Immunosuppression for inflammatory bowel disease does not influence Epstein-Barr viral load in the short-term / La inmunosupresión no modifica la carga viral del virus de Epstein-Barr a corto plazo en los pacientes con enfermedad inflamatoria intestinal

Introduction: Immunomodulators and biologics are two of the main drugs used for the treatment of inflammatory bowel disease (IBD). Some of these agents have been associated with certain infections and lymphoproliferative disorders, including Epstein-Barr virus (EBV) infection. Our aim was to determine the influence of immunosuppression in the EBV viral load in patients with IBD. Materials and methods: We prospectively included naïve patients with IBD who were starting immunosuppressive therapy in four IBD Units. All patients were assessed at baseline and four months after starting immunosuppression for clinical disease activity, biomarkers, EBV serology (IgM VCA, IgG VCA and IgG EBNA) and viral load. Results: Thirty-two patients were included. At baseline, all patients showed positive results for IgG VCA or IgG EBNA with undetectable EBV viral load. No patient showed detectable EBV viral load after starting the immunosuppressive therapy. Conclusion: Immunosuppression did not influence on EBV viral load in the short-term in naïve IBD patients

Introducción: Los fármacos inmunomoduladores y biológicos son algunos de los tratamientos usados con más frecuencia en la enfermedad inflamatoria intestinal (EII). Algunos de ellos se han relacionado con un mayor riesgo de infecciones o síndromes linfoproliferativos, entre los que se encuentra el virus de Epstein-Barr (VEB). Nuestro objetivo era determinar la influencia a corto plazo de la inmunosupresión sobre la carga viral en pacientes con EII. Material y métodos: Incluimos de forma prospectiva pacientes con EII en los que se iniciaba algún tratamiento inmunosupresor en 4 hospitales. Todos los pacientes fueron evaluados en el momento de iniciar el tratamiento y 4 meses después de iniciarlo, mediante la actividad clínica, los biomarcadores, la serología del VEB (IgM VCA, IgG VCA e IgG EBNA) y su carga viral. Resultados: Se incluyeron 32 pacientes, observando en todos ellos una serología positiva para IgG VCA o IgG EBNA, con una carga viral indetectable. No se observó ninguna muestra con carga viral detectable durante el seguimiento. Conclusión: La inmunosupresión no influye sobre la carga viral del VEB a corto plazo en pacientes con EII

Immunosuppression for inflammatory bowel disease does not influence Epstein-Barr viral load in the short-term.

INTRODUCTION: Immunomodulators and biologics are two of the main drugs used for the treatment of inflammatory bowel disease (IBD). Some of these agents have been associated with certain infections and lymphoproliferative disorders, including Epstein-Barr virus (EBV) infection. Our aim was to determine the influence of immunosuppression in the EBV viral load in patients with IBD. MATERIALS AND METHODS: We prospectively included naïve patients with IBD who were starting immunosuppressive therapy in four IBD Units. All patients were assessed at baseline and four months after starting immunosuppression for clinical disease activity, biomarkers, EBV serology (IgM VCA, IgG VCA and IgG EBNA) and viral load. RESULTS: Thirty-two patients were included. At baseline, all patients showed positive results for IgG VCA or IgG EBNA with undetectable EBV viral load. No patient showed detectable EBV viral load after starting the immunosuppressive therapy. CONCLUSION: Immunosuppression did not influence on EBV viral load in the short-term in naïve IBD patients.

Niveles plasmáticos de la vitamina B12 y ácido fólico en pacientes con hepatopatía crónica / Plasma levels of folate and vitamin B12 in patients with chronic liver disease

IntroducciónLos pacientes cirróticos con frecuencia presentan trastornos nutricionales.ObjetivosValorar en pacientes con hepatopatía crónica los niveles plasmáticos de ácido fólico y vitamina B12 y determinar si estos parámetros pueden ayudar al diagnóstico etiológico de esta enfermedad.Pacientes y métodoSe estudiaron 39 pacientes que ingresan por descompensación de su hepatopatía (29 de etiología alcohólica y 10 por otras causas) y se comparan con 35 controles. Se analizaron, entre otros, los niveles plasmáticos de ácido fólico, vitamina B12, volumen corpuscular medio (VCM), aspartato aminotransferasa (AST), alanino aminotransferasa (ALT), el cociente AST/ALT, la gammaglutamiltransferasa (GGT).ResultadosLos niveles plasmáticos de vitamina B12 en pacientes con hepatopatía crónica descompensada eran de 1.151±568pg/ml y 440±133pg/ml en los controles (p<0,05). Los niveles plasmáticos de ácido fólico fueron de 8,57±3,8ng/ml en los controles y de 6,68±2,74ng/ml en los pacientes con hepatopatía crónica descompensada (p<0,05). Los pacientes con hepatopatía crónica de etiología alcohólica tenían unos niveles plasmáticos de ácido fólico inferiores que los pacientes con hepatopatía no alcohólica (5,7±2,1 frente a 9,3±2.6; p<0,0005). El cociente entre la vitamina B12/ácido fólico discriminaba mejor la etiología alcohólica que otros parámetros analíticos como la AST, ALT, VCM, el cociente AST/ALT y la GGT.ConclusionesLos niveles plasmáticos de vitamina B12 en pacientes con hepatopatía crónica descompensada están altos, mientras que los niveles plasmáticos de ácido fólico están bajos. El cociente entre la vitamina B12 y el ácido fólico podría ser útil en el diagnóstico diferencial de la etiología de la hepatopatía crónica(AU)

BackgroundPatients with liver disease frequently experience changes in their nutritional status.ObjectiveTo determine changes in vitamin B12 and folic acid plasma levels in patients with chronic cirrhosis and to assess whether these parameters may be useful in the etiologic diagnosis of this disease.Patients and methodsThirty-nine patients admitted for decompensated cirrhosis (29 with alcoholic etiology and 10 with non-alcoholic etiology) and 35 controls were prospectively studied. Plasma levels of vitamin B12, folate acid, mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT ratio, and gamma-glutamyltransferase (GGT), among other parameters, were measured.ResultsVitamin B12 levels were 1151±568pg/ml in patients with decompensated cirrhosis and 440±133pg/ml in controls (p<0.05). Plasma folate levels were 8.57±3.8ng/ml in controls and 6.68±2.74ng/ml in patients with cirrhosis (p<0.05). Folate levels were lower in patients with alcoholic cirrhosis (mean value, 5.7±2.1) than in those with non-alcoholic cirrhosis (9.3±2.6; p<0.0005). The vitamin B12/folate ratio discriminated alcoholic etiology better than other parameters such as AST, ALT, MCV, AST/ALT ratio and GGT.ConclusionsPlasma levels of vitamin B12 in patients with decompensated chronic liver disease are high, whereas plasma folate levels are low. The ratio between vitamin B12 and folic acid may be useful in the differential diagnosis of the etiology of chronic liver disease(AU)

[Plasma levels of folate and vitamin B(12) in patients with chronic liver disease]. / Niveles plasmáticos de la vitamina B(12) y ácido fólico en pacientes con hepatopatía crónica.

BACKGROUND: Patients with liver disease frequently experience changes in their nutritional status. OBJECTIVE: To determine changes in vitamin B12 and folic acid plasma levels in patients with chronic cirrhosis and to assess whether these parameters may be useful in the etiologic diagnosis of this disease. PATIENTS AND METHODS: Thirty-nine patients admitted for decompensated cirrhosis (29 with alcoholic etiology and 10 with non-alcoholic etiology) and 35 controls were prospectively studied. Plasma levels of vitamin B(12), folate acid, mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT ratio, and gamma-glutamyltransferase (GGT), among other parameters, were measured. RESULTS: Vitamin B(12) levels were 1151+/-568pg/ml in patients with decompensated cirrhosis and 440+/-133pg/ml in controls (p<0.05). Plasma folate levels were 8.57+/-3.8ng/ml in controls and 6.68+/-2.74ng/ml in patients with cirrhosis (p<0.05). Folate levels were lower in patients with alcoholic cirrhosis (mean value, 5.7+/-2.1) than in those with non-alcoholic cirrhosis (9.3+/-2.6; p<0.0005). The vitamin B(12)/folate ratio discriminated alcoholic etiology better than other parameters such as AST, ALT, MCV, AST/ALT ratio and GGT. CONCLUSIONS: Plasma levels of vitamin B12 in patients with decompensated chronic liver disease are high, whereas plasma folate levels are low. The ratio between vitamin B12 and folic acid may be useful in the differential diagnosis of the etiology of chronic liver disease.

[Influence of lifestyle in patients with gastroesophageal reflux disease]. / Influencia del estilo de vida en la enfermedad por reflujo gastroesofágico.

The prevalence of the symptoms of reflux (hearthburn and acid regurgitation) and of gastro-esophageal reflux disease is high. Numerous lifestyle modifications have been advocated in the prognosis of reflux. Obesity, the decubitus, eating rapidly, tobacco, alcohol and exercise provoke symptoms of the reflux (hearthburn and acid regurgitation). The proportion of fat in the food and stress aren't factors associated with reflux. Some works point at the chocolate, at the acid juices, at the carbonated beverages and at the onions as factors that unleash symptoms of reflux. Nevertheless larger prospective controlled trials are warranted. Gum-chewing after eating, keep standing up and to go to bed 4 h after dinner improves the symptoms of the reflux and the gastro-esophageal reflux disease.

Influencia del estilo de vida en la enfermedad por reflujo gastroesofágico / Influence of lifestyle in patients with gastroesophageal reflux disease

La prevalencia del reflujo gastroesofágico y de la enfermedad por reflujo gastroesofágico es muy alta. Numerosos factores relacionados con el estilo de vida influyen en su aparición y evolución. La obesidad, el decúbito, comer rápido, el tabaco, el alcohol y el ejercicio favorecen los síntomas de reflujo (pirosis y regurgitación ácida). Algunos trabajos apuntan al chocolate, zumos ácidos, bebidas con gas y cebolla como factores que desencadenan síntomas de reflujo. Sin embargo, son necesarios más estudios que ayuden a confirmar estas observaciones. La proporción de grasa en la comida y el estrés no son factores desencadenantes. Masticar chicle después de comer, la bipedestación y acostarse 4 h después de la cena mejoran los síntomas de reflujo y de la enfermedad por reflujo gastroesofágico

The prevalence of the symptoms of reflux (hearthburn and acid regurgitation) and of gastro-esophageal reflux disease is high. Numerous lifestyle modifications have been advocated in the prognosis of reflux. Obesity, the decubitus, eating rapidly, tobacco, alcohol and exercise provoke symptoms of the reflux (hearthburn and acid regurgitation). The proportion of fat in the food and stress aren't factors associated with reflux. Some works point at the chocolate, at the acid juices, at the carbonated beverages and at the onions as factors that unleash symptoms of reflux. Nevertheless larger prospective controlled trials are warranted. Gum-chewing after eating, keep standing up and to go to bed 4 h after dinner improves the symptoms of the reflux and the gastro-esophageal reflux disease