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3.
Rev. esp. enferm. dig ; 112(5): 383-388, mayo 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-188376

RESUMO

Although SARS-CoV-2 may primarily enter the cells of the lungs, the small bowel may also be an important entry or interaction site, as the enterocytes are rich in angiotensin converting enzyme (ACE)-2 receptors. The initial gastrointestinal symptoms that appear early during the course of COVID-19 support this hypothesis. Furthermore, SARSCoV virions are preferentially released apically and not at the basement of the airway cells. Thus, in the setting of a productive infection of conducting airway epithelia, the apically released SARS-CoV may be removed by mucociliary clearance and gain access to the GI tract via a luminal exposure. In addition, post-mortem studies of mice infected by SARS-CoV have demonstrated diffuse damage to the GI tract, with the small bowel showing signs of enterocyte desquamation, edema, small vessel dilation and lymphocyte infiltration, as well as mesenteric nodes with severe hemorrhage and necrosis. Finally, the small bowel is rich in furin, a serine protease which can separate the S-spike of the coronavirus into two “pinchers” (S1 and 2). The separation of the S-spike into S1 and S2 is essential for the attachment of the virion to both the ACE receptor and the cell membrane. In this special review, we describe the interaction of SARS-CoV-2 with the cell and enterocyte and its potential clinical implications


Assuntos
Humanos , Diarreia/virologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Betacoronavirus/fisiologia , Intestino Delgado/virologia , Serina Proteases/metabolismo , Enterócitos/virologia , Pandemias , Receptor Tipo 2 de Angiotensina/metabolismo , Colite/virologia
4.
Pediatr. aten. prim ; 21(84): 405-410, oct.-dic. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-191984

RESUMO

La colitis eosinofílica es un trastorno gastrointestinal primario de etiología desconocida y ligada a procesos alérgicos. Se define por la presencia de un número anormal de eosinófilos en la mucosa colónica junto con síntomas de disfunción intestinal. Su incidencia ha aumentado en los últimos años debido a un mayor reconocimiento. El diagnóstico es endoscópico y requiere la exclusión de otras causas de eosinofilia colónica, como la enfermedad inflamatoria intestinal entre otras. Los criterios diagnósticos no están bien establecidos ya que no se conoce con certeza el número normal de eosinófilos en los distintos tramos del tubo digestivo. El tratamiento, de la misma manera, se basa en la opinión de expertos. Se presentan dos casos de colitis eosinofílica en la edad infantil con el objetivo de mejorar el conocimiento de esta enfermedad y poner de manifiesto la necesidad de realizar estudios que permitan homogeneizar el manejo de esta patología


Eosinophilic colitis is a primary gastrointestinal disease of unknown etiology and related to allergic processes. It is defined by the presence of an abnormal number of eosinophils in the colonic mucosa together with symptoms of intestinal dysfunction. Its incidence has increased in the last years due to a growing recognition. Diagnosis is endoscopic and requires the exclusion of other colonic eosinophilia causes, such as the inflammatory bowel disease, among others. Diagnosis criteria are not well stablished since there is no certainty about the normal number of eosinophilic cells in the different sections of the gastrointestinal tract. Likewise, treatment is based on expert opinion. Two cases of eosinophilic colitis in childhood are presented with the aim of improving the disease awareness as well as highlighting the need to carry out investigations that allow the homogenization of the management of this pathology


Assuntos
Humanos , Masculino , Adolescente , Criança , Colite/diagnóstico , Eosinofilia/diagnóstico , Hipersensibilidade/complicações , Colite/imunologia , Fatores de Risco , Endoscopia Gastrointestinal/métodos
9.
Gastroenterol. hepatol. (Ed. impr.) ; 41(8): 514-529, oct. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-178111

RESUMO

Actualmente, el manejo de la enfermedad inflamatoria intestinal (EII) se basa en la evaluación objetiva de las lesiones intestinales. Por ello, es de interés disponer de herramientas sencillas y no invasivas con las que monitorizar la actividad de la EII e identificar la presencia de lesiones. La calprotectina fecal (CF) constituye la principal proteína citosólica de los neutrófilos, es resistente a la degradación bacteriana y estable a temperatura ambiente durante días, características que la hacen adecuada para su uso en la práctica clínica. Es útil para diferenciar entre procesos inflamatorios y funcionales, se correlaciona con la actividad endoscópica, se asocia con la respuesta clínica y endoscópica al tratamiento y tiene valor pronóstico a corto plazo. El presente documento pretende ofrecer una visión actualizada sobre la información que la CF puede proporcionar al clínico en el diagnóstico, la monitorización y el manejo de la EII


The management of inflammatory bowel disease (IBD) is currently based on the objective evaluation of intestinal lesions. It would therefore be interesting to have access to simple and non-invasive tools to monitor IBD activity and to identify the presence of lesions. Faecal calprotectin (FC) is the main cytosolic protein of neutrophils, it is resistant to bacterial degradation and it is stable at room temperature for several days, characteristics that make it suitable for use in clinical practice. It can be used to differentiate between inflammatory and functional processes, it correlates with endoscopic activity, it is associated with clinical and endoscopic response to treatment and it has short-term prognostic value. This paper offers an up-to-date perspective on the information that FC can provide clinicians to aid diagnosis, monitoring and management of IBD


Assuntos
Humanos , Fezes/química , Doenças Inflamatórias Intestinais/diagnóstico , Complexo Antígeno L1 Leucocitário/análise , Biomarcadores , Cromatografia de Afinidade , Colite/diagnóstico , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Gerenciamento Clínico , Ensaio de Imunoadsorção Enzimática , Inflamação , Neutrófilos/metabolismo , Prognóstico , Recidiva , Manejo de Espécimes
12.
An. sist. sanit. Navar ; 41(2): 255-258, mayo-ago. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-173604

RESUMO

Los trastornos eosinofílicos primarios del tracto gastrointestinal abarcan una serie de enfermedades crónicas que cursan con un infiltrado eosinofílico a nivel intestinal en ausencia de otras causas de eosinofilia. Pueden afectar a cualquier área del tubo digestivo, siendo excepcional la afectación exclusiva del colon. Dada su baja prevalencia no suelen tenerse en cuenta en el diagnóstico diferencial de los pacientes con diarrea crónica, por lo que en muchos casos la demora diagnóstica puede ser de años. Describimos el caso de una paciente con enfermedad celíaca bien controlada y diarrea crónica de origen indeterminado que fue finalmente diagnosticada de una colitis eosinofílica. Recibió tratamiento con budesonida oral con muy buena respuesta clínica y en la actualidad se mantiene asintomática


Primary eosinophilic gastrointestinal disorders include a spectrum of inflammatory chronic diseases in which eosinophils infiltrate the gut in the absence of known causes of such tissue eosinophilia. They may affect any area of the gastrointestinal tract although exclusive colonic disease is exceptional. Due to their low prevalence these disorders are not usually taken into account when making a differential diagnosis in a patient with chronic diarrhea, which is the reason why in many cases the diagnosis can take many years. We describe the case of a patient with well-controlled celiac disease and chronic diarrhea of indeterminate origin. The final diagnosis was eosinophilic colitis. A complete response was obtained when she was treated with oral budesonide. Nowadays she remains asymptomatic


Assuntos
Humanos , Feminino , Idoso , Colite/imunologia , Eosinofilia/imunologia , Doença Celíaca/diagnóstico , Diagnóstico Diferencial , Diarreia/etiologia , Doença Crônica , Budesonida/uso terapêutico
15.
Rev. Soc. Esp. Dolor ; 24(6): 309-312, nov.-dic. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-169140

RESUMO

El avance científico y la aparición de la inmunoterapia en la oncología obliga a conocer tanto sus resultados en forma de supervivencia como la toxicidad que esta aporta. La estimulación farmacológica del sistema inmune puede producir distorsiones en la regulación del mismo, alterando el proceso de autotolerancia inmune y favoreciendo la aparición de reacciones autoinmunitarias desmedidas contra órganos sanos. La colitis autoinmune es un evento inmunorrelacionado que cursa habitualmente con diarrea. Pese a que el eje del tratamiento es el tratamiento corticoideo, no siempre se consigue controlar el efecto adverso ni el dolor que, en ocasiones, esta provoca. En nuestro caso, la utilización de fentanilo de acción rápida para control del dolor consiguió actuar colateralmente como coadyuvante al tratamiento inmunosupresor, enlenteciendo el tránsito intestinal y, por consiguiente, favoreciendo el control de la colitis (AU)


The scientific advance and the appearance of immunotherapy in oncology, requires to know both its results in the form of survival, and the toxicity that this contributes. Pharmacological stimulation of the immune system can cause distortions in the regulation of the immune system and alter the process of immune tolerance, favoring the appearance of excessive autoimmune reactions against healthy organs. Autoimmune colitis is an immunorelated event that usually courses with diarrhea. Although the treatment axis is corticoids, it is not always possible to control the adverse effect or the pain that, sometimes, these treatment cause. In our case, the use of fast-acting fentanyl for pain control was able to act as a coadjuvant to the immunosuppressive treatment, slowing the intestinal transit and, consequently, favoring the control of the colitis (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fentanila/administração & dosagem , Fatores Imunológicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Imunoterapia/efeitos adversos , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Metástase Neoplásica/tratamento farmacológico , Colite/induzido quimicamente
17.
Pediatr. aten. prim ; 19(76): e141-e145, oct.-dic. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-169607

RESUMO

Introducción: la colitis eosinofílica suele debutar con signos de enterocolitis, aunque hay casos descritos en los que se diagnostica tras episodios de obstrucción intestinal subaguda. Presentamos nuestra experiencia en niños diagnosticados de colitis eosinofílica que han sido intervenidos previamente de enfermedad de Hirschsprung. Resultados: 7 de los 44 pacientes intervenidos por enfermedad de Hirschsprung fueron diagnosticados de colitis eosinofílica. Mediana de edad de cirugía de enfermedad de Hirschsprung: tres meses; mediana de edad de colitis eosinofílica: 21 meses. Debutaron con diarrea mucosanguinolenta seis casos. Seis de siete niños presentaron cuadro de enteritis previo al diagnóstico de colitis eosinofílica y uno de siete rectorragia. El cribado infeccioso fue negativo en todos los casos. El diagnóstico de colitis eosinofílica mediante biopsia en todos los casos. Un paciente sin tratamiento, tres con fórmula elemental y solo dos con esteroides sistémicos (uno de ellos requirió cirugía finalmente). En todos los niños tratados se resolvió el cuadro, salvo en un caso que precisó instauración de nutrición parenteral y finalmente resección colónica con ileostomía. Conclusiones: en nuestra serie, hemos encontrado asociación entre enfermedad de Hirschsprung y colitis eosinofílica. En todos los casos se ha encontrado relación temporal entre ambas patologías, siendo siempre el diagnóstico de colitis eosinofílica posterior a la intervención quirúrgica por enfermedad de Hirschsprung. La exclusión de las proteínas de la leche de vaca y el empleo de antiinflamatorios han sido efectivos en la mayoría de los casos (AU)


Introduction: eosinophilic colitis tends to appear with signs of enterocolitis, although cases have been described after episodes of subacute intestinal obstruction. We present our experience in children diagnosed with eosinophilic colitis who had been previously operated for Hirschsprung disease. Results: 7 out of44 patients who underwent Hirschsprung disease were diagnosed with eosinophilic colitis. Median age of surgery for Hirschsprung disease was 3 months and the median age of diagnosis of eosinophilic colitis 21 months. Six cases debuted with diarrhea with blood. Six of seven children had enteritis prior to diagnosis of eosinophilic colitis and one of seven rectal bleeding. The infectious screening was negative in all cases.The diagnosis was performed by biopsy in all cases, compatible with eosinophilic colitis. Treatment: one patient did not require treatment, three children needed elemental formula and two patients systemic steroids (one of them finally required surgery). In all treated children the clinical picture was resolved, except in one case in which, given the persistence and impact of symptoms, required parenteral nutrition and finally colonic resection with ileostomy. Conclusions: In our series, we found some association between Hirschsprung disease and eosinophilic colitis. In all cases it was found a certain temporal relationship between the two diseases, always eosinophilic colitis after surgery for Hirschsprung disease. The exclusion of cow's milk proteins and the use of anti-inflammatory drugs have been effective in most cases (AU)


Assuntos
Humanos , Lactente , Masculino , Feminino , Doença de Hirschsprung/complicações , Colite/epidemiologia , Eosinofilia/epidemiologia , Doença de Hirschsprung/cirurgia , Síndrome Hipereosinofílica/complicações , Hemorragia Gastrointestinal/etiologia , Hipersensibilidade a Leite/epidemiologia
20.
Rev. esp. enferm. dig ; 109(6): 473-476, jun. 2017. ilus
Artigo em Inglês | IBECS | ID: ibc-163268

RESUMO

The use of fecal microbiota transplantation in recurrent Clostridium difficile infection and coexistent inflammatory bowel disease remains unclear. A 61-year-old man with ulcerative pancolitis was diagnosed with a third recurrence of Clostridium difficile infection, previously treated with metronidazole, vancomycin and fidaxomicin. Fecal microbiota transplantation of an unrelated healthy donor was performed by the lower route. After a twelve month follow-up, the patient remains asymptomatic without Clostridium difficile infection relapses or inflammatory bowel disease flare-ups. Fecal microbiota transplantation is relatively simple to perform, well-tolerated, safe and effective in recurrent Clostridium difficile infection with ulcerative pancolitis, as an alternative in case of antibiotic therapy failure (AU)


No disponible


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Microbiota Fecal/instrumentação , Transplante de Microbiota Fecal/métodos , Clostridium difficile/isolamento & purificação , Recidiva , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Colite/complicações , Colite/terapia , Colonoscopia/instrumentação , Colonoscopia/métodos
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