RESUMEN
BACKGROUND: a prolonged non-alcoholic steatohepatitis (NASH) condition can lead to advanced stages of liver disease and the development of hepatocellular carcinoma. AIM: to evaluate analytical, anthropometric and dietary factors associated with the presence of fibrosis as this is the factor that most influences survival and evolution. METHODS: seventy-six patients with liver biopsy-diagnosed non-alcoholic fatty liver disease (NAFLD) were included. Biopsies were scored considering the NASH criteria of Kleiner. Analytical, anthropometric and dietary (survey) parameters were obtained. NAFLD-FS is a non-invasive fibrosis index and was assessed for each patient. Leptin, adiponectin, resistin and TNF-alpha serum levels were determined. RESULTS: fifty-six patients were male (73.7%) and the mean age was 44.5 ± 11.3 years of age (19-68). Thirty-nine (51.3%) (F1-F2: 84.6%; F3-4: 15.4%) patients had fibrosis in the liver biopsy. Seventeen females (85%) had fibrosis versus 22 males (39%), which was statistically significant by univariate analysis (p < 0.01). Patients with advanced fibrosis were older, with lower platelet counts, lower serum albumin, greater homeostatic model assessment insulin resistance (HOMA-IR), lower dietary lipids percentage, higher serum leptin levels and higher NAFLD Fibrosis Score (NAFLD-FS) values. This index had a negative predictive value of 98% and a positive predictive value of 60% for the detection of fibrosis. Variables independently associated with fibrosis (logistic regression) included male gender (protective factor) (0.09, 95% CI 0.01-0.7; p < 0.05) and HOMA-IR (1.7, 95% CI, 1.03-2.79; p < 0.05). CONCLUSIONS: gender and HOMA-IR were the only independent factors associated with fibrosis. NAFLD-FS could be considered as an accurate scoring system to rule out advanced fibrosis.
Asunto(s)
Cirrosis Hepática/etiología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Adulto , Anciano , Biomarcadores/sangre , Estudios Transversales , Dieta/efectos adversos , Femenino , Humanos , Resistencia a la Insulina , Cirrosis Hepática/sangre , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/sangre , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
Recent advances in endoscopic therapeutics allow conditions such as fistulas of the digestive system to be treated endoscopically. These cases were recently managed with surgery. The Padlock® system includes a nitinol clip that was recently introduced for endoscopic therapy. There are few reports with regard to its use in the daily clinical practice. We report a case of a colonic fistula that was endoscopically managed with this novel over-the-scope nitinol clip system.
Asunto(s)
Enfermedades del Colon/cirugía , Endoscopía Gastrointestinal/métodos , Fístula Intestinal/cirugía , Hepatopatías/cirugía , Anciano , Aleaciones , Femenino , Humanos , Instrumentos QuirúrgicosRESUMEN
INTRODUCTION: The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed. AIM: To determine whether the negative predictive value of CE findings changes along the learning curve. METHODS: We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years. These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100. Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value. RESULTS: A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied. The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P>.05). CONCLUSION: The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training.
Asunto(s)
Endoscopía Capsular , Gastroenterología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Competencia Clínica , Femenino , Humanos , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Colonoscopy is the gold standard for the detection and prevention of colorectal cancer (CRC). However, some individuals are diagnosed with CRC soon after a previous colonoscopy. AIMS: To evaluate the rate of new onset or missed CRC after a previous colonoscopy and to study potential risk factors. METHODS: Patients in our endoscopy database diagnosed with CRC from March 2004 to September 2011 were identified, selecting those with a colonoscopy performed within the previous 5years. Medical records included age, gender, comorbidities and colonoscopy indication. Tumour characteristics studied were localization, size, histological grade and TNM stage and possible cause. These patients were compared with those diagnosed with CRC at their first endoscopy (sporadic CRC-control group). RESULTS: A total of 712 patients with CRC were included; 24 patients (3.6%) had undergone colonoscopy within the previous 5 years (50% male, 50% female, mean age 72). Post-colonoscopy CRCs were attributed to: 1 (4.2%) incomplete colonoscopy, 4 (16.6%) incomplete polyp removal, 1 (4.2%) failed biopsy, 8 (33.3%) 'missed lesions' and 10 (41.7%) new onset CRC. Post-colonoscopy CRCs were smaller in size than sporadic CRCs (3.2cm vs. 4.5cm, P<.001) and were mainly located in the proximal colon (63% vs. 35%, P=.006); no difference in histological grade was found (P=.125), although there was a tendency towards a lower TNM stage (P=.053). CONCLUSIONS: There is a minor risk of CRC development after a previous colonoscopy (3.6%). Most of these (58.4%) are due to preventable factors. Post-colonoscopy CRCs were smaller and mainly right-sided, with a tendency towards an earlier TNM stage.
Asunto(s)
Colonoscopía , Neoplasias Colorrectales/etiología , Adolescente , Adulto , Anciano de 80 o más Años , Biopsia , Estudios de Casos y Controles , Transformación Celular Neoplásica , Pólipos del Colon/diagnóstico , Pólipos del Colon/cirugía , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Errores Diagnósticos , Progresión de la Enfermedad , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasia Residual , Prevalencia , Estudios Retrospectivos , España/epidemiología , Adulto JovenRESUMEN
IBD flares or new diagnosis in patients receiving anti-TNF because of other diseases than IBD are rare events but the possibility of a paradoxical reaction must be considered as with psoriasis or uveitis. We present a patient suffering from RA who had a new CD onset after a two-year adalimumab treatment.
Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Enfermedad de Crohn/inducido químicamente , Adalimumab , Adulto , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Reumatoide/complicaciones , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Femenino , HumanosRESUMEN
We describe the case of a 43-year-old man recently diagnosed with ileal Crohn's disease complicated by a free peritoneal perforation of a Meckel's diverticulum and the presence of enteroliths in the intestinal lumen. The coexistence of Crohns disease, Meckel's diverticulum and enteroliths has rarely been reported. Meckel's diverticulum can hamper the management of Crohn's disease.
Asunto(s)
Enfermedad de Crohn/complicaciones , Obstrucción Intestinal/etiología , Litiasis/etiología , Divertículo Ileal/etiología , Adulto , Humanos , MasculinoAsunto(s)
Antibacterianos/efectos adversos , Azitromicina/efectos adversos , Pancreatitis/inducido químicamente , Enfermedad Aguda , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Causalidad , Femenino , Humanos , Persona de Mediana Edad , Recurrencia , Infecciones del Sistema Respiratorio/tratamiento farmacológicoAsunto(s)
Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Quinolinas/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/tratamiento farmacológico , Enfermedad Hepática Inducida por Sustancias y Drogas/terapia , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Quinolinas/uso terapéuticoAsunto(s)
Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Ascitis/tratamiento farmacológico , Norfloxacino/uso terapéutico , Peritonitis/microbiología , Peritonitis/prevención & control , Staphylococcaceae/efectos de los fármacos , Staphylococcaceae/aislamiento & purificación , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Anciano , Antibacterianos/farmacología , Ascitis/etiología , Humanos , Cirrosis Hepática Alcohólica/complicaciones , Masculino , Norfloxacino/farmacología , Peritonitis/etiología , Resultado del TratamientoRESUMEN
Antecedentes: la esteatohepatitis no alcohólica (EHNA) mantenida en el tiempo puede conducir a estadios avanzados de enfermedad hepática y al desarrollo de hepatocarcinoma. Objetivos: evaluar los factores analíticos, antropométricos y dietéticos asociados a la presencia de fibrosis hepática, evento que más influye en supervivencia y evolución. Métodos: fueron estudiados setenta y seis pacientes diagnosticados de enfermedad por hígado graso no alcohólica mediante biopsia. Las biopsias fueron clasificadas según el NAS-score (Kleiner). Se obtuvieron parámetros analíticos, antropométricos y dietéticos y se calculó el índice no invasivo NAFLD Fibrosis Score (NFLD-FS). Se determinaron los niveles séricos de leptina, adiponectina, resistina y TNF-alfa. Resultados: cincuenta y seis pacientes eran hombres (73,7%), con una edad media de 44,5 ± 11,3 años (19-68). Pacientes con fibrosis en biopsia: 39 (51,3%) (F1-F2: 84,6%; F3-4: 15,4%). Univariante: 17 mujeres (85%) presentaban fibrosis, frente a 22 hombres (39%) (p = 0,000). Los pacientes con fibrosis avanzada tenían mayor edad, menor recuento de plaquetas, menor albúmina sérica, mayor resistencia a la insulina (homeostatic model assessment insulin resistance, HOMA-IR), menor ingesta de lípidos, mayor nivel de leptina sérica y valores más altos de NAFLD-FS. Este índice presenta para detectar fibrosis avanzada un valor predictivo negativo del 98% y un valor predictivo positivo del 60%. Variables asociadas de forma independiente a la presencia de fibrosis (regresión logística): sexo masculino (factor protector) (0,09, IC 95%, 0,01-0,7; p < 0,05) y HOMA-IR (1,7, IC 95% 1,03-2,79; p < 0,05). Conclusiones: el sexo y el HOMA-IR son los únicos factores independientes que se asociaron a la presencia de fibrosis hepática en biopsia. El NAFLD-FS es un buen marcador no invasivo para descartar la presencia de fibrosis avanzada
Background: a prolonged non-alcoholic steatohepatitis (NASH) condition can lead to advanced stages of liver disease and the development of hepatocellular carcinoma. Aim: to evaluate analytical, anthropometric and dietary factors associated with the presence of fibrosis as this is the factor that most influences survival and evolution. Methods: seventy-six patients with liver biopsy-diagnosed non-alcoholic fatty liver disease (NAFLD) were included. Biopsies were scored considering the NASH criteria of Kleiner. Analytical, anthropometric and dietary (survey) parameters were obtained. NAFLD-FS is a non-invasive fibrosis index and was assessed for each patient. Leptin, adiponectin, resistin and TNF-alpha serum levels were determined. Results: fifty-six patients were male (73.7%) and the mean age was 44.5 ± 11.3 years of age (19-68). Thirty-nine (51.3%) (F1-F2: 84.6%; F3-4: 15.4%) patients had fibrosis in the liver biopsy. Seventeen females (85%) had fibrosis versus 22 males (39%), which was statistically significant by univariate analysis (p < 0.01). Patients with advanced fibrosis were older, with lower platelet counts, lower serum albumin, greater homeostatic model assessment insulin resistance (HOMA-IR), lower dietary lipids percentage, higher serum leptin levels and higher NAFLD Fibrosis Score (NAFLD-FS) values. This index had a negative predictive value of 98% and a positive predictive value of 60% for the detection of fibrosis. Variables independently associated with fibrosis (logistic regression) included male gender (protective factor) (0.09, 95% CI 0.01-0.7; p < 0.05) and HOMA-IR (1.7, 95% CI, 1.03-2.79; p < 0.05). Conclusions: gender and HOMA-IR were the only independent factors associated with fibrosis. NAFLD-FS could be considered as an accurate scoring system to rule out advanced fibrosis
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Cirrosis Hepática/etiología , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Fibrosis/etiología , Factores de Riesgo , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Enfermedad del Hígado Graso no Alcohólico/sangre , Biomarcadores/sangre , Estudios Transversales , Dieta/efectos adversos , Resistencia a la Insulina , Modelos Logísticos , Valor Predictivo de las PruebasRESUMEN
El avance de la terapéutica endoscópica está permitiendo abordar patologías que hasta hace poco quedaban reservadas al tratamiento quirúrgico, como las fístulas digestivas. El sistema Padlock(R) consiste en un clip de nitinol introducido recientemente para terapéutica endoscópica. Hasta el momento, son pocas las comunicaciones sobre su utilización en la práctica diaria. Presentamos un caso de fístula colónica tratada mediante este nuevo sistema de clip endoscópico de nitinol (AU)
Recent advances in endoscopic therapeutics allow conditions such as fistulas of the digestive system to be treated endoscopically. These cases were recently managed with surgery. The Padlock(R) system includes a nitinol clip that was recently introduced for endoscopic therapy. There are few reports with regard to its use in the daily clinical practice. We report a case of a colonic fistula that was endoscopically managed with this novel over-the-scope nitinol clip system (AU)
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Fístula/terapia , Fístula , Endoscopía/métodos , Fístula del Sistema Digestivo/terapia , Instrumentos Quirúrgicos , Colonoscopía/métodos , Antibacterianos/uso terapéutico , Resultado del TratamientoRESUMEN
INTRODUCCIÓN: La influencia de la experiencia acumulada del médico que interpreta cápsulas endoscópicas sobre su capacidad diagnóstica es discutida. OBJETIVO: Determinar si existen diferencias en el valor predictivo negativo de las cápsulas endoscópicas informadas por los mismos endoscopistas a lo largo del tiempo. MÉTODOS: Revisamos las 900 primeras cápsulas endoscópicas realizadas por tres gastroenterólogos expertos en endoscopia durante 8 años. Se dividieron en 3 grupos de 300 cápsulas cada uno. El grupo 1 fue la suma de las tres primeras centenas informadas por cada uno, el grupo 2 la suma de las tres segundas centenas y el grupo 3 la suma de las tres terceras centenas. Se hizo un seguimiento mínimo de 28 meses a los casos con exploración normal. RESULTADOS: Aunque se consideraron normales el 18% de las cápsulas del grupo 1, el 19,3% de las del grupo 2 y el 15,6% de las del grupo 3, solo fue posible seguir y finalmente analizar a 34 enfermos en el grupo 1, a 38 en el 2 y a 36 en el 3. Sobre estos casos, el valor predictivo negativo fue del 88,2% en el grupo 1, del 89,5% en el grupo 2 y del 97% en el grupo 3 (p > 0,05). CONCLUSIÓN: El valor predictivo negativo de la cápsula endoscópica, aunque con tendencia a aumentar, se mantiene alto y sin diferencias significativas desde las 100 primeras exploraciones si los médicos que la interpretan son expertos en endoscopia convencional y tienen formación específica previa
INTRODUCTION: The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed. AIM: To determine whether the negative predictive value of CE findings changes along the learning curve. METHODS: We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years. These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100. Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value. RESULTS: A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied. The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P > .05). CONCLUSION: The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training