RESUMO
The treatment of inflammatory bowel disease has undergone a significant transformation following the introduction of biologic drugs. Thanks to these drugs, treatment goals have evolved from clinical response and remission to more ambitious objectives, such as endoscopic or radiologic remission. However, even though biologics are highly effective, a significant percentage of patients will not achieve an initial response or may lose it over time. We know that there is a direct relationship between the trough concentrations of the biologic and its therapeutic efficacy, with more demanding therapeutic goals requiring higher drug levels, and inadequate exposure being common. Therapeutic drug monitoring of biologic medications, along with pharmacokinetic models, provides us with the possibility of offering a personalized approach to treatment for patients with IBD. Over the past few years, relevant information has accumulated regarding its utility during or after induction, as well as in the maintenance of biologic treatment, in reactive or proactive strategies, and prior to withdrawal or treatment de-escalation. The aim of this document is to establish recommendations regarding the utility of therapeutic drug monitoring of biologics in patients with inflammatory bowel disease, in different clinical practice scenarios, and to identify areas where its utility is evident, promising, or controversial.
RESUMO
Faecal microbiota transplantation (FMT) is an effective and safe treatment of recurrent Clostridioides difficile infection. It is essential to make every effort to perform FMT rigorously and based on scientific knowledge. Selection of the faecal microbiota donor is a key part of the process to ensure recipient safety. Protocols of action must be implemented that allow clinicians to act with the maximum guarantees and to minimise the risks of the procedure. In this regard, a multidisciplinary working group has been set up with the aim of establishing recommendations for selecting the faecal microbiota donor.
Assuntos
Seleção do Doador/normas , Transplante de Microbiota Fecal , HumanosRESUMO
Iron deficiency anemia is the most common type of anemia and can cause asthenia, cognitive and functional impairment, and decompensation of underlying diseases. Iron deficiency anemia is not a disease but is the result of a potentially serious medical problem. Consequently, patients should always undergo investigation of the underlying cause. In men and postmenopausal women, the condition is caused by gastrointestinal loss and malabsorption of iron. In this group, recommended procedures are gastroscopy, colonoscopy and serological testing for celiac disease. If the results of these tests are negative, repeat examinations and iron therapy should be considered. In treatment-refractory or recurrent anemia, the small intestine should be investigated. In this case, the procedure of choice is capsule endoscopy. Iron deficiency anemia should always be treated until iron deposits have returned to normal levels. A wide variety of preparations are available, in both oral and parental formulations.
Assuntos
Anemia Ferropriva/etiologia , Gastroenteropatias/complicações , Administração Oral , Adulto , Idoso , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/epidemiologia , Transfusão de Sangue , Doença Celíaca/sangue , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Doença Crônica , Endoscopia do Sistema Digestório , Feminino , Gastroenteropatias/sangue , Humanos , Infusões Intravenosas , Ferro/administração & dosagem , Ferro/uso terapêutico , Ferro da Dieta/farmacocinética , Síndromes de Malabsorção/sangue , Síndromes de Malabsorção/etiologia , Masculino , Menopausa , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
La anemia ferropénica es la forma más frecuente de anemia. Puede causar astenia, deterioro cognitivo y funcional y descompensar las enfermedades de base. No es una enfermedad, sino la consecuencia de un problema médico potencialmente grave, por lo que siempre debe investigarse la causa subyacente; en varones y mujeres posmenopáusicas es la pérdida digestiva y la malabsorción de hierro. En este grupo se aconseja una gastroscopia, una colonoscopia y una serología de celiaquía. Si los resultados son negativos deberá valorarse la repetición de exploraciones y se acepta una pauta de tratamiento con hierro. En caso de refractariedad o recidiva de la anemia debe ser investigado el intestino delgado. En este caso la cápsula endoscópica es la exploración de elección. En todos los casos debe tratarse la anemia ferropénica hasta la normalización de los depósitos, para lo cual disponemos de una gran variedad de formas de hierro oral y parenteral
Iron deficiency anemia is the most common type of anemia and can cause asthenia, cognitive and functional impairment, and decompensation of underlying diseases. Iron deficiency anemia is not a disease but is the result of a potentially serious medical problem. Consequently, patients should always undergo investigation of the underlying cause. In men and postmenopausal women, the condition is caused by gastrointestinal loss and malabsorption of iron. In this group, recommended procedures are gastroscopy, colonoscopy and serological testing for celiac disease. If the results of these tests are negative, repeat examinations and iron therapy should be considered. In treatment-refractory or recurrent anemia, the small intestine should be investigated. In this case, the procedure of choice is capsule endoscopy. Iron deficiency anemia should always be treated until iron deposits have returned to normal levels. A wide variety of preparations are available, in both oral and parental formulations
