OBJECTIVE: Chlamydia trachomatis is a prevalent cause of infectious proctitis, often misdiagnosed as cancer or inflammatory bowel disease (IBD). This study aims to describe the main clinical symptoms, together with endos...OBJECTIVE: Chlamydia trachomatis is a prevalent cause of infectious proctitis, often misdiagnosed as cancer or inflammatory bowel disease (IBD). This study aims to describe the main clinical symptoms, together with endoscopic and histopathological characteristics of C. trachomatis proctitis in the general population. PATIENTS AND METHODS: A retrospective observational study was conducted at a single institution, identifying all cases of proctitis due to C. trachomatis infection, detected by real-time PCR in rectal biopsy or anal smear, with endoscopic assessment. RESULTS: A total of 28 male patients were included (median age 37, IQR 31-48). Among them, 20 patients reported having sex with males. Concomitant infections included HIV (n=10), Neisseria gonorrhoea (n=4), and Treponema pallidum (n=2). A history of sexually transmitted diseases was reported by 18 patients (64%). The main clinical symptoms were rectal bleeding (79%) and diarrhoea (43%). The main endoscopic findings were rectal erythema (71%) and ulcers (57%), with rectal (89%) and sigmoid inflammation (11%). In 5 cases (18%), a single isolated deep rectal ulcer was the only finding. In 16 cases (57.1%), neoplasia, IBD or fissure was suspected according to endoscopy. Histological findings included mixed inflammatory infiltrate of lamina propria (95%), cryptitis (54%), and crypt abscesses (32%). CONCLUSIONS: Endoscopically detected C. trachomatis proctitis in men presents with worrisome symptoms and nonspecific rectal ulcers, with chronic inflammation histology. This generates doubts about differential diagnosis with IBD and rectal cancer.
Font R, Serradesanferm A, Clèries R
… +9 more, Solà J, Pellisé M, Balaguer F, Castellví JM, Navarro-Campàs O, Pascual-Argente N, Sánchez-Tilló E, Espinàs JA, Castells A
OBJECTIVE: The primary goal of a public health system is to ensure universal access to high-quality medical care. However, disparities in health outcomes have been observed across socio-demographic groups, some of them p...OBJECTIVE: The primary goal of a public health system is to ensure universal access to high-quality medical care. However, disparities in health outcomes have been observed across socio-demographic groups, some of them potentially related to their geographical location. To assess territorial equity, the Catalan Colorectal Cancer Screening Program was used, focusing on the adenoma detection rate (ADR) endoscopists. PATIENTS AND METHODS: This population-based screening program is based on fecal immunochemical testing. Positive individuals undergo colonoscopy in the endoscopy unit corresponding to their area of residence. Both ADR and serrated polyp detection rate (SPDR) of all endoscopists were assessed and reported in terms of variability among endoscopy units and proportion of endoscopists who did not reach pre-established quality standards (40% and 20%, respectively). RESULTS: A total of 35,825 colonoscopies performed by 206 endoscopists of 39 endoscopy units were evaluated. Analysis of ADR variability revealed that 11 units (28.2%) performed significantly above the average of Catalonia, while 3 units (7.7%) performed below it. In terms of SPDR variability, 22 units (56.4%) significantly exceeded the average, whereas 8 units (20.5%) fell below this benchmark. Moreover, all endoscopists in 28 units (71.8%) achieved the ADR threshold of 40%, while this was the case in only 12 (30.8%) when using the SPDR threshold of 20%. CONCLUSION: Quality of colonoscopy, measured by the ADR, was high with minimal variability among units; however, using the SPDR revealed greater variability. This analysis underscores the value of indicators derived from screening programs as essential tools for evaluating potential territorial inequities.
AIM: To identify factors associated with the presence of fatigue in patients with inflammatory bowel disease. PATIENTS AND METHOD: Prospective cross-sectional descriptive study conducted in a multidisciplinary centre for...AIM: To identify factors associated with the presence of fatigue in patients with inflammatory bowel disease. PATIENTS AND METHOD: Prospective cross-sectional descriptive study conducted in a multidisciplinary centre for the treatment of immune-mediated inflammatory disease (IMID). Participants were patients diagnosed with inflammatory bowel diseases (IBD) under follow-up in an advanced practice nurse (APN) consultation. Sociodemographic and clinical variables, biochemical parameters, disease activity, quality of life, severity of fatigue, anxiety and depression were collected. A multivariate analysis was performed with logistic regression adjusted for sex and years of disease progression. RESULTS: A total of 243 patients were included, 174 (71.6%) with Crohn's disease and 69 (28.4%) with ulcerative colitis; 73 (30.2%) reported fatigue. Patients with fatigue had a significantly lower quality of life EuroQol-5D-5L: 60.08 vs. 76.34, (P<.001, 95%CI: 12.15-20.36) and IBDQ-9 57.53 vs. 76.54 (P<.001, 95%CI: 15.35-22.67). The regression model adjusted for sex and years of disease included moderate disease activity (OR: 4.88, P<.001, 95%CI: 2.13-11. 14), probable case of anxiety (OR: 2.16, P=.031, 95%CI: 0.78-4.34), probable case of depression (OR: 2.86, P=.004, 95%CI: 1.41-5.81). CONCLUSIONS: Fatigue was significantly associated with poorer health-related quality of life in patients with moderate disease activity and those experiencing anxiety or depression. These findings highlight the necessity of a comprehensive approach that includes early detection of fatigue and associated psychosocial factors.
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern, particularly among individuals with obesity. While metabolic and behavioral risk factors have been well des...BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern, particularly among individuals with obesity. While metabolic and behavioral risk factors have been well described, the role of psychosocial determinants, such as weight stigma, remains underexplored. OBJECTIVES: To assess the association between sociodemographic variables, healthy lifestyle behaviors, and internalized weight stigma with MASLD risk in a large cohort of obese workers across Spain. PATIENTS AND METHODS: This cross-sectional study analyzed data from 26,816 obese employees who underwent occupational health screenings between January 2021 and December 2024. MASLD risk was assessed using three validated indices: the Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), and Lipid Accumulation Product (LAP). Sociodemographic characteristics, adherence to the Mediterranean diet, physical activity, smoking status, and weight stigma (assessed by the Weight Bias Internalization Scale) were evaluated. Multivariable logistic regression models were used to estimate associations. RESULTS: Weight stigma was significantly associated with higher risk of MASLD across all three indices, independent of age, sex, social class, and health behaviors. Participants with internalized weight stigma were 1.6-2.3times more likely to present with high-risk scores. Sociodemographic disparities and unhealthy lifestyle factors also contributed to elevated MASLD risk. CONCLUSIONS: Beyond metabolic and behavioral determinants, internalized weight stigma emerges as a strong independent factor associated with MASLD risk. These findings underscore the importance of incorporating psychosocial components into liver disease prevention strategies in occupational settings.
OBJECTIVE: The introduction of biologic therapies has transformed the management of Crohn's disease (CD), yet few studies have evaluated their impact on real-world outcomes over time. We aimed to compare two population-b...OBJECTIVE: The introduction of biologic therapies has transformed the management of Crohn's disease (CD), yet few studies have evaluated their impact on real-world outcomes over time. We aimed to compare two population-based cohorts of CD patients in Navarra, Spain, diagnosed in 2001-2003 (cohort A) and in 2017 (cohort B), to assess whether early use of advanced therapies has altered disease trajectory. PATIENTS AND METHODS: This prospective, multicentre cohort study included adult patients with confirmed CD from two periods. Clinical characteristics, treatments, hospitalizations, and surgical outcomes were analysed over five years. Time-to-event analyses were performed using Kaplan-Meier curves and Cox regression models. RESULTS: A total of 128 patients were included (83 in cohort A, 45 in cohort B). At diagnosis, immunomodulators were used in 1.2% of cohort A vs. 21% in cohort B, and biologics in 0% vs. 51%, respectively. Initiation of immunomodulators (hazard ratio [HR]: 1.94; 95% CI: 1.11-3.39) and biologics (HR: 5.42; 95% CI: 2.57-11.42) occurred earlier in cohort B. Hospitalization at diagnosis was more frequent in cohort A (47% vs. 22%), and five-year hospitalization rates were significantly lower in cohort B (34% vs. 63%; HR: 0.52; 95% CI: 0.28-0.96). No significant differences in intestinal or perianal surgery rates were observed between cohorts. CONCLUSIONS: Earlier and more widespread use of advanced therapies in CD has been associated with reduced hospitalization over time, although surgical rates have remained stable. These findings suggest a shift toward earlier and more intensive treatment strategies in routine clinical practice.
INTRODUCTION: The use of antiplatelet and anticoagulant drugs is common in patients undergoing elective endoscopic procedures. To minimize both bleeding and thromboembolic risks, an individualized assessment is essential...INTRODUCTION: The use of antiplatelet and anticoagulant drugs is common in patients undergoing elective endoscopic procedures. To minimize both bleeding and thromboembolic risks, an individualized assessment is essential. For this purpose, the Societat Catalana de Digestologia (SCD) commissioned a consensus document aimed at providing practical recommendations based on the best available evidence and expert agreement. MATERIAL AND METHODS: A panel of 10 specialists from the fields of Gastroenterology, Cardiology, Hematology, and Anesthesiology were involved in the development of the document. A non-systematic review of the literature was conducted using a modified Delphi method through online voting. Recommendations were reviewed and discussed during each round until consensus was reached. Recommendations with ≥80% agreement were accepted. RESULTS: A total of 16 endoscopic procedures were assessed based on their hemorrhagic risk, and tailored management guidelines were defined to different groups of antithrombotic agents. The document includes a management algorithm and stratification tables for bleeding and thrombotic risk. CONCLUSION: The recommendations developed by the SCD integrate international evidence and are adapted to the local healthcare context, providing a valuable tool for clinical practice. The importance of multidisciplinary coordination and effective communication with the patient is emphasized to ensure safety throughout the periprocedural period.
Estremera-Arevalo F, Bravo-Meléndez S, Hijos-Mallada G
… +24 more, Guarner-Argente C, Murzi M, Rodríguez-Santiago E, Herreros de Tejada A, Uchima-Koecklin H, Miranda-García P, Barquero-Declara D, Riesco-López JM, de María-Pallarés P, Fernández-Esparrach MG, Sánchez-Yagüe A, Aresté-Anduaga I, Gonzalez-Gete G, Teruel Sanchez-Vegazo C, Peñas-García B, Parejo-Carbonell S, Martínez-Sánchez A, Rojo E, Mata-Bilbao A, Araujo IK, Neurogastroenterology and Motility Working Group of the Spanish Association of Gastroenterology (AEG), GSEED of mucosal resection and third space endoscopy, Montori S, Gómez M, Albeniz E
OBJECTIVE: Peroral endoscopic myotomy (POEM) has emerged as a prominent endoscopic treatment for achalasia and other esophageal motility disorders (EMD). The objective of this study is to evaluate its clinical efficacy a...OBJECTIVE: Peroral endoscopic myotomy (POEM) has emerged as a prominent endoscopic treatment for achalasia and other esophageal motility disorders (EMD). The objective of this study is to evaluate its clinical efficacy and safety after its implementation in Spain. PATIENTS AND METHODS: This is a multicenter registry conducted across 13 hospitals in Spain. Symptomatic patients undergoing POEM for any EMD were recruited between June 2016 and February 2023. Baseline characteristics, procedural details and outcomes related to efficacy and safety during short and long-term follow-up were analyzed. RESULTS: A total of 441 patients were enrolled, with type II achalasia representing the most common diagnosis (62.1%). POEM was the primary treatment in 277 patients (62.8%). Clinical success data were available for 396 patients, with a success rate of 94.4% at the last available follow-up (2 years in 117 patients, 1 year in 140, <1 year in 139). A higher baseline Eckardt score was an independent risk factor for clinical failure in the long-term follow-up (p=0.024). Symptomatic reflux occurred in 4.7% of the patients, with a significant esophagitis rate of 11.3%. Complication incidence was 9.3% (41/441), including 14 (3.2%) severe events. Older age (p=0.025) and total procedure duration (p=0.036) were independent risk factors for complications, while mucosal injury was found to be a predictor of severe complications (p=0.027). CONCLUSIONS: These findings confirm the clinical efficacy and safety during the implementation phase of POEM for all EMD in Spain.
BACKGROUND AND AIMS: The incidence and prevalence of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are increasing across Latin America. IBD has an important impact on patie...BACKGROUND AND AIMS: The incidence and prevalence of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are increasing across Latin America. IBD has an important impact on patients' quality of life and is associated with significant healthcare resource utilization (HCRU). This study aimed to describe the more recent epidemiological characteristics and HCRU patterns of IBD in Colombia. METHODS: Retrospective study using real-world data from the national claims database SISPRO (Sistema de Información para la Protección Social) between 2017 and 2021. The data considered were sociodemographic (sex and age), epidemiological (incidence, prevalence, and mortality), and HCRU data. RESULTS: We identified 54,961 cases of prevalent ulcerative colitis (UC) and 13,136 cases of Crohn's disease (CD). Between 2017 and 2019, the incidence rates for UC increased from 3.82 to 5.18 per 100,000 individuals, while the incidence for CD rose from 0.48 to 0.83 per 100,000. The prevalence of these conditions reached its highest point in 2019, with UC at 48.65 and CD at 15.41 per 100,000 population. Mortality data indicated 259 deaths registered with UC and 77 with CD. The utilization of biologic therapies saw a significant rise from 2020 to 2021, particularly with anti-TNF agents being the most frequently prescribed. The patterns observed in outpatient visits and hospital admissions followed similar trajectories, exhibiting a downturn during the COVID-19 pandemic. CONCLUSIONS: This study examined the epidemiology, HCRU, and costs of IBD in Colombia using SISPRO data. Despite a decrease during the COVID-19 pandemic, the incidence and prevalence of IBD have increased over time, accompanied by elevated HCRU and medication costs. These insights could contribute to informed decision-making and resource allocation for enhanced patient care in Colombia.
BACKGROUND: Unlike Crohn's disease, ulcerative colitis (UC) lacks predictive factors of a bad prognosis. Therefore, immunosuppressant therapy is only considered in a step-up strategy when steroid refractoriness or depend...BACKGROUND: Unlike Crohn's disease, ulcerative colitis (UC) lacks predictive factors of a bad prognosis. Therefore, immunosuppressant therapy is only considered in a step-up strategy when steroid refractoriness or dependency develops. OBJECTIVE: To identify predictive factors for the early use of immunosuppressants, biological agents and colectomy in UC. PATIENTS AND METHODS: Retrospective, observational study of an incident cohort of UC at two referral centres over a 7-year period. Demographic, clinical, endoscopic and biologic variables at UC diagnosis were collected and early use (within five years) of immunosuppressants, biological agents and colectomy was assessed for a maximum of five years. RESULTS: A total of 239 patients were included. At baseline, 32% presented with extensive colitis, 15% severe disease activity and 13% large ulcers at diagnostic endoscopy. At the end of follow-up, 24% were exposed to thiopurines, 18% to biologicals and 4% were colectomized. The need for thiopurines, biological agents or colectomy was independently associated with extensive UC at diagnosis (OR 5.3; IC95% 1.6-17.2), the need for corticosteroids at disease onset (OR 7.8; IC95% 2.6-23.9) and proximal progression during follow-up (OR 13; IC95% 2.3-73.4). CONCLUSIONS: Less than a third of patients with UC use thiopurines or biological agents within the first five years of disease course. Unfortunately, there are no predictive factors robust enough to allow for the early introduction of advanced therapies at disease onset.
Mañosa M, Calafat M, Francia E
… +12 more, Riba F, Mesonero F, Suárez C, García-López S, Losfablos F, Calvet X, Domènech E, Gutiérrez Casbas A, Ordás I, Menchén L, Rodríguez-Moranta F, Zabana Y
Frailty is a state of vulnerability characterised by a decrease in physiological reserve and the ability to respond to stress, which increases the risk of complications, adverse effects of treatments and functional decli...Frailty is a state of vulnerability characterised by a decrease in physiological reserve and the ability to respond to stress, which increases the risk of complications, adverse effects of treatments and functional decline. Assessing frailty allows the biological age of patients to be determined, beyond their chronological age, providing a more accurate picture of their health status and care needs. The proportion of older adults with IBD is increasing in parallel with the ageing of the general population, and it is estimated that in the next decade, more than a third of IBD patients will be over 60 years of age. This population may suffer from complications arising from previously developed IBD and is particularly susceptible to developing side effects from treatment, making comprehensive assessment essential in order to identify those who are most vulnerable. Frailty is compounded by other geriatric syndromes such as comorbidity and polypharmacy, which can significantly interfere with the management and course of IBD, influencing the therapeutic strategy and prognosis. OBJECTIVE: In this context, comprehensive geriatric assessment should be systematic in elderly patients with IBD, with the aim of detecting functional deficits and implementing specific interventions for nutritional support, functional rehabilitation and psychological care to optimise their progress. This position paper aims to establish recommendations in this regard based on the available evidence. CONCLUSIONS: The systematic incorporation of comprehensive geriatric assessment in the management of older people with IBD represents an essential strategy for improving clinical outcomes, adapting treatments to the patient's functional capacity and promoting a truly person-centred approach.
Casellas F, Gutiérrez-Casbas A, Rodríguez C
… +12 more, P Gisbert J, Riestra S, Herrera de Guise C, Vera-Mendoza I, Martínez-Montiel P, Bernardo S, Medeiros I, Aparicio J, Tagarro I, Letosa-Abián T, Montoto C, Muñoz F
OBJECTIVE: Real-world evidence (RWE) on vedolizumab (VDZ), an anti-lymphocyte trafficking treatment that selectively targets the α4β7/MAdCAM-1 interaction on the gut, is mostly limited to patients who are repeatedly refr...OBJECTIVE: Real-world evidence (RWE) on vedolizumab (VDZ), an anti-lymphocyte trafficking treatment that selectively targets the α4β7/MAdCAM-1 interaction on the gut, is mostly limited to patients who are repeatedly refractory to anti-tumor necrosis factor-alpha (anti-TNF-α), and other treatments. The EVOLVE-IBERIA study assessed VDZ or anti-TNF-α as first- or second-line biologic treatment, in patients with Crohn's disease or ulcerative colitis (UC); here, we present the outcomes in patients with UC. PATIENTS AND METHODS: Medical records were retrospectively reviewed from 25 hospitals in Spain and Portugal. Eligible patients with UC were aged ≥18 years and had received treatment with first- or second-line VDZ or anti-TNF-α. Objectives were to evaluate clinical effectiveness, safety, and treatment patterns of VDZ and anti-TNF-α, and to characterize healthcare resource utilization. Baseline covariates were balanced in both cohorts by means of propensity scores, using the inverse probability of treatment weighting (PS-IPTW) method. RESULTS: A total of 199 patients with UC were included (median follow-up: 24.0 months). At Week 52, clinical response rates were 75.6% and 73.2% (p=0.72) and clinical remission rates were 56.6% and 62.0% (p=0.49), in the VDZ cohort and anti-TNF-α cohort, respectively. Treatment-related adverse event rates per 100 patient-years were 0.23 in the VDZ cohort and 1.1 in the anti-TNF-α cohort (p=0.037). CONCLUSION: The similar long-term effectiveness and lower incidence of adverse events of VDZ compared with anti-TNF-α in the real-world setting, confirm the favorable benefit:risk ratio of VDZ as first- or second-line biologic treatment for UC.
INTRODUCTION: Liver transplantation continues to be the most effective treatment of choice for patients with end-stage liver disease. Patients who go through that process experienced emotional stress and transplanted pat...INTRODUCTION: Liver transplantation continues to be the most effective treatment of choice for patients with end-stage liver disease. Patients who go through that process experienced emotional stress and transplanted patients have a high rate of readmission. AIMS: This study aims to analyze the relation between mental health and hospital readmissions during the first year after liver transplantation. METHOD: A prospective study was conducted in a cohort of liver transplant patients in a tertiary hospital. Sociodemographic and clinical variables were collected. A descriptive analysis of the data and a multivariate study using a mixed linear model were performed. RESULTS: Liver transplant patients improve their mental health within the first year. Hospital admissions during the first-year impact negatively increasing anxiety and depression in liver transplant patients, especially in women. CONCLUSION: The nurse must carry out a continuous psychological evaluation during the process and manage the necessary care, coordinating interdisciplinary care with the appropriate professionals to provide the emotional and psychological care. A multidisciplinary and interdisciplinary team should focus on the prevention of hospital admissions, controlling and managing cardiovascular risk, adherence to immunosuppressive treatment, adherence to the clinical follow-up prescribed by physicians, prevention of infections and promotion of healthy habits.