RESUMEN
BACKGROUND AND AIMS: Alcohol relapse after surviving an episode of alcohol-associated hepatitis (AH) is common. However, the clinical features, risk factors, and prognostic implications of recurrent alcohol-associated hepatitis (RAH) are not well described. APPROACH AND RESULTS: A registry-based study was done of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank tests. A total of 1118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. The median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 U/d, and history of liver decompensation. RAH was clinically more severe compared to the first AH (higher MELD, more frequent ACLF, and HE). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs. 45%, p <0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs. 21%, p = 0.026), and presenting with RAH independently predicted high mortality (HR: 1.55 [1.11-2.18]). CONCLUSIONS: RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.
RESUMEN
Macroenzymes are complexes formed by the binding of enzyme molecules to each other or to other plasma components. We report the clinical case of a woman with abnormal liver enzymes secondary to macro-AST. Macro-AST should be considered in the differential diagnosis as a cause of isolated AST elevation, thus avoiding unnecessary additional tests.
Asunto(s)
Hepatopatías , Femenino , Humanos , Aspartato Aminotransferasas , Hepatopatías/diagnóstico , Diagnóstico DiferencialRESUMEN
Vedolizumab is a monoclonal antibody that has demonstrated efficacy and a good safety profile in patients with inflammatory bowel disease. Varicella zoster virus encephalitis is a potentially serious complication not previously described with its use, highlighting the importance of vaccination, as well as early diagnosis and treatment of infections in this type of patients.
Asunto(s)
Varicela , Encefalitis por Varicela Zóster , Herpes Zóster , Humanos , Herpesvirus Humano 3 , Herpes Zóster/inducido químicamente , Herpes Zóster/complicaciones , Encefalitis por Varicela Zóster/complicaciones , Encefalitis por Varicela Zóster/diagnóstico , Anticuerpos Monoclonales Humanizados/efectos adversos , Varicela/complicacionesRESUMEN
Small bowel hemangiomas are benign congenital vascular lesions that can be asymptomatic or cause anemia, gastrointestinal bleeding, obstruction, or intestinal perforation. We report the case of a 75-year-old woman who, after years of study for iron-deficiency anemia, was diagnosed with a cavernous hemangioma of the jejunum by capsule endoscopy, which was confirmed after surgical resection.
Asunto(s)
Anemia Ferropénica , Hemangioma Cavernoso , Hemangioma , Femenino , Humanos , Anciano , Anemia Ferropénica/etiología , Intestino Delgado/diagnóstico por imagen , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/diagnóstico por imagen , Hemangioma Cavernoso/cirugía , YeyunoRESUMEN
Human papillomavirus (HPV) infection is one of the most frequent sexually transmitted infections in the world, with great importance due to its oncogenic potential. Both the risk of infection and the development of neoplasia are increased in people with human immunodeficiency virus (HIV) infection, so HPV vaccination should be recommended in these patients.
Asunto(s)
Neoplasias del Ano , Carcinoma de Células Escamosas , Condiloma Acuminado , Infecciones por VIH , Infecciones por Papillomavirus , Neoplasias del Ano/complicaciones , Neoplasias del Ano/patología , Carcinoma de Células Escamosas/complicaciones , Condiloma Acuminado/complicaciones , Condiloma Acuminado/patología , Infecciones por VIH/complicaciones , Papillomavirus Humano 16 , Humanos , Huésped Inmunocomprometido , Papillomaviridae , Infecciones por Papillomavirus/complicacionesRESUMEN
Neuroendocrine tumors (NETs) are heterogeneous, slow-growing tumors whose most common locations are lung, gastrointestinal tract, and pancreas.
Asunto(s)
Neoplasias del Íleon , Tumores Neuroendocrinos , Neoplasias Pancreáticas , Hemorragia Gastrointestinal/etiología , Humanos , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias Intestinales , Tumores Neuroendocrinos/complicaciones , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/patología , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Neoplasias GástricasRESUMEN
Aortoesophageal fistula is an extremely rare cause of upper gastrointestinal bleeding associated with high morbidity and mortality. Early clinical suspicion, as well as correct management since diagnosis, can increase the probability of survival of this gastrointestinal emergency. We present the first case reported of an aortoesophageal fistula successfully treated with the OTSC system, representing another therapeutic option for this high-risk entity.
Asunto(s)
Endoscopía Gastrointestinal , Fístula , Humanos , Endoscopía Gastrointestinal/efectos adversos , Instrumentos Quirúrgicos/efectos adversos , Estudios Retrospectivos , Diseño de Equipo , Resultado del Tratamiento , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Enfermedad Aguda , Fístula/complicacionesRESUMEN
Drug-induced inflammatory bowel disease (IBD) is a clinical entity on the rise due to the frequent use of immunomodulatory therapy. Here we report the case of Crohn's disease due to Ocrelizumab, a humanized anti-CD20 monoclonal antibody approved for the treatment of multiple sclerosis. The exact mechanism by which anti-CD20 antibodies can trigger IBD is unknown, but since IBD and multiple sclerosis are processes included within the spectrum of immunomediated diseases, we could suggest that Ocrelizumab could trigger IBD in genetically predisposed patients.
Asunto(s)
Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Esclerosis Múltiple , Humanos , Esclerosis Múltiple/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Factores Inmunológicos/farmacología , Factores Inmunológicos/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológicoAsunto(s)
Disuasivos de Alcohol , Alcoholismo , Enfermedad Hepática Inducida por Sustancias y Drogas , Disuasivos de Alcohol/efectos adversos , Alcoholismo/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Disulfiram/efectos adversos , HumanosRESUMEN
Macroenzymes are complexes formed by the binding of enzyme molecules to each other or to other plasma components. We report the clinical case of a woman with abnormal liver enzymes secondary to macro-AST. Macro-AST should be considered in the differential diagnosis as a cause of isolated AST elevation, thus avoiding unnecessary additional tests. (AU)
Asunto(s)
Humanos , Femenino , Anciano , Transaminasas , Insuficiencia Renal Crónica , Enzimas , Aspartato AminotransferasasAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Ano/complicaciones , Neoplasias del Ano/patología , Carcinoma de Células Escamosas/complicaciones , Infecciones por VIH/complicaciones , Infecciones por Papillomavirus/complicaciones , Papillomavirus Humano 16 , Huésped InmunocomprometidoRESUMEN
La enfermedad inflamatoria intestinal (EII) inducida por fármacos es una entidad clínica en aumento debido al uso frecuente de terapia inmunosupresora y biológica. Presentamos el caso de una paciente diagnosticada de enfermedad de Crohn durante el tratamiento con Ocrelizumab, anticuerpo monoclonal humanizado anti-CD20 aprobado para el tratamiento de la esclerosis múltiple. Se desconoce el mecanismo exacto por el que los fármacos inmunomoduladores pueden desencadenar EII, pero dado que la EII y la esclerosis múltiple son procesos incluidos dentro del espectro de enfermedades inmunomediadas, podríamos postular que el Ocrelizumab, al igual que otros anti-CD20 como el Rituximab o anti-TNF como Etanercept, pueda desencadenar o desenmascarar EII en pacientes genéticamente predispuestos. (AU)