Smoking does influence disease behaviour and impacts the need for therapy in Crohn's disease in the biologic era.

BACKGROUND: Recently, the notion that smoking may adversely affect Crohn's disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti-TNF drugs might offset the adverse effects of tobacco. AIM: To reassess the influence of tobacco smoking on disease phenotype and complications on a time-dependent analysis, taking into account the different therapeutic interventions. METHODS: We designed a retrospective cohort study of 3224 patients with Crohn's disease. The data were collected from the Spanish national inflammatory bowel disease registry (ENEIDA), including information regarding demographics, clinical characteristics, disease complications, therapeutic interventions and smoking status. Patients were classified as nonsmokers, smokers and former smokers, according to their present and past smoking habits. RESULTS: In the univariate analysis, smokers had more strictures (22.6% vs. 19.3%, P < 0.05) and less colonic involvement (7.2% vs. 10.9%, P < 0.05), and were more frequently under treatment with steroids (91.6% vs. 85.8%, P < 0.05), immunosuppressants (73.5% vs. 63.6% P < 0.05) or anti-TNF drugs (31.4% vs. 25.1%, P < 0.05) than nonsmokers. In the time-dependent multivariate analysis, smokers were found to have a significantly decreased survival free of stricturing disease (HR: 1.5, CI 95% 1.18-1.90) or perianal complications (HR: 1.50, CI 95% 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR: 1.20, CI 95% 1.05-1.30). CONCLUSION: These results suggest that, despite the widespread use of immunosuppressants and anti-TNF drugs, smokers with Crohn's disease still have a more severe disease course, with increased therapeutic requirements when compared with nonsmokers.

[Prevalence of Helicobacter pylori infection in the healthy population of Madrid (Spain)]. / Prevalencia de la infección por Helicobacter pylori en población sana en la Comunidad de Madrid.

OBJECTIVE: To determine the prevalence of Helicobacter pylori infection in the healthy population of Madrid Autonomous Community (AC). MATERIAL AND METHODS: A descriptive, cross-sectional study where Helicobacter pylori infection is diagnosed by means of the 13C-urea breath test. RESULTS: A total of 618 subjects were studied. Among these, 481 were considered evaluable with a prevalence of Helicobacter pylori infection of 60.3%. In this cohort 36.4% were men and 63.6% were women, with a prevalence of 60.6 and 60.1%, respectively, and no relevant differences between both subgroups. The median age of patients was 37.5 years (range 4-82), and a statistically significant linear relationship between Helicobacter pylori infection and age (linear chi2 =33.31; p < 0.001) was established -chances of infection increase with age. Prevalence increases with age and peaks at 60 to 69 years (83.3% infected). For 169 subjects (35.1%) education level was unknown, and no relationship between this level and Helicobacter pylori infection was found. CONCLUSIONS: The study shows that the prevalence of Helicobacter pylori infection in the healthy population of Madrid AC is high (60.3%), progressively increases with age, and peaks in people in their sixties. The sample showed no differences regarding sex or education level.

Prevalencia de la infección por Helicobacter pylori en población sana en la Comunidad de Madrid / Prevalence of Helicobacter pylori infection in the healthy population of the Community of Madrid

Objetivo: conocer la prevalencia de la infección por Helicobacterpylori en población sana en la Comunidad de Madrid.Material y métodos: estudio transversal descriptivo en el quese realiza el diagnóstico de la infección por Helicobacter pylorimediante la prueba del test del aliento con 13C-urea.Resultados: se estudian un total de 618 sujetos. De estos,481 son considerados evaluables con una prevalencia de infecciónpor Helicobacter pylori del 60,3%. En esta cohorte el36,4% eran varones y el 63,6% mujeres con una prevalencia del60,6 y 60,1% respectivamente sin diferencias significativas. Lamediana de edad de los pacientes evaluados fue de 37,5 años(rango 4-82) estableciéndose que existe una relación lineal consignificación estadística entre la infección por Helicobacter pyloriy la edad (X2 lineal = 33,31; p < 0,001): a mayor edad mayorprobabilidad de infección. La prevalencia aumenta con la edadsiendo máxima entre los 60 y 69 años (83,3% infectados). En169 sujetos (35,1%) se conoce el nivel de estudios sin que existarelación entre este y la infección por Helicobacter pylori.Conclusión: el estudio muestra que la prevalencia de la infecciónpor Helicobacter pylori en población sana en Madrid es elevada(60,3%), y aumenta progresivamente a lo largo de la vida paraalcanzar un pico máximo en la 6ª década. No se encuentran diferenciasen la muestra en función del sexo ni del nivel de estudios

Objective: to determine the prevalence of Helicobacter pyloriinfection in the healthy population of Madrid Autonomous Community(AC).Material and methods: a descriptive, cross-sectional studywhere Helicobacter pylori infection is diagnosed by means of the13C-urea breath test.Results: a total of 618 subjects were studied. Among these,481 were considered evaluable with a prevalence of Helicobacterpylori infection of 60.3%. In this cohort 36.4% were men and63.6% were women, with a prevalence of 60.6 and 60.1%, respectively,and no relevant differences between both subgroups.The median age of patients was 37.5 years (range 4-82), and astatistically significant linear relationship between Helicobacter pyloriinfection and age (linear X2 =33.31; p < 0.001) was established–chances of infection increase with age. Prevalence increaseswith age and peaks at 60 to 69 years (83.3% infected). For 169subjects (35.1%) education level was unknown, and no relationshipbetween this level and Helicobacter pylori infection was found.Conclusions: the study shows that the prevalence of Helicobacterpylori infection in the healthy population of Madrid AC ishigh (60.3%), progressively increases with age, and peaks in peoplein their sixties. The sample showed no differences regardingsex or education level

Uso inapropiado de antisecretores en el medio hospitalario / Incorrected use of acid-suppresive medications in hospitalized patients

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[Severe and disseminated infection by cytomegalovirus in immunocompetent patient]. / Infección diseminada y severa por citomegalovirus en paciente inmunocompetente.

Usually, cytomegalovirus infection dosen't cause symptoms in immunocompetents patients although sometimes can. In alcoholic and cirrhotic subjects can cause several and fatal infections. We describe a case of disseminated cytomegalovirus infection in an alcoholic patient with excellent response to ganciclovir.

Infección diseminada y severa por citome galovirus en paciente inmunocompetente / Disseminated cytomegalovirus infection in immuno competent patients

La infección por citomegalovirus en pacientes inmunocompetentes suele ser asintomática. Los pacientes inmunodeprimidos pueden presentar cuadros severos con mala respuesta al tratamiento. Presentamos el caso de un paciente alcohólico con infección diseminada por citomegalovirus con excelente respuesta al tratamiento con ganciclovir (AU)

Usually, cytomegalovirus infection dosen’t cause symtons in immunocompetents patients although sometimes can. In alcoholic and cirrhotic subjects can cause several and fatal infections. We describe a case of disseminated cytomegalovirus infection in an alcoholic patient with excellent response to ganciclovir (AU)

[Changes in the use of percutaneous liver biopsy over time]. / Cambios en la utilización de la biopsia hepática percutánea con el tiempo.

AIM: To study, through the pathology diagnosis obtained, the current use of percutaneous liver biopsy and its change with time. MATERIALS AND METHODS: Pathology diagnosis of 759 liver biopsies performed during last 5 years are reviewed and compared with our previously published experience. RESULTS: Neoplasms have decreased from 16% of all pathologic diagnosis obtained in 1961-81 to less than 1% in the last 5 years. In 1985-87, liver cirrhosis was the final diagnosis in 60% of all biopsies, while currently it is only 18%, with a steady absolute number of cirrhosis each year. The most remarkable change is the number of biopsy diagnosis of chronic hepatitis, which has increased from 19% in 1985-87 to 51% in the last 5 years. Ten percent of all biopsies was performed in HIV-positive patients; granulomatous hepatitis and tuberculosis were more prevalent in them. CONCLUSIONS: Percutaneous liver biopsy has been displaced for the diagnosis of liver cirrhosis and has been focussed on the diagnosis of chronic hepatitis. HIV-positive patients represent an important population for those who perform liver biopsy.

[Recurrent ascites in peritoneal mesothelioma. Its diagnostic and therapeutic management]. / Ascitis recidivante en el mesotelioma peritoneal. Manejo diagnóstico y terapéutico.

Peritoneal mesothelioma is an uncommon neoplasm often related to previous asbestos exposure. It is necessary to exclude other secondary peritoneal neoplasm. The application of immunohistochemical analysis in the biopsy sample is important for establishing an accurate diagnosis. We report the case of a peritoneal mesothelioma that started as a haemorrhagic ascites. After laparotomy, the initial diagnosis was peritoneal carcinomatosis from adenocarcinoma of unknown origin. The diagnosis was obtained by using immunohistochemical analysis: vimentin and keratine antibodies were positive and leu M1, antibodies were negative. The interest of our case resides in the difficulty for obtaining the diagnosis and the complicate management of refractory ascites. Our patient required intraperitoneal 5-fluorouracil for controlling the ascites.

[The spectrum of liver disease in infection by the human immunodeficiency virus: a study of 50 liver biopsies]. / El espectro de la hepatopatía en la infección por el virus de la inmunodeficiencia humana: estudio de 50 biopsias hepáticas.

BACKGROUND: The patients with human immunodeficiency virus (HIV) infection have hepatic abnormalities due to infective, neoplastic and toxic disorders. The aim of the present study was to describe the spectrum of liver disease in the HIV infection and to establish the usefulness and indications of hepatic biopsy. METHODS: The hepatic biopsies prospectively carried out in 50 patients infected by HIV with abnormal hepatic biochemical parameters, fever of unknown origin or space occupying lesions were evaluated. RESULTS: Hepatic granulomatosis was found in 37 patients (74%). In 15 (30%) the culture in Löwenstein medium was positive. The strains were typified as Mycobacterium tuberculosis in 14. This finding took place in 8 out of 18 biopsies carried out because of fever of unknown origin (FUO) (44%). The rate of granulomatosis due to mycobacteria was 40%. Other diagnoses were steatosis in 22 patients, chronic active hepatitis in 10, chronic lobular hepatitis in 3, infiltration by Hodgkin's lymphoma in one and metastatic invasion by non-differentiated carcinoma in one. Hepatic biopsy was diagnostic in 8 out of 18 carried out for FUO (44%) and in 24 out of 30 carried out for abnormal hepatic biochemical parameters (80%). CONCLUSIONS: In the evaluated patients with HIV infection, hepatic granulomatosis was the most common finding and was due to mycobacteria in 40%. Hepatic steatosis and chronic active and lobular hepatitis were the most common causes of abnormal hepatic biochemical parameters. Considering the high yield of hepatic biopsy, the authors think that it should be carried out in patients with HIV infection and FUO or unexplained abnormal hepatic biochemical parameters.