RESUMO
BACKGROUND: Gluten-free diet (GFD) is the only treatment for patients with coeliac disease (CD) and its compliance should be monitored to avoid cumulative damage. AIMS: To analyse gluten exposures of coeliac patients on GFD for at least 24 months using different monitoring tools and its impact on duodenal histology at 12-month follow-up and evaluate the interval of determination of urinary gluten immunogenic peptides (u-GIP) for the monitoring of GFD adherence. METHODS: Ninety-four patients with CD on a GFD for at least 24 months were prospectively included. Symptoms, serology, CDAT questionnaire, and u-GIP (three samples/visit) were analysed at inclusion, 3, 6, and 12 months. Duodenal biopsy was performed at inclusion and 12 months. RESULTS: At inclusion, 25.8% presented duodenal mucosal damage; at 12 months, this percentage reduced by half. This histological improvement was indicated by a reduction in u-GIP but did not correlate with the remaining tools. The determination of u-GIP detected a higher number of transgressions than serology, regardless of histological evolution type. The presence of >4 u-GIP-positive samples out of 12 collected during 12 months predicted histological lesion with a specificity of 93%. Most patients (94%) with negative u-GIP in ≥2 follow-up visits showed the absence of histological lesions (p < 0.05). CONCLUSION: This study suggests that the frequency of recurrent gluten exposures, according to serial determination of u-GIP, could be related to the persistence of villous atrophy and that a more regular follow-up every 6 months, instead of annually, provides more useful data about the adequate adherence to GFD and mucosal healing.
Assuntos
Doença Celíaca , Glutens , Humanos , Glutens/efeitos adversos , Glutens/análise , Seguimentos , Dieta Livre de Glúten , Peptídeos , Cooperação do PacienteRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Linfoma de Burkitt/patologia , Herpesvirus Humano 4/patogenicidade , Valva Ileocecal/patologia , Neoplasias Intestinais/patologia , Tomografia Computadorizada por Raios XAssuntos
Linfoma de Burkitt/patologia , Íleo/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma de Burkitt/diagnóstico por imagem , Linfoma de Burkitt/tratamento farmacológico , Linfoma de Burkitt/virologia , Colo/diagnóstico por imagem , Colo/patologia , Colonoscopia , Diagnóstico Tardio , Progressão da Doença , Herpesvirus Humano 4/isolamento & purificação , Humanos , Íleo/diagnóstico por imagem , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia Computadorizada por Raios X , Infecções Tumorais por Vírus/virologiaAssuntos
Azatioprina/uso terapêutico , Imunodeficiência de Variável Comum/complicações , Doença de Crohn/tratamento farmacológico , Imunossupressores/uso terapêutico , Corticosteroides/uso terapêutico , Azatioprina/efeitos adversos , Infecções por Campylobacter/complicações , Doença de Crohn/complicações , Gastrite/complicações , Gastrite/tratamento farmacológico , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-IdadeRESUMO
No disponible
Assuntos
Humanos , Talidomida/uso terapêutico , Hemorragia Gastrointestinal/cirurgia , Proctite/cirurgia , Argônio , Endoscopia Gastrointestinal/métodos , Lesões por Radiação/cirurgia , Radioterapia/efeitos adversosRESUMO
No disponible
Assuntos
Humanos , Talidomida/uso terapêutico , Hemorragia Gastrointestinal/cirurgia , Proctite/cirurgia , Argônio , Endoscopia Gastrointestinal/métodos , Lesões por Radiação/cirurgia , Radioterapia/efeitos adversosAssuntos
Inibidores da Angiogênese/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Radioterapia/efeitos adversos , Doenças Retais/tratamento farmacológico , Talidomida/uso terapêutico , Coagulação com Plasma de Argônio/métodos , Doença Crônica , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Proctite/tratamento farmacológico , Proctite/etiologia , Proctoscopia , Doenças Retais/etiologia , Doenças Retais/terapiaRESUMO
Objectives: to provide up-to-date information and to analyze recent changes in colorectal cancer mortality trends in Andalusia during the period of 1980-2008 using joinpoint regression models. Patients and methods: age- and sex-specific colorectal cancer deaths were taken from the official vital statistics published by the Instituto de Estadística de Andalucía for the years 1980 to 2008. We computed age-specific rates for each 5-year age group and calendar year and age-standardized mortality rates per 100,000 men and women. A joinpoint regression analysis was used for trend analysis of standardized rates. Joinpoint regression analysis was used to identify the years when a significant change in the linear slope of the temporal trend occurred. The best fitting points (the joinpoints) are chosen where the rate significantly changes. Results: mortality from colorectal cancer in Andalusia during the period studied has increased, from 277 deaths in 1980 to 1,227 in 2008 in men, and from 333 to 805 deaths in women. Adjusted overall colorectal cancer mortality rates increased from 7.7 to 17.0 deaths per 100,000 person-years in men and from 6.6 to 9.0 per 100,000 person-years in women Changes in mortality did not evolve similarly for men and women. Age-specific CRC mortality rates are lower in women than in men, which imply that women reach comparable levels of colorectal cancer mortality at higher ages than men. Conclusions: sex differences for colorectal cancer mortality have been widening in the last decade in Andalusia. In spite of the decreasing trends in age-adjusted mortality rates in women, incidence rates and the absolute numbers of deaths are still increasing, largely because of the aging of the population. Consequently, colorectal cancer still has a large impact on health care services, and this impact will continue to increase for many more years(AU)
Assuntos
Humanos , Masculino , Feminino , Neoplasias Colorretais/epidemiologia , Serviços de Saúde/estatística & dados numéricos , /métodos , /estatística & dados numéricos , Neoplasias Colorretais/mortalidade , Modelos Logísticos , Análise de RegressãoRESUMO
OBJECTIVES: Analysis of the incidence rate and the evolution of duodenal and stomach polyps in our familial adenomatous polyposis (FAP) patients, the suitability of the surveillance method and the cancer-preventing treatment applied and the analysis of the complications arising from each procedure employed. MATERIALS AND METHODS: Twenty-nine patients diagnosed with FAP underwent study and endoscopic surveillance of the upper digestive tract. Front-view and side-view endoscopies were used. Papillary biopsies were performed even when the papilla were macroscopically normal. The Spigelman classification was used to determine the seriousness of the condition and to establish the surveillance and treatment intervals. RESULTS: Duodenal and/or papillary polyps were presented by 79.3% of the patients. Endoscopic polypectomy was performed in 13 patients with duodenal polyps. Endoscopic polypectomies for the papilla were performed in all patients. One patient required a cephalic duodenopancreatectomy and another endoscopic ampullectomy. The condition did not become cancerous in any of the patients who underwent surveillance. We report two complications arising from treatment: one postpolypectomy haemorrhage and one stenosis of the biliary-enteric anastomosis after cephalic duodenopancreatectomy. CONCLUSION: Our study shows a high incidence rate of duodenal polyps in FAP patients. A minute examination of the duodenum and papilla is necessary, using side-view endoscopes and duodenal papilla biopsies even when papilla appears to be normal. None of the patients having completed the surveillance and the prescribed treatment developed cancer and all have a low Spigelman score. This method, therefore, seems to be adequate for the treatment and surveillance of duodenal polyps.