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1.
Nutrients ; 16(15)2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-39125392

RESUMEN

Diet is the only treatment for celiac disease (CeD), and good adherence to a gluten-free diet (GFD) is the only way to ensure complete remission and to prevent complications. Limited education about the disease and a GFD is an attributing factor to inadequate adherence. Thus, our aim was to assess the current knowledge about a GFD and the clinical monitoring of adherence to the diet among CeD people and HCPs. Specific questionnaires were designed and distributed to assess the knowledge of CeD people (Q1 questionnaire) (n = 2437) and to analyze the follow-up of the disease from the perspective of patients (Q2 questionnaire) (n = 1294) and HCPs (Q3 questionnaire) (n = 346). Two-thirds of HCPs specialized in pediatric care, while one-third did so in adult care. In CeD people, general questions regarding food classification and cross-contamination are well understood. When patients have doubts, 51.4% reported using the Internet and social networks. Thus, it is crucial that resources like social media are reliable and provide valuable information. Q3 revealed the lack of time to follow up the diet after diagnosis (48% of HCPs allocate < 15 min), the interest in further training, and the need for a professional specialized in diets within the healthcare system. In conclusion, it is essential to enhance nutritional education to increase awareness of a GFD.


Asunto(s)
Enfermedad Celíaca , Dieta Sin Gluten , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Humanos , Dieta Sin Gluten/estadística & datos numéricos , Enfermedad Celíaca/dietoterapia , Femenino , Masculino , Encuestas y Cuestionarios , Adulto , Educación del Paciente como Asunto/métodos , Cooperación del Paciente/estadística & datos numéricos , Persona de Mediana Edad , Adolescente , Adulto Joven , Niño
2.
Postgrad Med J ; 2024 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-38913019

RESUMEN

BACKGROUND AND AIMS: Familial inflammatory bowel disease (IBD) history is a controversial prognostic factor in IBD. We aimed to evaluate the impact of a familial history of IBD on the use of medical and surgical treatments in the biological era. METHODS: Patients included in the prospectively maintained ENEIDA database and diagnosed with IBD after 2005 were included. Familial forms were defined as those cases with at least one first-degree relative diagnosed with IBD. Disease phenotype, the use of biological agents, or surgical treatments were the main outcomes. RESULTS: A total of 5263 patients [2627 Crohn's disease (CD); 2636 ulcerative colitis (UC)] were included, with a median follow-up of 31 months. Of these, 507 (10%) corresponded to familial forms. No clinical differences were observed between familial and sporadic IBD forms except a lower age at IBD diagnosis and a higher rate of males in familial forms of UC. In CD, the proportions of patients treated with thiopurines (54.4% vs 46.7%; P = .015) and survival time free of thiopurines (P = .009) were lower in familial forms. No differences were found regarding the use of biological agents. Concerning surgery, a higher rate of intestinal resections was observed in sporadic CD (14.8% vs 9.9%, P = .027). No differences were observed in UC. CONCLUSIONS: In the era of biological therapies, familial and sporadic forms of IBD show similar phenotypes and are managed medically in a similar way; whether these is due to lack of phenotypical differences or an effect of biological therapies is uncertain. What is already known on this topic: IBD's etiopathogenesis points to an interaction between environmental and genetic factors, being familial history a controversial prognostic factor. Biological agents use and need for surgery regarding familial or sporadic forms of IBDs present conflicting results. What this study adds: Familial and sporadic forms of IBD have similar phenotypes and are managed medically and surgically in a similar way. How this study might affect research, practice or policy: Familial aggregation should not be considered a factor associated with more aggressive disease.

3.
Nutrients ; 16(2)2024 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-38257141

RESUMEN

Many patients undergo small bowel and colon surgery for reasons related to malignancy, inflammatory bowel disease (IBD), mesenteric ischemia, and other benign conditions, including post-operative adhesions, hernias, trauma, volvulus, or diverticula. Some patients arrive in the operating theatre severely malnourished due to an underlying disease, while others develop complications (e.g., anastomotic leaks, abscesses, or strictures) that induce a systemic inflammatory response that can increase their energy and protein requirements. Finally, anatomical and functional changes resulting from surgery can affect either nutritional status due to malabsorption or nutritional support (NS) pathways. The dietitian providing NS to these patients needs to understand the pathophysiology underlying these sequelae and collaborate with other professionals, including surgeons, internists, nurses, and pharmacists. The aim of this review is to provide an overview of the nutritional and metabolic consequences of different types of lower gastrointestinal surgery and the role of the dietitian in providing comprehensive patient care. This article reviews the effects of small bowel resection on macronutrient and micronutrient absorption, the effects of colectomies (e.g., ileocolectomy, low anterior resection, abdominoperineal resection, and proctocolectomy) that require special dietary considerations, nutritional considerations specific to ostomized patients, and clinical practice guidelines for caregivers of patients who have undergone a surgery for local and systemic complications of IBD. Finally, we highlight the valuable contribution of the dietitian in the challenging management of short bowel syndrome and intestinal failure.


Asunto(s)
Enfermedades Inflamatorias del Intestino , Trastornos Nutricionales , Nutricionistas , Humanos , Colectomía
4.
Nutrients ; 15(18)2023 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-37764795

RESUMEN

The gluten-free diet (GFD) remains a complex paradigm in managing celiac disease (CeD) in children and adults, and there are many reasons why GFD adherence should be strict to improve outcomes. However, this is a challenging task for patients, since they need to have access to quality healthcare resources that facilitate optimal GFD adherence. Understanding the strengths and weaknesses of the GFD, tackling coexisting nutritional deficiencies, and dealing with complex situations, such as seronegative CeD or non-responsive CeD, all require the involvement of a multidisciplinary team. The short- and long-term follow-up of CeD patients should preferably be performed by a combined Gastroenterology and Nutrition service with well-defined quality standards and the multidisciplinary involvement of physicians, nurses, dietitians, and psychologists. Nutritional advice and counseling by an experienced dietitian can reduce the costs associated with long-term follow-up of CeD patients. Likewise, psychological interventions may be essential in specific scenarios where implementing and sustaining a lifelong GFD can cause a significant psychological burden for patients. This manuscript aims to provide guidelines to improve clinical practice in the follow-up and monitoring of CeD patients and provide information on the nutritional risks of an ill-advised GFD. Clinicians, biochemists, food technologists, dietitians, and psychologists with a global view of the disease have been involved in its writing.


Asunto(s)
Enfermedad Celíaca , Adulto , Niño , Humanos , Dieta Sin Gluten , Cooperación del Paciente , Alimentos , Estado Nutricional
5.
Nutrients ; 14(22)2022 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-36432505

RESUMEN

The esophagus is the centerpiece of the digestive system of individuals and plays an essential role in transporting swallowed nutrients to the stomach. Diseases of the esophagus can alter this mechanism either by causing anatomical damage that obstructs the lumen of the organ (e.g., peptic, or eosinophilic stricture) or by generating severe motility disorders that impair the progression of the alimentary bolus (e.g., severe dysphagia of neurological origin or achalasia). In all cases, nutrient assimilation may be compromised. In some cases (e.g., ingestion of corrosive agents), a hypercatabolic state is generated, which increases resting energy expenditure. This manuscript reviews current clinical guidelines on the dietary and nutritional management of esophageal disorders such as severe oropharyngeal dysphagia, achalasia, eosinophilic esophagitis, lesions by caustics, and gastroesophageal reflux disease and its complications (Barrett's esophagus and adenocarcinoma). The importance of nutritional support in improving outcomes is also highlighted.


Asunto(s)
Esófago de Barrett , Trastornos de Deglución , Esofagitis Eosinofílica , Acalasia del Esófago , Humanos , Acalasia del Esófago/complicaciones , Esófago de Barrett/complicaciones , Trastornos de Deglución/complicaciones , Esofagitis Eosinofílica/complicaciones , Apoyo Nutricional/efectos adversos
6.
Nutrients ; 13(10)2021 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-34684433

RESUMEN

Iron is an essential nutrient to life and is required for erythropoiesis, oxidative, metabolism, and enzymatic activities. It is a cofactor for mitochondrial respiratory chain enzymes, the citric acid cycle, and DNA synthesis, and it promotes the growth of immune system cells. Thus, iron deficiency (ID) leads to deleterious effects on the overall health of individuals, causing significant morbidity. Iron deficiency anemia (IDA) is the most recognized type of anemia in patients with celiac disease (CD) and may be present in over half of patients at the time of diagnosis. Folate and vitamin B12 malabsorption, nutritional deficiencies, inflammation, blood loss, development of refractory CD, and concomitant Heliobacter pylori infection are other causes of anemia in such patients. The decision to replenish iron stores and the route of administration (oral or intravenous) are controversial due, in part, to questions surrounding the optimal formulation and route of administration. This paper provides an algorithm based on the severity of symptoms; its impact on the health-related quality of life (HRQL); the tolerance and efficiency of oral iron; and other factors that predict a poor response to oral iron, such as the severity of histological damage, poor adherence to GFD, and blood loss due to mucosal lesions.


Asunto(s)
Anemia Ferropénica/complicaciones , Enfermedad Celíaca/etiología , Enfermedad Celíaca/metabolismo , Hierro/metabolismo , Factores de Edad , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/epidemiología , Anemia Ferropénica/etiología , Biomarcadores , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/terapia , Terapia Combinada , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Femenino , Pruebas Hematológicas , Humanos , Hierro/sangre , Evaluación de Resultado en la Atención de Salud , Embarazo , Prevalencia , Factores de Riesgo , Evaluación de Síntomas
7.
Nutrients ; 13(4)2021 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-33920345

RESUMEN

Numerous disorders can alter the physiological mechanisms that guarantee proper digestion and absorption of nutrients (macro- and micronutrients), leading to a wide variety of symptoms and nutritional consequences. Malabsorption can be caused by many diseases of the small intestine, as well as by diseases of the pancreas, liver, biliary tract, and stomach. This article provides an overview of pathophysiologic mechanisms that lead to symptoms or complications of maldigestion (defined as the defective intraluminal hydrolysis of nutrients) or malabsorption (defined as defective mucosal absorption), as well as its clinical consequences, including both gastrointestinal symptoms and extraintestinal manifestations and/or laboratory abnormalities. The normal uptake of nutrients, vitamins, and minerals by the gastrointestinal tract (GI) requires several steps, each of which can be compromised in disease. This article will first describe the mechanisms that lead to poor assimilation of nutrients, and secondly discuss the symptoms and nutritional consequences of each specific disorder. The clinician must be aware that many malabsorptive disorders are manifested by subtle disorders, even without gastrointestinal symptoms (for example, anemia, osteoporosis, or infertility in celiac disease), so the index of suspicion must be high to recognize the underlying diseases in time.


Asunto(s)
Mucosa Intestinal/fisiopatología , Intestino Grueso/fisiopatología , Intestino Delgado/fisiopatología , Síndromes de Malabsorción/fisiopatología , Nutrientes/metabolismo , Anemia/diagnóstico , Anemia/etiología , Anemia/prevención & control , Humanos , Infertilidad/diagnóstico , Infertilidad/etiología , Infertilidad/prevención & control , Absorción Intestinal/fisiología , Mucosa Intestinal/diagnóstico por imagen , Intestino Grueso/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Síndromes de Malabsorción/complicaciones , Síndromes de Malabsorción/diagnóstico , Síndromes de Malabsorción/terapia , Osteoporosis/diagnóstico , Osteoporosis/etiología , Osteoporosis/prevención & control
8.
Gastroenterol. hepatol. (Ed. impr.) ; 29(10): 636-646, dic. 2006. ilus, tab, graf
Artículo en Es | IBECS | ID: ibc-052313

RESUMEN

No disponibleLa colitis isquémica es la forma más frecuente de isquemia intestinal y surge cuando el colon se ve transitoriamente privado del flujo vascular. Su diagnóstico requiere un elevado índice de sospecha clínica. Para ello, es esencial considerar la cronología de los síntomas (dolor abdominal seguido de urgencia defecatoria y rectorragia) y el contexto clínico en el que éstos aparecen (más del 90% incide en personas especialmente vulnerables a accidentes vasculares). Aunque el diagnóstico requiere una colonoscopia precoz (< 48 h) ésta no debe realizarse en presencia de peritonitis. En las formas graves, hay otras pruebas de imagen, como la ultrasonografía-Doppler o la tomografía computarizada abdominal, que proporcionan información con valor diagnóstico e incluso pronóstico. La angiografía queda reservada para los casos en que se plantean dudas acerca de la existencia de una isquemia mesentérica aguda. Es necesario realizar un estudio de trombofilia en las personas de menos de 60 años


Ischemic colitis is the most frequent form of intestinal ischemia and arises when the colon is temporarily deprived of blood supply. Diagnosis of this entity requires a high index of clinical suspicion. To achieve this, the chronology of the symptoms (abdominal pain followed by defecatory urgency and rectorrhagia) and the clinical context in which these symptoms appear (> 90% affect persons especially at risk for vascular accidents) must be taken into account. Although diagnosis requires early colonoscopy (< 48 h), this procedure should not be performed if peritonitis is present. In severe forms, other imaging techniques, such as Doppler ultrasound or abdominal computed tomography, provide information with diagnostic ­and even prognostic­ value. Angiography is reserved for patients in whom there is doubt about the presence of acute mesenteric ischemia. Thrombophilia should be investigated in persons aged less than 60 years old


Asunto(s)
Humanos , Colitis Isquémica/diagnóstico , Colitis Isquémica/terapia , Biomarcadores/sangre , Colitis Isquémica/etiología , Diagnóstico Diferencial , Factores de Riesgo , Pronóstico
9.
Gastroenterol Hepatol ; 29(10): 636-46, 2006 Dec.
Artículo en Español | MEDLINE | ID: mdl-17198642

RESUMEN

Ischemic colitis is the most frequent form of intestinal ischemia and arises when the colon is temporarily deprived of blood supply. Diagnosis of this entity requires a high index of clinical suspicion. To achieve this, the chronology of the symptoms (abdominal pain followed by defecatory urgency and rectorrhagia) and the clinical context in which these symptoms appear (> 90% affect persons especially at risk for vascular accidents) must be taken into account. Although diagnosis requires early colonoscopy (< 48 h), this procedure should not be performed if peritonitis is present. In severe forms, other imaging techniques, such as Doppler ultrasound or abdominal computed tomography, provide information with diagnostic -and even prognostic- value. Angiography is reserved for patients in whom there is doubt about the presence of acute mesenteric ischemia. Thrombophilia should be investigated in persons aged less than 60 years old.


Asunto(s)
Colitis Isquémica/diagnóstico , Algoritmos , Colitis Isquémica/etiología , Diagnóstico Diferencial , Humanos
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