INTRODUCTION: The use of herbal products and dietary supplements (HDS) carries a potential risk of liver toxicity. Data on HDS consumption among patients attending liver disease clinics remain unexplored. OBJECTIVE: To d...INTRODUCTION: The use of herbal products and dietary supplements (HDS) carries a potential risk of liver toxicity. Data on HDS consumption among patients attending liver disease clinics remain unexplored. OBJECTIVE: To determine the frequency, types and reasons for HDS consumption in patients attending a specialized liver disease outpatient clinic. METHODS: Prospective study including consecutive patients attending the hepatology outpatient clinic at the Hospital Clínic of Barcelona from June 2023 to October 2023. Following a standard medical visit, a trained nurse conducted a structured interview to assess HDS consumption. RESULTS: A total of 150 patients were included, with a median age of 59 (IQR: 49-67) and male predominance (56%, n=84). Only 12 patients (8%) reported HDS consumption during a standard medical interview, while the number increased to 92 (61%) after nurse-led structured interview. The primary reasons for dietary supplements use included vitamin supplementation (43%), fitness improvement (10.5%) and hair/nail health (10.5%). For herbal products, the most common reason for use was pleasure (73%). Reported HDS products with potential hepatotoxicity (levels A and B) were green tea (n=16), turmeric with black pepper (n=11), aloe (n=2), greater celandine (n=1) and black cohosh (n=1). CONCLUSION: HDS use is highly prevalent among patients with liver disease, but a structured interview is crucial to detect their consumption, as they usually forget spontaneous reporting. Importantly, a significant proportion of these products carry a risk of hepatic toxicity, underscoring the need for increased patient education and clinical vigilance.
OBJECTIVE: To evaluate the effectiveness of the Lille Index (LI) on day 2 (LI2) and day 4 (LI4) in predicting short-term mortality in patients with severe alcohol-associated hepatitis (SAH) and to assess its concordance...OBJECTIVE: To evaluate the effectiveness of the Lille Index (LI) on day 2 (LI2) and day 4 (LI4) in predicting short-term mortality in patients with severe alcohol-associated hepatitis (SAH) and to assess its concordance compared to the Lille Index on day 7 (LI7). PATIENTS AND METHODS: This retrospective, observational, single-center study included SAH patients admitted between 2016 and 2023. SAH was defined as a Maddrey score ≥32 and/or a MELD score ≥21. The predictive ability of LI2, LI4, and LI7 for 28-, 90-, and 180-day mortality was analyzed using AUC, Cox regression (Hazar Ratio (HR)), and Kaplan-Meier curves. RESULTS: Among 65 SAH patients, 62 received corticosteroids. Median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (P>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (68.33% vs. 70.97%, P=.752) and LI4 vs. LI7 (73.33% vs. 70.97%, P=.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7 was 93.33%. RESULTS: Among 65 SAH patients, 62 received corticosteroids. The median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (P>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (P=.752) and LI4 vs. LI7 (P=.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7, 93.33%. CONCLUSIONS: LI2 and LI4 were comparable to LI7 in predicting short-term mortality in SAH. Earlier calculation, particularly LI2, could anticipate clinical decisions in poor prognosis patients, such as corticosteroid discontinuation or evaluation for liver transplantation in selected cases.
OBJECTIVE: To estimate the incidence of complications following ileostomy reversal and to identify associated risk factors. PATIENTS AND METHODS: A retrospective cohort study was conducted, including patients who underwe...OBJECTIVE: To estimate the incidence of complications following ileostomy reversal and to identify associated risk factors. PATIENTS AND METHODS: A retrospective cohort study was conducted, including patients who underwent rectal cancer surgery with a protective ileostomy. The minimum follow-up period was one year. A univariate analysis was performed to identify potential risk factors for complications, and variables with P<0.1 were included in a multivariate analysis. RESULTS: Between January 1, 2015, and December 31, 2023, a total of 220 patients underwent surgery. Thirteen percent did not undergo ileostomy reversal. Thus, 193 patients were included in the final analysis. The median time to ileostomy reversal was 292 days. Postoperative complications occurred in approximately 27.5% of cases. Among the potential risk factors, albumin levels <4g/dl, open surgical approach for rectal pathology, absence of efferent loop stimulation, and side-to-side anastomosis were associated with P<.1 in univariate analysis. In the multivariate analysis, only low albumin levels and the open surgical approach for rectal pathology remained significantly associated with an increased risk of complications. CONCLUSION: Modifiable factors such as the use of a laparoscopic approach for rectal surgery, stimulation of the efferent loop, and optimization of preoperative nutritional status may help reduce the incidence of postoperative complications.
OBJECTIVE: Managing Crohn's disease (CD) requires addressing factors beyond medical treatment alone, including health-related quality of life (HRQoL) and physical activity. This study aimed to understand the relationship...OBJECTIVE: Managing Crohn's disease (CD) requires addressing factors beyond medical treatment alone, including health-related quality of life (HRQoL) and physical activity. This study aimed to understand the relationships between different intensities of physical activity, HRQoL, and inflammatory biomarkers in CD, considering sex as a factor that could influence these associations. PATIENTS AND METHODS: A cross-sectional, observational study was conducted in 63 CD patients. Sociodemographic and clinical data, including C-reactive protein and fecal calprotectin determinations, were collected. The Inflammatory Bowel Disease Questionnaire (IBDQ-9) and the Global Physical Activity Questionnaire (GPAQ) were used to measure HRQoL and physical activity, respectively. RESULTS: Although females had similar inflammation levels to males, they engaged in less physical activity and reported lower HRQoL (especially in psychosocial wellbeing). Sedentary behavior and intense physical activity negatively impacted HRQoL in the overall sample and only in females. Higher fecal calprotectin concentrations were associated with poorer HRQoL in the total group and only in males. No correlation was found between inflammation and physical activity. CONCLUSIONS: Sex differences influence the relationship between inflammation, physical activity, and HRQoL in CD. Given the greater impact of CD on emotional and social wellbeing in females, irrespective of physiological measures of inflammation, our findings support considering sex differences, which may inform more individualized approaches to improve HRQoL.
OBJECTIVES: Pancreatic surgery is burdened with high morbidity and mortality. There are quality indicators of the surgical process known as textbook outcomes (TO) that have been validated in areas such as esophagogastric...OBJECTIVES: Pancreatic surgery is burdened with high morbidity and mortality. There are quality indicators of the surgical process known as textbook outcomes (TO) that have been validated in areas such as esophagogastric surgery or liver surgery, and are beginning to be used in pancreatic surgery. This indicator assesses the absence of: 1) Mortality, 2) Pancreatic fistula, 3) Hemorrhage, 4) Biliary fistula, 5) Clavien-Dindo>II and 6) Readmission; TO is considered if all criteria are got. The aim of this study is to assess the impact of the achievement of TO on the prognosis of pancreatic adenocarcinoma. PATIENTS AND METHODS: Retrospective comparative study between two periods; before and after the creation of a pancreatic surgery unit. The results have been evaluated using Textbook Outcomes and the impact on survival of the achievement of these criteria was analyzed. RESULTS: A total of 185 patients with pancreatic adenocarcinoma were analyzed, divided into two 5-year periods before and after the creation of the pancreatic surgery unit. There were no significant differences in clinical-pathological variables. Since the creation of the unit, TO achievement increased from 47 to 80.7% (P<.05). The OS of patients at 1, 2, and 3 years in the groups with and without TO criteria fulfillment was 86.9, 55.7, 41 and 62.7, 40.3 and 31.3% respectively, with a statistically significant difference as shown in Image 1 (P=.013). Multivariate analysis of OS showed that compliance with all TOs significantly affects mortality (HR: 0.5 [0.31-0.81]; P=.004). CONCLUSION: The results support the hypothesis that the achievement of the TO surgical quality criteria has a positive impact on the oncological prognosis of curative surgery for pancreatic cancer. Centralization of pancreatic cancer surgery could help to meet the surgical quality criteria largely and thus improve the prognosis of patients.
OBJECTIVE: Exocrine pancreatic insufficiency (EPI) is common after pancreatic surgery. In patients with chronic pancreatitis, our previous results supported the use of fecal elastase-1 (FE-1) over the C-mixed triglycerid...OBJECTIVE: Exocrine pancreatic insufficiency (EPI) is common after pancreatic surgery. In patients with chronic pancreatitis, our previous results supported the use of fecal elastase-1 (FE-1) over the C-mixed triglyceride breath test (C-MTBT) for the diagnosis of EPI. However, it is poorly established how the performance of these two tests compares to the diagnosis of EPI after pancreatic surgery. PATIENTS AND METHODS: FE-1 and C-MTBT were compared with the gold standard coefficient of fat absorption (CFA). Area under ROC curve (AUC) and best cutoffs were used to assess presence of EPI. Patient characteristics were evaluated by extent of pancreatic resection. RESULTS: The AUC (95% confidence interval) was 0.724 (0.578-0.871) for FE-1 and 0.640 (0.482-0.799) for C-MTBT in the diagnosis of EPI. A pairwise comparison of the FE-1 and C-MTBT AUCs showed no statistically significant difference (P=.20). The best cut-off point was 65.5μg/g for FE-1 and 22.5% for C-MTBT. According to contingency analysis, both the FE-1 threshold of 65.5μg/g (P=.005) and the C-MTBT threshold of 22.5% (P=.015) showed statistical significance for diagnosing EPI. CONCLUSION: FE-1 was more accurate for diagnosing EPI after pancreatic surgery, but the differences were not statistically different.
BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) features diverse clinical presentations and progressions, impacting IFX exposure. Understanding IFX serum concentration changes is crucial for tailored monitoring in...BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) features diverse clinical presentations and progressions, impacting IFX exposure. Understanding IFX serum concentration changes is crucial for tailored monitoring in specific patient groups. The main objective of this study was to analyze ITL trajectories in patients with IBD to identify distinct groups and subgroups, revealing heterogeneity in treatment responses. METHODS: A retrospective cohort study was conducted involving IBD patients treated with infliximab in a regional reference hospital in Spain. Latent class linear mixed models were applied to identify subgroups based on serum infliximab measurements over time. To analyze the factors associated with IFX discontinuation, we employed both logistic regression and Cox regression models. RESULTS: The study included 165 IBD patients, and a total of 799 ITL samples were analyzed. The selected model included three clusters, with a random intercept and a random effect on both time and natural cubic spline time in the linear mixed model. Cluster 1 (20.6%) had lower IFX exposure, with 93.9% experiencing treatment discontinuation, compared to 45.1% in Cluster 2 (43.0%) and 43.3% in Cluster 3 (36.4%) (p<0.001). Treatment discontinuation was observed in 91 individuals (55.2%) out of the total patients. In the multivariate analysis, the presence of cluster 1 was a significant predictor (OR: 7.25, 95% CI: 1.45-36.12). Bayesian dose adjustment was found to significantly reduce the risk of IFX discontinuation (OR: 0.19, 95% CI: 0.46-1.96). CONCLUSIONS: The lack of TDM during induction and a lower proportion of adjustments made through Bayesian methods were associated with a subgroup demonstrating suboptimal pharmacokinetic profiles and reduced drug persistence. These findings highlight the clinical relevance of model-informed TDM in optimizing IFX exposure and minimizing treatment discontinuation in IBD.
Non-cirrhotic non tumoral portal vein thrombosis is an entity of low prevalence but with a potential risk of developing complications of portal hypertension, which has a significant prognostic impact on patients. In the...Non-cirrhotic non tumoral portal vein thrombosis is an entity of low prevalence but with a potential risk of developing complications of portal hypertension, which has a significant prognostic impact on patients. In the absence of liver cirrhosis, it is essential to rule out other chronic liver disease as well as local factors and prothrombotic conditions. Therefore, a thorough workup should be initiated immediately. In acute thrombosis, anticoagulation is the main treatment to prevent progression of thrombosis and development of intestinal ischemia. In chronic forms, however, close follow-up is essential to prevent and treat complications of portal hypertension. For refractory complications of portal hypertension, endovascular recanalization techniques have promising results and are becoming increasingly important.
Rivero-Sánchez L, Castillo-Iturra J, García-Rodríguez A
… +23 more, García Zafra B, Díez Redondo P, Núñez Rodríguez H, Ponce M, San Juan M, Borque Barrera P, Seoane A, Albert Carrasco M, Zaffalon D, Guarner C, Murzi M, Jover R, Medina-Prado L, Aspuru Rubio K, João Matias D, González Suárez B, Córdova H, Fernández-Simón A, Araujo I, Ginés À, Pellisé M, Balaguer F, Fernández-Esparrach G
BACKGROUND AND AIMS: Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality. Colonoscopy is the diagnostic gold standard, although its performance in symptomatic patients is limited. During the...BACKGROUND AND AIMS: Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality. Colonoscopy is the diagnostic gold standard, although its performance in symptomatic patients is limited. During the COVID-19 pandemic, the AEG-SEED societies proposed a clinical prioritization system. The aim of this study was to validate its diagnostic performance in detecting clinically relevant lesions (CRLs), including CRC, and to compare it with the fecal immunochemical test (FIT). PATIENTS AND METHODS: A national multicenter retrospective study was conducted in 12 Spanish hospitals. A total of 1078 adult patients with digestive symptoms attended between April and December 2020 were included. Colonoscopies were prospectively classified according to priority levels (P1, P2, P3). RESULTS: CRLs were identified in 18% of patients, including 36 cases of CRC (3%). The diagnostic yield was highest in P1 (PPV 27%, AUC 0.57 for CRLs; PPV 7%, AUC 0.64 for CRC), and decreased in P2 and P3. FIT was performed in 26% of patients based on the referring physician's clinical judgment, showing higher sensitivity and negative predictive value (NPV) for CRC (100%) and a higher AUC (0.69) compared to clinical criteria. CONCLUSIONS: The AEG-SEED clinical criteria offer moderate value for prioritizing colonoscopies in the absence of FIT. However, FIT demonstrates superior diagnostic performance and should be systematically incorporated. The combination of symptoms improves accuracy compared to isolated symptoms.
Llach J, Flores L, de Hollanda A
… +10 more, Andreu A, Espinet-Coll E, Casanova G, Olivé MI, Rivas E, Ibarzabal A, Osorio J, Vidal J, Balaguer F, Pellisé M
INTRODUCTION: Traditionally, anorectal abscesses and anal fistulas have been considered to originate from a common site within the fistula tract (the intersphincteric space), according to the cryptoglandular hypothesis....INTRODUCTION: Traditionally, anorectal abscesses and anal fistulas have been considered to originate from a common site within the fistula tract (the intersphincteric space), according to the cryptoglandular hypothesis. Understanding the distribution of cells and inflammatory mediators in different parts of the anal fistula tract is of significant interest. This study aimed to analyze the inflammatory characteristics of anal fistula tract specimens. METHODS: An observational study was conducted on specimens retrieved from consecutive cases. We analyzed samples of chronic anorectal fistulas, which were topographically divided into three parts: superficial part (including the external fistula opening, close to the perianal skin), middle (including the intersphincteric space), and deep part (close to the anal canal, including the internal fistula opening). These samples were reviewed under microscopy to describe cell types using hematoxylin-eosin staining and the presence of pro-inflammatory cytokines TNF-alpha and IL-36 using immunohistochemical staining. RESULTS: Fistula tract samples were obtained surgically from 15 patients. No epithelial lining was observed in any part of the samples. We found a predominance of granulation tissue with chronic inflammatory components and no signs of acute inflammation, with no differences among the different parts of each sample studied. Immunohistochemistry revealed the presence of TNF-alpha throughout the fistulous tract, with an increasing trend towards the deep third (internal opening), although this was not statistically significant. In contrast, IL-36 was uniformly distributed across all three parts of the fistula tract. CONCLUSIONS: There is no specific site within the anal fistula tract that shows distinct findings related to the inflammatory process.