BACKGROUND AND AIMS: This study aimed to provide a comprehensive nationwide assessment of the status of nursing management in inflammatory bowel disease (IBD). METHODS: A nationwide observational cross-sectional survey s...BACKGROUND AND AIMS: This study aimed to provide a comprehensive nationwide assessment of the status of nursing management in inflammatory bowel disease (IBD). METHODS: A nationwide observational cross-sectional survey study was conducted. Nurses involved in the care of patients with IBD completed the 90-item Nursing Care Quality in IBD Assessment (NCQ-IBD) questionnaire which classifies the level of quality of care from A (highest) to D (lowest). RESULTS: A total of 71 f questionnaires were analyzed. In this study, category A was achieved in 2 (2.8%) cases, category B in 53 (74.6%), and category C in 16 (22.5%). Of the list of 27 professional competencies identified for a specialized IBD nurse, 23 (85.2%) were met by more than 70% of participants. Regarding the presence of specific nursing IBD care only 28 (39.4%) worked for more than 4.5days/week. About 88.7% of nurses used clinical practice guidelines or protocols and 74.6% applied scales for assessing anxiety and depression, but just 18.8% and 25.4% evaluated IBD classification and activity indexes, respectively. Only 53.5% of participants reported to have available training plan in IBD. In the last 5 years, 25.4% of professionals had participated in more than five research projects, 9.9% had presented more than five communications in meetings, and 14.1% had published more than three articles. CONCLUSIONS: Nursing care was highly satisfactory. Signage on nursing consultation doors, administrative support, holiday coverage, encouraging research, and primarily increasing the ratio of nurses working full-time, are areas for improvement.
Ortiz de Solórzano Reig M, López de la Cruz J, Aso Gonzalvo MC
… +7 more, Aguilar Muñiz A, Latre Santos M, Ceamanos Ibarra E, Escuín Sanmartín M, Bernal Bandrés G, García Mateo S, Millastre Bocos J
OBJECTIVE: The objective of this research is to assess the accuracy and reliability of metagenomic next-generation sequencing (mNGS) in identifying pathogens in spontaneous bacterial peritonitis (SBP) patients and its im...OBJECTIVE: The objective of this research is to assess the accuracy and reliability of metagenomic next-generation sequencing (mNGS) in identifying pathogens in spontaneous bacterial peritonitis (SBP) patients and its impact on antibiotic treatment decisions. METHODS: Electronic databases were searched up to July 31, 2023. Studies reporting mNGS diagnostic sensitivity and specificity in SBP were included. Random or fixed-effects models were used. Heterogeneity was assessed using Chi-squared test and I statistics. RESULTS: Out of 75 identified studies, four studies with a total of 420 SBP patients were included. The pooled sensitivity for mNGS in ascites was 94% (95% CI: 86-97%), and specificity was 81% (95% CI: 71-89%). The AUC was calculated to be 0.95 (95% CI: 0.92-0.96), indicating high diagnostic accuracy. The most common pathogens identified by mNGS were Gram-positive bacteria (36%), followed by Gram-negative bacteria (29%), viruses (22%), and fungi (11%). CONCLUSION: mNGS shows high diagnostic accuracy in detecting pathogens in SBP patients, offering significant value in optimizing antimicrobial therapy. Its ability to identify a broad spectrum of pathogens makes it a promising tool in clinical management of SBP.
OBJECTIVE: The optimal timing for high-risk patients with acute upper gastrointestinal bleeding (AUGIB) remains uncertain. The study aimed to evaluate whether the timing of endoscopy influences outcomes in high-risk pati...OBJECTIVE: The optimal timing for high-risk patients with acute upper gastrointestinal bleeding (AUGIB) remains uncertain. The study aimed to evaluate whether the timing of endoscopy influences outcomes in high-risk patients with AUGIB. PATIENTS AND METHODS: We conducted a retrospective, international, multicenter cohort study. High-risk patients (Glasgow-Blatchford score >7 points) with AUGIB, who underwent therapeutic endoscopy between September and December 2023 (n=511), were recruited. Patients were classified into three groups based on endoscopic timing: urgent (t≤6h), early (6<t≤24h) and elective (t>24h). Using descriptive statistics and logistic regression analyses, we identified the optimal timing for endoscopy and analyzed its association with 30-day outcomes, adjusting for confounding factors. RESULTS: The results showed that urgent timing (n=130) was associated with worse outcomes compared to early (n=205) and elective (n=176) endoscopy, including higher 30-day all-cause mortality (p=0.047), increased rates of repeat endoscopy (p=0.034), higher 30-day transfusion rates (p=0.021), and longer lengths of stay (p=0.038). These findings were particularly consistent among patients admitted with non-variceal bleeding. In the multivariate analysis, urgent endoscopy (OR 2.47, 1.28-4.57), Charlson index (OR 1.39, 1.01-1.93), systolic blood pressure <90mmHg (OR 3.66, 1.44-9.31), tachycardia (OR 1.02, 1.01-1.05), and malignancy (OR 1.68, 1.37-7.73) were identified as worse prognostic factors. CONCLUSIONS: High-risk patients with AUGIB who underwent urgent endoscopy exhibited worse outcomes, particularly those patients with non-variceal bleeding. Comorbidities, shock, urgent endoscopy and malignancy were identified as predictors of 30-day mortality. These findings highlight the importance of prior resuscitation, pharmacotherapy, and early endoscopy.
Carreras I Hoyos M, Correa Bonito A, García Septiem J
… +5 more, Barreta Vargas SE, Viamontes Ugalde F, Gijón Moya F, Álvarez Hernández MDC, Martín Pérez E
Rodríguez-Lago I, Casas-Deza D, Rimola J
… +11 more, Calafat M, Ferreiro-Iglesias R, Pellino G, Avellaneda N, Iborra M, Barreiro-de Acosta M, Gutiérrez Casbas A, Menchén L, Ordás I, Rodríguez-Moranta F, Zabana Y
Crohn's disease consists on a complex condition where, despite most patients initially present with an inflammatory behavior, a significant proportion develop complicated lesions such as strictures, fistulas, abscesses,...Crohn's disease consists on a complex condition where, despite most patients initially present with an inflammatory behavior, a significant proportion develop complicated lesions such as strictures, fistulas, abscesses, or even perforations. These lesions progressively increase over time and are associated with a higher risk of surgery and hospitalization. Despite significant advances in their management after the introduction of biological therapies, particularly anti-TNF agents, these complications continue to pose challenges for the multiple professionals involved in their care. Fistulas that do not involve the perianal region (entero-enteric, entero-urinary, or entero-cutaneous) require a multidisciplinary strategy that combines medical, interventional, and surgical approaches. Their treatment ranges from general supportive measures to the use of antibiotics or, frequently, advanced therapies. Nevertheless, in cases of certain septic complications or those refractory to medical treatment, percutaneous drainage or surgical intervention remains essential. Although these lesions have a significant impact, evidence regarding the best strategies in this context, as well as the efficacy and safety of different therapies in these patients, remains limited. This is highlighted by the absence of specific recommendations in current guidelines. The objective of this document is to provide a comprehensive overview of non-perianal fistulizing Crohn's disease, addressing its epidemiological, clinical, and therapeutic aspects from a multidisciplinary perspective.
Romero-Gómez M, Escalada J, Noguerol M
… +12 more, Pérez A, Carretero J, Crespo J, Mascort JJ, Aguilar I, Tinahones F, Cañones P, Gómez-Huelgas R, de Luis D, Genúa Trullos I, Aller R, Rubio MA
Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideli...Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideline aims to respond to its main challenges, both in terms of disease burden and complexity. To this end, recommendations have been proposed to experts through the Delphi method. The consensus was optimal in recommendations regarding type 2 diabetes as a risk factor (1.5.1, 4.5.1), in which cases early detection of MetHS should be carried out (4.5.2). Its results also emphasize the importance of the use of non-invasive tests (FIB-4, NFS, HFS) for the exclusion of significant fibrosis in patients with suspected MetHS (2.3.1, 2.3.3). Diagnosis should be carried out through the sequential combination of non-invasive indices and transient elastography by FibroScan® for its risk stratification (2.3.3). A nearly unanimous consensus was reached regarding the role of early prevention in the impact on the quality of life and survival of patients (5.1.2), as well as on the effectiveness of the Mediterranean diet and physical exercise in relation to the improvement of steatosis, steatohepatitis and fibrosis in MetHS patients (5.2.2) and on the positive results offered by resmiterom and semaglutide in promoting fibrosis regression (5.4.1). Finally, a great consensus has been reached regarding the importance of multidisciplinary management in MetHS, for which it is essential to agree on multidisciplinary protocols for referral between levels in each health area (6.2.1), as well as ensuring that referrals to Hepatology/Digestive and Endocrinology or Internal Medicine services are effective and beneficial to prevent the risk of disease progression (6.2.3, 6.3.1).
INTRODUCTION: The treatment aims to achieve symptomatic remission, normalization of biomarkers such a fecal calprotectin, and endoscopic remission. Therefore, early recognition of inflammatory activity and timely therape...INTRODUCTION: The treatment aims to achieve symptomatic remission, normalization of biomarkers such a fecal calprotectin, and endoscopic remission. Therefore, early recognition of inflammatory activity and timely therapeutic intervention are essential to improve the morbidity and mortality. OBJECTIVE: Evaluate the adherence among gastroenterologists and the patients compliance with medical recommendations in the Inflammatory Bowel Disease Program at Clínica Universidad de los Andes PATIENTS AND METHODS: A retrospective study that included patients presenting with a flare confirmed by colonoscopy. Three follow-up stages were defined: Short-Term Control: symptomatic remission at 3months, Medium-Term Control: remission of fecal calprotectin as a biomarker (<250μg/g) between 4 and 6months, and Long-Term Control: endoscopic remission between 6 and 9months. RESULTS: A total of 104 patients were evaluated, 64% of the cohort were females and a median age of 41years. Among them, 81% had Crohn's disease, with an inflammatory phenotype in 87% and colonic localization in 39%. The remaining 19% had ulcerative colitis with left-sided involvement in 50%. Ninety percent of the patients attended short term control with a symptomatic remission in 72%. Eighty-two percent attended medium term control, resulting in biomarker remission for 83% of them. Seventy seven percent attended long term control, achieving endoscopic remission in 59% of the cases. CONCLUSION: The results indicate that our program achieves a physician adherence of over 90% to STRIDE-II, with patient's adherence to pharmacological therapy and follow up above 70%. Although these are high percentages, they are subject to improvement.
Moreno Vigil ML, Núñez Esteban M, Altamirano Jiménez MI
… +7 more, Pérez Sánchez M, Salazar Bardía M, Ruíz Blanco E, Martínez-Ocón J, González-Suárez B, Dana Muzzio F, Rivas E
INTRODUCTION: The implementation of motorized spiral enteroscopy (MSE) in digestive endoscopy units required the upgrading of assistencial guidelines to perform general anesthesia with orotracheal intubation in a systema...INTRODUCTION: The implementation of motorized spiral enteroscopy (MSE) in digestive endoscopy units required the upgrading of assistencial guidelines to perform general anesthesia with orotracheal intubation in a systematic and safe manner. OBJECTIVE: To describe the anaesthetic management during MSE and to evaluate the incidence of complications during and within 24hours after the procedure. To assess whether there is a relationship between the difficulty of inserting and withdrawing the MSE and the patient's airway characteristics. PATIENTS AND METHODS: Observational, prospective study in patients undergoing anterograde MSE under GA in our endoscopy unit between 2021 and 2023. We recorded clinical and demographic, and airway characteristics. We registered the anesthesia and MSE procedure, as well as the peri-procedure complications within 24hours. RESULTS: After excluding one patient due to a full stomach, 49 patients were included (mean age 63±14 years, 53% women, 41% ASA III-IV). All underwent total intravenous general anesthesia and orotracheal intubation, with a 12% incidence of difficult VA. The incidence of anaesthetic complications was 4%, with no serious events. 18% had difficulties in inserting and/or withdrawing the MSE and 33% had difficult airway. During recovery, 46% had sore throat and VAS>3 in 31%. At 24hours, VAS>3 persisted in 47% of cases. CONCLUSIONS: Motorized spiral enteroscopy under GA in the endoscopy unit is a safe procedure, with a low incidence of serious complications. Multidisciplinary collaboration and preanesthetic assessment are essential to minimize risk.
INTRODUCTION: In ulcerative colitis (UC), STRIDE-II consensus has established the long-term goal of achieving endoscopic remission (ER), which helps reduce inflammatory burden, prevent permanent intestinal damage, and im...INTRODUCTION: In ulcerative colitis (UC), STRIDE-II consensus has established the long-term goal of achieving endoscopic remission (ER), which helps reduce inflammatory burden, prevent permanent intestinal damage, and improve patient's quality of life. However, achieving histological remission (HR) is also associated with a lower risk of experiencing outbreaks of inflammatory activity, the need for corticosteroids, hospitalizations, and the development of colorectal cancer. OBJECTIVE: Evaluate the role of ER and HR in the development of inflammatory activity flares in patients who have achieved these long-term goals and are being followed in the Inflammatory Bowel Disease (IBD) Program. MATERIAL AND METHODS: A retrospective study was conducted on patients with UC treated in the IBD Program at the Universidad de los Andes, between January 2021 and April 2023. Patients with ER (Mayo Endoscopic Index [MEI] 0) or endoscopic response (MEI 1), with at least one year of follow-up, were included. HR was defined using the Nancy (<2), Geboes (<2), and Robarts (<3) indices. Inflammatory activity was assessed by a Partial Mayo Index (PMI) ≥2 and fecal calprotectin >250μg/g. RESULTS: A total of 84 patients were included, 57.1% were women, with a median age of 37 years (IQR 31-45). During follow-up, 71 patients continued in the study, and 24 (31%) experienced inflammatory flares. In the MEI 0 group, the percentage of flares at 12 and 44 months was 15% and 53%, respectively, compared to 43% and 67% in the MEI 1 group (p=0.0302). PMI and fecal calprotectin levels were significantly lower in MEI 0 than in MEI 1 (p<0.001 and p<0.05, respectively). Although the Nancy, Geboes, and Robarts indices showed significant differences between MEI 0 and MEI 1, none were associated with a lower risk of flares in the MEI 0 group. No cases of colorectal neoplasia or need for surgery were reported during follow-up. CONCLUSION: In this cohort, ER is a significant predictor of the development of inflammatory flares in patients with UC, while HR did not show a clear impact in this regard. Further studies are needed to clarify the role of HR as a therapeutic target in UC.