Nasogastric versus nasojejunal tube feeding for severe acutepancreatitis: A systematic review of randomized controlled trials

Early enteral nutrition through a feeding tube is essential for the management of severe acute pancreatitis (SAP). Nasojejunal tube nutrition has been preferred on the assumption that it provided pancreatic rest in comparison to the nasogastric tube. However, nasojejunal tube placement is complex, may delay feeding initiation and can increase hospital costs. Our aim was to compare the efficacy and safety of enteral feeding with a nasogastric tube versus nasojejunal tube in patients with SAP. We searched four databases (PubMed, Web of Science, Scopus, and Embase) until December 1, 2022. We included randomized controlled trials (RCTs) comparing enteral feeding by nasogastric and nasojejunal tubes in patients with SAP. Primary outcome was all-cause mortality. Secondary outcomes were organ failure, infection, complications, surgical intervention, duration of tube feeding and length of hospital stay. Risk of bias assessment was completed independently by two investigators using the Cochrane RoB 2.0 tool. We performed random effects model meta-analyses using the inverse variance method. Effect measures were reported as relative risks (RR) and their 95% CIs for dichotomous outcomes and mean differences (MD) and their 95% CIs for continuous outcomes. We included four RCTs involving 192 patients with SAP. The mean ages ranged between 36 and 62 years old. There was no significant difference in all-cause mortality between the nasogastric and nasojejunal feeding arms (18/98 vs. 23/93; RR 1.34, 95%CI 0.77-2.30; p=0.30). There were no significant differences in all secondary outcomes between feeding arms. There were three RCTs with some concerns of bias, in the randomization process. In conclusion, in patients with SAP, enteral feeding delivered by nasogastric tube was as efficacious and safe as nasojejunal tube. Further randomized controlled trials with more participants and better design are needed to confirm these findings.

La nutrición enteral temprana a través de una sonda de alimentación es esencial para el tratamiento de la pancreatitis aguda severa (PAS). Se ha preferido la nutrición por sonda nasoyeyunal, bajo el supuesto de que proporciona descanso pancreático en comparación con la sonda nasogástrica. Sin embargo, la colocación de la sonda nasoyeyunal es compleja, puede retrasar el inicio de la alimentación y aumentar los costos hospitalarios. Nuestro objetivo fue comparar la eficacia y seguridad de la alimentación enteral con sonda nasogástrica versus sonda nasoyeyunal en pacientes con PAS. Se realizaron búsquedas en cuatro bases de datos (PubMed, Web of Science, Scopus y Embase) hasta el 1 de diciembre de 2022. Se incluyeron ensayos controlados aleatorios (ECA) que compararon la alimentación enteral mediante sondas nasogástricas y nasoyeyunales en pacientes con PAS. El resultado primario fue la mortalidad por todas las causas. Los resultados secundarios fueron insuficiencia orgánica, infección, complicaciones, intervención quirúrgica, duración de la alimentación por sonda y duración de la estancia hospitalaria. Dos investigadores completaron de forma independiente la evaluación del riesgo de sesgo mediante la herramienta Cochrane RoB 2.0. Realizamos metanálisis de modelos de efectos aleatorios utilizando el método de varianza inversa. Las medidas del efecto se informaron como riesgos relativos (RR) y sus IC del 95% para resultados dicotómicos y diferencias de medias (DM) y sus IC del 95% para resultados continuos. Se incluyeron cuatro ECA con 192 pacientes con PAS. La edad media osciló entre 36 y 62 años. No hubo diferencias significativas en la mortalidad por todas las causas entre los brazos de alimentación nasogástrica y nasoyeyunal Cambiar lo resaltado por: (18/98 vs. 23/93; RR 1.34, 95%CI 0.77-2.30; p=0.30). No hubo diferencias significativas en todos los resultados secundarios entre los brazos de alimentación. Hubo tres ECA con algunas preocupaciones de sesgo en el proceso de asignación aleatorizado. En conclusión, en pacientes con PAS, la alimentación enteral administrada por sonda nasogástrica fue tan eficaz y segura como la sonda nasoyeyunal. Se necesitan más ensayos controlados aleatorios con más participantes y mejor diseño para confirmar estos hallazgos.

[Medical and surgical management of moderate-to-severe inflamatory bowel disease]. / Manejo médico quirúrgico de la enfermedad inflamatoria intestinal moderada-severa.

The management of inflammatory bowel disease (IBD) is mainly medical, however, more than 70% of patients with Crohn's disease (CD) and 25% with ulcerative colitis (UC) will require surgery during their lifetime. OBJECTIVE: To evaluate medical, surgical management and evolution in patients with moderate-to-severe IBD. MATERIALS AND METHODS: Observational, descriptive, retrospective study from January 2011 to December 2019 in the Gastroenterology Service of the Guillermo Almenara Irigoyen National Hospital, Lima-Peru. RESULTS: Twenty two patients with IBD, 17 with CD and 5 with UC were included. Male predominance (59%). Emergency surgery was performed in 35.2% and 60% of patients with CD and UC, respectively. Stenosis and toxic megacolon were the most frequent indications. According to the type of surgery, hemicolectomy (41%) and intestinalresection (41%) were the most frequently performed in CD, while in UC it was total colectomy (60%). Among the postoperative complications, dehiscence/fistula and intra-abdominal collections were the most frequently reported in CD; whereas in UC it was surgical site infection and adynamic ileus. After surgery, biologics and 5-ASA associated with immunomodulator were the most used treatment in CD and UC, respectively. Mortality was 17.6% in CD and 60% in UC. CONCLUSIONS: Surgical treatment is an option in the management of moderate-to-severe IBD. Emergency surgery in IBD continues to have a high morbidity and mortality rate.

Características clínico-patológicas y manejo de tumores primarios de intestino delgado de localización yeyuno-ileal / Clinical-pathological characteristics and management of primary tumors of the small intestine of jejuno-ileal location

RESUMEN Introducción : Los tumores primarios del intestino delgado (TPID) representan aproximadamente el 5% de todas las neoplasias gastrointestinales primarias; estas últimas incluyen lesiones benignas y malignas, con diferentes subtipos histológicos. Objetivo : Describir las características clínico-patológicas y el manejo de tumores de localización yeyuno-ileal. Materiales y métodos : Se realizó un estudio descriptivo, retrospectivo, en un único centro. Resultados : Se incluyó 45 pacientes, la edad promedio al diagnóstico fue de 54,2 ± 8,2 años. 27 eran de sexo masculino (60%). En el algoritmo diagnóstico se utilizó la tomografía computarizada en todos los pacientes, la enteroscopia de doble balón en 41 (91,1%) y video cápsula endoscópica en 32 (71,1%). Se realizaron procedimientos endoscópicos como: biopsias, tatuajes, resección y dilatación en 40 (88,9%), 39 (86,7%), 4 (8,9%) y 1(2,2%) paciente respectivamente. La localización más frecuente fue yeyuno en 39 (86%). Se confirmó GIST en 18 (40%), seguido de linfoma en 16 (35,6%) y adenocarcinoma en 5 (11%) casos. Todos los tumores GIST, adenocarcinoma y neuroendocrinos se sometieron a tratamiento quirúrgico y quimioterapia; el tratamiento de los linfomas consistió en tratamiento combinado principalmente; tres harmartomas y un fibroangiolipoma fueron resecados endoscópicamente. Conclusiones : Los tumores de intestino delgado yeyuno-ileal más frecuentes fueron los GIST, seguidos de linfomas y adenocarcinomas. La enteroscopia de doble balón fue la principal herramienta diagnóstica y terapéutica.

ABSTRACT Introduction : Primary tumors of the small intestine (PTID) represent approximately 5% of all primary gastrointestinal neoplasms; the latter include benign and malignant lesions, with different histological subtypes. Objective : To describe the clinical-pathological characteristics and the management of tumors located in the jejunum-ileum. Materials and methods : A descriptive, retrospective study was carried out in a single center. Results : 45 patients were included, the average age at diagnosis was 54.2 ± 8.2 years. 27 were male (60%). In the diagnostic algorithm, computed tomography was used in all patients, double-balloon enteroscopy in 41 (91.1%) and video capsule endoscopy in 32 (71.1%). Endoscopic procedures such as: biopsies, tattoos, resection and dilation were performed in 40 (88.9%), 39 (86.7%), 4 (8.9%) and 1 (2.2%) patients, respectively. The most frequent location was the jejunum in 39 (86%). GIST was confirmed in 18 (40%), followed by lymphoma in 16 (35.6%) and adenocarcinoma in 5 (11%) cases. All GIST, adenocarcinoma, and neuroendocrine tumors underwent surgical treatment and chemotherapy; treatment of lymphomas consisted mainly of combined treatment; three harmartomas and one fibroangiolipoma were resected endoscopically. Conclusions : The most frequent jejunoileal small intestine tumors were GISTs, followed by lymphomas and adenocarcinomas. Double-balloon enteroscopy was the main diagnostic and therapeutic tool.

Manejo de la hemorragia digestiva alta en pacientes con infección por SARS-CoV-2 en un hospital de Lima, Perú / Management of upper gastrointestinal bleeding in patients with SARS-COV-2 infection in a hospital in Lima-Peru

Resumen Introducción: la pandemia por SARS-CoV-2 ha conllevado la reestructuración de las unidades de endoscopía digestiva en el mundo, lo cual ha limitado los procedimientos endoscópicos y priorizado indicaciones de emergencia como la hemorragia digestiva alta (HDA). No obstante, existe escasa evidencia respecto a su impacto en la evolución y resultados. Objetivo: evaluar el manejo de la HDA en el contexto de la pandemia del coronavirus por SARS-CoV-2. Materiales y métodos: estudio observacional, descriptivo, retrospectivo de marzo a agosto de 2020 en pacientes con diagnóstico de HDA e infección por SARS-CoV-2. Resultados: de 4320 pacientes con infección por SARS-CoV-2, 51 presentaron HDA al ingreso. La mediana de edad fue de 70 años. El 58,8 % era de sexo masculino. El 56,9 % tenía una puntuación de Glasgow-Blatchford (SGB) ≥12. El 21,6 % requirió soporte de oxígeno. Solo 34 pacientes (66,7 %) recibieron tratamiento médico; asimismo, 17 (33,3 %) recibieron tratamiento médico más endoscopia digestiva alta (EDA); de estos, a 6 (35,3 %) se les realizó endoscopia terapéutica. La enfermedad ulcerosa péptica fue el hallazgo más frecuente. Al comparar el tipo de tratamiento recibido, no hubo diferencias significativas entre el número de transfusiones de glóbulos rojos, resangrado, reingreso por HDA, estancia hospitalaria ni mortalidad secundaria a la HDA. La mortalidad global fue del 25,4 % (13 pacientes) y se debió, principalmente, al compromiso respiratorio por SARS-CoV-2. Conclusiones: se observa una reducción en el número de EDA de emergencia por HDA en la pandemia actual, así como un tiempo mayor al estándar para su realización. Más del 80 % de los pacientes que recibieron solo tratamiento médico evolucionaron favorablemente, y solo un tercio de los pacientes a quienes se les realizó una EDA requirió terapéutica endoscópica.

Abstract Introduction: The SARS-CoV-2 pandemic has led to the restructuring of digestive endoscopy units around the world, limiting endoscopic procedures and prioritizing emergency indications such as upper gastrointestinal hemorrhage (UGH). However, there is little evidence regarding its impact on evolution and outcomes. Objective: To evaluate the management of UGH in the context of the SARS-CoV-2 coronavirus pandemic. Materials and methods: Observational, descriptive, retrospective study carried out between March and August 2020 in patients with diagnosis of UGH and SARS-CoV-2 infection. Results: Of 4 320 patients with SARS-CoV-2 infection, 51 had UGH on admission. The median age of the population was 70 years and 58.8% were male. Glasgow-Blatchford Bleeding Score (GBS) of ≥12 was obtained in 56.9%. Oxygen support was required by 21.6%. 34 (66.7%) patients received medical treatment only, while 17 (33.3%) received medical treatment plus upper gastrointestinal endoscopy (UGE), of which 6 (35.3%) underwent therapeutic endoscopy. Peptic ulcer disease was the most frequent finding. When comparing the type of treatment received, there were no significant differences between the number of red blood cell transfusions, rebleeding, re-admission due to UGH, hospital stay, or mortality secondary to UGH. Overall mortality was 25.4% (13 patients), mainly due to respiratory failure due to SARS-CoV-2. Conclusions: A reduction in the number of emergency upper gastrointestinal endoscopies for UGH was observed during the current pandemic, as well as a longer than standard time for their performance. More than 80% of patients who received medical treatment alone evolved favorably and only one third of the patients who underwent UGE required endoscopic therapy.

Análisis biomecánico en la zona para-radicular de primer molar con y sin la aplicación de micro-osteoperforaciones en mandíbula. Estudio en Elementos Finitos / Para-root zone biomechanical analysis with and without the application of micro-osteoperforations in the jaw: Finite Elements Study

RESUMEN Objetivo: El propósito del presente estudio fue investigar biomecánicamente si el tratamiento con micro-osteoperforaciones (Mops) genera diferencias de desplazamiento y de tensiones a nivel óseo cuando se aplica una carga ortodóncica, mediante el uso de análisis de elementos finitos. Material y Método: Un modelo de mandíbula dentada donde se eliminó el segundo premolar fue utilizado para el análisis. Posteriormente, se dividieron en 3 muestras dependiendo de la posición de las Mops: 1) Sin Mops (control); 2) Mops 1 mm adyacentes al primer molar; 3) Mops a 4 mm del molar. Para la simulación, se aplicó una carga estática horizontal de 150 gr (1,5N), simulando un resorte cerrado de Nitinol, tanto a nivel molar en dirección mesial como a nivel interproximal entre canino e incisivo lateral en dirección distal. Resultados: A pesar que se observó una ligera tendencia a aumentar el desplazamiento del molar con la presencia de Mops, no existieron mayores variaciones en relación a las magnitudes de desplazamiento ni tensiones entre los diferentes modelos. Conclusiones: Desde el punto de vista biomecánico no existen diferencias evidentes en los valores de tensiones ni de desplazamiento entre los modelos analizados.

ABSTRACT: Objective: The purpose of the present study was to biomechanically investigate if the treatment with micro-osteoperforations (Mops) generates displacement and tensions differences at bone level when an orthodontic load is applied, through the use of finite element analysis. Material and Method: A toothed jaw model where the second premolar was removed was used for the analysis. Subsequently, they were divided into 3 samples depending on the position of the Mops: 1) Without Mops (control); 2) Mops adjacent 1 mm to the first molar; 3) Mops 4 mm to molar. To simulate a closed Nitinol spring, an horizontal static load of 150 gr (1.5N) was applied, both at molar level in the mesial direction and at interproximal level between the canine and the lateral incisor in the distal direction. Results: Although a slight tendency to increase the displacement of the molar with the presence of Mops was observed, there were no major variations in relation to the magnitudes of displacement or tensions between the different models. Conclusions: From the biomechanical point of view, there are no obvious differences in the values of stresses or displacement between the models analyzed.

Uso de herramientas de la Web 2. 0 en la metodología aula invertida: una opción para clases a distancia en tiempos de COVID-19 / Use of web 2. 0 Tools in the flipped classroom methodology: an option for distance learning

Background: The flipped classroom is an active method where information in delivered before class and the time allocated for it is dedicated to achieving more complex learning objectives. Diverse resources are used in each phase of the methodology. However, Web 2.0 or "Social Web" tools allow greater personal and remote interaction. Aim: To describe the perception about flipped classroom methodology implemented using web 2.0 tools in 48 medical students from the University Mayor. Material and Methods: The students were invited to view four video-classes available on Edpuzzl. During the activity, questions about the topic were inserted to promote understanding, research, and teamwork, then the topic was discussed using Case-Based Learning through the Quizizz program. A survey composed of 12 closed items and an open question was applied to analyze the perceptions of students. Data were analyzed using the SPSS and Atlas-Ti programs. Results: A high satisfaction rate was observed about the way in which the content, discussion and communication of the information was presented. The methodology encouraged the development of generic competences, but it was not always positively perceived. Conclusions: The flipped classroom methodology developed with Edpuzzle was very well evaluated by students. This teaching method may be particularly useful in the epidemiological context of COVID-19 and other situations which require distant learning.

Manejo médico quirúrgico de la enfermedad inflamatoria intestinal moderada-severa

El tratamiento de la enfermedad inflamatoria intestinal (EII) es principalmente médico, sin embargo, más del 70% de pacientes con enfermedad de Crohn (EC) y 25% con colitis ulcerativa (CU) requerirán cirugía. Objetivos: Evaluar el manejo médico- quirúrgico y evolución en pacientes con EII moderada-severa. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo de enero del 2011 a diciembre del 2019 en el Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, Lima-Perú. Resultados: Se incluyó 22 pacientes con EII, 17 con EC y 5 con CU. El 59% fueron masculinos. Se realizó cirugía de emergencia en el 35,2% y el 60% de los pacientes con EC y CU respectivamente. La estenosis y el megacolon tóxico fueron las indicaciones más frecuentes. Según el tipo de cirugía, la hemicolectomía (41%) y la resección intestinal (41%) fueron las más frecuentemente realizadas en EC, mientras que, en CU fue la colectomía total (60%). Dentro de las complicaciones postquirúrgicas, las dehiscencias/fistulas y colecciones intraabdominales fueron las más frecuentemente reportadas en EC; mientras que, en CU fue la infección del sitio operatorio e íleo adinámico. Luego de cirugía, los biológicos y los 5-ASA asociados a inmunomodulador fueron el tratamiento más utilizados en EC y CU respectivamente. La mortalidad fue del 17,6% en EC y 60% en CU. Conclusiones: El tratamiento quirúrgico es una opción en el manejo de la EII moderada-severa. La cirugía de emergencia en EII continúa presentando una alta morbimortalidad.

The management of inflammatory bowel disease (IBD) is mainly medical, however, more than 70% of patients with Crohn's disease (CD) and 25% with ulcerative colitis (UC) will require surgery during their lifetime. Objective: To evaluate medical, surgical management and evolution in patients with moderate-to-severe IBD. Materials and methods: Observational, descriptive, retrospective study from January 2011 to December 2019 in the Gastroenterology Service of the Guillermo Almenara Irigoyen National Hospital, Lima-Peru. Results: Twenty two patients with IBD, 17 with CD and 5 with UC were included. Male predominance (59%). Emergency surgery was performed in 35.2% and 60% of patients with CD and UC, respectively. Stenosis and toxic megacolon were the most frequent indications. According to the type of surgery, hemicolectomy (41%) and intestinal resection (41%) were the most frequently performed in CD, while in UC it was total colectomy (60%). Among the postoperative complications, dehiscence/fistula and intra-abdominal collections were the most frequently reported in CD; whereas in UC it was surgical site infection and adynamic ileus. After surgery, biologics and 5-ASA associated with immunomodulator were the most used treatment in CD and UC, respectively. Mortality was 17.6% in CD and 60% in UC. Conclusions: Surgical treatment is an option in the management of moderate-to-severe IBD. Emergency surgery in IBD continues to have a high morbidity and mortality rate.

[Clinical-pathological characteristics and management of primary tumors of the small intestine of jejuno-ileal location]. / Características clínico-patológicas y manejo de tumores primarios de intestino delgado de localización yeyuno-ilea.

INTRODUCTION: Primary tumors of the small intestine (PTID) represent approximately 5% of all primary gastrointestinal neoplasms; the latter include benign and malignant lesions, with different histological subtypes. OBJECTIVE: To describe the clinical-pathological characteristics and the management of tumors located in the jejunum-ileum. MATERIALS AND METHODS: A descriptive, retrospective study was carried out in a single center. RESULTS: 45 patients were included, the average age at diagnosis was 54.2 ± 8.2 years. 27 were male (60%). In the diagnostic algorithm, computed tomography was used in all patients, double-balloon enteroscopy in 41 (91.1%) and video capsule endoscopy in 32 (71.1%). Endoscopic procedures such as: biopsies, tattoos, resection and dilation were performed in 40 (88.9%), 39 (86.7%), 4 (8.9%) and 1 (2.2%) patients, respectively. The most frequent location was the jejunum in 39 (86%). GIST was confirmed in 18 (40%), followed by lymphoma in 16 (35.6%) and adenocarcinoma in 5 (11%) cases. All GIST, adenocarcinoma, and neuroendocrine tumors underwent surgical treatment and chemotherapy; treatment of lymphomas consisted mainly of combined treatment; three harmartomas and one fibroangiolipoma were resected endoscopically. CONCLUSIONS: The most frequent jejunoileal small intestine tumors were GISTs, followed by lymphomas and adenocarcinomas. Double-balloon enteroscopy was the main diagnostic and therapeutic tool.

[Epidemiology and phenotype of Crohn's disease in a reference hospital in Lima - Peru]. / Epidemiología y fenotipo de la enfermedad de Crohn en un hospital de referencia en Lima - Perú.

Crohn's disease (CD) is a chronic inflammatory pathology of the digestive tract with great impact on the quality of life of patients. Global epidemiology is changing in recent years and its prevalence is increasing in Latin America. OBJECTIVE: To evaluate the epidemiological characteristics, phenotype, clinical course, diagnosis and treatment of CD. MATERIALS AND METHODS: Retrospective, descriptive, observational study of patients diagnosed with CD from January 2004 to December 2019 in the gastroenterology service of the Guillermo Almenara Irigoyen National Hospital, Lima-Peru. RESULTS: 55 patients with an average age of 56 ± 8.2 years were included. Male predominance (62%). The average diagnosis time was 18 ± 6.1 months. The most frequent symptoms were: abdominal pain 72.7% and weight loss 60%. Extraintestinal manifestations occurred in 20%. The ileal location (36.4%) was the most frequent, followed by colonic (32.7%). The inflammatory phenotype predominated in half of the patients, followed by stenosing in 25.5%. The most frequent activity clinical and endoscopic was moderate. For induction and maintenance treatment, systemic corticosteroids and biological therapy with anti-TNF were the most widely used, respectively. Approximately a third of patients required surgery during the evolution of the disease. Mortality was 5.4%. CONCLUSIONS: CD is an increasingly frequent disease in our country, with epidemiological and phenotypic characteristics that differ from other continents.

Significancia clínica de la presencia de granulomas en enfermedad de Crohn / Clinical significance of the presence of granulomas in Crohn's disease

RESUMEN Los granulomas epitelioides son hallazgos característicos de un grupo de pacientes con enfermedad de Crohn (EC), pero su significancia con respecto a la severidad y progresión de la enfermedad es aún incierta. Objetivo: Evaluar las características clínicas de los pacientes con EC en relación a la presencia o no de granulomas en los hallazgos histológicos. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo en pacientes con diagnóstico de EC desde enero 2004 a diciembre 2019 en el servicio de gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, Lima-Perú. Resultados: Se incluyó 55 pacientes con media de edad de 56 ± 8,2 años. La mediana de tiempo de enfermedad fue de 16 meses. Tener dos o más recaídas al año (p<0,001; OR= 9,75), edad menor a 30 años (p<0,001; OR=3,57) y un CDAI moderado a severo (≥220 puntos, OR= 11,4; p<0,008) se asoció significativamente con la presencia de granulomas. La actividad endoscópica severa (p<0,003; OR= 9,91) y el fenotipo estenosante-penetrante (p<0,001; OR= 22,1) también mostraron asociación con la presencia de granulomas. El grupo de granulomas presentó mayor probabilidad de uso de corticoides (p<0,024; OR= 3,92) e inmunomodulador (p<0,001; OR= 7,10) además de necesidad de cirugía de resección intestinal (p< 0,027; OR: 5,07). Conclusiones: La presencia de granulomas en EC podría asociarse a mayor severidad clínica, endoscópica, requerimiento de terapia inmunosupresora y mayor necesidad de resección intestinal.

ABSTRACT Epithelioid granuloma is a characteristic histological feature of Crohn's disease (CD), but their significance with respect to the severity and progression of the disease is still uncertain. Objective: To evaluate the clinical characteristics of CD patients in relation to the presence or not of granulomas in histological findings. Materials and methods: An observational, descriptive, retrospective study in patients diagnosed with CD from January 2004 to December 2019 in the gastroenterology department of the Guillermo Almenara Irigoyen National Hospital, Lima-Peru. Results: 55 patients were included. Average age of 56 ± 8.2 years. The median time of disease was 16 months. Have two or more relapses per year (p<0.001; OR=9.75), age less than 30 years (p<0.001; OR=3.57) and a moderate to severe CDAI (≥220 points, OR=11.4, p <0.008) was significantly associated with the presence of granulomas. Severe endoscopic activity (p <0.003; OR=9.91) and the stenosing-penetrating phenotype (p<0.001; OR=22.1) also showed association with the presence of granulomas. The group of granulomas had a higher probability of corticosteroid use (p <0.024; OR=3.92) and immunomodulator (p <0.001; OR=7.10), besides the need for intestinal resection surgery (p<0.027; OR=5.07). Conclusions: The presence of granulomas in CD may be associated with increased clinical severity, endoscopic severity, immunosuppressive therapy requirement and undergo for intestinal resection.

[Clinical-pathological characteristics and endoscopic management of colonic sessile serrated lesions in a reference hospital in Lima - Peru]. / Características clínico-patológicas y manejo endoscópico de lesiones serradas sésiles de colon en un hospital de referencia en Lima - Perú.

Colorectal cancer (CRC) is one of the most frequent worldwide. Approximately one third of cases originate from the serrated pathway of carcinogenesis, with colonic sessile serrated lesions (SSL) being the main cause of interval CRC. OBJECTIVE: To evaluate the clinical, endoscopic, histological characteristics and endoscopic management of colonic LSS. MATERIALS AND METHODS: Observational, descriptive, retrospective study from July 2017 to June 2019 in the gastroenterology service of the Guillermo Almenara Irigoyen National Hospital, Lima - Peru. The characteristics of 79 LSS were evaluated, the chi-square statistic was used to analyze the association of clinical and endoscopic variables with the presence of dysplasia; and the size of the lesion with the type of endoscopic resection. RESULTS: In 74 patients, 79 SSL were found, 67 (84.8%) with dysplasia (44 high-grade and 23 low-grade). Average age of 52 years and 44 (59.4%) were males. The location in the right colon (OR=5.09, 95% CI 1.38â€"18.7, p=0.009), the size >10 mm (OR=6.13, 95% CI 1.50â€"24,94, p=0.014) and the â€Å“blurred edges†(OR=5.08, 95% CI 1.17-21.98, p=0.019), are significantly related to the presence of dysplasia. SSL smaller than 20 mm showed statistical association with bloc resection (OR=69.3, 95% CI 7.35-653.9, p <0.001) with respect to the piecemeal resection. CONCLUSIONS: The finding of SSL during colonoscopies is frequent. The location, size and finding of blurred edges are related to the presence of dysplasia. Mucosal endoscopic resection was a safe and effective technique.

Epidemiología y fenotipo de la enfermedad de Crohn en un hospital de referencia en Lima Perú / Epidemiology and phenotype of Crohn's disease in a reference hospital in Lima Peru

RESUMEN La enfermedad de Crohn (EC) es una patología inflamatoria crónica del tracto digestivo con gran impacto en la calidad de vida de los pacientes. La epidemiología mundial está cambiando en los últimos años y su prevalencia está aumentando en Latinoamérica. Objetivo: Evaluar las características epidemiológicas, fenotipo, curso clínico, diagnóstico y tratamiento de la EC. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo de pacientes con diagnóstico de EC desde enero 2004 a diciembre 2019 en el servicio de gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, LimaPerú. Resultados: Se incluyó 55 pacientes, con edad promedio de 56 ± 8,2 años. Predominio masculino (62%). El tiempo promedio de diagnóstico fue de 18 ± 6,1 meses. Los síntomas más frecuentes fueron: dolor abdominal 72,7% y baja de peso 60%. Las manifestaciones extraintestinales se presentaron en 20%. La localización ileal (36,4%) fue la más frecuente, seguida de la colónica (32,7%). Predominó el fenotipo inflamatorio en la mitad de los pacientes, seguido de estenosante en 25,5%. La actividad clínica y endoscópica más frecuente fue moderada. Para el tratamiento de inducción y mantenimiento, los corticoides sistémicos y la terapia biológica con anti-TNF fueron los más utilizados respectivamente. Aproximadamente un tercio de pacientes requirieron cirugía durante la evolución de la enfermedad. La mortalidad fue del 5,4%. Conclusiones: La EC es una enfermedad cada vez más frecuente en nuestro país, con características epidemiológicas y fenotípicas que difieren de otros continentes.

ABSTRACT Crohn's disease (CD) is a chronic inflammatory pathology of the digestive tract with great impact on the quality of life of patients. Global epidemiology is changing in recent years and its prevalence is increasing in Latin America. Objective: To evaluate the epidemiological characteristics, phenotype, clinical course, diagnosis and treatment of CD. Materials and methods: Retrospective, descriptive, observational study of patients diagnosed with CD from January 2004 to December 2019 in the gastroenterology service of the Guillermo Almenara Irigoyen National Hospital, Lima-Peru. Results: 55 patients with an average age of 56 ± 8.2 years were included. Male predominance (62%). The average diagnosis time was 18 ± 6.1 months. The most frequent symptoms were: abdominal pain 72.7% and weight loss 60%. Extraintestinal manifestations occurred in 20%. The ileal location (36.4%) was the most frequent, followed by colonic (32.7%). The inflammatory phenotype predominated in half of the patients, followed by stenosing in 25.5%. The most frequent activity clinical and endoscopic was moderate. For induction and maintenance treatment, systemic corticosteroids and biological therapy with anti-TNF were the most widely used, respectively. Approximately a third of patients required surgery during the evolution of the disease. Mortality was 5.4%. Conclusions: CD is an increasingly frequent disease in our country, with epidemiological and phenotypic characteristics that differ from other continents.

[Loss of response to anti-TNF therapy in inflammatory bowel disease: experience in a reference hospital in Lima - Peru]. / Pérdida de respuesta a terapia anti-TNF en enfermedad inflamatoria intestinal: experiencia en un hospital de referencia en Lima - Perú.

OBJECTIVE: To evaluate the response to treatment with anti-TNFs in patients with inflammatory bowel disease. MATERIALS AND METHODS: Prospective observational study conducted in the Gastroenterology service of the Guillermo Almenara National Hospital, from January 2015 to August 2018. RESULTS: 31 patients with inflammatory bowel disease who received maintenance therapy with Infliximab were evaluated. Twelve (38.7%) patients (3 with ulcerative colitis and 9 with Crohn's disease) presented loss of response after 6 months of the beginning of the maintenance phase: 2 between 6-12 months, 4 between 12-18 months and 6 between 18- 24 months. As a first step, the dose was doubled (10 mg/kg) to the 12 patients, obtaining a response in 6 (50%) after 12 weeks. Of the remaining 6 patients, 4 switched to Adalimumab, 1 patient presented colon cancer and 1 patient presented anaphylaxis and sarcoidosis. Of the patients who received Adalimumab, 3 had endoscopic recurrence (75%) after 6 months and 1 did not respond to induction therapy and was subjected to colectomy (25%). CONCLUSIONS: Approximately one third of our patients presented loss of response to maintenance therapy with Infliximab. The dose escalation as a rescue therapy was successful in half of the patients. The change to Adalimumab in patients with loss of response to a first anti-TNF drug does not seem to be effective.

Características clínico-patológicas y manejo endoscópico de lesiones serradas sésiles de colon en un hospital de referencia en Lima - Perú / Clinical-pathological characteristics and endoscopic management of colonic sessile serrated lesions in a reference hospital in Lima - Peru

RESUMEN El cáncer colorrectal (CCR) es uno de los más frecuentes a nivel mundial. Aproximadamente un tercio de los casos se originan por la vía serrada de carcinogénesis, siendo las lesiones serradas sésiles (LSS) de colon, una las principales responsables del CCR de intervalo. Objetivo: Evaluar las características clínicas, endoscópicas, histológicas y el manejo endoscópico de las LSS de colon. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo de julio del 2017 a junio del 2019 en el servicio de gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, Lima - Perú. Se evaluó las características de 79 LSS, se utilizó el estadístico chi-cuadrado para analizar la asociación de variables clínicas y endoscópicas con la presencia de displasia; y el tamaño de la lesión con el tipo de resección endoscópica. Resultados: En 74 pacientes se halló 79 LSS, 67 (84,8%) con displasia (44 de alto grado y 23 de bajo grado). Edad media de 52 años y 44 (59,4%) fueron varones. La localización en colon derecho (OR=5,09, IC 95% 1,38-18,7, p= 0,009), el tamaño >10 mm (OR=6,13/IC 95%/1,50-24,94/ p=0,014) y los "bordes borrosos" (OR=5,08, IC 95% 1,17-21,98, p=0,019), se relacionan de manera significativa con la presencia de displasia. Las LSS menores a 20 mm mostraron asociación estadística con la resección en bloque (OR=69,3, IC 95% 7,35-653,9, p<0,001) respecto a la piecemeal. Conclusiones: El hallazgo de LSS durante colonoscopías es frecuente. La localización, el tamaño y el hallazgo de bordes borrosos se relacionan con la presencia de displasia. La resección endoscópica mucosa fue una técnica segura y efectiva.

ABSTRACT Colorectal cancer (CRC) is one of the most frequent worldwide. Approximately one third of cases originate from the serrated pathway of carcinogenesis, with colonic sessile serrated lesions (SSL) being the main cause of interval CRC. Objective: To evaluate the clinical, endoscopic, histological characteristics and endoscopic management of colonic LSS. Materials and methods: Observational, descriptive, retrospective study from July 2017 to June 2019 in the gastroenterology service of the Guillermo Almenara Irigoyen National Hospital, Lima - Peru. The characteristics of 79 LSS were evaluated, the chi-square statistic was used to analyze the association of clinical and endoscopic variables with the presence of dysplasia; and the size of the lesion with the type of endoscopic resection. Results: In 74 patients, 79 SSL were found, 67 (84.8%) with dysplasia (44 high-grade and 23 low-grade). Average age of 52 years and 44 (59.4%) were males. The location in the right colon (OR=5.09, 95% CI 1.38-18.7, p=0.009), the size >10 mm (OR=6.13, 95% CI 1.50-24,94, p=0.014) and the "blurred edges" (OR=5.08, 95% CI 1.17-21.98, p=0.019), are significantly related to the presence of dysplasia. SSL smaller than 20 mm showed statistical association with bloc resection (OR=69.3, 95% CI 7.35-653.9, p <0.001) with respect to the piecemeal resection. Conclusions: The finding of SSL during colonoscopies is frequent. The location, size and finding of blurred edges are related to the presence of dysplasia. Mucosal endoscopic resection was a safe and effective technique.

Pérdida de respuesta a terapia anti-TNF en enfermedad inflamatoria intestinal: experiencia en un hospital de referencia en Lima - Perú / Loss of response to anti-TNF therapy in inflammatory bowel disease: experience in a reference hospital in Lima - Peru

RESUMEN Objetivo: Evaluar la respuesta al tratamiento con anti-TNFs en pacientes con enfermedad inflamatoria intestinal. Materiales y métodos: Estudio prospectivo observacional realizado en el Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara, de enero 2015 a agosto 2018. Resultados: Se evaluó 31 pacientes con enfermedad inflamatoria intestinal que recibían terapia de mantenimiento con Infliximab. Doce (38,7%) pacientes (3 con colitis ulcerativa y 9 con enfermedad de Crohn) presentaron pérdida de respuesta a partir de los 6 meses del inicio de la fase de mantenimiento: 2 entre 6-12 meses, 4 entre 12-18 meses y 6 entre 18-24 meses. Como primera medida se duplicó la dosis (10 mg/kg) a los 12 pacientes, obteniendo respuesta en 6 (50%) luego de 12 semanas. De los 6 pacientes restantes, 4 cambiaron a Adalimumab, 1 paciente presentó cáncer de colon y 1 paciente presentó anafilaxia y sarcoidosis. De los pacientes que recibieron Adalimumab, 3 presentaron recidiva endoscópica (75%) a partir de los 6 meses y 1 no respondió a la terapia de inducción y fue sometido a colectomía (25%). Conclusiones: Aproximadamente un tercio de nuestros pacientes presentó pérdida de respuesta a terapia de mantenimiento con Infliximab. El escalamiento de dosis como rescate tuvo éxito en la mitad de los pacientes. El cambio a Adalimumab en pacientes con pérdida de respuesta a un primer fármaco anti-TNF no parece ser efectivo.

ABSTRACT Objective: To evaluate the response to treatment with anti-TNFs in patients with inflammatory bowel disease. Materials and methods: Prospective observational study conducted in the Gastroenterology service of the Guillermo Almenara National Hospital, from January 2015 to August 2018. Results: 31 patients with inflammatory bowel disease who received maintenance therapy with Infliximab were evaluated. Twelve (38.7%) patients (3 with ulcerative colitis and 9 with Crohn's disease) presented loss of response after 6 months of the beginning of the maintenance phase: 2 between 6-12 months, 4 between 12-18 months and 6 between 1824 months. As a first step, the dose was doubled (10 mg/kg) to the 12 patients, obtaining a response in 6 (50%) after 12 weeks. Of the remaining 6 patients, 4 switched to Adalimumab, 1 patient presented colon cancer and 1 patient presented anaphylaxis and sarcoidosis. Of the patients who received Adalimumab, 3 had endoscopic recurrence (75%) after 6 months and 1 did not respond to induction therapy and was subjected to colectomy (25%). Conclusions: Approximately one third of our patients presented loss of response to maintenance therapy with Infliximab. The dose escalation as a rescue therapy was successful in half of the patients. The change to Adalimumab in patients with loss of response to a first anti-TNF drug does not seem to be effective.

[Clinical significance of the presence of granulomas in Crohn's disease]. / Significancia clínica de la presencia de granulomas en enfermedad de Crohn.

Epithelioid granuloma is a characteristic histological feature of Crohn's disease (CD), but their significance with respect to the severity and progression of the disease is still uncertain. OBJECTIVE: To evaluate the clinical characteristics of CD patients in relation to the presence or not of granulomas in histological findings. MATERIALS AND METHODS: An observational, descriptive, retrospective study in patients diagnosed with CD from January 2004 to December 2019 in the gastroenterology department of the Guillermo Almenara Irigoyen National Hospital, Lima-Peru. RESULTS: 55 patients were included. Average age of 56 ± 8.2 years. The median time of disease was 16 months. Have two or more relapses per year (p<0.001; OR=9.75), age less than 30 years (p<0.001; OR=3.57) and a moderate to severe CDAI (≥220 points, OR=11.4, p <0.008) was significantly associated with the presence of granulomas. Severe endoscopic activity (p <0.003; OR=9.91) and the stenosing-penetrating phenotype (p<0.001; OR=22.1) also showed association with the presence of granulomas. The group of granulomas had a higher probability of corticosteroid use (p <0.024; OR=3.92) and immunomodulator (p <0.001; OR=7.10), besides the need for intestinal resection surgery (p<0.027; OR=5.07). CONCLUSIONS: The presence of granulomas in CD may be associated with increased clinical severity, endoscopic severity, immunosuppressive therapy requirement and undergo for intestinal resection.

Impact of the First Archwires Placement on the Everyday Activities of Orthodontics Patients / Impacto de la Instalación de los Primeros Arcos en las Actividades de Vida Diaria en Pacientes de Ortodoncia

ABSTRACT: Orthodontic treatment (OT) is essential for the aesthetic and functional rehabilitation of the chewing apparatus, however it may lead to certain complications which can have a negative impact on patients' everyday lives. The study included patients of the Dental Teaching Clinic of Universidad de La Frontera who were undergoing OT for the first time, with the placement of their first orthodontic arch. To analyse the impact of the placement of the first arches on everyday activities (EDA), patients completed a questionnaire with questions relating to their oral condition, including: functional limitation, physical impairment, psychological malaise, physical pain and oral hygiene. The impact on EDAs was classified as high, moderate or low. The chisquared test, Student's t-test and Spearman's coefficient were applied, using a significance threshold of 5 %. Statistical analysis used the SPSS software, v. 22.0. The variables were analysed by sex and age-band. Difficulty in brushing their teeth, eating and speaking were the limitations on EDAs most frequently reported by the patients. Females presented higher scores than males (p=0.003), showing that they suffer a greater negative impact on EDAs than do males. The majority of the patients presented a low impact on EDAs after the placement of their first orthodontic arches. Physical pain after installation, and difficulty in adapting to the orthodontic apparatus were factors determining a negative impact on EDAs, affecting sleep, speech, eating and oral hygiene of patients after starting OT.

RESUMEN: El tratamiento ortodóntico (TO) es esencial para la rehabilitación estética y funcional del aparato masticatorio, sin embargo puede determinar algunas complicaciones que pueden impactar negativamente en la vida diaria de los pacientes. Fueron incluidos pacientes de la Clínica Odontológica Docente Asistencial de la Universidad de La Frontera que realizaban tratamiento ortodóntico por primera vez, con instalación del primer arco ortodóntico. Para análisis del impacto de la instalación de los primeros arcos en las actividades de vida diaria (AVD), los pacientes llenaron un cuestionario con preguntas relacionadas a su condición oral, incluyendo: limitación funcional, incapacidad física, incapacidad psicológica, dolor físico e higiene oral. El impacto en las AVDs fueclasificado como alto, moderado y bajo. Para análisis estadístico se utilizó el software SPSS v. 22.0. Fueron aplicadas las pruebas de chi-cuadrado, t-student y Spearman's coefficient, considerándose umbral de significación de 5 %. Para análisis estadístico se utilizó el software SPSS v. 22.0. Las variables fueron analizadas según sexos y rangos etarios. Dificultad para cepillar los dientes, para comer y hablar fueron las limitaciones en las AVDs más frecuentemente reportadas por los pacientes. Las mujeres presentaron mayores puntajes en relación a los hombres (p=0,003), lo que demostró que presentan mayor impacto negativo en las AVDs en relación a los hombres. La mayoría de los pacientes presentaron bajo impacto en las AVDs tras la instalación de los primeros arcos de ortodoncia. El dolor físico tras instalación y la dificultad en la adaptación con el aparato ortodóntico fueron factores que determinaron impacto negativo en las AVDs, afectando el sueño, el habla, la alimentación y la higiene oral de los pacientes que iniciaron el TO.

[Evaluation of endoscopic and histological activity as predictors of clinical relapse in ulcerative colitis]. / Evaluación de actividad endoscópica e histológica como predictores de recaída clínica en colitis ulcerativa.

Ulcerative colitis is a chronic inflammatory disease characterized by a recurrent and remitting course. Clinical remission and mucosal healing are the current therapeutic goals in management. The histological remission could be a better objective because of its prognostic impact. OBJECTIVE: To evaluate endoscopic and histological activity as predictors of clinical relapse in patients with ulcerative colitis. MATERIALS AND METHODS: Prospective descriptive study conducted from January 2015 to June 2018 at Guillermo Almenara Irigoyen National Hospital. Thirty-three patients diagnosed with ulcerative colitis who presented clinical remission after a flare were evaluated. Endoscopic remission was assessed (Mayo Score ≤1) after 6 months of follow- up with ileocolonoscopy and rectosigmoid biopsies. Histological remission was defined as score < 2 in the Simplified Geboes Score (SGS). Follow-up was performed for one year to observe relapses. RESULTS: 26 (78.8%) patients achieved endoscopic remission at 6 months (mean age 53 years, males 57.7%). Histological remission was observed in 69.2% (18/26). After 1 year of follow-up, 83.3% (15/18) of the patients who presented clinical, endoscopic and histological remission remained clinically asymptomatic. The RR of clinical relapse at one year was 3,18 (95% IC, 1,58-6,42, p=0,004) in patients without endoscopic remission and 4 (95% IC, 1,34-11,94, p=0,003) in patients without histological remission. CONCLUSIONS: Histological activity could be a better predictor of relapse compared to endoscopic remission, and should be the final therapeutic objective in the management of patients with ulcerative colitis.

Effects of low-level laser on the repair of orthodontically induced inflammatory root resorption: a systematic review of studies in rats / Efectos del láser de bajo nivel en la reparación de la reabsorción radicular inflamatoria inducida por ortodoncia: una revisión sistemática de estudios en ratas

Orthodontically induced inflammatory root resorption (OIIRR) is a complication of dental treatment which consists of the degradation of local tissue due to an inflammatory reaction provoked by inappropriate orthodontic stimulus. The aim of the present systematic review was to assess the effectiveness of low-level laser therapy (LLLT) in reducing orthodontically induced inflammatory root resorption (OIIRR) in animal models. A systematic review was carried out in the MEDLINE, EMBASE and LILACS databases. Studies of interventions in animals were selected which analysed the effect of LLLT on OIIRR repair. The risk of bias was analysed through the 10 domains of the SYRCLE RoB tool for animal studies. Seventy-one studies were found; 27 were eliminated as duplicates and 44 titles/abstracts were analysed. Of these, 38 were excluded, and five studies were included for qualitative analysis. In 66.6 % of the studies included, the authors state that LLLT was effective in the inhibition/repair of OIIRR. In histological analysis it was observed that root resorption was significantly less in animals treated with laser as compared to the control. Furthermore, LLLT accelerated cicatrization after OIIRR. Laser proved effective in reducing root resorption lacunae and shortening the inflammatory process induced by the application of orthodontic force.

La resorción radicular inflamatoria inducida por tratamiento ortodontico (RRIITO) es una complicación del tratamiento odontológico que consiste en la degradación del tejido local debido a una reacción inflamación provocada por un estímulo ortodóntico inadecuado. El objetivo fue analizar la efectividad de la terapia láser de baja intensidad (LBI) en la disminución de RRIITO en ratas. Se realizó una revisión sistemática en las bases MEDLINE, EMBASE y LILACS. Fueron utilizados los términos 'resorción radicular', 'láser de baja intensidad', 'fototerapia', 'tratamiento ortodóntico', 'movimiento dental'. Fueron seleccionados estudios de intervención en animales, que analizaron el efecto del LBI en la reparación de la RRIITO. Los riesgos de sesgos fueron analizados mediante los 10 domínios de la herramienta SYRCLE RoB para estudios en animales. 71 estudios fueron encontrados, siendo eliminados 27 duplicados, y analizados 44 títulos/abstracts; de estos, fueron incluídos 5 estudios para análisis cualitativa. El 66,6 % de los estudios incluidos afirman que el LBI fue efectivo em reparar la RRIITO. En el análisis histológico se observó que la RRIITO fue significativamente menor en animales tratados con láser en comparación con el control. Además de eso, el LBI aceleró el proceso de cicatrización de la RRIITO. El láser se mostró efectivo en reducir las lagunas de resorción radicular y acortar el proceso inflamatorio inducido por la aplicación de fuerzas ortodonticas.

Evaluación de actividad endoscópica e histológica como predictores de recaída clínica en colitis ulcerativa

La colitis ulcerativa es una enfermedad inflamatoria crónica caracterizada por un curso recurrente y remitente. La remisión clínica y curación mucosa son los objetivos terapéuticos actuales en el manejo. La remisión histológica podría ser un mejor objetivo por su impacto pronóstico. Objetivo: Evaluar la actividad endoscópica e histológica como predictores de recaída clínica en colitis ulcerativa. Materiales y métodos: Estudio descriptivo prospectivo realizado desde enero 2015 a junio 2018 en el Hospital Nacional Guillermo Almenara Irigoyen. Se evaluaron 33 pacientes con diagnóstico de colitis ulcerativa que presentaron remisión clínica luego de un brote. Se valoró la remisión endoscópica (score de Mayo ≤1) luego de 6 meses de seguimiento con ileocolonoscopía y toma de biopsias rectosigmoideas. Se definió remisión histológica, como puntaje < 2 en el score simplificado de Geboes (SSG). Se realizó seguimiento durante un año para observar recaídas. Resultados: 26 (78,8%) pacientes lograron remisión endoscópica a los 6 meses (edad promedio 53 años; varones 57,7%). Se observó remisión histológica en 69,2% (18/26). Luego de 1 año de seguimiento, el 83,3% (15/18) de los pacientes que presentaron remisión clínica, endoscópica e histológica permanecieron clínicamente asintomáticos. El RR de recaída clínica al año fue 3,18 (95% IC, 1,58-6,42, p=0,004) en los pacientes sin remisión endoscópica y 4 (95% IC, 1,34-11,94, p=0,003) en los pacientes sin remisión histológica. Conclusiones: La actividad histológica podría ser mejor predictor de recaída respecto a la actividad endoscópica. La remisión histológica debería ser el objetivo terapéutico final en el manejo de pacientes con colitis ulcerativa.

Ulcerative colitis is a chronic inflammatory disease characterized by a recurrent and remitting course. Clinical remission and mucosal healing are the current therapeutic goals in management. The histological remission could be a better objective because of its prognostic impact. Objective: To evaluate endoscopic and histological activity as predictors of clinical relapse in patients with ulcerative colitis. Materials and methods: Prospective descriptive study conducted from January 2015 to June 2018 at Guillermo Almenara Irigoyen National Hospital. Thirty-three patients diagnosed with ulcerative colitis who presented clinical remission after a flare were evaluated. Endoscopic remission was assessed (Mayo Score ≤1) after 6 months of follow- up with ileocolonoscopy and rectosigmoid biopsies. Histological remission was defined as score < 2 in the Simplified Geboes Score (SGS). Follow-up was performed for one year to observe relapses. Results: 26 (78.8%) patients achieved endoscopic remission at 6 months (mean age 53 years, males 57.7%). Histological remission was observed in 69.2% (18/26). After 1 year of follow-up, 83.3% (15/18) of the patients who presented clinical, endoscopic and histological remission remained clinically asymptomatic. The RR of clinical relapse at one year was 3,18 (95% IC, 1,58-6,42, p=0,004) in patients without endoscopic remission and 4 (95% IC, 1,34-11,94, p=0,003) in patients without histological remission. Conclusions: Histological activity could be a better predictor of relapse compared to endoscopic remission, and should be the final therapeutic objective in the management of patients with ulcerative colitis.