Relationship between skin-to-skin contact during the first hour of life and duration of exclusive breastfeeding.

BACKGROUND: Exclusive breastfeeding (BF) has the greatest potential impact on child mortality of any preventive intervention. Skin-to-skin contact (SSC) during the first hour of life is beneficial for initiating BF; however, routine separation of mother and infant is still common. This work aimed to demonstrate that SSC during the first hour of life is associated with a greater frequency and duration of exclusive BF. METHODS: This is an observational case-control study. We reviewed the medical records of patients born between 2016 and 2022 classified as cases or controls based on the history of SSC in the first hour of life. Statistical analysis was performed using SPSS version 28. RESULTS: We included 362 medical records, of which 200 (55.2%) had SSC and were considered cases; the 162 (44.8%) who did not have SSC were considered controls. Those who received SSC were more likely to receive exclusive BF at 3 (163 [81.5%] vs. 94 [58%], p < 0.001) and 6 months of age (147 [73.5%] vs. 83 [51.2%], p < 0.001). CONCLUSIONS: Patients who received SSC in the first hour of life were more likely to receive exclusive BF at 3 and 6 months of age. Promoting and respecting this practice is essential to increase the possibility of a newborn to be exclusively breastfed for the first 6 months of life.

INTRODUCCIÓN: La lactancia materna exclusiva (LME) es la intervención preventiva con mayor impacto en mortalidad infantil. El contacto piel con piel (CPP) durante la primera hora de vida es un periodo crítico para establecer la lactancia; sin embargo, la separación rutinaria del recién nacido de su madre es frecuente. El objetivo de este trabajo fue demostrar que el CPP durante la primera hora se asocia con mayor frecuencia y duración de LME. MÉTODOS: Se llevó a cabo un estudio observacional de casos y controles. Se revisaron expedientes de pacientes de nuestra consulta pediátrica que nacieron entre 2016 y 2022. Se clasificaron como casos y controles de acuerdo con el antecedente de haber recibido CPP durante la primera hora de vida. Se realizó el análisis estadístico en SPSS version 28. RESULTADOS: Se incluyeron 362 expedientes, de los cuales 200 (55.2%) recibieron CPP en la primera hora de vida y fueron considerados casos; los 162 (44.8%) que no lo hicieron fueron considerados controles. Aquellos que recibieron CPP tuvieron con mayor frecuencia LME a los 3 (163 [81.5%] vs. 94 [58%], p < 0.001) y 6 meses de edad (147 [73.5%] vs. 83 [51.2%], p < 0.001). CONCLUSIONES: La frecuencia con la cual los pacientes lograron tener lactancia materna exclusiva a los 3 y 6 meses es mayor en aquellos en los que se respeta el CPP en la primera hora de vida. Promover y respetar esta práctica es fundamental para incrementar las probabilidades de que los lactantes reciban LME durante sus primeros 6 meses de vida.

Percentage of birth weight loss as a reference for the well-being of the exclusively breastfed newborn.

As health professionals, we have memorized that "newborns can lose up to 10% of their birth weight during the first week of life and should regain it by two weeks of age". However, this statement, which appears so accurate, comes from studies conducted in the 1960s, when medical knowledge and how newborns were fed were utterly different from what it is today. Currently, multiple factors contribute to the percentage of weight loss at birth and the rate at which this weight is regained. There are nomograms for exclusively breastfed and formula-fed newborns and those by vaginal or cesarean delivery. To meet the World Health Organization's goal of exclusively breastfeeding newborns, it is essential to recognize that "loss of more than 10% of birth weight" does not represent the need for formula supplementation. When assessing these cases, we must consider several factors that influence the percentage of weight loss in newborns. Therefore, diagnostic decisions should always be individualized in favor of breastfeeding.

Como profesionales de la salud hemos memorizado que "los recién nacidos pueden perder hasta el 10% de su peso al nacimiento durante la primera semana de vida, y deben recuperarlo al cumplir 2 semanas de vida". Sin embargo, esta afirmación, que aparenta ser matemáticamente exacta, proviene de estudios realizados en la década de los 60, cuando el conocimiento médico y la forma de alimentar a los recién nacidos era completamente diferente a lo que es ahora. Actualmente se reconocen múltiples factores que pueden influir en el porcentaje de pérdida de peso al nacimiento y el ritmo con el cual se recupera este peso. Se cuenta con diferentes nomogramas para recién nacidos alimentados exclusivamente con leche materna y aquellos alimentados con fórmula láctea, e incluso aquellos nacidos por cesárea o por vía vaginal. Para que se logre apoyar la meta de la Organización Mundial de la Salud de alimentar exclusivamente con leche materna a los recién nacidos, es imprescindible reconocer que la "pérdida de más del 10% del peso al nacimiento" no representa por sí sola la necesidad de suplementación artificial. Al evaluar estos casos, se deben considerar varios factores que influyen en el porcentaje de peso que pierde un recién nacido. Por ello, las decisiones diagnósticas deben ser siempre individualizadas en favor de la lactancia materna.

Percentage of birth weight loss as a reference for the well-being of the exclusively breastfed newborn / Porcentaje de pérdida de peso al nacimiento como referencia del bienestar del recién nacido alimentado exclusivamente con leche materna

Abstract As health professionals, we have memorized that "newborns can lose up to 10% of their birth weight during the first week of life and should regain it by two weeks of age". However, this statement, which appears so accurate, comes from studies conducted in the 1960s, when medical knowledge and how newborns were fed were utterly different from what it is today. Currently, multiple factors contribute to the percentage of weight loss at birth and the rate at which this weight is regained. There are nomograms for exclusively breastfed and formula-fed newborns and those by vaginal or cesarean delivery. To meet the World Health Organization's goal of exclusively breastfeeding newborns, it is essential to recognize that "loss of more than 10% of birth weight" does not represent the need for formula supplementation. When assessing these cases, we must consider several factors that influence the percentage of weight loss in newborns. Therefore, diagnostic decisions should always be individualized in favor of breastfeeding.

Resumen Como profesionales de la salud hemos memorizado que "los recién nacidos pueden perder hasta el 10% de su peso al nacimiento durante la primera semana de vida, y deben recuperarlo al cumplir 2 semanas de vida". Sin embargo, esta afirmación, que aparenta ser matemáticamente exacta, proviene de estudios realizados en la década de los 60, cuando el conocimiento médico y la forma de alimentar a los recién nacidos era completamente diferente a lo que es ahora. Actualmente se reconocen múltiples factores que pueden influir en el porcentaje de pérdida de peso al nacimiento y el ritmo con el cual se recupera este peso. Se cuenta con diferentes nomogramas para recién nacidos alimentados exclusivamente con leche materna y aquellos alimentados con fórmula láctea, e incluso aquellos nacidos por cesárea o por vía vaginal. Para que se logre apoyar la meta de la Organización Mundial de la Salud de alimentar exclusivamente con leche materna a los recién nacidos, es imprescindible reconocer que la "pérdida de más del 10% del peso al nacimiento" no representa por sí sola la necesidad de suplementación artificial. Al evaluar estos casos, se deben considerar varios factores que influyen en el porcentaje de peso que pierde un recién nacido. Por ello, las decisiones diagnósticas deben ser siempre individualizadas en favor de la lactancia materna.

Depression and Anxiety Disorders Impact in the Quality of Life of Patients with Inflammatory Bowel Disease.

OBJECTIVE: Anxiety and depression have a negative influence in the quality of life. The aim of the study was to determinate the levels of sensitivity and specificity of the Anxiety and Hospital Depression Scale (HADS) and compare the quality of life in patients with inflammatory bowel disease (IBD) and depression or anxiety. METHODS: This study included 104 patients with diagnosis of IBD. Each patient received psychiatric intervention with SCID-I (Structured Clinical Interview for DSMIV Axis I Disorders) instrument as a gold standard to stablish the cut-off points of HADS. Quality of life was also evaluated with IBDQ-32. Demographic and clinical variables were collected. RESULTS: Most of the patients reported a high quality of life (73.1%, n = 76), while 25.0% (n = 26) express a moderate quality of life. The ROC curves for both psychiatric entities showed an adequate discriminative capacity of the HADS-anxiety dimension (AUC = 0.84, 95%CI = 0.76-0.92) with a limited discriminability of the HADS-depression dimension (AUC = 0.58, 95%CI = 0.46-0.70) using the proposed scoring of 8 as a cut-off point. CONCLUSIONS: Anxiety and depression impact negatively in the quality of life in Mexican patients with IBD. The Mexican version of HADS had acceptable internal consistency and external validity, with moderate sensitivity and specificity for clearly identifying clinical cases of anxiety and depression in patients with IBD.

Prevalence of mental disorder and impact on quality of life in inflammatory bowel disease / Prevalencia del trastorno mental e impacto en la calidad de vida en la enfermedad inflamatoria intestinal

Introduction: Different studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL. Patients and methods: Subjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test. Results: In all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p=0.005), mood disorder (p=0.004), anxiety disorder (p=0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p=0.01). Major depressive disorder (p=0.004), social phobia (p=0.03), PTSD (p=0.02), and Generalized Anxiety Disorder (p<0.001), were found to be significantly associated with lower QoL. Conclusions: IBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.(AU)

Introducción: La comorbilidad psiquiátrica ha sido descrita en Enfermedad Inflamatoria Intestinal (EII), pero la mayoria de los reportes sólo se enfocan en la depresión y ansiedad. Los trastornos mentales son considerados uno de los principales factores que disminuyen la Calidad de Vida (CV), pero el papel que tienen en EII es hasta el momento incierto. Identificamos la prevalencia de diferentes trastornos mentales y su relación con la CV. Pacientes y métodos: Los pacientes fueron reclutados de la clínica de EII. El cuestionario IBDQ-32 y la Entrevista Clínica Estructurada (SCID) para los trastornos mentales del DSM IV Texto Revisado fueron aplicados. Variables sociodemográficas y clínicas fueron obtenidas por cuestionarios autoaplicados y expedientes clínicos. Se correlacionó los trastornos mentales y la CV utilizando la prueba de Correlación de Spearman. Resultados: Se incluyeron 104 pacientes, 12 con Enfermedad de Crohn y 92 con colitis ulcerativa. La prevalencia global de trastornos mentales fue 56.7%: ansiedad (44.2%), afecto (27.9%), uso de sustancias (12.2%) y otros trastornos mentales (17.3%). De ellos 29.8% presentaron 3 o más trastornos comórbidos. Se identificó a los trastornos mentales (p=0.005), trastornos afectivos (p=0.004), trastornos ansiosos (p=0.009), asociados significativamente con menor CV. Los trastornos por uso de sustancias estuvieron asociados a menor CV-digestiva (p=0.01). Depresión mayor (p=0.004), fobia social (p=0.03), PTSD (p=0.02), ansiedad generalizada (p<0.001), se asociaron a menor CV. Conclusiones: Los pacientes con EII tienen elevada comorbilidad psiquiátrica, la cual afecta su CV. Estos resultados justifican la evaluación sistemática de las condiciones psiquiátricas.(AU)

Prevalence of mental disorder and impact on quality of life in inflammatory bowel disease.

INTRODUCTION: Different studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL. PATIENTS AND METHODS: Subjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test. RESULTS: In all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p=0.005), mood disorder (p=0.004), anxiety disorder (p=0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p=0.01). Major depressive disorder (p=0.004), social phobia (p=0.03), PTSD (p=0.02), and Generalized Anxiety Disorder (p<0.001), were found to be significantly associated with lower QoL. CONCLUSIONS: IBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.

Mortality and Hospitalizations in Mexican Patients with Inflammatory Bowel Disease: Results from a Nationwide Health Registry.

Background: Incidence of inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is increasing worldwide; nevertheless, it is still unknown if this is the case in Mexico. Thus, the aim of this study was to analyze the distribution and trends of hospital discharges (HD) (for the period between 2004 and 2015) and deaths (for the period between 2004 and 2013) reported for UC and CD in Mexico. Methods: Quantitative cross-sectional study was performed. Secondary data sources analysis was performed through Dynamic Cubes of the General Direction of Health Information; variables were categorized by diagnosis, age, sex, and state. The Mann-Whitney U test was used to analyze the differences between the first and last years that were studied. Statistical analysis was performed in SPSS v.24. Results: The number of HD increased by 98.9% between 2004 and 2015 (IBD: p=0.033, CD: p=0.009, UC: p=0.051); it was more frequent, for both sexes and diagnoses, between 15 and 44 years, with a second peak for men with UC (between 45 and 64 years). Deaths increased by 96.2% from 2004 to 2011 (IBD: p=0.056, CD: p=0.064, UC: p=0.04). UC is three times more frequent than CD. Mexico City has the highest number of HD (4,179; 22.7%) while the state of Veracruz has the highest number of deaths (273; 38.2%). Conclusions: HD for IBD in Mexico is increasing significantly; the number of deaths increased until 2011, but from then on, they are apparently decreasing. IBD affects Mexican people without any gender predominance, often affecting patients between 15 and 44 years of age. UC is three times more frequent than CD.

Incidence and prevalence of inflammatory bowel disease in Mexico from a nationwide cohort study in a period of 15 years (2000-2017).

Despite the worldwide increasing incidence and prevalence of Inflammatory Bowel Disease (IBD), our knowledge about it in Mexico is still limited. The aim of this study is to describe the incidence and prevalence of IBD as well as its clinical and socio-demographical characteristics in Mexico from a nation-wide perspective.Multicenter nation-wide cohort study that included 42 IBD clinics from all over the country that participated with electronically register of the new cases over 17 years as well as all known existing cases together with their clinical and socio-demographical characteristics from patients with IBD (ulcerative colitis [UC], Crohn disease [CD], and inflammatory bowel disease unclassified [IBDU]). The data collection was conducted between January and October 2017. Incidence, prevalence, and mean incidence over 2 decades were then calculated. Data base was analyzed using SPSS v24 program SPSS (version 24, IBM Corp., Armonk, NY, USA).A total of 2645 patients with IBD were registered. The crude incidence rates of IBD, UC, and CD, respectively, were 0.21, 0.16, and 0.04 cases per 100,000-person year. The highest incidence was registered in the year 2015, compared with to the previous years. The mean incidence of IBD has increased steadily from 0.05 to 0.21 per 100,000 person-years over the past 15 years (P = .06). The incidence of IBD new cases have increased significantly throughout the last 16 years, 5.9-fold for IBD, 5.3-fold for UC, and 9.5-fold for CD. The prevalence rates of IBD, UC, and CD, respectively, were 1.83, 1.45, and 0.34 cases per 100,000-person-year.This is the first study from a nation-wide perspective that demonstrated a significant increase of prevalence and incidence of IBD in Mexico in the last 15 years.

Escala de Ansiedad y Depresión Hospitalaria (HADS): Validación en pacientes mexicanos con enfermedad inflamatoria intestinal / Hospital Anxiety and Depression Scale (HADS): Validation in Mexican Patients with Inflammatory Bowel Disease

INTRODUCCIÓN: La Escala de Ansiedad y Depresión Hospitalaria (HADS) es un instrumento autoadministrable para pacientes ambulatorios cuyo comportamiento difiere según la población clínica a la que se aplica. En México no está validada en pacientes con enfermedad inflamatoria intestinal (EII). OBJETIVOS: Validar la HADS en la población mexicana con EII. MÉTODOS: Se incluyeron 112 pacientes del Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán» con EII a los cuales se les aplicó la HADS y se valoraron algunas características demográficas y clínicas del padecimiento. Se realizó un análisis factorial exploratorio y obtención de la congruencia factorial para determinar la validez de constructo de la HADS y la confiabilidad se evaluó mediante el alfa de Cronbach. RESULTADOS: El resultado de la rotación varimax de los 14 ítems de la HADS explicó el 50,1% de la varianza, teniendo 2 factores principales. Diez ítems mostraron altas cargas factoriales para las dimensiones originalmente propuestas. La consistencia interna de la HADS fue alta (alfa=0,88) con altos valores en los coeficientes de congruencia. CONCLUSIONES: La HADS es un instrumento válido para detectar posibles casos de ansiedad y depresión en pacientes mexicanos con EII. La validación de este instrumento permite su utilización rutinaria para la evaluación integral del paciente y su referencia oportuna a salud mental

INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is a self-administered instrument for outpatients, but its behaviour differs according to the clinical population to which it is applied. In Mexico it is not validated in patients with Inflammatory Bowel Disease (IBD). OBJECTIVES:To validate the HADS scale in the Mexican population with IBD. METHODS: 112 patients with IBD from the "Salvador Zubirán" National Institute of Medical Sciences and Nutrition were included, to whom the HADS was applied and some demographic and clinical characteristics of the disease were evaluated. An exploratory factor analysis was performed and factorial congruence was calculated to determine the construct validity of the HADS, while reliability was evaluated using Cronbach's alpha. RESULTS: The result of the varimax rotation of the 14 items of the HADS explained 50.1% of the variance, having two main factors. Ten items showed high factor loading for the dimensions originally proposed. The internal consistency of the HADS was high (alpha=0.88) with high values for the congruence coefficients. CONCLUSIONS: The HADS scale is a valid instrument to detect possible cases of Anxiety and Depression in Mexican patients with IBD. The validation of this instrument allows its routine use for the integral evaluation of the patient and their timely referral to mental health

Caspase recruitment domain (CARD) family (CARD9, CARD10, CARD11, CARD14 and CARD15) are increased during active inflammation in patients with inflammatory bowel disease.

BACKGROUND: The CARD family plays an important role in innate immune response by the activation of NF-κB. The aim of this study was to determine the gene expression and to enumerate the protein-expressing cells of some members of the CARD family (CARD9, CARD10, CARD11, CARD14 and CARD15) in patients with IBD and normal controls without colonic inflammation. METHODS: We included 48 UC patients, 10 Crohn's disease (CD) patients and 18 non-inflamed controls. Gene expression was performed by RT-PCR and protein expression by immunohistochemistry. CARD-expressing cells were assessed by estimating the positively staining cells and reported as the percentage. RESULTS: The CARD9 and CARD10 gene expression was significantly higher in UC groups compared with CD (P < 0.001). CARD11 had lower gene expression in UC than in CD patients (P < 0.001). CARD14 gene expression was higher in the group with active UC compared to non-inflamed controls (P < 0.001). The low expression of CARD14 gene was associated with a benign clinical course of UC, characterized by initial activity followed by long-term remission longer than 5 years (P = 0.01, OR = 0.07, 95%CI:0.007-0.70). CARD15 gene expression was lower in UC patients versus CD (P = 0.004). CARD9 protein expression was detected in inflammatory infiltrates; CARD14 in parenchymal cells, while CARD15 in inflammatory and parenchymal cells. CARD9-, CARD14- and CARD15 - expressing cells were significantly higher in patients with active UC versus non-inflamed controls (P < 0.05). CONCLUSION: The CARD family is involved in the inflammatory process and might be involved in the IBD pathophysiology.

Hospital Anxiety and Depression Scale (HADS): Validation in Mexican Patients with Inflammatory Bowel Disease. / Escala de Ansiedad y Depresión Hospitalaria (HADS): Validación en pacientes mexicanos con enfermedad inflamatoria intestinal.

INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is a self-administered instrument for outpatients, but its behaviour differs according to the clinical population to which it is applied. In Mexico it is not validated in patients with Inflammatory Bowel Disease (IBD). OBJECTIVES: To validate the HADS scale in the Mexican population with IBD. METHODS: 112 patients with IBD from the "Salvador Zubirán" National Institute of Medical Sciences and Nutrition were included, to whom the HADS was applied and some demographic and clinical characteristics of the disease were evaluated. An exploratory factor analysis was performed and factorial congruence was calculated to determine the construct validity of the HADS, while reliability was evaluated using Cronbach's alpha. RESULTS: The result of the varimax rotation of the 14 items of the HADS explained 50.1% of the variance, having two main factors. Ten items showed high factor loading for the dimensions originally proposed. The internal consistency of the HADS was high (alpha=0.88) with high values for the congruence coefficients. CONCLUSIONS: The HADS scale is a valid instrument to detect possible cases of Anxiety and Depression in Mexican patients with IBD. The validation of this instrument allows its routine use for the integral evaluation of the patient and their timely referral to mental health.

Joint involvement in Mexican patients with ulcerative colitis: a hospital-based retrospective study.

The most frequent extra-intestinal manifestation in ulcerative colitis (UC) around the world is joint involvement. There are no previous data in Latin America that is about this aspect of disease; hence, the aim of this study was to determine the frequency and factors associated to joint involvement in Mexican patients with UC. A total of 295 patients with histological diagnosis of UC were studied, divided into two groups: (1) 154 cases with at least one joint affection (arthralgia, peripheral, or axial arthropathy (sacroilitis (SI) or ankylosing spondylitis (AS))) and (2) 141 controls that had never presented any joint involvement during the clinical course of UC. Demographic, clinical, and laboratory variables were collected from the clinical records, at the time of presentation of the joint involvement for the cases and with the last information available for controls. A total of 52.2% of the patients had joint involvement, which was also the most frequent extra-intestinal manifestation (EIM). The frequency of peripheral arthralgia was 46.8% and of axial arthropathy was 5.4% (2.7% AS, 2.4% SI, and 0.3% both). The female gender (P = 0.01, OR = 3.061 95% CI: 1.311-7.15), elevated erythrocyte sedimentation rate (ESR) (P = 0.07, OR = 8.04 95% CI: 1.759-36.764), and moderate disease activity by Truelove and Witts criteria (P = 0.024, OR = 4.37 95% CI: 1.211-15.78) were factors associated at the time of presentation of the joint affection. Joint involvement is the most frequent EIM in Mexican patients with UC. The female gender, elevated ESR, and disease activity are factors associated with its presentation.

Frequency, Clinical Features and Factors Associated with Pouchitis after Proctocolectomy with Ileo-Pouch-Anal Anastomosis in Patients with Ulcerative Colitis: A Latin-American Country Retrospective-Cohort Study.

BACKGROUND: Pouchitis is the most common complication of proctocolectomy with ileo-pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). No previous study in Mexico has evaluated this issue; our aim was to evaluate its frequency, clinical characteristics and factors associated with its presence in Mexican patients with UC and IPAA. METHODS: Retrospective-cohort study including 70 patients with histopathological diagnosis of UC and IPAA between 1983 and 2014 from inflammatory bowel disease clinic of a tertiary care center. The statistical analysis used descriptive statistics, chi-square and Fisher's exact test for categorical variables and Student's t test for numeric variables. Univariate analysis was performed to identify the factors associated. RESULTS: Patients presenting with pouchitis accounted for 48.6%. From the 34 cases, 12 (35.3%) had inactive pouchitis; 7 (20.6%) active acute pouchitis; 15 (44.1%) chronic active pouchitis. On average, pouchitis occurred 5.37 years after IPPA. Factors probably associated with its occurrence were the presence of autoimmune concomitant diseases (ACDs; p = 0.06, OR 4.40, 95% CI 0.84-22.9) and extra-intestinal manifestations (EIMs; p = 0.05, OR 2.53, 95% CI 0.96-6.64), which was also probably associated with chronic active pouchitis (p = 0.06, OR 0.31, 95% CI 0.07-1.31). CONCLUSIONS: The frequency of pouchitis is high in Mexican UC patients after IPAA. ACDs and EIMs were probably associated with its development.

Mild clinical behaviour of Crohn disease in elderly patients in a Latin American country: A case-control study.

BACKGROUND: Crohn disease is characterized by fluctuating clinical behaviour, which is influenced by various factors. There are no data from Latin America that evaluate the clinical behaviour of Crohn disease in elderly patients. OBJECTIVE: To evaluate the clinical course of elderly onset Crohn disease compared with younger onset in the Mexican population. METHODS: The present analysis was a case-control study that included 132 patients with a histopathological diagnosis of Crohn disease between 1983 and 2013 in an inflammatory bowel disease clinic of a tertiary care centre. Statistical analysis was performed using SPSS version 17 (IBM Corporation, USA) and descriptive statistics, χ2 and Fisher's exact test for categorical variables and Student's t test for numerical variables. Univariate and multivariate analysis were performed to identify associated risk factors and OR was calculated. RESULTS: A total of 132 patients (73 men and 59 women) were divided into two groups according to age at diagnosis: 27 cases (>60 years of age) and 105 controls (≤60 years of age). Factors influencing the clinical course of Crohn disease in the elderly were: female sex (OR 2.55 [95% CI 1.06 to 6.10]; P=0.02); colonic location (OR 0.22 [95% CI 0.03 to 0.89]; P=0.02); mild clinical behaviour of disease (OR 10.08 [95% CI 3.74 to 27.17]; P=0.0001); response to medical treatment (OR 2.85 [95% CI 1.08 to 7.48]; P=0.02); frequent use of sulfasalazine (OR 4.46 [95% CI 1.22 to 16.28]; P=0.03); less use of azathioprine (OR 0.38 [95% CI 0.13 to 1.03]; P=0.04); and long-term remission (OR 4.96 [95% CI 1.70 to 14.48]; P=0.002). CONLCUSION: Elderly patients with Crohn disease had a mild clinical course characterized by the lack of escalation to immunosuppressive and anti-tumour necrosis factor therapy, as well as long-term remission.