Latin America consensus statement inflammatory bowel disease: importance of timely access to diagnosis and treatment.

Background: Inflammatory bowel diseases (IBDs) are chronic conditions that negatively interferes with the quality of life of the patients, on a physical, emotional, and social level. Its symptoms can vary including diarrhea, bleeding, abdominal pain, fever, and weight loss, depending on the type and location and severity of the disease. Despite evolving treatment, they do not always achieve control of the symptoms, so between 23% and 45% of people with idiopathic chronic ulcerative colitis, and up to 75% of those with Crohn's disease, eventually, will need surgery. Objective: The increase in its incidence in Latin America has promoted a renewed interest on the part of the medical and scientific community in standardizing and unifying criteria for the proper diagnosis and management of the disease, which is part of the current discussions of various events; however, this interest has not yet been reflected in policies and initiatives by governments to address the disease. We decided to develop a consensus meeting in order to elucidate the actual situation of IBD care in our region. Design: The methodology employed to build the consensus document derived from a review of literature, evidence, and policies on IBD, followed by a process of validation and feedback with a group of 10 experts in the field. Methods: Nine experts from different countries in Latin America were reunited in web meetings on 2 days and voted on topics derived from the consensus document. A full agreement with 100% approval was needed, so topics were discussed to reach the consensus otherwise were removed. Results: There is still a lack of information about IBD in Latin America, therefore IBD continues to be an 'invisible' disease and is little recognized by decision-makers. Conclusion: This document describes the current situation of IBDs in the Latin American region, highlighting the main barriers and challenges in timely access to diagnosis and treatment, in order to demonstrate the need to promote the development and implementation of policies, in order to improve the quality of care of patients with IBD.

GADECCU 2022 Guideline for the treatment of Ulcerative Colitis. Adaptation and updating of the GETECCU 2020 Guideline. / Guía GADECCU 2022 para el tratamiento de la colitis ulcerosa. Adaptación y actualización de la Guía GETECCU 2020.

INTRODUCTION: Ulcerative colitis (UC) is a chronic inflammatory disease that compromises the colon, affecting the quality of life of individuals of any age. In practice, there is a wide spectrum of clinical situations. The advances made in the physio pathogenesis of UC have allowed the development of new, more effective and safer therapeutic agents. OBJECTIVES: To update and expand the evaluation of the efficacy and safety of relevant treatments for remission induction and maintenance after a mild, moderate or severe flare of UC. RECIPIENTS: Gastroenterologists, coloproctologists, general practitioners, family physicians and others health professionals, interested in the treatment of UC. METHODOLOGY: GADECCU authorities obtained authorization from GETECCU to adapt and update the GETECCU 2020 Guide for the treatment of UC. Prepared with GRADE methodology. A team was formed that included authors, a panel of experts, a nurse and a patient, methodological experts, and external reviewers. GRADE methodology was used with the new information. RESULTS: A 118-page document was prepared with the 44 GADECCU 2022 recommendations, for different clinical situations and therapeutic options, according to levels of evidence. A section was added with the new molecules that are about to be available. CONCLUSIONS: This guideline has been made in order to facilitate decision-making regarding the treatment of UC, adapting and updating the guide prepared by GETECCU in the year 2020.

Probiotic lactobacilli as a promising strategy to ameliorate disorders associated with intestinal inflammation induced by a non-steroidal anti-inflammatory drug.

Damage to the small intestine caused by non-steroidal anti-inflammatory drugs (NSAIDs) occurs more frequently than in the upper gastrointestinal tract, is more difficult to diagnose and no effective treatments exist. Hence, we investigated whether probiotics can control the onset of this severe condition in a murine model of intestinal inflammation induced by the NSAID, indomethacin. Probiotic supplementation to mice reduce the body weight loss, anemia, shortening of the small intestine, cell infiltration into the intestinal tissue and the loss of Paneth and Goblet cells associated with intestinal inflammation. Furthermore, a high antimicrobial activity in the intestinal fluids of mice fed with probiotics compared to animals on a conventional diet was elicited against several pathogens. Interestingly, probiotics dampened the oxidative stress and several local and systemic markers of an inflammatory process, as well as increased the secretion of IL-10 by regulatory T cells. Even more importantly, probiotics induced important changes in the large intestine microbiota characterized by an increase in anaerobes and lactobacilli, and a significant decrease in total enterobacteria. We conclude that oral probiotic supplementation in NSAID-induced inflammation increases intestinal antimicrobial activity and reinforces the intestinal epithelial barrier in order to avoid pathogens and commensal invasion and maintain intestinal homeostasis.

Extensive mesenteric lipodystrophy of the left colon: case report and brief review of the literature.

Mesenteric lipodystrophy is a rare inflammatory process that predominantly affects mesenteric adipose tissue of the small bowell. Several mechanisms have been suggested as responsible for this entity although the precise etiolog remains unknown. The diagnosis is based on CT or MRI imaging and generally confirmed by surgical biopsies. Treatment is individualized and empiric and depends on disease stage and symptoms. We report a case of a 35-year-old male who was admitted to our hospital with a history of abdominal pain, constipation and a palpable mass in the left lower quadrant. Abdominal CT scan showed diffuse thickening of the descending and rectosigmoid colon, associated with increased density of the mesenteric fat. After failure ofan initial treat- ment with glucocorticoids, he underwent a laparoscopic sigmoidectomy. Histopatholog analysis revealed extensive stea- tonecrosis ofpericolonicfat and lipid-ladenfoamy cells which was consistent with the diagnosis of mesenteric lipodystrophy. Clinical presentation and treatment as well as a brief review of the literature are discussed.

Risk of fracture in celiac disease: gender, dietary compliance, or both?

AIM: To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture risk. METHODS: We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age- and sex-matched controls who had been diagnosed with functional gastrointestinal disorders. Data were collected through in-person interviews with an investigator. The overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis). RESULTS: Compared with the control group, the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR): 1.78, 95% CI: 1.23-2.56, P < 0.002] and in men (HR: 2.67, 95% CI: 1.37-5.22, P < 0.004). Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003). In the time period after diagnosis, the risk of fractures was comparable between the CD cohort and controls in both sexes (HR: 1.08, 95% CI: 0.55-2.10 for women; HR: 1.57, 95% CI: 0.57-4.26 for men). CONCLUSION: CD patients have higher prevalence of fractures in the peripheral skeleton before diagnosis. This is associated with male sex and classic clinical presentation. The fracture risk was reduced after the treatment.

Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation.

BACKGROUND/AIMS: functional constipation is a prevalent problem within the western population. There is evidence supporting the fact that the inclusion of pre and probiotics in the diet can favorably modify the intestinal function. The present study evaluates the effect of the consumption of Activia, a yogurt containing 10(8) UFC/g of Bifidobacterium animalis (DN-173 010) and fructoligosaccharide, in women between the ages of 18 and 55 with and without functional constipation (Rome II criteria). METHODS: after a stabilization and a basal period, women were randomized to receive 2 units/day of Activia or a lacteous dessert without probiotics (control) for a period of 14 days. Afterwards the groups were intercrossed for another 14 days. RESULTS: of the 399 women who started the study, 378 were eligible for study participation. In the group of women with functional constipation (n=266), the consumption of the symbiotic was associated with a higher bowel evacuation rate (6.1+/-2.7 depositions/week with Activia vs. 5.0+/-2.6 dep./week in the control group; P<0.01), an improvement in the quality of the stools according to the Bristol scale (3.6+/-1.0 vs. 3.4+/-1.0; P<0.01), a reduced perception of straining effort (1.9+/-0.8 vs. 2.2+/-0.9; P<0.01) and a reduced perception of pain associated with defecation (0.1+/-0.2 vs. 0.2+/-0.3; P<0.01). In the group of women without constipation (n=112) there were statistically significant variations in equal sense but of smaller magnitude, with the exception of pain which, having a very low value in the basal period, did not experience changes. CONCLUSION: the consumption of a symbiotic yogurt by women with functional constipation showed a significant improvement in the parameters related with bowel evacuation. The use of this symbiotic food can result in a useful and safe tool for managing constipation.

Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation / Efecto de la ingesta de un alimento simbiótico sobre el hábito evacuatorio en mujeres con constipación funcional

Background/aims: functional constipation is a prevalent problem within the western population. There is evidence supporting the fact that the inclusion of pre and probiotics in the diet can favorably modify the intestinal function. The present study evaluates the effect of the consumption of Activia®, a yogurt containing 108 UFC/g of Bifidobacterium animalis (DN-173 010) and fructoligosaccharide, in women between the ages of 18 and 55 with and without functional constipation (Rome II criteria). Methods: after a stabilization and a basal period, women were randomized to receive 2 units/day of Activia or a lacteous dessert without probiotics (control) for a period of 14 days. Afterwards the groups were intercrossed for another 14 days. Results: of the 399 women who started the study, 378 were eligible for study participation. In the group of women with functional constipation (n= 266), the consumption of the symbiotic was associated with a higher bowel evacuation rate (6.1±2.7 depositions/week with Activia vs. 5.0±2.6 dep./week in the control group; P<0.01), an improvement in the quality of the stools according to the Bristol scale (3.6±1.0 vs. 3.4±1.0; P<0.01), a reduced perception of straining effort (1.9±0.8 vs. 2.2±0.9; P<0.01) and a reduced perception of pain associated with defecation (0.1±0.2 vs. 0.2±0.3; P<0.01). In the group of women without constipation (n=112) there were statistically significant variations in equal sense but of smaller magnitude, with the exception of pain which, having a very low vavaluein the basal period, did not experience changes. Conclusion: the consumption of a symbiotic yogurt by women with functional constipation showed a significant improvement in the parameters related with bowel evacuation. The use of this symbiotic food can result in a useful and safe tool for managing constipation.

Introducción/objetivos: la constipación funcional es un problema prevalente en la población occidental. Existen evidencias de que la toma de alimentos pre y probióticos puede modificar favorablemente el hábito evacuatorio intestinal. En este trabajo se estudió el efecto de la ingesta de Activia®, un yogur conteniendo 10 8 UFC/g de Bifidobacterium animalis (DN-173 010) y un fructoligosacárido en mujeres de 18 a 55 años con y sin constipación funcional (criterios de Roma II). Métodos: luego de sendos períodos de estabilización y basal fueron aleatorizadas a recibir durante 14 días 2 unidades/día de Activia o de un postre lácteo sin probiótico ni prebiótico (control). Luego los grupos fueron entrecruzados durante otros 14 días. Resultados: de las 399 mujeres que iniciaron el estudio, 378 fueron evaluables. En el grupo de constipadas (n= 266) la toma del simbiótico se asoció con una mayor frecuencia evacuatoria (6,1±2,7 dep./semana con Activia vs. 5,0±2,6 dep./semana en controles; P<0,01), mejoría en la escala de Bristol de calidad de las heces (3,6±1,0 vs. 3,4±1,0; P<0,01), menor esfuerzo evacuatorio (1,9±0,8 vs. 2,2±0,9; P<0,01) y menor proporción de dolor evacuatorio (0,1±0,2 vs. 0,2±0,3 ; P<0,01). En el grupo sin constipación se observaron variaciones estadísticamente significativas en igual sentido pero de menor magnitud, con excepción del dolor que mostró un valor basal muy bajo. Conclusión: la ingesta del yogurt prebiótico en mujeres con constipación funcional mostró una mejoría significativa de los parámetros relacionados con la evacuación intestinal. La utilización de este alimento simbiótico puede resultar una herramienta útil y segura en el manejo de la constipación.

[Clinical course of inflammatory bowel disease in patients transplanted for primary sclerosing cholangitis]. / Evolución de la enfermedad inflamatoria intestinal en pacientes sometidos a trasplante hepático por colangitis esclerosante primaria.

UNLABELLED: Primary sclerosing cholangitis is frequently associated with inflammatory bowel disease. OBJECTIVE: to evaluate the evolution of IBD in patients transplanted for PSC and the incidence of severe dysplasia/carcinoma. PATIENTS AND METHODS: we included 32 patients transplanted between 1988 and 2006 for PSC. Median follow-up: 8.7 years (1-20 y). All patients were evaluated pre-OLT with colonoscopy and multiple intestinal biopsies. Post-OLT surveillance colonoscopies were performed every 12 months. RESULTS: of 32 patients included, 26 had inflammatory bowel disease pre-OLT (ulcerative colitis 25, Crohn's disease 1). 12 patients had active intestinal disease pre-OLT and 2 patients had moderate dysplasia but were not surgically treated due to the severity of their liver disease. Among the 26 patients with IBD pre-OLT, 2 died in the postoperative period due to complications related to the transplantation procedure. Among the other 24 patients, 16 had a quiescent colonic disease post-OLT. Among them, 12 had quiescent disease pre-OLT and 4 showed improvement in their colonic symptoms after transplantation. Eight patients were symptomatic pre-OLT and had a transitory improvement in their symptoms post-OLT, with worsening of their intestinal disease by 5.7 +/- 2.8 months after transplantation. Three patients developed severe dysplasia or colonic cancer. CONCLUSIONS: over half of patients transplanted for PSC presented with quiescent intestinal disease. Yet, there was a group of patients that worsened their colonic symptoms and had a high incidence of dysplasia/carcinoma. It is necessary to maintain an adequate colonic surveillance even in the absence of colonic symptoms or active disease.