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Aldars-García L, Gil-Redondo R, Embade N, Riestra S, Rivero M, Gutiérrez A, Rodríguez-Lago I, Fernández-Salazar L, Ceballos D, Manuel Benítez J, Aguas M, Baston-Rey I, Bermejo F, José Casanova M, Lorente R, Ber Y, Ginard D, Esteve M, de Francisco R, José García M, Francés R, Rodríguez Pescador A, Velayos B, Del Río EG, Marín Pedrosa S, Minguez Sabater A, Barreiro-de Acosta M, Algaba A, Verdejo Gil C, Rivas O, Royo V, Aceituno M, Garre A, Baldán-Martín M, Ramírez C, Sanz-García A, Lozano JJ, Sidorova J, Millet O, Bernardo D, Gisbert JP, Chaparro M. Serum and Urine Metabolomic Profiling of Newly Diagnosed Treatment-Naïve Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2024; 30:167-182. [PMID: 37536268 DOI: 10.1093/ibd/izad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) is a prevalent chronic noncurable disease associated with profound metabolic changes. The discovery of novel molecular indicators for unraveling IBD etiopathogenesis and the diagnosis and prognosis of IBD is therefore pivotal. We sought to determine the distinctive metabolic signatures from the different IBD subgroups before treatment initiation. METHODS Serum and urine samples from newly diagnosed treatment-naïve IBD patients and age and sex-matched healthy control (HC) individuals were investigated using proton nuclear magnetic resonance spectroscopy. Metabolic differences were identified based on univariate and multivariate statistical analyses. RESULTS A total of 137 Crohn's disease patients, 202 ulcerative colitis patients, and 338 HC individuals were included. In the IBD cohort, several distinguishable metabolites were detected within each subgroup comparison. Most of the differences revealed alterations in energy and amino acid metabolism in IBD patients, with an increased demand of the body for energy mainly through the ketone bodies. As compared with HC individuals, differences in metabolites were more marked and numerous in Crohn's disease than in ulcerative colitis patients, and in serum than in urine. In addition, clustering analysis revealed 3 distinct patient profiles with notable differences among them based on the analysis of their clinical, anthropometric, and metabolomic variables. However, relevant phenotypical differences were not found among these 3 clusters. CONCLUSIONS This study highlights the molecular alterations present within the different subgroups of newly diagnosed treatment-naïve IBD patients. The metabolomic profile of these patients may provide further understanding of pathogenic mechanisms of IBD subgroups. Serum metabotype seemed to be especially sensitive to the onset of IBD.
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Affiliation(s)
- Laila Aldars-García
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de La Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | | | - Nieves Embade
- Precision Medicine and Metabolism Lab, CIC bioGUNE, Derio, Spain
| | - Sabino Riestra
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Montserrat Rivero
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Marqués de Valdecilla, Santander, Spain
| | - Ana Gutiérrez
- Hospital General Universitario de Alicante, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Iago Rodríguez-Lago
- Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | | | - Daniel Ceballos
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - José Manuel Benítez
- Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Mariam Aguas
- Hospital Universitari i Politecnic La Fe, La Fe Health Research Institute, Valencia, Spain
| | - Iria Baston-Rey
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Fernando Bermejo
- Hospital Universitario de Fuenlabrada, Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain
| | - María José Casanova
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de La Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Rufo Lorente
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Daniel Ginard
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - María Esteve
- Hospital Universitari Mutua Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Terrassa, Spain
| | - Ruth de Francisco
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - María José García
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Marqués de Valdecilla, Santander, Spain
| | - Rubén Francés
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Benito Velayos
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Elena Guerra Del Río
- Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Sandra Marín Pedrosa
- Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | | | - Manuel Barreiro-de Acosta
- Departamento Medicina Clínica, Universidad Miguel Hernández de Elche, Instituto Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche, Universidad Miguel Herñandez, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Investigación Sanitaria y Biomédica de Alicante, Elche, Spain
| | - Alicia Algaba
- Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | | | | | - Vanesa Royo
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Montserrat Aceituno
- Hospital Universitari Mutua Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Terrassa, Spain
| | - Ana Garre
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de La Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Montserrat Baldán-Martín
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de La Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Cristina Ramírez
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de La Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
| | - Juan J Lozano
- Bioinformatics Platform, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Julia Sidorova
- Bioinformatics Platform, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Oscar Millet
- Precision Medicine and Metabolism Lab, CIC bioGUNE, Derio, Spain
| | - David Bernardo
- Mucosal Immunology Lab, Unidad de Excelencia Instituto de Biología y Genética Molecular, Universidad de Valladolid, Consejo Superior de Investigaciones Científicas (CSIC), Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de La Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - María Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de La Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
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Pabón-Carrasco M, Keco-Huerga A, Castro-Fernández M, Saracino IM, Fiorini G, Vaira D, Pérez-Aísa Á, Tepes B, Jonaitis L, Voynovan I, Lucendo AJ, Lanas Á, Martínez-Domínguez SJ, Almajano EA, Rodrigo L, Vologzanina L, Brglez Jurecic N, Denkovski M, Bujanda L, Abdulkhakov RA, Huguet JM, Fernández-Salazar L, Alcaide N, Velayos B, Silkanovna Sarsenbaeva A, Zaytsev O, Ilchishina T, Barrio J, Bakulin I, Perona M, Alekseenko S, Romano M, Gravina AG, Núñez Ó, Gómez Rodríguez BJ, Ledro-Cano D, Pellicano R, Bogomolov P, Domínguez-Cajal M, Almela P, Gomez-Camarero J, Bordin DS, Gasbarrini A, Kupčinskas J, Cano-Català A, Moreira L, Nyssen OP, Mégraud F, O'Morain C, Gisbert JP. Role of proton pump inhibitors dosage and duration in Helicobacter pylori eradication treatment: Results from the European Registry on H. pylori management. United European Gastroenterol J 2024; 12:122-138. [PMID: 38050339 PMCID: PMC10859719 DOI: 10.1002/ueg2.12476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/15/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Management of Helicobacter pylori (H. pylori) infection requires co-treatment with proton pump inhibitors (PPIs) and the use of antibiotics to achieve successful eradication. AIM To evaluate the role of dosage of PPIs and the duration of therapy in the effectiveness of H. pylori eradication treatments based on the 'European Registry on Helicobacter pylori management' (Hp-EuReg). METHODS Hp-EuReg is a multicentre, prospective, non-interventionist, international registry on the routine clinical practice of H. pylori management by European gastroenterologists. All infected adult patients were systematically registered from 2013 to 2022. RESULTS Overall, 36,579 patients from five countries with more than 1000 patients were analysed. Optimal (≥90%) first-line-modified intention-to-treat effectiveness was achieved with the following treatments: (1) 14-day therapies with clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both independently of the PPI dose prescribed; (2) All 10-day (except 10-day standard triple therapy) and 14-day therapies with high-dose PPIs; and (3) 10-day quadruple therapies with clarithromycin-amoxicillin-bismuth, metronidazole-tetracycline-bismuth, and clarithromycin-amoxicillin-metronidazole (sequential), all with standard-dose PPIs. In first-line treatment, optimal effectiveness was obtained with high-dose PPIs in all 14-day treatments, in 10- and 14-day bismuth quadruple therapies and in 10-day sequential with standard-dose PPIs. Optimal second-line effectiveness was achieved with (1) metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10 days with standard and high-dose PPIs, respectively; and (2) levofloxacin-amoxicillin triple therapy for 14 days with high-dose PPIs. None of the 7-day therapies in both treatment lines achieved optimal effectiveness. CONCLUSIONS We recommend, in first-line treatment, the use of high-dose PPIs in 14-day triple therapy and in 10-or 14-day quadruple concomitant therapy in first-line treatment, while standard-dose PPIs would be sufficient in 10-day bismuth quadruple therapies. On the other hand, in second-line treatment, high-dose PPIs would be more beneficial in 14-day triple therapy with levofloxacin and amoxicillin or in 10-day bismuth quadruple therapy either as a three-in-one single capsule or in the traditional scheme.
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Affiliation(s)
| | - Alma Keco-Huerga
- Department of Gastroenterology, Hospital de Valme, Sevilla, Spain
| | | | | | | | | | - Ángeles Pérez-Aísa
- Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella, Spain
| | - Bojan Tepes
- Department of Gastroenterology, AM DC Rogaska, Rogaska Slatina, Slovenia
| | - Laimas Jonaitis
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irina Voynovan
- Department of Gastroenterology, A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Ángel Lanas
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Maja Denkovski
- Department of Gastroenterology, Interni Oddelek, Diagnostic Centre, Bled, Slovenia
| | - Luis Bujanda
- Hospital Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Rustam A Abdulkhakov
- Department of Hospital Medicine, Kazan State Medical University, Kazan, Tatarstan, Russia
| | - Jose M Huguet
- Patología Digestiva, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Fernández-Salazar
- Gastroenterology Department, Hospital Clínico Universitario de Valladolid (SACYL), Valladolid, Spain
| | - Noelia Alcaide
- Gastroenterology Department, Hospital Clínico Universitario de Valladolid (SACYL), Valladolid, Spain
| | - Benito Velayos
- Gastroenterology Department, Hospital Clínico Universitario de Valladolid (SACYL), Valladolid, Spain
| | | | - Oleg Zaytsev
- Gastroenterology Unit, First Clinical Medical Center Kovrov, Kovrov, Russia
| | | | - Jesús Barrio
- Unidad de Gastroenterología, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Igor Bakulin
- I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russia
| | - Monica Perona
- Gastroenterology Unit, Hospital Quiron Marbella, Marbella, Spain
| | | | - Marco Romano
- Gastroenterology and Endoscopy Unit, Dipartimento di Medicina di Precisione, Università Vanvitelli, Napoli, Italy
| | - Antonietta G Gravina
- Gastroenterology and Endoscopy Unit, Dipartimento di Medicina di Precisione, Università Vanvitelli, Napoli, Italy
| | - Óscar Núñez
- Gastroenterology Unit, Hospital Universitario La Moraleja, Madrid, Spain
| | | | - Diego Ledro-Cano
- Gastroenterology Department, Hospital Virgen de la Macarena, Sevilla, Spain
| | | | | | - Manuel Domínguez-Cajal
- Unidad de Gastroenterología y Hepatología, Hospital Universitario San Jorge, Huesca, Spain
| | - Pedro Almela
- Servicio de Medicina Digestiva, Hospital General Universitario de Castellón, Castellón, Spain
- Ciencias de la Salud (Medicina), Universidad CEU Cardenal Herrera, Castellón, Spain
| | | | - Dmitry S Bordin
- Department of Pancreatic, Biliary and Upper Digestive Tract Disorders, A. S. Loginov Moscow Clinical Scientific Center, Moscow, Russia
- Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Department of Outpatient Therapy and Family Medicine, Tver State Medical University, Tver, Russia
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Juozas Kupčinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Anna Cano-Català
- GOES Research Group, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Olga P Nyssen
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | - Colm O'Morain
- Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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3
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Pérez-Aisa Á, Nyssen OP, Keco-Huerga A, Rodrigo L, Lucendo AJ, Gomez-Rodriguez BJ, Ortuño J, Perona M, Huguet JM, Núñez O, Fernandez-Salazar L, Barrio J, Lanas A, Iyo E, Romero PM, Fernández-Bermejo M, Gomez B, Garre A, Gomez-Camarero J, Lamuela LJ, Campillo A, de la Peña-Negro L, Dominguez Cajal M, Bujanda L, Burgos-Santamaría D, Bermejo F, González-Carrera V, Pajares R, Notari PA, Tejedor-Tejada J, Planella M, Jiménez I, Lázaro YA, Cuadrado-Lavín A, Pérez-Martínez I, Amorena E, Gonzalez-Santiago JM, Angueira T, Flores V, Martínez-Domínguez SJ, Pabón-Carrasco M, Velayos B, Algaba A, Ramírez C, Almajano EA, Castro-Fernandez M, Alcaide N, Sanz Segura P, Cano-Català A, García-Morales N, Moreira L, Mégraud F, O'Morain C, Calvet X, Gisbert JP. Bismuth quadruple three-in-one single capsule three times a day increases effectiveness compared with the usual four times a day schedule: results from the European Registry on Helicobacter pylori Management (Hp-EuReg). Gut 2023; 72:2031-2038. [PMID: 37468228 DOI: 10.1136/gutjnl-2022-329259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The recommended schedule for single capsule bismuth quadruple therapy (scBQT, Pylera) includes a proton pump inhibitor (PPI) two times a day and three scBQT capsules four times a day. Four times a day treatments are inconvenient and reduce adherence. In contrast, adherence improves with three times a day schedules. In clinical practice, many gastroenterologists use four capsule scBQT three times a day. However, the effectiveness and safety of this latter approach remain uncertain. AIM To assess the effectiveness and safety of scBQT administered three times a day in the patients included in the European Registry on Helicobacter pylori Management (Hp-EuReg). METHODS All Spanish adult patients registered in the Asociación Española de Gastroenterología Research Electronic Data Capture (REDCap) database from June 2013 to March 2021 receiving 10-day scBQT were analysed. Modified intention-to-treat effectiveness, adherence and the safety of scBQT given three times a day were calculated and compared with the four times a day schedule. A multivariate analysis was performed to determine independent factors predicting cure of the infection. RESULTS Of the 3712 cases, 2516 (68%) were four times a day and 1196 (32%) three times a day. Mean age was 51 years, 63% were women and 15% had a peptic ulcer. The three times a day schedule showed significantly better overall cure rates than four times a day (1047/1112, 94%; 95% CI 92.7 to 95.6 vs 2207/2423, 91%; 95% CI 89.9 to 92.2, respectively, p=0.002). Adherence and safety data were similar for both regimens. In the multivariate analysis, three times a day dosage, first-line therapy, use of standard or high-dose PPIs and adherence over 90% were significantly associated with cure of the infection. CONCLUSIONS ScBQT prescribed three times a day was more effective than the traditional four times a day schedule. No differences were observed in treatment adherence or safety.
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Affiliation(s)
- Ángeles Pérez-Aisa
- Department of Gastroenterology, Hospital Costal del Sol, Marbella, Spain
- Redes de Investigación Cooperativa orientada a Resultados en Salud (RICORS), Marbella, Spain
| | - Olga P Nyssen
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Alma Keco-Huerga
- Department of Gastroenterology, Hospital de Valme, Sevilla, Spain
| | - Luís Rodrigo
- Gastroenterology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alfredo J Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Department of Gastroenterology, Hospital General Tomelloso, Tomelloso, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-Princesa), UniversidadAutónoma de Madrid (UAM), Madrid, Spain
| | | | - Juan Ortuño
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mónica Perona
- Department of Gastroenterology, Hospital Quiron Marbella, Marbella, Spain
| | - José María Huguet
- Gastroenterology Unit, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Oscar Núñez
- Department of Digestive Diseases, Hospital Universitario Sanitas La Moraleja, Madrid, Spain
| | - Luis Fernandez-Salazar
- Gastroenterologia, Hospital Clínico Universitario Valladolid, Gerencia Regional de Salud (SACYL), Valladolid, Spain
- Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Jesus Barrio
- Department of Gastroenterology, Hospital Rio Hortega, Valladolid, Spain
| | - Angel Lanas
- Instituto de Investigación Sanitària de Aragón (IIS Aragorn), Zaragoza, Spain
- Facultad de Medicina. Universidad de Zaragoza, Zaragoza, Spain
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Eduardo Iyo
- Digestive Service, Hospital Comarcal de Inca, Inca, Mallorca, Spain
| | - Pilar Mata Romero
- Department of Gastroenterology, Hospital Universitario de Caceres, Cáceres, Spain
| | | | - Barbara Gomez
- Department of Gastroenterology, Hospital de Mataró, Mataro, Spain
| | - Ana Garre
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | | | - Luis Javier Lamuela
- Instituto de Investigación Sanitària de Aragón (IIS Aragorn), Zaragoza, Spain
- Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ana Campillo
- Department of Gastroenterology, Hospital Reina Sofía, Tudela, Spain
| | | | | | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Department of Gastroenterology, Hospital Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastian, Spain
| | - Diego Burgos-Santamaría
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain
- Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | | | - Ramón Pajares
- Department of Gastroenterology, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Madrid, Spain
- Medicine Department, Universidad Europea de Madrid SLU, Madrid, Spain
| | - Pedro Almela Notari
- Digestive Service, Hospital General Universitari de Castelló, Castellon de la Plana, Spain
| | | | - Montserrat Planella
- Department of Gastroenterology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Itxaso Jiménez
- Department of Gastroenterology, Hospital Universitario de Galdakao-Usansolo, Galdakao, Spain
| | | | | | - Isabel Pérez-Martínez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Edurne Amorena
- Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús M Gonzalez-Santiago
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Department of Gastroenterology, Complejo Universitario de Salamanca. IBSAL, Salamanca, Spain
| | - Teresa Angueira
- Department of Gastroenterology, Hospital General Tomelloso, Tomelloso, Spain
| | - Virginia Flores
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón - Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Samuel J Martínez-Domínguez
- Instituto de Investigación Sanitària de Aragón (IIS Aragorn), Zaragoza, Spain
- Facultad de Medicina. Universidad de Zaragoza, Zaragoza, Spain
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Benito Velayos
- Gastroenterologia, Hospital Clínico Universitario Valladolid, Gerencia Regional de Salud (SACYL), Valladolid, Spain
- Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Alicia Algaba
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain
- Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | - Consuelo Ramírez
- Department of Gastroenterology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Enrique Alfaro Almajano
- Instituto de Investigación Sanitària de Aragón (IIS Aragorn), Zaragoza, Spain
- Facultad de Medicina. Universidad de Zaragoza, Zaragoza, Spain
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Noelia Alcaide
- Gastroenterologia, Hospital Clínico Universitario Valladolid, Gerencia Regional de Salud (SACYL), Valladolid, Spain
- Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | | | - Anna Cano-Català
- Department of Gastroenterology, Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Natalia García-Morales
- Digestive Service, Complexo Hospitalario Universitario de Vigo Sergas, Vigo, Spain
- South Galicia Health Research Institute, Vigo, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic-UB, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Colm O'Morain
- Department of Gastroenterology, Faculty of Health Science, Trinity College Dublin, Dublin, Ireland
| | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Digestive Diseases Department, Parc Taulí, Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí, Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
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Sicilia B, González-Lama Y, Velayos B, Suárez P, Maroto-Martín C, Nuñez A, Hernández L, Sáiz-Chumillas RM, Relea L, Fernández-Salazar L, Sierra-Ausín M, Barrio Andrés J, Muñoz F, Arias García L. Low risk of new dysplastic lesions in an inflammatory bowel disease population study with dye chromoendoscopy. Endosc Int Open 2023; 11:E490-E496. [PMID: 37206695 PMCID: PMC10191734 DOI: 10.1055/a-2048-2279] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/25/2023] [Indexed: 05/21/2023] Open
Abstract
Background and study aims Rates of new dysplastic lesions or cancer progression after first dye chromoendoscopy in the era of high-definition endoscopy have yet to be determined. Patients and methods A multicenter, population-based, retrospective cohort study was performed in seven hospitals in Spain. Patients with inflammatory bowel disease and fully resected (R0) dysplastic colon lesions under surveillance with high-definition dye-based chromoendoscopy were sequentially enrolled between February 2011 and June 2017, with a minimum endoscopic follow-up of 36 months. The aim was to assess the incidence of developing more advanced metachronous neoplasia by analyzing possible associated risk factors. Results The study sample included 99 patients and 148 index lesions (145 low-grade dysplasia lesions and three high-grade dysplasia [HGD] lesions with a mean follow-up of 48.76 months [IQR: 36.34-67.15]). The overall incidence of new dysplastic lesions was 0.23 per 100 patient-years, 1.15 per 100 patients at 5 years and 2.29 per 100 patients at 10 years. A history of dysplasia was associated with a higher risk of developing any grade of dysplasia during follow-up ( P = 0.025), whereas left colon lesions were associated with a lower risk ( P = 0.043). The incidence of more advanced lesions at 1 year and 10 years was 1 % and 14 % respectively, with lesion size > 1 cm being a risk factor ( P = 0.041). One of the eight patients (13 %) with HGD lesions developed colorectal cancer during follow-up. Conclusions The risk of dysplasia progressing to advanced neoplasia and, specifically, the risk of new neoplastic lesions after endoscopic resection of colitis-associated dysplasia, are both very low.
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Affiliation(s)
| | | | - Benito Velayos
- Hospital clínico universitario Valladolid Valladolid, Spain
| | | | | | | | | | | | - Lucia Relea
- Puerta de Hierro Hospital, Majadahonda, Spain
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Aladrén BS, González-Lama Y, García-Alvarado M, Sierra M, Barrio JA, Vicente VP, Hernández L, Velayos B, Garcia LA, Relea L, Suarez P, Atienza R, Vásquez M, Fernández-Salazar L, Muñoz F. Even non-experts identify non-dysplastic lesions in inflammatory bowel disease via chromoendoscopy: results of a screening program in real-life. Endosc Int Open 2019; 7:E743-E750. [PMID: 31157291 PMCID: PMC6524993 DOI: 10.1055/a-0839-4514] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Chromoendoscopy with targeted biopsy is the technique of choice for colorectal cancer screening in longstanding inflammatory bowel disease. We aimed to analyze results of a chromoendoscopy screening program and to assess the possibility of identifying low-risk dysplastic lesions by their endoscopic appearance in order to avoid histological analysis. Materials and methods We retrospectively reviewed chromoendoscopies performed between February 2011 and June 2017 in seven Spanish hospitals in a standardized fashion. We analyzed the findings and the diagnostic yield of the Kudo pit pattern for predicting dysplasia. Results A total of 709 chromoendoscopies (569 patients) were reviewed. Median duration of disease was 16.7 years (SD 8.1); 80.4 % had ulcerative colitis. A total of 2025 lesions (3.56 lesions per patient) were found; two hundred and thirty-two lesions were neoplastic (11.5 %) (223 were LGD (96.1 %), eight were HGD (3.4 %), and one was colorectal cancer (0.5 %). The correlation between dysplasia and Kudo pit patterns predictors of dysplasia (≥ III) was low, with an area under the curve of 0.649. Kudo I and II lesions were correctly identified with a high negative predictive value (92 %), even by non-experts. Endoscopic activity, Paris 0-Is classification, and right colon localization were risk factors for dysplasia detection, while rectum or sigmoid localization were protective against dysplasia. Conclusions Chromoendoscopy in the real-life setting detected 11 % of dysplastic lesions with a low correlation with Kudo pit pattern. A high negative predictive value would prevent Kudo I and, probably, Kudo II biopsies in the left colon, reducing procedure time and avoiding complications.
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Affiliation(s)
| | | | | | | | | | | | - Luis Hernández
- Hospital Santos Reyes. Aranda de Duero, Castilla y León, Spain
| | - Benito Velayos
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Lucia Relea
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Ramón Atienza
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - Mónica Vásquez
- Hospital Santos Reyes. Aranda de Duero, Castilla y León, Spain
| | | | - Fernando Muñoz
- Hospital Universitario de Salamanca, Castilla y León, Spain
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6
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Gisbert JP, Romano M, Gravina AG, Solís-Muñoz P, Bermejo F, Molina-Infante J, Castro-Fernández M, Ortuño J, Lucendo AJ, Herranz M, Modolell I, Del Castillo F, Gómez J, Barrio J, Velayos B, Gómez B, Domínguez JL, Miranda A, Martorano M, Algaba A, Pabón M, Angueira T, Fernández-Salazar L, Federico A, Marín AC, McNicholl AG. Helicobacter pylori second-line rescue therapy with levofloxacin- and bismuth-containing quadruple therapy, after failure of standard triple or non-bismuth quadruple treatments. Aliment Pharmacol Ther 2015; 41:768-75. [PMID: 25703120 DOI: 10.1111/apt.13128] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 11/22/2014] [Accepted: 01/29/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND The most commonly used second-line Helicobacter pylori eradication regimens are bismuth-containing quadruple therapy and levofloxacin-containing triple therapy, both offering suboptimal results. Combining bismuth and levofloxacin may enhance the efficacy of rescue eradication regimens. AIMS To evaluate the efficacy and tolerability of a second-line quadruple regimen containing levofloxacin and bismuth in patients whose previous H. pylori eradication treatment failed. METHODS This was a prospective multicenter study including patients in whom a standard triple therapy (PPI-clarithromycin-amoxicillin) or a non-bismuth quadruple therapy (PPI-clarithromycin-amoxicillin-metronidazole, either sequential or concomitant) had failed. Esomeprazole (40 mg b.d.), amoxicillin (1 g b.d.), levofloxacin (500 mg o.d.) and bismuth (240 mg b.d.) was prescribed for 14 days. Eradication was confirmed by (13) C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by questionnaires. RESULTS 200 patients were included consecutively (mean age 47 years, 67% women, 13% ulcer). Previous failed therapy included: standard clarithromycin triple therapy (131 patients), sequential (32) and concomitant (37). A total of 96% took all medications correctly. Per-protocol and intention-to-treat eradication rates were 91.1% (95%CI = 87-95%) and 90% (95%CI = 86-94%). Cure rates were similar regardless of previous (failed) treatment or country of origin. Adverse effects were reported in 46% of patients, most commonly nausea (17%) and diarrhoea (16%); 3% were intense but none was serious. CONCLUSIONS Fourteen-day bismuth- and levofloxacin-containing quadruple therapy is an effective (≥90% cure rate), simple and safe second-line strategy in patients whose previous standard triple or non-bismuth quadruple (sequential or concomitant) therapies have failed.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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7
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Berroa E, Alcaide N, Rodríguez M, Velayos B, Fernández-Salazar L. [Annular pancreas: a potentially overlooked congenital pancreatic anomaly]. Gastroenterol Hepatol 2014; 37:596-7. [PMID: 25124266 DOI: 10.1016/j.gastrohep.2014.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/27/2014] [Accepted: 02/18/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Edel Berroa
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Noelia Alcaide
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Margarita Rodríguez
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Benito Velayos
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Luis Fernández-Salazar
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España
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8
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Velayos B, Pons-Renedo F, Fernández-Salazar L, Muñoz MF, Olmo L, Almaraz A, Beltrán-Heredia J, Hernández-González JM. Atmospheric pressure does not influence acute diverticular disease. Int J Colorectal Dis 2013; 28:1725-6. [PMID: 23411679 DOI: 10.1007/s00384-013-1666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Benito Velayos
- Department of Gastroenterology, University Hospital of Valladolid, Av Ramón y Cajal 3, 47005, Valladolid, Spain,
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Velayos B, Prieto JM, Fernández L, González JM. [Cholecystocolonic fistula diagnosed by colonoscopy in a symptom-free woman]. Med Clin (Barc) 2013; 140:432. [PMID: 23517557 DOI: 10.1016/j.medcli.2013.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/07/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Benito Velayos
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, España.
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Marugán-Miguelsanz JM, Ontoria M, Velayos B, Torres-Hinojal MC, Redondo P, Fernández-Salazar L. Natural history of irritable bowel syndrome. Pediatr Int 2013; 55:204-7. [PMID: 23253156 DOI: 10.1111/ped.12028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/05/2012] [Accepted: 12/05/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic diarrhea and functional abdominal pain (FAP) in childhood could be an early manifestation of adult irritable bowel syndrome (IBS). The aim of this study was to investigate the presence of chronic functional digestive symptoms in childhood, interviewing adult patients diagnosed with IBS, in an attempt to establish a relationship between them. METHODS By means of a questionnaire, the history of colic, chronic diarrhea, functional abdominal pain, constipation and migraine in childhood, was analyzed in patients diagnosed with IBS according to the current Rome III criteria, and in control patients without known chronic digestive disorders. Fisher's exact test was used for comparison of frequencies. RESULTS The IBS study group was made up of 40 patients (24 women; average age, 33.03 years), and the control group by 40 adults (22 women; average age, 29.62 years). IBS-diagnosed adults spoke about a significantly higher prevalence of chronic diarrhea (32.5/7.5%; odds ratio [OR], 7.01; 95% confidence interval [CI]: 26.84-1.80), and FAP (37.5/15%; OR, 4.30; 95%CI: 12.67-1.43) in their childhood, than the control group. There were no differences in the presence of other childhood functional symptoms. Interestingly, the present patients, when asked about the onset of symptoms that led to the diagnosis of IBS, referred to them mostly beginning in adulthood, not linking their current diagnosis of IBS with their background in childhood. CONCLUSIONS In a proportion of adults with IBS the natural history of their symptoms probably began during their childhood.
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Velayos B, Fernández-Salazar L, Pons-Renedo F, Muñoz MF, Almaraz A, Aller R, Ruíz L, Del Olmo L, Gisbert JP, González-Hernández JM. Accuracy of urea breath test performed immediately after emergency endoscopy in peptic ulcer bleeding. Dig Dis Sci 2012; 57:1880-6. [PMID: 22453995 DOI: 10.1007/s10620-012-2096-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/10/2012] [Indexed: 02/07/2023]
Abstract
AIMS The aim of this work is to investigate the accuracy of the urea breath test (UBT) performed immediately after emergency endoscopy in peptic ulcer bleeding (PUB). METHODS Urea breath test was carried out right after emergency endoscopy in patients with PUB. The accuracy of this early UBT was compared to a delayed one after hospital discharge that was considered the gold standard. Clinical and epidemiological factors were analyzed in order to study their influence on the accuracy of the early UBT. RESULTS Early UBT was collected without any complication and good acceptance from all the 74 patients included. In 53 of the patients (71.6%), a delayed UBT was obtained. Comparing concordance between the two tests we have calculated an accuracy of 83% for the early UBT. Sensibility and specificity were 86.36 and 66%, respectively, with a positive predictive value of 92.68% and negative predictive value of 50% (Kappa index = 0.468; p = 0.0005; CI: 95%). We found no influence of epidemiological factors, clinical presentation, drugs, times to gastroscopy, Forrest classification, endoscopic therapy, hemoglobin, and urea levels over the accuracy of early UBT. CONCLUSIONS Urea breath test carried out right after emergency endoscopy in PUB is an effective, safe, and easy-to-perform procedure. The accuracy of the test is not modified by clinical or epidemiological factors, ulcer stage, or by the type of therapy applied. However, we have found a low negative predictive value for early UBT, so a delayed test is mandatory for all negative cases.
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Affiliation(s)
- Benito Velayos
- Department of Gastroenterology, Hospital Clínico de Valladolid, Valladolid, Spain.
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12
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Ruiz-Rebollo ML, de-la-Calle F, Velayos B, Fernández-Salazar L, Aller-de-la-Fuente R, González JM. Radiation enteritidis diagnosed by wireless capsule endoscopy. Rev Esp Enferm Dig 2012; 104:212-213. [PMID: 22537371 DOI: 10.4321/s1130-01082012000400008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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13
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Cocozza G, Contaldo A, Calabia A, Velayos B, Fernández-Salazar L. Doubts and similarities between Crohn's disease and Henoch-Schönlein purpura. Rev Esp Enferm Dig 2012; 104:222-223. [PMID: 22537377 DOI: 10.4321/s1130-01082012000400014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Fernández-Salazar LI, Gómez-González E, Velayos B, Barrio J, González JM, Arranz E, Garrote JA. NOD2/CARD15 gene mutations in patients with inflammatory bowel disease in Valladolid. Rev Esp Enferm Dig 2011; 103:500. [PMID: 21951126 DOI: 10.4321/s1130-01082011000900016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Velayos B, Fernández L, del Olmo L, Ruiz L, Aller R, Macho A, de la Calle F, Arranz T, González JM. Cat scratch esophagus: a new entity to be described? Rev Esp Enferm Dig 2011; 103:427-428. [PMID: 21867353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Benito Velayos
- Department of Gastroenterology, Hospital Clínico Universitario, Valladolid, Spain
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Abstract
INTRODUCTION Hepatic fibrosis can be assessed through serum markers or by the implementation of new non-invasive techniques, such as elastography. We must know patients' opinion on percutaneous liver biopsy (PLB) when it comes to comparing it with other procedures. AIMS To know the point of view of patients undergoing a PLB with regard to information provided to them, as well as the procedures and biopsy consequences. PATIENTS AND METHODS A questionnaire was sent by mail to 178 patients who underwent PLB from April 2006 to May 2010. Answers were analyzed. Results are expressed in percentages and compared based on gender and age (younger or older than 47 years of age) (Chi-square test). RESULTS Ninety patients of the group answered, 44 females, mean age 47 ± 12 years. The answers revealed that 93% of patients rated the information concerning the reasons for a PLB as adequate (86% women and 100% men). As for the information concerning the objective of the procedure, 88% of patients regarded it as adequate (81% of women vs. 93% of men, p = 0.08). As for the information concerning the risks of a biopsy, 77.7% see it as sufficient. About 12.20% of patients did not receive any information on the physician who asked for the PLB, or who performed it. PLB was considered very painful by 14% of patients, painful by 21%, bothersome by 41.1% and barely bothersome by 23% of patients. Thirty-five percent of patients required analgesia after the puncture. Even though 92% of patients regard PLB as a useful procedure, 46% of them have not received any treatment or a different nutritional regime (55.8%, among those older than 47 years of age, p = 0.03). Eighty percent of patients think that PLB has more benefits than drawbacks, although 87% would have opted for a less aggressive technique as long as it would have provided the same information. But 21% of patients would have also preferred a less aggressive technique, even though it provided fewer details. CONCLUSIONS In general, PLB is widely approved by patients and is also regarded as a useful procedure. One out of six patients would rather choose a less-aggressive technique even if it provided less information. PLB does not involve changes in the treatment in around a half of patients.
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Affiliation(s)
- Luis Fernández-Salazar
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
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Aller R, De Luis DA, Fernandez L, Calle F, Velayos B, Izaola O, Gonzalez Sagrado M, Conde R, Gonzalez JM. Influence of Ala54Thr polymorphism of fatty acid-binding protein 2 on histological alterations and insulin resistance of non alcoholic fatty liver disease. Eur Rev Med Pharmacol Sci 2009; 13:357-364. [PMID: 19961041] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A transition G to A at codon 54 of fatty acid binding protein type 2 (FABP2) produces an amino acid substitution (Ala 54 to Thr 54). This amino acid substitution was associated with modifications of insulin resistance, adipokines and insulin concentrations. The aim of this study was to evaluate the influence of Ala54Thr polymorphism in the FABP2 gene on the histological alterations of non-alcoholic fatty liver disease (NAFLD) and insulin resistance. Thirty subjects with the presence of biopsy-proven NAFLD were enrolled for this study. Glucose, Insulin, Insulin resistance (HOMA), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, resistin, leptin, adiponectin, interleukin-6 and TNF-alfa serum levels were measured at basal time. A tetrapolar bioimpedance, BMI, waist circumference, waist to hip ratio, blood pressure and a prospective serial assessment of nutritional intake with 3 days written food records were examined. Genotype of Ala54Thr FABP2 gene polymorphism was studied. The mean age was 41.6 +/- 11 years and the mean BMI 29.2 +/- 6.6 with 24 males (80%) and 6 females (20%). Fifteen patients (50%) had the genotype Ala54/Ala54 (wild type group) and 15 (50%) patients Ala54/Thr54 (13 patients) or Thr54/Thr54 (2 patients) (mutant type group). Both genotype groups have the similar anthropometric parameters. Serum aspartate aminotransferase and alcaline phosfatase were higher in wild type group than mutant type group, with an unclear explanation. Dietary intake was similar in both groups. A non-statistical significant low levels of adiponectin in mutant group was observed. No differences were detected among other adipokines. There were no differences between genotypes in histological results of inflammation (portal or lobular inflammation) or grade of steatosis or fibrosis. In conclusion, the present study demonstrates that the polymorphism Ala54Thr of FABP in patients with NAFLD doesn't predict liver histological changes, nor both insulin resistance and serum adipokines variations.
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Affiliation(s)
- R Aller
- Institute of Endocrinology and Nutrition, Medicine School and Unit of Investigation, Hospital Rio Hortega, Valladolid, Spain
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18
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Velayos B, Herreros de Tejada A, Fernández L, Aller R, Almaraz A, Olmo LD, Calle FDL, Arranz T, González JM. Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding. Rev esp enferm dig 2009; 101:11-9. [DOI: 10.4321/s1130-01082009000100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Velayos B, Muñoz MF, Fernández L, Aller R, Lozano F, de la Calle F, del Olmo L, Arranz T, González JM. [Measurement of lesion size by capsule endoscopy: an unsolved issue]. Rev Esp Enferm Dig 2008; 100:248-9. [PMID: 18563988 DOI: 10.4321/s1130-01082008000400015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Aller R, de Luis DA, Fernandez L, Calle F, Velayos B, Olcoz JL, Izaola O, Sagrado MG, Conde R, Gonzalez JM. Influence of insulin resistance and adipokines in the grade of steatosis of nonalcoholic fatty liver disease. Dig Dis Sci 2008; 53:1088-92. [PMID: 17934820 DOI: 10.1007/s10620-007-9981-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 08/15/2007] [Indexed: 12/16/2022]
Abstract
The objective of this work was to study the influence of insulin resistance and adipokines on the grade of steatosis in patients with NAFLD (nonalcoholic fatty liver disease) diagnosed by liver biopsy. A sample of 24 NAFLD patients was analyzed in a cross-sectional study. All patients with a two-week weight-stabilization period before recruitment were enrolled. A liver biopsy was realized. Weight, basal glucose, insulin, insulin resistance (HOMA), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, and adipokines blood levels were measured. A nutritional evaluation (dietary intake, indirect calorimetry, and bioimpedance) was performed. The mean age was 41.6 +/- 8.7 years and the mean body mass index (BMI) 29.4 +/- 4.7. Twelve patients had a low grade of steatosis (grade 1 of the Brunt classification) and 12 patients had a high grade of steatosis (grade 2 or 3). Only HOMA was higher in patients with a high grade of steatosis (1.4 +/- 0.5 vs. 2.8 +/- 1.7 units; P < 0.05). Anthropometric data and dietary intake were similar for both groups. Blood levels of adiponectin were higher in patients with a low grade of steatosis (37.7 +/- 22.5 vs. 24.2 +/- 33 ng mL(-1); P < 0.05). Blood levels of resistin were higher in patients with a high grade of steatosis (2.36 +/- 0.6 vs. 2.8 +/- 0.6 mg mL(-1); P < 0.05), without differences in TNF-alpha or leptin levels. In logistic regression analysis, the HOMA-IR remained in the model, with an odds ratio to develop high grade of steatosis of 7.8 (95% CI: 1.8-75) with each 1 unit of HOMA-IR adjusted by age, sex, BMI, and dietary intake. This study demonstrates that insulin resistance determined with the HOMA model is associated with a high grade of steatosis in patients with NAFLD.
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Affiliation(s)
- Rocio Aller
- Institute of Endocrinology of Nutrition Medicine School and Gastroenterology Dept H Clinico Universitario, University of Valladolid, Valladolid, Spain
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de la Morena López F, Fernández-Salazar L, Velayos B, Aller R, Juárez M, González JM. [Meckel's diverticulum and gastrointestinal stromal tumor: an unusual association]. Gastroenterol Hepatol 2008; 30:534-7. [PMID: 17980131 DOI: 10.1157/13111691] [Citation(s) in RCA: 4] [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: 11/21/2022]
Abstract
Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. Bleeding from Meckel's diverticulum is the most common clinical presentation, especially in childhood. In adults, manifestations include a broad spectrum of symptoms ranging from an incidental finding in surgery, iron deficiency anemia of unknown etiology, and acute abdomen due to mechanical complications of the diverticulum. Neoplastic transformation has been reported, but gastrointestinal stromal tumors are exceptional in this location. We report a case of gastrointestinal stromal tumor in Meckel's diverticulum, complicated by perforation.
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Velayos B, Fernández L, Aller R, de la Calle F, del Olmo L, Arranz T, González Hernández JM. Public opinion survey after capsule endoscopy: patient's point of view on its utility. Rev esp enferm dig 2006; 98:436-48. [PMID: 16948543 DOI: 10.4321/s1130-01082006000600005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM When programming a medical test such as capsule endoscopy (CE), finding the closest point between the patient's experience and his/her expectation is essential to improve any further explorations. For this purpose we designed a form which tries to collect the information required. MATERIAL AND METHODS From December 2003 to January 2005 we examined the small intestine of 98 patients with the help of CE. Later they were sent an anonymous questionnaire in July 2005, which included 10 questions upon the origin and previous knowledge of the patient about this technique, their tolerance to it, and the value they attached to it with regard to finding a new diagnosis and assigning different treatments, and also the incidence in the positive or negative evolution of their disease in particular and of medicine in general. RESULTS Answer rate reached 58% and was slightly higher among women and people over 70 years; 80% of repliers had been informed about CE by a physician, while nearly all the rest had received previous information from the media; 37% had had symptoms for more than 12 months, while only 17% had suffered them for one month before the exploration. A bit over 30% did not know what the specific diagnostic field of the test was (most of them women and young people), although most of them were not surprised by the procedure. Over 75% showed "acceptable" or "excellent" tolerance, while 5.5% (most of them young people) found it hard to bear. The opinion about its utility in the diagnosis was 37%, and although 70% thought that CE had revealed nothing new about their pathology, over 60% declared feeling better after the test; 84% pointed out that it had achieved a breakthrough for their quality of life (most of them men and very old people), and only 13% thought it was worthless. However, nearly all the answers agreed in that CE was an "important" or "very important" diagnostic device. CONCLUSIONS After the test using CE, the diagnostic benefit detected by the patient is not the same as that shown by technical studies. Nevertheless, the test can be highly satisfactory for the patient in particular, and also in an overall view. CE is a well-tolerated test, applied in our setting to chronic diseases and that, contrary to what we supposed, is explained to patients mainly by a physician. Most of them are not familiar with its specific indications.
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Affiliation(s)
- B Velayos
- Service of Digestive Diseases, Hospital Clínico, Valladolid, Spain.
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Buelta C, Velayos B, Abril C, Esteban E, Trueba J, Fernández L, Gago P, González JM. [Pancreaticobronchial fistula as the first manifestation of pancreatic pseudocysts]. Gastroenterol Hepatol 2006; 29:274-5. [PMID: 16584700 DOI: 10.1157/13085980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Velayos B, del Olmo L, Fernández L, Aller R, de la Calle F, Arranz T, González JM. Choledocho-renal fistula in locally advanced cholangiocarcinoma. Rev Esp Enferm Dig 2005; 97:750-1. [PMID: 16351467 DOI: 10.4321/s1130-01082005001000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- B Velayos
- Service of Digestive Diseases, Hospital Clínico, Valladolid, Spain
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Moreno JM, Rubio E, Pons F, Velayos B, Navarrete E, Herreros de Tejada A, López-Monclús J, Sánchez-Turrión V, Cuervas-Mons V. Usefulness of mycophenolate mofetil in patients with chronic renal insufficiency after liver transplantation. Transplant Proc 2003; 35:715-7. [PMID: 12644108 DOI: 10.1016/s0041-1345(03)00061-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J M Moreno
- Liver Transplantation Unit, Department of Medicine, Puerta de Hierro University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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