Mesalazine-induced esophageal ulcers. a rare adverse effect.

31-year-old woman. Diagnosis of ulcerative proctitis in February/2022. Calprotectin 1832 µg/g. Colonoscopy: erythematous, friable and erosive mucosa up to 10 cm from the anal margin. Pathology: compatible with ulcerative colitis with moderate activity. Start of oral mesalazine (3 gr/24 h granules) and topical (1 gr/24 h suppository). After three months, she achieved clinical remission. Calprotectin 57 µg/g. Two months later, she consulted for solid dysphagia, loss of 10 kg, and low-grade fever for a month. Fifteen days before, she went to an emergency room where Prednisone 50 mg/24 h was started. On the day of the assessment, she was receiving 30 mg with no improvement. The next day, gastroscopy showed 6-12 mm esophageal ulcers with non-confluent shallow geographic borders, biopsies were taken. Viral serologies and HLA B51 were requested. Given the severity of the symptoms, empirical treatment was started with Valaciclovir 1 g/12 h. Serologies: IgG for Ebstein Barr virus, cytomegalovirus and herpes virus with negative IgM. Cytomegalovirus viral load: <30 IU/ml. Pathology: acute extensively ulcerated esophagitis, inflammatory infiltrate and some eosinophils with negative histochemical staining for fungi, cytomegalovirus and herpes virus I and II. HLA B51 was negative. Valaciclovir and mesalazine are discontinued after seven days given the known relationship of the latter with low-grade fever and, exceptionally, with esophageal pathology. Three days later, the patient reported clear improvement in dysphagia from the day the mesalazine was discontinued. After eight months, she was still asymptomatic. Upon resolution of the symptoms, control gastroscopy was not performed, and mesalazine has not been reintroduced due to its probable causal association. Mesalazine has an excellent safety profile. Adverse effects include fever, headache, diarrhea and.

Poor agreement between clinical screening and universal pre-procedure SARS-CoV-2 PCR testing prior to endoscopy.

INTRODUCTION: scientific societies recommend screening for SARS-CoV-2 in patients prior to endoscopy. There is no solid evidence regarding the efficiency of universal screening by PCR testing for SARS-CoV-2. The present study aimed to assess the usefulness of clinical screening and universal pre-procedure PCR testing for the identification of patients capable of transmitting the SARS-CoV-2 infection. Concordance between both strategies was also evaluated. METHOD: a retrospective review was performed in a consecutive cohort of patients undergoing endoscopy at a tertiary teaching hospital between April 22 and June 22, 2020, following a screening protocol. RESULTS: three hundred and sixty-one patients were included. Clinical screening detected 13 patients with a high risk of infection (3.6 %, 95 % CI: 2.62-4.58) while the pre-procedure PCR test was positive in five patients (1.40 %, 95 % CI: 0.20-2.60). Three patients developed COVID-19 and one died from the disease. Agreement between both strategies was poor, with a kappa value of 0.093 (95 % CI: 0.001-0.185). Clinical screening only identified one of the five patients with a positive PCR test. CONCLUSION: clinical screening prior to endoscopy has a poor agreement with pre-procedure PCR testing.

Aspectos endoscópicos del tratamiento de la enfermedad de Parkinson avanzada con levodopa/carbidopa intraduodenal / Endoscopic management of duodenal levodopa-carbidopa therapy of advanced Parkinson's disease

Introducción: el tratamiento con levodopa intraduodenal mediante gastrostomía endoscópica percutánea constituye una alternativa terapéutica en pacientes con enfermedad de Parkinson. Disponemos de pocos estudios que evalúen los aspectos endoscópicos en esta indicación. Objetivos: describir nuestra experiencia en esta técnica e identificar factores asociados a la aparición de complicaciones. Métodos: estudio observacional retrospectivo en centro terciario entre enero de 2007 y enero de 2019. Resultados: se incluyeron 37 pacientes (21 varones, edad 65,1 +/- 10,3 años, diez años [rango 25] de evolución de la enfermedad) seguidos durante una mediana de 16 meses (rango 143). El sistema se colocó con éxito en el 100% de los casos. La tasa de persistencia con el tratamiento al final del seguimiento fue del 62,2%. El sistema se retiró en 14 pacientes: siete por empeoramiento, cuatro por deseo del paciente y tres por complicaciones. Hubo 53 complicaciones en 23 pacientes (62,2%; 0,63 por paciente-año), cuatro mayores (8,1%, 0,05 por paciente-año). Complicaciones menores: 14 (37,8%) relacionados con el estoma, seis (16,2%) con la gastrostomía y 15 (40,5%) con la sonda duodenal. La mayoría se resolvieron endoscópicamente. Se realizaron 44 recambios de sonda en 20 pacientes (54,1%; 0,52 por paciente-año). El sexo masculino, la edad mayor de 70 años y un mayor índice de comorbilidad se asociaron a mayor probabilidad de persistencia del sistema. No se identificaron factores predictores de complicaciones asociadas a la gastrostomía. Conclusiones: la gastrostomía para infusión de levodopa intraduodenal presenta una alta tasa de éxito técnico. Las complicaciones son frecuentes, pero la mayoría se resuelven endoscópicamente

Background: treatment of intraduodenal levodopa using percutaneous endoscopic gastrostomy is an alternative therapy in patients with advanced Parkinson's disease. There are few studies that have evaluated the endoscopic aspects of this technique. Objectives: to describe our experience and adverse events regarding this technique in advanced Parkinson's disease. Method: a retrospective study was performed from January 2007 to January 2019 in a tertiary healthcare center. Results: thirty-seven patients aged 65.1 +/- 10.3 years were included in the study, 21 were male and the disease duration was ten years (1-26). The median follow-up was 16 months (1-144). The device was successfully placed in all cases. The persistence rate with the PEG-D at the end of follow-up was 62.2%. The system was removed in 14 patients, seven due to neurological impairment, four because of the decision of the patient and three due to related events. Fifty-nine adverse events occurred in 23 patients (62.2%, 0.63 per patient-year), four of which were severe (8.1%, 0.05 per patient-year). Minor adverse events included 14 (37.8%) related to the stoma, six (16.2%) to the gastric tube and 15 (40.5%) to the duodenal tube. Forty-four system replacements were performed in 20 patients (54.1%, 0.52 per patient-year). Male sex, age over 70 and a higher comorbidity index were associated with a greater likelihood of persistence of the system (OR: 0.14, 95% CI: 0.03-0.62; OR: 0.52, 95% CI: 0.32-0.86; OR: 0.16, 95% CI: 0.03-0.99, respectively). No predictors of adverse events associated with PEG-D were identified. Conclusions: percutaneous endoscopic gastrostomy for the continuous delivery of duodenal levodopa is a highly effective technique. Adverse events are common, although most are resolved by endoscopy

Endoscopic management of duodenal levodopa-carbidopa therapy of advanced Parkinson's disease.

BACKGROUND: treatment of intraduodenal levodopa using percutaneous endoscopic gastrostomy is an alternative therapy in patients with advanced Parkinson's disease. There are few studies that have evaluated the endoscopic aspects of this technique. OBJECTIVES: to describe our experience and adverse events regarding this technique in advanced Parkinson's disease. METHOD: a retrospective study was performed from January 2007 to January 2019 in a tertiary healthcare center. RESULTS: thirty-seven patients aged 65.1 ± 10.3 years were included in the study, 21 were male and the disease duration was ten years (1-26). The median follow-up was 16 months (1-144). The device was successfully placed in all cases. The persistence rate with the PEG-D at the end of follow-up was 62.2%. The system was removed in 14 patients, seven due to neurological impairment, four because of the decision of the patient and three due to related events. Fifty-nine adverse events occurred in 23 patients (62.2%, 0.63 per patient-year), four of which were severe (8.1%, 0.05 per patient-year). Minor adverse events included 14 (37.8%) related to the stoma, six (16.2%) to the gastric tube and 15 (40.5%) to the duodenal tube. Forty-four system replacements were performed in 20 patients (54.1%, 0.52 per patient-year). Male sex, age over 70 and a higher comorbidity index were associated with a greater likelihood of persistence of the system (OR: 0.14, 95% CI: 0.03-0.62; OR: 0.52, 95% CI: 0.32-0.86; OR: 0.16, 95% CI: 0.03-0.99, respectively). No predictors of adverse events associated with PEG-D were identified. CONCLUSIONS: percutaneous endoscopic gastrostomy for the continuous delivery of duodenal levodopa is a highly effective technique. Adverse events are common, although most are resolved by endoscopy.