Aspectos prácticos para la manometría esofágica de alta resolución / Practical aspects of high resolution esophageal manometry

La manometría esofágica de alta resolución (MAR) está en fase de desarrollo, como se evidencia por las diferentes clasificaciones de Chicago. Con el fin de unificar criterios en algunos aspectos prácticos con limitada evidencia científica se llevó a cabo la Primera Reunión Nacional de Consenso en Manometría de Alta Resolución del Grupo Español de Motilidad Digestiva, en la que participaron un amplio grupo de expertos. Las propuestas se basaron en una encuesta previa con 47 preguntas, la exhaustiva revisión de la bibliografía disponible y la experiencia de los participantes. Se plantearon aspectos metodológicos sobre criterios de análisis poco definidos de algunos nuevos parámetros de alta resolución y otros aspectos no considerados, como la actividad espontánea o las ondas secundarias, elaborándose conclusiones finales con utilidad práctica (AU)

High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical application (AU)

Practical aspects of high resolution esophageal manometry.

High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical applications.

Ustekinumab en paciente con enfermedad de Crohn y psoriasis inducida por anti-TNF-¦Á / Ustekinumab in a patient with Crohn's disease and anti-TNF-¦Á-induced psoriasis

El tratamiento con farmacos antifactor de necrosis tumoral alfa (TNF-¦Á) en la enfermedad de Crohn es relativamente seguro aunque se han comunicado diferentes efectos secundarios cutaneos como la aparicion o exacerbacion de una psoriasis secundaria al tratamiento con anti-TNF-¦Á que, en ocasiones, puede llevar a la suspension del tratamiento. Por ello, son necesarias nuevas alternativas terapeuticas con nuevos mecanismos de accion. Se ha publicado que ustekinumab, un anticuerpo monoclonal que se une a la subunidad p40 de la interleucina 12/23, podrea inducir repuesta en pacientes con enfermedad de Crohn y ademas ha demostrado su eficacia en pacientes con psoriasis. Presentamos un caso de una paciente con enfermedad de Crohn que desarrollo psoriasis tras el tratamiento con 2 farmacos anti-TNF-¦Á (infliximab y adalimumab) que fue posteriormente tratada con ustekinumab con resolucion de las lesiones de la psoriasis y mantuvo la remision de la enfermedad de Crohn (AU)

Treatment with anti-tumor necrosis factor (TNF)-¦Á for Crohn's disease is relatively safe, although various cutaneous adverse effects have been reported such as the development or exacerbation of anti-TNF- ¦Á-induced psoriasis, which can sometimes lead to treatment withdrawal. Therefore, new alternative treatments with new mechanisms of action are required. Ustekinumab, a monoclonal antibody against the p40 subunit of interleukin 12/23, could induce response in patients with Crohn's disease and has demonstrated efficacy in patients with psoriasis. We present the case of a woman with Crohn's disease who developed psoriasis after treatment with two anti-TNF- ¦Á drugs (infliximab and adalimumab). The patient was subsequently treated with ustekinumab with resolution or psoriasis lesions and maintenance of remission of Crohn's disease (AU)

[Ustekinumab in a patient with Crohn's disease and anti-TNF-α-induced psoriasis]. / Ustekinumab en paciente con enfermedad de Crohn y psoriasis inducida por anti-TNF-α

Treatment with anti-tumor necrosis factor (TNF)-α for Crohn's disease is relatively safe, although various cutaneous adverse effects have been reported such as the development or exacerbation of anti-TNF- α-induced psoriasis, which can sometimes lead to treatment withdrawal. Therefore, new alternative treatments with new mechanisms of action are required. Ustekinumab, a monoclonal antibody against the p40 subunit of interleukin 12/23, could induce response in patients with Crohn's disease and has demonstrated efficacy in patients with psoriasis. We present the case of a woman with Crohn's disease who developed psoriasis after treatment with two anti-TNF- α drugs (infliximab and adalimumab). The patient was subsequently treated with ustekinumab with resolution or psoriasis lesions and maintenance of remission of Crohn's disease.

Impactación de un cuerpo extraño en un paciente con enfermedad de Crohn / Impacted foreign body in a patient with Crohn's disease

La enfermedad de Crohn (EC) se puede complicar con la aparición de estenosis intestinal. Las estenosis que no responden al tratamiento médico habitualmente requieren cirugía. La dilatación endoscópica con balón es una alternativa a la cirugía.A continuación se presenta el caso de un paciente con EC y una estenosis de la válvula ileocecal asintomática que se manifestó como un cuadro oclusivo secundario a la impactación de un cuerpo extraño (semilla de níspero). Se realizó una dilatación endoscópica y la extracción del cuerpo extraño. En este trabajo se lleva a cabo una revisión de la literatura médica en relación al tratamiento endoscópico de las estenosis intestinales secundarias a la EC (AU)

Crohn's disease is often complicated by intestinal strictures. Symptomatic strictures refractory to medical therapy usually require surgery. Endoscopic balloon dilatation is an alternative to surgery. We report the case of a patient with CrohnŒs disease with asymptomatic ileocecal stricture, which was identified after intestinal obstruction due to an impacted foreign body. The patient underwent endoscopic dilatation and the foreign body was extracted. We provide a review of the literature on endoscopic balloon dilatation of intestinal strictures in Crohn's disease (AU)

[Ileal perforation secondary to intestinal endometriosis]. / Perforación ileal secundaria a endometriosis.

Endometriosis is defined as the presence of endometrial tissue outside the uterus. The bowel is not often affected. There are no specific clinical findings for intestinal endometriosis. It is typically asymptomatic, but sometimes can present with abdominal pain, diarrhoea, constipation or intestinal obstruction. Ileal perforation is a rare complication of intestinal endometriosis and only a few cases have been reported in the literature. Intestinal endometriosis can mimic many gastrointestinal diseases, such as irritable bowel syndrome, inflammatory bowel disease, infections and neoplasms. The diagnosis is made by laparoscopy or laparotomy. We present a case of a woman with intermittent abdominal pain and ileal perforation secondary to intestinal endometriosis.

Perforación ileal secundaria a endometriosis / Ileal perforation secondary to intestinal endometriosis

La endometriosis es la presencia de tejido endometrial fuera del útero. La afección del intestino por endometriosis es una entidad poco frecuente y suele ser asintomática o presentarse de forma inespecífica con dolor abdominal, diarrea, estreñimiento u obstrucción intestinal. La perforación intestinal es poco frecuente, y hay pocos casos publicados en la literatura médica. La endometriosis intestinal puede imitar a un gran número de enfermedades digestivas, como el síndrome del intestino irritable, la enfermedad inflamatoria intestinal, infecciones o neoplasias. El diagnóstico se suele realizar a través de laparoscopia o laparotomía. Presentamos el caso de una paciente con dolor abdominal recurrente y posterior perforación ileal, secundaria a endometriosis

Endometriosis is defined as the presence of endometrial tissue outside the uterus. The bowel is not often affected. There are no specific clinical findings for intestinal endometriosis. It is typically asymptomatic, but sometimes can present with abdominal pain, diarrhoea, constipation or intestinal obstruction. Ileal perforation is a rare complication of intestinal endometriosis and only a few cases have been reported in the literature. Intestinal endometriosis can mimic many gastrointestinal diseases, such as irritable bowel syndrome, inflammatory bowel disease, infections and neoplasms. The diagnosis is made by laparoscopy or laparotomy. We present a case of a woman with intermittent abdominal pain and ileal perforation secondary to intestinal endometriosis