Correlación entre la endoscopia y la ecografía intestinal para la evaluación de la recurrencia posquirúrgica de la enfermedad de Crohn / Correlation between endoscopy and intestinal ultrasound for the evaluation of postoperative recurrence of Crohn's disease

Objetivo: La ecografía intestinal se considera una alternativa para la evaluación de la recurrencia posquirúrgica (RPQ) de la enfermedad de Crohn. El objetivo de este estudio es evaluar la correlación entre los hallazgos ecográficos y endoscópicos.Métodos: Se recogieron de forma retrospectiva los datos de pacientes con enfermedad de Crohn y resección ileocecal en los que se había realizado una colonoscopia y una ecografía intestinal para la detección de RPQ. La RPQ se evaluó empleando el índice de Rutgeerts (IR). Los hallazgos ecográficos analizados fueron el grosor de la pared intestinal, la hiperemia parietal por Doppler, la desestructuración del patrón de capas y la proliferación fibrograsa.Resultados: Se incluyó a un total de 31 pacientes, 15 (48,4%) sin recurrencia (IR? mm vs. 5,68mm; p?<0,001). La hiperemia también se asoció de forma significativa con la recurrencia endoscópica (p?=?0,03). Para el grosor parietal se obtuvo un área bajo la curva ROC (AUC) del 92,9% y, con punto de corte en 3,4mm, la sensibilidad fue del 100% y la especificidad del 86,6%. Al comparar con los biomarcadores principales (calprotectina fecal y PCR sérica) se obtuvo un AUC superior para el grosor (72,3% y 72,3% vs. 92,9%).Conclusiones: En nuestra experiencia, la ecografía tiene una alta rentabilidad diagnóstica para la detección de RPQ y puede considerarse en muchas ocasiones como una alternativa válida y no invasiva a la ileocolonoscopia.

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.

Optimization of azathioprine dose in combined treatment with anti-TNF-alpha in inflammatory bowel disease / Optimización de la dosis de azatioprina en tratamiento combinado con fármacos anti-TNF en la enfermedad inflamatoria intestinal

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.(AU)

Introducción: La dosis adecuada de los fármacos tiopurínicos en tratamientos combinados con anti-TNF en la enfermedad inflamatoria intestinal (EII) no ha sido establecida con claridad. El propósito de este estudio es evaluar si la dosis de azatioprina influye en las tasas de respuesta/remisión clínica y bioquímica y en los niveles de fármaco anti-TNF/formación de anticuerpos. Material y métodos: Se seleccionaron pacientes con EII en tratamiento combinado de mantenimiento con azatioprina (AZA) e infliximab (IFX) o adalimumab (ADA). En función de la dosis de AZA, se definieron dos grupos (estándar: 2-2,5 mg/kg/día o disminuida: menos de 2 mg/kg/día). Resultados: En el grupo IFX no hubo diferencias estadísticamente significativas (p = 0,204) en las tasas de remisión (39 vs. 41,3%), respuesta (10 vs. 21,7%) o fracaso (51,5 vs. 37%), dependiendo de la dosis de fármacos tiopurínicos. No se encontraron diferencias entre los niveles de IFX dependientes de la dosis de AZA (2,46 vs. 3,21 μg/mL; p = 0,211). En el grupo de ADA no hubo diferencias estadísticamente significativas (p = 0,83) en las tasas de remisión (66 vs. 56%), respuesta sin remisión (15,38 vs. 25%) o fallo (18 vs. 18%), dependiendo de la dosis de tiopurinas. Con respecto a los niveles de ADA, no se encontraron diferencias en ambos grupos (7,69 vs. 8,23 μg/mL; p = 0,37). Conclusión: En nuestra experiencia, no se encontraron diferencias estadísticamente significativas ni en los niveles de anti-TNF ni en las tasas de respuesta/remisión clínico-biológica basadas en las dosis de azatioprina.(AU)

[Signet ring cell carcinoma of the ampulla of Vater]. / Carcinoma de células en anillo de sello de la ampolla de Vater.

INTRODUCTION: Signet ring cell carcinoma of the ampulla of Vater is a rare entity and less than 20 cases have been described in the literature. We report the cases of two patients with this disease and provide a literature review of previous studies. CASE REPORT: We describe two patients with obstructive jaundice. Abdominal ultrasonography and abdominal computed tomography showed dilatation of the intrahepatic and common bile duct. Duodenoscopy indicated a protruding mass on the ampulla of Vater. Histopathological examination showed round cells and their nuclei were located on one side with prominent signet-ring features. One patient underwent a cephalic pancreatoduodenectomy with lymphadenectomy and the other a total pancreatectomy. DISCUSSION: Signet ring cell carcinoma of the ampulla of Vater has only been described in isolated cases in the literature. Therefore, the clinicopathological features and prognosis of this disease have not yet been well defined.