RESUMEN
Markers that allow for the selection of tailored treatments for individual patients with inflammatory bowel diseases (IBD) are yet to be identified. Our aim was to describe trends in real-life treatment usage. For this purpose, patients from the ENEIDA registry who received their first targeted IBD treatment (biologics or tofacitinib) between 2015 and 2021 were included. A subsequent analysis with Machine Learning models was performed. The study included 10,009 patients [71% with Crohn's disease (CD) and 29% with ulcerative colitis (UC)]. In CD, anti-TNF (predominantly adalimumab) were the main agents in the 1st line of treatment (LoT), although their use declined over time. In UC, anti-TNF (mainly infliximab) use was predominant in 1st LoT, remaining stable over time. Ustekinumab and vedolizumab were the most prescribed drugs in 2nd and 3rd LoT in CD and UC, respectively. Overall, the use of biosimilars increased over time. Machine Learning failed to identify a model capable of predicting treatment patterns. In conclusion, drug positioning is different in CD and UC. Anti-TNF were the most used drugs in IBD 1st LoT, being adalimumab predominant in CD and infliximab in UC. Ustekinumab and vedolizumab have gained importance in CD and UC, respectively. The approval of biosimilars had a significant impact on treatment.
RESUMEN
Microscopic colitis is a form of chronic and recurrent inflammatory bowel disease characterized by non-bloody, watery diarrhea, macroscopically normal colonic mucosa, and characteristic histopathological findings. Some drugs have been described as triggers of colonic inflammation in predisposed individuals, while others may exacerbate microscopic colitis that evolves on its own. We present the case of a patient diagnosed with active microscopic colitis in relation to taking fluoxetine at high doses.
RESUMEN
A 68-year-old male presented to the Emergency Department with a one-month history of intermittent epigastrium pain. Laboratory tests revealed leukocytosis and elevated lipase (4129 UI/l), with normal liver function, so he was admitted for its first episode of acute pancreatitis. Abdominal ultrasound showed liver steatosis, without cholelithiasis or bile duct dilatation. A thoraco-abdominal computed tomography was performed, revealing a pedunculated gastric polyp in lesser curvature measuring 64x38mm with no evidence of metastatic disease. Gastroscopy was performed, showing a 7-cm pedunculated gastric polyp prolapsed through the pylorus into the duodenum. The polyp was moved into the stomach, and a fragmented resection of the polyp was carried out with a hot snare. Histopathologic evaluation was compatible with hyperplastic polyp with low-grade dysplasia. The patient had a favourable evolution with no complications after the procedure.
RESUMEN
Elevated alkaline phosphatase (ALP) levels are found in multiple hepatobiliary diseases and in bone diseases. ALP can also originate in the intestine and placenta. Very few cases of persistent elevations of IALP or in the context of benign familial intestinal hyperphosphatasemia (BFIH) without underlying pathology have been reported in the literature. In the evaluation of elevated ALP, most patients will not require determination of its isoenzymes. However, it is important to be aware of this entity to avoid unnecessary additional studies and to establish the diagnosis of a persistent but benign biochemical abnormality.
