[Pan American Crohn's and Colitis Organization (PANCCO) and the Interamerican Society of Endoscopy (SIED) consensus on endoscopy in inflammatory bowel disease]. / Consenso de endoscopia en enfermedad inflamatoria intestinal de la Organización Panamericana de Crohn y Colitis (PANCCO) y la Sociedad Interamericana de endoscopia (SIED).

INTRODUCTION: Endoscopy plays a fundamental role in inflammatory bowel disease (IBD), and becomes essential in diagnosis, treatment monitoring, and detection and management of complications. MATERIALS AND METHODS: The Pan American Crohn's and Colitis Organization (PANCCO) and the Inter-American Society of Endoscopy (SIED) appointed 22 Latin American experts in IBD to develop a consensus study using the modified Delphi method, based on the best available evidence. A working group of 22 members from 9 countries identified 15 topics and formulated 98 statements, who participated in 2 rounds of voting. It was defined as agreement of ≥80% of experts for each statement. RESULTS: After the voting of all the statements, 8 statements were obtained that did not reach 80% consensus among the participants, so the questions were reconsidered in the Coordinating Committee of the consensus with the participation of the expert reviewers of these questions and 7 final statements were voted again by all the experts in a second round and 1 was eliminated with consensus. After two rounds of voting, the experts reached consensus with literature review with the best available evidence, the most important issues were developed with scientific evidence supporting each of the statements around the topic of endoscopy in IBD. CONCLUSIONS: Consensus statements were developed and based on the best available evidence about endoscopy in inflammatory bowel disease.

Consenso de endoscopia en enfermedad inflamatoria intestinal de la Organización Panamericana de Crohn y Colitis (PANCCO) y la Sociedad Interamericana de endoscopia (SIED) / Pan American Crohn's and Colitis Organization (PANCCO) and the Interamerican Society of Endoscopy (SIED) consensus on endoscopy in inflammatory bowel disease

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ABSTRACT Introduction: Endoscopy plays a fundamental role in inflammatory bowel disease (IBD), and becomes essential in diagnosis, treatment monitoring, and detection and management of complications. Materials and methods: The Pan American Crohn's and Colitis Organization (PANCCO) and the Inter-American Society of Endoscopy (SIED) appointed 22 Latin American experts in IBD to develop a consensus study using the modified Delphi method, based on the best available evidence. A working group of 22 members from 9 countries identified 15 topics and formulated 98 statements, who participated in 2 rounds of voting. It was defined as agreement of ≥80% of experts for each statement. Results: After the voting of all the statements, 8 statements were obtained that did not reach 80% consensus among the participants, so the questions were reconsidered in the Coordinating Committee of the consensus with the participation of the expert reviewers of these questions and 7 final statements were voted again by all the experts in a second round and 1 was eliminated with consensus. After two rounds of voting, the experts reached consensus with literature review with the best available evidence, the most important issues were developed with scientific evidence supporting each of the statements around the topic of endoscopy in IBD. Conclusions: Consensus statements were developed and based on the best available evidence about endoscopy in inflammatory bowel disease.

Colombian experience with the use of tofacitinib in severe acute ulcerative colitis: A case series study. / Experiencia colombiana con el uso de tofacitinib en colitis ulcerosa aguda grave: estudio de serie de casos.

INTRODUCTION: Tofacitinib is indicated in patients with moderate to severe ulcerative colitis (UC); however, given its rapid onset of action, it may constitute an alternative in patients with hospitalized severe acute UC. There are few data on this indication in the literature. The aim of this study was to describe the efficacy and safety of tofacitinib in the management of patients with hospitalized UC, as well as its clinical characteristics and other treatment patterns. MATERIALS AND METHODS: Descriptive observational study of adults and children with CUAG treated with tofacitinib between June 2019 and December 2022 in Colombia. Sociodemographic and clinical variables were collected, therapeutic response was evaluated in different periods of time and descriptive analysis of quantitative and qualitative variables was performed. RESULTS: Six patients (five adults and one pediatric), mean age 33.2 (SD: 8.5) years, with CUAG. Symptom remission was obtained in 100% of patients at day 7 after tofacitinib initiation. In three patients information was obtained beyond 6 months, with 100% clinical, biochemical, and endoscopic remission and without requiring colectomy. In the case of the pediatric patient, symptom remission was achieved one week after starting tofacitinib, remaining in clinical, biochemical and endoscopic remission beyond 6 months. No serious adverse events were reported in any of the cases. CONCLUSIONS: Tofacitinib represents a rescue therapeutic alternative in CUAG, with rapid clinical response, adequate tolerance and less need for colectomy, being sustained for periods beyond 6 months.

Tofacitinib in the treatment of moderate to severe ulcerative colitis in Colombia: Real world experience. / Tofacitinib en el tratamiento de la colitis ulcerosa moderada a grave en Colombia: experiencia en mundo real.

INTRODUCTION: There are no studies on efficacy of tofacitinib for ulcerative colitis (UC) in Latin America. The aim of this study was to describe the efficacy and safety, in the real world, of patients with moderate-severe UC treated with tofacitinib in our setting. MATERIALS AND METHODS: Multicenter descriptive observational study, in patients with UC who received treatment with tofacitinib in induction phase for 8 weeks and then, maintenance therapy, between June 2019 and June 2022. RESULTS: Thirty-four adult patients, 50% female, mean age 38.1 (range 22-72) years. 76.5% pancolitis, and 20.6% left colitis. 79.4% failure to tumor necrosis factor inhibitors (anti-TNFs), and 35.3% to vedolizumab. 14.7% naïve to biologic therapy. 23.5% had previous extraintestinal manifestations. During induction, 58.8% of patients achieved clinical, biochemical and endoscopic remission. During maintenance, 76.9% of patients at 26 weeks and 66.6% at 52 weeks presented clinical remission. Eight patients presented adverse events, none of them cardiovascular or thromboembolic. 44.1% were steroid-dependent, and 23.5% required steroids as rescue therapy. 38.3% required an increase in tofacitinib to 10mg every 12h during maintenance. In 17.6% tofacitinib was discontinued due to lack of efficacy. We included three pediatric-aged female patients, mean age 15.3 (range 14-17) years, 2/3 with pancolitis and 1/3 with left colitis, all with prior exposure to biologic therapy, who had clinical, biologic and endoscopic remission at induction. CONCLUSIONS: In this first Latin American study with tofacitinib in UC, efficacy and safety are demonstrated in the treatment of our patients with moderate to severe activity.

Cost Effectiveness of Tofacitinib for the Treatment of Moderate to Severe Active Ulcerative Colitis in Colombia.

OBJECTIVE: The aim of this study was to evaluate the cost effectiveness of tofacitinib versus other treatment options currently available in Colombia in naïve to biologics (first-line) and exposed to biologics (second-line) patients with moderate to severe active ulcerative colitis (UC). METHODS: A Markov model was constructed with 8-week cycles, simulating a cohort of patients in a 5-year time horizon. The health states included remission, treatment response, active UC, and colectomy. The transition probabilities for the induction and maintenance phase were obtained from a network meta-analysis, and effectiveness was measured using quality-adjusted life-years (QALYs). Unit costs were derived from official national sources. RESULTS: For first line, the incremental cost-effectiveness ratio (ICER) per QALY was $883 for tofacitinib and $3619 for infliximab, compared with adalimumab. Sensitivity analysis showed that tofacitinib is cost effective in 45% of the iterations, adalimumab in 5%, and infliximab in 50%. Meanwhile, the ICER of adalimumab was $14,927 compared with tofacitinib in second-line treatment. In the sensitivity analysis, tofacitinib was cost effective in 64% of the iterations, followed by adalimumab in 36%. Infliximab and golimumab were not included due to data limitations in the network meta-analysis of second-line treatment. CONCLUSION: The analysis suggests that in Colombia, treatment with tofacitinib for patients with moderate-to-severe UC is a cost-effective option in both lines compared with other treatment options.

Gastrointestinal involvement due to graft-versus-host disease / Compromiso gastrointestinal por enfermedad de injerto contra huésped

Abstract Graft-versus-host disease is a common complication after stem cell transplantation. The digestive tract is affected in many patients who suffer from it, with consequences that can be fatal. The proper approach, which includes endoscopic studies, allows ruling out differential diagnoses and managing the disease early.

Resumen La enfermedad de injerto contra huésped es una complicación frecuente después del trasplante de células madre. El tracto digestivo se afecta en una gran proporción de los pacientes que la sufren, con consecuencias que pueden llegar a ser fatales. El abordaje adecuado, que incluye el uso de estudios endoscópicos, permite descartar diagnósticos diferenciales y brindar un manejo temprano de la enfermedad.

Clinical characteristics and treatment of perianal fistulising Crohn's disease in Colombia: Results of a multicentric registry. / Características clínicas y tratamiento de la enfermedad de Crohn perianal fistulizante en Colombia: resultados de un registro multicéntrico.

INTRODUCTION: Perianal fistulizing Crohn's disease (CD) is a phenotype with a poor prognosis. There are no studies in our country. Our objective is to determine the clinical, sociodemographic and treatment characteristics of perianal fistulizing CD in a Colombian multicenter registry. MATERIALS AND METHODS: A retrospective, multicenter observational study was carried out, with prospective data collection, in the main reference centers for inflammatory Bowel disease (IBD) in the country. Continuous variables were expressed as medians and interquartile ranges. The categorical outcome variables were compared by the Chi-square test. RESULTS: Sixty-five patients with perianal fistulizing CD were documented, with a median age of appearance of perianal fistula of 31.0 years (range: 24-42), predominantly in men (61.5%; H:M ratio: 1.4:1). Complex perianal fistulas were more frequent than simple ones (75.35 vs. 24.6%). Regarding medical treatment, 66.2% of the patients received antibiotics, 64.6% steroids, 78.5% biological therapy, 47.7% non-cutting setons, and 46.2% required surgical management, other than seton placement. Only 29.2% achieved complete remission of the fistula, and 9.2% of the patients ended up in a definitive colostomy. CD patients with complex fistulas received more biological therapy, compared to CD patients with simple fistulas (84.8 vs. 56.3%; P: 0.038). CONCLUSIONS: Perianal fistulizing CD has a poor prognosis in our setting, only 3 out of 10 patients achieve complete remission despite treatment. A multidisciplinary management is essential for the comprehensive management of this difficult pathology.

Clinical differentiation of inflammatory bowel disease (IBD) in Latin America and the Caribbean.

ABSTRACT: The aim of the present study was to describe the epidemiological and clinical characteristics of inflammatory bowel disease (IBD), including medical and surgical treatments, in several countries in Latin America and the Caribbean.IBD is recognized as a global health problem because its incidence and prevalence have increased significantly over the last few years.This multicenter retrospective cohort study included 4714 patients with IBD diagnosed from 9 countries in Latin America and the Caribbean: Colombia, Cuba, Dominican Republic, Ecuador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela.Crohn disease (CD) was more frequent in Puerto Rico (71.9%), the Dominican Republic (61.0%), and Peru (53.1%). Ulcerative colitis was more frequent in Colombia (78.6%), Venezuela (78.2%), Mexico (75.5%), Cuba (69.9%), Ecuador (64.1%), and Uruguay (60.9%). The following clinical characteristics were more frequent in the Caribbean: penetrating behavior in CD, steroid dependence, steroid resistance, intolerance to thiopurines, extraintestinal manifestations, surgeries, hospitalizations due to IBD, and family history of IBD. The factors associated with the use of biological therapy were pancolitis in ulcerative colitis, penetrating behavior in CD, steroid resistance and dependence, presence of extraintestinal manifestations, and the need for surgery.This study from Latin America and the Caribbean demonstrated the different epidemiological and clinical characteristics of IBD.

Prevalencia y manejo de anemia en enfermedad inflamatoria intestinal en un centro de referencia en Colombia / Prevalence and treatment of anemia in inflammatory bowel disease in a Colombian reference center

Resumen Introducción: la anemia es la complicación más frecuente en enfermedad inflamatoria intestinal (EII). El objetivo de este estudio fue determinar la prevalencia, asociaciones y tratamiento de la anemia en EII en nuestro medio. Materiales y métodos: se analizaron de forma retrospectiva datos de pacientes adultos con EII del Hospital Pablo Tobón Uribe en Medellín, Colombia, que consultaron desde 2001 hasta febrero de 2019. Se emplearon frecuencias absolutas y relativas. Para comparar dos proporciones se utilizó la prueba de chi cuadrado de independencia y se estimó el Odds ratio (OR). Resultados: se documentaron 759 pacientes con EII, de los cuales 544 (71,6 %) presentaron colitis ulcerativa (CU); 200 (26,3 %), enfermedad de Crohn (EC), y 15, EII no clasificable (1,9 %). En total, 185 (24,4 %) pacientes con EII presentaron anemia, que es menos frecuente en CU que en EC (22,2 % frente a 32,5 %, respectivamente; OR: 0,684; IC: 0,456-0,96; p = 0,03). Los pacientes con CU extensa (54,1 %) tenían más anemia que aquellos con CU no extensa (46,3 %) (OR: 4,4; IC: 2,6-7,4; p = 0,001); lo mismo se observó al comparar la CU grave (66,1 %) con la no grave (32,3 %) (OR: 4,95; IC: 2,87-8,51; p = 0,000). En la EC, los pacientes con comportamiento no inflamatorio (B2, B3: 73,9 %) presentaron más anemia en comparación con aquellos con comportamiento inflamatorio (B1: 26,2 %) (OR: 0,35; IC: 0,18-0,67; p = 0,000). 44,3 % de los pacientes no recibió tratamiento, 19,5 % recibió hierro oral, 20,0 % recibió hierro intravenoso y 16,2 % fue transfundido. Conclusiones: la anemia es una complicación frecuente de la EII en nuestro medio (24,4 %). A pesar de las guías internacionales, el tratamiento es subóptimo en nuestro medio.

Abstract Introduction: Anemia is the most frequent complication of inflammatory bowel disease (IBD). This study aims to determine the prevalence, connection, and treatment of anemia in IBD in a local context. Materials and Methods: This retrospective study was conducted at The Pablo Tobon Uribe Hospital, in Medellín (Colombia) with adult patients who (were admitted) came for consultation from 2001, until February 2019. Absolut and relative frequencies were calculated. The Chi square test of independence was applied for comparing two proportions and the odds ratio (OR) was estimated. Results: A total of 759 IBD patients were enrolled, 544 (71.6%) with ulcerative colitis (UC); 200 (26.3%) Crohn's disease (CD), and 15 (1.9%) with non-classifiable IBD. In total, 185 (24,4 %) IBD patients had a diagnosis of anemia, that is less frequent in UC patients that in CD patients (22,2 % versus 32,5 %, respectively; OR: 0,684; CI: 0,456-0,96; p = 0,03). Extensive UC patients (54,1 %) had a more recurrent level of anemia than non-extensive UC (46,3 %) (OR: 4,4; CI: 2,6-7,4; p = 0,001); the same result was observed when severe UC (66,1 %) was compared with UC non-severe (32,3 %) (OR: 4,95; CI: 2,87-8,51; p = 0,000). In the analysis of CD, patients with a non-inflammatory response (B2, B3: 73,9 %) had a more recurrent level of anemia than patients with an inflammatory response (B1: 26,2 %) (OR: 0,35; CI: 0,18-0,67; p = 0,000). 44,3 % of the total number of patients received treatment, 19,5 % received oral iron, 20,0 % received intravenous iron, and 16,2 % received a blood transfusion. Conclusions: In our context, Anemia is a common complication in IBD cases (24,4 %). Despite the existence of international guidelines, the treatment in our context is not optimal.

El "efecto fin de semana" en pacientes que asisten a urgencias por hemorragia digestiva superior no varicosa. La experiencia en un hospital de alta complejidad / The "Weekend Effect" in patients admitted to the Emergency Unit with non-variceal upper gastrointestinal bleeding. A high-complexity hospital experience

Resumen Introducción y objetivos: el "efecto fin de semana" se define como un incremento en la mortalidad en pacientes que ingresan a centros asistenciales durante el fin de semana o días festivos. Este estudio se realizó para evaluar el posible "efecto fin de semana" en pacientes con hemorragia digestiva superior (HDS) con base en una experiencia de 3 años en un hospital de alta complejidad en Latinoamérica. Materiales y métodos: estudio observacional descriptivo realizado entre 2016 y 2018. Se describieron las características demográficas, factores de riesgo, síntomas de ingreso, hallazgos endoscópicos y diferentes intervenciones médicas. Además, se compararon los tiempos de realización de endoscopia, estancia hospitalaria y mortalidad entre los pacientes admitidos durante el fin de semana frente a días entre semana. Resultados: el análisis incluyó 274 pacientes en fines de semana y festivos (39,1 %) frente a pacientes en días entre semana (60,9 %). La mediana de edad fue de 68,5 años (rango intercuartílico [RIC]: 53-79), el 56,6 % fueron hombres. Las manifestaciones más comunes fueron melenas y hematemesis. La úlcera péptica fue el diagnóstico endoscópico más común (48,7 %). Los tiempos de estancia hospitalaria (7,38 ± 8,7 frente a 7,38 ± 7,1; p = 0,234) y mortalidad (1,9 % frente a 4,2 %; p = 0,274) fueron similares en ambos grupos. Se realizó una mayor cantidad de endoscopias después de las 24 horas en pacientes ingresados el fin de semana (19,6 % frente a 9,6 %; p = 0,041). Conclusiones: en esta cohorte no se presentó el "efecto fin de semana", no se observan diferencias en relación con la estancia hospitalaria, ni con la mortalidad en pacientes ingresados por HDS.

Abstract Introduction and Objectives: The "Weekend Effect" refers to an increase in mortality of patients admitted to health care centers on weekends or holidays. This study was performed to assess the impact of weekend admissions in patients with upper gastrointestinal bleeding (UGIB) based on a three year-experience in a high-complexity hospital in Latin America. Materials and Methods: A descriptive observational study was performed between 2016 and 2018. Data on demographic characteristics, risk factors, symptoms, endoscopic findings, and medical treatment was described. Moreover, the time to perform an endoscopy, the length of hospital stay, and the mortality level among patients admitted on weekends were compared with the same factors during the week. Results: The analysis included 274 patients admitted during the weekend and holidays (39.1%) versus patients admitted during the week (60.9%). The median age was 68.5 years old (interquartile range [IQR]: 53-79), and 56.6% were men. The most common conditions were tarry stools and hematemesis. Peptic ulcer was the most common endoscopic diagnosis (48.7%). Similar results were found in the length of hospital stay (7,38 ± 8,7 versus 7,38 ± 7,1; p = 0,234) and mortality groups (1,9 % versus 4,2 %; p = 0,274). A higher number of endoscopies 24 hours after the patient was admitted was performed (19,6 % versus 9,6 %; p = 0,041). Conclusions: The "Weekend Effect" was not present in the analyzed group, and there are no significant differences related to the length of hospital stay or the mortality of patients diagnosed with UGIB.

Trends in the epidemiology of inflammatory bowel disease in Colombia by demographics and region using a nationally representative claims database and characterization of inflammatory bowel disease phenotype in a case series of Colombian patients.

ABSTRACT: The incidence of inflammatory bowel disease (IBD) is on the rise in Latin America. The aims of this study were to examine epidemiologic trends of IBD in Colombia by demographics, region, urbanicity, and to describe the IBD phenotype in a large well-characterized Colombian cohort.We used a national database of 33 million adults encompassing 97.6% of the Colombian population in order to obtain epidemiologic trends of IBD using International Classification of Diseases 10codes for adults with ulcerative colitis (UC) and Crohn disease (CD). We calculated the incidence and prevalence of UC and CD from 2010-2017 and examined epidemiologic trends by urbanicity, demographics, and region. We then examined the IBD phenotype (using Montreal Classification), prevalence of IBD-related surgeries, and types of IBD-medications prescribed to adult patients attending a regional IBD clinic in Medellin, Colombia between 2001 and 2017.The incidence of UC increased from 5.59/100,000 in 2010 to 6.3/100,000 in 2017 (relative risk [RR] 1.12, confidence interval (CI) (1.09-1.18), P < .0001). While CD incidence did not increase, the prevalence increased within this period. The Andes region had the highest incidence of IBD (5.56/100,000 in 2017). IBD was seen less in rural regions in Colombia (RR=.95, CI (0.92-0.97), p < .01). An increased risk of IBD was present in women, even after adjusting for age and diagnosis year (RR 1.06 (1.02-1.08), P = .0003). The highest IBD risk occurred in patients 40 to 59 years of age. In the clinic cohort, there were 649 IBD patients: 73.7% UC and 24.5% CD. Mean age of diagnosis in CD was 41.0 years and 39.9 years in UC. UC patients developed mostly pancolitis (43%). CD patients developed mostly ileocolonic disease and greater than a third of patients had an inflammatory, non-fistulizing phenotype (37.7%). A total of 16.7% of CD patients had perianal disease. CD patients received more biologics than UC patients (odds ratio: 3.20, 95% CI 2.19-4.69 P < .001).Using both a national representative sample and a regional clinic cohort, we find that UC is more common in Colombia and is on the rise in urban regions; especially occurring in an older age cohort when compared to Western countries. Future studies are warranted to understand evolving environmental factors explaining this rise.

Characterization and prevalence of extraintestinal manifestations in a cohort of patients with inflammatory intestinal disease in Medellin, Colombia. / Caracterización y prevalencia de manifestaciones extraintestinales en una cohorte de pacientes con enfermedad inflamatoria intestinal en Medellín (Colombia).

INTRODUCTION: Extraintestinal manifestations (EIMs) are frequent in patients with inflammatory bowel disease (IBD). Our objective is to characterize and determine the prevalence of MEIs in our cohort of patients with IBD. PATIENTS AND METHODS: A retrospective study was carried out in adult patients with IBD at the Pablo Tobón Uribe Hospital in Medellín. Colombia. Articular MEIs, primary sclerosing cholangitis (PSC), both ophthalmological and dermatological, were considered. Absolute and relative frequencies were used. The Chi square test of independence was used to compare 2proportions and the odds ratio (OR) was estimated. RESULTS: Our registry has 759 patients with IBD, 544 present UC (71.6%), 200 CD (26.3%) and 15 unclassifiable IBD (1.9%); 177 patients with IBD (23.3%) presented EIMs, 123 of 544 (22.6%) with UC and 53 of 200 (26.5%) with CD (OR: 0.81, 95% CI: 0.55-1.17, P=0.31). Regarding the type of EIMs, the articular ones were the most frequent (13.5%), more in CD than in UC (20.0 vs. 11.3%, OR 1.94, 95% CI: 1.25-3.00, P=0.0037). Patients with IBD and EIMs used more antibodies against tumor necrosis factor (anti-TNFs), compared to those without EIMs (43.5 vs. 18.5%, OR 3.38, 95% CI: 2.31-4.90, P=0.0001). CONCLUSIONS: The prevalence of EIMs in our cohort is high (23.3%) and the most frequent type is joint. Anti-TNFs are most used when IBD and EIMs coexist. Our study provides valuable information on the association of EIMs and IBD in Latin America.

Clinical utility of the small bowel capsule endoscopy in the study of small bowel diseases in Colombia: Results of a national registry. / Utilidad clínica de la videocápsula endoscópica en el estudio de patologías de intestino delgado en Colombia: resultados de un registro nacional.

INTRODUCTION: The small bowel capsule endoscopy (SBCE) has revolutionised the study of small bowel diseases. The objective of this study is to determine the indications, findings and diagnostic yield of SBCE in a national registry. PATIENTS AND METHODS: An observational, analytical cross-sectional study was carried out, analysing the SBCE records at seven centres in the country, where different variables were collected. RESULTS: 1,883 SBCEs were evaluated. The average age was 55.4 years (5.6-94.2). The most frequent indications were suspicion of small bowel bleeding (SBB) (64.4%), study of Crohn's disease (15.2%) and chronic diarrhoea (11.2%). 54.3% were prepared with laxatives. The most frequent lesions found were erosions/ulcers (31.6%), angioectasias (25.7%) and parasitosis (2.7%). The diagnostic yield (P1+P2, Saurin classification) of SBCE in SBB was 60.6%, being higher in overt SBB (66.0%) compared to occult SBB (56.0%) (P=.003). The studies with better preparation showed higher detection of lesions (93.8% vs. 89.4%) (OR=1.8, CI: 95%: 1.2-2.6; P=.004). The SBCE complication rate was 3.1%, with complete SB visualisation at 96.6% and SB retention rate of 0.7%. 81.5% of SBCEs were performed on an outpatient basis, and presented a greater complete SB visualisation than hospital ones (97.1% vs. 94.3%) (OR=2.1, CI: 95%, 1.2-3.5; P=.008). CONCLUSIONS: The indications, findings and diagnostic performance of SBCEs in Colombia are similar to those reported in the literature, with a high percentage of complete studies and a low rate of complications.

Guía de práctica clínica para el tratamiento de la enfermedad de Crohn en población adulta / Clinical practice guidelines for the treatment of Crohn's disease in the adult population

Resumen Objetivo: La enfermedad de Crohn es un trastorno inflamatorio idiopático de etiología desconocida con características genéticas, inmunológicas e influencias del medio ambiente. La incidencia y la prevalencia de la enfermedad de Crohn han aumentado en Colombia. El tratamiento de estos pacientes no es fácil y ha evolucionado en los últimos años; por lo tanto, es necesario desarrollar una guía de práctica clínica en Colombia, orientada al tratamiento de esta compleja enfermedad, para unificar criterios. Materiales y métodos: Esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes a la entidad y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas usando la metodología GRADE. Resultados: Se realizó una guía de práctica clínica basada en la evidencia, para el tratamiento tanto médico como quirúrgico de la enfermedad de Crohn en población adulta en Colombia. Se diseñaron algoritmos de manejo teniendo en cuenta la actividad, el comportamiento y la localización de la enfermedad. Conclusiones: Se estableció que una adecuada evaluación clínica, endoscópica e imagenológica, así como una estratificación de riesgo individual son importantes para el manejo, y se especificaron las indicaciones para el adecuado tratamiento tanto médico como quirúrgico de estos pacientes.

Abstract Objective: Crohn's disease is an idiopathic inflammatory disorder of unknown origin, influenced by genetic, immunological, and environmental factors. The incidence and prevalence of Crohn's disease have increased in Colombia. The treatment of these patients is not easy and has improved in recent years. Therefore, it is necessary to develop the Colombian Clinical Practice Guideline to guide the treatment of this complex disease and unify criteria. Materials and methods: The present guideline was carried out by a multidisciplinary team with support from the Asociación Colombiana de Gastroenterología, the Cochrane ITS Team, and the Clinical Research Institute of the Universidad Nacional de Colombia. Clinical questions regarding this disease were developed, and national and international guidelines were searched in specialized databases. The existing guidelines were evaluated in terms of quality and applicability. The Cochrane Group conducted a systematic search of the existing literature. Evidence tables were elaborated, and recommendations were made using the GRADE methodology. Results: An evidence-based clinical practice guideline was developed for the medical and surgical treatment of Crohn's disease in the adult population in Colombia. Treatment algorithms were designed, taking into account the activity, behavior, and location of the disease. Conclusions: It was established that proper clinical, endoscopic, and imaging assessment, as well as individual risk stratification, are important for treatment. Also, the indications for adequate medical and surgical treatment of these patients were specified.

Guía para el manejo de colitis ulcerativa en población adulta (actualización) / Guidelines for the management of ulcerative colitis in the adult population (update)

Resumen Objetivo: desde 2015, la Asociación Colombiana de Gastroenterología, con el apoyo del Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia, realizó la guía de práctica clínica para el diagnóstico y tratamiento de colitis ulcerativa. Desde la publicación de esta guía, han aparecido nuevas alternativas terapéuticas y nuevos conceptos sobre los objetivos del tratamiento, por lo cual se consideró necesaria su actualización. Materiales y métodos: esta actualización fue realizada por un equipo multi-disciplinario con apoyo de la Asociación Colombiana de Gastroenterología y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas relevantes a nuevos tratamientos y vigilancia endoscópica de los pacientes adultos con colitis ulcerativa y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías fueron evaluadas en términos de calidad y aplicabilidad. El Grupo Cochrane llevó a cabo la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas usando la metodología GRADE. Resultados: se realizó una actualización de la guía para el tratamiento de la colitis ulcerativa en adultos en Colombia y se diseñaron nuevos algoritmos de tratamiento, teniendo en cuenta la extensión y la actividad de la enfermedad y los diferentes niveles de atención. Conclusiones: se estableció la importancia para el tratamiento de la evaluación clínica y endoscópica y se especificaron las indicaciones para el adecuado tratamiento de los pacientes con colitis ulcerativa. Adicionalmente, se dieron recomendaciones de vigilancia endoscópica de cáncer colorrectal y la importancia de la cromoendoscopia.

Abstract Objective: In 2015, the Asociación Colombiana de Gastroenterología (Colombian Association of Gastroenterology), with the support of the Institute of Clinical Research of the Universidad Nacional de Colombia, created the Clinical Practice Guideline for the diagnosis and treatment of ulcerative colitis. Since then, new therapeutic alternatives and concepts about treatment goals have emerged, making it necessary to update its contents. Materials and methods: The present update was carried out by a multidisciplinary team with support from the Asociación Colombiana de Gastroenterología and the Clinical Research Institute of the Universidad Nacional de Colombia. Questions regarding new treatments and endoscopic surveillance of adult patients with ulcerative colitis were developed, and national and international guidelines were searched in specialized databases. The guidelines were evaluated in terms of quality and applicability. The Cochrane Group conducted a systematic search of the existing literature, and evidence tables and recommendations were made using the GRADE methodology. Results: The guideline for the treatment of ulcerative colitis in adults in Colombia was updated, and new treatment algorithms were designed, taking into account the extent and activity of the disease and the different levels of care. Conclusions: The relevance of clinical and endoscopic assessment for treatment was established, and the indications for the proper management of patients with ulcerative colitis were specified. Furthermore, recommendations were made for endoscopic surveillance of colorectal cancer, and the importance of chromoendoscopy was established.

Manejo de pacientes con enfermedad inflamatoria intestinal durante la pandemia de COVID-19 / Management of patients with inflammatory bowel disease during the COVID-19 pandemic

La pandemia causada por el virus SARS-CoV-2, originada en Wuhan, capital de la provincia de Hubei (China), se ha convertido en un desafío para la humanidad. Es un virus altamente contagioso; hasta el momento, la enfermedad por coronavirus (COVID-19) presenta una mortalidad global alrededor del 6 %, que es mayor en pacientes con comorbilidades. La enfermedad inflamatoria intestinal (EII) es una patología discapacitante, con daño tisular y alteración en la respuesta inmunológica, lo cual, asociado a los medicamentos inmuno-supresores que se utilizan frecuentemente para su tratamiento, pone al paciente en riesgo de desarrollar infecciones y complicaciones. En esta revisión consideramos la interacción del virus SARS-CoV-2 con el tracto gastrointestinal y los potenciales mecanismos por los cuales un paciente con EII podría tener un riesgo incrementado de la infección por COVID-19. Adicionalmente, y a pesar de que no hay estudios clínicos pu-blicados en pacientes con EII y COVID-19, damos recomendaciones basadas en opinión de expertos sobre el cuidado de pacientes con EII, con énfasis en su tratamiento y la realización segura de procedimientos endoscópicos, tanto para el paciente como para el personal de salud. (AU)

The pandemic caused by the SARS-Cov-2 virus originating in Wuhan, capital of the province of Hubei (China), has become a challenge for humanity. It is a highly contagious virus and up to now the COVID-19 disease has an overall mortality of around 6 %, which is higher in patients with comorbidities. Inflammatory bowel disease (IBD) is a disabling pathology, with tissue damage and impaired immune response, which, associated with immunosuppressive drugs that are frequently used for their treatment, put the patient at risk of developing infections and complications. In this review we consider the interaction of the SARS-CoV-2 virus with the gastrointestinal tract and the potential mechanisms whereby a patient with IBD could have an increased risk of COVID-19 infection. Additionally, and despite the fact that there are no published clinical studies in patients with IBD and COVID-19, we make recommendations based on the opinion of experts on the care of patients with IBD, with an emphasis on its treatment and the safe performance of endoscopic procedures, both for the patient and the health personnel. (AU)

[Epidemiological and clinical characteristics of inflammatory bowel disease in a tertiary referral hospital in Lima-Peru]. / Características epidemiológicas y clínicas de la enfermedad inflamatoria intestinal en un hospital de referencia de Lima-Perú.

OBJECTIVE: To identify sociodemographic, clinical, and endoscopic characteristics in patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS: The study period was from January 2004 to December 2014. The final diagnosis was determined by clinical gastroenterologists experienced in the diagnosis and management of IBD, based on internationally accepted diagnostic criteria. RESULTS: 105 patients with IBD were studied, 77% with ulcerative colitis (UC) and 23% with Crohn's disease (CD). The average age of initial diagnosis for UC and CD was 53.02 and 57.7 years, respectively. Regarding the gender distribution, the male:female ratio was 1.3:1 for UC and 2:1 for CD. Predominant clinical manifestations were: diarrhea (76.5%) in CU and lower gastrointestinal bleeding / abdominal pain (66.6% for each symptom) in EC. The predominant form of presentation was moderate for both CU (49.3%) and EC (62.5%). 47% of patients with UC had extensive colitis and 54.2% of patients with CD had Ileocolitis. 6.2% of the UC patients underwent surgery, whereas 50% of the CD patients required it. CONCLUSIONS: There is a tendency to an increased detection of cases of Crohn's disease in our country and in Latin America with respect to previous studies. There is a prevalence of moderate forms of presentation for both UC and CD, and high percentages of surgery in EC is evident.

Guía de práctica clínica para el diagnóstico y tratamiento de la colitis ulcerativa en población adulta / Clinical practice guideline for the diagnosis and management of adult patients with Ulcerative Colitis

Objetivo: desarrollar una guía de práctica clínica que permita orientar el diagnóstico de los pacientes con colitis ulcerativa mediante el uso adecuado de criterios clínicos y direccionar la conducta terapéutica en las diferentes etapas de la enfermedad y en los diferentes niveles de atención. Materiales y métodos: esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes a la entidad y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad; una de las guías cumplió con los criterios de adaptación y el grupo decidió actualizar la búsqueda, desarrollando de novo las preguntas adicionales contempladas. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas usando la metodología GRADE. Resultados: se desarrolló una guía de práctica clínica, basada en la evidencia, para el diagnóstico y tratamiento de la colitis ulcerativa en adultos en Colombia. Conclusiones: se estableció la importancia para el diagnóstico de la evaluación clínica, endoscópica e histológica y se especificaron las indicaciones para el adecuado tratamiento de los pacientes con colitis ulcerativa, de acuerdo con su severidad y estado de remisión.

Objective: To provide an evidence-based clinical practice guideline for the diagnostic and treatment of ulcerative colitis for patients, caregivers, administrative, and government bodies at all levels of care in Colombia. Materials and Methods: This guide was developed by a multidisciplinary team with the support of the Colombian Association of Gastroenterology, Cochrane STI Group and Clinical Research Institute of the Universidad Nacional de Colombia. Relevant clinical questions were developed and the search for national and international guidelines in databases was performed. Existing guidelines were evaluated for quality and applicability. One of the guidelines met the criteria for adaptation, so the group decided to update the search and develop de novo the additional questions. Systematic literature searches were conducted. The tables of evidence and recommendations were made based on the GRADE methodology. Results: An evidence-based Clinical Practice Guidelines for the management of ulcerative colitis was developed for the Colombian context. Conclusions: The opportune management of ulcerative colitis would have an impact of the disease in Colombia.

Variación en el cuidado de pacientes con Enfermedad Inflamatoria Intestinal (EII): resultado de una encuesta / Survey results regarding variations in care of patients with inflammatory bowel disease

Objetivos: determinar, en Colombia, la variación en el cuidado de pacientes con enfermedad inflamatoria intestinal (EII) entre especialistas con experiencia en el manejo de esta entidad. La calidad en el cuidado de nuestros pacientes con EII es el principal mecanismo a través del cual podemos ofrecer un nivel adecuado de atención en salud a nuestra población.Métodos: se realizó un análisis estadístico descriptivo con las respuestas obtenidas de una encuesta con 13 preguntas relacionadas con calidad en el cuidado de pacientes con EII realizada durante el año 2011 a especialistas con interés en el manejo de pacientes con EII.Resultados: cincuenta y siete especialistas en gastroenterología y coloproctología contestaron el cuestionario de 13 preguntas. Dentro de los resultados más interesantes tenemos que 44% de los encuestados utiliza medicamentos 5-ASA tópico como monoterapia para el tratamiento de proctitis ulcerativa leve. 30% utiliza dosis correcta de azatioprina (2,0-2,5 mg/kg). Solo 47% de los especialistas prefieren la terapia biológica de inicio ("top down") en pacientes con Enfermedad de Crohn (EC) fistulizante. 54% realizan vacunación a sus pacientes con EII previo al inicio de terapia inmunosupresora. En cuanto al tabaquismo en EC, 67% consideran que deben suspenderlo pero 21% no dan recomendaciones al respecto. Solo 54% de los encuestados realizan tamizaje para osteoporosis en individuos con EII y uso crónico de esteroides. Por último, en cuanto a tamizaje de cáncer colorrectal en pacientes con EC, el 67% lo realiza similar a las recomendaciones para colitis ulcerativa (CU).Conclusión: existe una gran variabilidad en el manejo y en el cuidado preventivo de pacientes con EII en nuestro medio, esto representa una gran oportunidad para un mejoramiento continuo de nuestra práctica diaria. Es necesaria una mayor adherencia a las guías y recomendaciones internacionales por parte nuestra, para un adecuado manejo de los pacientes con EII.

Rendimiento diagnóstico y hallazgos de cápsula endoscópica en pacientes con sangrado digestivo de origen oscuro en el Hospital Pablo Tobón Uribe en Medellín - Colombia / Diagnostic performance of capsule endoscopy and findings from patients with obscure gastrointestinal bleeding at the Hospital Pablo Tobon Uribe in Medellin, Colombia

Objetivos: La cápsula endoscópica (CE) ha revolucionado la evaluación diagnóstica de pacientes con sangradogastrointestinal de origen oscuro (SGO). El objetivo de nuestro estudio fue evaluar el rendimientodiagnóstico de CE en pacientes con SGO en nuestro centro. Métodos: Se realizó un estudio descriptivoy retrospectivo, revisando historias clínicas en 60 pacientes consecutivos llevados a CE con indicación deSGO, entre septiembre de 2009 y septiembre de 2011, en el Hospital Pablo Tobón Uribe. Los hallazgos enCE se interpretaron según el grado de relevancia clínica para el diagnóstico definitivo: normales (P0), poco(P1) y altamente relevante (P2). Resultados: El rendimiento diagnóstico de CE en pacientes con SGO fue de57%. No se encontró diferencia significativa en la presencia de lesiones relevantes (P2), entre pacientes conSGO evidente y oculto (63% vs. 52%, p: 0,49); 26% de lesiones significativas (P2) en CE, se encontrabanal alcance de endoscopia alta (17%) o colonoscopia total (9%). En cuanto al tipo de lesión P2 encontrada,47% fueron vasculares, 44% inflamatorias y 9% neoplásicas. Los pacientes con lesiones P2 eran de mayoredad, comparados con aquellos con lesiones P1 y P0 (p: 0,05). Conclusión: El rendimiento diagnóstico deCE en SGO, en nuestra serie, es muy similar al reportado en publicaciones internacionales. El tipo de lesiónsignificativa (P2) más frecuentemente encontrada fue la vascular

Objectives: Capsule endoscopy (CE) has revolutionized diagnostic evaluation of patients with obscure gastrointestinal bleeding (OGB). The aim of our study was to evaluate diagnostic performance of CE in patients with OGB at our center. Methods: This retrospective study reviewed the medical records of 60 consecutive patients who had undergone capsule endoscopy because of OGB at the Hospital Pablo Tobon Uribe between September 2009 and September 2011. CE findings were interpreted according to degree of clinical relevance for definitive diagnosis: normal (P0), not very relevant (P1) and highly relevant (P2). Results: The diagnostic performance of CE for patients with OGB was 57%. No significant difference was found among patients with obvious and hidden relevant lesions (P2) OGB (63% vs. 52%, p: 0.49). 26% of relevant lesions (P2) found by EC could have been found with upper endoscopy (17%) or total colonoscopy (9%). Of the P2 lesions found, 47% were vascular, 44% were neoplastic and 9% were inflammatory. Patients with P2 lesions were older tan those with P1 and P0 lesions (p: 0.05). Conclusion: The diagnostic performance of CE for OGB in our seriesis similar to that reported in international publications. The most frequently found P2 lesions were vascular lesions