Correction: Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885.

The authors wish to make the following corrections to this paper [...].

Efficacy of Hepatitis B Virus Vaccines HBVaxpro40© and Fendrix© in Patients with Chronic Liver Disease in Clinical Practice.

Chronic liver disease results in a low response rate to the hepatitis B virus vaccine. Information on the efficacy of the double adjuvanted vaccine FENDRIX® (3-O-desacyl-4'-monophosphoryl lipid A and aluminum phosphate) and single adjuvant HBVAXPRO®40 (aluminum hydroxyphosphate sulfate) in chronic liver disease is scarce. The primary aim of this prospective study in clinical practice was to evaluate the effectiveness of HBVAXPRO®40 and FENDRIX® in this setting. Patients received HBVAXPRO® (0, 1 and 6 months) or FENDRIX® (0, 1, 2 and 6 months) depending on availability. Clinical data and anti-HBs levels were collected at 2, 6 and 12 months. A total of 125 patients were included (mean age 61.8 years; 57.6% males; 43.2% liver cirrhosis; 75.9% Child A and 24.1% Child B): 76 were vaccinated with HBVAXPRO® and 49 with FENDRIX®. There were no significant differences between the two vaccines. The overall response rates at 2, 6 and 12 months were 76.8, 72.8 and 59.2%, respectively. In the univariate analysis, active alcohol intake, alcohol etiology, liver cirrhosis and ultrasound signs of portal hypertension were associated with a lower response to vaccination, whereas in the multivariate analysis, liver cirrhosis was the only factor that significantly increased the likelihood of nonresponse (OR 10.5). HBVAXPRO® and FENDRIX® are good options for HBV vaccination in patients with chronic liver disease.

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study.

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.

The role of stents in the treatment of Crohn's disease strictures.

BACKGROUND AND AIMS: Stenosis is one of the most frequent local complications in Crohn's disease (CD). Surgery is not the ideal treatment because of the high rate of postoperative recurrence. Endoscopic balloon dilation (EBD) currently is the current treatment of choice for short strictures amenable to the procedure. However, it is not applicable or effective in all the cases, and it is not without related complications. Our goal was to summarize the published information regarding the use and the role of the stents in the treatment of CD stricture. A Medline search was performed on the terms "stricture," "stenosis," "stent" and "Crohn's disease." RESULTS: a total of 19 publications met our search criteria for an overall number of 65 patients. Placing a self-expanding metal stent (SEMS) may be a safe and effective alternative to EBD and/or surgical intervention in the treatment of short stenosis in patients with CD. Indications are the same as those for EBD. In addition, SEMS may be useful in stenosis refractory to EBD and may be suitable in the treatment of longer or more complex strictures that cannot be treated by EBD. With the current information, it seems that the best treatment option is the placement of a fully covered stent for a mean time of 4 weeks. Regarding the use of biodegradable stents, the information is limited and showing poor results. CONCLUSIONS: the use of stents in the treatment of strictures in CD should be taken into account either as a first endoscopic therapy or in case of EBD failure.

How do we manage vaccinations in patients with inflammatory bowel disease?

The mortality in inflammatory bowel disease (IBD) has been reported similar or slightly increased as compared to that of the general population. However, deaths related to infectious and parasitic diseases have been repeatedly reported in clinical trials, open series and registries. The IBD patients are exposed to the same infections affecting the community, added to opportunistic infectious related to the immunosuppression. Some of these infectious diseases may be prevented by the appropriate use of a vaccination program. Thus, vaccination status should be assessed at IBD diagnosis, and from time to time, and vaccination should be updated to every patient as soon as possible, since deaths due to preventable diseases should never occur. Present recommendations include vaccination for influenza (annually), for pneumococcal disease with the 23-valent strain (every 5 years), for hepatitis B virus (in patients with no detectable hepatitis B surface antibodies), combined vaccination against tetanus, diphtheria and inactivated poliomyelitis (every 10 years). The role of human papillomavirus vaccine preventing cervical dysplasia and neoplasia in IBD women taking immunosuppressive are at present unknown. In patients lacking varicella immunization, specific vaccination should be considered. Nevertheless, it should be taken into account that varicella vaccine contains live attenuated virus that cannot be administered in patients taking immunosuppressive. The same consideration should be kept in mind for patients travelling to endemic areas for yellow fever. Finally, IBD patients on immunosuppressive may have an altered response to vaccine immunization. Decreased response has been reported for hepatitis B and pneumoccocal vaccination. In those cases, testing for serological responses to vaccine should be performed and booster doses may be required.

Cuándo y cómo descartar una enfermedad celíaca en un paciente con síndrome del intestino irritable / Functional gastrointestinal disorders: when and how to exclude celiac disease inapatient with irritable bowel syndrome

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[How to approach screening for celiac disease in 2008]. / Cómo abordar el cribado de enfermedad celíaca en el año 2008.

Due to its high prevalence, celiac disease is a major health problem. Because of the long-term complications and difficulty of diagnosing this disease, the need for population-based screening has been raised. Serological methods for detection of celiac disease include antiendomysial and antitransglutaminase antibody detection, which has high sensitivity and specificity (nearly 100%) in forms with atrophy and low sensitivity and specificity (between 15 and 30%) in patients with minimal lesions, thus posing diagnostic difficulties in this group of individuals. The risk of late complications is unknown in this group of patients with lymphocytic enteritis. However, this group may be just as symptomatic as patients with atrophy and consequently would also benefit from a gluten-free diet. Systematic screening allows a greater number of patients with gluten-sensitive enteropathy to be detected. However, there are insufficient data to be able to evaluate the economic and social impact of systematic screening.

Cómo abordar el cribado de enfermedad celíaca en el año 2008 / How to approach screening of celiac disease in 2008

La enfermedad celíaca constituye un problema sanitario deprimera magnitud por su elevada prevalencia. Las complicacionesasociadas a largo plazo y la dificultad que suponesu diagnóstico han hecho plantear la necesidad del cribadopoblacional. Los métodos serológicos para la detección de laenfermedad celíaca incluyen la determinación de anticuerposantiendomisio y antitransglutaminasa, cuya sensibilidady especificidad es alta (cercana al 100%) para las formascon atrofia y baja (del 15-30%) en pacientes con lesiones mínimas,lo que plantea una lógica dificultad diagnóstica eneste grupo de individuos. Si bien se desconoce el riesgo deaparición de complicaciones tardías para este grupo de pacientescon enteritis linfocítica, se sabe que pueden estarigual de sintomáticos que los pacientes con atrofia y, portanto, también se beneficiarían de una dieta sin gluten. Elcribado sistemático permite detectar un mayor número depacientes con enteropatía sensible al gluten, pero todavía carecemosde datos suficientes para valorar el impacto económicoy social de su aplicación (AU)

Due to its high prevalence, celiac disease is a major healthproblem. Because of the long-term complications and difficultyof diagnosing this disease, the need for population-basedscreening has been raised. Serological methods fordetection of celiac disease include antiendomysial and antitransglutaminaseantibody detection, which has high sensitivityand specificity (nearly 100%) in forms with atrophyand low sensitivity and specificity (between 15 and 30%) inpatients with minimal lesions, thus posing diagnostic difficultiesin this group of individuals.The risk of late complications is unknown in this group ofpatients with lymphocytic enteritis. However, this groupmay be just as symptomatic as patients with atrophy andconsequently would also benefit from a gluten-free diet. Systematicscreening allows a greater number of patients withgluten-sensitive enteropathy to be detected. However, thereare insufficient data to be able to evaluate the economic andsocial impact of systematic screening (AU)

Cómo abordar el cribado de enfermedad celíaca en el año 2008 / How to approach screening of celiac disease in 2008

La enfermedad celíaca constituye un problema sanitario deprimera magnitud por su elevada prevalencia. Las complicacionesasociadas a largo plazo y la dificultad que suponesu diagnóstico han hecho plantear la necesidad del cribadopoblacional. Los métodos serológicos para la detección de laenfermedad celíaca incluyen la determinación de anticuerposantiendomisio y antitransglutaminasa, cuya sensibilidady especificidad es alta (cercana al 100%) para las formascon atrofia y baja (del 15-30%) en pacientes con lesiones mínimas,lo que plantea una lógica dificultad diagnóstica eneste grupo de individuos. Si bien se desconoce el riesgo deaparición de complicaciones tardías para este grupo de pacientescon enteritis linfocítica, se sabe que pueden estarigual de sintomáticos que los pacientes con atrofia y, portanto, también se beneficiarían de una dieta sin gluten. Elcribado sistemático permite detectar un mayor número depacientes con enteropatía sensible al gluten, pero todavía carecemosde datos suficientes para valorar el impacto económicoy social de su aplicación

Due to its high prevalence, celiac disease is a major healthproblem. Because of the long-term complications and difficultyof diagnosing this disease, the need for population-basedscreening has been raised. Serological methods fordetection of celiac disease include antiendomysial and antitransglutaminaseantibody detection, which has high sensitivityand specificity (nearly 100%) in forms with atrophyand low sensitivity and specificity (between 15 and 30%) inpatients with minimal lesions, thus posing diagnostic difficultiesin this group of individuals.The risk of late complications is unknown in this group ofpatients with lymphocytic enteritis. However, this groupmay be just as symptomatic as patients with atrophy andconsequently would also benefit from a gluten-free diet. Systematicscreening allows a greater number of patients withgluten-sensitive enteropathy to be detected. However, thereare insufficient data to be able to evaluate the economic andsocial impact of systematic screening

Development of antinuclear antibodies and its clinical impact in patients with Crohn's disease treated with chimeric monoclonal anti-TNFalpha antibodies (infliximab).

BACKGROUND: Although the efficacy of infliximab in Crohn's disease (CD) has been demonstrated, its safety profile has yet to be established. Autoimmune adverse events such as human anti-chimeric antibodies and the development of antinuclear antibodies (ANAs) have been notified, but the true incidence and clinical relevance of the latter is still unknown. OBJECTIVE: To evaluate the changes in ANA status in CD patients treated with infliximab and the clinical evolution of those who are ANA positive. METHODS: The ANA status of 36 CD patients treated with infliximab was determined at baseline and 6 weeks after the initial infliximab infusion. Patients were followed up monthly. In the case of infliximab re-treatment, ANA status was again evaluated. Twenty-eight patients (78%) were treated concomitantly with immunosuppressants. RESULTS: Eight patients (22%) were ANA positive at baseline; none developed anti-double-stranded DNA antibodies (aDNAds) at week 6. Three of them were re-treated: there were increasing ANA titres in all cases and developing aDNAds in two. Only six of 28 patients who were ANA negative at baseline changed their ANA status at week 6, but none developed aDNAds. One of them was retreated showing a further increase in ANA titre and developing aDNAds at high titre. No patient presented lupus-like syndrome. CONCLUSIONS: Only a few CD patients treated with infliximab and immunosuppressants develop ANAs. This condition is not associated with aDNAds and/or lupus-like syndrome in the majority of cases.