RESUMO
BACKGROUND: the training program of the gastroenterology specialty that is mandatory for resident physicians, obliges them to be proficient in diagnostic and therapeutic digestive ultrasound tools. METHODOLOGY: the Asociación Española de Ecografía Digestiva (AEED) performed a survey of the 93 Departments of Gastroenterology with training programs for resident physicians in gastroenterology, in order to assess the exact situation of training in digestive ultrasound in Spain. RESULTS: only 31 of the 93 (33%) Departments of Gastroenterology were able to provide training in Digestive Ultrasound. Moreover, 33% (48 out of 148) of the residents in gastroenterology did not receive specific training in digestive ultrasound. Whereas, 31% (46 out of 148) had received some specific training, but with ample room for improvement. These deficiencies were spread throughout the Spanish regions (Autonomous Communities) in an uneven manner, with almost half totally lacking gastroenterology departments that were capable of providing digestive ultrasound training. CONCLUSIONS: there is a significant deficit of gastroenterology departments capable of providing training in digestive ultrasound to residents, causing a significant training inequality. Until this situation can be reversed, the AEED has designed a training project in digestive ultrasound aimed at providing adequate training to all residents in gastroenterology as required.
Assuntos
Gastroenterologia/educação , Internato e Residência , Ultrassom/educação , Ultrassonografia , Gastroenterologia/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Sociedades Médicas , Espanha , Inquéritos e Questionários/estatística & dados numéricos , Ultrassom/estatística & dados numéricosRESUMO
The use of direct-acting antivirals (DAA) for the hepatitis C virus (HCV) has yielded a significant improvement in the treatment of autoimmune hepatitis (AIH) associated with HCV infection. Interferon was the cornerstone of HCV therapy before the introduction of these agents into the clinical practice. Herein, we report the case of an HCV-infected patient who developed an interferon-induced AIH and since then, has received immunosuppressive therapy. Administration of DAA resulted in a sustained virologic response (SVR) and clinical AIH remission which allowed a discontinuation of immunosuppressive treatment.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Hepatite Autoimune/tratamento farmacológico , Antivirais/efeitos adversos , Azatioprina/uso terapêutico , Benzimidazóis/uso terapêutico , Feminino , Fluorenos/uso terapêutico , Hepatite C Crônica/complicações , Hepatite Autoimune/etiologia , Humanos , Imunossupressores/uso terapêutico , Interferons/efeitos adversos , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Sofosbuvir , Resposta Viral Sustentada , Uridina Monofosfato/análogos & derivados , Uridina Monofosfato/uso terapêuticoRESUMO
We present the case of a patient with primary sclerosing cholangitis who presented a rapidly evolving cholestatic syndrome, with severe hyperbilirubinemia after placing a TIPS. It was resolved with a biliary prosthesis inserted by ERCP. To date, no similar cases have been described in the literature, as it is a rare complication and, on the other hand, the experience with TIPS in patients with PSC is limited. The causes of hyperbilirubinemia after TIPS placement are very varied and it is crucial to perform a differential diagnosis to establish an early treatment.
Assuntos
Colangite Esclerosante/complicações , Colangite Esclerosante/cirurgia , Colestase/etiologia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colestase/diagnóstico por imagem , Colestase/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/sangue , Próteses e ImplantesRESUMO
BACKGROUND: lung transplantation (LTx) is a viable option for most patients with end-stage lung diseases. Esophageal motor disorders (EMD) are frequent in candidates for LTx, but there is very little data about changes in esophageal motility post-LTx. AIM: the aim of our study was to assess esophageal motor disorders by high resolution manometry (HRM) both pre-LTx and six months post-LTx in patients with and without organ rejection. STUDY: HRM (Manoscan®) was performed in 57 patients both pre-LTx and six months post-LTx. HRM plots were analyzed according to the Chicago classification 3.0. RESULTS: EMD were found in 33.3% and in 49.1% of patients pre-LTx and post-LTx, respectively, and abnormal peristalsis was more frequently found post-LTx (p = 0.018). Hypercontractile esophagus was frequently found post-LTx (1.8% and 19.3% pre-LTx and post-LTx, respectively). Esophagogastric junction (EGJ) morphology changed significantly pre-LTx and post-LTx; type I (normal) was more frequent post-LTx (63-2% and 82.5% respectively, p = 0.007). EMD were more frequent post-LTx in both the non-rejection and rejection group, although particularly in the rejection group (43.2% and 69.2% respectively, p = 0.09). EMD such as distal spasm, hypercontractile esophagus and EGJ outflow obstruction were also observed more frequently post-LTx in the rejection group. CONCLUSION: significant changes in esophageal motility were observed pre-LTx and particularly post-LTx; hypercontractile esophagus was a frequent EMD found post-LTx. EMD were more frequent in the group of patients that experienced organ rejection compared to the non-rejection group. EMD leading to an impaired esophageal clearance should be considered as an additional factor that contributes to LTx failure.
Assuntos
Transtornos da Motilidade Esofágica/complicações , Rejeição de Enxerto/etiologia , Transplante de Pulmão , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Motilidade Esofágica/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND AND AIMS: endoscopic submucosal dissection (ESD) in the Western setting remains a challenge. Therefore, other simplified techniques such as knife-assisted snare resection (KAR) have been reported to overcome this issue. METHODS: patients who underwent an ESD for the treatment of gastrointestinal neoplasms were included in a retrospective cross-sectional observational study. Factors associated with the end of ESD as a salvage p-KAR were identified and a logistic regression model was developed. RESULTS: a total of 136 lesions in 133 patients were analyzed. Operator experience of under 50 cases and the combination of lesion size > 30 mm and colorectal location were independent predictive factors for switching to a salvage p-KAR according to the multivariate logistic regression analysis. We developed a risk scoring system based on these four variables (experience, size, location and the combination of size and location) with a receiver operating characteristic curve of 0.81 (95% CI: 0.74-0.89). The diagnostic accuracy of the score for a cut-off point ≥ 5 had a sensitivity of 0.79 (95% CI: 0.66-0.93) and a specificity of 0.71 (95% CI: 0.61-0.80). CONCLUSION: a simple predictive score system that includes four preoperative factors accurately predicts ESD to finish as a p-KAR. A careful selection of cases considering these variables could be useful to achieve better outcomes in the Western setting.
Assuntos
Conversão para Cirurgia Aberta , Ressecção Endoscópica de Mucosa , Neoplasias Gastrointestinais/cirurgia , Idoso , Conversão para Cirurgia Aberta/instrumentação , Conversão para Cirurgia Aberta/estatística & dados numéricos , Ressecção Endoscópica de Mucosa/estatística & dados numéricos , Feminino , Humanos , Masculino , Cuidados Pré-Operatórios , Estudos Retrospectivos , Medição de Risco , Resultado do TratamentoRESUMO
A 78-year-old woman with hypertension, diabetes, dyslipidemia, and revascularized ischemic heart disease was diagnosed with gastric adenocarcinoma in 2011, with suspected bilateral adrenal metastatic disease, and was treated with subtotal gastrectomy and palliative chemotherapy. A follow-up gastroscopy in 2015 identified a protruding, erosive mid-esophageal lesion suggestive of extrinsic compression or ulcerated submucosal lesion, which had not been described previously. Follow-up was advised, and the lesion persisted after three months. The patient had no esophageal symptoms, and subsequent thoracoabdominal CT scans found no bony abnormalities in the cervicothoracic spine or mediastinal changes. Endoscopic ultrasound was recommended given the patient's cancer history.
Assuntos
Endossonografia , Doenças do Esôfago/diagnóstico por imagem , Doenças do Esôfago/etiologia , Gastroscopia , Coluna Vertebral/diagnóstico por imagem , Idoso , Feminino , HumanosRESUMO
Subepithelial gastric tumours comprise a heterogeneous group of lesions. Endoscopic ultrasonography with fine-needle aspiration (EUS-FNA) is a useful approach but cannot always offer a definitive diagnosis to guide future therapeutic decisions. In the case we describe, biopsy samples of an antral subepithelial lesion and cytological analysis obtained with an EUS-FNA suggested the diagnosis of an adenocarcinoma. Endoscopic submucosal dissection (ESD) allowed en bloc resection of the tumour ensuring diagnosis and providing a definitive treatment.
Assuntos
Ressecção Endoscópica de Mucosa , Mucosa Gástrica/cirurgia , Pólipos/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Diagnóstico Diferencial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Humanos , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Pólipos/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND: High-resolution manometry (HRM) is a breakthrough in the morphological study of the gastroesophageal junction (GEJ) and its degrees of disruption. OBJECTIVES: a) Assessment of risk factors involved in the disruption of the GEJ in patients with gastroesophageal reflux (GER) symptoms; b) the relationship between the type of GEJ and GER demonstrated by 24 hours pH-monitoring; and c) identification of the alterations in the manometric parameters related to the morphology of the GEJ. METHODS: One hundred and fifteen patients with symptoms of GER studied with HRM and classified by the type of GEJ (type I: Normal; type II: Sliding; type III: Hiatal hernia). Twenty four hour pH-monitoring without proton pump inhibitors was performed in all of them. Epidemiological aspects, manometric parameters (Chicago 2012 classification) and the pH-monitoring results were evaluated. RESULTS: Age (OR 1.033 [1.006-1.060]; p = 0.16), BMI (OR 1.097 [1.022-1.176]; p = 0. 01) and abdominal perimeter (OR 1.034 [1.005-1.063]; p = 0.0215) were independent risk factors for the GEJ type III (area under the curve 0.70). Disruption of the GEJ was associated with a lower resting pressure (p = 0.006), greater length (p < 0.001) and greater esophageal shortening (p < 0.001). Abnormal acidic reflux was found in the total period (p = 0.015), standing (p = 0.022) and supine (p = 0.001) in patients with GEJ type II and III with respect to type I. CONCLUSIONS: Increased age, overweight and central obesity pose a higher risk of GEJ type III (hiatal hernia). The greater disruption of the GEJ is associated with lower resting pressure, esophageal shortening, and higher acid exposure in the pH-monitoring.
Assuntos
Junção Esofagogástrica/fisiopatologia , Esôfago/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Manometria/métodos , Idoso , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: Wexner's score is widely used to assess the severity of fecal incontinence (FI). The 36-item short form health survey (SF-36) and the Fecal Incontinence Quality of Life Scale (FIQLS), a disease-specific scale, are instruments measuring quality of life that have been validated into Spanish. AIM: To evaluate quality of life in patients with FI by using the FIQL and SF-36 scales to correlate the results with the Wexner's score. METHODS: Wexner's score, SF-36 and FIQLS were completed by 73 patients. The cut-off point for severity, as previously published, was 9 (Wexner's score <9=mild FI; Wexner's score ≥9=severe FI). RESULTS: the scores for all SF-36 sub-scales were lower in patients with FI than in the healthy Spanish population (p<0.001). The mental component of the SF-36 correlated with the subscales of «behavior¼ and «embarrassment¼ of the FIQLS (p<0.05). Wexner's score correlated with all the domains of the FIQLS (p<0.01). The results for all the domains of the FIQLS were lower for the Wexner ≥ 9 group than for the Wexner <9 group (p<0.001). There was no significant correlation between Wexner's score and the SF-36. Age, urge and daily FI, comorbidity and anorectal surgery worsened different aspects of quality of life measured by the FIQLS. CONCLUSIONS: quality of life measured by the SF-36 and FIQLS was substantially impaired in patients with FI. The severity of FI correlated with FIQLS. Other factors such as age, type and frequency of FI should be considered when evaluating quality of life.
Assuntos
Incontinência Fecal/diagnóstico , Qualidade de Vida , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e QuestionáriosAssuntos
Antivirais/efeitos adversos , Toxidermias/etiologia , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Polietilenoglicóis/efeitos adversos , Úlcera Cutânea/induzido quimicamente , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Desbridamento , Toxidermias/tratamento farmacológico , Toxidermias/cirurgia , Quimioterapia Combinada , Feminino , Humanos , Injeções Subcutâneas , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Interferon-alfa/uso terapêutico , Pessoa de Meia-Idade , Necrose , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Ribavirina/administração & dosagem , Ribavirina/uso terapêutico , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/cirurgiaRESUMO
BACKGROUND/AIMS: The body position can influence esophageal motility data obtained with high-resolution manometry (HRM). To examine whether the body position influences HRM diagnoses in patients with esophageal dysphagia and gastroesophageal reflux disease (GERD). METHODS: HRM (Manoscan) was performed in 99 patients in the sitting and supine positions; 49 had dysphagia and 50 had GERD as-sessed by 24-hour pH monitoring. HRM plots were analyzed according to the Chicago classification. RESULTS: HRM results varied in the final diagnoses of the esophageal body (EB) in patients with dysphagia (P = 0.024), the result being more distal spasm and weak peristalsis while sitting. In patients with GERD, the HRM diagnoses of the lower esophageal sphinc-ter (LES), the esophagogastric junction (EGJ) morphology, and EB varied depending on the position; (P = 0.063, P = 0.017, P = 0.041 respectively). Hypotensive LES, EGJ type III (hiatal hernia), and weak peristalsis were more frequently identified in the sitting position. The reliability (kappa) of the position influencing HRM diagnoses was similar in dysphagia and GERD ("LES diagnosis": dysphagia 0.32 [0.14-0.49] and GERD 0.31 [0.10-0.52], P = 0.960; "EB diagnosis": dysphagia 0.49 [0.30-0.69] and GERD 0.39 [0.20-0.59], P = 0.480). The reliability in "EGJ morphology" studies was higher in dysphagia 0.81 (0.68-0.94) than in GERD 0.55 (0.37-0.73), P = 0.020. CONCLUSIONS: HRM results varied according to the position in patients with dysphagia and GERD. Weak peristalsis was more frequently diagnosed while sitting in dysphagia and GERD. Hypotensive LES and EGJ type III (hiatal hernia) were also more frequently diagnosed in the sitting position in patients with GERD.
RESUMO
Presentamos el caso de un paciente con colangitis esclerosante primaria que presentó un síndrome colestásico de rápida evolución, con hiperbilirrubinemia grave tras colocar un TIPS que se resolvió con una prótesis biliar mediante CPRE. Hasta la fecha no se han descrito casos similares en la literatura, ya que se trata de una complicación rara y, por otro lado, la experiencia con el TIPS en pacientes con CEP es limitada. Las causas de hiperbilirrubinemia tras realizar un TIPS son muy variadas y es crucial realizar un diagnóstico diferencial para instaurar un tratamiento precoz (AU)
We present the case of a patient with primary sclerosing cholangitis who presented a rapidly evolving cholestatic syndrome, with severe hyperbilirubinemia after placing a TIPS. It was resolved with a biliary prosthesis inserted by ERCP. To date, no similar cases have been described in the literature, as it is a rare complication and, on the other hand, the experience with TIPS in patients with PSC is limited. The causes of hyperbilirubinemia after TIPS placement are very varied and it is crucial to perform a differential diagnosis to establish an early treatment (AU)
Assuntos
Humanos , Masculino , Adulto , Colangite Esclerosante/cirurgia , Colestase/etiologia , Stents/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Icterícia Obstrutiva/etiologiaRESUMO
Background: lung transplantation (LTx) is a viable option for most patients with end-stage lung diseases. Esophageal motor disorders (EMD) are frequent in candidates for LTx, but there is very little data about changes in esophageal motility post-LTx. Aim: the aim of our study was to assess esophageal motor disorders by high resolution manometry (HRM) both pre-LTx and six months post-LTx in patients with and without organ rejection. Study: HRM (Manoscan(r)) was performed in 57 patients both pre-LTx and six months post-LTx. HRM plots were analyzed according to the Chicago classification 3.0. Results: EMD were found in 33.3% and in 49.1% of patients pre-LTx and post-LTx, respectively, and abnormal peristalsis was more frequently found post-LTx (p = 0.018). Hypercontractile esophagus was frequently found post-LTx (1.8% and 19.3% pre-LTx and post-LTx, respectively). Esophagogastric junction (EGJ) morphology changed significantly pre-LTx and post-LTx; type I (normal) was more frequent post-LTx (63-2% and 82.5% respectively, p = 0.007). EMD were more frequent post-LTx in both the non-rejection and rejection group, although particularly in the rejection group (43.2% and 69.2% respectively, p = 0.09). EMD such as distal spasm, hypercontractile esophagus and EGJ outflow obstruction were also observed more frequently post-LTx in the rejection group. Conclusion: significant changes in esophageal motility were observed pre-LTx and particularly post-LTx; hypercontractile esophagus was a frequent EMD found post-LTx. EMD were more frequent in the group of patients that experienced organ rejection compared to the non-rejection group. EMD leading to an impaired esophageal clearance should be considered as an additional factor that contributes to LTx failure
No disponible
Assuntos
Humanos , Transtornos da Motilidade Esofágica/epidemiologia , Transplante de Pulmão/estatística & dados numéricos , Rejeição de Enxerto/epidemiologia , Manometria/métodos , Estudos Retrospectivos , Complicações Pós-Operatórias , Fatores de RiscoRESUMO
Background and aims: endoscopic submucosal dissection (ESD) in the Western setting remains a challenge. Therefore, other simplified techniques such as knife-assisted snare resection (KAR) have been reported to overcome this issue. Methods: patients who underwent an ESD for the treatment of gastrointestinal neoplasms were included in a retrospective cross-sectional observational study. Factors associated with the end of ESD as a salvage p-KAR were identified and a logistic regression model was developed. Results: a total of 136 lesions in 133 patients were analyzed. Operator experience of under 50 cases and the combination of lesion size > 30 mm and colorectal location were independent predictive factors for switching to a salvage p-KAR according to the multivariate logistic regression analysis. We developed a risk scoring system based on these four variables (experience, size, location and the combination of size and location) with a receiver operating characteristic curve of 0.81 (95% CI: 0.74-0.89). The diagnostic accuracy of the score for a cut-off point ≥ 5 had a sensitivity of 0.79 (95% CI: 0.66-0.93) and a specificity of 0.71 (95% CI: 0.61-0.80). Conclusion: a simple predictive score system that includes four preoperative factors accurately predicts ESD to finish as a p-KAR. A careful selection of cases considering these variables could be useful to achieve better outcomes in the Western setting
No disponible
Assuntos
Humanos , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Colorretais/cirurgia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento , Margens de Excisão , Biópsia/métodos , Sensibilidade e Especificidade , Neoplasias Colorretais/patologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Adenocarcinoma , Metástase Neoplásica , Gastroscopia/métodos , Cuidados Paliativos/métodos , Endossonografia , Neoplasias Gástricas , Esôfago/patologia , Esôfago , Sensibilidade e EspecificidadeRESUMO
Reactivation of hepatitis B is defined as the recurrence or an abrupt rise in hepatitis B virus (HBV) replication, often accompanied by an increase in serum transaminase levels, and both events occurring in a patient with a previous inactive hepatitis B infection. This reactivation can occur in situations in which the ratio of HBV replication and immune response is altered. It can happen during the treatment of hemato-oncological malignancies with chemotherapy and in immunosuppression of autoimmune diseases. Clinical manifestations of hepatitis B reactivation are variable and can range from asymptomatic to acute hepatitis, which are sometimes serious and result in acute liver failure with risk of death, and usually occur in the periods between cycles or at the end of chemotherapy. Immunosuppressive drugs such as corticosteroids or azathioprine can induce HBV reactivation in patients carrying hepatitis B virus surface antigen (HBsAg) or anti-HBc, but much less frequently than chemotherapy treatments. The tumor necrosis factor α inhibitors infliximab, etanercept and adalimumab may cause reactivation of hepatitis B, and the overall frequency with infliximab may be similar (50%-66%) to that caused by chemotherapy. Baseline HBV serology is recommended for all patients receiving chemotherapy and immunosuppressive drugs, and HBsAg positive patients should receive anti-HBV prophylaxis to decrease virus reactivation and death rates.
Assuntos
Antineoplásicos/efeitos adversos , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/virologia , Imunossupressores/efeitos adversos , Fígado/efeitos dos fármacos , Antivirais/uso terapêutico , Biomarcadores/sangue , DNA Viral/sangue , Hepatite B/diagnóstico , Hepatite B/prevenção & controle , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/genética , Vírus da Hepatite B/crescimento & desenvolvimento , Vírus da Hepatite B/imunologia , Vírus da Hepatite B/patogenicidade , Anticorpos Anti-Hepatite C/sangue , Humanos , Fígado/virologia , Ativação Viral/efeitos dos fármacos , Replicação Viral/efeitos dos fármacosRESUMO
Subepithelial gastric tumours comprise a heterogeneous group of lesions. Endoscopic ultrasonography with fine-needle aspiration (EUS-FNA) is a useful approach but cannot always offer a definitive diagnosis to guide future therapeutic decisions. In the case we describe, biopsy samples of an antral subepithelial lesion and cytological analysis obtained with an EUS-FNA suggested the diagnosis of an adenocarcinoma. Endoscopic submucosal dissection (ESD) allowed en bloc resection of the tumour ensuring diagnosis and providing a definitive treatment (AU)
No disponible
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Pólipos/cirurgia , Neoplasias Gástricas/cirurgia , Endossonografia , Lesões Pré-Cancerosas/patologia , Úlcera Péptica/patologia , Anemia Ferropriva/etiologia , Mucosa Gástrica/patologia , Cirurgia Assistida por Computador/métodosRESUMO
La aparición de los nuevos antivirales de acción directa (AAD) para el tratamiento del virus de la hepatitis C (VHC) supone un gran avance para pacientes con hepatitis autoinmune e infectados, ya que hasta el momento no se disponía de opciones terapéuticas libres de interferón. Presentamos el caso de una paciente con infección por VHC que sufrió una HAI desencadenada por interferón, sin conseguir suspender el tratamiento inmunosupresor durante años. Gracias a los AAD, se alcanzó una respuesta viral sostenida y, posteriormente, una remisión clínica completa de su enfermedad autoinmune, sin tratamiento actualmente
The use of direct-acting antivirals (DAA) for the hepatitis C virus (HCV) has yielded a significant improvement in the treatment of autoimmune hepatitis (AIH) associated with HCV infection. Interferon was the cornerstone of HCV therapy before the introduction of these agents into the clinical practice. Herein, we report the case of an HCV-infected patient who developed an interferon-induced AIH and since then, has received immunosuppressive therapy. Administration of DAA resulted in a sustained virologic response (SVR) and clinical AIH remission which allowed a discontinuation of immunosuppressive treatment
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Hepatite C Crônica/tratamento farmacológico , Hepatite Autoimune/tratamento farmacológico , Antivirais/uso terapêutico , Interferons/uso terapêutico , Interferons/efeitos adversos , Técnicas de Imagem por Elasticidade/métodos , Cirrose Hepática/diagnóstico por imagemRESUMO
Introducción: la manometría de alta resolución (MAR) constituye un gran avance en el estudio morfológico de la unión gastroesofágica (UGE) y en sus grados de disrupción. Objetivos: a) valoración factores de riesgo implicados en la disrupción de la UGE en pacientes con síntomas de reflujo gastroesofágico (RGE); b) la relación entre el tipo de UGE y RGE demostrado por pH-metría; y c) identificación de las alteraciones en los parámetros manométricos vinculados a la morfología de la UGE. Métodos: 115 pacientes con síntomas de RGE, estudiados con MAR y clasificados por el tipo de UGE (tipo I o normal; tipo II o deslizamiento; tipo III o hernia de hiato). En todos ellos se realizó pH-metría de 24 horas sin inhibidores de la bomba de protones. Se evaluaron aspectos epidemiológicos, parámetros manométricos (clasificación de Chicago 2012) y resultados de la pH-metría. Resultados: la edad (OR 1,033 [1,006-1,060]; p = 0,016), IMC (OR 1,097 [1,022-1,176]; p = 0,01) y perímetro abdominal (OR 1,034 [1,005-1,063]; p = 0,0215) fueron factores de riesgo independientes para la UGE tipo III (área bajo la curva 0,70). La disrupción de la UGE se asoció con una menor presión de reposo (p = 0,006), mayor longitud de la misma (p < 0,001) y mayor acortamiento esofágico (p < 0,001). Se encontró RGE patológico en el periodo total (p = 0,015), en bipedestación (p = 0,022) y supino (p = 0,001) en el canal distal en los pacientes con UGE tipo II y III respecto al tipo I. Conclusiones: la mayor edad, el sobrepeso y la obesidad central suponen mayor riesgo de desarrollar UGE tipo III (hernia de hiato). La mayor disrupción de la UGE se asocia con menor presión de reposo, mayor acortamiento esofágico y mayor exposición ácida en la pH-metría (AU)
Background: High-resolution manometry (HRM) is a breakthrough in the morphological study of the gastroesophageal junction (GEJ) and its degrees of disruption. Objectives: a) Assessment of risk factors involved in the disruption of the GEJ in patients with gastroesophageal reflux (GER) symptoms; b) the relationship between the type of GEJ and GER demonstrated by 24 hours pH-monitoring; and c) identification of the alterations in the manometric parameters related to the morphology of the GEJ. Methods: One hundred and fifteen patients with symptoms of GER studied with HRM and classified by the type of GEJ (type I: normal; type II: sliding; type III: hiatal hernia). Twenty four hour pH-monitoring without proton pump inhibitors was performed in all of them. Epidemiological aspects, manometric parameters (Chicago 2012 classification) and the pH-monitoring results were evaluated. Results: Age (OR 1.033 [1.006-1.060]; p = 0.16), BMI (OR 1.097 [1.022-1.176]; p = 0. 01) and abdominal perimeter (OR 1.034 [1.005-1.063]; p = 0.0215) were independent risk factors for the GEJ type III (area under the curve 0.70). Disruption of the GEJ was associated with a lower resting pressure (p = 0.006), greater length (p < 0.001) and greater esophageal shortening (p < 0.001). Abnormal acidic reflux was found in the total period (p = 0.015), standing (p = 0.022) and supine (p = 0.001) in patients with GEJ type II and III with respect to type I. Conclusions: Increased age, overweight and central obesity pose a higher risk of GEJ type III (hiatal hernia). The greater disruption of the GEJ is associated with lower resting pressure, esophageal shortening, and higher acid exposure in the pH-monitoring (AU)