Impact of mesalazine on the response to COVID-19 vaccination in patients with inflammatory bowel disease: Results of a prospective multicentre study of GETECCU (VACOVEII study). / Impacto de la mesalazina en la respuesta a la vacunación contra la COVID-19 en pacientes con enfermedad inflamatoria intestinal. Resultados de un estudio prospectivo multicéntrico de GETECCU (VACOVEII).

OBJECTIVE: The recommendations of the Spanish Ministry of Health on vaccination in risk groups include mesalazine among the treatments with a possible negative effect on its effectiveness. However, this is not the recommendation of most experts. Our objective was to evaluate the effect of mesalazine on the humoral response to the SARS-CoV-2 vaccine in patients with inflammatory bowel disease (IBD). METHODS: VACOVEII is a Spanish, prospective, multicenter study promoted by GETECCU, which evaluates the effectiveness of the SARS-CoV-2 vaccine in patients with IBD. This study includes IBD patients who have recieved the full vaccination schedule and without previous COVID-19 infection. Seroconversion was set at 260BAU/mL (centralized determination) and was assessed 6 months after full vaccination. In this subanalysis of the study, we compare the effectiveness of the vaccine between patients treated with mesalazine and patients without treatment. RESULTS: A total of 124 patients without immunosuppressive therapy were included, of which 32 did not receive any treatment and 92 received only mesalazine. Six months after full vaccination, no significant differences are observed in the mean concentrations of IgG anti-S between both groups. In the multivariate analysis, antibody titers were independently associated with the use of mRNA vaccines and with SARS-CoV-2 infection. CONCLUSION: Mesalazine does not have a negative effect on the response to SARS-CoV-2 vaccines in IBD patients.

A booster dose of SARS-COV-2 vaccine improves suboptimal seroconversion rates in patients with inflammatory bowel disease. Results of a prospective multicenter study of GETECCU (VACOVEII study).

BACKGROUND: The response to SARS-CoV-2 vaccination decreases in inflammatory bowel disease (IBD) patients, specially under anti-TNF treatment. However, data on medium-term effectiveness are limited, specially using new recommended seroconversion rate (>260BAU/mL). Our aim was to evaluate the 6-month>260 BAU-seroconversion rate after full vaccination and after booster-dose. METHODS: VACOVEII is a Spanish multicenter, prospective study promoted by GETECCU. IBD patients full vaccinated against SARS-CoV-2 and without previous COVID-19 infection, treated or not with immunosuppressants, were included. The booster dose was administered 6 months after the full vaccination. Seroconversion was set at 260BAU/mL, according to most recent recommendations and was assessed 6 months after the full vaccination and 6 months after booster-dose. RESULTS: Between October 2021 and March 2022, 313 patients were included (124 no treatment or mesalazine; 55 immunomodulators; 87 anti-TNF; 19 anti-integrin; and 28 ustekinumab). Most patients received mRNA-vaccines (86%). Six months after full vaccination, overall seroconversion rate was 44.1%, being significantly lower among patients on anti-TNF (19.5%, p<0.001) and ustekinumab (35.7%, p=0.031). The seroconversion rate after booster was 92%. Again, anti-TNF patients had a significantly lower seroconversion rate (67%, p<0.001). mRNA-vaccine improved seroconversion rate (OR 11.720 [95% CI 2.26-60.512]). CONCLUSION: The full vaccination regimen achieves suboptimal response in IBD patients, specially among those anti-TNF or ustekinumab. The booster dose improves seroconversion rate in all patients, although it remains limited in those treated with anti-TNF. These results reinforce the need to prioritize future booster doses in patients on immunosuppressants therapy, specially under anti-TNF, and using mRNA-vaccines.

Diverticulitis de Meckel perforada en un adulto como causa atípica de dolor abdominal / Perforated Meckel's diverticulitis in an adult as an atypical cause of abdominal pain

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Trombosis venosa mesentérica asociada a infección por CMV / Mesenteric vein thrombosis associated with a cytomegalovirus infection

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Ionizing radiation in patients with Crohn´s disease. Estimation and associated factors.

INTRODUCTION: exposure to ionizing radiation is associated with an increased risk of developing tumors. Patients with Crohn's disease (CD) usually require multiple imaging tests using this type of radiation. OBJECTIVES: the objectives of this study were to estimate the total dose of ionizing radiation received by patients with Crohn's disease during their course and to identify the factors associated with higher radiation doses. METHODS: two hundred thirty-five CD patients diagnosed between 1972 and 2010 were included. The effective dose (ED) received by each patient was calculated retrospectively based on the number of gastrointestinal transit studies and computed tomography scans performed. Considering recent epidemiological studies, an ED greater than or equal to 50 mSv was used as the cut-off point for increased risk of developing cancer. RESULTS: the mean ED received per patient was 33.4 mSv (95% CI 29.3-37.5). A total of 49 (20.8%) patients received an ED ≥ 50 mSv. The following factors were identified as independent predictors associated with an ED ≥ 50 mSv: Age older than 40 years, need for surgery, age under 16 years at diagnosis and disease duration over 8 years. CONCLUSIONS: a substantial proportion of patients with Crohn's disease receive high doses of potentially carcinogenic ionizing radiation. Identification of the most susceptible patients to receive high doses of radiation, monitoring of effective doses received and the use of imaging techniques that do not require ionizing radiation (MR enterography, abdominal ultrasound) could contribute in reducing patients' exposure to potentially carcinogenic ionizing radiation.

Radiación ionizante en pacientes con enfermedad de Crohn. Estimación y factores asociados / Ionizing radiation in patients with Crohn's disease. Estimation and associated factors

Introducción: la exposición a radiación ionizante se asocia a un mayor riesgo de desarrollar tumores. Los pacientes con enfermedad de Crohn requieren habitualmente múltiples pruebas de imagen que utilizan este tipo de radiación. Objetivos: los objetivos de este estudio son estimar la dosis total de radiación ionizante recibida por pacientes con enfermedad de Crohn a lo largo de su evolución e identificar los factores asociados a dosis de radiación más altas. Métodos: se incluyeron 235 pacientes con enfermedad de Crohn diagnosticados entre 1972 y 2010. Se calculó retrospectivamente la dosis efectiva (DE) recibida por cada paciente, teniendo en cuenta los tránsitos gastrointestinales y las tomografías computarizadas que se habían realizado. Basados en estudios epidemiológicos previos, se consideró un valor umbral de DE ≥ 50 mSv de mayor riesgo de desarrollar cáncer. Resultados: la media de DE recibida por paciente fue 33,4 mSv (IC 95% 29,3-37,5). Un total de 49 (20,8%) pacientes recibió una DE >= 50 mSv. Se identificaron como factores predictivos independientes asociados a una DE >= 50 mSv: edad mayor de 40 años, necesidad de cirugía, edad al diagnóstico menor 16 años y tiempo de evolución mayor de 8 años. Conclusiones: un porcentaje considerable de pacientes con enfermedad de Crohn recibe dosis elevadas de radiación ionizante potencialmente carcinogénicas. La identificación de los pacientes mas susceptibles a recibir dosis altas de radiación, la monitorización de la dosis efectiva recibida y la utilización de pruebas de imagen que no utilizan radiación ionizante (enterorresonancia, ecografía abdominal), podrían contribuir a reducir la exposición a la radiaciones ionizantes potencialmente carcinogénicas(AU)

Introduction: exposure to ionizing radiation is associated with an increased risk of developing tumors. Patients with Crohn’s disease (CD) usually require multiple imaging tests using this type of radiation. Objectives: the objectives of this study were to estimate the total dose of ionizing radiation received by patients with Crohn’s disease during their course and to identify the factors associated with higher radiation doses. Methods: two hundred thirty-five CD patients diagnosed between 1972 and 2010 were included. The effective dose (ED) received by each patient was calculated retrospectively based on the number of gastrointestinal transit studies and computed tomography scans performed. Considering recent epidemiological studies, an ED greater than or equal to 50 mSv was used as the cut-off point for increased risk of developing cancer. Results: the mean ED received per patient was 33.4 mSv (95% CI 29.3-37.5). A total of 49 (20.8%) patients received an ED >= 50 mSv. The following factors were identified as independent predictors associated with an ED >= 50 mSv: Age older than 40 years, need for surgery, age under 16 years at diagnosis and disease duration over 8 years. Conclusions: a substantial proportion of patients with Crohn’s disease receive high doses of potentially carcinogenic ionizing radiation. Identification of the most susceptible patients to receive high doses of radiation, monitoring of effective doses received and the use of imaging techniques that do not require ionizing radiation (MR enterography, abdominal ultrasound) could contribute in reducing patients’ exposure to potentially carcinogenic ionizing radiation(AU)

Estudio de enfermedad celíaca en pacientes adultos con diabetes mellitus de tipo 1 / Study of celiac disease in adults with type 1 diabetes mellitus

En el presente estudio determinamos los citados anticuerpos a 463 pacientes con DM1 y, a los que presentaban positividad para alguno de ellos, se les propuso la realización de una endoscopia con toma de biopsias de duodeno distal, y se clasificaron las lesiones histológicas, cuando existieron, según la clasificación de Marsh.Sesenta y dos de los 463 (13,4%) pacientes presentaron al menos uno de los 3 anticuerpos positivo y, de ellos, 42 accedieron a la realización de la endoscopia. En 14 pacientes (3% de los diabéticos) se encontraron alteraciones histológicas compatibles con EC. La mayoría de estos 14 pacientes no refería síntomas relacionados con la enfermedad, aunque varios presentaban alteraciones analíticas presentes frecuentemente en la EC. La existencia de datos clinicoanalíticos compatibles con EC fue independiente del grado de lesión histológica. Al analizar la sensibilidad y el valor predictivo positivo para cada anticuerpo, los ATG y EMA fueron los más sensibles, si bien la facilidad técnica de detección de los ATG mediante técnicas de ELISA hace, en nuestra opinión, que sea el de elección para la realización del cribado(AU)

Celiac disease (CD) presents a wide clinical spectrum. There are asymptomatic or oligosymptomatic forms, which are difficult to diagnose. Since patients with untreated CD can develop severe complications, early diagnosis of these forms is important. Consequently, in groups at risk for CD, such as patients with type 1 diabetes (DM1), screening through determination of antigliadin (AGA), anti-tissue transglutaminase (ATG) and antiendomysial antibodies (EMA) is recommended. In the present study, 463 DM1 patients were screened for these antibodies. Patients who were positive for one or more were offered an upper endoscopy to obtain distal duodenum biopsies. Histological lesions, when present, were classified using Marsh's classification. Of the 463 patients, 62 (13.4%) were positive for at least one of the three antibodies, and 42 accepted to undergo an endoscopy. Fourteen patients (3% of the DM1 patients) were histologically diagnosed with CD. Most of these patients had no symptoms of CD, although some showed laboratory findings frequent in CD. The presence of clinical or analytical data compatible with CD was independent of the grade of histological lesions. Finally, we calculated the sensitivity and positive predictive value for each antibody. The most sensitive were ATG and EMA. Because of the technical simplicity of determining ATG with ELISA, in our opinion, this test should be the option of choice for screening (AU)

[Study of celiac disease in adults with type 1 diabetes mellitus]. / Estudio de enfermedad celíaca en pacientes adultos con diabetes mellitus de tipo 1.

Celiac disease (CD) presents a wide clinical spectrum. There are asymptomatic or oligosymptomatic forms, which are difficult to diagnose. Since patients with untreated CD can develop severe complications, early diagnosis of these forms is important. Consequently, in groups at risk for CD, such as patients with type 1 diabetes (DM1), screening through determination of antigliadin (AGA), anti-tissue transglutaminase (ATG) and antiendomysial antibodies (EMA) is recommended. In the present study, 463 DM1 patients were screened for these antibodies. Patients who were positive for one or more were offered an upper endoscopy to obtain distal duodenum biopsies. Histological lesions, when present, were classified using Marsh's classification. Of the 463 patients, 62 (13.4%) were positive for at least one of the three antibodies, and 42 accepted to undergo an endoscopy. Fourteen patients (3% of the DM1 patients) were histologically diagnosed with CD. Most of these patients had no symptoms of CD, although some showed laboratory findings frequent in CD. The presence of clinical or analytical data compatible with CD was independent of the grade of histological lesions. Finally, we calculated the sensitivity and positive predictive value for each antibody. The most sensitive were ATG and EMA. Because of the technical simplicity of determining ATG with ELISA, in our opinion, this test should be the option of choice for screening.

Perineurioma intestinal / Intestinal perineurioma: report of four cases

Antecedentes: Los perineuriomas en el tracto gastrointestinalse describieron por primera vez en el año 2005como un subtipo especial de pólipos. Actualmente hay 15casos descritos en la literatura con esta denominación.Material y métodos: Presentamos cuatro casos (tres mujeresy un hombre de edades comprendidas entre los 47 y 80años) a los que les detectaron pólipos sésiles mediante colonospiay cuyo diagnóstico histológico fue de perineurioma.Resultados: El tamaño de los pólipos remitidos oscilabaentre 0,3 y 0,5 cm. Los pólipos mostraban una proliferaciónde células fusiformes, sin atipias, que se disponían en unpatrón fascicular y en el epitelio presentaban cambios hiperplásicos.Las células expresaban EMA, Glut-1, claudina 1 yvimentina y mostraban negatividad para S100, c-kit, cromogranina,desmina y actina alfa músculo lisa. En dos delos casos, se obtuvieron muestras del material en parafinapara estudio de ultraestructura observándose las característicastípicas del perineurioma. Discusión: Los perineuriomasgastrointestinales se presentan como pólipos, generalmentesésiles, que suelen ser detectados durante colonoscopiasde cribado en pacientes asintomáticos. Se localizanpreferentemente en colon y se observan con más frecuenciaen mujeres. Teniendo en cuenta los criterios actuales deperineurioma, cabe suponer que muchos pólipos intestinalesdiagnosticados previamente como pólipos fibroblásticos yneurofibromas eran realmente perineuriomas. Se asociancon cambios hiperplásicos en el epitelio adyacente. Se desconocesi esta asociación es coincidencia o si el perineuriomainduce la proliferación epitelial (AU)

Introduction: Gastrointestinal perineuriomas were firstdescribed in 2005 as a special subtype of polyps. Currently,there are 15 cases described in the medical literature withsuch denomination. Material and methods: We presentfour cases, three females and one male, from 47 to 80 years,who had sessile polyps detected during colonoscopy, diagnosedhistologically as intestinal perineuriomas. Results:The polyps ranged from 0.3 to 0.5 cm. Microscopically, theywere composed of uniform, bland spindle cells with a fasciculargrowth pattern and they exhibited hyperplastic changesin the epithelium. Cells were positive for epithelialmembrane antigen (EMA), Glut-1, claudin 1 and vimentinand negative for S-100 protein, C-kit, chromogranin andsmooth-muscle actin. Electron microscopy was performedin two cases, revealing typical features of perineurioma.Discussion: Gastrointestinal perineurioma is a distinctivetype of polyp frequently detected during screening colonoscopyas sessile lesions in asymptomatic patients. It appearsthey are most frequently seen in the colon and are morecommon in women. Taking into account the current criteriaof perineurioma, it seems likely that many intestinal polypspreviously diagnosed as fibroblastic polyps and neurofibromasare actually perineuriomas. They are frequently associatedwith hyperplastic changes in the adjacent epithelium.It is not known if this association is a coincidence or if theperineurioma induces the epithelial proliferation (AU)

[Gastric plasmacytoma as an uncommon cause of upper gastrointestinal bleeding]. / Plasmocitoma gástrico como causa infrecuente de hemorragia digestiva alta.

Gastric plasmacytoma is an infrequent form of presentation of monoclonal gammopathy that, if ulcerated, can cause upper gastrointestinal bleeding. This entity is usually localized but may progress to multiple myeloma or other forms of monoclonal gammopathy. Differential diagnosis should be performed with other monoclonal gammopathies, based on laboratory and histological criteria, as well as with other gastric tumors such as adenocarcinoma, gastrointestinal stromal tumors, neuroendocrine tumors and lymphomas. Differential diagnosis can be based on radiological and endoscopic characteristics, although definitive diagnosis will undoubtedly be based on histological study and immunohistochemical techniques. We describe the case of a male patient who underwent investigations for upper gastrointestinal bleeding and iron deficiency anemia. The final diagnosis was multiple myeloma associated with gastric plasmacytoma.

Plasmocitoma gástrico como causa infrecuente de hemorragia digestiva alta / Gastric plasmacytoma as an uncommon cause of upper gastrointestinal bleeding

El plasmocitoma gástrico es una forma rara de presentación de las gammapatías monoclonales, y puede ser una causa de hemorragia digestiva alta si se encuentra ulcerado. Suele ser localizado, pero puede evolucionar hacia un mieloma múltiple u otras formas de gammapatía monoclonal. El diagnóstico diferencial hay que hacerlo con otras gammapatías monoclonales, basándose en criterios analíticos e histológicos, y con otros tumores gástricos, como el adenocarcinoma, los tumores de la estroma gastrointestinal, los tumores neuroendocrinos y los linfomas. Para ello, nos podemos basar en las diferentes características radiológicas y endoscópicas, aunque, sin duda, el estudio histológico y las técnicas inmunohistoquímicas establecerán el diagnóstico definitivo. En esta observación clínica se describe el caso de un paciente que presentaba una hemorragia digestiva alta y una anemia ferropénica, con diagnóstico final de mieloma múltiple asociado a plasmocitoma gástrico

Gastric plasmacytoma is an infrequent form of presentation of monoclonal gammopathy that, if ulcerated, can cause upper gastrointestinal bleeding. This entity is usually localized but may progress to multiple myeloma or other forms of monoclonal gammopathy. Differential diagnosis should be performed with other monoclonal gammopathies, based on laboratory and histological criteria, as well as with other gastric tumors such as adenocarcinoma, gastrointestinal stromal tumors, neuroendocrine tumors and lymphomas. Differential diagnosis can be based on radiological and endoscopic characteristics, although definitive diagnosis will undoubtedly be based on histological study and immunohistochemical techniques. We describe the case of a male patient who underwent investigations for upper gastrointestinal bleeding and iron deficiency anemia. The final diagnosis was multiple myeloma associated with gastric plasmacytoma