Background: The usefulness of thiopurines has been poorly explored in pouchitis and other pouch disorders. Objective: To evaluate the effectiveness and safety of azathioprine as maintenance therapy in inflammatory pouch disorders. Design: This was a retrospective and multicentre study. Methods: We included patients diagnosed with inflammatory pouch disorders treated with azathioprine in monotherapy. Effectiveness was evaluated at 1 year and in the long term based on normalization of stool frequency, absence of pain, faecal urgency or fistula discharge (clinical remission), or any improvement in these symptoms (clinical response). Endoscopic response was evaluated using the Pouchitis Disease Activity Index (PDAI). Results: In all, 63 patients were included [54% males; median age, 49 (28-77) years]. The therapy was used to treat pouchitis (n = 37) or Crohn's disease of the pouch (n = 26). The rate of clinical response, remission and non-response at 12 months were 52%, 30% and 18%, respectively. After a median follow-up of 23 months (interquartile range 11-55), 19 patients (30%) were in clinical remission, and 45 (66%) stopped therapy. Endoscopic changes were evaluated in 19 cases. PDAI score decreased from 3 (range 2-4) to 1 (range 0-3). In all, 21 patients (33%) presented adverse events and 16 (25%) needed to stop therapy. Conclusion: Azathioprine may be effective in the long term for the treatment of inflammatory pouch disorders and could be included as a therapeutic option.
BACKGROUND: This study considers care management for older chronic patients during and after the COVID-19 pandemic. AIMS: To identify groups of variables at previous time points as a basis for deriving efficient classification models during and after a pandemic situation and to quantify the effect of each variable within the model to predict levels of worsening risk in diastolic and systolic arterial hypertension (AHT). MATERIAL AND METHODS: In this prospective longitudinal study, data were collected at three time points: before, during, and after the COVID-19 pandemic period. RESULTS: The study included 148 patients with an average age of 81.6 years. During the study period, mean systolic blood pressure among this population rose by 5 mmHg to 128.8 mmHg; the number of patients with systolic blood pressure > 140 mmHg rose by 45.3%; among those with diastolic blood pressure > 90, the number rose by 41.2%; mean triglycerides levels rose to 152.6 mg/dL; cholesterol levels rose to 147 mg/dL; and LDL cholesterol rose to 112.2 mg/dL. Meanwhile, mean levels of HDL cholesterol decreased to 46.5 mg/dL. Binary-response logistic regression models were constructed to identify the most relevant variables for predicting AHT risk during and after the pandemic. The heart rate (OR = 1.79; 95% CI: 1.22-2.72) and body mass index (OR = 1.75; 95% CI: 1.08-2.94) variables were significant at the population level (p < 0.05) for diastolic and systolic AHT in the pandemic period risk models. The body mass index variable was also significant for diastolic AHT in the post-pandemic period risk model (OR = 1.97; 95% CI: 1.32-2.94), whilst the triglycerides variable was significant in the systolic AHT post-pandemic period risk model (OR = 1.49; 95% CI: 1.01-1.86). CONCLUSIONS: Bad control of arterial hypertension in older patients with chronic disease is associated with elevated levels of LDL cholesterol, total cholesterol, systolic blood pressure, heart rate and triglycerides, and lower levels of HDL cholesterol.
BACKGROUND: One aspect of the distancing measures imposed in response to the COVID-19 pandemic is that telemedicine consultations have increased exponentially. Among these consultations, the assessment and follow-up of patients with chronic diseases in a non-presential setting has been strengthened considerably. Nevertheless, some controversy remains about the most suitable means of patient follow-up. OBJECTIVE: To analyze the impact of the telemedicine measures implemented during the COVID-19 period on chronic patients. MATERIAL AND METHODS: A systematic review was carried out using the following databases: PubMed, Pro-Quest, and Scopus. The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search equation utilized descriptors sourced from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "hypertension AND older AND primary care AND (COVID-19 OR coronavirus)" and its Spanish equivalent. RESULTS: The following data were obtained: 14 articles provided data on 6,109,628 patients and another 4 articles focused on a study population of 9684 physicians. Telemedicine was less likely to be used by elderly patients (OR 0.85; 95% C.I. 0.83-0.88; p = 0.05), those of Asian race (OR 0.69; 95% C.I. 0.66-0.73; p = 0.05), and those whose native language was not English (OR 0.89; 95% C.I. 0.78-0.9; p = 0.05). In primary care, lower use of telemedicine was associated with residents of rural areas (OR 0.81; p = 0.05), patients of African American race (OR 0.65, p = 0.05), and others (OR 0.64; p = 0.05). A high proportion (40%) of physicians had no prior training in telemedicine techniques. The highest quality in terms of telephone consultation was significantly associated with physicians who did not increase their prescription of antibiotherapy during the pandemic (OR = 0.30, p = 0.05) or prescribe more tests (OR 0.06 p = 0.05), i.e., who maintained their former clinical criteria despite COVID-19. CONCLUSIONS: Telemedicine is of proven value and has been especially useful in the COVID-19 pandemic. A mixed remote-presential model is most efficient. Appropriate training in this area for physicians and patients, together with correct provision, is essential to prevent errors in implementation and use.
Inflammatory Bowel Disease (IBD) presents distinct challenges during pregnancy due to its influence on maternal health and pregnancy outcomes. This literature review aims to dissect the existing scientific evidence on pregnancy in women with IBD and provide evidence-based recommendations for clinical management. A comprehensive search was conducted across scientific databases, selecting clinical studies, systematic reviews, and other pertinent resources. Numerous studies have underscored an increased risk of complications during pregnancy for women with IBD, including preterm birth, low birth weight, neonates small for gestational age, and congenital malformations. Nevertheless, it's evident that proactive disease management before and throughout pregnancy can mitigate these risks. Continuation of IBD treatment during pregnancy and breastfeeding is deemed safe with agents like thiopurines, anti-TNF, vedolizumab, or ustekinumab. However, there's a call for caution when combining treatments due to the heightened risk of severe infections in the first year of life. For small molecules, their use is advised against in both scenarios. Effective disease management, minimizing disease activity, and interdisciplinary care are pivotal in attending to women with IBD. The emphasis is placed on the continual assessment of maternal and infant outcomes and an expressed need for further research to enhance the understanding of the ties between IBD and adverse pregnancy outcomes.
Background: Conflicting data exists regarding risk factors associated with Gastroesophageal Reflux Disease (GERD) and Functional Dyspepsia (FD). Few studies examine anxiety/depression in relation to GERD phenotypes (Esophagitis/EE, and Non-Erosive Reflux Disease/NERD), FD, and Rome-IV syndromes. Our aim was to evaluate the association between epidemiological factors and comorbidities with GERD phenotypes, FD, and Rome-IV syndromes, as well as their relationship with anxiety/depression. Methods: 338 subjects were selected from 357 patients referred to three tertiary-centers for endoscopic evaluation. Every subject was interviewed individually to administer three validated questionnaires: GERD-Q, Rome-IV and HADS. Results: 45/338 patients were controls, 198/58.6% classified as GERD, 81/24.0% EE (49/14.5% symptomatic, and 32/9.5% asymptomatic), 117/34.6% NERD, 176/52.1% FD (43/12.7% epigastric pain syndrome, 36/10.7% postprandial distress syndrome, and 97/28.7% overlapping syndrome). 81 patients were mixed GERD-FD. Multivariate analysis found significant independent associations: age in NERD and FD; sex in EE, asymptomatic EE and FD; body mass index in NERD and FD; alcohol in EE; anxiety/depression in FD; use of calcium channel antagonists in EE; and inhalers in FD. We compared controls vs different groups/subgroups finding significantly more anxiety in NERD, FD, all Rome-IV syndromes, and mixed GERD-FD; more depression in FD, overlapping syndrome, and mixed GERD-FD; and higher levels of anxiety+depression in NERD, FD, overlapping syndrome, and mixed GERD-FD. Conclusions: NERD and FD share demographic and psychopathological risk factors which suggests that they may form part of the same pathophysiological spectrum. Regarding NERD anxiety was predominant, and in FD anxiety+depression, suggesting that both processes may require complementary psychological therapy.(AU)
Antecedentes: Existen datos controvertidos sobre los factores de riesgo asociados a la enfermedad por reflujo gastroesofágico (ERGE) y la dispepsia funcional (DF). Pocos estudios han evaluado la relación entre ansiedad/depresión y los diferentes fenotipos de la DF (criterios Roma IV) y de la ERGE (erosiva [EE] y no erosiva [NERD]). Nuestro objetivo fue valorar la asociación entre diferentes factores epidemiológicos y comorbilidades y los fenotipos de la ERGE, la DF y sus síndromes, y su relación con la ansiedad/depresión. Métodos: Se seleccionaron 338 pacientes entre 357 remitidos para estudio endoscópico en 3 hospitales terciarios. Cada uno fue entrevistado individualmente y completó 3 cuestionarios validados: GERD-Q, Roma IV y HADS. Resultados: Cuarenta y cinco de los 338 pacientes fueron controles. Se clasificaron 198/58,6% como ERGE, 81/24,0% como EE (49/14,5% sintomática y 32/9,5% asintomática), 117/34,6% como NERD y 176/52,1% como DF (43/12,7% síndrome de dolor epigástrico, 36/10,7% síndrome de molestias posprandiales y 97/28,7% solapamiento epigastralgia-molestias posprandiales). Ochenta y uno solapaban ERGE-DF. El análisis multivariante encontró las siguientes asociaciones significativas: edad en NERD y DF; sexo en EE, EE asintomática y DF; IMC en NERD y DF; alcohol en EE; ansiedad/depresión en DF; toma de antagonistas del calcio en EE e inhaladores en DF. Al comparar el grupo control vs. diferentes grupos/subgrupos encontramos significativamente más ansiedad en NERD, solapamiento DF-ERGE, DF y todos sus síndromes Roma IV; más depresión en DF, solapamientos epigastralgia-molestias posprandiales y ERGE-DF; y más ansiedad+depresión en NERD, DF y solapamientos epigastralgia-molestias posprandiales y ERGE-DF. Conclusiones: La DF y la NERD comparten factores de riesgo demográficos y psicopatológicos, lo que evidencia que forman parte de un mismo espectro fisiopatológico...(AU)
Humans , Gastroesophageal Reflux , Dyspepsia , Comorbidity , Epidemiologic Factors , Anxiety , Depression , Gastroenterology , Gastrointestinal Diseases , Cross-Sectional Studies , Risk Factors
Objective: It has been reported that professional cyclists had an accelerated solid gastric emptying which decreased by increasing the exercise intensity. That could be explained by a predominance of stress-dependent motility inhibitors such gastrointestinal hormones, neurotransmitters and or the predominance of the gastric inhibitory vagal motor circuit. The aim of this preliminary study was to evaluate the role of β-endorphins, inhibitors of gastric motility, in these findings. Methods: Gastric emptying of solids marked with Tc99 while resting and plasmatic levels of β-endorphins were evaluated in 27 healthy controls and 19 professional cyclists (day 1). Besides, gastric emptying of solids was also assessed in cyclists when they reached 50% (day 1) and 75% (day 2) of the maximum oxygen consumption (low and high, respectively), during exercise on the cycle-ergometer. The third day, naloxone was administered in cyclists in order to block the β-endorphins receptors and gastric emptying was measured when they reached 75% of the maximum oxygen consumption. Results: Basal β-endorphin levels were lower in cyclists vs controls (p<0.05) and they increased with the exercise intensity (p<0.001). There were no significant differences in gastric emptying of solids with or without naloxone when 75% of the maximum oxygen consumption was reached. Conclusions: The inhibitory effect of the exercise in the gastric emptying of solids does not seem to be secondary to the action of β-endorphins, that leaves the gastric inhibitory vagal motor circuit a more likely predominant role.(AU)
Objetivo: Se ha informado de que los ciclistas profesionales tienen un vaciado gástrico sólido acelerado que disminuye al aumentar la intensidad del ejercicio. Esto podría explicarse por un predominio de los inhibidores de la motilidad dependientes del estrés, como las hormonas gastrointestinales, los neurotransmisores y o el predominio del circuito motor vagal inhibidor gástrico. El objetivo de este estudio preliminar fue evaluar el papel de las β-endorfinas, inhibidores de la motilidad gástrica, en estos hallazgos. Métodos: Se evaluó el vaciado gástrico de sólidos marcado con Tc99 mientras se evaluaban los niveles en reposo y plasmáticos de β-endorfinas en 27 controles sanos y 19 ciclistas profesionales (día 1). Además, también se evaluó el vaciado gástrico de sólidos en los ciclistas cuando alcanzaron el 50% (día 1) y el 75% (día 2) del consumo máximo de oxígeno (bajo y alto, respectivamente), durante el ejercicio en el cicloergómetro. El tercer día, se administró naloxona en los ciclistas para bloquear los receptores de β-endorfinas y se midió el vaciado gástrico cuando alcanzaron el 75% del consumo máximo de oxígeno. Resultados: Los niveles basales de β-endorfina fueron menores en los ciclistas frente a los controles (p<0,05) y aumentaron con la intensidad del ejercicio (p<0,001). No hubo diferencias significativas en el vaciado gástrico de sólidos con o sin naloxona cuando se alcanzó el 75% del consumo máximo de oxígeno. Conclusiones: El efecto inhibidor del ejercicio en el vaciado gástrico de sólidos no parece ser secundario a la acción de las β-endorfinas, lo que deja al circuito motor vagal inhibitorio gástrico un papel más probablemente predominante.(AU)
Humans , Endorphins , Gastric Emptying , Athletes , Bicycling
Inflammatory bowel disease (IBD) is a chronic and debilitating condition that impacts a substantial number of individuals globally [...].
BACKGROUND: Conflicting data exists regarding risk factors associated with Gastroesophageal Reflux Disease (GERD) and Functional Dyspepsia (FD). Few studies examine anxiety/depression in relation to GERD phenotypes (Esophagitis/EE, and Non-Erosive Reflux Disease/NERD), FD, and Rome-IV syndromes. Our aim was to evaluate the association between epidemiological factors and comorbidities with GERD phenotypes, FD, and Rome-IV syndromes, as well as their relationship with anxiety/depression. METHODS: 338 subjects were selected from 357 patients referred to three tertiary-centers for endoscopic evaluation. Every subject was interviewed individually to administer three validated questionnaires: GERD-Q, Rome-IV and HADS. RESULTS: 45/338 patients were controls, 198/58.6% classified as GERD, 81/24.0% EE (49/14.5% symptomatic, and 32/9.5% asymptomatic), 117/34.6% NERD, 176/52.1% FD (43/12.7% epigastric pain syndrome, 36/10.7% postprandial distress syndrome, and 97/28.7% overlapping syndrome). 81 patients were mixed GERD-FD. Multivariate analysis found significant independent associations: age in NERD and FD; sex in EE, asymptomatic EE and FD; body mass index in NERD and FD; alcohol in EE; anxiety/depression in FD; use of calcium channel antagonists in EE; and inhalers in FD. We compared controls vs different groups/subgroups finding significantly more anxiety in NERD, FD, all Rome-IV syndromes, and mixed GERD-FD; more depression in FD, overlapping syndrome, and mixed GERD-FD; and higher levels of anxiety+depression in NERD, FD, overlapping syndrome, and mixed GERD-FD. CONCLUSIONS: NERD and FD share demographic and psychopathological risk factors which suggests that they may form part of the same pathophysiological spectrum. Regarding NERD anxiety was predominant, and in FD anxiety+depression, suggesting that both processes may require complementary psychological therapy.
Dyspepsia , Esophagitis , Gastroesophageal Reflux , Humans , Dyspepsia/epidemiology , Dyspepsia/etiology , Cross-Sectional Studies , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/epidemiology , Risk Factors , Esophagitis/complications
OBJECTIVE: It has been reported that professional cyclists had an accelerated solid gastric emptying which decreased by increasing the exercise intensity. That could be explained by a predominance of stress-dependent motility inhibitors such gastrointestinal hormones, neurotransmitters and or the predominance of the gastric inhibitory vagal motor circuit. The aim of this preliminary study was to evaluate the role of ß-endorphins, inhibitors of gastric motility, in these findings. METHODS: Gastric emptying of solids marked with Tc99 while resting and plasmatic levels of ß-endorphins were evaluated in 27 healthy controls and 19 professional cyclists (day 1). Besides, gastric emptying of solids was also assessed in cyclists when they reached 50% (day 1) and 75% (day 2) of the maximum oxygen consumption (low and high, respectively), during exercise on the cycle-ergometer. The third day, naloxone was administered in cyclists in order to block the ß-endorphins receptors and gastric emptying was measured when they reached 75% of the maximum oxygen consumption. RESULTS: Basal ß-endorphin levels were lower in cyclists vs controls (p<0.05) and they increased with the exercise intensity (p<0.001). There were no significant differences in gastric emptying of solids with or without naloxone when 75% of the maximum oxygen consumption was reached. CONCLUSIONS: The inhibitory effect of the exercise in the gastric emptying of solids does not seem to be secondary to the action of ß-endorphins, that leaves the gastric inhibitory vagal motor circuit a more likely predominant role.
Gastroparesis , beta-Endorphin , Humans , Naloxone , Gastric Emptying
BACKGROUND AND AIMS: Polyps histology and diameter up to 1 cm determine whether a patient needs a colonoscopy after 3 years or less, or far ahead. Endoscopists' and pathologists' size estimations can be imprecise. Our aim was to assess endoscopist ability to correctly recommend surveillance colonoscopies for patients with polyps around the 10 mm threshold, based on its endoscopic sizing and optical diagnosis by NBI. METHODS: NBI-assisted diagnosis and endoscopist estimation of polyp size were compared with reference standard, considering this as the post resection polyp measurements by the nurse assistant and the pathologic results, in a prospective, multicenter, real life study, that recruited adults undergoing colonoscopy in five hospitals. By comparing the endoscopic and pathologist size estimation, with polyps' measurement after resection, and optical and histological diagnoses in patients with polyps between 5 and 15 mm, sensitivity was assessed at the patient level by means of two characteristics: the presence of adenoma, and the surveillance interval. Surveillance intervals were established by the endoscopist, based on optical diagnosis, and by another gastroenterologist, grounded on the pathologic report. Determinants of accuracy were explored at the polyp level. RESULTS: 532 polyps were resected in 451 patients. Size estimation was more precise for the endoscopist. Endoscopist sensitivity for the presence of adenoma or carcinoma was 98.7%. Considering the presence of high-grade dysplasia or cancer, sensitivity was 82.6% for the endoscopic optical diagnosis. Sensitivity for a correct 3-year surveillance interval was 91.5%, specificity 82.3%, with a PPV of 93.2% and NPV of 78.5% for the endoscopist. 6.51% of patients would have had their follow-up colonoscopy delayed, whereas 22 (4.8%) would have it been performed earlier, had endoscopist recommendations been followed. CONCLUSION: Our study observes that NBI optical diagnosis can be recommended in routine practice to establish surveillance intervals for polyps between 5 and 15 mm. CLINICAL TRIALS REGISTRATION NUMBER: NCT04232176.
Adenoma , Colonic Polyps , Colorectal Neoplasms , Adenoma/diagnostic imaging , Adenoma/pathology , Adult , Colonic Polyps/diagnostic imaging , Colonic Polyps/pathology , Colonoscopy/methods , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/pathology , Humans , Narrow Band Imaging/methods , Predictive Value of Tests , Prospective Studies
Every invasive procedure carries some kind of risk, however rutine it may be. We present a case of a male patient which suffers a gastric and splenic perforation by a nasogastric tube, solved by means of surgery.
Intubation, Gastrointestinal , Stomach , Humans , Intubation, Gastrointestinal/adverse effects , Male , Spleen/diagnostic imaging , Spleen/surgery , Stomach/diagnostic imaging , Stomach/surgery
Gastric mucosa has been widely studied during the pre/post-Helicobacter pylori (Hp) era. Excluding peptic ulcer disease (PUD), the duodenal mucosa has not been thoroughly analyzed, even less so in functional dyspepsia (FD). We would like to make some comments after studying 161 dyspeptic patients with samples taken from the gastric body, antrum, proximal and distal duodenum.
Duodenal Ulcer , Dyspepsia , Gastritis , Helicobacter Infections , Helicobacter pylori , Duodenal Ulcer/complications , Duodenum , Dyspepsia/etiology , Gastric Mucosa , Helicobacter Infections/complications , Humans
We share the preliminary results of a study we are conducting about the relation between gastric emptying and physical activity. It is a subject not well known, and so far studied with different methodologies and with discordant results. The aim of this letter is to communicate our results, which can be very useful in future nutritional programs in athletes.
Digestion , Gastric Emptying , Athletes , Humans
BACKGROUND: the autonomic dysfunction defines the neuropathy of the autonomic nervous system. The prevalence of the gastric dysmotility and its relationship with the autonomic dysfunction in patients with alcohol chronic liver disease is not well known. METHODS: thirty-six patients with alcohol chronic liver disease and 25 healthy controls were evaluated, in order to detect an autonomic dysfunction through different cardiovascular reflexes and gastric emptying tests. RESULTS: ninety-four per cent of the patients showed an impaired R index (variations in heart rate during six deep inspirations-expirations per minute) and/or S/S-HR (variations in heart rate when standing from a supine position). Seventy-five per cent of the patients showed gastroparesis (T1/2: gastric half-emptying time was delayed). There was a correlation between the R index and T1/2 (r = -0.49; p < 0.01). CONCLUSIONS: we suggest that gastroparesis detected in alcoholic chronic liver disease is another clinical manifestation of the autonomic parasympathetic dysfunction.
Autonomic Nervous System Diseases , Gastroparesis , Liver Diseases , Autonomic Nervous System , Autonomic Nervous System Diseases/etiology , Gastric Emptying , Gastroparesis/etiology , Humans , Liver Diseases/complications
En los últimos años se han venido realizando numerosos estudios sobre la función de la vitamina D en diversos procesos tanto fisiológicos como patológicos. Uno de los más interesantes se presenta en la Enfermedad inflamatoria intestinal, donde se ha observado una gran prevalencia de déficit de esta vitamina en los pacientes que la padecen. Este trabajo pretende revisar la literatura publicada hasta el momento y explicar su relación con la enfermedad, sus factores de riesgo, ponderar la importancia de la exposición solar, describir cómo afecta a los diversos tratamientos de la enfermedad o mostrar el efecto de la suplementación con vitamina en estos pacientes
No disponible
Humans , Vitamin D/physiology , Vitamin D/therapeutic use , Inflammatory Bowel Diseases/therapy , Vitamin D Deficiency/epidemiology , Dietary Supplements , Sunlight/adverse effects , Vitamin D Deficiency/therapy , Polymerase Chain Reaction , Risk Factors , Avitaminosis/epidemiology , Fatigue
In the last years,several studies have focused on the involement of vitamin D in different physiological and pathological processes. One of the most interesting actions occurs in the Inflammatory bowel disease, where a higher prevalence of vitamin D deficiency has been observed. This study aimed to review the literature in order to explain its relationship with the disease, the risk factors, measuring the importance of sun exposure, describing how treatments are affected or observing the effect of vitamin supplementation in this type of patients.
Colitis , Inflammatory Bowel Diseases , Vitamin D Deficiency , Humans , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/epidemiology , Vitamin D , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiology , Vitamins/therapeutic use
