ABSTRACT
Introducción: Las principales guías de práctica clínica recomiendan la realización de endoscopia dentro de las 24horas posteriores a la admisión en urgencias en pacientes con hemorragia digestiva alta no variceal. Sin embargo, es un margen de tiempo muy amplio y el papel de la endoscopia urgente (<6horas) es controvertido. Material y métodos: Estudio prospectivo observacional realizado en Hospital Universitario La Paz, donde son seleccionados todos los pacientes, desde el 1 de enero de 2015 hasta el 30 de abril de 2020, que acudieron a urgencias y fueron sometidos a endoscopia por sospecha de hemorragia digestiva alta. Se establecieron dos grupos de pacientes: endoscopia urgente (<6horas) y precoz (6-24horas). El objetivo primario del estudio fue la mortalidad a los 30días. Resultados: Un total de 1.096 pacientes fueron incluidos, de los cuales 682 fueron sometidos a endoscopia urgente. La mortalidad a los 30 días fue del 6% (5% vs 7,7%, p=0,064) y del resangrado fue del 9,6%. No hubo diferencias estadísticamente significativas en la mortalidad, resangrado, necesidad de tratamiento endoscópico, cirugía y/o embolización, pero sí en la necesidad de transfusión (57,5% vs 68,4%, p<0,001) y el número de concentrados de hematíes transfundidos (2,85±4,01 vs 3,51±4,09, p=0,008). Conclusión: La endoscopia urgente, en pacientes con hemorragia digestiva alta aguda, también el subgrupo de alto riesgo (GBS ≥ 12), no se asoció con una mortalidad menor a los 30 días que la endoscopia precoz. Sin embargo, en los pacientes con lesiones endoscópicas de alto riesgo (Forrest I-IIB), fue un predictor significativo de menor mortalidad. Por lo tanto, se requieren más estudios para la identificación correcta de pacientes, que se beneficien de esta actitud médica (endoscopia urgente). (AU)
Introduction: The main clinical practice guidelines recommend endoscopy within 24hours after admission to the Emergency Department in patients with non-variceal upper gastrointestinal bleeding. However, it is a wide time frame and the role of urgent endoscopy (<6hours) is controversial. Material and methods: Prospective observational study carried out at La Paz University Hospital, where all patients were selected, from January 1, 2015 to April 30, 2020, who attended the Emergency Room and underwent endoscopy for suspected upper gastrointestinal bleeding. Two groups of patients were established: urgent endoscopy (<6hours) and early endoscopy (6-24hours). The primary endpoint of the study was 30-day mortality. Results: A total of 1096 were included, of whom 682 underwent urgent endoscopy. Mortality at 30days was 6% (5% vs 7.7%, P=.064) and rebleeding was 9.6%. There were no statistically significant differences in mortality, rebleeding, need for endoscopic treatment, surgery and/or embolization, but there were differences in the necessity for transfusion(57.5% vs 68.4%, P<.001) and the number of concentrates of transfused red blood cells (2.85±4.01 vs 3.51±4.09, P=.008). Conclusion: Urgent endoscopy, in patients with acute upper gastrointestinal bleeding, as well as the high-risk subgroup (GBS ≥12), was not associated with lower 30-day mortality than early endoscopy. However, urgent endoscopy in patients with high-risk endoscopic lesions (ForrestI-IIB), was a significant predictor of lower mortality. Therefore, more studies are required for the correct identification of patients who benefit from this medical approach (urgent endoscopy). (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Gastrointestinal Hemorrhage , Endoscopy/mortality , Endoscopy/methods , Prospective Studies , Cohort Studies , Endoscopy, GastrointestinalABSTRACT
INTRODUCTION: The main clinical practice guidelines recommend endoscopy within 24hours after admission to the Emergency Department in patients with non-variceal upper gastrointestinal bleeding. However, it is a wide time frame and the role of urgent endoscopy (<6hours) is controversial. MATERIAL AND METHODS: Prospective observational study carried out at La Paz University Hospital, where all patients were selected, from January 1, 2015 to April 30, 2020, who attended the Emergency Room and underwent endoscopy for suspected upper gastrointestinal bleeding. Two groups of patients were established: urgent endoscopy (<6hours) and early endoscopy (6-24hours). The primary endpoint of the study was 30-day mortality. RESULTS: A total of 1096 were included, of whom 682 underwent urgent endoscopy. Mortality at 30days was 6% (5% vs 7.7%, P=.064) and rebleeding was 9.6%. There were no statistically significant differences in mortality, rebleeding, need for endoscopic treatment, surgery and/or embolization, but there were differences in the necessity for transfusion(57.5% vs 68.4%, P<.001) and the number of concentrates of transfused red blood cells (2.85±4.01 vs 3.51±4.09, P=.008). CONCLUSION: Urgent endoscopy, in patients with acute upper gastrointestinal bleeding, as well as the high-risk subgroup (GBS ≥12), was not associated with lower 30-day mortality than early endoscopy. However, urgent endoscopy in patients with high-risk endoscopic lesions (ForrestI-IIB), was a significant predictor of lower mortality. Therefore, more studies are required for the correct identification of patients who benefit from this medical approach (urgent endoscopy).
Subject(s)
Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage , Humans , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hospitalization , Prospective StudiesABSTRACT
OBJECTIVE: Intestinal ultrasound is considered to be a valid alternative for the evaluation of post-operative recurrence (POR) of Crohn's disease. The aim of this study is to assess the correlation between ultrasound and endoscopic findings. METHODS: Patients with Crohn's disease were retrospectively recruited who had undergone ileocecal resection, and for whom a colonoscopy and intestinal ultrasound had been performed for the detection of POR. Recurrence was assessed using the Rutgeerts score (RS). The ultrasound findings analysed were bowel wall thickness (BWT), parietal hyperaemia using power Doppler, loss of layer pattern and mesenteric fat hypertrophy. RESULTS: A total of 31 patients were included, of which 15 (48.4%) had no POR (RS<2b) and 16 (51.6%) had POR (RS≥2b). A statistically significant association was identified between BWT and the presence of endoscopic recurrence (a mean of 2.75mm vs. 5.68mm, P>0.001). There was also a statistically significant difference in hyperaemia between the 2groups (P=0.03). For wall thickness, an area under the ROC curve (AUC) of 92.9% was obtained, and with a cut-off point of 3.4mm, a sensitivity of 100% and specificity of 86.6%. When comparing with the most frequent biomarkers (fecal calprotectin and serum CRP), a higher AUC was obtained for wall thickness (72.3% and 72.3% vs. 92.9%). CONCLUSIONS: In our experience, ultrasound has high diagnostic efficacy in the detection of POR and can be considered a valid non-invasive alternative to endoscopy.
Subject(s)
Colonoscopy , Crohn Disease/diagnostic imaging , Ultrasonography , Biomarkers/analysis , C-Reactive Protein/analysis , Crohn Disease/surgery , Feces/chemistry , Humans , Hyperemia/diagnostic imaging , Ileum/diagnostic imaging , Intestines/blood supply , Intestines/diagnostic imaging , Leukocyte L1 Antigen Complex/analysis , Middle Aged , ROC Curve , Recurrence , Retrospective Studies , Sensitivity and SpecificityABSTRACT
INTRODUCTION: The dose of thiopurine drugs in combined treatments with anti-TNF in inflammatory bowel disease (IBD) has not been clearly established. The purpose of this study is to assess whether the dose of azathioprine influences clinical and biochemical response/remission rates, and anti-TNF drug levels/antibody formation. MATERIAL AND METHODS: Patients with IBD on combined maintenance treatment with azathioprine and infliximab or adalimumab were selected. Based on the dose of azathioprine, two groups were defined (standard: 2-2.5mg/kg/day; and decreased: less than 2mg/kg/day). RESULTS: In the IFX group, there were no statistically significant differences (p=0.204) in the rates of remission (39% vs 41.3%), response (10% vs 21.7%) or failure (51.5% vs 37%) depending on the dose of thiopurine drugs. No differences were found between AZA-dose dependent IFX levels (2.46 vs 3.21µg/mL; p=0.211). In the adalimumab group, there were no statistically significant differences (p=0.83) in the rates of remission (66% vs 56%), response without remission (15.38% vs 25%) or failure (18% vs 18%) depending on the dose of thiopurines. With respect to ADA-levels, no differences were found in both groups (7.69 vs 8.23µg/mL; p=0.37). CONCLUSION: In our experience, no statistically significant differences were found in either anti-TNF levels or clinical-biological response/remission rates based on doses of azathioprine.
Subject(s)
Adalimumab/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Azathioprine/administration & dosage , Gastrointestinal Agents/administration & dosage , Inflammatory Bowel Diseases/drug therapy , Infliximab/administration & dosage , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adolescent , Adult , Aged , Aged, 80 and over , Drug Combinations , Female , Humans , Male , Middle Aged , Remission Induction , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Amyloidosis is a chronic multisystem disease that could show multitude of nonspecific symptoms. Gastrointestinal amyloidosis is a very unusual cause of lower gastrointestinal bleeding and it does not usually lead the patient to death. We report a case of a 73-year-old woman who presented a severe, refractory lower gastrointestinal bleeding secondary to ileal ulcers due to amyloid deposit.
Subject(s)
Amyloidosis , Gastrointestinal Diseases , Protein-Losing Enteropathies , Aged , Female , Gastrointestinal Hemorrhage , Humans , UlcerABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Amyloidosis/diagnostic imaging , Peptic Ulcer/etiology , Gastrointestinal Hemorrhage/etiology , Amyloidosis/complications , Chronic DiseaseABSTRACT
No disponible
Subject(s)
Humans , Mycophenolic Acid/adverse effects , Atrophy/chemically induced , Intestinal Mucosa/drug effects , Celiac Disease/pathology , Diagnosis, Differential , Immunosuppressive Agents/adverse effects , Endoscopy, Gastrointestinal/methodsABSTRACT
Necrotizing enterocolitis in adults (ECNA) is a disease of uncertain etiology, very rare, with very few cases described in the literature and with high mortality. There is a strong correlation between vascular and infectious events involved in the pathogenesis of massive intestinal necrosis in this entity.
Subject(s)
Enterocolitis, Necrotizing/etiology , Mesenteric Ischemia/complications , Enterocolitis, Necrotizing/diagnostic imaging , Fatal Outcome , Hemoperitoneum/diagnostic imaging , Humans , Male , Mesenteric Ischemia/diagnostic imaging , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Mycophenolate mofetil (MMF) is an immunosuppressive agent that is used in transplanted patients, with frequent gastrointestinal adverse effects. We report the case of a patient, under chronic therapy with mycophenolate mofetil , during a diagnostic workup for a chronic diarrhea, which presents a duodenal villous atrophy ( VA) with negative celiac serology, which is a diagnostic challenge. VA secondary to MMF is a very unusual adverse effect. Just a few cases have been reported in the literature.
Subject(s)
Duodenum/pathology , Immunosuppressive Agents/adverse effects , Mycophenolic Acid/adverse effects , Adult , Atrophy/chemically induced , Celiac Disease/diagnosis , Duodenum/drug effects , Endoscopy, Gastrointestinal , Humans , Kidney , Transplant RecipientsABSTRACT
La obstrucción maligna de la vía biliar es una entidad habitual en la práctica clínica siendo infrecuente que ocurra por neoplasias no biliopancreáticas. Presentamos el caso de un varón que acude con obstrucción de vía biliar de origen maligno demostrándose tras los numerosos estudios realizados que dicha obstrucción corresponde a la forma de presentación de un adenocarcinoma pulmonar estadio IV. Las neoplasias pulmonares tienen comportamientos variables encontrándose en muchas ocasiones extendidas al diagnóstico especialmente en los subtipos más agresivos como el carcinoma microcítico. No obstante, no es habitual que se manifiesten en forma de ictericia obstructiva y cuando esto sucede suele ser debido a daño hepático y no a metástasis a la región periampular que son extremadamente infrecuentes. En este caso fue fundamental el papel de la anatomía patológica y la inmunohistoquímica para filiar el origen del tumor e iniciar tratamiento ya que la clínica y pruebas de laboratorio e imagen habituales no permitían diferenciarlo de un colangiocarcinoma primario
Malignant bile duct obstruction is a common entity in clinical practice and is infrequently caused by non-biliopancreatic neoplasms. We report the case of a male admitted with malignant obstruction of the biliary tract, showing after numerous studies that this obstruction was the initial presentation of a stage IV adenocarcinoma of the lung. Pulmonary neoplasms have variable behaviors being often spread at time of diagnosis, especially in the more aggressive subtypes. However, it is uncommon its manifestation as obstructive jaundice and when this happens it is usually due to liver damage and not to metastases to periampullary region that are extremely infrequent. In this case, the role of pathological anatomy and immunohistochemistry was essential in identifying the origin of the tumor and starting targeted treatment, since the clinical presentation and usual laboratory and image tests did not allow to differentiate it from a primary cholangiocarcinoma
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma/diagnosis , Lung Neoplasms/diagnosis , Jaundice, Obstructive/diagnosis , Cholangiocarcinoma/diagnostic imaging , Cholangiopancreatography, Endoscopic Retrograde , Neoplasm Metastasis/pathologyABSTRACT
Malignant bile duct obstruction is a common entity in clinical practice and is infrequently caused by non-biliopancreatic neoplasms. We report the case of a male admitted with malignant obstruction of the biliary tract, showing after numerous studies that this obstruction was the initial presentation of a stage IV adenocarcinoma of the lung. Pulmonary neoplasms have variable behaviors being often spread at time of diagnosis, especially in the more aggressive subtypes. However, it is uncommon its manifestation as obstructive jaundice and when this happens it is usually due to liver damage and not to metastases to periampullary region that are extremely infrequent. In this case, the role of pathological anatomy and immunohistochemistry was essential in identifying the origin of the tumor and starting targeted treatment, since the clinical presentation and usual laboratory and image tests did not allow to differentiate it from a primary cholangiocarcinoma.
Subject(s)
Adenocarcinoma/complications , Jaundice, Obstructive/etiology , Lung Neoplasms/complications , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/drug therapy , Adenocarcinoma of Lung , Cholangiopancreatography, Endoscopic Retrograde , Early Diagnosis , Humans , Jaundice, Obstructive/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/drug therapy , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Chilaiditi Syndrome/complications , Intestinal Volvulus/etiology , Sigmoid Diseases/etiology , Risk Factors , Liver/injuriesABSTRACT
Chilaiditi's sign is an anatomical alteration consisting of the transposition of the small intestine or colon between the liver and diaphragm that is asymptomatic and is usually an accidental radiological finding. The onset of Chilaiditi syndrome is accompanied by clinical symptoms and is even rarer. Moreover, the combination of sigmoid volvulus and Chilaiditi syndrome is extremely rare, with only 17 previous published cases, one of which occurred in a female patient.
