Update on biosimilars in inflammatory bowel disease: Position and recommendations in Mexico. / Actualización sobre los medicamentos biocomparables en la enfermedad inflamatoria intestinal: posición y recomendación en México.

The biotechnology-derived medicines known as biosimilars are defined as non-originator treatments that have demonstrated quality, efficacy, and safety comparable to the reference biologic drug. Clinical trials have shown that the infliximab biosimilar, CT-P13, and the candidates for the adalimumab biosimilars, ABP 501 and ZRC 3197, are not significantly different, with respect to efficacy and safety, from the originator drugs in patients with other autoimmune diseases. However, controversy has arisen over the use of biosimilars in inflammatory bowel disease, due to the incipient evidence not only in patients with no previous biotechnology treatment, but also in patients in remission, that could be switched to a biosimilar for non-medical reasons. The present review is the first critical analysis by different specialists in the area of gastroenterology on the use of biosimilars in inflammatory bowel disease, the evidence on interchangeability, the extrapolation of indications, efficacy, safety, immunogenicity, and the clinical impact of the Mexican health regulations. The aim of our review was to make the positioning and recommendations of these new therapeutic options known, given that they have a potential cost-benefit for both patients and healthcare institutions.

The Mexican consensus on the diagnosis and treatment of ulcerative colitis. / Consenso mexicano para el diagnóstico y tratamiento de la colitis ulcerosa crónica idiopática.

The guidelines presented herein are an updated version of the recommendations published in 2007. Since then, there has been a rapid advance in the knowledge about the pathophysiology of ulcerative colitis and its therapeutic options. New drugs have been approved, novel targeted therapies have emerged, and new strategies have been developed to improve the previously available approaches to the disease. The aim of the present consensus is to promote the current knowledge of and Mexican perspective on the epidemiology, diagnosis, and medical and surgical treatment of chronic idiopathic ulcerative colitis. The final vote on the statements and their ultimate modifications were carried out at the consensus working group meeting. Evidence was evaluated through the GRADE classification.

[Prevalence of neutropenic enterocolitis in adults with severe neutropenia and associated mortality.]. / Prevalencia de enterocolitis neutropénica en adultos con neutropenia grave y mortalidad asociada.

BACKGROUND: Neutropenic enterocolitis (NEC) is characterized by inflammatory damage and necrosis of the intestinal mucosa, mainly of the terminal ileum and the cecum. It is more frequent in patients with leukemia and/or undergoing antineoplastic chemotherapy, and the main risk factor is neutropenia <1000/mm3. OBJECTIVE: To know the prevalence of NEC and the mortality associated with it in adults with hematologic conditions and neutropenia <1000/mm3. MATERIAL AND METHODS: All adult patients who were hospitalized for malignant hematologic conditions with neutropenia <1000/mm3 were enrolled in the study; those with neutropenia >1000/mm3 were excluded. The diagnosis of NEC was based on the clinical data and imaging tests (abdominal plain X-rays and CT scan). Demographics of all patients were collected, as well as the data related with the course and treatment of the underlying hematologic condition and the NEC. RESULTS: 117 patients were enrolled in the study; 75.2% of them with some type of acute leukemia. The diagnosis of NEC was made in 8 patients (6.8%). NEC occurred in 10.5% of the patients with acute myeloid leukemia and in 8.0% of those with acute lymphocytic leukemia. Three patients died, which resulted in a 37.5% mortality rate. No association was found between the severity of neutropenia and the onset of NEC or NEC-related mortality. CONCLUSIONS: The prevalence of NEC in patients with hematologic conditions admitted for severe neutropenia is 6.8% and the mortality rate associated with this complication is 37.5%.

[Colonic poliposis and acromegaly. Colonoscopy prevalence and detection]. / Pólipos colónicos y acromegalia. Prevalencia y detección por colonoscopia.

BACKGROUND: The prevalence of colorectal polyps in the general population is 10%. Hormonal alterations in acromegaly stimulates adenomatose polyps development making that increase it prevalence. Colonoscopy has elevated sensibility and specificity in detection of colorectal adenomas. OBJECTIVE: Identify colonic polyps in patients with acromegaly and establish the importance of colonoscopy as a detection method. MATERIAL AND METHODS: Retrospective, observational and descriptive study made in Colon and Rectum Surgery Department from March 2000 to March 2007 in patients with acromegaly and colonoscopy. Analyzed variables were: gender,age, endoscopy findings and histopathological results. Descriptive statistics were used to analysis of results. RESULTS: Thirty-two patients were included: 14 (44%) men, 18 (56%) women. The mean age was 48 (range 22 to 75 years old). In 9 (28%) patients were detected colorectal polyps, predominately in the sigmoid. Fifteen polyps lesion were found: 7 (46.6%) adenomas: 5 (33.3%) tubular and 2 (13.3) villous, 6 (40%) hyperplasic, 1 (6.6%) inflammatory and 1 (6.6%) carcinoma. Colonoscopy was complete in 30 (93.7%) patients. CONCLUSIONS: The prevalence of colonic polyps inpatients with acromegaly undergoing colonoscopy,was 28%, higher than expected in the general population. Colonoscopy constitutes an important diagnosis technique in early neoplasia detection.

[Non Hodgkin lymphoma of the sigmoid colon: case report]. / Linfoma no Hodgkin de sigmoides: reporte de un caso.

Non-Hodgkin lymphoma (NHL) occurs in extranodal location in approximately 20% of patients with limited stage, high-grade disease. Colon is infrequently involved as a primary location, accounting for 4% of all extranodal NHL and far less than 1% of all colonic malignancies. Colonic NHL differs significantly in terms of presentation, therapy and outcome relative to other more common gastrointestinal sites, like stomach or small bowel. The most common location is the cecum (60-74% of cases), while the sigmoid is involved in 2.5-14%. Largely related to the lack of specific signs and symptoms, patients frequently present advanced locoregional disease. Moreover, more than half of patients require an emergent surgery, usually due to pain, bleeding, or obstruction. Therapy usually involves resection of the affected colon and regional lymph nodes followed by adjuvant chemotherapy or/and radiotherapy. Utilizing this approach 5 years survival rates range between 27-55%. We present a 59 years old man with weight loss,abdominal pain, palpable mass and intestinal obstruction. A sigmoidectomy was realized with histopathologic report of NHL. Systemic adjuvant chemotherapy and abdominal radiation were administered. After a 6 month follow-up from initial procedure he is now asymptomatic with Karnofsky of 90. Therefore a surgeon should consider the possibility of NHL when evaluating such patients.

Endoanal sonography in assessment of fecal incontinence following obstetric trauma.

OBJECTIVES: Fecal incontinence is a common, incapacitating and largely unrecognized medical problem and can be caused by various factors. Obstetric trauma is the most common cause of fecal incontinence secondary to trauma. We aimed to analyze the role of endoanal ultrasound in assessment of this type of fecal incontinence, and report the functional results of surgical treatment. METHODS: We reviewed the records of all 22 patients with fecal incontinence secondary to obstetric trauma who were evaluated by endoanal ultrasound and underwent surgical management in our department from April to 1997 to April 2002. Pre- and postoperative evaluation of the degree of incontinence was done using the incontinence score of Jorge and Wexner. RESULTS: The patients had a median age of 43 (range, 29-68) years. All had vaginal deliveries, five of which (22.7%) were instrumental. Most of the patients had total fecal incontinence (solids) with preoperative incontinence score values of 15-20 (median, 18). Endoanal ultrasound confirmed structural defects in the anterior external anal sphincter alone in 16 (72.7%) patients, and both anterior external and internal sphincter defects in six (27.3%) patients. A thinned perineal body was present in all patients. All patients received surgical treatment with overlapping sphincteroplasty and there was improvement of continence in 19 (86.4%) patients with postoperative incontinence score values between 4 and 0 (median, 2). CONCLUSIONS: Endoanal sonography is an accurate method for assessing sphincter anatomy, delineating both internal and external anal sphincters. Surgical treatment of sphincter defects is associated with good outcome.

[Colonoscopy. Analysis of 2,000 procedures]. / La colonoscopia. Análisis de 2,000 procedimientos.

BACKGROUND: During the last 3 decades, colonoscopy has become the diagnostic study with greatest sensitivity and acuity in colonic pathology. AIMS: To know the most frequent diagnostic and colonoscopic disorders, and the pathology found, to establish certainty of the colonoscopic procedure. METHOD: Between 1987 and 1997, a descriptive, transversal, retrospective and observational study of the 2,000 colonoscopies that were carried out at on service was done, making a registry of the endoscopic search in colorectal pathology and their characteristics in on patients. RESULTS: Colonoscopies were done in 967 men (47.3%) and 1,053 women (52.6%) with a median age of 55.8 years (10 range (-) 93 years). In 1,780 of them (89.%), it was possible to arrive to cecum; 1,150 (57.5%) were pathologic. The most frequent finding was hemorrhage of the lower digestive tube in 525 (26.2%) patients; in addition cancer in 402 (20.1%), suspicion of intestinal inflammatory disease 292 (14.6%) and colorectal polyps 199 (10%) were found. The most frequent endoscopic diagnosis was colorectal polyps in 405 (35.7%) patients; in additions diverticular disease was found in 404 (35.1%) patients intestinal inflammatory disease in 185 (16%), colorectal cancer in 85 (7.4%), and vascular ectasias in 52 (4.5%) patients. There were four complicated cases (0.25%), three by resolved therapeutic colonoscopy and one diagnostically. CONCLUSION: The most frequent colonoscopic were findings hemorrhage of the lower digestive tube and the finding of cancer. The most frequent diagnoses were colorectal polyps and diverticular disease. Colonoscopy is a safe diagnostic and therapeutic procedure.

[Malignant stromal tumor of the transverse colon. Case report]. / Tumor estromal maligno de colon transverso. Informe de un caso.

OBJECTIVE: Case report of a malignant stromal tumor of the transverse colon. BACKGROUND: Colon sarcomas are rare; the most frequent presentation is the leiomyosarcoma. Forty five cases of malignant stromal tumor have been reported in the international literature. The histogenesis of these mesenchymatous neoplasms is determined by ultrastructural analysis and immunohistochemical stains, nevertheless when special techniques are negative and there is uncertainty related to the cellular differentiation line (smooth muscle, neural or undifferentiated) it is preferable to call them stromal tumors of gastrointestinal tract. METHOD: A 46 year old patient with the diagnosis of malignant stromal tumor of transverse colon and the prescribed treatment was reported. RESULTS: A case of a patient with the diagnosis of malignant stromal tumor in transverse colon is presented, who had as the main clinical features abdominal pain, transanal hemorrhage and finally intestinal occlusion. He was submitted to exploratory laparotomy finding a transverse colon intussusception, which was treated with an extended right hemicolectomy and a post surgical satisfactory recovery. Follow-up to three years hasn't found tumoral activity. CONCLUSIONS: Stromal tumors are rare in colon, treatment is a wide surgical resection with curative or palliative purposes.

[Colitis cystica profunda. A case report]. / Colitis quística profunda. Informe de un caso.

OBJECTIVE: To present a pathology not previously informed in national literature. BACKGROUND: Colitis cystica profunda (CCP) is a rare benign entity and with an unknown etiology. There are 148 cases documented in world literature at the present time. Histologically it is defined as the obliteration of lamina propria by fibroblasts and the presence of submucous cysts. It comes in localized, segmental or diffuse forms and associated to other entities as solitary rectal ulcer, rectal prolapse, alterations in the pelvic floor, etc. Treatment can be medical or surgical according to severity of its manifestations. METHOD: A case of CCP is revised as well as the treatment effectuated. RESULTS: A case of patient with the diagnosis of CCP of localized type is presented, which principal symptom was transanal mucous secretion; on physical exploration a sessile mucous polypoid formation at 8 cm from anal verge was found and was treated with surgical resection with a satisfactory outcome. CONCLUSIONS: In a patient with alterations in pelvic floor or puborectal bundle contraction and sigmoidorectal intussusception CCP must be suspected. Treatment can be medical with a high percentage of failure being optimal treatment the surgical one.

[Colonic adenoma: risk factors for their malignant transformation]. / Adenomas colónicos: factores de riesgo para su malignización.

BACKGROUND: Almost all colorectal cancers develop from adenomatous polyp, its detection and resection prevent the malignization. Several adenoma characteristics like: number, size, morphology, histologic type and grade of dysplasia have become considered as malignization risk factors. AIMS: This study was designed to determine the frequency of colorectal adenoma and the principal risk factors for malignization. METHODS: Between June of 1989 and July of 1994, 846 colonoscopies were performed and retrospectively analyzed in the same number of patients. The patients with colorectal polyps were chosen for the analysis of this study as well all the polyps characteristics, to determine the risk factors for malignization. RESULTS: There were 183 patients (21.6%) with 322 colorectal polyps. Of all of them, only 214 (66.4%) underwent colonoscopy snare resection and were studied; 120 (57%) were neoplastic polyps and 94 (43%) non neoplastic; among those neoplastic polyps, 100 (83.4%) were tubular adenomas, 11 (9.1%) were tubulovillous adenomas, and 9 (7.5%) were villous adenomas. We found 16 (7.4%) polyps with adenocarcinoma, 14 (87.5%) were found in patients older than 50 years of age and in polyps larger than 1 cm in diameter (p 0.040). Eleven (68.7%) were sessiles (p 0.001). CONCLUSIONS: After the evaluation of polyps, the tubular adenomas were the neoplastic polyps more frequently found. In this particular study, the patient age, polyp size and morphology were the more statistically significant risk factors for malignization in our patient group.