Revistas
Autores:
Lucendo, A. J. (Autor de correspondencia); Santander, C.; Savarino, E.; et al.
Revista:
THERAPEUTIC ADVANCES IN GASTROENTEROLOGY
ISSN:
1756-283X
Año:
2022
Vol.:
15
Págs.:
17562848221074204
Background: The growing prevalence of eosinophilic esophagitis (EoE) represents a considerable burden to patients and health care systems. Optimizing cost-effective management and identifying mechanisms for disease onset and progression are required. However, the paucity of large patient cohorts and heterogeneity of practice hinder the defining of optimal management of EoE. Methods: EoE CONNECT is an ongoing, prospective registry study initiated in 2016 and currently managed by EUREOS, the European Consortium for Eosinophilic Diseases of the Gastrointestinal Tract. Patients are managed and treated by their responsible specialists independently. Data recorded using a web-based system include demographic and clinical variables; patient allergies; environmental, intrapartum, and early life exposures; and family background. Symptoms are structurally assessed at every visit; endoscopic features and histological findings are recorded for each examination. Prospective treatment data are registered sequentially, with new sequences created each time a different treatment (active principle, formulation, or dose) is administered to a patient. EoE CONNECT database is actively monitored to ensure the highest data accuracy and the highest scientific and ethical standards. Results: EoE CONNECT is currently being conducted at 39 centers in Europe and enrolls patients of all ages with EoE. In its aim to increase knowledge, to date EoE CONNECT has provided evidence on the effectiveness of first- and second-line therapies for EoE in clinical practice, the ability of proton pump inhibitors to induce disease remission, and factors associated with improved response. Drug effects to reverse fibrous remodeling and endoscopic features of fibrosis in EoE have also been assessed. Conclusion: This prospective registry study will provide important information on the epidemiological and clinical aspects of EoE and evidence as to the real-world and long-term effectiveness and safety of therapy. These data will potentially be a vital benchmark for planning future EoE health care services in Europe.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2021
Vol.:
113
N°:
8
Págs.:
580-584
Obscure gastrointestinal bleeding is defined as bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy, being capsule endoscopy the next step in those patients. Some patients may be unsuitable for conventional endoscopy and performing a capsule pan-endoscopic test as a first line procedure might potentially reduce the number of endoscopies and their subsequent risk. The aim of our study was to analyse our experience with capsule endoscopy in the bleeding patient setting. We retrospectively reviewed the first 100 pan-endoscopic capsule procedures performed in our centre from August 2011 until December 2016. 61.2% of our patients had positive findings; 46.26% had a previous negative gastroscopy and in 67.7% of them the capsule detected small bowel lesions and in 80.64%, colonic findings. Taking into consideration that our population were high-risk patients (mainly because of comorbidities), and that we use up to 45 ml of sodium phosphate, we analysed sodium, potassium and creatinine changes before and after procedure. The mean "before" values were respectively 140.68, 4.04 and 1.36. The mean "after" values were 140.28, 3.9 and 1.35 (p=n.s) According to our findings in 64.5% of patients with negative gastroscopy no other endoscopic studies would be needed. According to capsule results, in all our study sample, in 68.6% of cases conventional endoscopy could have been avoided. Panendoscopy with capsule may be useful and safe in bleeding high-risk patients, by selecting the patients who need therapeutic endoscopy, avoiding up to 68.6% of diagnostic endoscopies in our series.
Autores:
Navarro, P.; Laserna-Mendieta, E. J.; Guagnozzi, D.; et al.
Revista:
DIGESTIVE AND LIVER DISEASE
ISSN:
1590-8658
Año:
2021
Vol.:
53
N°:
11
Págs.:
1479 - 1485
Background: Long-standing inflammation leads to esophageal remodeling with stricture formation in patients with eosinophilic esophagitis (EoE). The ability of proton pump inhibitors (PPI) to reverse endoscopic features of fibrosis is still unknown. Objective: To investigate the effect of a short course of PPI treatment in reducing endoscopic findings indicative of esophageal fibrosis in EoE patients. Methods: Cross-sectional analysis of the EoE CONNECT registry. Patients who received PPI to induce EoE remission were evaluated. Endoscopic features were graded using the EoE Endoscopic Reference Score (EREFS), with rings and strictures indicating fibrosis. Results were compared to those from patients treated with swallowed topic corticosteroids (STC). Results: Clinico-histological remission was achieved in 83/166 adult patients treated with PPI (50%) and in 65/79 (82%) treated with STC; among responders, 60 (36%) and 57 (72%) patients respectively achieved deep histological remission (<5 eosinophils/hpf). At baseline, mean +/- SD EREFS was lower in patients treated with PPI compared to those who received STC (p < 0.001). Short term treatment significantly reduced EREFS scores in patients treated either with PPI or STC as well as rings and strictures. Among patients treated with PPI, deep histological remission (<5 eosinophils/hpf) provided further reduction in total EREFS score. Conclusion: Effective PPI therapy for EoE significantly reduced endoscopic esophageal fibrosis in the short term.
Autores:
Laserna-Mendieta, E. J.; Casabona, S.; Guagnozzi, D.; et al.
Revista:
ALIMENTARY PHARMACOLOGY AND THERAPEUTICS
ISSN:
1365-2036
Año:
2020
Vol.:
52
Págs.:
798 - 807
Background Proton pump inhibitors (PPIs) are the most commonly used first-line therapy for patients with eosinophilic oesophagitis (EoE). However, many aspects related to PPIs in EoE are still unknown. Aims To assess the effectiveness of PPI therapy for EoE in real-world practice. Methods This cross-sectional study collected data on PPI efficacy from the multicentre EoE CONNECT database. Clinical remission was defined as a decrease >= 50% in dysphagia symptom score; histological remission was defined as a peak eosinophil count below 15 eosinophils per high-power field. Factors associated with effectiveness of PPI therapy were identified by binary logistic regression multivariate analyses. Results Overall, 630 patients (76 children) received PPI as initial therapy (n = 600) or after failure to respond to other therapies (n = 30). PPI therapy achieved eosinophil density below 15 eosinophils per high-power field in 48.8% and a decreased symptom score >= 50% from baseline in 71.0% of patients. More EoE patients with an inflammatory rather than stricturing phenotype accomplished clinico-histological remission after PPI therapy (OR 3.7; 95% CI, 1.4-9.5); as well as those who prolonged treatment length from 8 to 12 weeks (OR 2.7; 95% CI, 1.3-5.3). After achieving clinico-histological remission of EoE, PPI dosage reduction was effectively maintained in 69.9% of cases, but tended to be less effective among patients with a stricturing phenotype. Conclusions Inflammatory EoE phenotype a
Autores:
Laserna-Mendieta, E. J. (Autor de correspondencia); Casabona, S.; Savarino, E.; et al.
Revista:
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
ISSN:
1542-3565
Año:
2020
Vol.:
18
N°:
13
Págs.:
2903 - 2911
BACKGROUND & AIMS: Topical steroids, proton pump inhibitors (PPIs), and dietary interventions are recommended first- and second-line therapies for eosinophilic esophagitis (EoE). We investigated differences in their effectiveness in a real-world, clinical practice cohort of patients with EoE. METHODS: We collected data on the efficacy of different therapies for EoE (ability to induce clinical and histologic remission) from the multicenter EoE CONNECT database-a database of patients with a confirmed diagnosis of EoE in Europe that began in 2016. We obtained data from 589 patients, treated at 11 centers, on sex, age, time of diagnosis, starting date of any therapy, response to therapy, treatment end dates, alternative treatments, and findings from endoscopy. The baseline endoscopy was used for diagnosis of EoE; second endoscopy was performed to evaluate response to first-line therapies. After changes in treatment, generally because lack of efficacy, a last endoscopy was performed. The time elapsed between endoscopies depended on the criteria of attending physicians. Clinical remission was defined by a decrease of more than 50% in Dysphagia Symptom Score; improvement in symptoms by less than 50% from baseline was considered as clinical response. Histologic remission was defined as a peak eosinophil count below 5 eosinophils/hpf. A peak eosinophil count between 5 and 14 eosinophils/hpf was considered histologic response. We identified factors associated with therapy selection and effectiveness using chi(2) and multinomial logistic regression analyses RESULTS: PPIs were the first-line treatment for 76.4% of patients, followed by topical steroids (for 10.5%) and elimination diets (for 7.8%). Topical steroids were most effective in inducing clinical and histologic remission or response (in 67.7% of patients), followed by empiric elimination diets (in 52.0%), and PPIs (in 50.2%). Among the 344 patients who switched to a second-line therapy, dietary interventions were selected for 47.1% of patients, followed by PPIs (for 29.1%) and topical steroids (for 18.6%). Clinical and histologic remission or response was achieved by 80.7% of patients treated with topical steroids, 69.2% of patients given PPIs, and 41.7% of patients on empiric elimination diets. Multivariate analyses found the stricturing phenotype of EoE to be associated with selection of topical steroids over PPIs as the first-line therapy; lack of fibrotic features at initial endoscopy was associated with selection of elimination diets over topical steroids as a second-line therapy. The recruiting center was significantly associated with therapy choice; second-line treatment with topical steroids or PPIs were the only variables associated with clinical and histologic remission. CONCLUSIONS: In an analysis of data from a large cohort of patients with EoE in Europe, we found topical steroids to be themost effective at inducing clinical and histologic remission, but PPIs to be the most frequently prescribed. Treatment approaches vary with institution and presence of fibrosis or strictures.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2017
Vol.:
109
N°:
12
Págs.:
863 - 864
Atezolizumab is an IgG1 isotype monoclonal antibody against the protein programmed cell death-ligand 1 (PD- L1). PD-L1 may be highly expressed in some tumors and is believed to inhibit immune cells that recognize and attack tumor cells. Inhibition of PD-L1 can remove its inhibitory effect and provoke an anti-tumor response. In October 2016, the Food and Drugs Administration (FDA) approved atezolizumab for the treatment of patients with metastatic non-small cell lung cancer after disease progression during or following platinum based chemotherapy. We present the case of a 43-year-old male with stage IV lung adenocarcinoma in progression, despite standard chemotherapy.
Revista:
NUTRICION CLINICA Y DIETETICA HOSPITALARIA
ISSN:
0211-6057
Año:
2016
Vol.:
36
N°:
1
Págs.:
64-74
Revista:
MEDICINE (ELSEVIER)
ISSN:
0304-5412
Año:
2016
Vol.:
12
N°:
2
Págs.:
57 - 110
Introducción
El dolor abdominal cronico o recurrente es un problema muy frecuente en la practica clinica. Se define como aquel dolor de mas de tres meses de duracion.
Etiología
La causa mas frecuente es la patologia de visceras abdominales, seguida del dolor referido de patologia toracica.
Proceso diagnóstico
Es imprescindible partir de un enfoque clinico, considerando los datos de la anamnesis y de la exploracion fisica. Las pruebas complementarias se deben solicitar orientadas segun la sospecha diagnostica; entre ellas destacan la ecografia y la tomografia computadorizada (TC) abdominal. En ocasiones no se logra identificar una causa organica que justifique la patologia del paciente, por lo que habra que considerar que se trate de un dolor de origen funcional.
Revista:
GASTROINTESTINAL ENDOSCOPY
ISSN:
0016-5107
Año:
2016
Vol.:
83
N°:
3
Págs.:
566 - 573
Background and Aims: It is known that sodium picosulfate-magnesium citrate (SPMC) bowel preparations are effective, well tolerated and safe, and that split-dosing is more effective for colon cleansing than previous-day regimens. Anesthetic guidelines consider that residual gastric fluid is independent of clear liquid fasting times. However, reluctance to use split-dosing persists. This may be due to limited data on residual gastric fluid volumes (RGFVs) and split-dosing bowel preparations, and that these may not be perceived as standard clear liquids. Furthermore, no studies are available on RGFV/residual gastric fluid pH (RGFpH) and SPMC. We aimed to evaluate the cleansing effectiveness and the RGFV/RGFpH achieved after an SPMC split-dosing regimen compared with a SPMC previous-day regimen.
Methods: This was a single-center observational study. A total of 328 outpatients scheduled for simultaneous EGD and colonoscopy and following a split-dosing or previous-day regimen of SPMC were included. We prospectively measured colon cleanliness by using the Ottawa Bowel Preparation Scale, RGFV, and RGFpH.
Results: Ottawa Bowel Preparation Scale scores for overall, right, mid-colon, and colon fluid were significantly better in the split-dosing group. In the split-dosing group, the 3- to 4-hour fasting time consistently achieved the best cleansing quality. RGFV was significantly lower in the split-dosing group (11.09 vs 18.62, P < .001). No significant differences in RGFpH were detected.
Conclusions: Split-dosing SPMC provides higher colon cleansing quality with lower RGFVs than previous-day SPMC regimens. SPMC in split-dosing acts exactly as a standard clear liquid acts, and thus anesthetic guidelines on this issue may be applied with no concerns.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2015
Vol.:
107
N°:
2
Págs.:
121 - 122
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2013
Vol.:
105
N°:
4
Págs.:
208 - 214
Background and objectives: recently, Olympus developed a new prototype (XCF-Q180AY2L) with responsive insertion technology (RIT), which besides the still known variable stiffness technology, included a passive bending section and a new high force insertion tube. Our objective was to investigate whether the use of this prototype could ease colonoscope insertion, increasing the cecal intubation rate, and/or shortening the cecal intubation time.
Material and methods: the study was designed as a prospective observational study in 305 consecutive patients from a colo-rectal cancer screening program. We compared colonoscopies performed with conventional colonoscopes (CFH180AL/CFQ160L) with those performed with the prototype XCF-Q180AY2L. End points were mean cecal and terminal ileal intubation times, cecum intubation rate, and need for specific maneuvers. All colonoscopies were performed under sedation with intravenous propofol. Finally, 288 patients were included.
Results: no complications were observed. Complete cecal intubation rate was 100 % in both groups. The ileum could be reached in 98.95 % of cases. Mean time required to reach the cecum was shorter in the prototype endoscope group (4.31 min, SD 2.63 min) than in the conventional endoscope group (4.66 min, SD 2.52 min) (p < 0.05). Compared with the standard colonoscope group, we observed in the prototype group less subjective sensation of difficulty in the passage of the sigma (p < 0.01), fewer maneuvers when it proved necessary to straighten the scope (p < 0.01), and less frequent need to modify the stiffness of the endoscope (p < 0.05).
Conclusion: we concluded that the prototype endoscope (XCF-Q180AY2L) facilitated colonoscope insertion, requiring slightly less time to reach the cecum than a standard colonoscope.
Autores:
Lucendo, A. J.; Arias, A.; Molina Infante, J.; et al.
Revista:
DIGESTIVE AND LIVER DISEASE
ISSN:
1590-8658
Año:
2013
Vol.:
45
N°:
7
Págs.:
562 - 568
BACKGROUND:
Eosinophilic oesophagitis has emerged as a common cause of oesophageal symptoms.
AIMS:
To document practice variation in care provided to eosinophilic oesophagitis patients in Spain and to assess adherence to available guidelines.
METHODS:
A prospective survey-based registry including data from all patients receiving care from gastroenterologists and allergists throughout Spain was developed.
RESULTS:
Data from 705 patients (82% adults, male:female ratio 4.1:1) were collected from 26 Spanish hospitals. 42.7% received care in teaching hospitals. Adults presented dysphagia and food impaction more frequently; vomiting and weight loss predominated in children (p < 0.01). A mean diagnostic delay of 54.7 and 28.04 months was documented for adults and children, respectively. Normal endoscopic exams were reported in 27.6% and directly related to the experience in managing the disease (p < 0.05). Paediatric patients, non-teaching hospitals and greater experience in managing eosinophilic oesophagitis were associated with increased frequency in eosinophil count reports and with taking gastric and duodenal biopsies (p < 0.001). Initial therapy consisted of topical steroids (61.7% of patients), proton pump inhibitors (52.4%), dietary modifications (51.26%) and endoscopic dilation (7.2%). Referrals to allergy units occurred more frequently in teaching hospitals (p = 0.003) where food restrictions generally followed allergy test results (p < 0.001).
CONCLUSIONS:
Availability of facilities and the physician's experience constituted the most important factors in explaining differences in patient management.
Revista:
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
ISSN:
1542-3565
Año:
2013
Vol.:
11
N°:
1
Págs.:
A33
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2012
Vol.:
104
N°:
5
Págs.:
237 - 241
Introduction: insufflation with carbon dioxide (CO2) during endoscopies compared to air is associated with a decrease in abdominal discomfort after the examination, because CO2 is readily absorbed through the small intestine and eliminated by the lungs.
Aim: the objective of this randomized clinical trial was to assess the effect of CO2 insufflation on pain and abdominal distension after an ileo-colonoscopy (I) and after an ileo-colonoscopy plus gastroscopy (I+G).
Material and methods: we included a total of 309 patients in the study and all endoscopies were performed under sedation with propofol. Two hundred fourteen patients underwent an I (132 with CO2 / 82 with air) and 95 underwent an I+G (53 with CO2 / 42 with air). Abdominal pain was studied at 10, 30 and 120 minutes of exploration and abdominal perimeter difference before and after the procedure.
Results: both in group I and in group I+G, the use of CO2 translated into an average of abdominal pain significantly lower (p < 0.05). Similarly, a smaller increase in waist circumference was found among group I and group I+G, in patients where CO2 was used (p < 0.05).
Conclusion: the insufflation of CO2 instead of air during the performance of endoscopy significantly reduces the discomfort and abdominal pain after an ileo-colonoscopy and after a gastroscopy + ileo-colonoscopy.
Revista:
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
ISSN:
1130-0108
Año:
2012
Vol.:
104
N°:
4
Págs.:
214 - 217
Herpetic esophagitis in immunocompetent individuals is a rare entity that should be suspected clinically by an acute onset of symptoms, and without apparent cause of a symptomatic triad consisting on odynophagia, heartburn and fever. Its occurrence may be due to reactivation of a previous infection or less often a primary infection. Herpes simplex type 1 is the most common cause. Upper endoscopy establishes the diagnosis of suspicion of herpetic esophagitis. It also allows to take multiple biopsy samples and viral culture, leading to a definitive diagnosis. The severity of symptoms is related to the degree of oesophageal involvement. In immunocompromised patients treatment is indicated with acyclovir, but the indication in immunocompetent patients is controversial because the process is time, limited with a low probability of complications. We present a case of acute herpetic esophagitis in an immunocompetent host that debuted acutely with severe upper gastrointestinal tract symptoms, associated with an insidious and nonspecific onset of flu-like symptoms. Endoscopic findings showed a severe involvement in the lower third of the oesophageal mucosa.
Revista:
ENDOSCOPY
ISSN:
0013-726X
Año:
2012
Vol.:
44
N°:
Supl. 2
Págs.:
E224
Revista:
GASTROENTEROLOGIA Y HEPATOLOGIA
ISSN:
0210-5705
Año:
2011
Vol.:
34
N°:
5
Págs.:
333 - 336