OBJECTIVE: Cardiovascular (CV) risk assessment in patients with inflammatory bowel disease (IBD) remains insufficiently explored. This study aimed to assess the role of vascular Doppler ultrasound in refining CV risk str...OBJECTIVE: Cardiovascular (CV) risk assessment in patients with inflammatory bowel disease (IBD) remains insufficiently explored. This study aimed to assess the role of vascular Doppler ultrasound in refining CV risk stratification in patients with IBD. PATIENTS AND METHODS: We conducted a cross-sectional study including patients with Crohn's disease (CD) and ulcerative colitis (UC) under active follow-up in a tertiary referral center. Consecutive patients referred for cardiology assessment according to predefined clinical criteria between May 2024 and December 2025 underwent carotid and femoral Doppler ultrasound to estimate the prevalence of atherosclerosis. Ultrasound operators were blinded to the CV risk score results and clinical risk stratification at time to image acquisition and interpretation. In the primary prevention cohort, the ability of the PREVENT 10-year risk score for detecting subclinical atherosclerosis was assessed using receiver operating characteristic (ROC) analysis. The optimal cutoff point was determined using the Youden index. RESULTS: A total of 106 patients were included, of whom 100 without established atherosclerotic cardiovascular disease (ASCVD) constituted the main analytical population. The median age was 54.4 years, and 59% were men. Before Doppler assessment, 55% of patients were classified as low risk, 10% as borderline risk, 28% as intermediate risk, and 7% as high risk. Subclinical atherosclerosis was detected in 46%, prompting risk reclassification. Overall upward reclassification occurred in 41% and downward reclassification in 5%, yielding a net reclassification of 36%. The PREVENT 10-year risk score showed good discriminatory performance for the detection of subclinical atherosclerosis (AUC=0.85; 95% CI, 0.77-0.93), with an optimal cutoff value of 2.8%. CONCLUSIONS: Vascular Doppler imaging revealed a high prevalence of subclinical atherosclerosis and was associated with substantial CV risk reclassification beyond traditional scores.
Rubio de la Plaza I, Javier Parra F, Sanz Prieto A
… +5 more, Gil Santana M, Castillo Herrera LA, Martín-Falquina IC, Fuentes-Valenzuela E, Bejerano Domínguez A
OBJECTIVE: Our aim was to (i) undertake a comprehensive translation of the FR-QoL-29 instrument to Brazilian-Portuguese; and (ii) evaluate its validity and reliability in patients with IBD in Brazil. MATERIALS AND METHOD...OBJECTIVE: Our aim was to (i) undertake a comprehensive translation of the FR-QoL-29 instrument to Brazilian-Portuguese; and (ii) evaluate its validity and reliability in patients with IBD in Brazil. MATERIALS AND METHODS: The FR-QoL-29 underwent forward and backward translation to Brazilian-Portuguese. A cross-sectional study was conducted in patients with IBD either in remission or with active disease at a tertiary referral center in Brazil. Clinical and demographic characteristics, Montreal classification and anthropometric measurements were collected. Data were compared with controls without any gastrointestinal disease. RESULTS: A total of 203 consecutive patients were included, of whom 173 had IBD and 30 were controls. Cronbach's α was 0.93 for IBD patients without previous IBD-related surgery, 0.93 for IBD patients with previous intestinal surgery, and 0.80 for the control group. Using the Kaiser-Meyer-Olkin (KMO) test to assess sample adequacy, the result was 0.85 for IBD patients without previous surgery (p<0.001) and 0.73 for those with previous IBD-related operations (p<0.001). CONCLUSION: The FR-QoL-29-Portuguese-Brazil is a valid and reliable tool for use in this language and in this specific population to measure the important factor of food-related quality of life.
OBJECTIVE: Corticosteroids (CS) are effective in the induction of remission in inflammatory bowel disease (IBD), but have an unfavorable side effect profile. A CS sparing strategy is frequently recommended, but its conse...OBJECTIVE: Corticosteroids (CS) are effective in the induction of remission in inflammatory bowel disease (IBD), but have an unfavorable side effect profile. A CS sparing strategy is frequently recommended, but its consequences in IBD outcomes have been scarcely studied. Our primary aim was to evaluate current CS use and excess in IBD patients, comparing them with a historic cohort. Our secondary aims were to identify predictors of CS excess and compare outcomes (surgery, hospitalization, new CS cycle, structural damage and a composite outcome) at 12 months between three prescription groups (no CS use, standard CS use, and excess CS use). PATIENTS AND METHODS: A retrospective study, including adult IBD outpatients from two trimesters (one in 2014 and one in 2023). CS prescription trends were compared between groups. The latter was used to identify predictors of CS excess and compare outcomes between prescription groups. RESULTS: A total of 1131 outpatients with IBD were included, 374 in 2014 and 757 in 2023. CS use was 3.2 times lower in 2023 (6.5% vs. 20.6%, p<0.001), and CS excess was 5.5 times lower (12.0% vs. 2.2%, p<0.001). Crohn's disease, extraintestinal manifestations, absence of medication, clinical activity and hospitalization in the previous 12 months were independent predictors of CS excess. CS excess prescription was an independent predictor of hospitalization (HR 15.225, 95% CI 2.189-105.913, p=0.006), new CS cycle (HR 38.392, 95% CI 13.866-106.299, p<0.001) and the composite outcome (HR 32.253, 95% CI 13.260-78.452, p<0.001) at 12 months. CONCLUSIONS: CS prescription rate has significantly decreased in our center. CS excess was associated with negative outcomes, namely hospitalization and new CS cycles. Improving quality-of-care in IBD should focus on avoiding excess CS prescription.
Lens S, García F, Mascort J
… +8 more, Casado M, Freyre C, Lázaro A, Muñoz G, Molera C, García-Samaniego J, Buti M, Representantes de las sociedades científicas
Chronic infection by hepatitis B virus (HBV) and hepatitis D virus (HDV) continues to pose a major public health challenge in Spain due to its high morbidity and mortality and the risk of progression to cirrhosis and hep...Chronic infection by hepatitis B virus (HBV) and hepatitis D virus (HDV) continues to pose a major public health challenge in Spain due to its high morbidity and mortality and the risk of progression to cirrhosis and hepatocellular carcinoma. Although effective tools exist for the control of hepatitis B and recent therapeutic advances have been made for hepatitis D, significant inequalities persist in early diagnosis, access to treatment, and appropriate patient follow-up. This consensus document has been jointly developed by the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC)-through its Viral Hepatitis Study Group (GEHEP)-the Spanish Society of Digestive Pathology (SEPD), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Hospital Pharmacy (SEFH), the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), and the Spanish Society of Paediatric Gastroenterology, Hepatology and Nutrition (SEGHNP). The objective is to provide updated and consensus-based recommendations on the diagnosis, management, and treatment of chronic HBV and HDV infection, from a multidisciplinary perspective and adapted to real-world clinical practice. The document addresses screening and diagnostic strategies, criteria for assessing liver fibrosis, indications for antiviral treatment, specific management of hepatitis D, and the role of coordination between primary care and hospital care. Likewise, it emphasizes the need to implement strategies to advance toward the goals of viral hepatitis elimination.
OBJECTIVE: Intravenous fluid resuscitation is central to the early management of acute pancreatitis (AP), but the optimal intensity remains uncertain. This systematic review and meta-analysis compared intensive or aggres...OBJECTIVE: Intravenous fluid resuscitation is central to the early management of acute pancreatitis (AP), but the optimal intensity remains uncertain. This systematic review and meta-analysis compared intensive or aggressive vs. moderate fluid resuscitation in adults with AP. PATIENTS AND METHODS: This systematic review and meta-analysis followed PRISMA 2020 and was registered in PROSPERO (CRD42024626152). PubMed, Scopus, Web of Science, and Embase were searched from inception to February 15, 2024 for Randomized Controlled Trials (RCT) enrolling adults with acute pancreatitis and comparing intensive/aggressive vs. moderate fluid resuscitation. The primary outcome was in-hospital mortality; secondary outcomes were length of hospital stay, persistence of systemic inflammatory response syndrome (SIRS), fluid-overload complications, and early clinical improvement (≤36h). Risk of bias was assessed with RoB 2.0. Pooled relative risks (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models according to heterogeneity (I). Analyses were performed in RevMan 5.4.1. RESULTS: Seven RCTs were included. IFR was associated with higher mortality than MFR (RR 2.60; 95% CI 1.48-4.57; I=0%). IFR did not reduce LOS (MD 1.21 days; 95% CI 0.72-1.69; I=65%) or SIRS persistence (RR 0.87; 95% CI 0.50-1.52; I=26%). Fluid-overload complications were more frequent with IFR (RR 3.34; 95% CI 1.60-6.98; I=0%). Early clinical improvement did not differ (RR 1.20; 95% CI 0.63-2.29; I=72%). Risk of bias was generally low. CONCLUSIONS: Across randomized evidence, intensive hydration offers no clinical benefit over moderate regimens and is associated with higher mortality and greater risk of fluid overload. Findings support moderate, goal-directed, individualized fluid therapy in acute pancreatitis and highlight the need for large multicenter RCTs to refine fluid targets and monitoring endpoints.
BACKGROUND: Cirrhosis is a progressive liver disease associated with high morbidity and reduced quality of life. Mood disorders are common in chronic liver disease and may worsen outcomes through inflammation, poor adher...BACKGROUND: Cirrhosis is a progressive liver disease associated with high morbidity and reduced quality of life. Mood disorders are common in chronic liver disease and may worsen outcomes through inflammation, poor adherence and reduced care engagement. Their specific impact on cirrhosis outcomes, however, remains unclear. METHODS: Using the TriNetX global research network, we conducted a retrospective cohort study of adults with cirrhosis, comparing those with comorbid mood disorders to those without. Propensity score matching (1:1) was performed using demographic variables. Outcomes included variceal bleeding, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, hepatorenal syndrome, liver transplantation, and all-cause mortality. RESULTS: After matching, cirrhotic patients with mood disorders had significantly higher complication rates than controls, including varices (RR 1.19), ascites (RR 1.13), SBP (RR 1.40), hepatic encephalopathy (RR 1.52), and hepatorenal syndrome (RR 1.34) (all p<0.001). They were also more likely to undergo liver transplantation (RR 1.76) and had a modest increase in all-cause mortality (RR 1.06). CONCLUSION: Mood disorders in cirrhosis are associated with increased decompensation, transplant utilization, and mortality, highlighting the need for integrated psychiatric care and further prospective evaluation.
OBJECTIVE: Despite specific recommendations, immunization rates among patients with inflammatory bowel disease (IBD) remain suboptimal. This study aimed to assess vaccination management by exploring the concordance and d...OBJECTIVE: Despite specific recommendations, immunization rates among patients with inflammatory bowel disease (IBD) remain suboptimal. This study aimed to assess vaccination management by exploring the concordance and discordance between physicians' reported vaccination recommendations and patients' recall of having received those recommendations, as well as patients' adherence following a medical recommendation. PATIENTS AND METHODS: An anonymous online survey was sent to 8000 patients from a national patient association (ACCU Spain) and 1000 members of the Spanish IBD Working Group (GETECCU). RESULTS: A total of 144 physicians and 1302 patients responded (mean age of 43 years). Almost all physicians expressed concern about vaccination in IBD and 63% deemed them very important. Although 69% of physicians reported recommending influenza vaccination during pregnancy, only 11.1% of pregnant patients recalled having received such advice. Among patients who reported having received a vaccination recommendation, adherence varied widely by vaccine type, ranging from 55% for HPV to over 80% for influenza, pneumococcal, hepatitis B, and tetanus vaccines. The main reasons for non-adherence were the perception that vaccination was unnecessary and fear of adverse events. CONCLUSIONS: Discordance exists between physicians' reported vaccination practices and patients' recall of the information received. Although physicians awareness is high, communication gaps and other barriers may limit effective implementation.
OBJECTIVE: Gluten-free diets are increasingly adopted by individuals without gluten-related disorders, despite limited evidence for anti-inflammatory benefit. We evaluated whether varying gluten exposure influences intes...OBJECTIVE: Gluten-free diets are increasingly adopted by individuals without gluten-related disorders, despite limited evidence for anti-inflammatory benefit. We evaluated whether varying gluten exposure influences intestinal inflammation in healthy rats using fecal calprotectin (fKp) as the outcome. PATIENTS AND METHODS: Forty newly weaned male Wistar albino rats were randomized to four isocaloric, iso-nitrogenic diets for 12 weeks (n=10/group): (1) standard wheat-containing control, (2) gluten-free animal protein-based diet, (3) control diet supplemented with 6% vital wheat gluten, and (4) control diet supplemented with 12% vital wheat gluten. Food and water were provided ad libitum. After a 12-h fast, rats were sacrificed and cecal fecal samples were collected individually. fKp was measured using an enzyme-linked immunosorbent assay (ELISA). RESULTS: Mean fKp differed across groups (one-way ANOVA, p=0.030). Compared with the gluten-free group (26.57±5.77μg/g), fKp was lower with 6% gluten (23.33±5.14μg/g) and 12% gluten (23.57±4.86μg/g) (p=0.013). fKp did not differ between the standard control (29.98±5.76μg/g) and gluten-free diets (p>0.05). There was no difference between 6% and 12% supplementation, indicating a plateau effect. CONCLUSION: In healthy rats, gluten-containing diets did not increase intestinal inflammation as assessed by fKp. Gluten elimination provided no anti-inflammatory advantage over a standard diet, whereas moderate gluten supplementation was associated with lower fKp without a clear dose-response. Findings should be interpreted cautiously and considered hypothesis-generating rather than definitive.