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Montenegro Almeida AI, Vidal Aguirre SV, Piris Pinilla MÁ, Saperas E. Natural killer cell enteropathy mimicking lymphoma. Gastroenterol Hepatol 2024; 47:101-102. [PMID: 37080288 DOI: 10.1016/j.gastrohep.2023.04.003] [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: 11/19/2022] [Revised: 03/19/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023]
Affiliation(s)
| | | | | | - Esteban Saperas
- Servicio de Aparato Digestivo, Hospital Universitario General de Cataluña, Sant Cugat del Vallès, Barcelona, España
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Mego M, Huaman JW, Videla S, Jansana M, Tinoco K, Saperas E. Effectiveness of a high fiber diet in improving constipation in patients with defecatory dyssynergy under treatment with anorrectal biofeedback. Exploratory, randomized clinical trial. Gastroenterol Hepatol 2023; 46:774-783. [PMID: 36731727 DOI: 10.1016/j.gastrohep.2023.01.012] [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] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/03/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Fiber is the initial treatment in chronic functional constipation. However, its role in the group of patients with defecatory dyssynergy is not well established. The objective of the study is to evaluate the efficacy and safety of a high fiber diet in patients with defecatory dyssynergy in the treatment with anorectal biofeedback. PATIENTS AND METHODS An exploratory, randomized (1:1), double-blind, controlled «add-on» clinical trial was carried out in a reference center in Spain in patients with functional constipation and defecatory dyssynergy according to the ROMEIV criteria. CONTROL GROUP treatment with biofeedback and low-fiber diet (15-20g/day). Experimental group: treatment with biofeedback and high fiber diet (25-30g/day). Analyzed: responder (primary endpoint), patient whose defecatory dyssynergy had been corrected (>20% reduction in anal pressure during the defecation maneuver and normal balloon expulsion test); anorectal parameters (anal relaxation, reduced straining); safety (abdominal symptoms: flatulence, pain, borborygmus, bloating). RESULTS A total of 44 patients were randomized: 22 per group. The percentage of responders was 75% (15/20; 95%CI: 53 89%) control group and 70% (14/20; 95%CI: 48-85%) experimental group, P=.225. Differences in favor of the control group were only observed in abdominal symptoms: flatulence (P=.028), abdominal distension (P=.041) and digestive comfort (P=.043). CONCLUSIONS In patients with defecatory dyssynergy, a high-fiber diet not only does not improve the efficacy of anorectal biofeedback but is associated with a loss of improvement in abdominal symptoms.
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Affiliation(s)
- Marianela Mego
- Servicio de Gastroenterología, Hospital Universitari General de Catalunya, Grupo QuirónSalud, Sant Cugat del Vallès, Barcelona, España
| | - José Wálter Huaman
- Servicio de Gastroenterología, Hospital Universitari General de Catalunya, Grupo QuirónSalud, Sant Cugat del Vallès, Barcelona, España; Escuela de Medicina, Universitat Internacional de Catalunya, Barcelona, España.
| | - Sebastian Videla
- Unidad de Soporte a la Investigación Clínica, Departamento de Farmacología Clínica, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España; Unidad de Farmacología, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina y Ciencias de la Salud, IDIBELL, Universidad de Barcelona, Barcelona, España
| | - Marta Jansana
- Servicio de Endocrinología, Hospital Universitari General de Catalunya, Grupo QuirónSalud, Sant Cugat del Vallès, Barcelona, España
| | - Karen Tinoco
- Servicio de Medicina Interna, Hospital Universitari General de Catalunya, Grupo QuirónSalud, Sant Cugat del Vallès, Barcelona, España
| | - Esteban Saperas
- Servicio de Gastroenterología, Hospital Universitari General de Catalunya, Grupo QuirónSalud, Sant Cugat del Vallès, Barcelona, España; Escuela de Medicina, Universitat Internacional de Catalunya, Barcelona, España
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Sánchez A, Roos VH, Navarro M, Pineda M, Caballol B, Moreno L, Carballal S, Rodríguez-Alonso L, Ramon Y Cajal T, Llort G, Piñol V, López-Fernández A, Salces I, Picó MD, Rivas L, Bujanda L, Garzon M, Pizarro A, Martinez de Castro E, López-Arias MJ, Poves C, Garau C, Rodriguez-Alcalde D, Herraiz M, Alvarez-Urrutia C, Dacal A, Carrillo-Palau M, Cid L, Ponce M, Barreiro-Alonso E, Saperas E, Aguirre E, Romero C, Bastiaansen B, Gonzalez-Acosta M, Morales-Romero B, Ocaña T, Rivero-Sánchez L, Jung G, Bessa X, Cubiella J, Jover R, Rodríguez-Moranta F, Balmaña J, Brunet J, Castells A, Dekker E, Capella G, Serra-Burriel M, Moreira L, Pellise M, Balaguer F. Quality of Colonoscopy Is Associated With Adenoma Detection and Postcolonoscopy Colorectal Cancer Prevention in Lynch Syndrome. Clin Gastroenterol Hepatol 2022; 20:611-621.e9. [PMID: 33157315 DOI: 10.1016/j.cgh.2020.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 07/07/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS. METHODS We conducted a multicenter study focused on LS carriers without previous CRC undergoing colonoscopy surveillance (n = 893). Incident colorectal neoplasia during surveillance and quality indicators of all colonoscopies were analyzed. We performed an emulated target trial comparing the results from the first and second surveillance colonoscopies to assess the effect of colonoscopy quality indicators on adenoma detection and PCCRC incidence. Risk analyses were conducted using a multivariable logistic regression model. RESULTS The 10-year cumulative incidence of adenoma and PCCRC was 60.6% (95% CI, 55.5%-65.2%) and 7.9% (95% CI, 5.2%-10.6%), respectively. Adequate bowel preparation (odds ratio [OR], 2.07; 95% CI, 1.06-4.3), complete colonoscopies (20% vs 0%; P = .01), and pan-chromoendoscopy use (OR, 2.14; 95% CI, 1.15-3.95) were associated with significant improvement in adenoma detection. PCCRC risk was significantly lower when colonoscopies were performed during a time interval of less than every 3 years (OR, 0.35; 95% CI, 0.14-0.97). We observed a consistent but not significant reduction in PCCRC risk for a previous complete examination (OR, 0.16; 95% CI, 0.03-1.28), adequate bowel preparation (OR, 0.64; 95% CI, 0.17-3.24), or previous use of high-definition colonoscopy (OR, 0.37; 95% CI, 0.02-2.33). CONCLUSIONS Complete colonoscopies with adequate bowel preparation and chromoendoscopy use are associated with improved adenoma detection, while surveillance intervals of less than 3 years are associated with a reduction of PCCRC incidence. In LS, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.
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Affiliation(s)
- Ariadna Sánchez
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Victorine H Roos
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Matilde Navarro
- Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals
| | - Marta Pineda
- Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals
| | - Berta Caballol
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Lorena Moreno
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Sabela Carballal
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Lorena Rodríguez-Alonso
- Department of Gastroenterology, Hospital Universitari de Bellvitge, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Teresa Ramon Y Cajal
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Llort
- Department of Medical Oncology and Gastroenterology, Parc Tauli Hospital Universitari, Conscorci Sanitari de Terrasa, Sabadell-Terrasa, Spain
| | - Virginia Piñol
- Department of Gastroenterology, University of Girona, Hospital Dr Josep Trueta, Girona, Spain
| | - Adrià López-Fernández
- Department of Medical Oncology, Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Inmaculada Salces
- Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain
| | - Maria Dolores Picó
- Department of Gastroenterology, Hospital General Universitario de Elche, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Elche, Spain
| | - Laura Rivas
- Department of Gastroenterology, Complexo Hospitalario Universitario de Orense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Ourense, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), San Sebastián, Spain
| | - Marta Garzon
- Department of Gastroenterology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Angeles Pizarro
- Department of Gastroenterology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Eva Martinez de Castro
- Department of Medical Oncology and Gastroenterology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Maria Jesus López-Arias
- Department of Medical Oncology and Gastroenterology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carmen Poves
- Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | - Catalina Garau
- Department of Gastroenterology, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | | | - Maite Herraiz
- Department of Gastroenterology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Cristina Alvarez-Urrutia
- Department of Gastroenterology, Institut Hospital del Mar d'Investigacions Biomèdiques (IMIM), Hospital del Mar Medical Research Institute, Barcelona Hospital del Mar, Barcelona; Spain
| | - Andres Dacal
- Department of Gastroenterology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Marta Carrillo-Palau
- Department of Gastroenterology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Lucia Cid
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, Servizo Galego de Saude (SERGAS), Research Group in Digestive Diseases, Instituto de Investigacion Sanitaria Galicia Sur (IISGS), SERGAS-Universidade de Vigo (UVIGO), Vigo, Spain
| | - Marta Ponce
- Department of Gastroenterology, Hospital Universitario de la Fe de Valencia, Valencia, Spain
| | - Eva Barreiro-Alonso
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Esteban Saperas
- Department of Gastroenterology, Hospital Universitari General de Catalunya, Sant Cugat, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Elena Aguirre
- Genetic Counseling Unit, Department of Medical Oncology, Hospital Quirónsalud Zaragoza, Zaragoza, Spain
| | - Cristina Romero
- Department of Medical Oncology and Gastroenterology, Parc Tauli Hospital Universitari, Conscorci Sanitari de Terrasa, Sabadell-Terrasa, Spain
| | - Barbara Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Maribel Gonzalez-Acosta
- Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals
| | - Blai Morales-Romero
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Teresa Ocaña
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Gerhard Jung
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Xavier Bessa
- Department of Gastroenterology, Institut Hospital del Mar d'Investigacions Biomèdiques (IMIM), Hospital del Mar Medical Research Institute, Barcelona Hospital del Mar, Barcelona; Spain
| | - Joaquin Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Orense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Ourense, Spain
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Francisco Rodríguez-Moranta
- Department of Gastroenterology, Hospital Universitari de Bellvitge, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Judith Balmaña
- Department of Medical Oncology, Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology, Institut d'Investigacio Biomèdica de Giron Dr. Josep Trueta (IDIBGI), Medical Sciences Department, School of Medicine, University of Girona, Hospital Dr Josep Trueta, Girona, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gabriel Capella
- Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals
| | - Miquel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Maria Pellise
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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Rivero-Sánchez L, Gavric A, Herrero J, Remedios D, Alvarez V, Albéniz E, Gordillo J, Puig I, López-Vicente J, Huerta A, López-Cerón M, Salces I, Peñas B, Parejo S, Rodriguez E, Herraiz M, Carretero C, Gimeno-Garcia AZ, Saperas E, Alvarez C, Arnau-Collell C, Ortiz O, Sánchez A, Jung G, Balaguer F, Pellisé M. The "diagnose and leave in" strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial. Endoscopy 2022; 54:27-34. [PMID: 33271604 DOI: 10.1055/a-1328-5405] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The "diagnose-and-leave-in" policy has been established to reduce the risks and costs related to unnecessary polypectomies in the average-risk population. In individuals with Lynch syndrome, owing to accelerated carcinogenesis, the general recommendation is to remove all polyps, irrespective of size, location, and appearance. We evaluated the feasibility and safety of the diagnose-and-leave-in strategy in individuals with Lynch syndrome. METHODS : We performed a post hoc analysis based on per-polyp data from a randomized, clinical trial conducted by 24 dedicated colonoscopists at 14 academic centers, in which 256 patients with confirmed Lynch syndrome underwent surveillance colonoscopy from July 2016 to January 2018. In vivo optical diagnosis with confidence level for all detected lesions was obtained before polypectomy using virtual chromoendoscopy alone or with dye-based chromoendoscopy. Primary outcome was the negative predictive value (NPV) for neoplasia of high-confidence optical diagnosis among diminutive (≤ 5 mm) rectosigmoid lesions. Histology was the reference standard. RESULTS Of 147 rectosigmoid lesions, 128 were diminutive. In 103 of the 128 lesions (81 %), the optical diagnostic confidence was high and showed an NPV of 96.0 % (95 % confidence interval [CI] 88.9 %-98.6 %) and accuracy of 89.3 % (95 %CI 81.9 %-93.9 %). By following the diagnose-and-leave-in policy, we would have avoided 59 % (75/128) of polypectomies at the expense of two diminutive low grade dysplastic adenomas and one diminutive sessile serrated lesion that would have been left in situ. CONCLUSION In patients with Lynch syndrome, the diagnose-and-leave-in strategy for diminutive rectosigmoid polyps would be feasible and safe.
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Affiliation(s)
- Liseth Rivero-Sánchez
- Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Aleksandar Gavric
- Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University Medical Centre Ljubljana, Department of Gastroenterology and Hepatology Ljubljana, Slovenia
| | - Jesús Herrero
- Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, CIBERehd, Gastroenterology, Ourense, Spain
| | - David Remedios
- Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, CIBERehd, Gastroenterology, Ourense, Spain
| | - Victoria Alvarez
- Complexo Hospitalario de Pontevedra, Digestive Department, Pontevedra, Spain
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Digestive System Service, Endoscopy Unit, Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain
| | - Jordi Gordillo
- Hospital de la Santa Creu i Sant Pau, Gastroenterology Unit, Barcelona, Spain
| | - Ignasi Puig
- Althaia, Xarxa Assistencial Universitària de Manresa, Gastroenterology Department, Manresa, Spain
| | - Jorge López-Vicente
- Hospital Universitario de Móstoles, Digestive System Service, Móstoles, Madrid, Spain
| | - Alain Huerta
- Hospital Galdakao-Usansolo, Department of Gastroenterology, Galdakao, Spain
| | - María López-Cerón
- Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
| | - Inmaculada Salces
- Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
| | - Beatriz Peñas
- Hospital Universitario Ramon y Cajal, Department of Gastroenterology, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Sofía Parejo
- Hospital Universitario Ramon y Cajal, Department of Gastroenterology, Madrid, Spain
| | - Enrique Rodriguez
- Hospital Universitario Ramon y Cajal, Department of Gastroenterology, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Maite Herraiz
- University of Navarra Clinic-IdiSNA, Gastroenterology Department, Pamplona, Spain
| | - Cristina Carretero
- University of Navarra Clinic-IdiSNA, Gastroenterology Department, Pamplona, Spain
| | - Antonio Z Gimeno-Garcia
- Hospital Universitario de Canarias, Gastroenterology Department, Santa Cruz de Tenerife, Spain
| | - Esteban Saperas
- Hospital General de Catalunya, Gastroenterology Department, Sant Cugat del Vallès, Spain
| | | | - Coral Arnau-Collell
- Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Oswaldo Ortiz
- Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Ariadna Sánchez
- Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Gerhard Jung
- Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Francesc Balaguer
- Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - María Pellisé
- Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Huaman JW, Mego M, Bendezú A, Monrroy H, Samino S, Accarino A, Saperas E, Azpiroz F. Correction of Dyssynergic Defecation, but Not Fiber Supplementation, Reduces Symptoms of Functional Dyspepsia in Patients With Constipation in a Randomized Trial. Clin Gastroenterol Hepatol 2020; 18:2463-2470.e1. [PMID: 31811952 DOI: 10.1016/j.cgh.2019.11.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/23/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with functional dyspepsia are believed to have increased sensitivity of the gastrointestinal tract, and some also have functional constipation. We investigated whether in patients with functional dyspepsia, correction of dyssynergic defecation can reduce postprandial fullness. METHODS We performed a parallel trial at 2 referral centers in Spain, from June 2016 through January 2018 of 50 patients who fulfilled the Rome IV criteria for functional dyspepsia with postprandial distress syndrome and functional constipation and dyssynergic defecation. After a 2-week pretreatment phase, the patients were randomly assigned to groups that learned to correct dyssynergic defecation (2-3 sessions of biofeedback combined with instructions for daily exercise; n = 25) or received dietary fiber supplementation (3.5 g plantago ovata per day; n = 25) for 4 weeks. The primary outcome was change in postprandial abdominal fullness, measured daily on a scale of 0-10, during the last 7 days treatment phase vs the last 7 days of the pretreatment phase. Anal gas evacuations were measured (by an event marker) during the last 2 days of the pretreatment vs treatment phases. RESULTS Biofeedback treatment corrected dyssynergic defecation in 19/25 patients; corrected dyssynergic defection reduced postprandial fullness by 22%±1% in these patients (P < .001), and reduced the number of anal evacuations by 21%±8% (P = .009). Fiber supplementation did not reduce postprandial fullness or anal evacuations (P ≤ .023 between groups for both parameters in the intent to treat analysis). CONCLUSIONS Diagnosis and correction of dyssynergic defecation reduces dyspeptic symptoms by more than 20% in patients with functional dyspepsia and associated constipation. Dietary fiber supplementation does not reduce symptoms in these patients. ClinicalTrials.gov no: NCT02956187.
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Affiliation(s)
- Jose-Walter Huaman
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Gastroenterology, University Hospital General of Catalonia, San Cugat del Valles, Spain
| | - Marianela Mego
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Gastroenterology, University Hospital General of Catalonia, San Cugat del Valles, Spain
| | - Alvaro Bendezú
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Gastroenterology, University Hospital General of Catalonia, San Cugat del Valles, Spain
| | - Hugo Monrroy
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sara Samino
- Metabolomics Platform, Campus Sescelades, Universitat Rovira i Virgili, Tarragona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas, Instituto Carlos III, Madrid, Spain
| | - Anna Accarino
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Esteban Saperas
- Department of Gastroenterology, University Hospital General of Catalonia, San Cugat del Valles, Spain
| | - Fernando Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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6
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Cuatrecasas M, Gorostiaga I, Riera C, Saperas E, Llort G, Costa I, Matias-Guiu X, Carrato C, Navarro M, Pineda M, Dueñas N, Brunet J, Marco V, Trias I, Busteros JI, Mateu G, Balaguer F, Fernández-Figueras MT, Esteller M, Musulén E. Complete Loss of EPCAM Immunoexpression Identifies EPCAM Deletion Carriers in MSH2-Negative Colorectal Neoplasia. Cancers (Basel) 2020; 12:cancers12102803. [PMID: 33003511 PMCID: PMC7599495 DOI: 10.3390/cancers12102803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Colorectal carcinomas from patients with Lynch syndrome (LS) due to EPCAM deletions show loss of MSH2 expression. The aim of our study was to evaluate the usefulness of EPCAM expression in identifying carriers of EPCAM deletion among patients with MSH2-negative lesions. MSH2 and EPCAM immunohistochemistry was performed in a large series of lesions (190) composed of malignant and benign neoplasms as well as precursor lesions of different organs from 71 patients with suspected LS due to MSH2 alterations. Germ-line analysis confirmed LS in 68 patients due to MSH2 mutations (53) and EPCAM deletions (15). Among colorectal lesions with lack of MSH2 expression, only 17 were EPCAM-negative and belonged to patients with EPCAM deletions. We confirm that loss of EPCAM expression identifies EPCAM deletion carriers with 100% specificity and we recommend adding EPCAM IHC to the algorithm of MSH2-negative colorectal neoplasia. Abstract The use of epithelial cell adhesion molecule (EPCAM) immunohistochemistry (IHC) is not included in the colorectal cancer (CRC) screening algorithm to detect Lynch syndrome (LS) patients. The aim of the present study was to demonstrate that EPCAM IHC is a useful tool to guide the LS germ-line analysis when a loss of MSH2 expression was present. We retrospectively studied MSH2 and EPCAM IHC in a large series of 190 lesions composed of malignant neoplasms (102), precursor lesions of gastrointestinal (71) and extra-gastrointestinal origin (9), and benign neoplasms (8) from different organs of 71 patients suspicious of being LS due to MSH2 alterations. LS was confirmed in 68 patients, 53 with MSH2 mutations and 15 with EPCAM 3′-end deletions. Tissue microarrays were constructed with human normal tissues and their malignant counterparts to assist in the evaluation of EPCAM staining. Among 154 MSH2-negative lesions, 17 were EPCAM-negative, including 10 CRC and 7 colorectal polyps, and 5 of them showed only isolated negative glands. All lesions showing a lack of EPCAM expression belonged to patients with EPCAM 3′-end deletions. EPCAM IHC is a useful screening tool, with 100% specificity to identify LS patients due to EPCAM 3′-end deletions in MSH2-negative CRC and MSH2-negative colorectal polyps.
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Affiliation(s)
- Míriam Cuatrecasas
- Department of Pathology, Center of Biomedical Diagnosis (CDB), Hospital Clínic, 08036 Barcelona, Spain;
- Universitat de Barcelona (UB), 08007 Barcelona, Spain; (X.M.-G.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08036 Barcelona, Spain;
| | - Iñigo Gorostiaga
- Department of Pathology, Hospital Universitario de Araba, 01009 Vitoria-Gasteiz, Spain;
| | - Cristina Riera
- Gastroenterology Department, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Sant Cugat del Valles, 08195 Barcelona, Spain; (C.R.); (E.S.)
| | - Esteban Saperas
- Gastroenterology Department, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Sant Cugat del Valles, 08195 Barcelona, Spain; (C.R.); (E.S.)
- Universitat Internacional de Catalunya (UIC), Sant Cugat del Vallès, 08017 Barcelona, Spain;
| | - Gemma Llort
- Oncology Department, Parc Taulí Hospital Universitari, Sabadell, 08208 Barcelona, Spain;
- Oncology Department, Consorci Sanitari de Terrassa, Terrassa, 08208 Barcelona, Spain
| | - Irmgard Costa
- Department of Pathology, Parc Taulí Hospital Universitari, Sabadell, 08208 Barcelona, Spain;
| | - Xavier Matias-Guiu
- Universitat de Barcelona (UB), 08007 Barcelona, Spain; (X.M.-G.); (M.E.)
- Department of Pathology, Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Department of Pathology, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
- Universitat de Lleida, IRBLLEIDA, 25003 Lleida, Catalonia, Spain
- Centro de Investigación Biomédica en Red Cancer (CIBERONC), 28029 Madrid, Spain; (M.N.); (M.P.); (N.D.); (J.B.)
| | - Cristina Carrato
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain;
| | - Matilde Navarro
- Centro de Investigación Biomédica en Red Cancer (CIBERONC), 28029 Madrid, Spain; (M.N.); (M.P.); (N.D.); (J.B.)
- Hereditary Cancer Program, Catalan Institute of Oncology, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), ONCOBELL Program, Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Marta Pineda
- Centro de Investigación Biomédica en Red Cancer (CIBERONC), 28029 Madrid, Spain; (M.N.); (M.P.); (N.D.); (J.B.)
- Hereditary Cancer Program, Catalan Institute of Oncology, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), ONCOBELL Program, Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Núria Dueñas
- Centro de Investigación Biomédica en Red Cancer (CIBERONC), 28029 Madrid, Spain; (M.N.); (M.P.); (N.D.); (J.B.)
- Hereditary Cancer Program, Catalan Institute of Oncology, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), ONCOBELL Program, Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Joan Brunet
- Centro de Investigación Biomédica en Red Cancer (CIBERONC), 28029 Madrid, Spain; (M.N.); (M.P.); (N.D.); (J.B.)
- Hereditary Cancer Program, Catalan Institute of Oncology, Institut d’Investigació Biomèdica de Girona (IDIBGI), Universitat de Girona, 17190 Girona, Spain
| | - Vicente Marco
- Department of Pathology, Hospital Quirónsalud Barcelona, 08023 Barcelona, Spain;
| | - Isabel Trias
- Department of Pathology, Hospital Platón, 08006 Barcelona, Spain;
| | - José Ignacio Busteros
- Department of Pathology, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Madrid, Spain;
| | - Gemma Mateu
- Department of Pathology, University Hospital Josep Trueta, 17007 Girona, Spain;
| | - Francesc Balaguer
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08036 Barcelona, Spain;
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, 08036 Barcelona, Spain
| | - María-Teresa Fernández-Figueras
- Universitat Internacional de Catalunya (UIC), Sant Cugat del Vallès, 08017 Barcelona, Spain;
- Department of Pathology, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Sant Cugat del Vallès, 08190 Barcelona, Spain
| | - Manel Esteller
- Universitat de Barcelona (UB), 08007 Barcelona, Spain; (X.M.-G.); (M.E.)
- Centro de Investigación Biomédica en Red Cancer (CIBERONC), 28029 Madrid, Spain; (M.N.); (M.P.); (N.D.); (J.B.)
- Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain
| | - Eva Musulén
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain;
- Department of Pathology, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Sant Cugat del Vallès, 08190 Barcelona, Spain
- Josep Carreras Leukaemia Research Institute (IJC), 08916 Badalona, Barcelona, Spain
- Correspondence: or
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7
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Seoane Urgorri A, Saperas E, O'Callaghan Castella E, Pera Román M, Raga Gil A, Riu Pons F, Barranco Priego L, Dedeu Cusco JM, Pantaleón Sánchez M, Bessa Caserras X, Álvarez-González MA. Colonic stent vs surgical resection of the primary tumor. Effect on survival from stage-IV obstructive colorectal cancer. Rev Esp Enferm Dig 2020; 112:694-700. [PMID: 32755149 DOI: 10.17235/reed.2020.5701/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES the impact of surgical primary tumor resection on survival of obstructive metastatic colorectal cancer remains controversial. The primary goal of this study was to analyze survival in patients with obstructive metastatic colorectal cancer after treatment with either resection surgery or a colonic stent. MATERIAL AND METHODS a prospective study was performed of all patients with stage-IV colorectal cancer and obstructive manifestations, diagnosed from 2005 to 2012 and managed with either resection surgery or a colonic stent. Cases with a perforation, abscess, right colon or distal rectal malignancy, multiple colorectal cancer or derivative surgery were excluded. RESULTS a total of 95 patients were included, 49 were managed with resection surgery and 46 with a colonic stent. The colonic stent group had a higher Charlson index (9.5 ± 2.1 vs 8.6 ± 1.5, p = 0.01), a shorter time to oral intake (0.9 ± 1.1 vs 16.4 ± 53.5 days, p = 0.05), a shorter hospital stay (4 ± 4.8 vs 16.7 ± 15.5 days, p = 0.0001), less need for stomata (11.1 % vs 32.7 %, p = 0.01), fewer early complications (4.3 % vs 46.9 %, p = 0.0001) and more late complications (33.3 % vs 6.4 %, p = 0.001). Undergoing chemotherapy (p = 0.008) was the only independent factor related to increased survival. In the subgroup of patients managed with chemotherapy, surgical primary tumor resection was an independent factor associated with increased survival. CONCLUSION both treatments are effective for resolving obstructive manifestations in patients diagnosed with stage-IV obstructive colorectal cancer. Resection surgery has no positive impact on survival and thus cannot be recommended as a therapy of choice.
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Affiliation(s)
| | | | | | | | | | - Faust Riu Pons
- Aparato Digestivo, Parc de Salut Mar. Hospital del Mar, España
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8
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Albéniz E, Gimeno-García AZ, Fraile M, Ibáñez B, Guarner-Argente C, Alonso-Aguirre P, Álvarez MA, Gargallo CJ, Pellisé M, Ramos Zabala F, Herreros de Tejada A, Nogales Ó, Martínez-Ares D, Múgica F, de la Peña J, Espinós J, Huerta A, Álvarez A, Gonzalez-Santiago JM, Navajas F, Martínez-Cara JG, Redondo-Cerezo E, Merlo Mas J, Sábado F, Rivero L, Saperas E, Soto S, Rodríguez-Sánchez J, López-Roses L, Rodríguez-Téllez M, Rullán Iriarte M, Elosua González A, Pardeiro R, Valdivielso Cortázar E, Concepción-Martín M, Huelin Álvarez P, Colán Hernández J, Cobian J, Santiago J, Jiménez A, Remedios D, López-Viedma B, García O, Martínez-Alcalá F, Pérez-Roldán F, Carbó J, Enguita M. Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions. Gastrointest Endosc 2020; 91:868-878.e3. [PMID: 31655045 DOI: 10.1016/j.gie.2019.10.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 04/26/2019] [Accepted: 10/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models. METHODS A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies. RESULTS DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets. CONCLUSIONS The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT03050333.).
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Affiliation(s)
| | | | | | - Berta Ibáñez
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA and REDISSEC, Pamplona, Spain
| | - Carlos Guarner-Argente
- Hospital de la Santa Creu y Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Óscar Nogales
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Múgica
- Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | | | | | | | - Alberto Álvarez
- Complejo Asistencial Universitario de Salamanca, IBSAL, Salamanca, Spain
| | | | | | | | | | | | - Fernando Sábado
- Consorcio Hospitalario Provincial Castellón, Castellón, Spain
| | | | | | | | | | | | | | | | | | | | | | - Mar Concepción-Martín
- Hospital de la Santa Creu y Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Juan Colán Hernández
- Hospital de la Santa Creu y Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Julyssa Cobian
- Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - José Santiago
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | | | | | | | | | - Jorge Carbó
- Hospital Universitario La Paz, Madrid, Spain
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9
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Rivero-Sánchez L, Arnau-Collell C, Herrero J, Remedios D, Cubiella J, García-Cougil M, Alvarez V, Albéniz E, Calvo P, Gordillo J, Puig I, López-Vicente J, Huerta A, López-Cerón M, Salces I, Peñas B, Parejo S, Rodriguez de Santiago E, Herraiz M, Carretero C, Gimeno-Garcia AZ, Saperas E, Alvarez-Urturi C, Moreira R, Rodriguez de Miguel C, Ocaña T, Moreira L, Carballal S, Sánchez A, Jung G, Castells A, Llach J, Balaguer F, Pellisé M. White-Light Endoscopy Is Adequate for Lynch Syndrome Surveillance in a Randomized and Noninferiority Study. Gastroenterology 2020; 158:895-904.e1. [PMID: 31520613 DOI: 10.1053/j.gastro.2019.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 05/31/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Dye-based pancolonic chromoendoscopy is recommended for colorectal cancer surveillance in patients with Lynch syndrome. However, there is scarce evidence to support its superiority to high-definition white-light endoscopy. We performed a prospective study assess whether in the hands of high detecting colonoscopists, high-definition, white-light endoscopy is noninferior to pancolonic chromoendoscopy for detection of adenomas in patients with Lynch syndrome. METHODS We conducted a parallel controlled study, from July 2016 through January 2018 at 14 centers in Spain of adults with pathogenic germline variants in mismatch repair genes (60% women; mean age, 47 ± 14 years) under surveillance. Patients were randomly assigned to groups that underwent high-definition white-light endoscopy (n = 128) or pancolonic chromoendoscopy (n = 128) evaluations by 24 colonoscopists who specialized in detection of colorectal lesions in high-risk patients for colorectal cancer. Adenoma detection rates (defined as the proportion of patients with at least 1 adenoma) were compared between groups, with a noninferiority margin (relative difference) of 15%. RESULTS We found an important overlap of confidence intervals (CIs) and no significant difference in adenoma detection rates by pancolonic chromoendoscopy (34.4%; 95% CI 26.4%-43.3%) vs white-light endoscopy (28.1%; 95% CI 21.1%-36.4%; P = .28). However, pancolonic chromoendoscopy detected serrated lesions in a significantly higher proportion of patients (37.5%; 95% CI 29.5-46.1) than white-light endoscopy (23.4%; 95% CI 16.9-31.4; P = .01). However, there were no significant differences between groups in proportions of patients found to have serrated lesions of 5 mm or larger (9.4% vs 7.0%; P = .49), of proximal location (11.7% vs 10.2%; P = .68), or sessile serrated lesions (3.9% vs 5.5%; P = .55), respectively. Total procedure and withdrawal times with pancolonic chromoendoscopy (30.7 ± 12.8 minutes and 18.3 ± 7.6 minutes, respectively) were significantly longer than with white-light endoscopy (22.4 ± 8.7 minutes and 13.5 ± 5.6 minutes; P < .001). CONCLUSIONS In a randomized parallel trial, we found that for Lynch syndrome surveillance, high-definition white-light endoscopy is not inferior to pancolonic chromoendoscopy if performed by experienced and dedicated endoscopists. ClinicalTrials.gov no: NCT02951390.
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Affiliation(s)
- Liseth Rivero-Sánchez
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Coral Arnau-Collell
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jesús Herrero
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, CIBERehd, Ourense, Spain
| | - David Remedios
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, CIBERehd, Ourense, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, CIBERehd, Ourense, Spain
| | - Marta García-Cougil
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, CIBERehd, Ourense, Spain
| | - Victoria Alvarez
- Complejo Hospitalario de Pontevedra, Department of Gastroenterology, Pontevedra, Spain
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Digestive System Service, Endoscopy Unit, Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain
| | - Patricia Calvo
- Complejo Hospitalario de Navarra, Nurse High-Risk Clinic, Pamplona, Spain
| | - Jordi Gordillo
- Hospital de la Santa Creu i Sant Pau, Gastroenterology Unit, Barcelona, Spain
| | - Ignasi Puig
- Althaia, Xarxa Assistencial Universitària de Manresa, Digestive System Service, Manresa, Spain
| | - Jorge López-Vicente
- Hospital Universitario de Móstoles, Digestive System Service, Móstoles, Spain
| | - Alain Huerta
- Hospital Galdakao-Usansolo, Department of Gastroenterology, Galdakao, Spain
| | - María López-Cerón
- Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
| | - Inmaculada Salces
- Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
| | - Beatriz Peñas
- Hospital Universitario Ramón y Cajal, Department of Gastroenterology, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Sofía Parejo
- Hospital Universitario Ramón y Cajal, Department of Gastroenterology, Madrid, Spain
| | | | - Maite Herraiz
- University of Navarra Clinic-IdiSNA, Gastroenterology Department, Pamplona, Spain
| | - Cristina Carretero
- University of Navarra Clinic-IdiSNA, Gastroenterology Department, Pamplona, Spain
| | | | - Esteban Saperas
- Hospital General de Catalunya, Digestive System Service, Sant Cugat del Vallès, Spain
| | | | - Rebeca Moreira
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain
| | | | - Teresa Ocaña
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain
| | - Leticia Moreira
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Sabela Carballal
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Ariadna Sánchez
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Gerhard Jung
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Antoni Castells
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Josep Llach
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain
| | - Francesc Balaguer
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - María Pellisé
- Hospital Clinic of Barcelona, Department of Gastroenterology, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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10
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Huaman JW, Mego M, Manichanh C, Cañellas N, Cañueto D, Segurola H, Jansana M, Malagelada C, Accarino A, Vulevic J, Tzortzis G, Gibson G, Saperas E, Guarner F, Azpiroz F. Effects of Prebiotics vs a Diet Low in FODMAPs in Patients With Functional Gut Disorders. Gastroenterology 2018; 155:1004-1007. [PMID: 29964041 DOI: 10.1053/j.gastro.2018.06.045] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [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: 02/27/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/02/2022]
Abstract
Prebiotics and diets low in fermentable oligo-, di-, mono-saccharides and polyols (low-FODMAP diet) might reduce symptoms in patients with functional gastrointestinal disorders, despite reports that some nonabsorbable, fermentable meal products (prebiotics) provide substrates for colonic bacteria and thereby increase gas production. We performed a randomized, parallel, double-blind study of patients with functional gastrointestinal disorders with flatulence. We compared the effects of a prebiotic supplement (2.8 g/d Bimuno containing 1.37 g beta-galactooligosaccharide) plus a placebo (Mediterranean-type diet (prebiotic group, n = 19) vs a placebo supplement (2.8 g xylose) plus a diet low in FODMAP (low-FODMAP group, n = 21) for 4 weeks; patients were then followed for 2 weeks. The primary outcome was effects on composition of the fecal microbiota, analyzed by 16S sequencing. Secondary outcomes were intestinal gas production and digestive sensations. After 4 weeks, we observed opposite effects on microbiota in each group, particularly in relation to the abundance of Bifidobacterium sequences (increase in the prebiotic group and decrease in the low-FODMAP group; P = .042), and Bilophila wadsworthia (decrease in the prebiotic group and increase in the low-FODMAP group; P = .050). After 4 weeks, both groups had statistically significant reductions in all symptom scores, except reductions in flatulence and borborygmi were not significant in the prebiotic group. Although the decrease in symptoms persisted for 2 weeks after patients discontinued prebiotic supplementation, symptoms reappeared immediately after patients discontinued the low-FODMAP diet. Intermittent prebiotic administration might therefore be an alternative to dietary restrictions for patients with functional gut symptoms. ClinicalTrials.gov no.: NCT02210572.
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Affiliation(s)
- Jose-Walter Huaman
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Department of Gastroenterology, University Hospital General of Catalonia, San Cugat del Valles, Barcelona, Spain
| | - Marianela Mego
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Chaysavanh Manichanh
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Nicolau Cañellas
- Metabolomics Platform, Universitat Rovira i Virgili, Campus Sescelades, Tarragona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas (Ciberdem), Madrid, Spain
| | - Daniel Cañueto
- Metabolomics Platform, Universitat Rovira i Virgili, Campus Sescelades, Tarragona, Spain
| | - Hegoi Segurola
- Nutritional Support Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Marta Jansana
- Department of Endocrinology and Nutrition, University Hospital General of Catalonia, San Cugat del Valles, Barcelona, Spain
| | - Carolina Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Anna Accarino
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Jelena Vulevic
- Clasado Research Services Ltd, Science and Technology Centre, University of Reading, Early Gate, Reading, UK
| | - George Tzortzis
- Clasado Research Services Ltd, Science and Technology Centre, University of Reading, Early Gate, Reading, UK
| | - Glenn Gibson
- Food Microbial Sciences Unit, Department of Food and Nutritional Sciences, The University of Reading, Whiteknights, Reading, UK
| | - Esteban Saperas
- Department of Gastroenterology, University Hospital General of Catalonia, San Cugat del Valles, Barcelona, Spain
| | - Francisco Guarner
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Fernando Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
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Albéniz E, Pellisé M, Gimeno-García AZ, Lucendo AJ, Alonso-Aguirre PA, Herreros de Tejada A, Álvarez MA, Fraile M, Herráiz Bayod M, López Rosés L, Martínez Ares D, Ono A, Parra Blanco A, Redondo E, Sánchez-Yagüe A, Soto S, Díaz-Tasende J, Montes Díaz M, Rodríguez-Téllez M, García O, Zuñiga Ripa A, Hernández Conde M, Alberca de Las Parras F, Gargallo CJ, Saperas E, Muñoz Navas M, Gordillo J, Ramos Zabala F, Echevarría JM, Bustamante M, González-Haba M, González-Huix F, González-Suárez B, Vila Costas JJ, Guarner Argente C, Múgica F, Cobián J, Rodríguez Sánchez J, López Viedma B, Pin N, Marín Gabriel JC, Nogales Ó, de la Peña J, Navajas León FJ, León Brito H, Remedios D, Esteban JM, Barquero D, Martínez Cara JG, Martínez Alcalá F, Fernández-Urién I, Valdivielso E. Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions. Rev Esp Enferm Dig 2018; 110:179-194. [PMID: 29421912 DOI: 10.17235/reed.2018.5086/2017] [Citation(s) in RCA: 1] [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: 11/20/2022]
Abstract
This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.
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Affiliation(s)
- Eduardo Albéniz
- Aparato Digestivo. Unidad de Endoscopia Digestiva, Complejo Hospitalario de Navarra, España
| | | | | | | | | | | | | | | | - Maite Herráiz Bayod
- Unidad de Endoscopia. Departamento de Digestivo, Clínica Universidad de Navarra
| | | | | | - Akiko Ono
- Digestivo/Endoscopias, Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | | | | | | - José Díaz-Tasende
- Servicio de Medicina del Aparato Digestivo, Hospital Universitario 12 de Octubre, España
| | - Marta Montes Díaz
- Departamento de Anatomía Patológica, Complejo Hospitalario de Navarra, España
| | | | | | | | - Marta Hernández Conde
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | | | | | | | | | | | | | | | - Marco Bustamante
- Digestive Endoscopy Unit. Gastoenterology, Hospital Universitari i Politècnic La Fe, España
| | | | | | | | | | | | | | | | | | | | | | | | - Óscar Nogales
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón, España
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12
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Albéniz E, Pellisé M, Gimeno García AZ, Lucendo AJ, Alonso Aguirre PA, Herreros de Tejada A, Álvarez MA, Fraile M, Herráiz Bayod M, López Rosés L, Martínez Ares D, Ono A, Parra Blanco A, Redondo E, Sánchez Yagüe A, Soto S, Díaz Tasende J, Montes Díaz M, Téllez MR, García O, Zuñiga Ripa A, Hernández Conde M, Alberca de las Parras F, Gargallo C, Saperas E, Navas MM, Gordillo J, Ramos Zabala F, Echevarría JM, Bustamante M, González Haba M, González Huix F, González Suárez B, Vila Costas JJ, Guarner Argente C, Múgica F, Cobián J, Rodríguez Sánchez J, López Viedma B, Pin N, Marín Gabriel JC, Nogales Ó, de la Peña J, Navajas León FJ, León Brito H, Remedios D, Esteban JM, Barquero D, Martínez Cara JG, Martínez Alcalá F, Fernández Urién I, Valdivielso E. Guía clínica para la resección mucosa endoscópica de lesiones colorrectales no pediculadas. Gastroenterología y Hepatología 2018; 41:175-190. [DOI: 10.1016/j.gastrohep.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
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Rodríguez-D Jesus A, Saperas E. Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening. Rev Esp Enferm Dig 2017; 108:257-62. [PMID: 27023867 DOI: 10.17235/reed.2016.4008/2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM The usefulness of high definition colonoscopy plus i-scan (HD+i-SCAN) for average-risk colorectal cancer screening has not been fully assessed. The detection rate of adenomas and other measurements such as the number of adenomas per colonoscopy and the flat adenoma detection rate have been recognized as markers of colonoscopy quality. The aim of the present study was to compare the diagnostic performance of an HD+i-SCAN with that of standard resolution white-light colonoscope. METHODS This is a retrospective analysis of a prospectively collected screening colonoscopy database. A comparative analysis of the diagnostic yield of an HD+i-SCAN or standard resolution colonoscopy for average-risk colorectal screening was conducted. RESULTS During the period of study, 155/163 (95.1%) patients met the inclusion criteria. The mean age was 56.9 years. Sixty of 155 (39%) colonoscopies were performed using a HD+i-SCAN. Adenoma-detection-rates during the withdrawal of the standard resolution versus HD+i-SCAN colonoscopies were 29.5% and 30% (p = n.s.). Adenoma/colonoscopy values for standard resolution versus HD+i-SCAN colonoscopies were 0.46 (SD = 0.9) and 0.72 (SD = 1.3) (p = n.s.). A greater number of flat adenomas were detected in the HD+i-SCAN group (6/60 versus 2/95) (p < .05). Likewise, serrated adenomas/polyps per colonoscopy were also higher in the HD+i-SCAN group. CONCLUSIONS A HD+i-SCAN colonoscopy increases the flat adenoma detection rate and serrated adenomas/polyps per colonoscopy compared to a standard colonoscopy in average-risk screening population. HD+i-SCAN is a simple, available procedure that can be helpful, even for experienced providers. The performance of HD+i-SCAN and substantial prevalence of flat lesions in our average-risk screening cohort support its usefulness in improving the efficacy of screening colonoscopies.
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Affiliation(s)
| | - Esteban Saperas
- Servicio de Digestivo, Hospital General de Catalunya, España
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Albéniz E, Fraile M, Ibáñez B, Alonso-Aguirre P, Martínez-Ares D, Soto S, Gargallo CJ, Ramos Zabala F, Álvarez MA, Rodríguez-Sánchez J, Múgica F, Nogales Ó, Herreros de Tejada A, Redondo E, Pin N, León-Brito H, Pardeiro R, López-Roses L, Rodríguez-Téllez M, Jiménez A, Martínez-Alcalá F, García O, de la Peña J, Ono A, Alberca de Las Parras F, Pellisé M, Rivero L, Saperas E, Pérez-Roldán F, Pueyo Royo A, Eguaras Ros J, Zúñiga Ripa A, Concepción-Martín M, Huelin-Álvarez P, Colán-Hernández J, Cubiella J, Remedios D, Bessa I Caserras X, López-Viedma B, Cobian J, González-Haba M, Santiago J, Martínez-Cara JG, Valdivielso E, Guarner-Argente C. A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions. Clin Gastroenterol Hepatol 2016; 14:1140-7. [PMID: 27033428 DOI: 10.1016/j.cgh.2016.03.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 12/16/2015] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk. METHODS We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the β parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding. RESULTS Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age ≥75 years (odds ratio [OR], 2.36; P < .01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P ≤ .05), aspirin use during EMR (OR, 3.16; P < .05), right-sided lesions (OR, 4.86; P < .01), lesion size ≥40 mm (OR, 1.91; P ≤ .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P ≤ .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively. CONCLUSIONS The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.
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Affiliation(s)
| | - María Fraile
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Berta Ibáñez
- NavarraBiomed-Fundación Miguel Servet and Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Pamplona, Spain
| | | | | | | | | | | | | | | | - Fernando Múgica
- Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Óscar Nogales
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Noel Pin
- Hospital Juan Canalejo, La Coruña, Spain
| | | | | | | | | | | | | | | | | | - Akiko Ono
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | - Mar Concepción-Martín
- Hospital de la Santa Creu y Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Juan Colán-Hernández
- Hospital de la Santa Creu y Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Julyssa Cobian
- Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | | | - José Santiago
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | - Carlos Guarner-Argente
- Hospital de la Santa Creu y Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Huamán JW, Felip A, Guedea E, Jansana M, Videla S, Saperas E. [The diet low in fermentable carbohydrates short chain and polyols improves symptoms in patients with functional gastrointestinal disorders in Spain]. Gastroenterol Hepatol 2014; 38:113-22. [PMID: 25458546 DOI: 10.1016/j.gastrohep.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 08/18/2014] [Accepted: 08/27/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Successful treatment of patients with irritable bowel syndrome (IBS) often remains elusive. Recent studies in Australia, the United Kingdom and New Zealand have suggested the efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the management of these patients. The aims of this study were to determine whether a diet low in FODMAPs improves symptoms in patients with functional gastrointestinal disorders (FGID) in Spain and to analyze the predictors of a good response. PATIENTS AND METHODS A prospective study was carried out in consecutive patients with FGID type IBS and functioanl abdominal bloating. At inclusion all patients underwent an assessment through a baseline demographic questionnaire of symptoms of anxiety and depression and quality of life. A hydrogen breath test with lactose and fructose was performed and a low FODMAPs diet was indicated for 2 months by expert dietitians. These tests were taken as a reference. A positive response was defined as an improvement of at least 5 points out of a possible 10 in the symptom questionnaire. RESULTS We included 30 patients (24 women, 39 [12] years). The response to the low FODMAPs diet was positive in controlling overall symptoms and specific symptoms such as functioanl abdominal bloating, abdominal pain, diarrhea, flatulence, nausea and fatigue in more than 70% of patients (P<.05). By contrast, constipation was controlled in only 48% of patients (P>.05). Adherence to the diet was good in 87% of patients and was a predictor of positive response in the univariate analysis. CONCLUSIONS A diet low in FODMAPs is associated with symptom improvement in patients with IBS and functioanl abdominal bloating. Adherence to the diet was a determining factor.
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Affiliation(s)
- José Wálter Huamán
- Servicio de Aparato Digestivo, Hospital General de Catalunya, Universidad Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Ana Felip
- Servicio de Endocrinología, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Elena Guedea
- Servicio de Endocrinología, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Marta Jansana
- Servicio de Endocrinología, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Sebastián Videla
- Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, España
| | - Esteban Saperas
- Servicio de Aparato Digestivo, Hospital General de Catalunya, Universidad Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España.
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Huamán JW, Aliaga V, Domenech G, Videla S, Saperas E. [What is the utility of proton pump inhibitor testing in non-cardiac chest pain?]. Gastroenterol Hepatol 2014; 37:452-61. [PMID: 24725608 DOI: 10.1016/j.gastrohep.2014.02.009] [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: 11/17/2013] [Revised: 02/17/2014] [Accepted: 02/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Noncardiac chest pain (NCCP) often represents a diagnostic and therapeutic challenge. Given that gastroesophageal reflux disease (GERD) is the most common cause of NCCP, initial treatment with proton-pump inhibitors (PPI) has been proposed for all patients (PPI testing), reserving esophageal function testing solely for non-responders. The aim of the present study was to provide evidence on the clinical utility of PPI testing with high-dose pantoprazole in patients with NCCP. PATIENTS AND METHODS We carried out a study of diagnostic performance with a cohort design in patients with NCCP, who had been assessed by the Cardiology Service. All patients underwent upper endoscopy, esophageal manometry, and 24h esophageal pH monitoring before PPI testing with pantoprazole 40 mg every 12h for 1 month. Before and after treatment, we assessed the severity (intensity and frequency) of chest pain, quality of life, and anxiety and depression by means of specific questionnaires. The diagnosis of GERD was based on a pathological finding of esophageal pH monitoring. A positive response to PPI testing was defined as an improvement in chest pain >50% compared with the baseline score after 1 month of PPI therapy. RESULTS We included 30 consecutive patients (17 men/13 women) with a mean age of 49 years. Of these 30 patients, 20 with NCCP had GERD (67%, 95%CI: 47%-83%). A positive response to PPI therapy was observed in 13 of the 30 (43%) patients with NCCP: 11 of the 20 (55%) patients in the GERD-positive group and 2 of the 10 (20%) in the GERD-negative group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PPI testing was 55%, 80%, 85%, 47% and 63%, respectively. A significant reduction in chest pain after pantoprazole therapy (P=.003) and a slight non significant improvement in anxiety and depression was achieved in the GERD-positive group as compared to the GERD-negative group. CONCLUSIONS In NCCP, PPI testing with pantoprazole has a low sensitivity for the diagnosis of GERD, placing in doubt the strategy of reserving functional study to non-responders to antisecretory therapy. Esophageal function testing and accurate diagnosis would allow appropriate targeted therapy for all patients with NCCP.
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Affiliation(s)
- José Wálter Huamán
- Servicio de Aparato Digestivo y Endoscopia, Hospital General de Catalunya, UIC, Sant Cugat del Vallès, Barcelona, España
| | - Verónica Aliaga
- Servicio de Cardiología, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Gemma Domenech
- Servicio de Aparato Digestivo y Endoscopia, Hospital General de Catalunya, UIC, Sant Cugat del Vallès, Barcelona, España
| | - Sebastián Videla
- Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, España
| | - Esteban Saperas
- Servicio de Aparato Digestivo y Endoscopia, Hospital General de Catalunya, UIC, Sant Cugat del Vallès, Barcelona, España.
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Rodríguez-D'Jesús A, Gordillo J, Uchima H, Araujo I, Saperas E, Elizalde I, Fernández-Esparrach G. [Prevalence and epidemiology of Barrett's esophagus in the province of Barcelona]. Gastroenterol Hepatol 2014; 37:397-401. [PMID: 24674710 DOI: 10.1016/j.gastrohep.2014.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The prevalence of Barrett's esophagus (BE) varies from 0.45% to 2.2% in patients who undergo upper endoscopy and is >12% when the indication is for reflux symptoms. The prevalence has progressively increased in recent years but is unknown in the population of the province of Barcelona. OBJECTIVES To determine the prevalence of BE and its epidemiological characteristics in our population. PATIENTS AND METHODS We prospectively evaluated patients referred to the Endoscopy Unit of Hospital Clinic and Hospital General de Catalunya for an upper endoscopy. We excluded patients with known BE, prior upper endoscopy, esophagogastric surgery or refusal to participate in the study. Demographic data, alcohol intake, Helicobacter pylori infection and consumption of antisecretory agents were recorded, among other information. Participants completed a standardized questionnaire to assess the presence of gastroesophageal reflux disease (GERD) symptoms and their severity. RESULTS Between July 2010 and July 2012, we included 200 patients (100 in each center). The mean age was 48.9 ± 15.6 years and the majority were women (n=120, 60%). Symptoms of GERD were present in 46 patients (23%) and some degree of esophagitis was present in 31 (15.5%). Infection by H. pylori was present in 29.7%. BE was found endoscopically in 14 (7%) patients, but was histologically confirmed in only 8 (4%). The only variable that correlated with the finding of BE was male sex. CONCLUSION The prevalence of BE in our environment is similar to that reported in Western countries. The absence of reflux symptoms does not rule out the possibility of BE.
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Affiliation(s)
| | - Jordi Gordillo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Hugo Uchima
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Isis Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Esteban Saperas
- Servicio de Digestivo, Hospital General de Catalunya, Barcelona, España
| | - Ignasi Elizalde
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, Hospital Clínic, CIBERehd, IDIBAPS, Universitat de Barcelona, Barcelona, España.
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Martínez C, Vicario M, Ramos L, Lobo B, Mosquera JL, Alonso C, Sánchez A, Guilarte M, Antolín M, de Torres I, González-Castro AM, Pigrau M, Saperas E, Azpiroz F, Santos J. The jejunum of diarrhea-predominant irritable bowel syndrome shows molecular alterations in the tight junction signaling pathway that are associated with mucosal pathobiology and clinical manifestations. Am J Gastroenterol 2012; 107:736-46. [PMID: 22415197 DOI: 10.1038/ajg.2011.472] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [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] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Diarrhea-predominant irritable bowel syndrome (IBS-D) patients show altered epithelial permeability and mucosal micro-inflammation in both proximal and distal regions of the intestine. The objective of this study was to determine the molecular events and mechanisms and the clinical role of upper small intestinal alterations. METHODS Clinical assessment and a jejunal biopsy was obtained in IBS-D patients and healthy subjects. Routine histology and immunohistochemistry was performed in all participants to assess the number of mast cells (MCs) and intraepithelial lymphocytes. RNA in tissue samples was isolated to identify genes showing consistent differential expression by microarray analysis followed by pathway and network analysis in order to identify the biological functions of the differentially expressed genes in IBS-D. Gene and protein expression of tight junction (TJ) components was also assessed by quantitative real-time polymerase chain reaction and confocal microscopy to evaluate the pathways identified by gene expression analysis. RESULTS The analysis reveals a strong association between the transcript signature of the jejunal mucosa of IBS-D and intestinal permeability, MC biology, and TJ signaling. The expression of zonula occludens 1 (ZO-1) was reduced in IBS-D at both gene and protein level, with protein redistribution from the TJ to the cytoplasm. Remarkably, our analysis disclosed significant correlation between ZO proteins, MC activation, and clinical symptoms. CONCLUSIONS IBS-D manifestations are linked to molecular alterations involving MC-related dysregulation of TJ functioning in the jejunal mucosa.
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Affiliation(s)
- Cristina Martínez
- Department of Gastroenterology, Digestive System Research Unit, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona-Departmento de Medicina, Barcelona, Spain
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Vicario M, Alonso C, Guilarte M, Serra J, Martínez C, González-Castro AM, Lobo B, Antolín M, Andreu AL, García-Arumí E, Casellas M, Saperas E, Malagelada JR, Azpiroz F, Santos J. Chronic psychosocial stress induces reversible mitochondrial damage and corticotropin-releasing factor receptor type-1 upregulation in the rat intestine and IBS-like gut dysfunction. Psychoneuroendocrinology 2012; 37:65-77. [PMID: 21641728 DOI: 10.1016/j.psyneuen.2011.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [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: 09/15/2010] [Revised: 03/11/2011] [Accepted: 05/09/2011] [Indexed: 02/06/2023]
Abstract
The association between psychological and environmental stress with functional gastrointestinal disorders, especially irritable bowel syndrome (IBS), is well established. However, the underlying pathogenic mechanisms remain unknown. We aimed to probe chronic psychosocial stress as a primary inducer of intestinal dysfunction and investigate corticotropin-releasing factor (CRF) signaling and mitochondrial damage as key contributors to the stress-mediated effects. Wistar-Kyoto rats were submitted to crowding stress (CS; 8 rats/cage) or sham-crowding stress (SC; 2 rats/cage) for up to 15 consecutive days. Hypothalamic-pituitary-adrenal (HPA) axis activity was evaluated. Intestinal tissues were obtained 1h, 1, 7, or 30 days after stress exposure, to assess neutrophil infiltration, epithelial ion transport, mitochondrial function, and CRF receptors expression. Colonic response to CRF (10 μg/kg i.p.) and hyperalgesia were evaluated after ending stress exposure. Chronic psychosocial stress activated HPA axis and induced reversible intestinal mucosal inflammation. Epithelial permeability and conductance were increased in CS rats, effect that lasted for up to 7 days after stress cessation. Visceral hypersensitivity persisted for up to 30 days post stress. Abnormal colonic response to exogenous CRF lasted for up to 7 days after stress. Mitochondrial activity was disturbed throughout the intestine, although mitochondrial response to CRF was preserved. Colonic expression of CRF receptor type-1 was increased in CS rats, and negatively correlated with body weight gain. In conclusion, chronic psychosocial stress triggers reversible inflammation, persistent epithelial dysfunction, and colonic hyperalgesia. These findings support crowding stress as a suitable animal model to unravel the complex pathophysiology underlying to common human intestinal stress-related disorders, such as IBS.
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Affiliation(s)
- María Vicario
- Department of Gastroenterology, Institut de Recerca Vall d'Hebron, CIBERehd, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Departament of Medicine, Barcelona, Spain
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20
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Martínez Cerezo FJ, Mreish Tatros G, Vida Mombiela F, Tomas A, Abad Á, Campo R, Saló J, Boadas J, Baños F, Rigau J, Sabat M, Fàbregas S, Vidal L, Planella M, Castellví JM, Giné J, Saperas E, Torra S, Creix AJ, Torres M, Rey J, García V, Laguna JC, Pascual D, Manso C. Asistencia urgente a los pacientes con hemorragia digestiva alta en los hospitales comarcales catalanes. Gastroenterología y Hepatología 2011; 34:605-10. [DOI: 10.1016/j.gastrohep.2011.07.003] [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] [Received: 05/02/2011] [Revised: 06/27/2011] [Accepted: 07/01/2011] [Indexed: 01/13/2023]
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Vicario M, Guilarte M, Alonso C, Yang P, Martínez C, Ramos L, Lobo B, González A, Guilà M, Pigrau M, Saperas E, Azpiroz F, Santos J. Chronological assessment of mast cell-mediated gut dysfunction and mucosal inflammation in a rat model of chronic psychosocial stress. Brain Behav Immun 2010; 24:1166-75. [PMID: 20600818 DOI: 10.1016/j.bbi.2010.06.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [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: 04/01/2010] [Revised: 06/04/2010] [Accepted: 06/06/2010] [Indexed: 02/07/2023] Open
Abstract
Life stress and mucosal inflammation may influence symptom onset and severity in certain gastrointestinal disorders, particularly irritable bowel syndrome (IBS), in connection with dysregulated intestinal barrier. However, the mechanism responsible remains unknown. Crowding is a validated animal model reproducing naturalistic psychosocial stress, whose consequences on gut physiology remain unexplored. Our aims were to prove that crowding stress induces mucosal inflammation and intestinal dysfunction, to characterize dynamics in time, and to evaluate the implication of stress-induced mast cell activation on intestinal dysfunction. Wistar-Kyoto rats were submitted to 15 days of crowding stress (8 rats/cage) or sham-crowding (2 rats/cage). We measured spontaneous and corticotropin-releasing factor-mediated release of plasma corticosterone. Stress-induced intestinal chrono-pathobiology was determined by measuring intestinal inflammation, epithelial damage, mast cell activation and infiltration, and intestinal barrier function. Corticosterone release was higher in crowded rats throughout day 15. Stress-induced mild inflammation, manifested earlier in the ileum and the colon than in the jejunum. While mast cell counts remained mostly unchanged, piecemeal degranulation increased along time, as the mucosal content and luminal release of rat mast cell protease-II. Stress-induced mitochondrial injury and increased jejunal permeability, both events strongly correlated with mast cell activation at day 15. Taken together, we have provided evidences that long-term exposure to psychosocial stress promotes mucosal inflammation and mast cell-mediated barrier dysfunction in the rat bowel. The notable resemblance of these findings with those in some IBS patients, support the potential interest and translational validity of this experimental model for the research of stress-sensitive intestinal disorders, particularly IBS.
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Affiliation(s)
- María Vicario
- Digestive Diseases Research Unit, Lab Neuro-Immuno-Gastroenterology, Institut de Recerca Vall d'Hebron, CIBERehd, Department of Gastroenterology, Barcelona, Spain
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22
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Rezzi S, Martin FP, Alonso C, Guilarte M, Vicario M, Ramos L, Martínez C, Lobo B, Saperas E, Malagelada JR, Santos J, Kochhar S. Metabotyping of Biofluids Reveals Stress-Based Differences in Gut Permeability in Healthy Individuals. J Proteome Res 2009; 8:4799-809. [DOI: 10.1021/pr900525w] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Serge Rezzi
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - François-Pierre Martin
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Carmen Alonso
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Mar Guilarte
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - María Vicario
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Laura Ramos
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Cristina Martínez
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Beatriz Lobo
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Esteban Saperas
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Juan Ramón Malagelada
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Javier Santos
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Sunil Kochhar
- Bioanalytical Science Department, Metabonomics & Biomarkers Group, Nestlé Research Center, Lausanne, Switzerland, and Digestive Diseases Research Unit, Institut de Recerca, Department of Gastroenterology; Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
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Alonso C, Guilarte M, Vicario M, Ramos L, Ramadan Z, Antolín M, Martínez C, Rezzi S, Saperas E, Kochhar S, Santos J, Malagelada JR. Maladaptive intestinal epithelial responses to life stress may predispose healthy women to gut mucosal inflammation. Gastroenterology 2008; 135:163-172.e1. [PMID: 18455999 DOI: 10.1053/j.gastro.2008.03.036] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [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: 04/23/2007] [Revised: 02/24/2008] [Accepted: 03/13/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS), a highly prevalent disorder among women, has been associated with life stress, but the peripheral mechanisms involved remain largely unexplored. METHODS A 20-cm jejunal segment perfusion was performed in 2 groups of young healthy women, equilibrated by menstrual phase, experiencing either low (LS; n = 13) or moderate background stress (MS; n = 11). Intestinal effluents were collected every 15 minutes, for 30 minutes under basal conditions, and for 1 hour after cold pain stress. Cardiovascular and psychological response, changes in circulating stress and gonadal hormones, and epithelial function (net water flux, albumin output and luminal release of tryptase and alpha-defensins) to cold stress were determined. RESULTS Cold pain induced a psychological response stronger in the MS than in the LS group, but similar increases in heart rate, blood pressure, adrenocorticotrophic hormone, and cortisol, whereas estradiol and progesterone remained unaltered. Notably, the jejunal epithelium of MS females showed a chloride-related decrease in peak secretory response (Delta[15-0 minutes]: LS, 97.5 [68.4-135.0]; MS, 48.8 [36.6-65.0] microL/min/cm; P < .001) combined with a marked enhancement of albumin permeability (LS(AUC), 6.35 [0.9-9.6]; MS(AUC), 13.97 [8.3-23.1] mg/60 min; P = .008) after cold stress. Epithelial response in both groups was associated with similar increases in luminal tryptase and alpha-defensins release. CONCLUSIONS Increased exposure to life events determines a defective jejunal epithelial response to incoming stimuli. This abnormal response may represent an initial step in the development of prolonged mucosal dysfunction, a finding that could be linked to enhanced susceptibility for IBS.
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Affiliation(s)
- Carmen Alonso
- Digestive Diseases Research Unit, Institut de Reçerca, Department of Gastroenterology, Barcelona, Spain
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Abstract
Lower gastrointestinal bleeding represents one-fourth of all gastrointestinal hemorrhages. The bleeding usually originates in the colon while less than 10% of cases originate in the small bowel. Colonoscopy is considered the initial procedure of choice due to its diagnostic efficacy, safety, and therapeutic potential. Mesenteric arteriography can be an alternative in patients with massive hemorrhage. Helical computed tomography of the abdomen with endovenous contrast can be useful but has not been directly compared with arteriography. When the results of gastroscopy and colonoscopy are negative, small bowel bleeding is suspected. Capsule endoscopy allows non-invasive examination of the entire small bowel. The diagnostic efficacy of this procedure is clearly superior to that of other conventional examinations and, compared with intraoperative endoscopy, capsule endoscopy has a sensitivity of 95% and a specificity of 75%. Double balloon enteroscopy is a new modality that also allows complete examination of the small bowel with the additional advantage of its therapeutic potential. Definitive diagnosis of the hemorrhagic site is essential for appropriate treatment. Endoscopic and angiographic advances are therapeutic alternatives to surgical resection. Endoscopic treatment is indicated in lesions with active bleeding or signs of recent hemorrhage. Arterial embolization can be a therapeutic alternative when arteriography shows active hemorrhage. Surgical treatment is reserved for patients with persistent bleeding in whom other options have failed.
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Affiliation(s)
- Esteban Saperas
- Unidad de Sangrantes, Servicio Aparato Digestivo, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Junquera F, Saperas E, Videla S, Feu F, Vilaseca J, Armengol JR, Bordas JM, Piqué JM, Malagelada JR. Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia. Am J Gastroenterol 2007; 102:254-60. [PMID: 17311647 DOI: 10.1111/j.1572-0241.2007.01053.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [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] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Preliminary studies suggested that octreotide may be therapeutic in bleeding angiodysplasia. Our aim was to investigate the efficacy of long-term octreotide therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. METHODS A cohort of 32 patients diagnosed with bleeding from angiodysplasia was treated with octreotide 50 mu 12 h subcutaneously for a 1-2 yr period. This cohort was compared with an external control group (38 patients who had received placebo [1 tablet/day] in a concurrent randomized clinical trial for the same period. RESULTS Two patients of the octreotide group were lost to follow-up. Treatment failure occurred in seven of 30 (23%) patients in the octreotide group and in 17 of 35 (48%) in the placebo group (three dropouts before first visit) (P= 0.043). The actuarial probability of remaining free of rebleeding at 1 and 2 yr of follow-up was 77% and 68%, respectively, for the octreotide group and 55% and 36%, respectively, for the placebo group (log rank P= 0.030). Multivariate proportional hazards-regression analysis showed that octreotide therapy and previous bleeding episodes were positive and negative predictors of efficacy, respectively. No significant differences between the groups were observed according to number of bleeding episodes (0.4 +/- 0.7 vs 0.9 +/- 1.5, P= 0.070) and transfusion requirements (1.1 +/- 2.6 vs 0.7 +/- 1.5 units); however, iron requirements were lower in the octreotide than in the placebo group (22 +/- 62 vs 166 +/- 267 units; P < 0.001). Likewise, major adverse events (1 vs 1) and mortality (0 vs 1) were similar between groups. CONCLUSIONS This study suggests that octreotide treatment may be beneficial in preventing rebleeding from gastrointestinal angiodysplasia.
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Affiliation(s)
- Félix Junquera
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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26
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Affiliation(s)
- E Saperas
- Department of Gastroenterology, University Hospital Vall d'Hebron, Barcelona, Spain.
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27
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Guilarte M, Santos J, de Torres I, Alonso C, Vicario M, Ramos L, Martínez C, Casellas F, Saperas E, Malagelada JR. Diarrhoea-predominant IBS patients show mast cell activation and hyperplasia in the jejunum. Gut 2007; 56:203-9. [PMID: 17005763 PMCID: PMC1856785 DOI: 10.1136/gut.2006.100594] [Citation(s) in RCA: 301] [Impact Index Per Article: 17.7] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increased numbers of mast cells and mast cell activation in distal gut segments are associated with symptom onset and severity in irritable bowel syndrome (IBS). Although upper gut symptoms are common, mast cells have not been thoroughly evaluated in proximal gut in IBS patients. METHODS Jejunal biopsies obtained by Watson's capsule, aspiration of intestinal fluid and one blood sample were obtained in 20 diarrhoea-predominant patients with IBS (D-IBS) and 14 healthy volunteers (H). Psychological stress (Holmes-Rahe Scale) and depression (Beck's Depression Inventory) were evaluated at baseline and food and respiratory allergy excluded. Biopsies were processed for H&E staining and microscopic inflammation assessed by counting intraepithelial lymphocytes. Mast cells in lamina propria were counted by immunohistochemistry with CD117 (c-kit). Tryptase concentration was measured in intestinal fluid and serum. RESULTS D-IBS patients showed higher psychological stress than healthy volunteers (D-IBS: 203 (SD 114) v H: 112 (SD 99); p = 0.019). Immunohistochemical staining of jejunal mucosa revealed mild increase in intraepithelial CD3+ cells in D-IBS patients (D-IBS: 15.3 (SD 5.5; 95% CI 12.7 to 17.9) v H: 10.3 (SD 3.9; 95% CI 8.0 to 12.5); p = 0.006). Moreover, D-IBS patients showed marked increase in mast cells numbers (D-IBS: 34 (SD 9.3); H: 15.3 (SD 4.4) mast cells/hpf; p<0.001) and higher tryptase concentration in jejunal fluid (D-IBS: 0.45 (SD 0.38); H: 0.09 (SD 0.10) microg/l; p = 0.005). Upper gut symptoms were not associated with gender, mast cell counts, jejunal tryptase or basal stress. CONCLUSION This jejunal mucosal inflammatory profile may help identify diarrhoea-predominant IBS, a stress-related disorder.
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Affiliation(s)
- Mar Guilarte
- Department of Medicine, Hospital Universitari General Vall d'Hebron, 08035 Barcelona, Spain
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González A, Augustin S, Pérez M, Dot J, Saperas E, Tomasello A, Segarra A, Armengol JR, Malagelada JR, Esteban R, Guardia J, Genescà J. Hemodynamic response-guided therapy for prevention of variceal rebleeding: an uncontrolled pilot study. Hepatology 2006; 44:806-12. [PMID: 17006916 DOI: 10.1002/hep.21343] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [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] [Indexed: 12/14/2022]
Abstract
The clinical usefulness of assessing hemodynamic response to drug therapy in the prophylaxis of variceal rebleeding is unknown. An open-labeled, uncontrolled pilot trial was performed to evaluate the feasibility and efficacy of using the hemodynamic response to pharmacological treatment to guide therapy in this setting. Fifty patients with acute variceal bleeding underwent a hepatic venous pressure gradient (HVPG) measurement 5 days after the episode. Nadolol and nitrates were initiated, and a second HVPG was measured 15 days later. Responder patients (> or =20% decrease in HVPG from baseline) were maintained on drugs, partial responders (> or =10% and <20%) had banding ligation added to the drugs, and nonresponders (<10%) received a transjugular intrahepatic portal-systemic shunt (TIPS). Mean follow-up was 22 months. Eight patients (16%) did not receive the second HVPG, 6 of them because of early variceal rebleeding. Of the other 42 patients, 24 were classified as responders (57%); 10 as partial responders (24%), who had banding added; and 8 as nonresponders (19%), who received a TIPS. Patients with cirrhosis of viral etiology compared to alcoholic cirrhosis tended to present more early rebleedings, less response to drugs and needed more TIPS. Variceal rebleeding occurred in 22% of all patients but only in 12% of patients whose hemodynamic response was assessed. The 3 therapeutic groups were not different. In conclusion, using hemodynamic response to pharmacological treatment to guide therapy in secondary prophylaxis to prevent variceal bleeding is feasible and effectively protects patients from rebleeding. In this context, viral cirrhosis seems to present a worse outcome than alcoholic cirrhosis.
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Affiliation(s)
- Antonio González
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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Lanas A, Perez-Aisa MA, Feu F, Ponce J, Saperas E, Santolaria S, Rodrigo L, Balanzo J, Bajador E, Almela P, Navarro JM, Carballo F, Castro M, Quintero E. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal antiinflammatory drug use. Am J Gastroenterol 2005; 100:1685-93. [PMID: 16086703 DOI: 10.1111/j.1572-0241.2005.41833.x] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.2] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND The worst outcome of gastrointestinal complications is death. Data regarding those associated with nonsteroidal antiinflammatory drug (NSAID) or aspirin use are scarce. AIM To determine mortality associated with hospital admission due to major gastrointestinal (GI) events and NSAID/aspirin use. METHODS The study was based on actual count of deaths from two different data sets from 2001. Study 1 was carried out in 26 general hospitals serving 7,901,198 people. Study 2 used a database from 197 general hospitals, representative of the 269 hospitals in the Spanish National Health System. Information regarding gastrointestinal complications and deaths was obtained throughout the Minimum Basic Data Set (CIE-9-MC) provided by participating hospitals. Deaths attributed to NSAID/aspirin use were estimated on the basis of prospectively collected data from hospitals of study 1. RESULTS The incidence of hospital admission due to major GI events of the entire (upper and lower) gastrointestinal tract was 121.9 events/100,000 persons/year, but those related to the upper GI tract were six times more frequent. Mortality rate was 5.57% (95% CI = 4.9-6.7), and 5.62% (95% CI = 4.8-6.8) in study 1 and study 2, respectively. Death rate attributed to NSAID/aspirin use was between 21.0 and 24.8 cases/million people, respectively, or 15.3 deaths/100,000 NSAID/aspirin users. Up to one-third of all NSAID/aspirin deaths can be attributed to low-dose aspirin use. CONCLUSION Mortality rates associated with either major upper or lower GI events are similar but upper GI events were more frequent. Deaths attributed to NSAID/ASA use were high but previous reports may have provided an overestimate and one-third of them can be due to low-dose aspirin use.
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Affiliation(s)
- Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Zaragoza, Zaragoza, Spain
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Junquera F, Saperas E, Anglés A, Abadía C, Monasterio J, Malagelada JR. Increased plasma fibrinolytic activity in bleeding gastrointestinal angiodysplasia. Eur J Gastroenterol Hepatol 2005; 17:199-205. [PMID: 15674098 DOI: 10.1097/00042737-200502000-00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Gastrointestinal angiodysplasia is a major cause of recurrent bleeding. Haemostatic abnormalities have been implicated in the haemorrhage from these common vascular lesions but their precise contribution remains to be established. Our aim was to investigate whether bleeding angiodysplasia is associated with any specific coagulation disorder. METHODS Clinical features and blood samples were prospectively obtained from 21 patients with bleeding gastrointestinal angiodysplasia 3 months after the last episode of haemorrhage. Plasma levels of von Willebrand factor, D-dimer, plasminogen activator inhibitor type 1 (PAI-1), tissue-plasminogen activator activity, tissue factor pathway inhibitor and activated factor VII (FVIIa-rTF) were measured. A group of 14 patients with bleeding duodenal ulcer were similarly studied as controls. RESULTS Mean plasma von Willebrand factor levels were higher in angiodysplasia patients (208+/-12%) than in controls (143+/-11%) (P<0.05). D-dimer levels (661+/-80 ng/ml) and tissue-plasminogen activator activity levels (2.04+/-0.14 IU/ml) were also higher than in controls: 395+/-99 ng/ml and 1.6+/-0.1 IU/ml, respectively (P<0.05), whereas levels of PAI-1, FVIIa-rTF and tissue factor pathway inhibitor were similar in both groups. However, PAI-1 levels (31.5+/-11 ng/ml) were lower in high-bleeding-rate angiodysplasia (more than two bleeding episodes/year) than in low-bleeding-rate angiodysplasia (< or = 2 bleeding episodes/year) (PAI-1 47+/-14 ng/ml) (P<0.05). In a multivariate regression analysis, the plasma level of PAI-1 was a predictor of haemorrhage from angiodysplasia (P<0.05). CONCLUSIONS Increased plasma fibrinolytic activity may contribute to bleeding from angiodysplasia. Low plasma PAI-1 levels constitute a risk factor for bleeding tendency in patients with angiodysplasia.
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Affiliation(s)
- Félix Junquera
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, P Vall d'Hebron, Barcelona, Spain
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Alvarez-Uría G, Pallero M, de Torres I, Majó J, Ordi J, Saperas E. [Massive hemorrhage due to nodular hyperplasia of Brunner's glands in antiphospholipid syndrome]. Gastroenterol Hepatol 2003; 26:635-8. [PMID: 14670237 DOI: 10.1016/s0210-5705(03)70423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Gastrointestinal hemorrhage is an exceptional complication of antiphospholipid syndrome and most reported cases are secondary to ischemic lesions. Brunner's gland hyperplasia is an infrequent and usually asymptomatic condition that has been associated with chronic renal failure. We report a patient with primary antiphospholipid syndrome who, after mechanic heart valve replacement and while in a state of drug-induced anticoagulation, experienced a life-threatening upper gastrointestinal hemorrhage due to nodular hyperplasia of Brunner's glands. This entity may be considered in the differential diagnosis of upper gastrointestinal bleeding in patients with antiphospholipid syndrome, most of whom are treated with oral anticoagulatory drugs, and particularly in patients with chronic renal failure.
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Affiliation(s)
- G Alvarez-Uría
- Servicio de Aparato Digestivo. Hospital General Universitario Vall d'Hebron. Barcelona. Spain
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32
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Saperas E. [What do we really know about colonic angiodysplasia?]. Med Clin (Barc) 2003; 121:137-8. [PMID: 12867018 DOI: 10.1016/s0025-7753(03)73882-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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33
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Feu F, Brullet E, Calvet X, Fernández-Llamazares J, Guardiola J, Moreno P, Panadès A, Saló J, Saperas E, Villanueva C, Planas R. [Guidelines for the diagnosis and treatment of acute non-variceal upper gastrointestinal bleeding]. Gastroenterol Hepatol 2003; 26:70-85. [PMID: 12570891 DOI: 10.1016/s0210-5705(03)79046-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- F Feu
- Societat Catalana de Digestologia. Barcelona. España.
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34
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Kresse AE, Million M, Saperas E, Taché Y. Colitis induces CRF expression in hypothalamic magnocellular neurons and blunts CRF gene response to stress in rats. Am J Physiol Gastrointest Liver Physiol 2001; 281:G1203-13. [PMID: 11668029 DOI: 10.1152/ajpgi.2001.281.5.g1203] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We investigated hypothalamic neuronal corticotropin-releasing factor (CRF) gene expression changes in response to visceral inflammation induced by 2,4,6-trinitrobenzenesulfonic acid (TNB) and acute stress. Seven days after TNB, rats were subjected to water-avoidance stress (WAS) or restraint for 30 min and euthanized. Hypothalamic CRF primary transcripts (heteronuclear RNA, hnRNA) and CRF and arginine vasopressin (AVP) mRNAs were assessed by in situ hybridization. Antisense (35)S-labeled cRNA probes against CRF mRNA intronic and exonic sequences and an oligonucleotide probe against the AVP mRNA were used. TNB induced macroscopic lesions and a fivefold elevation in myeloperoxidase activity in the colon. Colitis increased CRF hnRNA and mRNA signals in the magnocellular part of the paraventricular nucleus of the hypothalamus (PVN) and supraoptic neurons, whereas AVP mRNA was not altered. Colitis did not modify CRF hnRNA signal in the parvocellular part of the PVN (pPVN), plasma corticosterone, and serum osmolarity levels. However, CRF hnRNA expression in the pPVN and the rise in corticosterone and defecation induced by WAS or restraint were blunted in colitic rats. These data show that colitis upregulates CRF gene synthesis in magnocellular hypothalamic neurons but dampens CRF gene transcription in the pPVN and plasma corticosterone responses to environmental acute stressors.
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Affiliation(s)
- A E Kresse
- CURE: Digestive Diseases Research Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA
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35
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Junquera F, Feu F, Papo M, Videla S, Armengol JR, Bordas JM, Saperas E, Piqué JM, Malagelada JR. A multicenter, randomized, clinical trial of hormonal therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. Gastroenterology 2001; 121:1073-9. [PMID: 11677198 DOI: 10.1053/gast.2001.28650] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.6] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS The efficacy of hormonal therapy for recurrent bleeding from gastrointestinal angiodysplasia remains uncertain. We investigated the efficacy of long-term estrogen-progestagen therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. METHODS Seventy-two noncirrhotic patients bleeding from gastrointestinal angiodysplasia confirmed by endoscopy or angiography were randomized to receive in double-blind conditions treatment with ethinylestradiol (0.01 mg) plus norethisterone (2 mg) (1 tablet/d), or placebo (1 tablet/d) for a minimum period of 1 year (range: 1-2 years). RESULTS Four patients could not be assessed because they did not attend the first follow-up visit. Failure of treatment occurred in 13 of 33 (39%) patients in the treatment group and in 16 of 35 (46%) patients in the placebo group (P = NS). No significant differences between groups were found according to number of bleeding episodes (0.7 +/- 1.0 vs. 0.9 +/- 1.5) and transfusional requirements (0.9 +/- 1.9 vs. 0.7 +/- 1.5 units). Treatment received was not an independent predictor for rebleeding prevention in the multivariate regression analysis. Severe adverse events (2 vs. 1) and mortality (0 vs. 1 patient, respectively) were similar between the treatment and placebo groups. CONCLUSIONS Continuous estrogen-progestagen treatment is not useful in the prevention of rebleeding from gastrointestinal angiodysplasia.
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Affiliation(s)
- F Junquera
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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36
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Junquera F, Quiroga S, Saperas E, Pérez-Lafuente M, Videla S, Alvarez-Castells A, Miró JR, Malagelada JR. Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology 2000; 119:293-9. [PMID: 10930363 DOI: 10.1053/gast.2000.9346] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS The diagnosis of colonic angiodysplasia is often challenging and relies on endoscopy or catheter angiography. We investigated whether computed tomographic angiography (CTA) contributes to the diagnosis of colonic angiodysplasia. METHODS Twenty-eight patients with suspected bleeding from colonic angiodysplasia were prospectively evaluated. Gastrointestinal bleeding was investigated by colonoscopy plus visceral angiography and by CTA. The level of agreement between CTA and the former procedures was determined. RESULTS CTA images of diagnostic quality were obtained in 26 patients. Eighteen patients were diagnosed with colonic angiodysplasia by colonoscopy plus visceral angiography, and 14 by CTA (kappa = 0.68; P < 0.001). Sensitivity, specificity, and positive predictive values of CTA for detection of colonic angiodysplasia were 70%, 100%, and 100%, respectively. CTA signs including accumulation of vessels in the colonic wall, early filling vein, and supplying enlarged artery were present in 55%, 50%, and 22% of cases, respectively. None of these signs were present in the 8 patients with obscure gastrointestinal bleeding and negative diagnostic investigation of the digestive tract. CONCLUSIONS CTA is a sensitive, specific, well-tolerated, and minimally invasive tool for the diagnosis of colonic angiodysplasia.
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Affiliation(s)
- F Junquera
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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37
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Vergara M, Casellas F, Saperas E, de Torres I, Lopez J, Borruel N, Armengol JR, Malagelada JR. Helicobacter pylori eradication prevents recurrence from peptic ulcer haemorrhage. Eur J Gastroenterol Hepatol 2000; 12:733-7. [PMID: 10929898 DOI: 10.1097/00042737-200012070-00003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [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] [Indexed: 12/10/2022]
Abstract
BACKGROUND Successful eradication of Helicobacter pylori infection clearly modifies the natural history of peptic ulcer disease and prevents further recurrences of duodenal and gastric ulcers. However, there are few prospective studies about actual rates of rebleeding after H. pylori eradication, a highly relevant aspect of management as re-infection, relapse of ulcer disease for other reasons (i.e. anti-inflammatory agents) or idiopathic ulcers unrelated to H. pylori may develop and cause further bleeding episodes. OBJECTIVE To determine the incidence of bleeding episodes after eradication of H. pylori infection in patients who had bled from an H. pylori-positive peptic ulcer. PARTICIPANTS AND INTERVENTIONS H. pylori-positive patients who bled from a gastric or duodenal ulcer were treated with appropriate triple and/or quadruple therapy. H. pylori eradication was confirmed by urea breath test 4 weeks after treatment. Patients received no further treatment but were followed clinically and additional urea breath tests were performed every 6 months. Endoscopy with antral and corpus biopsies and urea breath test were repeated as soon as patients manifested any dyspeptic symptoms that might signal recurrence. RESULTS A total of 103 patients with bleeding duodenal ulcer were included in the study; H. pylori was successfully eradicated in 93 of these patients, who were followed for a median interval of 27 months. The yearly re-infection rate was calculated to be 0.6%. There were no instances of rebleeding in any patients during the follow-up period. CONCLUSIONS Even after prolonged follow-up, successful H. pylori eradication prevents rebleeding.
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Affiliation(s)
- M Vergara
- Digestive System Research Unit, Hospitals Vall d'Hebron, Barcelona, Spain
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38
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Junquera F, López-Talavera JC, Mearin F, Saperas E, Videla S, Armengol JR, Esteban R, Malagelada JR. Somatostatin plus isosorbide 5-mononitrate versus somatostatin in the control of acute gastro-oesophageal variceal bleeding: a double blind, randomised, placebo controlled clinical trial. Gut 2000; 46:127-32. [PMID: 10601068 PMCID: PMC1727780 DOI: 10.1136/gut.46.1.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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] [Indexed: 12/08/2022]
Abstract
BACKGROUND Variceal bleeding is a severe complication of portal hypertension. Somatostatin reduces portal pressure by decreasing splanchnic blood flow, and nitrates by diminishing intrahepatic resistance. Experimental studies have shown that the combination of somatostatin and nitrates has an additive effect in decreasing portal pressure. AIM To compare the therapeutic efficacy of either intravenous infusion of somatostatin plus oral isosorbide 5-mononitrate or somatostatin alone in gastro-oesophageal variceal bleeding associated with liver cirrhosis. METHODS A unicentre, double blind, placebo controlled, clinical trial was conducted. Sixty patients bleeding from oesophageal or gastric varices were randomised to receive intravenous infusion of somatostatin (250 microg/hour) plus oral isosorbide 5-mononitrate (40 mg/12 hours) (group I) or somatostatin infusion plus placebo (group II) for 72 hours. RESULTS The two groups of patients had similar clinical, endoscopic, and haematological characteristics. Control of bleeding was achieved in 18 out of 30 patients (60%) in group I and 26 out of 30 patients (87%) in group II (p<0.05). There was no significant difference in mean transfusion requirements between the two groups: 2.6 (2.2) v 1.8 (1.6) respectively; means (SD). Mortality and side effects were similar in the two groups, but development of ascites was higher in group I (30%) than in group II (7%) (p<0.05). CONCLUSION In cirrhotic patients with acute gastro-oesophageal variceal bleeding, addition of isosorbide 5-mononitrate to somatostatin does not improve therapeutic efficacy, induces more adverse effects, and should not be used.
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Affiliation(s)
- F Junquera
- Digestive System Research Unit, Hospital General Universitari Vall d'Hebron, Autonomous University of Barcelona, Spain
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39
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Santos J, Bayarri C, Saperas E, Nogueiras C, Antolín M, Mourelle M, Cadahia A, Malagelada JR. Characterisation of immune mediator release during the immediate response to segmental mucosal challenge in the jejunum of patients with food allergy. Gut 1999; 45:553-8. [PMID: 10486364 PMCID: PMC1727679 DOI: 10.1136/gut.45.4.553] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Food allergy is a common complaint among patients with a broad spectrum of abdominal and extra-abdominal symptoms that must be distinguished from other more common non-immunological food intolerances. AIMS To investigate whether human intestinal hypersensitivity reactions are associated with detectable release of inflammatory mediators from activated cells, which may serve as a biological marker of true allergic reactions. PATIENTS/METHODS In eight patients with food allergy and seven healthy volunteers, a closed-segment perfusion technique was used to investigate the effects of jejunal food challenge on luminal release of tryptase, histamine, prostaglandin D(2), eosinophil cationic protein, peroxidase activity, and water flux. RESULTS Intraluminal administration of food antigens induced a rapid increase in intestinal release of tryptase, histamine, prostaglandin D(2), and peroxidase activity (p<0.05 v basal period) but not eosinophil cationic protein. The increased release of these mediators was associated with a notable water secretory response. CONCLUSIONS These results suggest that human intestinal hypersensitivity reactions are characterised by prompt activation of mast cells and other immune cells, with notable and immediate secretion of water and inflammatory mediators into the intestinal lumen. Analysis of the profile of markers released into the jejunum after food provocation may be useful for the objective diagnosis of food allergy.
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Affiliation(s)
- J Santos
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain
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40
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Casadevall M, Saperas E, Panés J, Salas A, Anderson DC, Malagelada JR, Piqué JM. Mechanisms underlying the anti-inflammatory actions of central corticotropin-releasing factor. Am J Physiol 1999; 276:G1016-26. [PMID: 10198346 DOI: 10.1152/ajpgi.1999.276.4.g1016] [Citation(s) in RCA: 6] [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: 12/23/2022]
Abstract
Immune activation of hypothalamic corticotropin-releasing factor (CRF) provides a negative feedback mechanism to modulate peripheral inflammatory responses. We investigated whether central CRF attenuates endothelial expression of intercellular adhesion molecule 1 (ICAM-1) and leukocyte recruitment during endotoxemia in rats and determined its mechanisms of action. As measured by intravital microscopy, lipopolysaccharide (LPS) induced a dose-dependent increase in leukocyte rolling, adhesion, and emigration in mesenteric venules, which was associated with upregulation of endothelial ICAM-1 expression. Intracisternal injection of CRF abrogated both the increased expression of ICAM-1 and leukocyte recruitment. Intravenous injection of the specific CRF receptor antagonist astressin did not modify leukocyte-endothelial cell interactions induced by a high dose of LPS but enhanced leukocyte adhesion induced by a low dose. Blockade of endogenous glucocorticoids but not alpha-melanocyte-stimulating hormone (alpha-MSH) receptors reversed the inhibitory action of CRF on leukocyte-endothelial cell interactions during endotoxemia. In conclusion, cerebral CRF blunts endothelial upregulation of ICAM-1 and attenuates the recruitment of leukocytes during endotoxemia. The anti-inflammatory effects of CRF are mediated by adrenocortical activation and additional mechanisms independent of alpha-MSH.
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Affiliation(s)
- M Casadevall
- Gastroenterology Department, Institut Clínic de Malalties Digestives, Hospital Clínic, University of Barcelona, 08035 Barcelona, Spain
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Abstract
OBJECTIVE Angiodysplasia of the colon is a distinct vascular abnormality characterized by focal accumulation of ectatic vessels in the mucosa and submucosa. To investigate whether angiogenesis contributes to the pathogenesis of human colonic angiodysplasia, we examined the expression of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF), and its endothelial cell receptors flt-1 and KDR. METHODS Immunohistochemistry was performed in sections of specimens obtained from 18 patients with colonic angiodysplasia and from eight patients with colon cancer and its adjacent, histologically normal margins of resection. We used affinity-purified rabbit polyclonal antibodies and a streptoavidin-biotin peroxidase method. RESULTS We detected strong immunoreactivity for vascular endothelial growth factor, homogeneously distributed in the endothelial lining of blood vessels of all sizes in 16 (89%) specimens of colonic angiodysplasia and in seven (88%) patients with colon cancer. In contrast, very limited immunoreactivity was found in normal colon. Vascular staining for flt-1 was observed in eight (44%) and one (12.5%) of the colonic angiodysplasia or colon cancer specimens, respectively, but not in normal colon. Vascular immunoreactivity for basic fibroblast growth factor was observed in seven (39%) specimens from patients with colonic angiodysplasia, whereas either very limited or no immunostaining was found in sections from specimens of patients with colon cancer and its normal margins. CONCLUSIONS In human colonic angiodysplasia, increased expression of angiogenic factors is likely to play a pathogenic role.
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Affiliation(s)
- F Junquera
- Pathology Department, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain
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42
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Casellas F, Lopez J, Borruel N, Saperas E, Vergara M, de Torres I, Armengol JR, Malagelada JR. The impact of delaying gastric emptying by either meal substrate or drug on the [13C]-urea breath test. Am J Gastroenterol 1999; 94:369-73. [PMID: 10022631 DOI: 10.1111/j.1572-0241.1999.860_i.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Optimal [13C]-urea breath test (UBT) conditions for diagnosis of Helicobacter pylori infection are still being fine-tuned. In the present study we investigated the impact of delaying gastric emptying by different meal substrates or L-DOPA, a drug known to induce gastric stasis, on the performance of the [13C]-UBT. METHODS A total of 115 patients participated in the study. On two consecutive days, participants ingested [13C]-urea (100 mg) 10 min after either 270 ml of a mixed formula meal (1 Kcal/ml) or an equivalent amount of tap water. In 11 participants two additional tests were performed with or without oral 500 mg L-DOPA given 30 min before [13C]-urea load. The 13C/12C ratio in a basal breath sample was compared with ratios in samples collected 30 and 60 min after [13C]-urea. Histological assessment of H. pylori presence in antral biopsy served as reference standard. RESULTS Formula UBT showed excellent specificity (100% at 30 and 60 min) and good sensitivity (97% at both time intervals), whereas water UBT had the same specificity but slightly lower sensitivity (94% at 30 min and 73% at 60 min). In formula UBT, 13C/12C ratios were higher at 60 min than at 30 min (21.7+/-2 vs 17.7+/-1.8 per thousand respectively, p < 0.01, whereas in water UBT 13C/12C ratios were higher at 30 min than at 60 min (13.9+/-1.5 vs 8.4+/-0.09 per thousand respectively, p < 0.01). Pretreatment with L-DOPA did not modify either the sensitivity or the specificity of the UBT. CONCLUSIONS The performance of the [13C]-urea with a formula meal may not be improved by pharmacologically delaying gastric emptying. A short, water-based test may be a sensible approach to worldwide standardization of the [13C]-UBT for H. pylori infection.
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Affiliation(s)
- F Casellas
- Centre d'Investigacions en Bioquímica i Biologia Molecular, and Department of Pathology, Hospital General Vall d'Hebron, Barcelona, Spain
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Martínez-Sánchez G, Saperas E, Benavent J, Mearin F, Piñol JL, Barenys M, Mascort JJ, Forné M, Bordas JM, Azagra R, Piqué JM. [The attitude of primary health care physicians in the metropolitan area of Barcelona about the diagnosis and treatment of Helicobacter pylori infection in gastroduodenal diseases]. Gastroenterol Hepatol 1998; 21:473-8. [PMID: 9927791] [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: 02/10/2023]
Abstract
AIM To evaluate the attitude of primary health care physicians versus the diagnosis and treatment of infection by Helicobacter pylori in patients with dyspepsia and gastroduodenal ulcer. DESIGN An observational, transversal study was performed by a self administered questionnaire from June to October, 1997. PARTICIPANTS Primary health care physicians from 38 reformed Medical Centers in the metropolitan area of Barcelona were included in the study. RESULTS Of the 359 doctors to whom the questionnaire was sent, 283 responded (78.8%). In a patient with dyspepsia 95.4% would first request endoscopy. If they knew of the presence of infection by Helicobacter pylori 96.1% would administer eradication treatment in patients with gastric and duodenal ulcer and 15% would also do so if the endoscopy were normal. If the presence of infection by Helicobacter pylori were unknown in a patient with gastroduodenal ulcer, 65.3% would treat with anti-H2 or proton pump inhibitors associated with a diagnostic test of infection by Helicobacter pylori. If the physician decided to carry out eradication treatment of Helicobacter pylori infection, 98.6% would use one of the regimes recommended by different scientific societies. If confirmation of eradication of Helicobacter pylori infection were requested, 89% would do so one and three months after completion of treatment. In patients with gastric ulcer, 69.3% would request endoscopy on completion of treatment. The percentage of physicians specialized in Family and Community Medicine who would carry out eradication treatment in patients with duodenal ulcer and Helicobacter pylori infection and who would request endoscopies in patients with dyspepsia was found to be statistically significant in comparison with physicians without this specialty. CONCLUSIONS The attitude of primary care physicians in the metropolitan area of Barcelona with regard to the diagnosis and treatment of infection by Helicobacter pylori in gastroduodenal diseases largely reflects the recommendations recently made by several scientific societies. In general there are no significant differences with respect to this attitude in regard to the age and sex of the physician, although their training was found to influence in some of the responses analyzed.
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Affiliation(s)
- G Martínez-Sánchez
- Grupo de Estudio de la Dispepsia y las Enfermedades Relacionadas con la Infección por Helicobacter pylori, Sociedad Catalana de Digestología, Barcelona
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Vergara M, Herrero J, de Torres I, Armengol JR, Saperas E, Malagelada JR. [Gastric ulcers as the only manifestation of infection by cytomegalovirus in immunocompetent patients]. Gastroenterol Hepatol 1998; 21:332-4. [PMID: 9808896] [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: 02/09/2023]
Abstract
Gastritis is an infrequent manifestation of infection by cytomegalovirus (CMV) in a healthy host. This complication is usually associated to a mononucleosic syndrome during the course of a disseminated infection. Macroscopically, it presents with edema and mucosal congestion, multiple erosions or ulcers. Histologic examination of the endoscopic biopsies allows the etiologic diagnosis to be established in most cases. In immunocompetent patients the clinical course of gastritis by CMV is usually self-limited. We herein present two immunocompetent patients with gastric ulcerous disease as the only manifestation of CMV infection. Both patients required antiviral treatment due to refractoryness to the antisecretor treatment and one case evolved to pyloric stenosis requiring surgery.
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Affiliation(s)
- M Vergara
- Servicio de Aparato Digestivo, Hospital General Universitari Vall d'Hebron, Barcelona
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Abstract
BACKGROUND & AIMS The central nervous system regulates gut functions via complex interactions between the enteric nervous and immune systems. The aim of this study was to investigate whether mast cell mediators are released into the human jejunal lumen during stress. METHODS A closed-segment perfusion technique was used to investigate jejunal release of tryptase, histamine, prostaglandin D2, and water flux in response to the cold pressor test in 8 healthy subjects and 9 patients with food allergy. In 6 food-allergic patients, jejunal biochemical responses to cold pain stress were compared with those induced by food intraluminal challenge. RESULTS Cold pain stress elevated heart rate and blood pressure and increased luminal release of mast cell mediators and jejunal water secretion in both groups. Stress-induced release of tryptase and histamine, but not of prostaglandin D2 and water flux, was greater in food-allergic patients than in healthy volunteers. In food-allergic patients, jejunal biochemical responses induced by cold pain stress were similar to those induced by antigen challenge. CONCLUSIONS These results show the ability of the central nervous system to modulate intestinal mast cell activity and suggest that mast cells have a role in stress-related gut dysfunction.
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Affiliation(s)
- J Santos
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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Santos J, Saperas E, Mourelle M, Antolín M, Malagelada JR. Regulation of intestinal mast cells and luminal protein release by cerebral thyrotropin-releasing hormone in rats. Gastroenterology 1996; 111:1465-73. [PMID: 8942724 DOI: 10.1016/s0016-5085(96)70007-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND & AIMS Intestinal mast cell activity is modulated by the central nervous system, but the mechanisms are not well established. The aim of this study was to investigate whether cerebral thyrotropin-releasing hormone (TRH) activates intestinal mast cells and to elucidate the mechanisms involved, specifically, the contribution of mast cells to vagally stimulated luminal protein release. METHODS In anesthetized rats, mast cell activation was assessed by measuring the release of the specific mucosal rat mast cell protease II (RMCP II) and prostaglandin (PG) D2 into the intestinal lumen. Luminal protein release was measured as an index of epithelial permeability to macromolecules. RESULTS Intracisternal injection of the TRH analogue RX 77368 (30 ng) induced a transient increase in intestinal release of RMCP II and PGD2 that was abolished by dox-antrazole. RX 77368-stimulated RMCP II release was also abolished by vagotomy and reduced by atropine by 65%. However, both systemic capsaicin and indo-methacin enhanced RMCP II release. RX 77368-stimulated luminal protein release was abolished by vagotomy and reduced by doxantrazole. CONCLUSIONS Central vagal activation by TRH stimulates intestinal mast cell secretion, in part via peripheral muscarinic receptors, and is modulated by PGs and capsaicin-sensitive afferent innervation. Intestinal mast cell activation contributes to the TRH analogue-stimulated luminal protein release.
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Affiliation(s)
- J Santos
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain
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Saperas E, Mourelle M, Santos J, Moncada S, Malagelada JR. Central vagal activation by an analogue of TRH stimulates gastric nitric oxide release in rats. Am J Physiol 1995; 268:G895-9. [PMID: 7541945 DOI: 10.1152/ajpgi.1995.268.6.g895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the stomach nitric oxide (NO) appears to be involved in vagally induced cholinergic vasodilation and nonadrenergic, noncholinergic relaxation of the fundus. We investigated whether central vagal activation by intracisternal injection of a thyrotropin-releasing hormone (TRH) analogue stimulates gastric NO release in anesthetized rats. To quantitate gastric NO production, the luminal release of NO breakdown products, nitrite (NO2-) and nitrate (NO3-), were measured by the Griess method. Intracisternal injection of RX-77368 (30-300 ng) dose dependently stimulated gastric NO2- and NO3- release (P < 0.05) along with a significant acid secretory response (P < 0.05). The specific inhibitor of NO synthesis, NG-nitro-L-arginine methyl ester (10 mg/kg ip), completely blocked gastric luminal NO2- and NO3- release without affecting the acid secretory response to the highest dose of RX-77368. Either bilateral cervical vagotomy, hexamethonium (15 mg/kg ip), or atropine (1 mg/kg ip) abolished both gastric luminal release of NO-derived metabolites and the acid secretory responses to RX-77368. These results indicate that intracisternal injection of RX-77368 stimulates gastric release of NO through vagal nicotinic pathways and peripheral activation of muscarinic receptors. These findings provide evidence for central nervous system regulation of NO-mediated functions in the rat stomach through TRH-sensitive vagal pathways.
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Affiliation(s)
- E Saperas
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain
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Saperas E, Fernández PL. [A man of 83 with generalized bone pains and a biological malabsorption syndrome]. Med Clin (Barc) 1995; 104:387-95. [PMID: 7707734] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- E Saperas
- Servicio de Aparato Digestivo, Hospital General Universitari Vall d'Hebron, Barcelona
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Junquera F, Santos J, Saperas E, Armengol JR, Malagelada JR. [Estrogen and progestagen treatment in digestive hemorrhage caused by vascular malformations]. Gastroenterol Hepatol 1995; 18:61-5. [PMID: 7621276] [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: 01/26/2023]
Abstract
The efficacy of an association of estrogens and progestagens in the treatment of gastrointestinal bleeding by angiodysplasia was analyzed. Thirty-three patients with gastrointestinal bleeding due to vascular malformations were admitted from January 1986 to December 1993. Fifteen of the 33 patients were submitted to surgical or endoscopic treatment. The remaining 18 patients underwent daily oral treatment with a combination of estrogens-progestagens containing 2.5 mg of lynestrenol and 0.075 mg of mestranol. One patient presented a venous thrombosis leading to suppression of treatment at one month of initiation. The 17 remaining patients were treated for a mean of 22 +/- 4 months (range: 3-60). During treatment 13 of the 17 patients (76%) did not present evidence of hemorrhage. Likewise, the number of hemorrhagic episodes per year decreased from 4.4 +/- 1.2 prior to treatment to 0.7 +/- 0.5 during treatment (p < 0.05) with transfusional requirements decreasing from 7.9 +/- 2.8 erythrocyte concentrates per year prior to treatment to 1.2 +/- 1.0 during treatment (p < 0.05). In conclusion, the combined treatment with estrogens and progestagens prevents recurrence of gastrointestinal bleeding by angiodysplasia.
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Affiliation(s)
- F Junquera
- Servicio de Aparato Digestivo, Hospital General Universitari Vall d'Hebron, Barcelona
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