[Esofagitis eosinofílica, eficacia de las alternativas terapéuticas en el adulto: revisión sistemática.] / Eosinophilic esophagitis, efficacy of therapeutic alternatives in adults: a systematic review.

OBJECTIVE: Eosinophilic esophagitis is actually the main cause of dysphagia in adults. The choise of therapy must be agreed with the patient. The objective of this study was to review the scientific literature to determine the efficacy of the different therapeutic options for eosinophilic esophagitis in adults. METHODS: A search for articles was carried out during the month of February 2023 in the databases PubMed, Web of Science, Scopus and Scielo using the search terms: eosinophilic esophagitis, therapeutics and treatment. Clinical trials and observational studies published in the last ten years in adults were selected. RESULTS: A total of 1,138 articles were obtained, of which 41 were selected after applying the eligibility criteria. Of the available therapies, the most frequently analyzed treatment was swallowed corticosteroids, followed by elimination diets and proton pump inhibitors. Clinical trials predominated. The studies show results on the efficacy of these therapies in histological and clinical remission, both in induction and in the long-term. CONCLUSIONS: There are basically three therapies for eosinophilic esophagitis in adults, all of them are superior to placebo in histological and clinical response.

OBJETIVO: La esofagitis eosinofílica es hoy en día la principal causa de disfagia en el adulto. La elección de la terapia se debe consensuar con el paciente. El objetivo de este trabajo fue revisar la bibliografía científica para conocer la eficacia de las distintas opciones terapéuticas de la esofagitis eosinofílica en el adulto. METODOS: Se realizó una búsqueda de artículos durante el mes de febrero de 2023 en las bases de datos de PubMed, Web of Science, Scopus y Scielo, empleando los términos de búsqueda eosinophilic esophagitis, therapeutics y treatment, seleccionándose los ensayos clínicos y estudios observacionales publicados en los últimos diez años en adultos. RESULTADOS: Se obtuvieron un total de 1.138 artículos, de los cuales 41 fueron seleccionados tras aplicar los criterios de elegibilidad. De las terapias disponibles, el tratamiento más frecuentemente analizado fueron los corticoides deglutidos, seguido de las dietas de eliminación y de los inhibidores de la bomba de protones, predominando los ensayos clínicos. Los estudios arrojan resultados sobre la eficacia de estas terapias en la remisión histológica y clínica, tanto en la inducción como a largo plazo. CONCLUSIONES: Existen fundamentalmente tres terapias en la esofagitis eosinofílica en el adulto, siendo todas superiores frente a placebo en respuesta histológica y clínica.

Esofagitis eosinofílica, eficacia de las alternativas terapéuticas en el adulto: revisión sistemática / Eosinophilic esophagitis, efficacy of therapeutic alternatives in adults: a systematic review

Fundamentos: La esofagitis eosinofílica es hoy en día la principal causa de disfagia en el adulto. La elección de la terapia se debeconsensuar con el paciente. El objetivo de este trabajo fue revisar la bibliografía científica para conocer la eficacia de las distintasopciones terapéuticas de la esofagitis eosinofílica en el adulto. Métodos: Se realizó una búsqueda de artículos durante el mes de febrero de 2023 en las bases de datos dePubMed, Web ofScience, Scopus yScielo, empleando los términos de búsquedaeosinophilic esophagitis,therapeutics ytreatment, seleccionándoselos ensayos clínicos y estudios observacionales publicados en los últimos diez años en adultos.Resultados: Se obtuvieron un total de 1.138 artículos, de los cuales 41 fueron seleccionados tras aplicar los criterios de elegibilidad. De las terapias disponibles, el tratamiento más frecuentemente analizado fueron los corticoides deglutidos, seguido de las dietasde eliminación y de los inhibidores de la bomba de protones, predominando los ensayos clínicos. Los estudios arrojan resultadossobre la eficacia de estas terapias en la remisión histológica y clínica, tanto en la inducción como a largo plazo. Conclusiones: Existen fundamentalmente tres terapias en la esofagitis eosinofílica en el adulto, siendo todas superiores frentea placebo en respuesta histológica y clínica.(AU)

Background: Eosinophilic esophagitis is actually the main cause of dysphagia in adults. The choise of therapy must be agreedwith the patient. The objective of this study was to review the scientific literature to determine the efficacy of the different therapeuticoptions for eosinophilic esophagitis in adults.Methods: A search for articles was carried out during the month of February 2023 in the databasesPubMed, Web of Science,Scopus andScielo using the search terms:eosinophilic esophagitis,therapeutics andtreatment. Clinical trials and observational studiespublished in the last ten years in adults were selected. Results: A total of 1,138 articles were obtained, of which 41 were selected after applying the eligibility criteria. Of the availabletherapies, the most frequently analyzed treatment was swallowed corticosteroids, followed by elimination diets and proton pump inhibitors. Clinical trials predominated. The studies show results on the efficacy of these therapies in histological and clinical remission,both in induction and in the long-term. Conclusions: There are basically three therapies for eosinophilic esophagitis in adults, all of them are superior to placebo inhistological and clinical response.(AU)

Satisfacción de los pacientes celíacos de la Consulta de Enfermería de un Servicio de Digestivo / Kaposi's sarcoma with gastric and rectal involvement in HIV patient

La valoración de la atención recibida es un indicador del funcionamiento de los Servicios Sanitarios (1). El diagnóstico de celiaquía genera en el paciente preocupación y limitación de la calidad de vida, y la adherencia al tratamiento condiciona mejoría sintomática (2-4). Por ello, se ha puesto en marcha una Consulta de Enfermería de educación sanitaria y nutricional al paciente celíaco en nuestro hospital. El objetivo principal busca conocer el grado de satisfacción de esta Consulta respecto a aspectos técnicos y comunicativos, y valorar la influencia en la salud de la adherencia a la dieta sin gluten (DSG) a través de parámetros clínicos y analíticos. Se trata de un estudio observacional transversal descriptivo en pacientes diagnosticados de enfermedad celíaca desde enero de 2019 a junio de 2021 según los criterios de Catassi (5) y que han asistido a la Consulta de Enfermería. Posteriormente se realizó la encuesta de satisfacción (Tabla) y se analizaron los resultados clínicos y analíticos de forma descriptiva y estadística mediante la prueba t de Student. La satisfacción de la Consulta fue superior al 90%, destacando parámetros como la claridad de la información, el interés y la amabilidad del personal sanitario. El 94,5% de los pacientes mostraron mejoría clínica tras la realización de la educación sanitaria y los niveles de hemoglobina, ferritina y vitamina B12 aumentaron significativamente en el control analítico tras la DSG. (AU)

Celiac patient satisfaction with nursing consultations in a gastroenterology department.

The assessment of the personal care received is an indicator of the quality of the health care system. The diagnosis of celiac disease generates concern in the patient and limits the quality of life, and adherence to treatment determines symptomatic improvement. For this reason, a nursing consultation for health and nutritional education for celiac patients has been set up in our hospital. The objectives were to know the degree of patient´s satisfaction of this health program regarding technical and communicative aspects, as well as to assess the influence of adherence to the gluten-free diet (GFD) on health through clinical and analytical parameters. This is a descriptive cross-sectional observational study in patients diagnosed of celiac disease from January 2019 to June 2021 according to the Catassi criteria and who have attended the nursing consultation. Subsequently, the satisfaction survey was carried out and the clinical and analytical results were analyzed descriptively and statistically using the Student's t-test. The satisfaction of the nursing consultation was higher than 90%, highlighting aspects such as the clarity of the information, the interest and the kindness of the healthcare professionals. About 94.5% of the patients showed clinical improvement after the health education and the levels of hemoglobin, ferritin and vitamin B12 increased significantly in the analytical control after the GFD.

Cytomegalovirus associated rectal ulcer as a manifestation of primary HIV infection.

We present the case of a 40-year-old male sent for fatigue, mild weight loss and rectal bleeding for 2 months, neither fever nor diarrhea. He referred unprotected intercourse. Blood test revealed mild elevation of transaminases. We requested serologies, with positive CMV IgG and CMV plasma levels of 47UI/ml (PCR), and a negative result of the rest of hepatotropic viruses. Abdominal ultrasound was normal and during colonoscopy we observed an ulcer in lower rectum, with negative biopsies for malignancy and a positive immunohistochemistry (IHC) for CMV. We amplified the serologic analysis and detected positive antibodies for the human immunodeficiency virus (HIV), with a viral load of 50500 copies/ml, negative p24 antigen and CD4+ cell count of 900 cells/mm3 (30%). Rest of serologies and triple-site testing were negative. We referred the patient to the infectious disease consultation and they started antiretroviral therapy (ART). We decided a watchful waiting approach for the rectal ulcer with close endoscopic follow-up, with early healing and complete resolution.

Effectiveness and Safety of Ustekinumab in Ulcerative Colitis: Real-world Evidence from the ENEIDA Registry.

BACKGROUND AND AIMS: The development programm UNIFI has shown promising results of ustekinumab in ulcerative colitis [UC] treatment which should be confirmed in clinical practice. We aimed to evaluate the durability, effectiveness, and safety of ustekinumab in UC in real life. METHODS: Patients included in the prospectively maintained ENEIDA registry, who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score [PMS]>2], were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at Week 16. RESULTS: A total of 95 patients were included. At Week 16, 53% of patients had response [including 35% of patients in remission]. In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at Weeks 24 and 52, respectively; 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at Week 16, 63% at Week 56, and 59% at Week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. CONCLUSIONS: Ustekinumab is effective in both the short and the long term in real life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.