INTRODUCTION: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with significant global prevalence. Despite advancements in medical management, including the widespread use of biologic agents and small mole...INTRODUCTION: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with significant global prevalence. Despite advancements in medical management, including the widespread use of biologic agents and small molecules, approximately 15-20% of patients eventually require surgery. This study aimed to analyze colectomy and hospitalization rates for UC in Brazil from 2012 to 2022 and assess their temporal trends. METHODS: This was a retrospective, observational, population-based study using public database records from January 1, 2012, to December 31, 2022. The study included all patients with one or more diagnostic codes associated with UC (ICD-10) who underwent a UC-related surgical procedure during the study period. RESULTS: A total of 178,552 unique UC patients were identified. UC prevalence increased significantly, from 17.31 per 100,000 in 2012 to 84.23 per 100,000 in 2022, with an annual average percentage change (AAPC) of 15% (95% CI 14.97-15.11, p<0.001). The Southeastern and Southern regions accounted for the highest number of cases. Among the 1374 surgical procedures identified, 69.4% were total colectomies, and 10.6% were pouch procedures. By the end of 2022, the proportion of surgeries relative to the total number of UC patients was 0.7%, with a declining trend (AAPC -11.8%; 95% CI -13.38 to -10.33, p<0.001). Hospitalization rates also showed a significant decline over time (AAPC -14.3%; 95% CI -14.75 to -14.03, p<0.001). CONCLUSIONS: UC prevalence in Brazil has increased substantially over the past decade. However, colectomy rates remain low and have shown a declining trend over the same period. Additionally, there has been a notable reduction in hospitalization rates, reflecting potential improvements in UC management and disease control.
González-Villarreal M, Jáquez-Quintana JO, Bocanegra-Ibarias P
… +6 more, Millán-Alanís JM, Reyna-Aréchiga AI, Cab-Morales VA, Hernández-Rodarte V, Camacho-Ortiz A, Maldonado-Garza HJ
AIMS: There is limited information on bacterial isolation, antibiotic susceptibility, and microbiological profile in obstructive biliary disease (OBD). Providing information on this could help offer more effective empiri...AIMS: There is limited information on bacterial isolation, antibiotic susceptibility, and microbiological profile in obstructive biliary disease (OBD). Providing information on this could help offer more effective empirical antibiotic therapy in clinical cholangitis. This study aims to evaluate the clinical and microbiological profile in obstructive biliary disease. PATIENTS AND METHODS: The study was conducted at a tertiary academic center between August 2021 and January 2023. Hospitalized patients with OBD, with indication for biliary drainage by endoscopic retrograde cholangiopancreatography, were recruited. Biliary samples were obtained following a standardized protocol, and were processed in laboratory for Gram staining, culture, subculture. Microorganisms were identified and subjected to antibiotic susceptibility testing. RESULTS: A total of 61 patients were included, 73.8% were women, average age was 44.8 years. Overweight/obesity was the most common comorbidity (62.3%); clinical cholangitis was present in 75.4%. Biliary lithiasis was the most common etiology of OBD (86.9%). Positive cultures were obtained in 44.3% of participants, predominating the group of Gram-positive bacteria; individually, Escherichia coli was the most isolated microorganism. A 68.2% of bacteria showed resistance to at least one antibiotic. We found significant associations between bile appearance and cholangitis, bile appearance and OBD etiology, OBD etiology and cholangitis severity. Male sex, increased age, tobacco use were associated with positive cultures. We found a spectrum of microorganisms and antibiotic susceptibilities partially different from those of Tokyo Guidelines 2018 and other publications. CONCLUSIONS: Our findings highlight the need to characterize microbiological profile in OBD according to each region.
OBJECTIVE: To present an overview to summarize the efficacy and safety of biologics for the treatment of Crohn's disease (CD). METHODS: We gathered systematic reviews or meta-analyses on the efficacy and safety of biolog...OBJECTIVE: To present an overview to summarize the efficacy and safety of biologics for the treatment of Crohn's disease (CD). METHODS: We gathered systematic reviews or meta-analyses on the efficacy and safety of biologic therapy for CD from the beginning to September 30, 2023, by searching the databases of the Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database, Web of Science, the Cochrane Library, PubMed, and Embase. Analysing reviews and extracting data, two researchers worked independently. Any discrepancies in the two researchers' assessments of the review process were reevaluated, and the argument was settled by consulting to other researchers. The following details was taken out of the data: author, publication year, study type, number of included studies, country of study, sample size, risk bias tools, biologic therapy, and primary outcomes. Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and the AMSTAR-2, a critical appraisal tool for systematic reviews (2nd edition), were then utilized to assess the methodological quality and reporting quality of the evidence. RESULTS: There were 19 reviews in all. One systematic review, 5 meta-analyses, and 13 systematic reviews and meta-analyses were among the reviews that were included. Nine studies met the high quality, 5 met the moderate quality, 3 met the poor quality, and 2 met the critically low quality requirements of the AMSTAR-2 criteria. CONCLUSIONS: The analysis of the evidence finds biologic agents for CD are effective and safe. Overall, there was moderate to high quality biologic evidence for CD, but future head-to-head controlled studies are required to better inform the relative positioning of these drugs for the management of CD.
OBJECTIVE: Vedolizumab (VDZ) and infliximab (IFX) are first-line therapies for moderate-to-severe ulcerative colitis (UC). Despite their widespread use, there are no direct comparative studies, and real-world data, parti...OBJECTIVE: Vedolizumab (VDZ) and infliximab (IFX) are first-line therapies for moderate-to-severe ulcerative colitis (UC). Despite their widespread use, there are no direct comparative studies, and real-world data, particularly in Latin America, are limited. This study compared the effectiveness and safety of VDZ and IFX in biologic-naïve UC patients. METHODS: This retrospective cohort study included patients with moderate-to-severe UC (Mayo score 6-12, endoscopic sub-score ≥2) treated with VDZ or IFX. Primary endpoints were clinical remission (partial Mayo score ≤2), endoscopic remission (Mayo sub-score=0), and steroid-free clinical remission at week 52. Secondary endpoints included clinical response, endoscopic response, biological therapy optimization, adverse events (AEs), hospitalizations, and biochemical remission at week 52. Propensity score adjustment (1/PS) was used to adjust for potential confounders. RESULTS: A total of 297 UC patients (156 IFX, 141 VDZ) were analyzed. Clinical remission at week 52 was 82.3% for VDZ and 77.6% for IFX (p=0.11), while endoscopic remission was higher in VDZ patients (47.4% vs. 33.1%, p=0.03). Steroid-free clinical remission rates were similar between groups (p=0.98). Endoscopic response at week 52 favored VDZ (78.4% vs. 62.7%, p<0.001), and VDZ had higher treatment persistence (80.8% vs. 61.8%, p<0.001). AEs and hospitalizations were more frequent in IFX patients (p<0.001). CONCLUSIONS: Both VDZ and IFX are effective in biologic-naïve UC patients, however VDZ demonstrated superior endoscopic outcomes, higher treatment persistence, and a better safety profile, supporting its use as a first-line therapy.
Ginard D, Fontanillas N, Bastón-Rey I
… +13 more, Pejenaute ME, Piqueras M, Alcalde S, Nos P, Ricote M, Expósito L, Mañosa M, Barreiro-de Acosta M, Rodríguez-Moranta F, Zabana Y, Polo J, Gutiérrez A, en representación de GETECCU y SEMERGEN
Primary Care is the first point of contact for most patients after the onset of symptoms of inflammatory bowel disease (IBD). Establishing an initial diagnostic process based on compatible symptoms and agreed criteria an...Primary Care is the first point of contact for most patients after the onset of symptoms of inflammatory bowel disease (IBD). Establishing an initial diagnostic process based on compatible symptoms and agreed criteria and referral pathways, depending on the degree of suspicion and the patient's situation, can reduce diagnostic delays. Once the patient is referred to the Digestive specialist and the diagnosis of IBD is established, a treatment and follow-up plan is structured. The management of the patient must be shared with the participation of the family practitioners in the diagnosis and treatment of concomitant or intercurrent pathologies, the recognition of flare-ups or complications (of IBD or treatments), education tasks or adherence control. With the purpose of developing a comprehensive guide on the management of IBD aimed at Primary Care doctors, we have developed this positioning document collaboratively between the Spanish Society of Primary Care Physicians (SEMERGEN) and the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU).
Hepatitis B virus is a public health issue, with severe complications such as cirrhosis and liver cancer that impose significant economic, emotional, and psychosocial burdens. Despite the availability of a vaccine and or...Hepatitis B virus is a public health issue, with severe complications such as cirrhosis and liver cancer that impose significant economic, emotional, and psychosocial burdens. Despite the availability of a vaccine and oral treatments, effective management of this disease remains a challenge. Telemedicine and mobile applications have the potential to improve the management of chronic diseases; this study examines their utility in hepatitis B. A search was conducted in four databases in November 2024 following the PRISMA guidelines. Out of 216 articles, seven studies were included. These studies evaluated the use of mobile applications in providing access to information, detection and linkage to care, quality of life assessment, and vaccination promotion. The findings showed the usefulness of these tools, considering mobile applications as a helpful tool in the management and prevention of hepatitis B.
INTRODUCTION: Subcutaneous (sc) vedolizumab is an alternative to intravenous (iv) vedolizumab for the treatment of patients with mild-to-moderate flares of inflammatory bowel disease (IBD). AIMS: To analyse the persisten...INTRODUCTION: Subcutaneous (sc) vedolizumab is an alternative to intravenous (iv) vedolizumab for the treatment of patients with mild-to-moderate flares of inflammatory bowel disease (IBD). AIMS: To analyse the persistence rate of the sc vedolizumab and its pharmacokinetics in patients previously treated with iv vedolizumab; describing clinical and biochemical remission rates at one year, and comparing previous intravenous intensification regimens. METHODS: Multicenter, descriptive, observational, and retrospective study of a cohort of 54 patients with IBD treated with iv vedolizumab for more than six months, who were switched to sc vedolizumab under a standard regimen, 32 patients (59%) with a diagnosis of ulcerative colitis (UC) and 22 patients (41%) with Crohn's disease (CD) RESULTS: After one year of follow-up, 93% of the patients continued with vedolizumab, 100% were in clinical remission, and 86% achieved biochemical remission (calprotectin <150). A progressive increase in vedolizumab levels was observed after switching to sc vedolizumab, with statistical significance (p<0.05). 14 patients (25.9%) were on an intensified regimen before switching to sc vedolizumab; however, all patients remained on subcutaneous vedolizumab at a dose of 108 mg every two weeks without the need for intensification. CONCLUSION: After switching to sc vedolizumab in patients with endovenous vedolizumab treatment, high persistence rate at one year of follow-up is achieved, with a greater tendency to biochemical remission, which is more pronounced in previously intensified patients without the need for subcutaneous vedolizumab intensification.
OBJECTIVES: Moderate to severe Crohn's disease (CD) treatment was revolutionized by introducing anti-tumor necrosis factor (TNF) agents, which is still a cornerstone of the treatment. It is speculated that adipose tissue...OBJECTIVES: Moderate to severe Crohn's disease (CD) treatment was revolutionized by introducing anti-tumor necrosis factor (TNF) agents, which is still a cornerstone of the treatment. It is speculated that adipose tissue may influence treatment response, especially for non-weight-adjusted agents. PATIENTS AND METHODS: Research comparing the effectiveness of anti-TNFs between eutrophic and overweight patients may impact clinical management. We performed a retrospective analysis of a CD patient database. The primary endpoint was loss of response (LOR) after 54 weeks with infliximab (IFX) and adalimumab (ADA) in patients with body mass index (BMI) <25 and ≥25. Secondary endpoints were steroid-free remission and endoscopic remission rate. RESULTS: One hundred seventy-nine CD patients were evaluated; 48.9% had LOR after 54 weeks of anti-TNF therapy. Fifty-four patients had a BMI ≥25, with 51 receiving IFX and 28 receiving ADA. The univariate analysis identified LOR in 56.5% of the patients with IFX and 34.9% in the ADA group (p=0.009). In the 54-week multivariate analysis, loss of response in the IFX group with BMI ≥25 had a relative risk of 1.04 [CI 0.60-1.80 (p=0.891)] compared to patients with BMI <25. Being overweight or obese led to a risk of 1.50 for LOR for ADA at 54-week time point [CI 0.60-3.74 (p=0.0387)]. Clinical remission at 54 weeks was similar between BMI groups. CONCLUSIONS: Being overweight did not influence the LOR to treatment when IFX and ADA were compared, nor did it affect clinical and endoscopic remission after 54 weeks.
OBJECTIVE: We aimed to determine the prevalence of intestinal and extra-intestinal symptoms according to depression severity in a large cohort of patients with irritable bowel syndrome (IBS). PATIENTS AND METHODS: A cons...OBJECTIVE: We aimed to determine the prevalence of intestinal and extra-intestinal symptoms according to depression severity in a large cohort of patients with irritable bowel syndrome (IBS). PATIENTS AND METHODS: A consecutive series of patients with diagnosis of IBS according to Rome IV criteria undertaking a social-media based program (B15 program) were analyzed. The B15 program provides evidence-based dietary and non-pharmacological recommendations (i.e., mindfulness techniques and exercise) to improve gastrointestinal health. All patients completed the symptom-severity questionnaire (IBS-SSS) to determine severity of disease and the patient health questionnaire (PHQ9) to assess depressive symptoms. Patients' depression severity was stratified according to the PHQ9 score: none (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27). Demographics, IBS phenotype and prevalence of intestinal and extra-intestinal symptoms were compared among groups. RESULTS: A total of 15,675 patients with IBS were included; 895 (12.1%) with none, 5709 (36.4%) with mild, 4279 (27.3%) with moderate, 2457 (15.7%) with moderately severe, and 1335 (8.5%) with severe depression. Mean IBS-SSS score was significantly higher in patients with depressive symptoms (none 256.5 vs. severe 324.1, p<0.0001). IBS-M (mixed bowel habits alternating constipation and diarrhea) was more frequent in those with depression (p<0.0001). The presence of bloating, heartburn, dyspepsia, and belching were significantly more common in patients with higher levels of depression (p<0.0001). The prevalence and number of extra-intestinal symptoms were also associated with the severity of depression (p<0.0001). CONCLUSIONS: The presence and severity of depression are strongly associated with the prevalence of intestinal and extra-intestinal symptoms in patients with IBS. Stratifying patients based on both their symptomatic and psychological profile could help targeting therapy.
Pérez Solís D, Serrano-Vela JI, Pérez Sixto C
… +7 more, Bermejo Delgado T, Cilleruelo Pascual ML, Barrio Torres J, Donat Aliaga E, Torres Peral R, Román Riechmann E, en representación del Grupo de Trabajo de Enfermedad Celíaca de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP)
INTRODUCTION: There is high variability in the follow-up of paediatric patients with coeliac disease (CD) in Europe. The aim of this study was to know the current reality of paediatric CD follow-up in Spain through profe...INTRODUCTION: There is high variability in the follow-up of paediatric patients with coeliac disease (CD) in Europe. The aim of this study was to know the current reality of paediatric CD follow-up in Spain through professionals and the patients themselves and their families. PATIENTS AND METHODS: A cross-sectional descriptive study was conducted using 2 anonymous web surveys, one aimed at paediatric gastroenterologists, and the other at members of CD patients' associations. RESULTS: A total of 96 responses from paediatricians and 4745 from patients (1362<15 years) were analysed. Among the professionals, 84.4% carry out follow-up only at the hospital level. A percentage of 80.2 lack a joint follow-up protocol with primary health care. The transition after the paediatric age is made to adult gastroenterologists by 56.2% of professionals (only 8.3% in a protocolized manner). A percentage of 58.3 do not have a dietitian and 64.6% do not use quality of life questionnaires. The patients stated that they mainly performed follow-up visits in the hospital (68.8%). Only 15.7% ever consult a dietitian. Scheduled visits were more frequent in paediatric patients than in adults (95.1% vs. 63.5%, p<0.001). The variable most associated with attendance at follow-up visits was that the survey had been answered by the patient's parents (odds ratio 2.6, p<0.001). CONCLUSIONS: In Spain, there is a lack of follow-up protocols for paediatric CD patients integrating hospitals and primary care, as well as protocols for the transition to adult professionals. The participation of dietitians is very low. Adult patients adhere less to follow-up visits.
INTRODUCTION: Variceal upper gastrointestinal bleeding is a common cause of decompensation in patients with liver cirrhosis. While mortality data, which are from 10 to 15%, are available, there are no validated scales to...INTRODUCTION: Variceal upper gastrointestinal bleeding is a common cause of decompensation in patients with liver cirrhosis. While mortality data, which are from 10 to 15%, are available, there are no validated scales to predict in-hospital mortality in this patient population. OBJECTIVE: To determine whether the MELD-Lactate (MELD-LA) level is associated with in-hospital mortality in patients with chronic liver disease who are admitted for variceal bleeding. MATERIAL AND METHODS: A prospective, observational, and analytical study was conducted that included 120 patients. The MELD-LA cut-off point was obtained, and in-hospital mortality was obtained using conventional prognostic scales that had the highest sensitivity and specificity for comparison purposes. Additionally, a survival analysis was performed using the MELD-LA cut-off point obtained. RESULTS: In our cohort, 6 (5.0%) patients died during hospitalization. Patients who died had a mean MELD-LA value of 20.0 (±4.97) as opposed to those who did not die, 13.62 (±3.29), (p<0.001). The MELD-LA cut-off point of >14.0, with a sensitivity of 100%, a specificity of 71.0%, a positive predictive value of 15.4%, a negative predictive value of 100.0%, and an AUC (area under the curve) of 0.886, was most well correlated with higher in-hospital mortality. Survival was 71.1% in patients with MELD-LA levels>14.0 versus 100.0% in those with lower levels (p=0.001) during hospitalization. CONCLUSION: The measurement of MELD-LA at admission seems to be a good complementary marker for the evaluation and prognosis of in-hospital mortality in patients with liver cirrhosis, and variceal upper gastrointestinal bleeding.
Etrasimod is a synthetic, non-biological, orally administered small molecule sphingosine-1-phosphate receptor (S1PR) modulator. Etrasimod was approved by the Food and Drug Administration in 2023 and by the European Medic...Etrasimod is a synthetic, non-biological, orally administered small molecule sphingosine-1-phosphate receptor (S1PR) modulator. Etrasimod was approved by the Food and Drug Administration in 2023 and by the European Medicine Agency in 2024, constituting a new therapeutic option for the treatment of moderately to severely active ulcerative colitis in patients 16 years of age and older in the European Union. Its efficacy and tolerability have been demonstrated in several clinical trials both as induction and maintenance treatment, as well as in long-term extension studies. This article reviews the pharmacodynamic characteristics of etrasimod, its main differences with biological drugs and other small molecules (janus kinases inhibitors), as well as its clinical efficacy including certain subpopulations such as patients with isolated ulcerative proctitis, and the impact on their quality of life.
INTRODUCTION: Artificial intelligence (AI) allows the optimization of diagnostic processes for hepatitis C virus (HCV) patients. Our objective was to evaluate the clinical, economic, and management benefits of an AI-base...INTRODUCTION: Artificial intelligence (AI) allows the optimization of diagnostic processes for hepatitis C virus (HCV) patients. Our objective was to evaluate the clinical, economic, and management benefits of an AI-based clinical decision support system (Intelligen-C strategy). METHODS: The Intelligen-C strategy consisted of (1) a retrospective phase (Dec 2013-Sep 2021), in which medical records were reviewed to search for anti-HCV-positive and/or HCV-RNA+ patients lost in the system, and (2) a prospective phase (Feb 2022-Jan 2023), in which automated screening (40-70 years) and routine testing for risk factors were performed in patients who were admitted to the emergency department or were hospitalized. With the use of automated screening, the system identified patients without an HCV diagnosis among those requiring blood tests and requested HCV serology; if the results were positive, reflex testing for HCV-RNA was performed. If a patient was HCV-RNA+, an alert was generated and sent to the hepatology department. In addition, the prospective phase was compared with the previous period to evaluate its effectiveness and efficiency. RESULTS: In the retrospective phase, the Intelligen-C strategy allowed the identification of 272 anti-HCV- or HCV-RNA+ patients who were lost to follow-up, of whom 11 were treated; in the prospective phase, after 7312 serologies were performed, 28 HCV-RNA+ patients were identified, 14 attended the appointment, and 9 were treated. In the prospective phase vs. the previous period, increased serology (7312 vs. 909), HCV-RNA+ detection (28 vs. 3), and treated patients (9 vs. 1) generated savings to the health system related to medical visits. In addition, Intelligen-C was cost-effective. CONCLUSIONS: The implementation of the Intelligen-C strategy allowed the identification of patients with undiagnosed infection, facilitated their diagnosis, reduced healthcare processes and associated hospital costs, and proved to be efficient.
PURPOSE: This meta-analysis aimed to evaluating the prevalence of Crohn's disease in primary sclerosing cholangitis (PSC) and the incidence of primary sclerosing cholangitis in Crohn's disease (CD), along with their inte...PURPOSE: This meta-analysis aimed to evaluating the prevalence of Crohn's disease in primary sclerosing cholangitis (PSC) and the incidence of primary sclerosing cholangitis in Crohn's disease (CD), along with their interrelation. METHODS: An extensive search was conducted in the PubMed and Embase to identify available publications up to December 2023. Studies were included if they reported the prevalence of CD in PSC patients, or vice versa. Proportions were assessed using the DerSimonian and Laird method, followed by transformation via the Freeman-Tukey double inverse sine transformation. The quality of the included studies utilizing the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS: Based on quantitative analysis of 61 studies, the prevalence of PSC in patients with CD was 0.88% (95% CI: 0.53-1.30%). The prevalence of PSC in male CD patients was 0.45% (95% CI: 0.03-1.16%). In female CD patients, the prevalence was 0.51% (95% CI: 0.09-1.14%). The prevalence of CD with PSC was 11.27% (95% CI: 9.56-13.10%). The prevalence of CD in male PSC patients was 10.71% (95% CI: 7.42-14.50%). Among female PSC patients, the pooled prevalence of CD was 13.05% (95% CI: 11.05-15.19%). CONCLUSIONS: We found a significant bidirectional association between PSC and CD, with a higher prevalence of CD in female with PSC compared to male. These findings provide important epidemiological data for clinical practice.
AIM: To describe the usefulness of cellular indices in the diagnosis of ulcerative colitis (UC). METHODS: Diagnostic study of patients under 15 years of age undergoing colonoscopy±esophagogastroduodenoscopy for suspected...AIM: To describe the usefulness of cellular indices in the diagnosis of ulcerative colitis (UC). METHODS: Diagnostic study of patients under 15 years of age undergoing colonoscopy±esophagogastroduodenoscopy for suspected inflammatory bowel disease between 2015 and 2022 in a pediatric hospital. Patients with normal biopsy and anatomopathological diagnosis of UC were included. Using the area under the ROC curve, the values of platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), calculated by dividing the number of platelets, neutrophils, and monocytes by the number of lymphocytes, respectively, were compared to establish the sensitivity, specificity, predictive values and odds ratio of each parameter in the diagnosis of UC. RESULTS: Twenty-six patients were included: 14 with normal biopsy and 12 with UC. PLR and MLR values were significantly higher in patients with UC (p<0.05). The sensitivity, specificity, and negative predictive value of PLR, NLR and MLR for diagnosing UC were 58%, 83% and 91%; 85%, 35% and 50%; 70%, 71% and 87%, respectively. The biomarker with the highest diagnostic performance was MLR with a cutoff point of 0.235, area under the curve of 0.735 and odds ratio of 11 (95% CI 1.1-109.6; p=0.041). CONCLUSIONS: MLR has a high sensitivity, negative predictive value, and odds ratio in the pre-endoscopic diagnosis of ulcerative colitis. These findings, although exploratory, suggest that MLR could be useful in clinical practice in the initial diagnostic workup of UC, and perhaps in the future in the prioritization of endoscopic studies according to MLR values.