RESUMEN
Treatment with continuous infusion of intraduodenal (Duodopa®) levodopa / carbidopa is indicated in patients with advanced Parkinson's disease who have not responded to conventional treatment. We present here the case of a patient with this type of probe that debuted jejunitis. A distal phytobezoar was the main causal agent. This rare complication may be favored in cases of intestinal hypomotility. Treatment involves its withdrawal as soon as possible and replacement by a new probe, which results in healing.
Asunto(s)
Antiparkinsonianos/efectos adversos , Carbidopa/efectos adversos , Bombas de Infusión Implantables/efectos adversos , Enfermedades del Yeyuno/inducido químicamente , Enfermedades del Yeyuno/diagnóstico por imagen , Levodopa/efectos adversos , Anciano , Antiparkinsonianos/uso terapéutico , Bezoares , Carbidopa/uso terapéutico , Combinación de Medicamentos , Endoscopía Gastrointestinal , Femenino , Humanos , Levodopa/uso terapéutico , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/tratamiento farmacológicoRESUMEN
BACKGROUND: Current guidelines address the initiation of treatment to prevent postoperative recurrence (PR) after ileo-cecal resection in Crohn's disease (CD), but appropriate management of postoperative CD patients who are already receiving treatment to prevent PR is yet to be defined. Usefulness of endoscopic monitoring in this scenario remains uncertain. AIMS: To evaluate the usefulness of endoscopy-based management of postoperative CD patients who are already under pharmacological prevention of PR. METHODS: Retrospective review of clinical outcome of all CD patients with ileo-cecal resection who underwent postoperative colonoscopy between 2004 and 2013 at our centre. Postoperative endoscopic findings were classified as no endoscopic recurrence (Rutgeerts i0-i1) or endoscopic recurrence (Rutgeerts i2-i4). Patients with endoscopic recurrence were classified as "endoscopy-based management (EBM)" if treatment step-up after endoscopy, or "non EBM (N-EBM)". Clinical recurrence was considered if re-operation, CD related hospitalization or treatment change. Time until clinical recurrence or the end of the follow up was considered. RESULTS: One hundred sixty six patients initially identified. One hundred twenty nine (77%) under pharmacological prevention of PR at the time of colonoscopy were analyzed: 34% were receiving aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo. Colonoscopy showed endoscopic recurrence in 57% of patients; those with N-EBM were more likely to have clinical recurrence than patients with EBM along the follow up (p = 0.01). Conclussions: Endoscopic monitoring could be useful in postoperative CD patients also in patients already receiving pharmacological treatment to prevent PR.
Asunto(s)
Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/cirugía , Endoscopía Gastrointestinal/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Colonoscopía , Terapia Combinada , Enfermedad de Crohn/diagnóstico por imagen , Femenino , Fármacos Gastrointestinales/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Recurrencia , Estudios Retrospectivos , Adulto JovenRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Yeyuno/lesiones , Levodopa/administración & dosificación , Carbidopa/administración & dosificación , Úlcera Péptica/etiología , Intubación Gastrointestinal/efectos adversos , Bezoares/diagnóstico por imagen , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/tratamiento farmacológicoRESUMEN
BACKGROUND: Current guidelines address the initiation of treatment to prevent postoperative recurrence (PR) after ileo-cecal resection in Crohn's disease (CD), but appropriate management of postoperative CD patients who are already receiving treatment to prevent PR is yet to be defined. Usefulness of endoscopic monitoring in this scenario remains uncertain. AIMS: To evaluate the usefulness of endoscopy-based management of postoperative CD patients who are already under pharmacological prevention of PR. METHODS: Retrospective review of clinical outcome of all CD patients with ileo-cecal resection who underwent postoperative colonoscopy between 2004 and 2013 at our centre. Postoperative endoscopic findings were classified as no endoscopic recurrence (Rutgeerts i0-i1) or endoscopic recurrence (Rutgeerts i2-i4). Patients with endoscopic recurrence were classified as 'endoscopy-based management (EBM)' if treatment step-up after endoscopy, or 'non EBM (N-EBM)'. Clinical recurrence was considered if re-operation, CD related hospitalization or treatment change. Time until clinical recurrence or the end of the follow up was considered. RESULTS: One hundred sixty six patients initially identified. One hundred twenty nine (77%) under pharmacological prevention of PR at the time of colonoscopy were analyzed: 34% were receiving aminosalicylates, 50% thiopurines, 11% anti-TNF, 5% combo. Colonoscopy showed endoscopic recurrence in 57% of patients; those with N-EBM were more likely to have clinical recurrence than patients with EBM along the follow up (p = 0.01). Conclussions: Endoscopic monitoring could be useful in postoperative CD patients also in patients already receiving pharmacological treatment to prevent PR
No disponible