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1.
Inflamm Bowel Dis ; 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31504569

RESUMO

BACKGROUND: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. METHODS: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. RESULTS: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. CONCLUSIONS: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response.

3.
Therap Adv Gastroenterol ; 12: 1756284819847034, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205485

RESUMO

Background: Inflammatory bowel disease (IBD) is associated with a considerable burden to the patient and society. However, current data on IBD incidence and burden are limited because of the paucity of nationwide epidemiological studies, heterogeneous designs, and a low number of participating centers and sample size. The EpidemIBD study is a large-scale investigation to provide an accurate assessment of the incidence of IBD in Spain, as well as treatment patterns and outcomes. Methods: This multicenter, population-based incidence cohort study included patients aged >18 years with IBD (Crohn's disease, ulcerative colitis, or unclassified IBD) diagnosed during 2017 in 108 hospitals in Spain, covering 50% of the Spanish population. Each participating patient will attend 10 clinic visits during 5 years of follow up. Demographic data, IBD characteristics and family history, complications, treatments, surgeries, and hospital admissions will be recorded. Results: The EpidemIBD study is the first large-scale nationwide study to investigate the incidence of IBD in Spain. Enrollment is now completed and 3627 patients are currently being followed up. Conclusions: The study has been designed to overcome many of the limitations of previous European studies into IBD incidence by prospectively recruiting a large number of patients from all regions of Spain. In addition to epidemiological information about the burden of IBD, the 5-year follow-up period will also provide information on treatment patterns, and the natural history and financial burden of IBD.

4.
J Crohns Colitis ; 13(12): 1492-1500, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31063540

RESUMO

BACKGROUND AND AIMS: Primary sclerosing cholangitis [PSC] is usually associated with inflammatory bowel disease [IBD]. An increased risk of malignancies, mainly colorectal cancer [CRC] and cholangiocarcinoma [CCA], has been reported in PSC-IBD patients. Our aim was to determine the clinical characteristics and management of PSC in IBD patients, and the factors associated with malignancies. METHODS: PSC-IBD patients were identified from the Spanish ENEIDA registry of GETECCU. Additional data were collected using the AEG-REDCap electronic data capture tool. RESULTS: In total, 277 PSC-IBD patients were included, with an incidence rate of 61 PSC cases per 100 000 IBD patient-years, 69.7% men, 67.5% ulcerative colitis and mean age at PSC diagnosis of 40 ± 16 years. Most patients [85.2%] were treated with ursodeoxycholic acid. Liver transplantation was required in 35 patients [12.6%] after 79 months (interquartile range [IQR] 50-139). It was more common in intra- and extrahepatic PSC compared with small-duct PSC (16.3% vs 3.3%; odds ratio [OR] 5.7: 95% confidence interval [CI] = 1.7-19.3). The incidence rate of CRC since PSC diagnosis was 3.3 cases per 1000 patient-years [95% CI = 1.9-5.6]. Having symptoms of PSC at PSC diagnosis was the only factor related to an increased risk of CRC after IBD diagnosis [hazard ratio= 3.3: 95% CI = 1.1-9.9]. CCA was detected in seven patients [2.5%] with intra- and extrahepatic PSC, with median age of 42 years [IQR 39-53], and presented a lower life expectancy compared with patients without CCA and patients with or without CRC. CONCLUSIONS: PSC-IBD patients with symptoms of PSC at PSC diagnosis have an increased risk of CRC. CCA was only diagnosed in patients with intra- and extrahepatic PSC and was associated with poor survival.

5.
Surg Endosc ; 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31144122

RESUMO

BACKGROUND: There is no information regarding the outcome of Crohn's disease (CD) patients treated with endoscopic balloon dilation (EBD) in non-referral hospitals, nor on the efficacy of EBD in ulcerative colitis (UC). We report herein the results of the largest series published to date. AIM: To assess the efficacy and safety of EBD for inflammatory bowel disease (IBD) stenosis performed in 19 hospitals with different levels of complexity and to determine factors related to therapeutic success. METHODS: We identified IBD patients undergoing EBD in the ENEIDA database. Efficacy of EBD was compared between CD and UC and between secondary and tertiary hospitals. Predictive factors of therapeutic success were assessed with multivariate analysis. RESULTS: Four-hundred dilations (41.2% anastomotic) were performed in 187 IBD patients (13 UC/Indeterminate colitis). Technical and therapeutic success per dilation was achieved in 79.5% and 55.3%, respectively. Therapeutic success per patient was achieved in 78.1% of cases (median follow-up: 40 months) with 49.7% requiring more than one dilation. No differences related to either diagnosis or hospital complexity was found. Technical success [OR 4.12 (95%CI 2.4-7.1)] and not receiving anti-TNF at the time of dilation [OR 1.7 (95% CI 1.1-2.6)] were independently related to therapeutic success per dilation. A stricture length ≤ 2 cm [HR 2.43 (95% CI 1.11-5.31)] was a predictive factor of long-term success per patient. The rate of major complications was 1.3%. CONCLUSIONS: EBD can be performed with similar efficacy and safety in hospitals with differing levels of complexity and it might be a suitable treatment for UC with short stenosis. To achieve a technical success and the short length of the stenosis seem to be critical for long-term therapeutic success.

6.
Medicine (Baltimore) ; 97(39): e12486, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278537

RESUMO

Ulcerative colitis (UC) may severely limit patients' capacity to work. Recently, we validated a work disability questionnaire (WDQ) for Crohn disease. As UC shares clinical characteristics with Crohn disease, we hypothesized that the questionnaire might also be useful for UC. The study was aimed to validate the WDQ for use in UC.Consecutive patients with UC (n = 142, 67 women; age 48 ±â€Š1) completed the UC-WDQ and the inflammatory bowel disease questionnaire-9 (IBDQ-9), and EuroQoL-5D quality-of-life questionnaires. Validation of the UC-WDQ included an assessment of its construct validity, including: discriminant validity, convergent validity, and reproducibility (test-retest). We also calculated the intraclass correlation and the Cronbach alpha.The UC-WDQ is a valid and reliable tool for measuring work disability in patients with UC.


Assuntos
Colite Ulcerativa/psicologia , Pessoas com Deficiência/psicologia , Doenças Inflamatórias Intestinais/psicologia , Autorrelato/normas , Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Doença de Crohn/psicologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas
7.
Aliment Pharmacol Ther ; 48(8): 839-851, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30281832

RESUMO

BACKGROUND: Effectiveness of vedolizumab in real world clinical practice is unknown. AIM: To evaluate the short and long-term effectiveness of vedolizumab in patients with inflammatory bowel disease (IBD). METHODS: Patients who received at least 1 induction dose of vedolizumab were included. Effectiveness was defined based on Harvey-Bradshaw index (HBI) in Crohn's disease (CD) and Partial Mayo Score (PMS) in ulcerative colitis (UC). Short-term response was assessed at week 14. Variables associated with short-term remission were identified by logistic regression analysis. The Kaplan-Meier method was used to evaluate the long-term durability of vedolizumab treatment. Cox model was used to identify factors associated with discontinuation of treatment and loss of response. RESULTS: 521 patients were included (median follow-up 10 months [interquartile range 5-18 months]). At week 14, 46.8% had remission and 15.7% clinical response. CD (vs UC), previous surgery, higher CRP concentration and disease severity at baseline were significantly associated with impaired response. The rate of vedolizumab discontinuation was 37% per patient-year of follow-up (27.6% in UC and 45.3% in CD, P < 0.01). CD (vs UC), anaemia at baseline, steroids during induction and CRP concentration were associated with lower durability of treatment. Seven per cent of patients developed adverse events, infections being the most frequent. CONCLUSIONS: Over 60% of IBD patients respond to vedolizumab. Many patients discontinue treatment over time. CD and disease burden impair both short- and long-term response. Vedolizumab seems to be safe in clinical practice.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Sistema de Registros , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/epidemiologia , Doenças Transmissíveis/induzido quimicamente , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/epidemiologia , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Doença de Crohn/epidemiologia , Feminino , Seguimentos , Fármacos Gastrointestinais/efeitos adversos , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Indução de Remissão , Espanha/epidemiologia , Resultado do Tratamento
9.
Inflamm Bowel Dis ; 22(7): 1662-9, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27306072

RESUMO

BACKGROUND: Ustekinumab is a fully human monoclonal antibody against IL-12/23. Ustekinumab induced clinical response and maintained higher rate of response than placebo in patients with Crohn's disease (CD). This study aims to assess the effectiveness and safety of ustekinumab in refractory patients with CD in real-life practice. METHODS: Consecutive patients with CD who were treated with subcutaneous ustekinumab between March 2010 and December 2014 were retrospectively included in a multicenter open-label study. Clinical response was defined by Harvey-Bradshaw index score and assessed after the loading doses, 6, 12 months, and last follow-up. RESULTS: One hundred sixteen patients were included, with a median follow-up of 10 months (interquartile range: 5-21). Clinical response after loading ustekinumab was achieved in 97/116 (84%) patients. The clinical benefit at 6, 12 months, and at the end of the follow-up was 76%, 64%, and 58%, respectively. Dose escalation was effective in 8 of 11 (73%) patients. Perianal disease also improved in 11 of 18 (61%) patients with active perianal fistulae. The initial response to ustekinumab and previous use of more than 2 immunosuppressant drugs were associated with a clinical response to ustekinumab maintenance therapy. In contrast, previous bowel resection predicted a long-term failure with ustekinumab. Adverse events were reported in 11 (9.5%) patients, but none required ustekinumab withdrawal. CONCLUSIONS: Subcutaneous ustekinumab is effective and safe in a high proportion of patients with CD that were resistant to conventional immunosuppressant and antitumor necrosis factor drugs.


Assuntos
Anti-Inflamatórios/uso terapêutico , Doença de Crohn/tratamento farmacológico , Fístula Cutânea/tratamento farmacológico , Fístula Retal/tratamento farmacológico , Ustekinumab/uso terapêutico , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Doença de Crohn/complicações , Fístula Cutânea/etiologia , Esquema de Medicação , Feminino , Seguimentos , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Fístula Retal/etiologia , Retratamento , Estudos Retrospectivos , Espanha , Ustekinumab/administração & dosagem , Ustekinumab/efeitos adversos
10.
Inflamm Bowel Dis ; 22(4): 955-62, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26933747

RESUMO

BACKGROUND: The aim was to develop and validate a self-reported short Crohn's disease work disability questionnaire (sCDWDQ). METHODS: (1) Development of a shortened questionnaire-Patients' responses to the validation process (n = 108) of a previously developed, 16-item Spanish Crohn's disease work disability questionnaire (CDWDQ) were analyzed using the Rasch model for multiple response items. After this process, a 9-item sCDWDQ was obtained. (2) Validation phase-The validation assessed the questionnaire's convergent validity, discriminant validity, test-retest reproducibility, and internal consistency. Spearman rank correlation, t test, intra-class correlation and Cronbach's alpha were used for the analysis. RESULTS: One hundred fifty-one patients were included in the validation phase. (1) Convergent validity was confirmed by correlations between the sCDWDQ and clinical activity (r = 0.66, P < 0.01), the short inflammatory bowel disease questionnaire IBDQ-9 (r = 0.74, P < 0.001), Euroqol-5D (r = 0.63, P < 0.01), the EuroQol-5D visual analog scale (r = 0.54, P < 0.01), and overall work impairment (r = 0.66, P < 0.01); (2) Discriminant validity-sCDWDQ scores were higher in patients with active disease (20.1 ± 6.3 versus 13.0 ± 3.8 inactive, P < 0.001), in those requiring previous sick leave (19.6 ± 6.9 versus no sick leave 14.2 ± 4.8, P < 0.01) and in those requiring hospitalization (20.0 ± 7.3 [n = 29] versus no hospitalization 14.1 ± 7.3 [n = 90], P < 0.01); (3) Internal consistency was also good (Cronbach's alpha = 0.92); and (4) Reproducibility-sCDWDQ measures obtained 2 weeks apart showed an excellent intraclass correlation coefficient of 0.92 (95% confidence interval, 0.90-0.94). CONCLUSIONS: The self-reported sCDWDQ appears to be a simple, valid, and reliable tool for measuring work disability in Crohn's disease.


Assuntos
Doença de Crohn/diagnóstico , Doença de Crohn/psicologia , Pessoas com Deficiência/psicologia , Psicometria , Avaliação da Capacidade de Trabalho , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Qualidade de Vida , Índice de Gravidade de Doença , Licença Médica , Inquéritos e Questionários , Adulto Jovem
11.
Inflamm Bowel Dis ; 22(4): 894-901, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26933750

RESUMO

BACKGROUND: Psoriasis induced by anti-tumor necrosis factor-α (TNF) therapy has been described as a paradoxical side effect. AIM: To determine the incidence, clinical characteristics, and management of psoriasis induced by anti-TNF therapy in a large nationwide cohort of inflammatory bowel disease patients. METHODS: Patients with inflammatory bowel disease were identified from the Spanish prospectively maintained Estudio Nacional en Enfermedad Inflamatoria Intestinal sobre Determinantes genéticos y Ambientales registry of Grupo Español de Trabajo en Enfermedad de Croh y Colitis Ulcerosa. Patients who developed psoriasis by anti-TNF drugs were the cases, whereas patients treated with anti-TNFs without psoriasis were controls. Cox regression analysis was performed to identify predictive factors. RESULTS: Anti-TNF-induced psoriasis was reported in 125 of 7415 patients treated with anti-TNFs (1.7%; 95% CI, 1.4-2). The incidence rate of psoriasis is 0.5% (95% CI, 0.4-0.6) per patient-year. In the multivariate analysis, the female sex (HR 1.9; 95% CI, 1.3-2.9) and being a smoker/former smoker (HR 2.1; 95% CI, 1.4-3.3) were associated with an increased risk of psoriasis. The age at start of anti-TNF therapy, type of inflammatory bowel disease, Montreal Classification, and first anti-TNF drug used were not associated with the risk of psoriasis. Topical steroids were the most frequent treatment (70%), achieving clinical response in 78% of patients. Patients switching to another anti-TNF agent resulted in 60% presenting recurrence of psoriasis. In 45 patients (37%), the anti-TNF therapy had to be definitely withdrawn. CONCLUSIONS: The incidence rate of psoriasis induced by anti-TNF therapy is higher in women and in smokers/former smokers. In most patients, skin lesions were controlled with topical steroids. More than half of patients switching to another anti-TNF agent had recurrence of psoriasis. In most patients, the anti-TNF therapy could be maintained.


Assuntos
Adalimumab/efeitos adversos , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Infliximab/efeitos adversos , Psoríase/epidemiologia , Psoríase/prevenção & controle , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adolescente , Adulto , Anti-Inflamatórios/efeitos adversos , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Seguimentos , Fármacos Gastrointestinais/efeitos adversos , Humanos , Incidência , Masculino , Prognóstico , Psoríase/patologia , Espanha/epidemiologia , Suspensão de Tratamento
12.
Am J Gastroenterol ; 111(2): 261-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26753886

RESUMO

OBJECTIVES: New e-health technologies can improve patient-physician communication and contribute to optimal patient care. We compared the diagnostic performance of the Simple Clinical Colitis Activity Index (SCCAI) self-administered by patients with ulcerative colitis (UC) at home (through a website) with the in-clinic gastroenterologist-assessed SCCAI. METHODS: Patients were followed-up over 6 months. At months 3 and 6, patients completed the SCCAI online at home; within 48 h, gastroenterologists (blinded to patients' scores) completed the in-clinic SCCAI (reference). SCCAI scores were dichotomized to remission or active disease, and SCCAI changes in disease activity from month 3 to 6 were classed as worsening, stability, or improvement. RESULTS: A total of 199 patients (median age: 38 years; 56% female) contributed with 340 pairs of questionnaires. Correlation of SCCAI scores by patients and physicians was good (Spearman's ρ=0.79), with 85% agreement for remission or activity (95% CI: 80.8-88.6, κ=0.66). The negative predictive value for active disease was 94.5% (91.4-96.6); the positive predictive value was 68.0% (58.8-69.2). Agreement between patient and physician was higher in the 168 month 6 pairs than in the 172 month 3 pairs of questionnaires (89.3% (83.6-93.1) vs. 80.8% (74.2-86.0), P=0.027). CONCLUSIONS: In patients with UC, SCCAI self-administration via an online tool resulted in a high percentage of agreement with evaluation by gastroenterologists, with a remarkably high negative predictive value for disease activity. Remote monitoring of UC patients is possible and might reduce hospital visits.


Assuntos
Colite Ulcerativa/diagnóstico , Diagnóstico por Computador , Internet , Adolescente , Adulto , Idoso , Colite Ulcerativa/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Telemedicina , Adulto Jovem
13.
United European Gastroenterol J ; 3(4): 335-42, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26279841

RESUMO

BACKGROUND AND AIMS: Data on the prevalence of work disability in patients with inflammatory bowel disease (IBD) are heterogeneous. As most studies have been performed in selected, often severe, IBD patients, the true prevalence of disability in the community remains controversial. The aim of this cross-sectional study was to evaluate the prevalence and severity of disability and its predictive factors in a community-based IBD population. PATIENTS AND METHODS: Patients recorded in the community-based IBD register at the Hospital Universitario de Burgos were contacted. After informed consent they completed a set of questionnaires including demographic, clinical, disability and quality of life data. The statistical study was performed using SPSS 21. RESULTS: A total of 293 patients were included - 151 Crohn's disease (CD), 142 ulcerative colitis (UC), 137 female, mean age: 45 ± 11 years, mean time since diagnosis: 10.6 ± 11 years. Twelve patients (4.1%) had a work-disability pension. In addition, 93 (32%) of all patients had an officially recognized disability degree, which was generally moderate (n = 73, 25%) or severe (N = 16, 5%). Age, time since IBD diagnosis, CD, perianal disease, incontinence, active disease, the need for anti-TNF or psychological treatment, previous surgeries and the number of diagnostic tests and medical visits in the previous year were predictors of disability. Major predictors of qualifying for a disability pension were age, IBD activity, incontinence, need for biological drugs and ostomy. CONCLUSION: Mild to moderate work disability is frequent in IBD. However, only a minority of patients develop severe disability qualifying them for a pension.

14.
J Crohns Colitis ; 8(3): 240-51, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24295646

RESUMO

BACKGROUND AND AIMS: While it is commonly accepted that Inflammatory bowel disease (IBD) Comprehensive Care Units (ICCUs) facilitate the delivery of quality care to Crohn's disease and ulcerative colitis patients, it remains unclear how an ICCU should be defined or evaluated. The aim of the present study was to develop a comprehensive set of Quality Indicators (QIs) of structure, process, and outcomes for defining and evaluating an ICCU. METHODS: A Delphi consensus-based approach with a standardized three-step process was used to identify a core set of QIs. The process included an exhaustive search using complementary approaches to identify potential QIs, and two Delphi voting rounds to select the QIs defining the core requirements for an ICCU. RESULTS: The consensus selected a core set of 56 QIs (12 structure, 20 process and 24 outcome). Structure and process QIs highlighted the need for multidisciplinary management and continuity of care. The minimal IBD team should include an IBD nurse, gastroenterologists, radiologists, surgeons, endoscopists and stoma management specialists. ICCUs should be able to provide both outpatient and inpatient care and admission should not break the continuity of care. Outcome QIs focused on the adequate prophylaxis of disease complication and drug adverse events, the need to monitor appropriateness of treatment and the need to reinforce patient autonomy by providing adequate information and facilitating the patients' participation in their own care. CONCLUSIONS: The present Delphi consensus identified a set of core QIs that may be useful for evaluating and certifying ICCUs.


Assuntos
Colite Ulcerativa/terapia , Doença de Crohn/terapia , Técnica Delfos , Unidades Hospitalares/normas , Equipe de Assistência ao Paciente/normas , Indicadores de Qualidade em Assistência à Saúde , Assistência Ambulatorial , Colite Ulcerativa/diagnóstico , Continuidade da Assistência ao Paciente/normas , Doença de Crohn/diagnóstico , Unidades Hospitalares/organização & administração , Hospitalização , Humanos , Equipe de Assistência ao Paciente/organização & administração
16.
Gastroenterol. hepatol. (Ed. impr.) ; 36(2): 104-114, feb. 2013. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-110474

RESUMO

Background and aim: Evidence-based clinical guidelines on Ulcerative colitis (UC) have been developed through a consensus, while GRADE methodology is the current standard for guideline development. This is the first one based on GRADE methodology on UC. Methods: Following GRADE methodology, the Spanish Group of Ulcerative Colitis and Crohn’s disease (GETECCU) have developed a guideline on UC treatment. After selection of relevant clinical scenarios, 32 clinical questions were chosen and recommendations were established. Results: In 2 questions no recommendation was possible. Twenty-two actions were recommended for, 14 strongly and 8 weakly. However, in 8 questions a recommendation against doing something was obtained, weak in 5 and strong in 3. The majority of recommendations were based on moderate quality evidence, and only 5 on high-quality evidence. Conclusions: With GRADE methodology we find a clear recommendation on possible actions inmost clinical decisions in UC treatment, but much more clinical high-quality research is needed (AU)


Antecedentes y objetivo: Las guías clínicas para la colitis ulcerosa (CU), basadas en la evidencia, se elaboran a través del consenso; por otra parte, la metodología GRADE es el estándar actual para la elaboración de directrices. Esta es la primera guía para la CU que se basa en la metodología GRADE. Métodos: De acuerdo con la metodología GRADE, el Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) ha elaborado una guía sobre el tratamiento de la CU. Después de seleccionar los escenarios clínicos pertinentes, se eligieron 32 preguntas clínicas y se establecieron recomendaciones. Resultados: En 2 preguntas no fue posible realizar recomendación alguna. Se recomendaron22 acciones, 14 con un grado de recomendación sólido y 8 con grado débil. Sin embargo, para8 preguntas se obtuvo una recomendación en contra de realizar una acción, y de ellas, 5 resultaron recomendaciones sólidas y 3 débiles. La mayoría de las recomendaciones se basaron en pruebas de una calidad moderada, y sólo 5 pruebas se pudieron considerar de alta calidad. Conclusiones: Con la metodología GRADE encontramos una clara recomendación acerca de acciones posibles durante la mayoría de las decisiones clínicas realizadas para el tratamiento de la CU, pero se necesita mucho más investigación clínica de alta calidad (AU)


Assuntos
Humanos , Colite Ulcerativa/tratamento farmacológico , Esquema de Medicação , Padrões de Prática Médica
17.
Gastroenterol Hepatol ; 36(2): 104-14, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23332546

RESUMO

BACKGROUND AND AIM: Evidence-based clinical guidelines on Ulcerative colitis (UC) have been developed through a consensus, while GRADE methodology is the current standard for guideline development. This is the first one based on GRADE methodology on UC. METHODS: Following GRADE methodology, the Spanish Group of Ulcerative Colitis and Crohn's disease (GETECCU) have developed a guideline on UC treatment. After selection of relevant clinical scenarios, 32 clinical questions were chosen and recommendations were established. RESULTS: In 2 questions no recommendation was possible. Twenty-two actions were recommended for, 14 strongly and 8 weakly. However, in 8 questions a recommendation against doing something was obtained, weak in 5 and strong in 3. The majority of recommendations were based on moderate quality evidence, and only 5 on high-quality evidence. CONCLUSIONS: With GRADE methodology we find a clear recommendation on possible actions in most clinical decisions in UC treatment, but much more clinical high-quality research is needed.


Assuntos
Colite Ulcerativa/terapia , Algoritmos , Humanos
18.
Gastroenterol Hepatol ; 35 Suppl 1: 51-6, 2012 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-23018008

RESUMO

In Digestive Disease Week 2012, held in San Diego, numerous studies were presented on the epidemiology of inflammatory bowel disease. Some of these studies were population-based, providing greater information on known risk factors and helping to eliminate proposed risk factors for which there is no known evidence. In this meeting, special attention was paid to the natural history of the disease as well as surgery in patients aged more than 65 years old who should clearly be treated as a separate subgroup from the standard population in clinical trials from which older individuals are excluded. Another especially important topic were extraintestinal complications and manifestations, with Clostridium difficile and primary sclerosing cholangitis as the main culprits. Finally, with reference to diagnosis, calprotectin was confirmed as an essential marker in distinct scenarios and new imaging techniques such as virtual chromoendoscopy (i-scan) will be important in the management of these patients, although their precise role remains to be defined.


Assuntos
Doenças Inflamatórias Intestinais , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/mortalidade , Doenças Inflamatórias Intestinais/cirurgia , Recidiva , Fatores de Risco
19.
Gastroenterol. hepatol. (Ed. impr.) ; 35(supl.1): 51-56, sept. 2012.
Artigo em Espanhol | IBECS | ID: ibc-136516

RESUMO

En esta reunión de la DDW 2012 (Digestive Disease Week 2012) celebrada en San Diego se han presentado múltiples trabajos en relación con la epidemiología de las enfermedades inflamatorias intestinales, algunos de ellos poblacionales, que nos aportan mayor información sobre factores de riesgo ya descritos en la bibliografía y, por otra parte, nos ayudan a eliminar algunos de ellos propuestos sin ninguna evidencia científica. Especial atención se ha prestado en esta reunión a los hallazgos, tanto en evolución natural como en cirugía, de los pacientes mayores de 65 años que claramente han de tratarse como un subgrupo de población “diferente” al de la población estándar de los ensayos clínicos de los que están excluidos. Otro apartado especialmente importante ha sido el de las complicaciones y manifestaciones extraintestinales con Clostridium difficile y la colangitis esclerosante primaria como principales protagonistas. Finalmente, y referentes al diagnóstico, la calprotectina se confirma como marcador imprescindible en diferentes escenarios, y nuevas técnicas de imagen como la cromoendoscopia virtual (i-scan) buscan su posición en el manejo de estos pacientes (AU)


In Digestive Disease Week 2012, held in San Diego, numerous studies were presented on the epidemiology of inflammatory bowel disease. Some of these studies were population-based, providing greater information on known risk factors and helping to eliminate proposed risk factors for which there is no known evidence. In this meeting, special attention was paid to the natural history of the disease as well as surgery in patients aged more than 65 years old who should clearly be treated as a separate subgroup from the standard population in clinical trials from which older individuals are excluded. Another especially important topic were extraintestinal complications and manifestations, with Clostridium difficile and primary sclerosing cholangitis as the main culprits. Finally, with reference to diagnosis, calprotectin was confirmed as an essential marker in distinct scenarios and new imaging techniques such as virtual chromoendoscopy (i-scan) will be important in the management of these patients, although their precise role remains to be defined (AU)


Assuntos
Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/mortalidade , Doenças Inflamatórias Intestinais/cirurgia , Recidiva , Fatores de Risco
20.
Gastroenterol. hepatol. (Ed. impr.) ; 34(supl.3): 18-24, dic. 2011. tab
Artigo em Espanhol | IBECS | ID: ibc-138130

RESUMO

Esponemos en la actualidad de diferentes fármacos que van a intentar conseguir el mantenimiento de la remisión de los pacientes que han obtenido respuesta tras uno u otro tipo de tratamiento de inducción en dependencia de la gravedad inicial del brote. Así, los salicilatos serán los fármacos de elección en el mantenimiento de la remisión obtenida tras brote leve-moderado controlado con los propios salicilatos o corticoides orales. Los fármacos tiopurínicos serán de elección en el mantenimiento de la remisión obtenida tras brote grave o de aquellos pacientes en situación de corticodependencia o corticorresistencia. Los fármacos biológicos, fundamentalmente infliximab, tienen su papel en el mantenimiento de la remisión de los pacientes tras inducción de brote grave con el propio infliximab en los que los fármacos tiopurínicos han fracasado y en aquellos pacientes con intolerancia a ellos. Pero estos escenarios no siempre coinciden con lo que el especialista en aparato digestivo se encuentra en la práctica clínica diaria y serán fundamentalmente las condiciones del propio paciente (edad, evolución de la enfermedad, tratamientos previos, efectos secundarios y opinión propia), así como el «arte desempeñado por el médico», lo que determinará finalmente la actitud individualizada para cada paciente en particular (AU)


Several drugs are currently available to maintain remission in patients who have responded after one or other type of induction therapy, depending on the initial severity of the outbreak. Salicylates are the drugs of choice to maintain remission after a mild-to-moderate outbreak controlled by salicylates or oral corticosteroids. To maintain remission after a severe outbreak or in patients with corticosteroid dependence or resistance, thiopurines are the drugs of choice. In patients who have failed to respond to thiopurines and in those with thiopurine intolerance, biological agents, mainly infliximab, can be used to maintain remission in patients after induction therapy with infliximab for a severe outbreak. However, these scenarios may not reflect reality of gastroenterologists’ daily clinical practice. Treatment will therefore be based on the patient's individual characteristics (age, clinical course, previous treatment, adverse effects and personal preferences) as well as the physician's medical art (AU)


Assuntos
Feminino , Humanos , Masculino , Síndrome do Intestino Irritável/enzimologia , Síndrome do Intestino Irritável/metabolismo , Corticosteroides/administração & dosagem , Corticosteroides , Colonoscopia/métodos , Colonoscopia/enfermagem , Salicilatos/administração & dosagem , Salicilatos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Corticosteroides/classificação , Corticosteroides/farmacologia , Colonoscopia/educação , Colonoscopia/instrumentação , Salicilatos/metabolismo , Salicilatos/farmacologia
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