Evaluation of the sensitivity and specificity of sigmoidoscopy in comparison to colonoscopy regarding the detection of intestinal inflammatory activity in the follow-up of patients with ulcerative colitis. / Evaluación de la sensibilidad y especificidad de la sigmoidoscopia en comparación con la colonoscopia en la detección de actividad inflamatoria intestinal en el seguimiento de pacientes con colitis ulcerosa.

INTRODUCTION: Ulcerative colitis (UC) is a chronic disease characterized by periods of inflammatory activity and remission, which vary from the rectum to the proximal colon. Currently, mucosal healing is a long-term goal in the management of inflammatory bowel disease, with colonoscopy and sigmoidoscopy being the recommended tools for evaluation. OBJECTIVE: To assess the effectiveness of both examinations in determining the presence of inflammatory activity in the follow-up of patients with UC. METHODS: Retrospective observational study analyzing colonoscopies performed as part of the follow-up of UC patients between January 2021 and July 2023 by gastroenterologists from the Inflammatory Bowel Disease Program at the Clínica Universidad de los Andes. The study compared endoscopic and histological activity observed in the rectosigmoid region with that found in the rest of the colon. Sensitivity and specificity were determined using concordance and correlations tests. RESULTS: A very good concordance and correlation were observed regarding endoscopic findings, with a Kappa index of 0.97 and a Spearman coefficient of 0.97. The Positive Predictive Value (PPV) of sigmoidoscopy for endoscopic activity was 1, and the Negative Predictive Value (NPV) was 0.96. In relation to histological activity, the concordance had a Kappa index of 0.93 and a Spearman coefficient of 0.93, with a PPV of sigmoidoscopy for histological activity being 1 and an NPV of 0.91. CONCLUSION: This cohort suggests that sigmoidoscopy is a cost-effective option for evaluating mucosal healing in UC patients in symptomatic and biomarker remission. However, complete colonoscopy should be considered in cases of discrepancies with the clinical picture or in colorectal cancer surveillance.

Apendicectomía electiva en el manejo de la Colitis ulcerosa refractaria: Reporte de caso

Introducción: La colitis ulcerosa (CU) es una enfermedad inflamatoria intestinal que afecta el colon y el recto de etiología desconocida. Se ha planteado la apendicectomía electiva en pacientes con colitis ulcerosa refractaria como una alternativa de tratamiento. Objetivo: Comunicar el caso clínico de una paciente con CU refractaria a quien la apendicectomía electiva permitió una mejoría de su sintomatología y calidad de vida. Resultados: Se presenta el caso de una paciente de 46 años con antecedentes de hipotiroidismo y colitis ulcerosa de 2 años de evolución, con rectorragia, dolor abdominal y diarrea importante pese a la terapia biológica. Se decide apendicectomía laparoscópica electiva, logrando una mejoría sintomática de la paciente objetivada mediante la aplicación de la encuesta "Inflammatory Bowel Disease Questionnaire". El puntaje preoperatorio de la paciente fue de 60 puntos, y el postoperatorio de 176. Discusión: Se hace evidente que la colitis ulcerosa y el apéndice cecal están íntimamente relacionados. Los desafíos futuros deberían apuntarse a identificar las características clínicas que precisen qué pacientes se benefician de esta intervención.

Introduction: Ulcerative colitis (UC) is an inflammatory bowel disease that affects the colon and rectum of unknown etiology. Elective appendectomy has been proposed as a possible treatment for patients with refractory ulcerative colitis. Objective: To report the clinical case of a patient with refractory UC who showed improvement in symptomatology and quality of life after undergoing elective appendectomy. Results: We present the case of a 46-year-old patient with a 2-year history of hypothyroidism and ulcerative colitis, with rectal bleeding, abdominal pain, and significant diarrhea despite biological therapy. Elective laparoscopic appendectomy was performed, resulting in symptomatic improvement of the patient as measured by the Inflammatory Bowel Disease Questionnaire. The patient's preoperative score was 60 points, and the postoperative score was 176. Discussion: It seems evident that ulcerative colitis and the cecal appendix are intimately related. Future challenges should aim to identify clinical characteristics that determine which patients benefit from this intervention.

Transición en enfermedades inflamatorias intestinales: de la pediatría a la adultez / Transition in inflammatory bowel diseases: from childhood to adulthood

El 25% de los pacientes con Enfermedades Inflamatorias Intestinales (EII) se diagnostican antes de los 20 años. En la mayor parte de los centros del país se lleva a cabo la "transferencia" del paciente desde un centro de atención pediátrico a uno de adultos. La "transición" es un criterio de calidad con beneficios en el control de la EII reduciendo el número de recaídas, de hospitalizaciones y de cirugías. Por tal motivo hemos desarrollado un Programa Interdisciplinario de Transición entre dos hospitales de referencia nacional e internacional en EII. Materiales y métodos: Entre 1/2021 y 12/ 2022 se incorporaron 24 pacientes que ingresaron en 3 fases: Fase 1 Pacientes entre 14 y 16 años asistidos en el Hospital Garrahan (HG) con un abordaje interdisciplinario. Fase 2. A partir de los 17 años se realizaron 2 (dos) encuentros en el HG en conjunto con gastroenterólogos de adultos evaluando adherencia y autonomía y la Fase 3 llevada a cabo en el Hospital B. Udaondo (HBU) sólo con el equipo de adultos luego de 6 meses de realizada la transferencia evaluando adherencia al tratamiento, consultas a emergencias, internación y/o cirugías Resultados: Al inicio del Programa el 66% de los pacientes presentaban una actividad moderada a severa vs el 8% al finalizar la fase 3. Luego de la transferencia el 12,5% necesito ingreso a guardia e internación y un 8% tratamiento quirúrgico. El 83% de los pacientes continúan en seguimiento luego de 6 meses de haber sido transferidos (AU)

Twenty-five percent of patients with inflammatory bowel diseases (IBD) are diagnosed before the age of 20 years. In most centers in the country, the "transfer" of the patient from a pediatric to an adult care center is done. However, "transition" is a quality criterion with benefits in the control of IBD by reducing the number of relapses, hospitalizations, and surgeries. For this reason, we developed an Interdisciplinary Transition Program between two national and international reference hospitals in IBD. Materials and Methods: Between January 2021 and December 2022, we incorporated 24 patients into a three-phase program. Phase 1 involved patients between 14 and 16 years of age seen at Garrahan Hospital (HG) with an interdisciplinary approach. Phase 2 began from 17 years of age, with two meetings held at HG involving adult gastroenterologists to evaluate adherence and autonomy. Phase 3 was conducted at Hospital B. Udaondo (HBU) only with the adult team, six months after the transfer, evaluating adherence to treatment, emergency consultations, hospitalizations, and/or surgeries. Results: At the beginning of the program, 66% of the patients presented with moderate to severe disease activity, compared to 8% at the end of Phase 3. After the transfer, 12.5% of the patients required emergency department visits and hospitalization, and 8% required surgical treatment. Eighty-three percent of the patients continue in the program and are still being followed up six months after the transfer (AU)

Fenotipificación y genotipificación en pacientes con enfermedad inflamatoria intestinal en un centro de referencia de Colombia / Phenotyping and genotyping in patients with inflammatory bowel disease in a reference center in Colombia

RESUMEN Introducción: Se ha tratado de identificar los factores genéticos relacionados con susceptibilidad para enfermedad inflamatoria intestinal (EII), y los hallazgos actuales se inclinan por un modelo de patología complejo, sin un patrón hereditario claro. Objetivo: Realizar caracterización fenotípica y genotípica de pacientes con EII en población colombiana y describir su posible asociación con predisposición. Materiales y métodos: Serie de casos, 16 pacientes con EII por criterios clínicos y anatomopatológicos, inicio de síntomas gastrointestinales después de los 18 años. Todos tuvieron asesoramiento genético pre-test y se realizaron árboles genealógicos de mínimo tres generaciones. También, genotipificación, por medio de un panel de genes múltiples que incluía genes relacionados con EII y algunos trastornos autoinmunitarios. Finalmente, se realizó análisis genómico de variantes. Resultados: 9 mujeres y 7 hombres, con edad media de diagnóstico de EII 35 años, y 32 años para aparición de síntomas gastrointestinales. 11/16(68,75%) requirieron terapia biológica. 10/16 (62,5%) presentaron refractariedad a terapia estándar. 3/16 (18,75%) tenían antecedentes familiares positivos de EII. 100% casos presentaron al menos un single nucleotide polymorphism relacionado con riesgo de EII en más de un gen. Los genes más relacionados con colitis ulcerosa (CU), fueron CD48, CD6, y TYK2 para CU, y CD6 e ITGAM para la enfermedad de Crohn. El gen más frecuente fue CD6. Se observó en 3/16 (18,75%) presencia de hasta 5 genes, 4 en 3/16 (18,75%), y tres en 5/16 (31,25%). Conclusión: En EII hay presencia de variantes genéticas con predisposición asociada, pero sin patogenicidad confirmada, y cuya sumatoria parece contribuir en su fisiopatología.

ABSTRACT Introduction: Attempts have been made to identify the genetic factors related to susceptibility to inflammatory bowel disease (IBD), and the current conclusions are in favor of a complex pathology model, without a clear hereditary pattern. Objective: To perform phenotypic and genotypic characterization of patients with IBD in Colombian population and to describe its possible association with predisposition. Materials and methods: case series, 16 patients with IBD according to clinical and pathological criteria, onset of gastrointestinal symptoms after 18 years of age. All had pre-test genetic counseling and family trees of at least three generations were made. Also, genotyping, using a multigene panel that included genes related to IBD and some autoimmune disorders. Finally, a genomic analysis of variants was performed. Results: 9 women and 7 men, with mean age of diagnosis of IBD of 35 years, and gastrointestinal symptoms appearance of 32 years. 11/16 (68.75%) required biological therapy. 10/16 (62.5%) were refractory to standard therapy. 3/16 (18.75%) had positive family history of IBD. 100% cases presented at least one single nucleotide polymorphism related to IBD risk in more than one gene. The genes most related to ulcerative colitis (UC) were CD48, CD6, and TYK2 for UC, and CD6 and ITGAM for Crohn's disease. The most frequent gene was CD6. It was found presence of up to 5 genes in 3/16 (18.75%), 4 in 3/16 (18.75%), and three in 5/16 (31.25%). Conclusion: In IBD there is the presence of genetic variants with associated predisposition, but without confirmed pathogenicity, and whose sum seems to contribute to its pathophysiology.

ITPA polymorphisms do not predict additional risk beyond TPMT and NUDT15 for thiopurine-induced cytopenia in inflammatory bowel disease.

INTRODUCTION AND AIM: Thiopurine-related leukopenia is associated with polymorphisms in the thiopurine methyltransferase (TPMT) and nucleoside diphosphate-linked moiety X type motif 15 (NUDT15) genes. However, those polymorphisms explain only a fraction of thiopurine-related leukopenia. Our aim was to study the role of an inosine triphosphate pyrophosphatase (ITPA) polymorphism in patients with inflammatory bowel disease (IBD) and thiopurine-related leukopenia that was unexplained by the TPMT and NUDT15 polymorphisms. MATERIAL AND METHODS: We enrolled consecutive IBD patients on thiopurines (azathioprine or 6-mercaptopurine) from January 2019-March 2020, at a tertiary care center in North India. The presence of the ITPA (C.94C > A) polymorphism was evaluated in all patients, along with its association with thiopurine-related leukopenia. RESULTS: Of the 33 patients (from a total of 119 patients) that developed leukopenia, 8 had the TPMT (n = 1) or NUDT15 (n = 7) polymorphism. Of the remaining 111 patients, their mean age was 36.36 ±â€¯13.54 years and 57 (51.3%) were males. Twenty-five (21.01%) had unexplained leukopenia. The ITPA polymorphism was detected in 4 (16%) patients in the unexplained leukopenia group and 24 (27.9%) patients in the non-leukopenia group (p = 0.228). The odds ratio for predicting leukopenia with the ITPA polymorphism was 0.4921 (95% CI 0.1520-1.5830, p = 0.234). CONCLUSION: The ITPA (C.94C > A) polymorphism was frequently detected in the study population but was not predictive for leukopenia in patients with IBD on thiopurine therapy.

Ecografía digestiva de la enfermedad inflamatoria intestinal en pediatría

La enfermedad inflamatoria intestinal es un problema de salud que actualmente genera alta morbilidad en el paciente pediátrico. Existen múltiples métodos diagnósticos que permiten su evaluación, entre los cuales y de creciente uso, está la ecografía digestiva. El objetivo de la presente investigación fue mostrar una panorámica actualizada de la utilidad e idoneidad de esta técnica en el seguimiento de la enfermedad inflamatoria intestinal en pacientes pediátricos. Se hizo una recopilación y revisión de la literatura nacional e internacional de mayor novedad y profundidad en el tratamiento del tema, en un período de 4 meses (febrero de 2022 a mayo de 2022). La estrategia de búsqueda adoptada fue el uso de las palabras clave o descriptores en español e inglés como: enfermedad inflamatoria intestinal, pediatría, enfermedad de Crohn, colitis ulcerosa, ultrasonido, ecografía digestiva. En total se utilizaron 50 artículos, de diferentes bases de datos como:Scielo, PubMed/Medline, Ebesco, Clinical Key y Springer. Se escogieron 30 citas para realizar la revisión, donde se analizó la importancia de la técnica en la descripción de las características ecográficas intestinales en pacientes pediátricos, confirmándose el papel que tiene en la identificación e intervención temprana de la enfermedad inflamatoria intestinal.

Inflammatory bowel disease is a health problem that currently causes high morbidity in pediatric patients. There are several diagnostic methods that allow its evaluation, among which gastrointestinal ultrasound is increasingly used. The aim of this research was to provide an updated review of the usefulness and suitability of this technique in the follow-up of inflammatory bowel disease in pediatric patients. A compilation and review of the national and international literature of greater novelty and depth in the treatment of the subject was made over a period of 4 months (February 2022 to May 2022). The search strategy adopted was the use of keywords or descriptors in Spanish and English such as: inflammatory bowel disease; pediatrics; Crohn's disease; ulcerative colitis; ultrasound; digestive ultrasound. A total of 50 articles were used from different databases such as: Scielo, PubMed/Medline, Ebesco, Clinical Key and Springer. Thirty citations were selected for review, analyzing the importance of the technique in the description of intestinal ultrasound characteristics in pediatric patients, confirming its role in the identification and early intervention of inflammatory bowel disease.

A doença inflamatória intestinal é um problema de saúde que atualmente causa elevada morbilidade no doente pediátrico. Existem vários métodos de diagnóstico que permitem a sua avaliação, entre os quais a ecografia gastrointestinal é cada vez mais utilizada. O objetivo deste trabalho foi fazer uma revisão actualizada da utilidade e adequação desta técnica no seguimento da doença inflamatória intestinal em idade pediátrica. Foi feita uma compilação e revisão da literatura nacional e internacional de maior novidade e profundidade no tratamento do tema, durante um período de 4 meses (fevereiro de 2022 a maio de 2022). A estratégia de busca adotada foi o uso de palavras-chave ou descritores em espanhol e inglês, tais como: doença inflamatória intestinal; pediatria; doença de Crohn; colite ulcerativa; ultrassom; ultrassom digestivo. Foram utilizados 50 artigos de diferentes bases de dados, como: Scielo, PubMed/Medline, Ebesco, Clinical Key e Springer. Foram selecionadas 30 citações para revisão, analisando a importância da técnica na descrição das características ultra-sonográficas intestinais em pacientes pediátricos, confirmando seu papel na identificação e intervenção precoce da doença inflamatória intestinal.

Tofacitinib in the treatment of moderate to severe ulcerative colitis in Colombian pediatric patients: Real world experience. / Tofacitinib en el tratamiento de la colitis ulcerosa moderada a grave en pacientes pediátricos colombianos: experiencia en mundo real.

INTRODUCTION: There are no studies on efficacy of tofacitinib for moderate-severe ulcerative colitis (UC) in pediatric patients in Latin America. The aim of this study was to describe the efficacy and safety, in real world, treated with tofacitinib in our setting. MATERIALS AND METHODS: Case series of pediatric patients with UC who received treatment with tofacitinib in induction phase for 8 weeks and then maintenance therapy between November 2021 and February 2023. RESULTS: Four female patients, median age 14.5 (SD 2.1; RIQ 12.5-16.5) years, all with prior biologic exposure, all 4 with prior use of anti-TNF, and 2/4 with prior use of anti-integrin. Clinical, biochemical and endoscopic remission was obtained in 3/4 at induction. Information was obtained from 3 patients in 6-month maintenance, 2/3 remained in clinical, biochemical and endoscopic remission and 1/3 has not achieved biochemical or endoscopic remission. Information was obtained from 1 patient in 12-month maintenance, achieving clinical and biochemical remission, however, endoscopic remission has not been achieved. One patient was initiated for severe acute UC with risk of colectomy, with significant improvement after 7 days, reaching therapeutic objectives at induction. No serious adverse events were reported in any of the cases. CONCLUSIONS: Efficacy and safety are demonstrated with tofacitinib in pediatric patients. With high percentage of response in induction treatment, sustained over time, and safe. In the context of severe acute hospitalized UC, it has a role as a potential rescue therapy due to its rapid action.

Colombian experience with the use of tofacitinib in severe acute ulcerative colitis: A case series study. / Experiencia colombiana con el uso de tofacitinib en colitis ulcerosa aguda grave: estudio de serie de casos.

INTRODUCTION: Tofacitinib is indicated in patients with moderate to severe ulcerative colitis (UC); however, given its rapid onset of action, it may constitute an alternative in patients with hospitalized severe acute UC. There are few data on this indication in the literature. The aim of this study was to describe the efficacy and safety of tofacitinib in the management of patients with hospitalized UC, as well as its clinical characteristics and other treatment patterns. MATERIALS AND METHODS: Descriptive observational study of adults and children with CUAG treated with tofacitinib between June 2019 and December 2022 in Colombia. Sociodemographic and clinical variables were collected, therapeutic response was evaluated in different periods of time and descriptive analysis of quantitative and qualitative variables was performed. RESULTS: Six patients (five adults and one pediatric), mean age 33.2 (SD: 8.5) years, with CUAG. Symptom remission was obtained in 100% of patients at day 7 after tofacitinib initiation. In three patients information was obtained beyond 6 months, with 100% clinical, biochemical, and endoscopic remission and without requiring colectomy. In the case of the pediatric patient, symptom remission was achieved one week after starting tofacitinib, remaining in clinical, biochemical and endoscopic remission beyond 6 months. No serious adverse events were reported in any of the cases. CONCLUSIONS: Tofacitinib represents a rescue therapeutic alternative in CUAG, with rapid clinical response, adequate tolerance and less need for colectomy, being sustained for periods beyond 6 months.

Mesalazine dose modification based on faecal calprotectin levels in patients with ulcerative colitis in clinical remission. / Modificación de la dosis de mesalazina en función de los niveles de calprotectina fecal en pacientes con colitis ulcerosa en remisión clínica.

BACKGROUND: Faecal calprotectin (FC) shows an excellent correlation with endoscopic and histological activity of ulcerative colitis (UC) and it is the best predictor of clinical relapse. Our aim was to evaluate the usefulness of modifying the dose of mesalazine based on FC levels, in clinical practice. METHODS: Retrospective, single-centre study in UC patients in clinical remission while treated with mesalazine which dosage was decreased (DOWN) or increased (UP) according to FC levels. The main endpoint was the long-term maintenance of clinical remission. RESULTS: A total of 56 patients were included (39 DOWN, 17 UP). In the DOWN group, the median baseline dose of mesalazine was 3.6g/day and the median baseline FC was 36µg/g. After a median follow-up of 22 months, 28% required rescue therapy. The cumulative relapse-free survival after tapering was 91% and 82% at 12 and 24 months, respectively. In the UP group, the median baseline dose of mesalazine was 2.4g/day, with a median baseline FC of 524µg/g. After a median follow-up of 12 months, 29% required rescue therapy. The cumulative relapse-free survival after dose increase was 86% and 72% at 12 and 24 months, respectively. CONCLUSIONS: Mesalazine dose modification based on FC monitoring seems to be a safe strategy in patients with UC in clinical remission, with a probability of clinical relapse around 20% at two years.

De-escalating therapy in inflammatory bowel disease: Results from an observational study in clinical practice.

BACKGROUND AND OBJECTIVES: Combination therapy with an immunomodulator (IMM) and an anti-TNF is commonly recommended in Crohn's disease (CD) and ulcerative colitis (UC) patients. However, little is known about relapse rates after therapeutic de-escalation. This study aimed to evaluate the risk of relapse in a cohort of UC and CD patients with long-standing clinical remission after discontinuation of IMM or anti-TNF and to identify predictive factors for relapse. METHODS: This retrospective study included patients with UC or CD on combination therapy and clinical remission for at least 6 months. IMM or anti-TNF was stopped upon physician decision. Primary objective was to evaluate the relapse rates after discontinuation of IMM or anti-TNF and to analyze predictors of relapse. RESULTS: The study included 88 patients, 48 patients (54.5%) discontinued IMM and 40 (45.5%) anti-TNF. During follow-up, relapse rates were 16.7% and 52.5% in the IMM discontinuation group and anti-TNF discontinuation group, respectively (p<0.001). Multivariate analysis showed that anti-TNF discontinuation (HR=3.01; 95% CI=1.22-7.43) and ileal CD location (HR=2.36; 95% CI=1.02-5.47) were predictive factors for relapse while inflammatory CD phenotype was a protective factor (HR=0.32; 95% CI=0.11-0.90). Reintroduction of anti-TNF upon relapse was effective and safe. CONCLUSION: Anti-TNF discontinuation led to significantly higher relapse rates compared to IMM discontinuation in UC and CD patients on combination therapy. Anti-TNF discontinuation and ileal CD location were identified as predictive factors for relapse while inflammatory CD phenotype was a protective factor. Retreatment after anti-TNF discontinuation was effective and safe.

Asociación entre la vitamina D y las enfermedades inflamatorias intestinales

La vitamina D es una hormona conocida desde larga fecha, por sus efectos sobre la salud ósea y la regulación del metabolismo del fósforo y calcio. Desde el descubrimiento de receptores para esta molécula en un gran número de células del organismo, se ha abierto el campo para el estudio de sus efectos sobre el sistema inmune. Sus relaciones con las células del sistema inmune, genes y microbiota hace que el interés sea grande en relación con enfermedades inmunomediadas. Muchos datos indican que esta vitamina tiene efectos preventivos, moduladores y controladores de los efectos adversos de las Enfermedades Inflamatorias Intestinales (EII) en la salud ósea, aunque es difícil demostrar la causalidad de forma taxativa. En esta revisión intentamos resumir la situación actual y los temas de controversia en este interesante campo, centrándonos en las enfermedades inflamatorias intestinales.

Vitamin D is a hormone known for a long time, for its effects on bone health and the regulation of phosphorus and calcium metabolism. Since the discovery of receptors for this molecule in a large number of cells in the body, the field has been opened for the study of its effects on the immune system. Its relationships with the cells of the immune system, genes, and microbiota cause great interest in relation to immune-mediated diseases. Many data indicates that this vitamin has preventive, modulating and controlling effects of the adverse effects of Inflammatory Bowel Diseases (IBD) on bone health, although it is difficult to definitively demonstrate causality. In this review, we try to summarize the current situation and controversial issues in this interesting field, focusing on inflammatory bowel diseases.

Effects of Mimosa caesalpiniifolia pre-formulation on the intestinal barrier during sodium dextran sulfate-induced colitis in Wistar rats / Efectos de la preformulación de Mimosa caesalpiniifolia sobre la barrera intestinal durante la colitis inducida por sulfato de dextrano sódico en ratas Wistar

Introduction. Anti-inflammatories, immunosuppressants, and immunobiological are commonly used in the treatment of inflammatory bowel disease. However, some patients do not present an adequate response or lose effective response during the treatment. A recent study found a potential anti-inflammatory effect of the hydroalcoholic extract of Mimosa caesalpiniifolia on trinitrobenzene sulfonic acid-induced colitis in Wistar rats. Objective. To evaluate the effects of M. caesalpiniifolia pre-formulation on the intestinal barrier using dextran sulfate sodium-induced colitis model. Materials and methods. Leaf extracts were prepared in 70% ethanol and dried with a Buchi B19 Mini-spray dryer using 20% Aerosil® solution. Thirty-two male Wistar rats were randomized into four groups: basal control, untreated colitis, pre-formulation control (125 mg/kg/day), and colitis treated with pre-formulation (125 mg/kg/day). Clinical activity index was recorded daily and all rats were euthanized on the ninth day. Colon fragments were fixed and processed for histological and ultrastructural analyses. Stool samples were collected and processed for analysis of the short-chain fatty acid. Results. Treatment with the pre-formulation decreased the clinical activity (bloody diarrhea), inflammatory infiltrate, and the ulcers. Pre-formulation did not repair the epithelial barrier and there were no significant differences in the goblet cells index. There was a significant difference in butyrate levels in the rats treated with the pre-formulation. Conclusions. The pre-formulation minimized the clinical symptoms of colitis and intestinal inflammation, but did not minimize damage to the intestinal barrier.

Introducción. Los antiinflamatorios, inmunosupresores e inmunobiológicos se utilizan comúnmente para tratar la enfermedad intestinal inflamatoria. Sin embargo, algunos pacientes no presentan una respuesta adecuada o pierden respuesta efectiva durante el tratamiento. En un estudio reciente, se encontró un potencial efecto antiinflamatorio del extracto hidroalcohólico de Mimosa caesalpiniifolia en la colitis inducida por el ácido trinitrobenceno sulfónico utilizando ratas Wistar. Objetivo. Evaluar los efectos de la preformulación de M. caesalpiniifolia sobre la barrera intestinal durante la colitis inducida por sulfato de dextrano sódico. Materiales y métodos. Los extractos de hojas se prepararon con una solución que contenía 70 % de etanol y se secaron con un secador por aspersión Mini B19 de Buchi usando una solución con 20 % de Aerosil®. Treinta y dos ratas Wistar macho se aleatorizaron en cuatro grupos: control basal, colitis sin tratar, control con preformulación (125 mg/kg/ día) y colitis tratada con preformulación (125 mg/kg/día). El índice de actividad clínica se registró diariamente y todas las ratas se sacrificaron el noveno día. Los fragmentos de colon se fijaron y se procesaron para análisis histológicos y ultraestructurales. Se recolectaron muestras de heces y se procesaron para el análisis de ácidos grasos de cadena corta. Resultados. El tratamiento con la preformulación disminuyó la actividad clínica (diarrea sanguinolenta), el infiltrado inflamatorio y las úlceras. La preformulación no reparó la barrera epitelial y no hubo diferencias significativas en el índice de células caliciformes. Se obtuvo una diferencia significativa en los niveles de butirato en las ratas tratadas con la preformulación. Conclusiones: La preformulación minimizó los síntomas clínicos de colitis e inflamación intestinal pero no minimizó el daño a la barrera intestinal.

YouTube® in Spanish as a source of information for patients with inflammatory bowel disease.

INTRODUCTION AND AIM: The majority of patients with inflammatory bowel disease (IBD) seek information about their disease on the Internet. The reliability, comprehensiveness, and quality of said information in Spanish has not previously been studied. MATERIALS AND METHODS: An analytic observational study was conducted that included YouTube® videos on IBD available in Spanish, describing general characteristics, engagement, and sources. Standard tools for evaluating reliability (DISCERN), comprehensiveness, and overall quality (Global Quality Score, GQS) were employed. RESULTS: One hundred videos were included. Eighty-eight videos consisted of information produced by healthcare professionals (group 1) and 12 included patient opinions (group 2). There were no differences in the median scores for reliability (DISCERN 3 vs 3, p = 0.554) or comprehensiveness (3 vs 2.5, p = 0.768) between the two groups, but there was greater overall quality in the group 2 videos (GQS 3 vs 4, p = 0.007). Reliability was higher for the videos produced by professional organizations (DISCERN 4; IQR 3-4), when compared with healthcare information websites and for-profit agencies (DISCERN 3; IQR 2.5-3.5) (p < 0.001), but the videos with healthcare information website and for-profit sources had a higher quality score (GQS 3 vs 4, p < 0.001). Comprehensiveness scores were similar. CONCLUSION: The majority of YouTube® videos in Spanish on IBD have good reliability, comprehensiveness, and quality. Reliability was greater for the videos produced by professional organizations, whereas quality was higher for those created from healthcare information websites and for-profit agencies.

Calidad de vida relacionada con la salud por IBDQ-32 en pacientes colombianos con enfermedad inflamatoria intestinal en remisión: Un estudio de corte transversal

En Colombia no hay datos acerca de la percepción de la calidad de vida (CdV) en enfermedad infamatoria intestinal (EII). Se plantea como objetivo determinar la percepción de la CdV mediante el cuestionario IBDQ-32 en pacientes con EII a partir de una muestra de pacientes de diferentes centros de referencia. Se realizó un estudio de corte transversal en adultos, con EII en remisión clínica, en seguimiento ambulatorio, en 3 instituciones en diferentes ciudades, entre junio 2022 a noviembre 2022, se identificaron sujetos elegibles, se recolectó información en fechas distintas, acerca aspectos sociodemográficos y clínicos, se evaluó el cuestionario IBDQ-32 en una ocasión y se realizó análisis descriptivo y analítico de las variables evaluadas. Como resultado, se obtuvieron 80 pacientes, 70% mujeres, edad media 38,5 (rango18-72; SD 13,25) años. 67,5% colitis ulcerosa (CU), 32,5% enfermedad de Crohn (EC). Se encontró compromiso moderado de la CdV (mediana 150 puntos, rango-intercuartílico 118,3-181,5) en EII, en CU mediana 151 (rango-intercuartílico 120-174,75) puntos, mientras en EC 133(rango-intercuartílico 106,25-186,25) puntos. Hubo mayor afección en dominio sistémico, con medianas 21 (rango-intercuartílico 15,8-27) puntos, y 18,5 (rango-intercuartílico 12,8-25,3) puntos, para CU y EC, respectivamente. Y, los menos afectados correspondieron al dominio digestivo y función social, en CU medianas 48,5 (rango-intercuartílico 40-58,3), y 27 (rango-intercuartílico 20,8-33); en EC medianas 43 (rango-intercuartílico 35,5-61,75) y 24,5 (rango-intercuartílico 18-32,5), respectivamente. No se encontraron diferencias estadísticamente significativas. Este estudio aporta información única acerca CdV de los pacientes con EII en Colombia. Se requiere seguir reforzando el acompañamiento, apoyo, y educación a los pacientes con EII.

In Colombia there are no data about perception of quality of life (QoL) in inflammatory bowel disease (IBD). The aim of this study was to determine the perception of QoL by means of the IBDQ-32 questionnaire in patients with IBD from a sample of patients from different referral centers. We carried out a cross-sectional study in adults with IBD in clinical remission, in outpatient follow-up, in 3 institutions in different cities, between June 2022 and November 2022, eligible subjects were identified, information was collected on different dates, about socio-demographic and clinical aspects, and the IBDQ-32 questionnaire was evaluated on one occasion. Descriptive and analytical analysis of the variables evaluated was performed. 80 patients, 70% women, mean age 38.5(range 18-72; SD 13.25) years. 67.5% ulcerative colitis (UC), 32.5% Crohn´s disease (CD). Moderate QoL involvement (median 150 points, interquartile range118.3-181.5) was found in IBD, in UC median 151 (interquartile range120-174.75) points, while in CD 133 (interquartile range106.25-186.25) points. There was greater involvement in the systemic domain, with median 21 (interquartile range 15.8-27) points, and 18.5 (interquartile range 12.8-25.3) points, for UC and CD, respectively. The least affected corresponded to the digestive domain and social function, in median UC 48.5 (interquartile range 40-58.3), and 27(interquartile range 20.8-33); in median CD 43 (interquartile range 35.5-61.75) and 24.5(interquartile range 18-32.5), respectively. No statistically significant differences were found. This study provides unique information about QoL of patients with IBD in Colombia. It is necessary to continue reinforcing the accompaniment, support, and education of patients with IBD.

The interrelation between anxiety and quality of life among patients with ulcerative colitis in remission.

OBJECTIVE: To determine if anxiety and depression are associated with a lower QoL in patients with UC in remission. PATIENTS AND METHODS: We included consecutive patients with a previously confirmed diagnosis of UC in remission for at least 12 months and who answered complete questionnaires: IBDQ-32, HAD. Clinical and sociodemographic characteristics were obtained. We performed non-parametric tests, and correlations between HADS and IBDQ-32 were analyzed using Spearman's correlation coefficient (r). A p-value of less than 0.05 was considered significant. RESULTS: Among 124 patients, 65% were men, with a median evolution of UC of 10 years (IQR: 5-79 years). Prevalence for anxiety was 15.3% and 2.4% for depression. Global QoL was 192 (IQR: 175-208). Lower QoL was associated with anxiety (p=0.002) and depression (p=0.013). Depression represented lower QoL at the digestive level than no depression (p=0.04). Anxiety negatively correlated with QoL (r=-0.54; p<0.001). CONCLUSIONS: Anxiety is frequent in patients with UC in remission; therefore, timely diagnosis and treatment must be implemented to improve QoL.

Enfermedad Inflamatoria Intestinal en el adulto mayor: Características clínicas y manejo en un hospital de referencia

La enfermedad inflamatoria intestinal (EII) en adultos mayores se caracteriza por su variabilidad clínica, distintos diagnósticos diferenciales y manejo terapéutico. El objetivo de la presente investigación es evaluar las características clínicas y manejo de los pacientes adultos mayores con EII. Se realizó un estudio observacional, descriptivo, retrospectivo de enero del 2011 a diciembre del 2019 en pacientes con EII en el Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, Lima-Perú. Fueron evaluados 55 pacientes con EC y 107 con CU; 45,6% de pacientes con EII eran adultos mayores. De ellos, 28 tenían EC y 46 CU. Los adultos mayores con EC presentaron fenotipo inflamatorio y localización colónica predominantemente, mientras en CU, la colitis extensa e izquierda fueron las más frecuentes. Asimismo, los ancianos tuvieron menor puntaje CDAI (279,8 vs 323,2) y menor índice de Mayo (7,1 vs 9,2) con relación a los pacientes jóvenes, sin diferencias significativas. Respecto al tratamiento, se observó un menor uso de azatioprina (2 vs 8, p<0,03) y Anti-TNF (9 vs 18, p<0,01) en los adultos mayores con EC. La necesidad de cirugía y la frecuencia de complicaciones post quirúrgicas fueron similares entre ambos grupos. En conclusión, casi la mitad de los pacientes con EII son adultos mayores. La localización colónica fue la más frecuente en EC, y en CU la colitis extensa e izquierda. Observamos un menor uso de azatioprina y terapia biológica en adultos mayores, sin diferencias significativas en el uso de corticoides y aminosalicilatos respecto a los jóvenes.

Inflammatory bowel disease (IBD) in elderly patients is characterized by its clinical variability, different differential diagnoses and therapeutic management. The objective of our investigation is to evaluate the clinical characteristics and management of elderly patients with IBD. We developed an observational, descriptive, retrospective study from January 2011 to December 2019 in patients with IBD at the Gastroenterology Service of Guillermo Almenara Irigoyen National Hospital, Lima-Peru. 55 patients with CD and 107 with UC were evaluated; 45.6% of patients with IBD are older adults. Of these, 28 had CD and 46 UC. Older adults with CD presented predominantly an inflammatory phenotype and colonic location, while extensive and left-sided colitis were the most frequent in UC. Elderly patients had a lower CDAI score (279.8 vs 323.2) and a lower Mayo index (7.1 vs 9.2) in relation to the younger, without significant differences. Regarding treatment, a lower use of azathioprine (2 vs 8, p <0.03) and Anti-TNF (9 vs 18, p <0.01) was observed in the elderly with CD. The need for surgery and the frequency of post-surgical complications were similar between both groups. In conclusion, nearly half of IBD patients are older adults. The colonic location was the most frequent in CD, and in UC extensive and left colitis. We observed a lower use of azathioprine and biological therapy in elderly patients, without significant differences in the use of corticosteroids and aminosalicylates compared to younger people.

Tofacitinib in the treatment of moderate to severe ulcerative colitis in Colombia: Real world experience. / Tofacitinib en el tratamiento de la colitis ulcerosa moderada a grave en Colombia: experiencia en mundo real.

INTRODUCTION: There are no studies on efficacy of tofacitinib for ulcerative colitis (UC) in Latin America. The aim of this study was to describe the efficacy and safety, in the real world, of patients with moderate-severe UC treated with tofacitinib in our setting. MATERIALS AND METHODS: Multicenter descriptive observational study, in patients with UC who received treatment with tofacitinib in induction phase for 8 weeks and then, maintenance therapy, between June 2019 and June 2022. RESULTS: Thirty-four adult patients, 50% female, mean age 38.1 (range 22-72) years. 76.5% pancolitis, and 20.6% left colitis. 79.4% failure to tumor necrosis factor inhibitors (anti-TNFs), and 35.3% to vedolizumab. 14.7% naïve to biologic therapy. 23.5% had previous extraintestinal manifestations. During induction, 58.8% of patients achieved clinical, biochemical and endoscopic remission. During maintenance, 76.9% of patients at 26 weeks and 66.6% at 52 weeks presented clinical remission. Eight patients presented adverse events, none of them cardiovascular or thromboembolic. 44.1% were steroid-dependent, and 23.5% required steroids as rescue therapy. 38.3% required an increase in tofacitinib to 10mg every 12h during maintenance. In 17.6% tofacitinib was discontinued due to lack of efficacy. We included three pediatric-aged female patients, mean age 15.3 (range 14-17) years, 2/3 with pancolitis and 1/3 with left colitis, all with prior exposure to biologic therapy, who had clinical, biologic and endoscopic remission at induction. CONCLUSIONS: In this first Latin American study with tofacitinib in UC, efficacy and safety are demonstrated in the treatment of our patients with moderate to severe activity.

Current perspectives on pediatric inflammatory bowel disease focusing on transitional care management. What should we consider?

The prevalence of inflammatory bowel disease (IBD) continues to rise around the globe. Although the percentage of pediatric IBD patients seems to be increasing, rates are surprisingly heterogeneous among different populations. Although the pathogenesis of IBD is believed to be multifactorial, a genetic predisposition may be especially relevant in pediatric-onset IBD. Phenotypic characteristics can also be significantly different when comparing pediatric and adult-onset IBD. Patients that develop the disease at a younger age usually present with more extensive and more aggressive disease and develop complications faster when compared to those that develop it during adulthood. Children with IBD are found to have frequent mood disorders and have a higher risk of developing socio-economic hardship, failing to meet development milestones. Therefore, IBD management should always involve a multidisciplinary team that is not limited to medical providers. Most institutions do not have an established transition protocol and lack the resources and training for transition care. Although there is no consensus on an optimal timing to transition the patient's care to an adult team, it is usually accepted they should be eligible for adult care when most of the key transition points have been met. Management strategies should be tailored to each patient's developmental level and environment. A successful transition can improve the long-term outcomes such as sustained remission, medication adherence, mental health and social and academic performance, while decreasing healthcare utilization. Every institution that manages pediatric IBD patients should have a well-established transition protocol in order to make sure to maintain continuity of care.

A descriptive study of inflammatory bowel disease at an Egyptian tertiary care center.

INTRODUCTION AND AIMS: Inflammatory bowel disease (IBD) is a group of chronic intestinal disorders that trigger prolonged inflammation of the digestive tract. Its incidence and prevalence appear to be increasing in the African population and in Egypt. The present study aims to highlight the pattern and management of IBD in Egyptian patients. MATERIALS AND METHODS: Two hundred patients with IBD were assessed for ulcerative colitis (UC), through the Mayo score, and for Crohn's disease (CD), with the Crohn's disease activity index (CDAI). RESULTS: Median patient age was 35 years, with a predominance of females. UC was more common than CD (88% and 12%, respectively) and severity was moderate, in the majority of cases. Most UC patients had left-sided lesions, whereas ileitis was the most common finding (37.5%) in the CD patients. Proctitis was the least common finding in both diseases and Crohn's fistulizing disease was detected in 4.1% of the patients. Interestingly, peripheral arthropathy was the most common extraintestinal manifestation in the IBD patients (70%) and axial arthropathy was the least common (6%). Severe ocular or mucocutaneous involvement was very rare. Finally, biologic treatment was prescribed to 15.4% of the UC patients and 20.8% of the CD patients. CONCLUSIONS: Although the clinical presentation of IBD in Egypt is comparable to that reported worldwide, diagnoses were found to be delayed. There were fewer cases of CD than UC, but more mild-to-moderate disease severity. The surveillance of patients with IBD must continue and awareness of the disease in the Egyptian medical community needs to increase. A national registry must be established, multicenter studies need to be conducted, and molecular diagnostics is recommended.

Study of the gut microbiome in Egyptian patients with active ulcerative colitis.

INTRODUCTION AND AIM: Ulcerative colitis (UC) is characterized by chronic, uncontrolled inflammation of the intestinal mucosa. Gut microbiota dysbiosis was reported to be a factor in intestinal inflammation. The aim of the present study was to study changes in the gut microbiome in Egyptian patients with active UC. MATERIALS AND METHODS: In this cross-sectional study, the gut bacterial microbiome of 21 UC patients and 20 control subjects was analyzed using the quantitative SYBR Green real-time PCR technique, targeting the 16S rRNA gene of selected bacterial phyla/genera and/or species. RESULTS: UC patients showed marked dysbiosis evidenced by a significant decrease in the Firmicutes and F. prausnitzii anti-inflammatory bacteria. The Firmicutes/Bacteroidetes ratio was also lower in the UC cases (1.65), compared with the healthy controls (2.93). In addition, the UC cases showed a statistically significant decrease in Ruminococcus, compared with the control group. However, there were no statistically significant differences between UC patients and the controls, regarding A. muciniphila, Bifidobacterium, Lactobacillus, Bacteroides, and Prevotella. One UC case was positive for the pathogenic bacterium, Clostridioides difficile, with low relative abundance. CONCLUSION: The current study showed differences in the gut microbiome of UC patients, compared with healthy controls. This may help in identifying the gut microbiome and specific bacterial changes that can be targeted for treatment of UC.