Debut de enfermedad de Crohn durante tratamiento con ocrelizumab en paciente con esclerosis múltiple / Crohn's disease induced by ocrelizumab in a patient with multiple sclerosis

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)

Eficacia y seguridad de la pinza disectora SB Knife(TM) Jr. en el tratamiento del divertículo de Zenker. Serie de casos / No disponible

INTRODUCCIÓN Y OBJETIVO: la pinza disectora SB Knife(TM) es un nuevo dispositivo endoscópico que se puede utilizar en el tratamiento del divertículo de Zenker, pero la experiencia es limitada. Nuestro objetivo fue evaluar la eficacia y seguridad del SB Knife(TM) en el tratamiento del divertículo de Zenker. MÉTODOS: estudio unicéntrico prospectivo en el que se incluyeron 16 pacientes entre mayo de 2017 y abril de 2019. Se evaluaron las complicaciones del procedimiento y la evolución clínica. RESULTADOS: la mediana de edad fue de 78 años y el 62,5% fueron varones. El 100% presentaba disfagia; el 43,8%, atragantamientos; el 31,3%, regurgitación; y el 6,3%, aspiraciones. La mediana de tamaño del divertículo fue de 20 mm y la mediana de seguimiento, 281 días. No hubo ninguna complicación intraprocedimiento y solo una posprocedimiento importante (microperforación). En todos los pacientes hubo mejoría inicial, pero en dos hubo recurrencia clínica que se trató con el mismo sistema con buen resultado. CONCLUSIONES: el SB Knife(TM) parece una opción segura y eficaz en el tratamiento del divertículo de Zenker

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Pioderma gangrenoso y criptococosis cutánea primaria en un paciente con colitis ulcerosa / Pyoderma gangrenosum and primary cutaneous cryptococcosis in an ulcerative colitis patient

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Clinical status, quality of life, and work productivity in Crohn’s disease patients after one year of treatment with adalimumab

Objective: Clinical trials have shown the efficacy of adalimumab in Crohn’s disease, but the outcome in regular practice remains unknown. The aim of the study was to examine clinical status, quality of life, and work productivity of Crohn’s disease patients receiving adalimumab for one year in the context of usual clinical practice. Material and methods: This was a prospective, observational study with a one-year follow-up. After baseline, Crohn’s disease patients were evaluated at 1, 3, 6, 9, and 12 months after starting treatment with adalimumab. Outcome variables included: clinical status (measured with CDAI), quality of life (measured with EuroQoL-5D and IBDQ), and work productivity (measured with WPAI questionnaire). These outcome variables were compared using the Student’s t test or Wilcoxon test for paired comparison data according to the data distribution. Statistical significance was set at two-sided p < 0.05. Results: The sample was composed of 126 patients (age [mean] 39.1 ± [standard deviation] 13.8 years; 51% male). Significant changes were observed during the follow-up period: CDAI decreased from [median] 194 ([25-75 percentiles] 121-269) to 48.2 (10.1-122.0) (p < 0.05); the EuroQoL-5D increased from 0.735 (0.633-0.790) to 0.797 (0.726-1.000) (p < 0.05); the EuroQoL- 5D visual analogue scale increased from 50.0 (40-70) to 80.0 (60- 90); (p < 0.05) and the IBDQ increased from 56.7 (51.6-61.5) to 67.5 (60.1-73.6) (p < 0.05). The total work productivity impact decreased from 53% to 24% (p < 0.05). Conclusions: In regular practice, adalimumab is clinically effective in the treatment of Crohn’s disease patients and results in a significant improvement in quality of life and work product (AU)

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Risk factors for tuberculosis in inflammatory bowel disease: anti-tumor necrosis factor and hospitalization

Aims: To determine risk factors for active tuberculosis in patients with inflammatory bowel diseases. Methods: Retrospective, case-control study at 4 referral hospitals in Spain. Cases developed tuberculosis after a diagnosis of inflammatory bowel disease. Controls were inflammatory bowel disease patients who did not develop tuberculosis. For each case, we randomly selected 3 controls matched for sex, age (within 5 years) and time of inflammatory bowel disease diagnosis (within 3 years). Inflammatory bowel disease characteristics, candidate risk factors for tuberculosis and information about the tuberculosis episode were recorded. Multivariate analysis and a Chi-squared automatic interaction detector were used. Results: Thirty-four cases and 102 controls were included. Nine of the 34 cases developed active tuberculosis between 1989 and 1999, and 25 became ill between 2000 and 2012. Multivariate regression showed an association between active tuberculosis and anti-TNF (tumor necrosis factor) therapy in the previous 12 months (OR 7.45; 95% CI, 2.39-23.12; p = 0.001); hospitalization in the previous 6 months (OR 4.38; 95% CI, 1.18-16.20; p = 0.027); and albumin levels (OR 0.88; 95% CI, 0.81-0.95; p = 0.001). The median time between the start of biologic therapy and the onset of active tuberculosis was 13 (interquartile range, 1-58) months. Tuberculosis developed after a year of anti-TNF therapy in 53%, and late reactivation occurred in at least 3 of 8 patients. Conclusions: The main risks factors for developing tuberculosis were anti-TNF therapy and hospitalization. Over half the cases related to anti-TNF treatment occurred after a year (AU)

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