/VHC en pacientes VHC tratados con AAD en la Comunidad de Madrid (CM) y determinar la incidencia y relevancia clínica de la reactivación del VHB; y b) conocer las tasas de cribado del VHB en pacientes VHC en nuestra comunidad. Se evaluaron 1.337 pacientes VHC consecutivos tratados con AAD en dos hospitales del sur de la CM desde enero de 2015 hasta junio de 2017. Resultados: nueve de los 1.337 (0,67%) presentaban HBsAg positivo y 356 (26,6%) presentaban algún marcador de infección VHB pasada. Dos de los cuatro (50%) pacientes HBsAg positivo sin tratamiento desarrollaron reactivación virológica VHB pero no bioquímica. De los 356 con patrón de infección VHB pasada, el 100% presentó transaminasas normales al finalizar el tratamiento y durante el seguimiento. La tasa de cribado VHB ascendió al 92,9% de la cohorte. Conclusiones: la prevalencia de infección VHB (HBsAg positivos) en pacientes con hepatitis crónica por VHC en la zona sur de la CM es baja. La reactivación del VHB en pacientes HBsAg positivo que reciben AAD es frecuente, pero sin relevancia clínica. En nuestro medio existe una alta tasa de cribado del VHB en pacientes con VHC candidatos a recibir AAD


Introduction: cases of hepatitis B virus (HBV) reactivation have been reported in patients with hepatitis C virus (HCV) treated with direct antiviral agents (DAA). Objectives and methods: the main objectives of the present study are: a) to determine the prevalence of HBV/HCV coinfection in HCV patients treated with DAAs in the Autonomous Community of Madrid (CM) and also to determine the incidence and clinical relevance of HBV reactivation; and b) to determine the HBV screening rates in HCV patients in our region. For that purpose, 1,337 HCV patients were consecutively treated with DAAs in two hospitals located in South CM between January 2015 and June 2017. Results: nine of the 1,337 (0.67%) participants were HBsAg positive and 356 (26.6%) had previous HBV infection markers. Two of the four (50%) HBsAg positive patients with untreated HBV developed a virological reactivation, but not a biochemical reaction. Of the 356 patients with previous HBV infection markers, all had normal transaminases at the end of treatment and during follow-up. The HBV screening rate amounted to 92.9% of the cohort. Conclusions: the prevalence of HBV (HBsAg positive) infection in patients with chronic hepatitis C in the southern area of the CM is low. HBV reactivation in HBsAg positive patients treated with DAAs is common, although without clinical relevance. In our region, there is a high rate of HBV screening in patients with HCV that are likely treated with DAAs


Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Hepatitis B Crónica/epidemiología , Hepatitis C Crónica/complicaciones , Tamizaje Masivo/métodos , Activación Viral/efectos de los fármacos , Coinfección/epidemiología , Antivirales/uso terapéutico , Carga Viral/efectos de los fármacos
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