Severe pembrolizumab-induced gastritis in a patient with lung adenocarcinoma.

Cancer immunotherapy is an increasingly common treatment option based on anti-tumor immune response. However, a challenge is arising regarding its potential, which is the poorly understood recognized immune-mediated adverse effects.

Risk factors for Clostridium difficile diarrhea in patients with inflammatory bowel disease.

BACKGROUND: Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors. METHOD: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. RESULTS: Three cases (20%) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67%) received treatment with proton pump inhibitors (PPIs) versus 2 (13%) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in one (14%). Fourteen (93%) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of community-acquired infection (13 patients, 87%), immunosuppressive treatment (7 patients, 47%) and less patients had received previous antibiotic treatment (3 patients, 20%) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66% and 80%, respectively p = 0.266). CONCLUSIONS: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable.

Factores de riesgo de diarrea por Clostridium difficile en pacientes con enfermedad inflamatoria intestinal / Risk factors for Clostridium difficile diarrhea in patients with inflammatory bowel disease

INTRODUCCIÓN: a pesar de la incidencia creciente de diarrea por Clostridium difficile (DCD) en pacientes con enfermedad inflamatoria intestinal (EII) disponemos de un conocimiento limitado de factores de riesgo. MÉTODO: estudio retrospectivo comparando casos de DCD en pacientes con EEI con pacientes portadores de EEI que no desarrollaron DCD. También se realizó una comparación con pacientes que desarrollaron DCD, pero que no padecían EII. RESULTADOS: tres casos (20 %) con EII y DCD habían recibido antibióticos durante los tres meses previos frente a ninguno de los controles (EEI sin DCD, p = 0,22). Diez casos (67 %) estaban recibiendo tratamiento con un inhibidor de la bomba de protones (IBP) frente a dos (13 %) entre los controles (EEI sin DCD, p = 0,001). Se visualizaron pseudomembranas en uno (14 %) de los siete casos en los que se hizo colonoscopia. Hubo respuesta favorable a metronidazol en 14 pacientes (93 %). Los pacientes con EEI y DCD presentaron menor edad (36 ± 10 años), mayor grado de adquisición comunitaria de la infección (13 pacientes, 87 %) y tratamiento inmunosupresor (7 pacientes, 47 %) junto a menos pacientes con tratamiento antibiótico previo (3 pacientes, 20 %) que los pacientes con DCD pero sin EII. La proporción de pacientes que recibían tratamiento con un IBP era similar (66 % y 80 %, respectivamente; p = 0,266). CONCLUSIONES: los casos de DCD en portadores de EEI se caracterizan por afectar a pacientes más jóvenes, mayoritaria adquisición comunitaria (y menor nosocomial), guardar más relación con el tratamiento previo con IBP que con el tratamiento antibiótico y presentar evolución clínica favorable

BACKGROUND: Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors. METHOD: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. RESULTS: Three cases (20 %) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67 %) received treatment with proton pump inhibitors (PPIs) versus 2 (13 %) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in ne (14 %). Fourteen (93 %) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of communityacquired infection (13 patients, 87 %), immunosuppressive treatment (7 patients, 47 %) and less patients had received previous antibiotic treatment (3 patients, 20 %) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66 % and 80 %, respectively p = 0.266). CONCLUSIONS: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable