Association between autoimmune pancreatitis and ulcerative colitis: a report of 12 patients.

INTRODUCTION: pancreatic manifestations in inflammatory bowel disease (IBD) mainly include acute pancreatitis secondary to drugs and, less frequently, autoimmune pancreatitis, in particular type 2 autoimmune pancreatitis. METHODS: retrospective study of patients diagnosed with ulcerative colitis (UC) and autoimmune pancreatitis (AIP) in control at two centers in Santiago, Chile, between 2007 and 2018. Clinical data, laboratory results, images and response to treatment were recorded. RESULTS: twelve patients were identified with both diseases, the average age was 34 years and 42 % were male. In all cases, a likely diagnosis with type-2 AIP was established based on pancreatic magnetic resonance imaging (MRI), association with IBD and a rapid response to therapy with corticosteroids. Samples for histology were obtained from two patients, which showed inconclusive results. AIP recurrence was reported in only one case. A total of 58 % of patients had extensive UC, 100 % received 5-ASA therapy and 33 % were treated with azathioprine. Only one patient had a serious flare-up, none developed complications and none required biologics or surgery. CONCLUSION: an association between UC and type-2 AIP was confirmed in our cases. No increase in IBD severity was observed in this group of patients.

[Mortality of acute pancreatitis in a 20 years period]. / Mortalidad de la pancreatitis aguda: experiencia de 20 años en el Hospital Clínico Universidad de Chile.

BACKGROUND: Mortality for acute pancreatitis (AP) in Chile has fluctuated between 7 ana 10% in last years. AIM: To evaluate AP mortality over a period of 20 years in a clinical hospital in Santiago, Chile. MATERIAL AND METHODS: Review of the database of hospital discharges with the diagnosis of acute pancreatitis, between 1990 and 2010 and the medical records of those patients. Age, gender, length of hospital stay, surgeries, percutaneous interventions and mortality were registered. To compare the evolution of the disease over time, patients were divided in two groups: those hospitalized between 1990 and 1999 and those hospitalized between 2000 and 2010. RESULTS: We reviewed the records of 1367 patients with a median age of 48 years (48% men). In the first period, 93 of 637 (14.6%) patients died, whereas in the second period, 22 of 730 patients died (3.0%). In the first and second period, 41.9 and 25.3% of patients were subjected to surgical procedures. The hospital stay was shorter in the second group, compared with the first (14.2 and 25.9 days respectively). CONCLUSIONS: There was a decrease in mortality caused by AP in the last 10 years, probably associated with a better interdisciplinary management of these patients.

[Bedside index for severity in acute pancreatitis (BISAP) score as predictor of clinical outcome in acute pancreatitis: retrospective review of 128 patients]. / Índice clínico de gravedad en pancreatitis aguda: BISAP ("Bedside Index for Severity in Acute Pancreatitis"): dos años de experiencia en el Hospital Clínico Universidad de Chile.

BACKGROUND: Identification of patients at risk for severe disease early in the course of acute pancreatitis (AP) is essential to optimize management and to improve outcomes. AIM: To assess BISAP score as a predictor of severity of AP. PATIENTS AND METHODS: Retrospective review of AP patients between January 2009 and December 2010. BISAP, APACHE II and Balthazar scores were calculated. Length of stay, local complications, organ failure and mortality were registered. Accuracy of the scoring system for predicting severity was measured by the area under the receiver operating curve (AUC). RESULTS: The medical records of 128 patients, median age 46.5 years (55.5% men), were reviewed. Mean hospital stay was 15 days, 18 patients (14%) had local complications, 7 patients (5.4%) developed organ failure and 2 patients died (1.6%). The AUC for BISAP score to detect organ failure was 0.977 (95% IC 0.947-1.000). A BISAP score > 3 had a sensitivity, specificity, positive and negative predictive value of 71.4, 99.1, 83.3 and 98.3% respectively. An APACHE II score > 8 had a sensitivity and specificity of 71.5 and 86.8% respectively. The figures for a Balthazar score > 6 were 42.8 and 98.3% respectively. There was a significant correlation between BISAP score and length of hospital stay. CONCLUSIONS: BISAP score was a useful method for predicting the severity of PA, with the advantage of being simple and based on parameters obtained on the first day of hospitalization. Its sensitivity and specificity were superior to APACHE II and Balthazar score in this cohort.

[Ménétrier disease. Report of one case]. / Enfermedad de Ménétrier con compromiso gástrico difuso y duodenal: Caso clínico.

BACKGROUND: Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome.

[Emergency of vancomycin-resistant Enterococcus infections in a teaching hospital in Chile]. / Emergencia de infecciones por Enterococcus sp resistente a vancomicina en un hospital universitario en Chile.

An active surveillance of vancomycin-resistant enterococci (VRE) intestinal colonization in selected group of patients has been developed in Chile since year 2000. Nevertheless, no reports of clinical cases have been published. Aim. To describe main clinical and microbiological features of patients infected by VRE in a tertiary-level teaching Hospital. Patients and methods. Intestinal and clinical samples positive to VRE were provided by laboratory, and a retrospective analysis of potential risk factors, clinical features, treatment and outcomes was performed. Study encompassed years 2001 to 2006. Main results. 23 cases of infections were identified, all cases occurring during 2005 and 2006. Incidence rate was 0.07 and 0.09 cases per 1000 occupied bed-days, respectively. The mean age was 62.0 +/- 17 years. A significant proportion of patients had cancer (39.1%), recent surgical procedures (54.1%), were on dialysis (26.1%), or were using steroids (26.1%). Most patients had received 2 or more antimicrobial (87%), almost a third represented transfers from other hospitals and an additional 22% readmissions before 30 days of latest discharge. Patients were mainly hospitalized in the ICU (60.9%) but nearly 30% were associated exclusively to nephrological or onco-hematological wards. Clinical manifestations included bacteremia (30.4%), surgical site infections or abscesses (26.1%), urinary tract infections (26.1%) and others. . Three patients (13%) did not have symptoms. After identification was possible, all isolates were identified as E. faecium (82.6% of total), the rest as Enterococcus sp. Most strains showed intermediate susceptibility to vancomycin (66.7%). For 14 strains studied both with vancomycin and teicoplanin, , phenotype Van B was predominant (85.7%), followed by VanA (7.1%) and VanB/VanD type (7.1%). No molecular studies were performed. Fifteen patients (65.4%) received a surgical and/or medical treatment. A favorable response was observed in 80% of these cases. Eight patients were not treated (34.8%), in 2 cases because of a rapidly-fatal infection. The global risk-fatality ratio for VRE infections was 13% and increased to 42.9% in patients with bacteremia. Microbiological eradication was documented in 52.2%

Immunological Changes in Blood of Newborns Exposed to Anti-TNF-α during Pregnancy.

BACKGROUND: Although anti-TNF-α monoclonal antibodies are considered safe during pregnancy, there are no studies on the development of the exposed-infant immune system. The objective was to study for the first time the impact of throughout pregnancy exposure to anti-TNF-α has an impact in the development of the infant's immune system, especially B cells and the IL-12/IFN-γ pathway. METHODS: Prospective study of infants born to mothers with inflammatory bowel disease treated throughout pregnancy with anti-TNF-α (adalimumab/infliximab). Infants were monitored both clinically and immunologically at birth and at 3, 6, 12, and 18 months. RESULTS: We included seven patients and eight healthy controls. Exposed infants had detectable levels of anti-TNF-α until 6 months of age; they presented a more immature B- and helper T-phenotype that normalized within 12 months, with normal immunoglobulin production and vaccine responses. A decreased Treg cell frequency at birth that inversely correlated with mother's peripartum anti-TNF-α levels was observed. Also, a decreased response after mycobacterial challenge was noted. Clinically, no serious infections occurred during follow-up. Four of seven had atopia. CONCLUSION: This study reveals changes in the immune system of infants exposed during pregnancy to anti-TNF-α. We hypothesize that a Treg decrease might facilitate hypersensitivity and that defects in IL-12/IFN-γ pathway might place the infant at risk of intracellular infections. Pediatricians should be aware of these changes. Although new studies are needed to confirm these results, our findings are especially relevant in view of a likely increase in the use of these drugs during pregnancy in the coming years.

Cystic Lesions in Autoimmune Pancreatitis.

Autoimmune pancreatitis (AIP) can be chronic or recurrent, but frequently completely reversible after steroid treatment. A cystic lesion in AIP is a rare finding, and it can mimic a pancreatic cystic neoplasm. Difficulties in an exact diagnosis interfere with treatment, and surgery cannot be avoided in some cases. We report the history of a 63-year-old male presenting with jaundice and pruritus. AIP was confirmed by imaging and elevated IgG4 blood levels, and the patient completely recovered after corticosteroid therapy. One year later, he presented with a recurrent episode of AIP with elevated IgG4 levels, accompanied by the appearance of multiple intrapancreatic cystic lesions. All but 1 of these cysts disappeared after steroid treatment, but the remaining cyst in the pancreatic head was even somewhat larger 1 year later. Pancreatoduodenectomy was finally performed. Histology showed the wall of the cystic lesion to be fibrotic; the surrounding pancreatic tissue presented fibrosis, atrophy and lymphoplasmacytic infiltration by IgG4-positive cells, without malignant elements. Our case illustrates the rare possibility that cystic lesions can be part of AIP. These pseudocysts appear in the pancreatic segments involved in the autoimmune disease and can be a consequence of the local inflammation or related to ductal strictures. Steroid treatment should be initiated, after which these cysts can completely disappear with recovery from AIP. Surgical intervention may be necessary in some exceptional cases.

Asociación entre pancreatitis autoinmune y colitis ulcerosa: descripción de 12 pacientes / No disponible

INTRODUCCIÓN: las manifestaciones pancreáticas en enfermedad inflamatoria intestinal (EII) incluyen principalmente pancreatitis aguda secundaria a fármacos y, con menor frecuencia, pancreatitis autoinmune. Existe asimismo una asociación particular con la pancreatitis autoinmune tipo 2. MÉTODOS: estudio retrospectivo de pacientes con diagnóstico de colitis ulcerosa (CU) y pancreatitis autoinmune (PAI) en control en dos centros en Santiago de Chile, entre los años 2007 y 2018. Se registraron datos clínicos, resultados de laboratorio e imágenes, evolución en el tiempo y tratamientos utilizados. RESULTADOS: se identificaron 12 pacientes con ambas enfermedades, la edad promedio fue 34 años, con un 42 % de sexo masculino. En todos los casos se estableció el diagnóstico probable de PAI tipo 2 en base a la resonancia magnética (RM) de páncreas, la asociación con EII y la rápida respuesta a tratamiento con corticoides. En dos casos se tomaron muestras para estudio histológico pero el resultado fue no concluyente. Se observó recurrencia de la PAI en un solo caso. El 58 % de los pacientes tenían una CU extensa, el 100 % recibe tratamiento con 5-ASA y el 33 %, con azatioprina. Solo un paciente tuvo un brote grave y ninguno presentó complicaciones, necesidad de tratamiento con biológicos ni cirugía. CONCLUSIÓN: en nuestra casuística se confirma la asociación entre CU y PAI tipo 2. No se observó mayor severidad de la EII en este grupo de pacientes

No disponible

Mortalidad de la pancreatitis aguda: experiencia de 20 años en el Hospital Clínico Universidad de Chile / Mortality of acute pancreatitis in a 20 years period

Background: Mortality for acute pancreatitis (AP) in Chile has fluctuated between 7 ana 10% in last years. Aim: To evaluate AP mortality over a period of 20 years in a clinical hospital in Santiago, Chile. Material and Methods: Review of the database of hospital discharges with the diagnosis of acute pancreatitis, between 1990 and 2010 and the medical records of those patients. Age, gender, length of hospital stay, surgeries, percutaneous interventions and mortality were registered. To compare the evolution of the disease over time, patients were divided in two groups: those hospitalized between 1990 and 1999 and those hospitalized between 2000 and 2010. Results: We reviewed the records of 1367 patients with a median age of 48 years (48% men). In the first period, 93 of637 (14.6%) patients died, whereas in the second period, 22 of 730 patients died (3.0%). In the first and second period, 41.9 and 25.3% of patients were subjected to surgical procedures. The hospital stay was shorter in the second group, compared with the first (14.2 and 25.9 days respectively). Conclusions: There was a decrease in mortality caused by AP in the last 10 years, probably associated with a better interdisciplinary management of these patients.

Índice clínico de gravedad en pancreatitis aguda: BISAP ("Bedside Index for Severity in Acute Pancreatitis"): Dos años de experiencia en el Hospital Clínico Universidad de Chile / Bedside index for severity in acute pancreatitis (BISAP) score as predictor of clinical outcome in acute pancreatitis: Retrospective review of 128 patients

Background: Identification of patients at risk for severe disease early in the course of acute pancreatitis (AP) is essential to optimize management and to improve outcomes. Aim: To assess BISAP score as a predictor of severity of AP. Patients and Methods: Retrospective review of AP patients between January 2009 and December 2010. BISAP, APACHE II and Balthazar scores were calculated. Length of stay, local complications, organ failure and mortality were registered. Accuracy of the scoring system for predicting severity was measured by the area under the receiver operating curve (AUC). Results: The medical records of 128 patients, median age 46.5 years (55.5% men), were reviewed. Mean hospital stay was 15 days, 18 patients (14%) had local complications, 7 patients (5.4%) developed organ failure and 2 patients died (1.6%). The AUC for BISAP score to detect organ failure was 0.977 (95% IC 0.947-1.000). A BISAP score > 3 had a sensitivity, specificity, positive and negative predictive value of 71.4, 99.1, 83.3 and 98.3% respectively. An APACHE II score > 8 had a sensitivity and specificity of 71.5 and 86.8% respectively. The figures for a Balthazar score > 6 were 42.8 and 98.3% respectively. There was a significant correlation between BISAP score and length of hospital stay. Conclusions: BISAP score was a useful method for predicting the severity of PA, with the advantage of being simple and based on parameters obtained on the first day of hospitalization. Its sensitivity and specificity were superior to APACHE II and Balthazar score in this cohort.

Enfermedad de Ménétrier con compromiso gástrico difuso y duodenal: Caso clínico / Ménétrier disease: Report of one case

Background: Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome.