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García García MD, Galván Fernández MD, Van de Wiel Fernández S, Machuca Aguado J, Caunedo Álvarez Á, Rodríguez-Téllez M. Primary malignant melanoma of the colon and the importance of an adequate anatomopathological analysis. Rev Esp Enferm Dig 2023; 115:666-667. [PMID: 37882159 DOI: 10.17235/reed.2023.9956/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Primary malignant melanoma of the colon is an extremely rare tumor due to the absence of melanoblasts in this segment of the digestive tract. We report the case of a patient presenting an ulcerated lesion with a neoplastic appearance in the dentate line during a coloscopy. After chemotherapy and radiotherapy, surgical amputation was performed. The study of the surgical specimen described an invasive malignant melanoma located in the submucosa without involvement of the overlying epithelium or the muscularis propria, nor vascular or lymph node invasion, and with tumor free margins. The patient was presented to the melanoma committee, which determited follow up in consultations. This case strengthens the importance of a good anatomopathological study to prevent delays in diagnosis and appropriate treatment.
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García-García MD, Bellido Muñoz F, Cordero Ruiz P, Caunedo Álvarez Á. Drug-induced liver injury associated to red yeast rice. Rev Esp Enferm Dig 2023. [PMID: 37449514 DOI: 10.17235/reed.2023.9797/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Hepatotoxicity is defined as a liver injury induced by a drug or a non-pharmacological agent like herbal medications or dietary supplements. Red yeast rice is rich in monacolin K, which has the same chemical structure as lovastatin, reason why it has been used for the management of hiperlipidemia. A 62 years old woman presented to the emergency service with 38.5ºC fever, coluric orine and loss of weight in the previous 3 weeks. The patient was taking RYR since the week before to the initial symptoms. Mixed hepatocellular and cholestatic acute hepatitis was diagnosed. Autoimmune liver serology resulted positive. Total DILI RECAM Score was 8 (highly probable DILI). Conservative treatment with exclusion of RYR was decided and during follow-up bilirubin and transaminases gradually dropped off. It has been reported a few cases of hepatitis associated to the use of RYR, promoted by a toxic or immunogenic metabolite. Cross-reactions may justify positive autoantibodies so hepatotoxicity should not be discard as a diagnose.
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Navajas Hernández P, Del Pino Bellido P, Aparcero López R, Machuca Aguado J, Caunedo Álvarez Á. A rare gastrointestinal tumor: primary gastric melanoma. Rev Esp Enferm Dig 2023; 115:278-279. [PMID: 36263830 DOI: 10.17235/reed.2022.8715/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Primary gastric melanoma is an exceptional tumour with less than 20 cases described in the literature, as its origin is not entirely clear as the presence of melanocytes in the stomach has not been demonstrated. Symptomatology is non-specific, which prevents its early detection, and it is diagnosed in late stages. We present the case of a patient who was admitted to our hospital for vomiting in coffee grounds with analytical and haemodynamic repercussions. Urgent gastroscopy revealed a gastric lesion suspicious for malignancy, which was histologically confirmed as gastric melanoma. The therapeutic approach to these tumours is complex and they have a very poor prognosis.
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Belvis Jiménez M, Aparcero López R, Caunedo Álvarez Á. Abdominal splenosis: a rare entity with a possible non-invasive diagnosis. Rev Esp Enferm Dig 2021; 112:739-740. [PMID: 32755145 DOI: 10.17235/reed.2020.6856/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Splenosis is an uncommon pathology whose diagnosis requires a high index of suspicion. In most cases they are incidental findings, so their suspicion is essential to carry out a non-invasive diagnosis. We present a case of intraabadominal splenosis and perform a brief review of the literature.
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Guerra Veloz MF, Cordero Ruiz P, Ríos-Villegas MJ, Del Pino Bellido P, Bravo-Ferrer J, Galvés Cordero R, Cadena Herrera ML, Vías Parrado C, Bellido Muñoz F, Vega Rodríguez F, Caunedo Álvarez Á, Rodríguez-Baño J, Carmona Soria I. Liver manifestations in COVID-19 and the influence of pre-existing liver disease in the course of the infection. Rev Esp Enferm Dig 2021; 113:103-109. [PMID: 33393329 DOI: 10.17235/reed.2020.7627/2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION patients with advanced chronic liver disease (CLD) may be at an increased risk of a severe course due to cirrhosis-associated immune dysfunction. The aim of this study was to determine the prevalence of CLD in COVID-19 patients and to analyze the course of the infection, compared with patients with non-liver disease. MATERIALS AND METHODS this was a retrospective single center study of all patients with a positive SARS-CoV-2 polymerase chain reaction (PCR) test from March 23rd to April 30th, 2020. Clinical and biochemical data of patients with and without CLD and COVID-19 were collected from the medical records. RESULT four hundred and forty-seven patients with a SARS-CoV-2 positive PCR were included, 6.3 % had CLD; 69.7 % of patients with CLD were male, with a median age of 65.5 years and active alcohol consumption and smoking; 75 % had non-advanced liver fibrosis and most had non-alcoholic fatty liver disease (NAFLD). The hospital admission rate (92.9 % vs 47.7 %, p < 0.001), concomitant comorbidities (diabetes 38.5 vs 16.5 %, p = 0.011; obesity 30.8 vs 8.5 %, p = 0.033; cancer 23.1 vs 5 %, p = 0.027; and chronic obstructive pulmonary disease (COPD) 19.2 vs 9 %, p = 0.009) and concomitant antibiotics treatment (19.3 vs 5 %, p = 0.018) were higher in patients with CLD than in those without CLD. In-patient hospital mortality rates were similar in both groups (30.8 vs 19.6 %, p = 0.289). The presence of CLD was not associated with mortality (OR = 1.06; 95 % CI = 0.35-3.18; p = 0.924). However, patients with CLD and COVID-19 who were male, obese or under concomitant antibiotic treatment had the highest risk of mortality according to the univariate analysis. CONCLUSION patients with CLD had a higher risk of hospital admission, with worse outcomes during the COVID-19 infection associated to other concomitant comorbidities and a suspicion of bacterial co-infection.
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Affiliation(s)
| | | | | | | | - José Bravo-Ferrer
- Enfermedades Infecciosas, Microbiología, Hospital Universitario Virgen Macarena
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Valdés Delgado T, Maldonado Pérez MB, Caunedo Álvarez Á. Double strangeness: a young male with intestinal obstruction secondary to gastrointestinal follicular lymphoma. Rev Esp Enferm Dig 2021; 113:621-622. [PMID: 33393327 DOI: 10.17235/reed.2020.7656/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary follicular lymphomas (FL) of the gastrointestinal (GI) tract are very rare and constitute < 4 % of all non-Hodgkin's lymphomas at this location. We report our experience with primary FL of the GI tract.
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Del Pino Bellido P, Guerra Veloz MF, Cordero Ruíz P, Bellido Muñoz F, Vega Rodriguez F, Caunedo Álvarez Á, Carmona Soria I. CHRONIC HEPATITIS C PATIENTS LOST IN THE SYSTEM: PREDICTIVE FACTORS OF NON-REFERRAL OR LOSS OF FOLLOW UP TO HEPATOLOGY UNITS. Rev Esp Enferm Dig 2021; 113:833-839. [PMID: 33393328 DOI: 10.17235/reed.2020.7573/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Several barriers remain in the hepatitis C care cascade, which need to be removed in order to eliminate Chronic Hepatitis C. These barriers include deficiencies in screening and confirmatory diagnosis as well as difficulties in accessing treatment. AIMS To identify factors associated with the non-referral of patients with positive HCV-antibody and to identify factors associated with loss of follow-up or non-attendance of these patients to specialist consultation after their referral. METHODS Observational and retrospective single-centre-study, including all positive HCV serologies performed between January 2013 and May 2018 in the Virgen Macarena health area before implementing the one-step diagnosis. Non-referred patients and patients who were lost to follow-up after being referred were identified. RESULTS A total of 54 (77.4%) patients diagnosed in PC and 54 (22.2%) from hospital specialists were not referred (p <0.001). Predictors for non-referral were: stay in prison/ institutionalized (p = 0.04), suffering COPD (p = 0.07), a normal AST value (p = 0.034) or test requested by PCP (p = 0.004). Patients referred from PC were more likely to be lost to follow-up than those referred from hospital specialists (p <0.001). Predictors for loss of follow-up included: opioid replacement therapy (p = 0.034), absence of high blood pressure (p = 0.039) and test requested by PCP (p = 0.049). CONCLUSIONS A high percentage of patients with positive HCV serology were not referred or lost follow-up, mainly those belonging to high risk social groups or those with associated comorbidities. Patients with average values of transaminases or those diagnosed in primary care were also less referred.
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Fernández Álvarez P, Belvis Jiménez M, Maldonado Pérez B, Castro Laria L, Caunedo Álvarez Á, Rodríguez de Los Ríos JL, Argüelles-Arias F. Views of patients with inflammatory bowel disease during the COVID-19 pandemic: ACCU survey results. Rev Esp Enferm Dig 2020; 113:92-97. [PMID: 33371692 DOI: 10.17235/reed.2020.7472/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES the SARS-COV-2 pandemic has forced a substantial change in the care of patients with digestive pathologies, especially for inflammatory bowel disease (IBD) patients taking immunosuppessive medications. In this regard, some national and international guidelines have indicated the standards to be taken into account. However, few studies have evaluated how patients have dealt with this infection. Therefore, this study was performed with the aim to determine how the SARS-COV-2 pandemic has affected our IBD patients. MATERIAL AND METHODS an online survey was performed among the members (295) of the Association of Crohn's Disease and Ulcerative Colitis (ACCU), which consisted of 19 questions. Finally, it was completed by 168 patients. RESULTS fifty-eight per cent of cases were female, 63.7 % had Crohn's disease (CD) and 53 % received biologic therapy. Five per cent were infected by SARS-CoV-2 and were male. The main concern of the patients was the fear of acquiring the infection (80.9 %). More than 90 % continued their treatments and half of the patients worked from home during the pandemic period. CONCLUSIONS the perspective of the patients is necessary to achieve an adequate management and evolution of the disease. More studies are needed to assess the impact that exceptional situations, such as the COVID-19 pandemic, may have on IBD patients in order to improve adherence and control of the disease.
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Fernández Álvarez P, Maldonado Pérez B, Caunedo Álvarez Á. An extremely uncommon complication of acute pancreatitis: spontaneous pancreatic cutaneous fistula. Rev Esp Enferm Dig 2020; 113:222. [PMID: 33207906 DOI: 10.17235/reed.2020.7121/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of a 67-year-old male who was referred to our hospital due to severe abdominal pain and fever. His past medical history included a total gastrectomy surgery for stomach cancer. Abdominal examination showed intense pain on deep palpation in the epigastric region. Laboratory test revealed elevated C-reactive protein (235 mg/l) and amylase (1,789 U/l). Computerized tomography reported a pancreatic collection with the presence of air bubbles inside and areas of necrotic pancreatic parenchyma.
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Belvis Jiménez M, Hergueta-Delgado P, Gómez Rodríguez BJ, Maldonado Pérez B, Castro Laria L, Rodríguez-Téllez M, Morales Barroso ML, Galván Fernández MD, Guerra Veloz MF, Jiménez García VA, Romero Castro R, Benítez Roldán A, Castro Márquez C, Aparcero López R, Garrido Serrano A, Caunedo Álvarez Á, Argüelles Arias F. Index of the Mayo Endoscopy and Ulcerative Colitis Endoscopy Index of Severity: are they equally valid? Rev Esp Enferm Dig 2020; 112:821-825. [PMID: 33054301 DOI: 10.17235/reed.2020.6832/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION endoscopy plays an essential role in the management of patients with ulcerative colitis (UC), as it allows us to visualize and assess the severity of the disease. Different scores have been devised to standardize the findings because such assessments are not always objective. AIMS the aim of this study was to assess the interobserver variability between the Index of Mayo Endoscopy (IME) and the Ulcerative Colitis Endoscopy Index of Severity (UCEIS), analyzing the severity of the endoscopic lesions in patients with UC. The secondary aim was to analyze if the cathartic preparation affected the degree of concordance amongst the endoscopists. MATERIAL AND METHODS this was a single-cohort observational, comparative study in which a colonoscopy was performed in patients with UC, as the normal clinical practice. The results were classified according to the IME and the UCEIS by three endoscopic specialists. In order to assess the degree of interobserver correlation, the Kappa index for IME was used and the intraclass correlation coefficient was used for UCEIS. RESULTS sixty-seven patients were included in the study. The average age was 51 (SD ± 16.7) and the average Mayo Clinic index was 3.07 (SD ± 2.54). The weighted Kappa index between endoscopists A and B for the IME was 0.8, 0.52 between A and C and 0.49 between B and C. The intraclass correlation coefficient for UCEIS was 0.922 between the three endoscopists (95 % CI: 0.832-0.959). A better interobserver correlation was found when the cathartic preparation was ≥ 8 based on the Boston Scale. CONCLUSIONS there was a higher correlation between the different endoscopists for the UCEIS than for the IME. Thus, this should be considered to be the best index to use in the clinical practice. A good cleansing preparation is important to improve the interobserver correlation.
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Valdés Delgado T, Guerra Veloz MF, Castro Laria L, Maldonado Pérez B, Perea Amarillo R, Merino Bohórquez V, Sáez A, Caunedo Álvarez Á, Argüelles Arias F. Cut-off ranges of infliximab serum levels in Crohn's disease in the clinical practice. Rev Esp Enferm Dig 2020; 112:756-761. [PMID: 32954770 DOI: 10.17235/reed.2020.6539/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION between 30 % and 40 % of patients treated with infliximab lose response during maintenance. Therapeutic drug monitoring could be used to optimize management in these situations. However, infliximab serum levels are not well defined. The aim of this study was to determine the cut-off range of infliximab serum levels in Crohn's disease patients in remission in the clinical practice. METHODS an observational retrospective study was performed from 2016 to 2017. Patients were included with established Crohn's disease, who had been on a maintenance dose schedule of infliximab. Infliximab levels and antibodies to infliximab were measured at least twice in all patients, after induction and after six months of treatment. Clinical remission was defined as ≤ 4 using the Harvey-Bradshaw index. Cluster analysis was used to analyze the results. RESULTS one hundred and five Crohn's disease patients were included in the study; 57.1 % were male with a mean age of 39 years (SD ± 12.9). The median (range) time of the disease was eleven years (7-15) and the median (range) time of follow-up was 32 months (22-38). Patients who achieved remission had infliximab serum levels between 4.26-8.26 ug/ml versus 0.06-1.43 ug/ml in patients who did not achieve remission after induction. Infliximab serum levels were 2.84-7.75 ug/ml and 0.05-2.69 ug/ml in patients who achieved remission versus those who did not achieve remission after six months of treatment. Overall, 4.26-8.26 ug/ml was found to be the best cut-off range for remission. CONCLUSIONS in our clinical practice, serum levels of infliximab in Crohn's disease patients should be higher than 4 ug/ml to achieve clinical remission.
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Del Pino Bellido P, Belvis Jiménez M, Castro Laria L, Maldonado Pérez MB, Sáez Díaz A, Caunedo Álvarez Á, Argüelles-Arias F. Vedolizumab response in inflammatory bowel disease. Two years of follow-up. Rev Esp Enferm Dig 2020; 112:555-558. [PMID: 32579005 DOI: 10.17235/reed.2020.7130/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND vedolizumab is an α4β7 integrin antagonist. The aim of this study was to evaluate the clinical response and remission rates with vedolizumab. METHODS this was a retrospective study of inflammatory bowel disease (IBD) patients who received vedolizumab between 2016 and 2019. Response and remission rates were analyzed at three, six, 12, 18 and 24 months after induction. RESULTS fifty-five patients were included. Clinical remission rates in CD and UC at three, six, 12, 18 and 24 months were 19.35 %, 26.67 %, 30.43 %, 30 %, 38.89 % and 29.17 %, 26.09 %, 19.05 %, 26.67 % and 20 %, respectively. CONCLUSIONS vedolizumab is effective for induction and maintenance of clinical remission, both in Crohn's disease and ulcerative colitis.
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Fernández Álvarez P, Valladolid León JM, Caunedo Álvarez Á. Esophageal compression by a mediastinal vascular structure as a result of a dysphagia lusoria. Rev Esp Enferm Dig 2020; 112:505. [PMID: 32379480 DOI: 10.17235/reed.2020.6592/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dysphagia lusoria is an uncommon cause of mechanical dysphagia due to extrinsic compression. It is a congenital aortic root abnormality that occurs as a consequence of an aberrant right subclavian artery, in most cases. We report an illustrative case of dysphagia lusoria in a young female, secondary to the presence of the abnormal mediastinal vessel.
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Guerra Veloz MF, Belvis Jiménez M, Valdes Delgado T, Castro Laria L, Maldonado Pérez B, Perea Amarillo R, Merino Bohórquez V, Caunedo Álvarez Á, Vilches Arenas Á, Argüelles-Arias F. Long-term follow up after switching from original infliximab to an infliximab biosimilar: real-world data. Therap Adv Gastroenterol 2019; 12:1756284819858052. [PMID: 31258621 PMCID: PMC6585238 DOI: 10.1177/1756284819858052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/23/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several studies have reported positive efficacy outcomes for patients with inflammatory bowel disease treated with CT-P13, an infliximab biosimilar. Data from follow-up periods longer than 1 year are still scarce. Here, we assessed the long-term efficacy data, loss of response and safety after switching from infliximab to CT-P13 in patients with inflammatory bowel disease. METHODS This was a prospective single-center observational study involving patients with moderate-to-severe Crohn's disease and ulcerative colitis switched from infliximab to CT-P13 treatment and reviewed up to 24 months. Efficacy and loss of response were measured using the Harvey-Bradshaw (HB) index and partial Mayo score for patients with Crohn's disease and ulcerative colitis respectively. C-reactive protein, infliximab drug levels, adverse events and antidrug antibodies were also monitored throughout the study. RESULTS A total of 64 patients with Crohn's disease and 36 patients with ulcerative colitis were included. Most of them (72%) remained on CT-P13. Overall, 28% of patients discontinued the therapy due to loss of response, adverse events or long-lasting clinical remission. Remission at 18 and 24 months occurred in 69.9% and 68.5% of patients, respectively. Dose increase was performed in 22% of patients, with remission being reached in 60% of them. HB index, partial Mayo score, C-reactive protein and infliximab drug levels did not show significant changes. Serious adverse events were reported in 14% of patients. Overall, two patients developed low levels of antidrug antibodies. CONCLUSIONS Most of the patients switching from original infliximab were maintained on CT-P13 at 2 years of follow up with a good profile of efficacy and safety.
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Affiliation(s)
| | - María Belvis Jiménez
- Gastroenterology Department, Virgen Macarena University Hospital, Seville, Spain
| | | | - Luisa Castro Laria
- Gastroenterology Department, Virgen Macarena University Hospital, Seville, Spain
| | | | - Raúl Perea Amarillo
- Gastroenterology Department, Virgen Macarena University Hospital, Seville, Spain
| | | | | | - Ángel Vilches Arenas
- Preventive Medicine and Public Health, University Hospital Virgen Macarena, Seville, Spain
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Moreno Márquez C, Galván Fernández MD, Cortés Sañudo X, Caunedo Álvarez Á. An unusual association: median arcuate ligament syndrome and nutcracker syndrome. Rev Esp Enferm Dig 2019; 111:241-242. [PMID: 30746954 DOI: 10.17235/reed.2019.5997/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of arcuate ligament syndrome diagnosed in a 23-year-old patient with epigastric pain, vomiting and weight loss, using Doppler ultrasound and CT-angiography, treated by surgical resection of the ligament with complete resolution of symptoms. In addition, incidentally the patient was diagnosed with a nutcracker syndrome, without clinical repercussions.
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Guerra Veloz MF, Vázquez Morón JM, Belvis Jiménez M, Pallarés Manrique H, Valdés Delgado T, Castro Laria L, Maldonado Pérez B, Benítez Roldán A, Perea Amarillo R, Merino V, Caunedo Álvarez Á, Argüelles Arias F. Switching from reference infliximab to CT-P13 in patients with inflammatory bowel disease: results of a multicenter study after 12 months. Rev Esp Enferm Dig 2019; 110:564-570. [PMID: 29893581 DOI: 10.17235/reed.2018.5368/2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS infliximab has changed the natural history of inflammatory bowel disease (IBD). The advent of biosimilar treatments such as CT-P13 will hopefully improve the availability of biological therapies. Data with regard to drug switching are currently limited. The objective of the study was to assess the effectiveness and safety of switching from the reference product (RP), infliximab, to CT-P13 in patients with IBD. METHODS this was a multicenter prospective observational study in patients with Crohn's disease (CD) and ulcerative colitis (UC). All patients had switched from infliximab RP (Remicade®) to CT-P13 treatment and were followed up for 12 months. The efficacy endpoint was the change in clinical remission assessed at 0 and 12 months, according to the Harvey-Bradshaw score and partial Mayo score for patients with CD and UC, respectively. Adverse events were monitored and recorded throughout the study. RESULTS a total of 167 patients (116 CD/51 UC) were included; 88.8% (103/116) of patients with CD were in remission at the time of the drug switch and 69.7% were in remission at 12 months. The Harvey-Bradshaw (HB) score significantly changed at 12 months (p = 0.001); 84.3% (43/51) of patients with UC were in remission at the time of the drug switch and 76.7% were in remission at 12 months. No significant changes in the median partial Mayo score (p = 0.87) were observed at 12 months. Serious adverse events related to medication were reported in 12/167 (7.2%) cases. CONCLUSION switching from infliximab RP to CT-P13 is safe and effective at 12 months. The loss of efficacy at 12 months was 15.7%.
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Affiliation(s)
| | | | | | | | | | | | - Belén Maldonado Pérez
- Unidad de Gestión de Aparato Digestivo, Hospital Universitario Virgen Macarena, España
| | | | - Raúl Perea Amarillo
- Unidad de Gestión Clínica Intercentros de Aparato , Hospital Universitario Virgen Macarena, España
| | | | - Ángel Caunedo Álvarez
- Unidad de Gestión Clínica de Aparato , Hospital Universitario Virgen Macarena , España
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Guerra Veloz MF, Argüelles-Arias F, Castro Laria L, Maldonado Pérez B, Benítez Roldan A, Perea Amarillo R, Merino Bohórquez V, Calleja MA, Caunedo Álvarez Á, Vilches Arenas Á. Loss of efficacy and safety of the switch from infliximab original to infliximab biosimilar (CT-P13) in patients with inflammatory bowel disease. World J Gastroenterol 2018; 24:5288-5296. [PMID: 30581277 PMCID: PMC6295832 DOI: 10.3748/wjg.v24.i46.5288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/18/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infliximab original has changed the natural history of inflammatory bowel diseases (IBD) over the past two decades. However, the recent expiration of its patent has allowed the entry of the first Infliximab biosimilar into the European and Spanish markets. Currently switching drugs data in IBD are limited.
AIM To compare the efficacy of infliximab biosimilar, CT-P13, against infliximab original, analyzing the loss of response of both at the 12 mo follow-up in patients with IBD.
METHODS An observational study of two cohorts has been conducted. One retrospective cohort that included patients with IBD treated with Infliximab original, and a prospective cohort of patients who were switching from infliximab original to infliximab biosimilar (CT-P13). We had analyzed the overall efficacy and loss of efficacy in patients in remission at the end of one year after treatment with the original drug compared to the results of the year of treatment with the biosimilar.
RESULTS 98 patients (CD 67, CU 31) were included in both cohorts. The overall efficacy for infliximab original per year of treatment was 71% vs 68.2% for infliximab biosimilar (P = 0.80). The loss of overall efficacy at 12 mo for infliximab original was 6.6% vs 14.5% for infliximab biosimilar (P = 0.806). The loss of efficacy in patients who were in basal remission was 16.3% for infliximab original vs 27.1% for infliximab biosimilar. Adverse events were 9.2% for infliximab original vs 11.2% for infliximab biosimilar.
CONCLUSION The overall efficacy and loss of treatment response with infliximab biosimilar (CT-P13) is similar to that observed with infliximab original in patients who were switching at the 12 mo follow-up. There is no difference in the rate of adverse events.
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Affiliation(s)
| | | | - Luisa Castro Laria
- Department of Gastroenterology, University Hospital Virgen Macarena, Seville 41007, Spain
| | - Belén Maldonado Pérez
- Department of Gastroenterology, University Hospital Virgen Macarena, Seville 41007, Spain
| | - Antonio Benítez Roldan
- Department of Gastroenterology, University Hospital Virgen Macarena, Seville 41007, Spain
| | - Raúl Perea Amarillo
- Department of Gastroenterology, University Hospital Virgen Macarena, Seville 41007, Spain
| | | | | | - Ángel Caunedo Álvarez
- Department of Gastroenterology, University Hospital Virgen Macarena, Seville 41007, Spain
| | - Ángel Vilches Arenas
- Preventive Medicine and Public Health, University Hospital Virgen Macarena, Seville 41007, Spain
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Chaaro Benallal D, Guerra Veloz MF, Argüelles-Arias F, Benítez JM, Perea Amarillo R, Iglesias E, Castro Laria L, Sánchez García V, Maldonado Pérez MB, Vilches Á, Caunedo Álvarez Á, Romero Gómez M. Evolution of the incidence of inflammatory bowel disease in Southern Spain. Rev Esp Enferm Dig 2018; 109:757-760. [PMID: 28776379 DOI: 10.17235/reed.2017.4739/2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The incidence of inflammatory bowel disease is increasing in Europe and in Spain. However, there is no recent data from Southern Spain. OBJECTIVES To determine the evolution of the hospital incidence of inflammatory bowel disease in Southern Spain. MATERIAL AND METHODS A retrospective study was performed in two hospitals in Southern Spain. Data was collected from inflammatory bowel disease patients, divided into two periods (1995-2000 and 2001-2014) and compared. The reference population from both areas was 1,011,555 inhabitants. RESULTS A total of 430 patients were registered during the first period (1995-2000); 50% (215) had Crohn's disease that resulted in a cumulative incidence rate of 7.08 cases/100,000 inhabitants per year. The overall inflammatory bowel disease incidence was 3.54 cases/100,000 inhabitants per year. During the second period (2001-2014), 2,089 patients were collected; 51.7% had ulcerative colitis (1,081). The rate of cumulative incidence of inflammatory bowel disease was 14.7 cases/100,000 inhabitants per year (7.6 cases of ulcerative colitis/100,000 inhabitants/year and 7.1 cases of Crohn´s disease/100,000 inhabitants/year). CONCLUSIONS The incidence of inflammatory bowel disease in Southern Spain has doubled in the last decade and is similar to that of the rest of the country and Europe.
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Affiliation(s)
- Dina Chaaro Benallal
- Unidad de Gestión Clínica Intercentros de Aparato , Hospital Universitario Virgen Macarena, España
| | | | - Federico Argüelles-Arias
- Unidad de Gestión Clínica Intercentros de Aparato , Hospital Universitario Virgen Macarena, España
| | - José Manuel Benítez
- Unidad de Gestión Clínica Aparato Digestivo. , Hospital Universitario Reina Sofía , España
| | - Raúl Perea Amarillo
- Unidad de Gestión Clínica Intercentros de Aparato , Hospital Universitario Virgen Macarena, España
| | - Eva Iglesias
- Aparato Digestivo, Hospital Reina Sofía , España
| | - Luisa Castro Laria
- Unidad de Gestión Clínica Intercentros de Aparato , Hospital Universitario Virgen Macarena , España
| | - Valle Sánchez García
- Unidad de Gestión Clínica Aparato Digestivo, Hospital Universitario Reina Sofía , España
| | | | | | - Ángel Caunedo Álvarez
- Unidad de Gestión Clínica Intercentros de Aparato , Hospital Universitario Virgen Macarena , España
| | - Manuel Romero Gómez
- Dirección Gerencia, Hospitales Universitarios Virgen Macarena-Rocío., España
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Gómez Rodríguez BJ, Castro Laria L, Argüelles Arias F, Castro Márquez C, Caunedo Álvarez Á, Romero Gómez M. A real life study of Helicobacter pylori eradication with bismuth quadruple therapy in naïve and previously treated patients. Rev Esp Enferm Dig 2017; 109:552-558. [DOI: 10.17235/reed.2017.4809/2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Arroyo-Martínez Q, Rodríguez-Téllez M, García-Escudero A, Brugal-Medina J, González-Cámpora R, Caunedo Álvarez Á. Epidemiology of Barrett's esophagus and esophageal adenocarcinoma in Spain. A unicentric study. Rev Esp Enferm Dig 2016; 108:609-617. [PMID: 27616661 DOI: 10.17235/reed.2016.4229/2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Barrett's esophagus (BE) is an acquired disease defined by the presence of intestinal metaplasia with goblet cells in the distal esophagus. The prevalence of BE has increased dramatically over the last years. AIMS The primary aims of the study were to analyze the characteristics of BE and esophageal adenocarcinoma (EAC) in a Spanish health district during a follow-up period. METHODOLOGY Sociodemographic factors, alcohol consumption and cigarette smoking were analyzed. We also studied the histological behavior and cause of death in each group. RESULTS In the present study 430 patients were included, 338 with BE and 92 with EAC. Incidence rates have risen from 2.25 and 1.25 per 100,000 inhabitants in 1996 to 6.5 and 4.75 per 100,000 in 2011, respectively. In the EAC group, male gender, age and alcohol consumption were higher in comparison to the BE group, and the overall survival was 23 months. In the BE group, the main causes of death were non-esophageal cancer and cardiovascular disease. CONCLUSIONS The incidence and prevalence rates of AEC and BE have risen over the past years. Risk factors for these conditions were male gender, age and alcohol consumption. Long BE (> 3 cm) is involved in dysplasia progression. AEC diagnosis mainly occurs after neoplasia is detected and, in a few cases, due to a previous BE. Cardiovascular diseases and non-esophageal cancers have been found to be the main cause of death in BE patients.
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