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Gratacós-Ginès J, Ruz-Zafra P, Celada-Sendino M, Martí-Carretero A, Pujol C, Martín-Mateos R, Echavarría V, Frisancho LE, García S, Barreales M, Tejedor-Tejada J, Vázquez-Rodríguez S, Cañete N, Fernández-Carrillo C, Valenzuela M, Martí-Aguado D, Horta D, Quiñones M, Bernal-Monterde V, Acosta S, Artaza T, Pinazo J, Villar-Lucas C, Clemente-Sánchez A, Badia-Aranda E, Giráldez-Gallego Á, Rodríguez M, Sancho-Bru P, Cabezas J, Ventura-Cots M, Fernández-Rodríguez C, Aguilera V, Tomé S, Bataller R, Caballería J, Pose E. Recurrent alcohol-associated hepatitis is common and is associated with increased mortality. Hepatology 2024:01515467-990000000-00773. [PMID: 38441908 DOI: 10.1097/hep.0000000000000825] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/06/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND AIMS Alcohol relapse after surviving an episode of alcohol-associated hepatitis (AH) is common. However, the clinical features, risk factors, and prognostic implications of recurrent alcohol-associated hepatitis (RAH) are not well described. APPROACH AND RESULTS A registry-based study was done of patients admitted to 28 Spanish hospitals for an episode of AH between 2014 and 2021. Baseline demographics and laboratory variables were collected. Risk factors for RAH were investigated using Cox regression analysis. We analyzed the severity of the index episodes of AH and compared it to that of RAH. Long-term survival was assessed by Kaplan-Meier curves and log-rank tests. A total of 1118 patients were included in the analysis, 125 (11%) of whom developed RAH during follow-up (median: 17 [7-36] months). The incidence of RAH in patients resuming alcohol use was 22%. The median time to recurrence was 14 (8-29) months. Patients with RAH had more psychiatric comorbidities. Risk factors for developing RAH included age <50 years, alcohol use >10 U/d, and history of liver decompensation. RAH was clinically more severe compared to the first AH (higher MELD, more frequent ACLF, and HE). Moreover, alcohol abstinence during follow-up was less common after RAH (18% vs. 45%, p <0.001). Most importantly, long-term mortality was higher in patients who developed RAH (39% vs. 21%, p = 0.026), and presenting with RAH independently predicted high mortality (HR: 1.55 [1.11-2.18]). CONCLUSIONS RAH is common and has a more aggressive clinical course, including increased mortality. Patients surviving an episode of AH should undergo intense alcohol use disorder therapy to prevent RAH.
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Affiliation(s)
- Jordi Gratacós-Ginès
- Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
| | - Pilar Ruz-Zafra
- Department of Digestive Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Miriam Celada-Sendino
- Department of Liver Diseases, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Aina Martí-Carretero
- Department of Liver Diseases, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Clàudia Pujol
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Rosa Martín-Mateos
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Víctor Echavarría
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Luis E Frisancho
- Department of Liver Diseases, Hospital Parc Taulí, Sabadell, Spain
| | - Sonia García
- Department of Hepatology and Liver Transplant, Hospital Universitari i Politècnic La Fe, IISLa FE, Valencia, Spain
| | - Mónica Barreales
- Department of Liver Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Sergio Vázquez-Rodríguez
- Department of Gastroenterology. Xerencia Xestion Integrada de Vigo Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, SERGAS, Vigo, Spain
| | - Nuria Cañete
- Liver Section, Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Carlos Fernández-Carrillo
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - María Valenzuela
- Department of Gastroenterology and Hepatology, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - David Martí-Aguado
- Digestive Disease Department, Clínic University Hospital, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Diana Horta
- Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Marta Quiñones
- Gastroenterology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Silvia Acosta
- Department of Digestive Diseases, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Tomás Artaza
- Department of Digestive Diseases, Hospital Universitario de Toledo, Toledo, Spain
| | - José Pinazo
- Department of Gastroenterology, Hospital Virgen de la Victoria, Málaga, Spain
| | - Carmen Villar-Lucas
- Department of Digestive Diseases, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ana Clemente-Sánchez
- Department of Liver Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ester Badia-Aranda
- Department of Digestive Diseases, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Manuel Rodríguez
- Department of Liver Diseases, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Pau Sancho-Bru
- Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Joaquín Cabezas
- Department of Gastroenterology and Hepatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Meritxell Ventura-Cots
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
- Department of Liver Diseases, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Conrado Fernández-Rodríguez
- Gastroenterology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
- Department of Medicine, Universidad Rey Juan Carlos, Madrid, Spain
| | - Victoria Aguilera
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
- Department of Hepatology and Liver Transplant, Hospital Universitari i Politècnic La Fe, IISLa FE, Valencia, Spain
| | - Santiago Tomé
- Department of Liver Diseases, Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Ramon Bataller
- Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
| | - Juan Caballería
- Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
| | - Elisa Pose
- Department of Liver Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- Liver, Digestive System and Metabolism Department Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
- Department of Liver Injury, Progression of Cirrhosis and Liver Transplantation, Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain
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2
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Martin-Cardona A, Horta D, Florez-Diez P, Vela M, Mesonero F, Ramos Belinchón C, García MJ, Masnou H, de la Peña-Negro L, Suarez Ferrer C, Casanova MJ, Durán MO, Peña E, Calvet X, Fernández-Prada SJ, González-Muñoza C, Piqueras M, Rodríguez-Lago I, Sainz E, Bas-Cutrina F, Mancediño Marcos N, Ojeda A, Orts B, Sicilia B, García AC, Domènech E, Esteve M. Safety and effectiveness of direct-acting antiviral drugs in the treatment of hepatitis C in patients with inflammatory bowel disease. Dig Liver Dis 2024; 56:468-476. [PMID: 37770282 DOI: 10.1016/j.dld.2023.09.004] [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: 04/25/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) management in Inflammatory Bowel Disease (IBD) is uncertain. The ECCO guidelines 2021 recommended HCV treatment but warn about the risk of IBD reactivation. We aimed to evaluate 1) the effectiveness and safety of direct-acting antivirals (DAAs) in IBD; 2) the interaction of DAAs with IBD drugs. METHODS Multicentre study of IBD patients and HCV treated with DAAs. Variables related to liver diseases and IBD, as well as adverse events (AEs) and drug interactions, were recorded. McNemar's test was used to assess differences in the proportion of active IBD during the study period. RESULTS We included 79 patients with IBD and HCV treated with DAAs from 25,998 IBD patients of the ENEIDA registry. Thirty-one (39.2 %) received immunomodulators/biologics. There were no significant differences in the percentage of active IBD at the beginning (n = 11, 13.9 %) or at the 12-week follow-up after DAAs (n = 15, 19 %) (p = 0.424). Sustained viral response occurred in 96.2 % (n = 76). A total of 8 (10.1 %) AEs occurred and these were unrelated to activity, type of IBD, liver fibrosis, immunosuppressants/biologics, and DAAs. CONCLUSIONS We demonstrate a high efficacy and safety of DAAs in patients with IBD and HCV irrespective of activity and treatment of IBD.
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Affiliation(s)
- A Martin-Cardona
- Digestive Diseases Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - D Horta
- Digestive Diseases Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - P Florez-Diez
- Digestive Diseases Department, H.U. Central de Asturias, Oviedo, Spain
| | - M Vela
- Digestive Diseases Department, H. Nuestra Sra. de la Candelaria, Santa Cruz de Tenerife, Spain
| | - F Mesonero
- Digestive Diseases Department, H. Ramón y Cajal, Madrid, Spain
| | | | - M J García
- Gastroenterology and Hepatology Department, H. U. Marques de Valdecilla, IDIVAL, Santander, Spain
| | - H Masnou
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Digestive Diseases Department, H.U. Germans Trias i Pujol, Badalona, Spain
| | - L de la Peña-Negro
- Digestive Diseases Department, H.U. Bellvitge, Hospitalet de Llobregat, Spain
| | | | - M J Casanova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Digestive Diseases Department, Hospital Universitario de La Princesa-Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - M Ortiz Durán
- Digestive Diseases Department, H.U. Infanta Cristina, Madrid, Spain
| | - E Peña
- Digestive Diseases Department, Hospital Royo Villanova, Zaragoza, Spain
| | - X Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain; Digestive Diseases Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
| | | | - C González-Muñoza
- Digestive Diseases Department, H. de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Piqueras
- Digestive Diseases Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - I Rodríguez-Lago
- Digestive Diseases Department, Hospital Universitario de Galdakao and Biocruces Bizkaia Health Research Institute- Galdakao, Galdakao, Spain
| | - E Sainz
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - F Bas-Cutrina
- Digestive Diseases Department, H. General de Granollers, Granollers, Spain
| | - N Mancediño Marcos
- Digestive Diseases Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - A Ojeda
- Digestive Diseases Department, H.G.U. Elche, Elche, Spain
| | - B Orts
- Clinical Pharmacology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - B Sicilia
- Digestive Diseases Department, Hospital Universitario de Burgos, Burgos, Spain
| | - A Castaño García
- Digestive Diseases Department, H.U. Central de Asturias, Oviedo, Spain
| | - E Domènech
- Digestive Diseases Department, H.U. Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - M Esteve
- Digestive Diseases Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
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3
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Romero-Gutiérrez M, Pascual S, Márquez L, Gómez-Rubio M, Miquel M, Alarcón C, Ferrer T, Aracil C, Horta D, Latorre R, González Santiago J, Bernal V, Fernández C, Piqueras B, Gutiérrez ML, Martín A, Morillas J, Morales D, Blanco S, Rendón P, Chico I, Testillano M, Delgado C, Matilla A, Gómez Rodríguez R. Spontaneously ruptured hepatocellular carcinoma on non-cirrhotic liver: A prospective case series. Gastroenterol Hepatol 2023:S0210-5705(23)00395-3. [PMID: 37633519 DOI: 10.1016/j.gastrohep.2023.08.008] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND AND AIMS Spontaneous ruptured hepatocellular carcinoma is an uncommon complication, and there are scarce data about non-cirrhotic patients. Tumor treatment is not standardized and the risk of peritoneal dissemination is unclear. AIM we analyzed the treatment and survival in patients with rHCC on non-cirrhotic liver. METHODS One hundred and forty-one non-cirrhotic patients with hepatocellular carcinoma diagnosed by histology were included in a multicenter prospective registry (2018-2022). Seven of them (5%) presented with hemoperitoneum due to spontaneous rupture. RESULTS Liver disease was associated in three patients (42.9%). A single nodule was detected in three cases (42.9%). One patient had vascular invasion and none extrahepatic spread. Initial hemostatic therapy and sequential treatment was individualized. Patients with single nodule were treated: resection (one case) with recurrence at 4 months treated with TACE and sorafenib. TACE/TAE followed by surgery (two cases) one in remission 43 months later, the other had liver recurrence at 18 months and was transplanted. Patients with multiple lesions were treated: TAE/emergency surgery and subsequent systemic therapy (two cases), one received lenvatinib (1-year survival) and the other sorafenib (5-month survival). TAE and surgery with subsequent systemic therapy (one case). Initial hemostatic surgery, dying on admission (one case). No patient developed intraperitoneal metastasis. All patients with multiple lesions died by tumor. The 3-year survival rate was 42.9%. CONCLUSIONS Initial hemostasis was achieved in all patients by TAE/TACE or surgery. Subsequent treatment was individualized, based on tumor characteristics, regardless of rupture. Long-time remission could be achieved in single nodule patients.
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Affiliation(s)
| | - Sonia Pascual
- Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Laura Márquez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Teresa Ferrer
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carles Aracil
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Diana Horta
- Hospital Universitario Mútua de Terrassa, Barcelona, Spain
| | - Raquel Latorre
- Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | | | - Vanesa Bernal
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | - Ana Martín
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | | | - Sonia Blanco
- Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | | | - Ana Matilla
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Díaz-González Á, Hernández-Guerra M, Pérez-Medrano I, Sapena V, Riveiro-Barciela M, Barreira-Díaz A, Gómez E, Morillas RM, Del Barrio M, Escudé L, Mateos B, Horta D, Gómez J, Conde I, Ferre-Aracil C, El Hajra I, Arencibía A, Zamora J, Fernández A, Salcedo M, Molina E, Soria A, Estévez P, López C, Álvarez-Navascúes C, García-Retortillo M, Crespo J, Londoño MC. Budesonide as first-line treatment in patients with autoimmune hepatitis seems inferior to standard predniso(lo)ne administration. Hepatology 2023; 77:1095-1105. [PMID: 36626622 DOI: 10.1097/hep.0000000000000018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/05/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS In patients with non-severe acute or chronic autoimmune hepatitis (AIH) without cirrhosis, clinical practice guidelines recommend indistinct use of prednisone or budesonide. However, budesonide is infrequently used in clinical practice. We aimed to describe its use and compare its efficacy and safety with prednisone as first-line options. APPROACH AND RESULTS This was a retrospective, multicenter study of 105 naive AIH patients treated with budesonide as the first-line drug. The control group included 276 patients treated with prednisone. Efficacy was assessed using logistic regression and validated using inverse probability of treatment weighting propensity score. The median time to biochemical response (BR) was 3.1 months in patients treated with budesonide and 4.9 months in those with prednisone. The BR rate was significantly higher in patients treated with prednisone (87% vs. 49% of patients with budesonide, p < 0.001). The probability of achieving BR, assessed using the inverse probability of treatment weighting propensity score, was significantly lower in the budesonide group (OR = 0.20; 95% CI: 0.11-0.38) at any time during follow-up, and at 6 (OR = 0.51; 95% CI: 0.29-0.89) and 12 months after starting treatment (0.41; 95% CI: 0.23-0.73). In patients with transaminases <2 × upper limit of normal, BR was similar in both treatment groups. Prednisone treatment was significantly associated with a higher risk of adverse events (24.2% vs. 15.9%, p = 0.047). CONCLUSIONS In the real-life setting, the use of budesonide as first-line treatment is low, and it is generally prescribed to patients with perceived less disease activity. Budesonide was inferior to prednisone as a first-line drug but was associated with fewer side effects.
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Affiliation(s)
- Álvaro Díaz-González
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases Group, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Indhira Pérez-Medrano
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - Víctor Sapena
- Medical Statistics Core Facility, Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spainand CIBERehd
| | - Ana Barreira-Díaz
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spainand CIBERehd
| | - Elena Gómez
- Servicio de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España
| | - Rosa M Morillas
- Hepatology Department, Hospital Germans Trias i Pujol and Germans Trias i Pujol Research Institute, IGTP, Badalona, Department of Medicine, Universitat Autònoma de Barcelona; Centro de investigación biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd
| | - María Del Barrio
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases Group, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - Laia Escudé
- Liver Unit, Hospital Clínic de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Centro de investigación biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, University of Barcelona, Barcelona, España
| | - Beatriz Mateos
- Servicio de Aparato Digestivo, Hospital Universitario Ramón y Cajal, CIBERehd, IRYCIS, Madrid, Spain
| | - Diana Horta
- Servicio de Aparato Digestivo, Hospital Universitari Mutua de Terrassa, Terrassa, España
| | - Judith Gómez
- Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Burgos, España
| | - Isabel Conde
- Servicio de Aparato Digestivo, Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Carlos Ferre-Aracil
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Ismael El Hajra
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Ana Arencibía
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Javier Zamora
- Servicio de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España
| | - Ainhoa Fernández
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Magdalena Salcedo
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Esther Molina
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - Anna Soria
- Unidad de Hepatología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, España
| | - Pamela Estévez
- Servicio de Aparato Digestivo, Hospital Universitario Álvaro Cunqueiro, Vigo, España
| | - Carmen López
- Servicio de Aparato Digestivo, Hospital Universitari Josep Trueta, Girona, España
| | | | | | - Javier Crespo
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases Group, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - María-Carlota Londoño
- Liver Unit, Hospital Clínic de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Centro de investigación biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, University of Barcelona, Barcelona, España
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5
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Horta D, Forné M, Agustí A, Raga A, Martín-Cardona A, Hernández-Soto JM, Ruiz-Ramírez P, Esteve-Comas M. Efficacy of Hepatitis B Virus Vaccines HBVaxpro40© and Fendrix© in Patients with Chronic Liver Disease in Clinical Practice. Vaccines (Basel) 2022; 10:1323. [PMID: 36016211 PMCID: PMC9416157 DOI: 10.3390/vaccines10081323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic liver disease results in a low response rate to the hepatitis B virus vaccine. Information on the efficacy of the double adjuvanted vaccine FENDRIX® (3-O-desacyl-4'-monophosphoryl lipid A and aluminum phosphate) and single adjuvant HBVAXPRO®40 (aluminum hydroxyphosphate sulfate) in chronic liver disease is scarce. The primary aim of this prospective study in clinical practice was to evaluate the effectiveness of HBVAXPRO®40 and FENDRIX® in this setting. Patients received HBVAXPRO® (0, 1 and 6 months) or FENDRIX® (0, 1, 2 and 6 months) depending on availability. Clinical data and anti-HBs levels were collected at 2, 6 and 12 months. A total of 125 patients were included (mean age 61.8 years; 57.6% males; 43.2% liver cirrhosis; 75.9% Child A and 24.1% Child B): 76 were vaccinated with HBVAXPRO® and 49 with FENDRIX®. There were no significant differences between the two vaccines. The overall response rates at 2, 6 and 12 months were 76.8, 72.8 and 59.2%, respectively. In the univariate analysis, active alcohol intake, alcohol etiology, liver cirrhosis and ultrasound signs of portal hypertension were associated with a lower response to vaccination, whereas in the multivariate analysis, liver cirrhosis was the only factor that significantly increased the likelihood of nonresponse (OR 10.5). HBVAXPRO® and FENDRIX® are good options for HBV vaccination in patients with chronic liver disease.
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Affiliation(s)
- Diana Horta
- Department of Gastroenterology and Hepatology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Montserrat Forné
- Department of Gastroenterology and Hepatology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Terrassa, Spain
| | - Anna Agustí
- Department of Gastroenterology and Hepatology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Terrassa, Spain
| | - Agnes Raga
- Department of Gastroenterology and Hepatology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Terrassa, Spain
| | - Albert Martín-Cardona
- Department of Gastroenterology and Hepatology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juana María Hernández-Soto
- Department of Gastroenterology and Hepatology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Terrassa, Spain
| | - Pablo Ruiz-Ramírez
- Department of Gastroenterology and Hepatology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Terrassa, Spain
| | - Maria Esteve-Comas
- Department of Gastroenterology and Hepatology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
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6
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Soria A, Calvo M, Casas M, Vidales Z, Muñoz-Martínez S, Sapena V, Puigvehi M, Canillas L, Guardeño R, Gallego A, Mínguez B, Horta D, Clos A, Montoliu S, Roget M, Reig M, Vergara M. Survival and adverse events of elderly patients treated with sorafenib for hepatocellular carcinoma. Front Oncol 2022; 12:829483. [PMID: 35982971 PMCID: PMC9380437 DOI: 10.3389/fonc.2022.829483] [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] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The first-line treatment for advanced hepatocellular carcinoma (HCC) is atezolizumab plus bevacizumab, but its availability is not universal and elderly patients are underrepresented in clinical trials. There is little evidence of efficacy and tolerability in elderly patients under systemic treatment. The aims of this study were to characterize the profile of elderly patients treated with sorafenib, assess their survival and safety profile in order to extrapolate their eligibility for systemic treatment. Methods Retrospective multicentre study of HCC patients aged ≥75 years old treated with sorafenib from January 2008 to December 2019. Demographic data, baseline characteristics, and variables related to HCC and sorafenib were recorded. Overall survival (OS) and safety were analyzed. Results The study included 206 patients from 11 hospitals, median age 77.9 years; 71.4% men and 62.6% stage Barcelona Clinic Liver Cancer- C (BCLC-C). The main causes of cirrhosis were hepatitis C (60.7%) and alcohol (14.7%). Most patients (84.5%) started with sorafenib 800mg and 15.5% at lower dosage. Arterial hypertension (AHT) (74.2 vs 62.2%; standardized mean differences (STD): 26) and baseline ECOG-PS>0 (45.3 vs 34.7%; STD: 38.2) differed significantly between patients receiving low and full doses. Median OS was 15.4 months (18.2 in BCLC-B vs 13.6 in BCLC-C). OS was not modified by comorbidities, age or period with more expertise. Conclusions Sorafenib appears to be safe in elderly patients with HCC. This is the first study to characterize the profile of elderly patients to be considered for systemic treatment. These findings could be used as the reference profile for elderly candidates for atezolizumab-bevacizumab.
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Affiliation(s)
- Anna Soria
- Department of Digestive Diseases, Liver Unit, Parc Taulí University Hospital, Investigation and Innovation Institute Parc Taulí I3PT, Universitat Autònoma of Barcelona, Sabadell, Spain
| | - Mariona Calvo
- Medical Oncology Department, Catalan Institute of Oncology, Hospitalet, Barcelona, Spain
| | - Meritxell Casas
- Department of Digestive Diseases, Liver Unit, Parc Taulí University Hospital, Investigation and Innovation Institute Parc Taulí I3PT, Universitat Autònoma of Barcelona, Sabadell, Spain
| | - Zara Vidales
- Medical Oncology Department, Catalan Institute of Oncology, Hospitalet, Barcelona, Spain
| | - Sergio Muñoz-Martínez
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Clinical Insitute of Digestive and Metabolic Diseases (ICMDiM), Clinic Hospital, Barcelona University, Barcelona, Spain
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Victor Sapena
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Clinical Insitute of Digestive and Metabolic Diseases (ICMDiM), Clinic Hospital, Barcelona University, Barcelona, Spain
- Medical Statistics Core Facility, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain
- Liver Unit, University Hospital Vall d’Hebron, Liver Diseases Research Group, Vall d’Hebron Institut of Research (VHIR), Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Marc Puigvehi
- Department of Digestive Diseases, Liver Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Lidia Canillas
- Department of Digestive Diseases, Liver Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Raquel Guardeño
- Medical Oncology Department, Josep Trueta University Hospital, Catalan Institute of Oncology, Girona, Spain
| | - Adolfo Gallego
- Department of Digestive Diseases, Sant Pau i Santa Creu University Hospital, Barcelona, Spain
| | - Beatriz Mínguez
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
- Liver Unit, University Hospital Vall d’Hebron, Liver Diseases Research Group, Vall d’Hebron Institut of Research (VHIR), Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Diana Horta
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
- Department of Gastroenterology, University Hospital Mútua Terrassa, Barcelona University, Terrassa, Spain
| | - Ariadna Clos
- Department of Digestive Diseases, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Silvia Montoliu
- Department of Digestive Diseases, Joan XXIII University Hospital, Tarragona, Spain
| | - Mercè Roget
- Department of Digestive Diseases, Liver Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Maria Reig
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Clinical Insitute of Digestive and Metabolic Diseases (ICMDiM), Clinic Hospital, Barcelona University, Barcelona, Spain
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Mercedes Vergara
- Department of Digestive Diseases, Liver Unit, Parc Taulí University Hospital, Investigation and Innovation Institute Parc Taulí I3PT, Universitat Autònoma of Barcelona, Sabadell, Spain
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
- *Correspondence: Mercedes Vergara,
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7
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Llovet LP, Gratacós-Ginès J, Téllez L, Gómez-Outomuro A, Navascués CA, Riveiro-Barciela M, Vinuesa R, Gómez-Camarero J, García-Retortillo M, Díaz-Fontenla F, Salcedo M, García-Eliz M, Horta D, Guerrero M, Rodríguez-Perálvarez M, Fernández-Rodriguez C, Albillos A, G-Abraldes J, Parés A, Londoño MC. Noninvasive Prediction of Outcomes in Autoimmune Hepatitis-Related Cirrhosis. Hepatol Commun 2022; 6:1392-1402. [PMID: 34989164 PMCID: PMC9134802 DOI: 10.1002/hep4.1889] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/29/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022] Open
Abstract
The value of noninvasive tools in the diagnosis of autoimmune hepatitis (AIH)-related cirrhosis and the prediction of clinical outcomes is largely unknown. We sought to evaluate (1) the utility of liver stiffness measurement (LSM) in the diagnosis of cirrhosis and (2) the performance of the Sixth Baveno Consensus on Portal Hypertension (Baveno VI), expanded Baveno VI, and the ANTICIPATE models in predicting the absence of varices needing treatment (VNT). A multicenter cohort of 132 patients with AIH-related cirrhosis was retrospectively analyzed. LSM and endoscopies performed at the time of cirrhosis diagnosis were recorded. Most of the patients were female (66%), with a median age of 54 years. Only 33%-49% of patients had a LSM above the cutoff points described for the diagnosis of AIH-related cirrhosis (12.5, 14, and 16 kPa). Patients with portal hypertension (PHT) had significantly higher LSM than those without PHT (15.7 vs. 11.7 kPa; P = 0.001), but 39%-52% of patients with PHT still had LSM below these limits. The time since AIH diagnosis negatively correlated with LSM, with longer time being significantly associated with a lower proportion of patients with LSM above these cutoffs. VNT was present in 12 endoscopies. The use of the Baveno VI, expanded Baveno VI criteria, and the ANTICIPATE model would have saved 46%-63% of endoscopies, but the latter underpredicted the risk of VNT. Conclusions: LSM cutoff points do not have a good discriminative capacity for the diagnosis of AIH-related cirrhosis, especially long-term after treatment initiation. Noninvasive tools are helpful to triage patients for endoscopy.
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Affiliation(s)
- Laura-Patricia Llovet
- Liver UnitHospital Clínic BarcelonaIDIBAPSCIBEREHDUniversity of BarcelonaBarcelonaSpain
| | - Jordi Gratacós-Ginès
- Liver UnitHospital Clínic BarcelonaIDIBAPSCIBEREHDUniversity of BarcelonaBarcelonaSpain
| | - Luis Téllez
- Department of Gastroenterology and HepatologyHospital Universitario Ramón y CajalInstituto Ramón y Cajal de Investigación SanitariaCIBEREHDUniversidad de AlcaláMadridSpain
| | - Ana Gómez-Outomuro
- 16474Liver UnitDivision of Gastroenterology & HepatologyHospital Universitario Central de AsturiasOviedoSpain
| | - Carmen A Navascués
- 16474Liver UnitDivision of Gastroenterology & HepatologyHospital Universitario Central de AsturiasOviedoSpain
| | - Mar Riveiro-Barciela
- Liver UnitInternal Medicine DepartmentVall d'Hebron HospitalCIBEREHDBarcelonaSpain
| | - Raquel Vinuesa
- 16821Department of Hepatology and GastroenterologyHospital Universitario de BurgosBurgosSpain
| | - Judith Gómez-Camarero
- 16821Department of Hepatology and GastroenterologyHospital Universitario de BurgosBurgosSpain
| | - Montserrat García-Retortillo
- Liver SectionGastroenterology DepartmentDepartament der MedicinaHospital del MarUniversistat Autonoma de BarcelonaIMIMBarcelonaSpain
| | - Fernando Díaz-Fontenla
- Liver Unit and Digestive DepartmentHospital General Universitario Gregorio MarañónCIBEREHDMadridSpain
| | - Magdalena Salcedo
- Liver Unit and Digestive DepartmentHospital General Universitario Gregorio MarañónCIBEREHDMadridSpain
| | - María García-Eliz
- Liver Transplantation Unit and HepatologyHospital Universitario La FeCIBEREHDValenciaSpain
| | - Diana Horta
- Digestive Diseases UnitHospital Universitari Mutua TerrassaTerrassaSpain
| | - Marta Guerrero
- Department of Hepatology and Liver TransplantationIMIBICCIBEREHD, Hospital Universitario Reina SofíaCórdobaSpain
| | - Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver TransplantationIMIBICCIBEREHD, Hospital Universitario Reina SofíaCórdobaSpain
| | | | - Agustín Albillos
- Department of Gastroenterology and HepatologyHospital Universitario Ramón y CajalInstituto Ramón y Cajal de Investigación SanitariaCIBEREHDUniversidad de AlcaláMadridSpain
| | - Juan G-Abraldes
- Liver UnitDivision of GastroenterologyCEGIIRUniversity of AlbertaEdmontonABCanada
| | - Albert Parés
- Liver UnitHospital Clínic BarcelonaIDIBAPSCIBEREHDUniversity of BarcelonaBarcelonaSpain
| | - Maria-Carlota Londoño
- Liver UnitHospital Clínic BarcelonaIDIBAPSCIBEREHDUniversity of BarcelonaBarcelonaSpain
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8
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Blasi A, Machlab S, Risco R, Costa-Seixas JP, Hernández-Cely G, Horta D, Bofill A, Ruiz-Ramirez P, Profitos J, Sanahuja JM, Fernandez-Simon A, Gómez MV, Sánchez-Delgado J, Cardenas A. Corrigendum to ‘A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation’ [JHEP Reports 6 (2021)]. JHEP Reports 2022; 4:100476. [DOI: 10.1016/j.jhepr.2022.100476] [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: 11/28/2022]
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9
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Blasi A, Machlab S, Risco R, Costa-Freixas JP, Hernández-Cely G, Horta D, Bofill A, Ruiz-Ramirez P, Profitos J, Sanahuja JM, Fernandez-Simon A, Gómez MV, Sánchez-Delgado J, Cardenas A. A multicenter analysis of the role of prophylactic transfusion of blood products in patients with cirrhosis and esophageal varices undergoing endoscopic band ligation. JHEP Rep 2021; 3:100363. [PMID: 34765959 PMCID: PMC8572136 DOI: 10.1016/j.jhepr.2021.100363] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023]
Abstract
Background & Aims Prophylactic administration of platelets and fresh frozen plasma (FFP) has been recommended in patients with cirrhosis with low platelets and/or prolonged international normalized ratio (INR) without scientific evidence to support this practice. In this analysis, we evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation (EBL). Methods This is a multicenter retrospective analysis of consecutive EBL procedures in patients with cirrhosis at 4 hospitals in Spain from 01/2010-01/2017. FFP and/or platelet transfusion were given at the discretion of the physician if INR was >1.5 and/or platelet count <50x109/L. Patient demographics, endoscopic findings, bleeding events after EBL, and the use of prophylactic FFP or platelets were recorded. Results A total of 536 patients underwent 1,472 EBL procedures: 72% male; main etiology HCV and alcohol (72%); median MELD score 11; Child-Pugh A/B/C (59/33/8%). EBL procedures were performed for primary (51%) or secondary (49%) prophylaxis. A median of 2 procedures per patient were performed.1-4 FFP and/or platelets were administered in 41 patients (7.6%). The prophylactic transfusion protocol was followed in 16% and 28% of procedures with high INR and/or low platelets, respectively. Post-EBL bleeding occurred in 26 out of 536 patients (4.8%) and in 33 out of 1,472 procedures (2.2%). Bleeding was due to post-EBL ulcers in 21 patients and due to band dislodgment in 5. In 6 patients, bleeding occurred within 24 hours and in the remaining patients it occurred within 2 weeks after EBL. In those that bled, 7 met criteria for transfusion (2 for FFP and 5 for platelets), of whom only 1 received FFP and 4 received platelets; the remaining 19 patients did not meet criteria for transfusion. There was no association between INR or platelet count and bleeding events. Univariate and multivariate analysis revealed that Child-Pugh and MELD scores were risk factors for post-EBL bleeding. Conclusions The incidence of post-EBL bleeding is low and is associated with advanced liver disease. Post-EBL bleeding was not related to baseline INR/platelet count and most outpatients with post-EBL bleeding did not meet criteria for prophylactic transfusion. Lay summary Patients with chronic liver disease or cirrhosis and enlarged veins (varices) of the esophagus that can potentially bleed commonly need an endoscopy to treat these varices with elastic rubber bands (endoscopic band ligation). Some patients have low platelet counts or prolonged coagulation tests. This analysis of 4 centers evaluated the use of prophylactic administration of blood products in outpatients with cirrhosis undergoing endoscopic band ligation. The results showed that bleeding after band ligation is uncommon and that if bleeding occurs it does not seem to be related with coagulation tests or the administration of blood products to prevent bleeding after band ligation of esophageal varices. Multicenter analysis of prophylactic administration of blood products in 536 outpatients with cirrhosis undergoing EBL. The prophylactic transfusion protocol was only followed in 16% and 28% of procedures with high INR and/or low platelets, respectively. Post EBL-bleeding occurred in 26 patients – 4.8% of patients and in 2.2% of procedures. Patients that bled had higher Child-Pugh and MELD scores compared to those that did not bleed. There was no clear relationship between post-EBL bleeding and the baseline INR/platelet count before the procedure.
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Affiliation(s)
- Annabel Blasi
- Anesthesia Department, Hospital Clinic, Barcelona, Spain.,Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona Spain
| | - Salvador Machlab
- Digestive Diseases Department, Corporació Sanitària Universitària Parc Taulí, Institut d' Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Spain
| | - Raquel Risco
- Anesthesia Department, Hospital Clinic, Barcelona, Spain
| | - Joao Pedro Costa-Freixas
- Digestive Diseases Department, Corporació Sanitària Universitària Parc Taulí, Institut d' Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Spain
| | - Geovanny Hernández-Cely
- Fundación Cardioinfantil, Gastroenterology and Hepatology Department, Colombia.,GI Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Barcelona, Spain
| | - Diana Horta
- Gastroenterology Department, Hospital Universitario Mutua de Terrassa, Spain
| | - Alex Bofill
- GI Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Barcelona, Spain
| | - Pablo Ruiz-Ramirez
- Gastroenterology Department, Hospital Universitario Mutua de Terrassa, Spain
| | - Joaquim Profitos
- Gastroenterology Department, Consorci Sanitari de Terrassa, Spain
| | - Josep Marti Sanahuja
- Anesthesia Department, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona Spain
| | | | - Mercedes Vergara Gómez
- Digestive Diseases Department, Corporació Sanitària Universitària Parc Taulí, Institut d' Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Spain.,Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Jordi Sánchez-Delgado
- Digestive Diseases Department, Corporació Sanitària Universitària Parc Taulí, Institut d' Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Spain.,Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Andrés Cardenas
- Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,GI & Liver Transplant Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona Spain
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10
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Ruiz-Ramírez P, Carreras G, Fajardo I, Tristán E, Carrasco A, Salvador I, Zabana Y, Andújar X, Ferrer C, Horta D, Loras C, García-Puig R, Fernández-Bañares F, Esteve M. Intraepithelial Lymphocyte Cytometric Pattern Is a Useful Diagnostic Tool for Coeliac Disease Diagnosis Irrespective of Degree of Mucosal Damage and Age-A Validation Cohort. Nutrients 2021; 13:nu13051684. [PMID: 34063411 PMCID: PMC8155844 DOI: 10.3390/nu13051684] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: The study of intraepithelial lymphocytes (IEL) by flow cytometry is a useful tool in the diagnosis of coeliac disease (CD). Previous data showed that an increase in %TCRγδ+ and decrease of %CD3− IEL constitute a typical CD cytometric pattern with a specificity of 100%. However, there are no data regarding whether there are differences in the %TCRγδ+ related to sex, age, titers of serology, and degree of histological lesion. Study aims: To confirm the high diagnostic accuracy of the coeliac cytometric patterns. To determine if there are differences between sex, age, serology titers, and histological lesion grade. Results: We selected all patients who fulfilled “4 of 5” rule for CD diagnosis (n = 169). There were no differences in %TCRγδ+ between sexes (p = 0.909), age groups (p = 0.986), serology titers (p = 0.53) and histological lesion grades (p = 0.41). The diagnostic accuracy of complete CD cytometric pattern was: specificity 100%, sensitivity 82%, PPV 100%, NPV 47%. Conclusion: We confirmed, in a validation cohort, the high diagnostic accuracy of complete CD pattern irrespective of sex, age, serology titers, and grade of mucosal lesion.
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Affiliation(s)
- Pablo Ruiz-Ramírez
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
| | - Gerard Carreras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
| | - Ingrid Fajardo
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
| | - Eva Tristán
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Anna Carrasco
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Isabel Salvador
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
| | - Yamile Zabana
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xavier Andújar
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carme Ferrer
- Department of Pathology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain;
| | - Diana Horta
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
| | - Carme Loras
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Roger García-Puig
- Department of Pediatrics, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain;
| | - Fernando Fernández-Bañares
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maria Esteve
- Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, 08221 Barcelona, Spain; (P.R.-R.); (G.C.); (I.F.); (E.T.); (A.C.); (I.S.); (Y.Z.); (X.A.); (D.H.); (C.L.); (F.F.-B.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-937365050
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11
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Horta D, Moreno-Torres M, Ramírez-Lázaro MJ, Lario S, Kuligowski J, Sanjuan-Herráez JD, Quintas G, Villoria A, Calvet X. Analysis of the Association between Fatigue and the Plasma Lipidomic Profile of Inflammatory Bowel Disease Patients. J Proteome Res 2020; 20:381-392. [PMID: 32969224 DOI: 10.1021/acs.jproteome.0c00462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing noninfectious inflammatory condition of the intestinal tract with two main phenotypes, ulcerative colitis (UC) and Crohn's disease (CD), and globally increasing incidence and prevalence. Nearly 80% of the IBD patients with active disease and 50% of those with inactive disease suffer fatigue with significant impairment of their quality of life. Fatigue has been associated with multiple factors in IBD patients but, in most cases, no direct cause can be identified, and risk factors in clinically quiescent IBD are contradictory. Furthermore, as the assessment of fatigue is subjective, there is an unmet clinical need for fatigue biomarkers. In this explorative study, we analyzed the plasma lipidomic profiles of 47 quiescent UC and CD patients (23 fatigued, 24 nonfatigued) using ultraperformance liquid chromatography-time-of-flight mass spectrometry (UPLC-TOFMS). The results showed changes in lipids associated with fatigue and IBD. Significantly decreased levels of phosphatidylcholines, plasmanyls, sphingomyelins, lysophosphatidylcholines, phosphatidylethanolamines, phosphatidylinositols, phosphatidylserines, and eicosanoids were observed in patients with fatigue. Network and metabolic pathway analysis indicated a dysregulation of the arachidonic acid and glycerophospholipid metabolisms and the sphingolipid pathway. The protein-metabolite interaction network showed interactions between functionally related metabolites and proteins, displaying 40 disease-associated hidden proteins including ABDH4, GLTP, and LCAT.
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Affiliation(s)
- Diana Horta
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Spain
| | - Marta Moreno-Torres
- Unidad de Hepatología Experimental, Health Research Institute La Fe, Valencia, 46026 Spain
| | - María José Ramírez-Lázaro
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Instituto de Salud Carlos III, Madrid, 28029 Spain
| | - Sergio Lario
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Instituto de Salud Carlos III, Madrid, 28029 Spain
| | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe, Valencia, 46026 Spain
| | | | - Guillermo Quintas
- Health and Biomedicine, LEITAT Technological Center, Barcelona, 08028 Spain.,Unidad Analítica, Health Research Institute Hospital La Fe, Valencia, 46026 Spain
| | - Albert Villoria
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Instituto de Salud Carlos III, Madrid, 28029 Spain
| | - Xavier Calvet
- Digestive Diseases Service, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, 08208 Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Instituto de Salud Carlos III, Madrid, 28029 Spain
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12
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Horta D, Lira A, Sanchez-Lloansi M, Villoria A, Teggiachi M, García-Rojo D, García-Molina S, Figuerola A, Esteve M, Calvet X. A Prospective Pilot Randomized Study: Electroacupuncture vs. Sham Procedure for the Treatment of Fatigue in Patients With Quiescent Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:484-492. [PMID: 31091322 DOI: 10.1093/ibd/izz091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue is a common symptom in patients with inflammatory bowel disease (IBD), and it often persists despite clinical remission. Acupuncture has been shown to be effective for treating fatigue in patients with many chronic diseases. The main objective of the study was to assess the efficacy of electroacupuncture (EAc), compared with sham EAc (ShEAc) or being on a waitlist (WL), for treating fatigue in patients with quiescent IBD in a single-blind randomized trial. METHODS Fifty-two patients with IBD in clinical remission and fatigue were randomly assigned to 1 of 3 groups: EAc, ShEAc, or WL. Patients in the EAc and ShEAc groups received 9 sessions over 8 weeks. Fatigue was evaluated with the IBD-validated Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-FS). RESULTS Baseline characteristics were similar in the 3 groups. Both EAc and ShEAc presented improved Functional Assessment of Chronic Illness Therapy-Fatigue Scale scores compared with baseline: the respective improvements were 9.53 (95% confidence intervals, 6.75-12.3, P < 0.001) and 5.46 points (95% confidence intervals, 2.7-9.7, P = 0.015), respectively. No significant changes were observed in the WL group. In the comparison of treatment groups, EAc was nonsignificantly better than ShEAc (EAc, 33.27 and ShEAc, 28.13, P = 0.168); both EAc and ShEAc improved fatigue scores significantly compared to WL (24.5; P = 0.01 and 0.04, respectively). CONCLUSIONS Both EAc and ShEAc reduced fatigue scores in IBD patients when compared to WL. No differences were observed between EAc and ShEAc, although the study was not powered to rule out a difference. Acupuncture may offer improvements to patients with few other treatment alternatives. Clinical Trials Org Id: NCT02733276.
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Affiliation(s)
- Diana Horta
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Alba Lira
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Albert Villoria
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Dario García-Rojo
- Medical Acupuncturist. Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - Ariadna Figuerola
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Maria Esteve
- Digestive Diseases Unit, Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - Xavier Calvet
- Digestive Diseases Unit, Hospital Universitari Parc Taulí, Sabadell, Spain.,Department of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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13
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Llovet LP, Horta D, Eliz MG, Berenguer M, Fábrega E, Sáez-Royuela F, García-Retortillo M, Torrijos YS, Romero-Gómez M, Fernández C, Domínguez EG, Parés A, Londoño MC. Presentation and Outcomes of Pregnancy in Patients With Autoimmune Hepatitis. Clin Gastroenterol Hepatol 2019; 17:2819-2821. [PMID: 30616023 DOI: 10.1016/j.cgh.2018.12.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/07/2018] [Revised: 11/20/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Abstract
Autoimmune hepatitis (AIH) frequently affects women of childbearing age in whom the desire to have a family raises the question regarding the potential risks for the fetus and the mother. The information on AIH in pregnant patients is scarce.1 The aims of this study were (1) to identify the risk factors associated with flares in pregnant patients diagnosed with AIH, (2) to determine the course of AIH in patients with pregnancy-related flares, and (3) to describe the outcome of AIH diagnosed in the postpartum period.
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Affiliation(s)
- Laura-Patricia Llovet
- Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Diana Horta
- Department of Gastroenterology, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | - Maria García Eliz
- Liver Transplantation and Hepatology Unit, Hospital Universitario La Fe, University of Valencia, CIBERehd, Valencia, Spain
| | - Marina Berenguer
- Liver Transplantation and Hepatology Unit, Hospital Universitario La Fe, University of Valencia, CIBERehd, Valencia, Spain
| | - Emilio Fábrega
- Liver Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Federico Sáez-Royuela
- Gastroenterology and Hepatology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Montserrat García-Retortillo
- Liver Section, Gastroenterology Department, Hospital del Mar, Universistat Autonoma de Barcelona, Departament der Medicina, IMIM, Barcelona, Spain
| | - Yolanda Sánchez Torrijos
- Unit for the Clinical Management of Digestive Diseases, Hospital Universitario Virgen del Rocío, CIBERehd, University of Seville, Seville, Spain
| | - Manuel Romero-Gómez
- Unit for the Clinical Management of Digestive Diseases, Hospital Universitario Virgen del Rocío, CIBERehd, University of Seville, Seville, Spain
| | | | - Elena Gómez Domínguez
- Digestive Diseases Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Albert Parés
- Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Maria-Carlota Londoño
- Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain.
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14
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Ardevol A, Ibañez-Sanz G, Profitos J, Aracil C, Castellvi JM, Alvarado E, Cachero A, Horta D, Miñana J, Gomez-Pastrana B, Pavel O, Dueñas E, Casas M, Planella M, Castellote J, Villanueva C. Survival of patients with cirrhosis and acute peptic ulcer bleeding compared with variceal bleeding using current first-line therapies. Hepatology 2018; 67:1458-1471. [PMID: 28714072 DOI: 10.1002/hep.29370] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 01/05/2017] [Revised: 05/18/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED The presence of cirrhosis increases the mortality of patients with peptic ulcer bleeding (PUB). Both acute variceal bleeding (AVB) and PUB are associated with substantial mortality in cirrhosis. This multicenter cohort study was performed to assess whether the mortality of patients with cirrhosis with PUB is different from that of those with AVB. Patients with cirrhosis and acute gastrointestinal bleeding were consecutively included and treated with somatostatin and proton pump inhibitor infusion from admission and with antibiotic prophylaxis. Emergency endoscopy with endoscopic therapy was performed within the first 6 hours. 646 patients with AVB and 144 with PUB were included. There were baseline differences between groups, such as use of gastroerosive drugs or β-blockers. Child-Pugh and Model for End-Stage Liver Disease MELD scores were similar. Further bleeding was more frequent in the AVB group than those in the PUB group (18% vs. 10%; odds ratio [OR] = 0.50; 95% confidence interval [CI] = 0.29-0.88). However, mortality risk at 45 days was similar in both groups (19% in the AVB group vs. 17% in the PUB group; OR = 0.85; 95% CI = 0.55-1.33; P = 0.48). Different parameters, such as Child-Pugh score, acute kidney injury, acute on chronic liver failure, or presence of shock or bacterial infection, but not the cause of bleeding, were related to the risk of death. Only 2% of the PUB group versus 3% of the AVB group died with uncontrolled bleeding (P = 0.39), whereas the majority of patients in either group died from liver failure or attributed to other comorbidities. CONCLUSION Using current first-line therapy, patients with cirrhosis and acute peptic ulcer bleeding have a similar survival than those with variceal bleeding. The risk of further bleeding is higher in patients with variceal hemorrhage. However, few patients in both groups died from uncontrolled bleeding, rather the cause of death was usually related to liver failure or comorbidities. (Hepatology 2018;67:1458-1471).
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Affiliation(s)
- Alba Ardevol
- Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Ibañez-Sanz
- Hepatology and Liver Transplant Unit, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joaquim Profitos
- Department of Gastroenterology, Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
| | - Carles Aracil
- Department of Gastroenterology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Josep M Castellvi
- Department of Gastroenterology, Hospital de Mataró, Barcelona, Spain
| | - Edilmar Alvarado
- Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Cachero
- Hepatology and Liver Transplant Unit, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Diana Horta
- Department of Gastroenterology, Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
| | - Josep Miñana
- Department of Gastroenterology, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Oana Pavel
- Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Eva Dueñas
- Hepatology and Liver Transplant Unit, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Meritxell Casas
- Department of Gastroenterology, Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
| | | | - Jose Castellote
- Hepatology and Liver Transplant Unit, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Candid Villanueva
- Department of Gastroenterology, Hospital de Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Villoria A, García V, Dosal A, Moreno L, Montserrat A, Figuerola A, Horta D, Calvet X, Ramírez-Lázaro MJ. Fatigue in out-patients with inflammatory bowel disease: Prevalence and predictive factors. PLoS One 2017; 12:e0181435. [PMID: 28749985 PMCID: PMC5531543 DOI: 10.1371/journal.pone.0181435] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/30/2017] [Indexed: 12/14/2022] Open
Abstract
Background and Aim Fatigue is a common and bothersome symptom in inflammatory bowel disease (IBD) patients. The study was aimed to determine the relationship of biological and psychological factors with IBD-related fatigue. Methods Consecutive clinically inactive IBD outpatients receiving immunosuppressants or biological drugs were enrolled between January and December 2013. Patients completed a Fatigue score (FACIT-F), various psychological, quality of life (IBDQ-9), and IBD activity scores. Biological parameters were assessed, including levels of interleukins (IL-5, IL-8 and IL-12) and micronutrients. Results We prospectively recruited 202 patients (28% ulcerative colitis and 72% Crohn’s disease) for the study. Fatigue measured by FACIT-F score was prevalent in the studied population (54%, 96/177) and higher than in the general population. In the univariate analysis no relation was found between IL levels or micronutrient deficiencies and fatigue. Fatigue was significantly related to female sex, Crohn’s disease, joint disorders, body mass index (BMI), psychological tests, thiopurine use, and anti-TNF treatment. All these variables were included in the multivariate analysis. Female sex (OR: 4.8), high BMI (OR:1.2) and higher depression rates (OR:1.2) were predictors of increased fatigue. High IBDQ-9 score (OR: 0.82) was significantly related to lower degrees of fatigue. Conclusion Fatigue was prevalent in quiescent IBD patients with moderate-to-severe disease. It was associated with high levels of depression, low quality of life, and female sex. No association was found with the other biological and psychological factors evaluated.
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Affiliation(s)
- Albert Villoria
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Grup de Recerca Consolidat (SGR01500), Barcelona, Spain
| | - Víctor García
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
| | - Angelina Dosal
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
| | - Laura Moreno
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
| | - Antònia Montserrat
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
- Grup de Recerca Consolidat (SGR01500), Barcelona, Spain
| | - Ariadna Figuerola
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Grup de Recerca Consolidat (SGR01500), Barcelona, Spain
| | - Diana Horta
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
| | - Xavier Calvet
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Grup de Recerca Consolidat (SGR01500), Barcelona, Spain
- * E-mail:
| | - María José Ramírez-Lázaro
- Servei Aparell Digestiu, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Grup de Recerca Consolidat (SGR01500), Barcelona, Spain
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16
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Horta D, Escoda MR, Melcarne L. Hepatic glycogenosis: a diagnostic challenge. Rev Esp Enferm Dig 2017. [PMID: 28625068 DOI: 10.17235/reed.2017.4605/2016] [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
Recently, several cases of hepatic glycogenosis (HG) have been reported. García-Suárez et al. described a young female patient with poorly controlled type 1 diabetes, right upper quadrant pain and elevated serum transaminases and GGT. After other causes of liver disease were excluded and a liver biopsy was performed, the patient was diagnosed with HG. HG is rare and can be misdiagnosed as steatohepatitis. To date, less than 20 cases have been reported in adults.
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Affiliation(s)
| | - Maria-Rosa Escoda
- Servicio de Anatomía Patológica, Parc Tauli Sabadell. Hospital Universitari,Parc Tauli Sabadell. Hospital Universitari, España,España
| | - Luigi Melcarne
- Unidad de Hepatología. Servicio Aparato Digestivo, Parc Tauli Sabadell. Hospital Universitari., España
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17
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Horta D, García-Iglesias P, Calvet X. [Do proton pump inhibitors increase the risk of myocardial infarction?]. Gastroenterol Hepatol 2016; 39:365-368. [PMID: 26895699 DOI: 10.1016/j.gastrohep.2015.11.003] [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] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/17/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Diana Horta
- Unidad de Gastroenterología, Servicio de Digestivo, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Madrid, España
| | - Pilar García-Iglesias
- Unidad de Gastroenterología, Servicio de Digestivo, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Madrid, España
| | - Xavier Calvet
- Unidad de Gastroenterología, Servicio de Digestivo, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Carlos III, Madrid, España.
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19
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Horta D, Machlab S, Brullet E, Martinez-Bauer E, Junquera F, Campo R. [Temporomandibular joint dislocation after endoscopy: A rare complication]. Gastroenterol Hepatol 2015; 39:241-2. [PMID: 26096288 DOI: 10.1016/j.gastrohep.2015.05.005] [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: 04/14/2015] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Diana Horta
- Endoscopia Digestiva, Servicio de Digestivo, Hospital de Sabadell, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España.
| | - Salvador Machlab
- Endoscopia Digestiva, Servicio de Digestivo, Hospital de Sabadell, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Enric Brullet
- Endoscopia Digestiva, Servicio de Digestivo, Hospital de Sabadell, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Eva Martinez-Bauer
- Endoscopia Digestiva, Servicio de Digestivo, Hospital de Sabadell, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Félix Junquera
- Endoscopia Digestiva, Servicio de Digestivo, Hospital de Sabadell, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Rafael Campo
- Endoscopia Digestiva, Servicio de Digestivo, Hospital de Sabadell, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
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Loures L, Vargues P, Horta D. Landscape aesthetic and visual analysis facing the challenge of development of sustainable landscapes – a case study of the post-industrial area to the left margin of the Arade River. ACTA ACUST UNITED AC 2008. [DOI: 10.2495/d&ne-v3-n1-65-74] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Phytoplasmas and rickettsias have been associated with recent nonviral papaya diseases (1,2). Forty leaf samples with symptoms similar to papaya bunchy top (PBT) (1) and Australian papaya diseases (2) were collected from surveys done in Cuban papaya areas of Havana and Villa Clara provinces. Thirty nine plants showed typical PBT symptoms, while 35 plants also exhibited symptoms previously described for phytoplasma diseases (2) such as yellowing, crinkling, necrosis and deformation of older leaves, phyllody, virescence, short internodes, reduced latex flow, stunted crown leaves, and abscission of the fruit. Samples were evaluated by transmission electron microscopy, nested polymerase chain reaction (nPCR) with 16S ribosomal RNA phytoplasma primers SN910601/DH6-R16F2n/R16R2, PCR with rickettsial succinate dehydrogenase gene (sdhA) primers PBT1/PBT2, HaeIII, RsaI, and AluI enzyme restriction, and phytoplasma intergenic sequence analyses. Rickettsia PCR amplifications of 750 bp were obtained for samples with PBT symptoms, while the 35 phytoplasma-infected samples yielded amplifications of 1,250 bp. Restriction profiles and a 98% homology in the intergenic sequence (GenBank Accession No. AY257547) confirmed the presence of apple proliferation phytoplasma group. Electron microscopy analysis evidenced the presence of particles similar to rickettsia and phytoplasma pleomorfic bodies in more than 50% of samples analysed. Also, those similar to potyvirus and rhabdovirus were observed in 22.5%. To our knowledge, these results are the first report on the molecular detection of phytoplasmas in papaya in Cuba and suggest a possible concomitance among phytopathogens detected. References: (1) M. Davis et al. Curr. Microbiol. 36:80, 1998. (2) K. Gibb et al. Plant Dis. 80:174, 1996.
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Affiliation(s)
- Y Arocha
- National Centre for Animal and Plant Health, Apdo 10, San José de Las Lajas, Habana, Cuba
| | - D Horta
- National Institute of Tropical Crops Research, Villa Clara, Cuba
| | - E Peralta
- National Institute of Sugarcane Research, Havana, Cuba
| | - P Jones
- IACR-Rothamsted, Harpenden, U.K
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