Randomised clinical trial: intravenous vs oral iron for the treatment of anaemia after acute gastrointestinal bleeding.

BACKGROUND: Acute gastrointestinal bleeding is prevalent condition and iron deficiency anaemia is a common comorbidity, yet anaemia treatment guidelines for affected patients are lacking. AIM: To compare efficacy and safety of intravenous ferric carboxymaltose (FCM) and oral ferrous sulphate (FeSulf) in patients with anaemia secondary to non-variceal gastrointestinal bleeding METHODS: A prospective 42-day study randomised 61 patients with haemoglobin <10 g/dL upon discharge (Day 0) to receive FCM (n = 29; Day 0: 1000 mg, Day 7: 500 or 1000 mg; per label) or FeSulf (n = 32; 325 mg/12 hours for 6 weeks). Outcome measures were assessed on Days 0 (baseline), 7, 21 and 42. The primary outcome was complete response (haemoglobin ≥12 g/dL [women], ≥13 g/dL [men]) after 6 weeks. RESULTS: A higher proportion of complete response was observed in the FCM vs the FeSulf group at Days 21 (85.7% vs 45.2%; P = 0.001) and 42 (100% vs 61.3%; P < 0.001). Additionally, the percentage of patients with partial response (haemoglobin increment ≥2 g/dL from baseline) was significantly higher in the FCM vs the FeSulf group (Day 21:100% vs 67.7%; P = 0.001, Day 42:100% vs 74.2%; P = 0.003). At Day 42, normalisation of transferrin saturation to 25% or greater was observed in 76.9% of FCM vs 24.1% of FeSulf-treated patients (P < 0.001). No patient in the FCM group reported any adverse event vs 10 patients in the FeSulf group. CONCLUSION: FCM provided greater and faster Hb increase and iron repletion, and was better tolerated than FeSulf in patients with iron deficiency anaemia secondary to non-variceal acute gastrointestinal bleeding.

[Duodenal adenocarcinoma: a rare diagnosis]. / Adenocarcinoma duodenal: un diagnóstico poco frecuente.

Duodenal adenocarcinoma is a rare disease whose symptoms are usually vomit, weight loss and lack of appetite; appearing more frequently in men in their sixties. Upper gastrointestinal endoscopy is the technique chosen for its diagnosis, also relying on other techniques such as endoscopic ultrasonography or computed tomography for the extension study. In this regard we report the case of a patient diagnosed of bulbar duodenal adenocarcinoma in our hospital.

Adenocarcinoma duodenal: un diagnóstico poco frecuente / Duodenal adenocarcinoma: a rare diagnosis

El adenocarcinoma duodenal es una entidad poco prevalente que suele cursar con clínica de vómitos, pérdida de peso e hiporexia; presentándose más frecuentemente en varones en la sexta década de la vida. La endoscopia digestiva alta supone la técnica de elección para el diagnóstico, siendo útiles para el estudio de extensión tanto la ecoendoscopia como la tomografía computarizada (TC). En relación a esta rara patología presentamos el caso de un paciente diagnosticado de neoplasia de bulbo duodenal en nuestro centro...

Duodenal adenocarcinoma is a rare disease whose symptoms are usually vomit, weight loss and lack of appetite; appearing more frequently in men in their sixties. Upper gastrointestinal endoscopy is the technique chosen for its diagnosis, also relying on other techniques such as endoscopic ultrasonography or computed tomography for the extension study. In this regard we report the case of a patient diagnosed of bulbar duodenal adenocarcinoma in our hospital...

Síndrome de Zollinger-Ellison / Zollinger-Ellison syndrome

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Seguimiento a largo plazo de 3 casos de anemia hemolítica asociada a colitis ulcerosa / No disponible

No disponible

Infliximab como rescate a ciclosporina en un brote grave de colitis ulcerosa / No disponible

No disponible

[Effectiveness of maintenance azathioprine therapy without oral cyclosporine after severe attacks of ulcerative colitis refractory to endovenous steroids]. / Eficacia del mantenimiento con azatioprina sin ciclosporina oral tras un brote grave de colitis ulcerosa refractario a esteroides intravenosos.

INTRODUCTION: Intravenous (i.v.) cyclosporine (CsA) has proved effective in controlling acute attacks of ulcerative colitis unresponsive to IV steroids. After the initial response to i.v. CsA, two alternatives for maintaining remission have been proposed: either double or triple association with immunosuppressors. The aim of this study was to evaluate the effectiveness of i.v. CsA, its adverse effects, and the subsequent long-term effectiveness of azathioprine/6-mercaptopurine without oral CsA. MATERIAL AND METHODS: Intravenous CsA was administered for 10 days, at a dose of 4 mg/kg per day, to 20 patients diagnosed with a severe attack of ulcerative colitis who did not respond to IV steroid treatment. Patients who responded to CsA and could be discharged were administered azathioprine or 6-mercaptopurine associated with a decreasing dose of oral steroids, without oral CsA. RESULTS: Sixty per cent (12/20) of the patients showed clinical-biological improvement after CsA administration, thus avoiding colectomy, and were discharged from hospital. Nine of the 12 responders (three withdrew from the study) were followed-up long term. Of these nine patients, four (44.4%) underwent colectomy, all before the sixth month of discharge. All adverse effects were mild, except for one death. CONCLUSIONS: Intravenous CsA is effective in inducing remission of ulcerative colitis in severe attacks resistant to i.v. steroids. When treatment with azathioprine is administered without oral CsA, patients requiring colectomy need this procedure within the first 6 months of discharge.

Eficacia del mantenimiento con azatioprina sin ciclosporina oral tras un brote grave de colitis ulcerosa refractario a esteroides intravenosos / Effectiveness of maintenance azathioprine therapy without oral cyclosporine after severe attacks of ulcerative colitis refractory to endovenous steroids

INTRODUCCIÓN: La ciclosporina (CyA) intravenosa (i.v.) hademostrado ser eficaz en el control de los brotes agudos gravesde colitis ulcerosa que no responden a esteroides i.v.Tras la respuesta inicial a la CyA i.v., se han propuesto dosalternativas para mantener la remisión, la doble o triple asociaciónde inmunosupresores. Los objetivos de nuestro estudiohan sido valorar la eficacia de CyA i.v., sus efectos secundariosy la efectividad posterior a largo plazo de laazatioprina/6-mercaptopurina sin CyA oral.MATERIAL Y MÉTODOS: Se administró CyA i.v. durante 10días, en dosis de 4 mg/kg/día a 20 pacientes diagnosticadosde colitis ulcerosa en brote grave y que no respondieron atratamiento con esteroides i.v. A los que respondieron y pudieronser dados de alta se les administró azatioprina o 6-mercaptopurina asociadas a esteroides orales en pauta descendentey sin CyA oral.RESULTADOS: El 60% (12/20) de los pacientes presentó unamejoría clínico-biológica tras la administración de CyA, loque permitió evitar la colectomía y que fueran dados de altahospitalaria. Se siguieron a largo plazo 9 de los 12 pacientesque respondieron (3 se excluyeron del estudio), y de ellos 4(44,4%) tuvieron que ser colectomizados, todos antes delsexto mes del alta. Los efectos secundarios fueron todos leves,excepto un fallecimiento.CONCLUSIONES: La CyA i.v. es eficaz para inducir la remisiónde la colitis ulcerosa en los brotes graves resistentes aesteroides i.v. Con la estrategia de administrar azatioprinasin CyA oral, los pacientes que requieren colectomía la precisanen los primeros 6 meses tras el alta (AU)

INTRODUCTION: Intravenous (i.v.) cyclosporine (CsA) hasproved effective in controlling acute attacks of ulcerative colitisunresponsive to IV steroids. After the initial response toi.v. CsA, two alternatives for maintaining remission havebeen proposed: either double or triple association with immunosuppressors.The aim of this study was to evaluate theeffectiveness of i.v. CsA, its adverse effects, and the subsequentlong-term effectiveness of azathioprine/6-mercaptopurinewithout oral CsA.MATERIAL AND METHODS: Intravenous CsA was administeredfor 10 days, at a dose of 4 mg/kg per day, to 20 patientsdiagnosed with a severe attack of ulcerative colitis who didnot respond to IV steroid treatment. Patients who respondedto CsA and could be discharged were administeredazathioprine or 6-mercaptopurine associated with a decreasingdose of oral steroids, without oral CsA.RESULTS: Sixty per cent (12/20) of the patients showed clinical-biological improvement after CsA administration, thusavoiding colectomy, and were discharged from hospital. Nineof the 12 responders (three withdrew from the study) werefollowed-up long term. Of these nine patients, four (44.4%)underwent colectomy, all before the sixth month of discharge.All adverse effects were mild, except for one death.CONCLUSIONS: Intravenous CsA is effective in inducing remissionof ulcerative colitis in severe attacks resistant to i.v.steroids. When treatment with azathioprine is administeredwithout oral CsA, patients requiring colectomy need thisprocedure within the first 6 months of discharge (AU)