Pancreatitis and cholangitis following intraductal migration of a metal clip 5 years after laparoscopic cholecystectomy / Pancreatitis y colangitis secundaria a la migración intraductal de un clip de metal 5 años después de una colecistectomía laparoscópica

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Comparison of the prognostic value of Chronic Liver Failure Consortium scores and traditional models for predicting mortality in patients with cirrhosis.

BACKGROUND AND AIM: Recently, the European Association for the Study of the Liver - Chronic Liver Failure (CLIF) Consortium defined two new prognostic scores, according to the presence or absence of acute-on-chronic liver failure (ACLF): the CLIF Consortium ACLF score (CLIF-C ACLFs) and the CLIF-C Acute Decompensation score (CLIF-C ADs). We sought to compare their accuracy in predicting 30- and 90-day mortality with some of the existing models: Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), MELD-Na, integrated MELD (iMELD), MELD to serum sodium ratio index (MESO), Refit MELD and Refit MELD-Na. METHODS: Retrospective cohort study that evaluated all admissions due to decompensated cirrhosis in 2 centers between 2011 and 2014. At admission each score was assessed, and the discrimination ability was compared by measuring the area under the ROC curve (AUROC). RESULTS: A total of 779 hospitalizations were evaluated. Two hundred and twenty-two patients met criteria for ACLF (25.9%). The 30- and 90-day mortality were respectively 17.7 and 37.3%. CLIF-C ACLFs presented an AUROC for predicting 30- and 90-day mortality of 0.684 (95% CI: 0.599-0.770) and 0.666 (95% CI: 0.588-0.744) respectively. No statistically significant differences were found when compared to traditional models. For patients without ACLF, CLIF-C ADs had an AUROC for predicting 30- and 90-day mortality of 0.689 (95% CI: 0.614-0.763) and 0.672 (95% CI: 0.624-0.720) respectively. When compared to other scores, it was only statistically superior to MELD for predicting 30-day mortality (p=0.0296). CONCLUSIONS: The new CLIF-C scores were not statistically superior to the traditional models, with the exception of CLIF-C ADs for predicting 30-day mortality.

Olmesartan-Induced Enteropathy: An Unusual Cause of Villous Atrophy.

We report a case of a 63-year-old-man presenting with chronic diarrhea and weight loss while on olmesartan treatment for hypertension. Investigation showed multiple nutritional deficiencies associated with diffuse intestinal villous atrophy. Serologies for celiac disease were negative and other causes of villous atrophy were excluded. Olmesartan as a precipitant agent was suspected and withdrawn. Clinical improvement occurred in days with no need for other therapeutic measures. Follow-up at three months showed clinical remission and almost complete recovery of intestinal atrophy. Olmesartan is an angiotensin receptor blocker commonly prescribed for the management of hypertension. Spruelike enteropathy associated with this drug is a recently described entity with few cases reported. It presents with chronic diarrhea and intestinal villous atrophy and should be included in its differential diagnosis. This case intends to alert clinicians for the possibility of this event in a patient on treatment with this drug.

Apresentamos o caso de um homem de 63 anos com diarreia crónica e perda ponderal. Apresentava hipertensão arterial tratada com olmesartan. A investigação complementar mostrou múltiplos défices nutricionais associados a atrofia vilositária intestinal difusa. As serologias de doença celíaca foram negativas e outras causas de atrofia vilositária foram excluídas. Suspeitou-se do olmesartan como agente precipitante, sendo este suspenso. Observou-se melhoria clínica em dias, sem necessidade de outras medidas terapêuticas. No seguimento, aos 3 meses, constatou-se remissão clínica e recuperação quase completa da atrofia intestinal.O olmesartan é um bloqueador dos recetores da angiotensina, geralmente prescrito no tratamento da hipertensão. A enteropatia "spruelike" associada a este fármaco é uma entidade recentemente descrita, com poucos casos reportados. Manifesta-se por diarreia crónica associada a atrofia vilositária intestinal, devendo ser incluída no seu diagnóstico diferencial. Com este caso pretende-se alertar os clínicos para a possibilidade deste evento em doentes sob tratamento com este fármaco.