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Casas Deza D, Polo Cuadro C, de Francisco R, Vela González M, Bermejo F, Blanco I, de la Serna Á, Bujanda L, Bernal L, Rueda García JL, Gargallo-Puyuelo CJ, Fuentes-Valenzuela E, Castro B, Guardiola J, Ladrón G, Suria C, Sáez Fuster J, Gisbert JP, Sicilia B, Gomez R, Muñoz Vilafranca C, Barreiro-De Acosta M, Peña E, Castillo Pradillo M, Cerrillo E, Calvet X, Manceñido N, Monfort I Miquel D, Marín S, Roig C, Marce A, Ramírez de Piscina P, Betoré E, Martin-Cardona A, Teller M, Alonso Abreu I, Maroto N, Frago S, Gardeazabal D, Pérez-Martínez I, Febles González ÁD, Barrero S, Taxonera C, García de la Filia I, Ezkurra-Altuna A, Madero L, Martín-Arranz MD, Gomollón F, Domènech E, García-López S. Initial Management of Intra-abdominal Abscesses and Preventive Strategies for Abscess Recurrence in Penetrating Crohn's Disease: A National, Multicentre Study Based on ENEIDA Registry. J Crohns Colitis 2024; 18:578-588. [PMID: 37930823 DOI: 10.1093/ecco-jcc/jjad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Intra-abdominal abscesses complicating Crohn's disease [CD] are a challenging situation. Their management, during hospitalisation and after resolution, is still unclear. METHODS Adult patients with CD complicated with intra-abdominal abscess. who required hospitalisation, were included from the prospectively maintained ENEIDA registry from GETECCU. Initial strategy effectiveness and safety to resolve abscess was assessed. Survival analysis was performed to evaluate recurrence risk. Predictive factors associated with resolution were evaluated by multivariate regression and predictive factors associated with recurrence were assessed by Cox regression. RESULTS In all, 520 patients from 37 Spanish hospitals were included; 322 [63%] were initially treated with antibiotics alone, 128 [26%] with percutaneous drainage, and 54 [17%] with surgical drainage. The size of the abscess was critical to the effectiveness of each treatment. In abscesses < 30 mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50 mm, surgery was superior to percutaneous drainage, although it was associated with a higher complication rate. After abscess resolution, luminal resection was associated with a lower 1-year abscess recurrence risk [HR 0.43, 95% CI 0.24-0.76]. However, those patients who initiated anti-TNF therapy had a similar recurrence risk whether luminal resection had been performed. CONCLUSIONS Small abscesses [<30mm] can be managed with antibiotics alone; larger ones require drainage. Percutaneous drainage will be effective and safer than surgery in many cases. After discharge, anti-TNF therapy reduces abscess recurrence risk in a similar way to bowel resection.
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Affiliation(s)
- Diego Casas Deza
- Gastroenterology Department, University Hospital Miguel Servet, Zaragoza, Spain
- Institute for Health Research Aragón [IIS Aragón], Zaragoza, Spain
| | | | - Ruth de Francisco
- Gastroenterology Department, University Hospital Central de Asturias, and Instituto de Investigación Sanitaria del Principado de Asturias [ISPA], Oviedo, Spain
| | - Milagros Vela González
- Gastroenterology Department, University Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Fernando Bermejo
- Gastroenterology Department, University Hospital of Fuenlabrada, Fuenlabrada, Spain
| | - Ignacio Blanco
- Gastroenterology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | - Álvaro de la Serna
- Gastroenterology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Luis Bujanda
- Gastroenterology Department, University Hospital of Donostia, San Sebastian, Spain; Instituto Biodonostia, Universidad del País Vasco [UPV/EHU], CIBERehd, Spain
| | - Lorena Bernal
- Gastroenterology Department, Hospital General de Alicante, Alicante, Spain
| | - José Luis Rueda García
- Gastroenterology Department, La Paz University Hospital. School of Medicine; Universidad Autónoma de Madrid. Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - Carla J Gargallo-Puyuelo
- Gastroenterology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Spain
- Institute for Health Research Aragón [IIS Aragón], Zaragoza, Spain
| | | | - Beatriz Castro
- Gastroenteroly Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Jordi Guardiola
- Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Gemma Ladrón
- Gastroenterology Department, University Hospital General de Castelló, Castellón, Spain
| | - Carles Suria
- Gastroenterology Department, University Hospital Clínico de Valencia, Valencia, Spain
| | - Julia Sáez Fuster
- Gastroenterology Department, University Hospital General de Elche, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-Princesa], Universidad Autónoma de Madrid [UAM], Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Spain
| | - Beatriz Sicilia
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Raquel Gomez
- Gastroenterology Department, University Hospital Fundación de Alcorcón, Alcorcón, Spain
| | | | | | - Elena Peña
- Gastroenterology Department, Hospital Royo Villanova, Zaragoza, Spain
| | | | - Elena Cerrillo
- Gastroenterology Department, University Hospital La Fe, Valencia, Spain
| | - Xavier Calvet
- Gastroenterology Department, University Hospital Parc Taulí, Sabadel, Spain and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Spain
| | - Noemí Manceñido
- Gastroenterology Department, University Hospital Infanta Sofía, San Sebastián de los Reyes, Spain
| | | | - Sandra Marín
- Gastroenterology Department, University Hospital Reina Sofía, Córdoba, Spain
| | - Cristina Roig
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ainhoa Marce
- Gastroenterology Department, Hospital Moisès Broggi, Sant Joan Despí, Spain
| | | | - Elena Betoré
- Gastroenterology Department, Hospital Universitario San Jorge, Huesca, Spain
| | - Albert Martin-Cardona
- Gastroenterology Department, Hospital Universitari Mútua Terrassa, Spain
- University of Barcelona, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Spain
| | - Marta Teller
- Gastroenterology Department, Althaia Xarxa Assistencial Universitaria de Manresa, Manresa, Spain
| | | | - Nuria Maroto
- Gastroenterology Department, Hospital de Manises, Manises, Spain
| | - Santiago Frago
- Gastroenterology Department, Hospital Santa Bárbara, Soria, España
| | | | - Isabel Pérez-Martínez
- Gastroenterology Department, University Hospital Central de Asturias, and Instituto de Investigación Sanitaria del Principado de Asturias [ISPA], Oviedo, Spain
| | - Ángel David Febles González
- Gastroenterology Department, University Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Sara Barrero
- Gastroenterology Department, University Hospital of Fuenlabrada, Fuenlabrada, Spain
| | - Carlos Taxonera
- Gastroenterology Department, University Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ander Ezkurra-Altuna
- Gastroenterology Department, University Hospital of Donostia, San Sebastian, Spain; Instituto Biodonostia, Universidad del País Vasco [UPV/EHU], CIBERehd, Spain
| | - Lucía Madero
- Gastroenterology Department, Hospital General de Alicante, Alicante, Spain
| | - María Dolores Martín-Arranz
- Gastroenterology Department, La Paz University Hospital. School of Medicine; Universidad Autónoma de Madrid. Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - Fernando Gomollón
- Gastroenterology Department, University Hospital Lozano Blesa, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Spain
- Institute for Health Research Aragón [IIS Aragón], Zaragoza, Spain
| | - Eugeni Domènech
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Spain
- Universitat Autònoma de Barcelona, Spain
| | - Santiago García-López
- Gastroenterology Department, University Hospital Miguel Servet, Zaragoza, Spain
- Institute for Health Research Aragón [IIS Aragón], Zaragoza, Spain
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Guerra I, Barros F, Chaparro M, Benítez JM, Martín-Arranz MD, de Francisco R, Piqueras M, de Castro L, Carbajo AY, Bermejo F, Mínguez M, Gutiérrez A, Mesonero F, Cañete F, González-Muñoza C, Calvo M, Sicilia B, Alfambra E, Rivero M, Lucendo AJ, Tardillo CA, Almela P, Bujanda L, van Domselaar M, Ramos L, Fernández Sánchez M, Hinojosa E, Verdejo C, Gimenez A, Rodríguez-Lago I, Manceñido N, Pérez Calle JL, Moreno MDP, Delgado-Guillena PG, Antolín B, Ramírez de la Piscina P, Casanova MJ, Soto Escribano P, Martín Arranz E, Pérez-Martínez I, Mena R, García Morales N, Granja A, Boscá Watts MM, Francés R, Fernández C, Calafat M, Roig-Ramos C, Vera MI, Carracedo Á, Domènech E, Gisbert JP. Evaluation of genetic variants associated with the risk of thiopurine-related pancreatitis: a case control study from ENEIDA registry. Dig Dis 2024:000537782. [PMID: 38452742 DOI: 10.1159/000537782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Risk factors for developing pancreatitis due to thiopurines in patients with inflammatory bowel disease (IBD) are not clearly identified. AIM Our aim was to evaluate the predictive pharmacogenetic risk of pancreatitis in IBD patients treated with thiopurines. METHODS We conducted an observational pharmacogenetic study of acute pancreatitis events in a cohort study of IBD patients treated with thiopurines from the prospectively maintained ENEIDA registry biobank of GETECCU. Samples were obtained and the CASR, CEL, CFTR, CDLN2, CTRC, SPINK1, CPA1, and PRSS1 genes, selected based on their known association with pancreatitis, were fully sequenced. RESULTS Ninety-five cases and 105 controls were enrolled, 57% were women. Median age at pancreatitis diagnosis was 39 years. We identified 81 benign variants (50 in cases and 67 in controls) and a total of 35 distinct rare pathogenic and unknown significance variants (10 in CEL, 21 in CFTR, 1 in CDLN2, and 3 in CPA1). None of the cases or controls carried pancreatitis-predisposing variants within the CASR, CPA1, PRSS1, and SPINK1 genes, nor a pathogenic CFTR mutation. Four different variants of unknown significance were detected in the CDLN and CPA1 genes; one of them was in the CDLN gene in a single patient with pancreatitis, and 3 in the CPA1 gene in 5 controls. After the analysis of the variants detected, no significant differences were observed between cases and controls. CONCLUSION In patients with IBD, genes known to cause pancreatitis seem not to be involved in thiopurine-related pancreatitis onset.
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Echarri A, Pérez-Calle JL, Calvo M, Molina G, Sierra-Ausín M, Morete-Pérez MC, Manceñido N, Botella B, Cano N, Castro B, Martín-Rodríguez D, Sánchez-Ortega Y, Corsino P, Cañas M, López-Calleja AM, Nos P, Muñiz J. Should Inflammatory Bowel Disease Clinicians Provide Their Patients with e-Health Resources? Patients' and Professionals' Perspectives. Telemed J E Health 2023; 29:1504-1513. [PMID: 36576850 PMCID: PMC10589484 DOI: 10.1089/tmj.2022.0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction: The internet is emerging as a source of information for patients with inflammatory bowel disease (IBD). However, it is not always reliable and may cause anxiety. We aim to assess patients' information habits and patients' and professionals' perceptions of a national website integrated as an educational resource for the IBD unit. Methods: Patients aged 18-65 years, comfortable with the internet, and attending follow-ups at participating IBD units (March-June 2019) and their professionals were invited to evaluate a recommended website through an online survey. Results: Three hundred eighty-nine patients and 95 professionals completed the survey. The internet (n = 109; 27.4%) was the second preferred source of information after the health care team (n = 229; 57.5%). Eighty percent of patients searched the internet for information on their disease and 28.6% did so at least once a week (n = 114), especially newly diagnosed ones (<2 years). Patients valued a website recommended by their professional (n = 379; 95.2%) and endorsed by the National Working Group (n = 377; 94.7%). They would attend online educational initiatives on the website (n = 279; 70.1%) and complete periodical surveys to improve its usefulness (n = 338; 84.9%). According to IBD professionals, this type of website is the best patient source of supplementary information (n = 76; 80%) and they "prescribe" it to most patients (67.0 ± 25.2%), especially the newly diagnosed patients (52.7 ± 26.5%). It effectively integrates routine face-to-face education (n = 95; 100%). Conclusions: Patients of IBD units, especially newly diagnosed ones, appreciate a trusted e-Health resource to back up professional information. The favorable opinion of patients and professionals will allow its use in training interventions.
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Affiliation(s)
- Ana Echarri
- IBD Unit. Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Spain
| | - José L. Pérez-Calle
- IBD Unit. Gastroenterology, Hospital Universitario Fundación Alcorcón, Spain
| | - Marta Calvo
- IBD Unit. Gastroenterology, Hospital Universitario Puerta de Hierro, Majalahonda, Spain
| | - Gema Molina
- IBD Unit. Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Spain
| | | | | | - Noemí Manceñido
- IBD Unit. Gastroenterology, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Spain
| | - Belén Botella
- IBD Unit. Gastroenterology, Hospital Universitario Infanta Cristina, Parla, Spain
| | - Noelia Cano
- IBD Unit. Gastroenterology, Hospital Universitario de Leon, Spain
| | - Beatriz Castro
- IBD Unit. Gastroenterology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Pilar Corsino
- IBD Unit. Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Mercedes Cañas
- IBD Unit. Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Pilar Nos
- IBD Unit. Gastroenterology, Hospital Universitario La Fe, Valencia, Spain
- CIBEREHD, Madrid, Spain
| | - Javier Muñiz
- Departamento de Ciencias de la Salud e INIBIC, A Coruña, Spain
- Universidad de A Coruña, CIBERCV, A Coruña, Spain
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4
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Casas-Deza D, Lamuela-Calvo LJ, Gomollón F, Arbonés-Mainar JM, Caballol B, Gisbert JP, Rivero M, Sánchez-Rodríguez E, Arias García L, Gutiérrez Casbas A, Merino O, Márquez L, Laredo V, Martín-Arranz MD, López Serrano P, Riestra Menéndez S, González-Muñoza C, de Castro Parga L, Calvo Moya M, Fuentes-Valenzuela E, Esteve M, Iborra M, Dura Gil M, Barreiro-De Acosta M, Lorente-Poyatos RH, Manceñido N, Calafat M, Rodríguez-Lago I, Guardiola Capo J, Payeras MA, Morales Alvarado VJ, Tardillo C, Bujanda L, Muñoz-Nuñez JF, Ber Nieto Y, Bermejo F, Almela P, Navarro-Llavat M, Martínez Montiel P, Rodríguez Gutiérrez C, Van Domselaar M, Sesé E, Martínez Pérez T, Ricart E, Chaparro M, García MJ, López-Sanromán A, Sicilia B, Orts B, López-García A, Martín-Arranz E, Pérez-Calle JL, de Francisco R, García-Planella E, Domènech E, García-López YS. Effectiveness and Safety of Ustekinumab in Elderly Patients with Crohn's Disease: Real World Evidence From the ENEIDA Registry. J Crohns Colitis 2023; 17:83-91. [PMID: 35913456 DOI: 10.1093/ecco-jcc/jjac108] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 05/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS Clinical trials and real-life studies with ustekinumab in Crohn's disease [CD] have revealed a good efficacy and safety profile. However, these data are scarcely available in elderly patients. Therefore, we aim to assess the effectiveness and safety of ustekinumab in elderly patients with CD. METHODS Elderly patients [>60 years old] from the prospectively maintained ENEIDA registry treated with ustekinumab due to CD were included. Every patient was matched with two controls under 60 years of age, according to anti-tumour necrosis factor use and smoking habit. Values for the Harvey-Bradshaw Index [HBI], endoscopic activity, C-reactive protein [CRP] and faecal calprotectin [FC] were recorded at baseline and at weeks 16, 32 and 54. RESULTS In total, 648 patients were included, 212 of whom were elderly. Effectiveness was similar between young and elderly patients during the follow-up. Steroid-free remission was similar at week 16 [54.6 vs 51.4%, p = 0.20], 32 [53.0% vs 54.5%, p = 0.26] and 54 [57.8% vs 51.1%, p = 0.21]. Persistence of ustekinumab as maintenance therapy was similar in both age groups [log-rank test; p = 0.91]. There was no difference in the rate of adverse effects [14.2% vs 11.2%, p = 0.350], including severe infections [7.1% vs 7.3%, p = 1.00], except for the occurrence of de novo neoplasms, which was higher in older patients [0.7% vs 4.3%, p = 0.003]. CONCLUSIONS Ustekinumab is as effective in elderly patients with CD as it is in non-elderly patients. The safety profile also seems to be similar except for a higher rate of de novo neoplasms, probably related to the age of the elderly patients.
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Affiliation(s)
- Diego Casas-Deza
- Gastroenterology Department, University Hospital Miguel Servet, Zaragoza, Spain.,Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Luis Javier Lamuela-Calvo
- Gastroenterology Department, University Hospital Miguel Servet, Zaragoza, Spain.,Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Fernando Gomollón
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Gastroenterology Department, University Hospital Lozano Blesa, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - José Miguel Arbonés-Mainar
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Instituto Aragonés de Ciencias de la Salud (IACS), Instituto de Investigación Sanitaria (IIS) de Aragón, Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Berta Caballol
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Montserrat Rivero
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación IDIVAL Santander, Spain
| | | | - Lara Arias García
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Ana Gutiérrez Casbas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital General de Alicante, Alicante, Spain
| | - Olga Merino
- Gastroenterology Department, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Lucía Márquez
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
| | - Viviana Laredo
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.,Gastroenterology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - María Dolores Martín-Arranz
- Department of Gastroenterology of La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid, Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - Pilar López Serrano
- Gastroenterology Department, Hospital Universitario Fundación de Alcorcón, Alcorcón, Spain
| | - Sabino Riestra Menéndez
- Gastroenterology Department, University Hospital Central de Asturias, and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | | | - Luisa de Castro Parga
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Marta Calvo Moya
- Gastroenterology Department, Hospital Universitario Puerto de Hierro, Madrid, Spain
| | | | - Maria Esteve
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Mútua de Terrasa, Terrasa, Spain
| | - Marisa Iborra
- Gastroenterology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Miguel Dura Gil
- Gastroenterology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Noemí Manceñido
- Gastroenterology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Margalida Calafat
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | - Jordi Guardiola Capo
- Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | - Carlos Tardillo
- Gastroenterology department, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | | | | | - Fernando Bermejo
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Pedro Almela
- Gastroenterology Department, Hospital General de Castelló, Castellón, Spain
| | | | | | | | | | - Eva Sesé
- Gastroenterology Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Clínic, Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - María José García
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación IDIVAL Santander, Spain
| | | | - Beatriz Sicilia
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Beatriz Orts
- Clinical Pharmacology, ISABIAL, Hospital General Universitario de Alicante, Spain
| | | | - Eduardo Martín-Arranz
- Department of Gastroenterology of La Paz University Hospital. Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | | | - Ruth de Francisco
- Gastroenterology Department, University Hospital Central de Asturias, and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | | | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Gastroenterology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Y Santiago García-López
- Gastroenterology Department, University Hospital Miguel Servet, Zaragoza, Spain.,Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
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5
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Mañosa M, Fernández-Clotet A, Nos P, Martín-Arranz MD, Manceñido N, Carbajo A, Hinojosa E, Hernández-Camba A, Muñoz-Pérez R, Boscá-Watts M, Calvo M, Sierra-Ausín M, Sánchez-Rodríguez E, Barreiro-de Acosta M, Núñez-Alonso A, Zabana Y, Márquez L, Gisbert JP, Guardiola J, Sáinz E, Delgado-Guillena P, Busquets D, van Domselaar M, Girona E, Lorente R, Casas-Deza D, Huguet JM, Maestro S, Cabello MJ, Castro J, Iborra M, Cañete F, Calafat M, Domènech E. Ustekinumab and vedolizumab for the prevention of postoperative recurrence of Crohn's disease: Results from the ENEIDA registry. Dig Liver Dis 2023; 55:46-52. [PMID: 35948459 DOI: 10.1016/j.dld.2022.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anti-TNF agents are the only effective biological agents for the prevention of postoperative recurrence (POR) in Crohn's disease (CD). However, they are contraindicated or have been shown to fail in some patients. Although ustekinumab and vedolizumab were licensed for CD some years ago, data in this setting are scarce. METHODS All CD patients in whom ustekinumab or vedolizumab was prescribed for the prevention of POR within three months of ileocolonic resection with anastomosis were identified from the ENEIDA registry. The development of endoscopic, clinical and surgical POR was registered. RESULTS Forty patients were treated for the prevention of POR with ustekinumab and 25 were treated with vedolizumab. Eighty per cent had at least one risk factor for POR (prior resections, active smoking, perianal disease or penetrating disease behaviour). All the patients had been exposed to anti-TNF therapy. After a median follow-up of 17 and 26 months, the cumulative probability of clinical POR at 12 months after surgery was 32% and 30% for ustekinumab and vedolizumab, respectively. Endoscopic assessment within the first 18 months after surgery was available for 80% of the patients on ustekinumab and 70% for those on vedolizumab. The rate of endoscopic POR was 42% for ustekinumab and 40% for vedolizumab. One patient treated with ustekinumab and two with vedolizumab underwent a new intestinal resection. CONCLUSIONS Ustekinumab and vedolizumab seem to be effective in the prevention of POR in patients at high risk. Our results warrant controlled trials comparing these drugs with conventional therapies.
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Affiliation(s)
- Míriam Mañosa
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Badalona, Catalonia 08916 Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
| | - Agnès Fernández-Clotet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pilar Nos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Hospital Politècnic La Fe, Valencia, Spain
| | - María Dolores Martín-Arranz
- Department of Gastroenterology, and Innate Immunity Group, IdiPAZ Institute for Health Research, La Paz Hospital, Madrid, Spain; Universidad Autónoma de Madrid, Spain
| | | | | | | | | | - Roser Muñoz-Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | | | | | | | | | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Hospital Mútua de Terrassa, Spain
| | - Lucía Márquez
- Hospital Parc de Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | | | | | - David Busquets
- Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | | | - Eva Girona
- Hospital General Universitario de Elche, Elche, Spain
| | | | - Diego Casas-Deza
- Instituto de Investigación Sanitaria de Aragón (IISA), Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | - Jesús Castro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marisa Iborra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Hospital Politècnic La Fe, Valencia, Spain
| | - Fiorella Cañete
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Badalona, Catalonia 08916 Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Margalida Calafat
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Badalona, Catalonia 08916 Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Eugeni Domènech
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Badalona, Catalonia 08916 Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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6
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Chaparro M, Kunovský L, Aguas M, Livne M, Rivière P, Bar-Gil Shitrit A, Myrelid P, Arroyo M, Barreiro-de Acosta M, Bautista M, Biancone L, Biron IA, Boysen T, Carpio D, Castro B, Dragoni G, Ellul P, Holubar SD, de Jorge MÁ, Leo E, Manceñido N, Moens A, Molnár T, Ramírez de la Piscina P, Ricanek P, Sebkova L, Sempere L, Teich N, Gisbert JP, Julsgaard M. Surgery due to Inflammatory Bowel Disease During Pregnancy: Mothers and Offspring Outcomes From an ECCO Confer Multicentre Case Series [Scar Study]. J Crohns Colitis 2022; 16:1428-1435. [PMID: 35380641 DOI: 10.1093/ecco-jcc/jjac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS i] To evaluate the evolution of pregnancies and offspring after inflammatory bowel disease [IBD] surgery during pregnancy; and ii] to describe the indications, the surgical techniques, and the frequency of caesarean section concomitant with surgery. METHODS Patients operated on due to IBD during pregnancy after 1998 were included. Participating clinicians were asked to review their databases to identify cases. Data on patients' demographics, IBD characteristics, medical treatments, IBD activity, pregnancy outcomes, surgery, delivery, and foetal and maternal outcomes, were recorded. RESULTS In all, 44 IBD patients were included, of whom 75% had Crohn's disease; 18% of the surgeries were performed in the first trimester, 55% in the second, and 27% in the third trimester. One patient had complications during surgery, and 27% had postsurgical complications. No patient died. Of deliveries, 70% were carried out by caesarean section. There were 40 newborns alive. There were four miscarriages/stillbirths [one in the first, two in the second, and one in the third trimester]; two occurred during surgery, and another two occurred 2 weeks after surgery; 14% of the surgeries during the second trimester and 64% of those in the third trimester ended up with a simultaneous caesarean section or vaginal delivery. Of the 40 newborns, 61% were premature and 47% had low birth weight; 42% of newborns needed hospitalisation [25% in the intensive care unit]. CONCLUSIONS IBD surgery during pregnancy remains an extremely serious situation. Therefore, surgical management should be performed in a multidisciplinary team, involving gastroenterologists, colorectal surgeons, obstetricians, and neonatal specialists.
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Affiliation(s)
- María Chaparro
- Hospital Universitario de La Princesa, [IIS-IP], UAM, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
| | - Lumír Kunovský
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mariam Aguas
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | | | | | | | - Pär Myrelid
- Linköping University Hospital and Department of Biomedical and Clinical Sciences, Linköping, Sweden
| | - Maite Arroyo
- Hospital Clínico Universitario Lozano Blesa and CIBERehd, IIS Aragón, Zaragoza, Spain
| | | | | | | | | | | | - Daniel Carpio
- Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, Pontevedra, Spain
| | - Beatriz Castro
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | | | | | - Eduardo Leo
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Noemí Manceñido
- Hospital Universitario Infanta Sofía. San Sebastián de los Reyes, Spain
| | | | - Tamás Molnár
- University of Szeged, Albert Szent-Györgyi Medical School, Department of Internal Medicine, Szeged, Hungary
| | | | | | | | - Laura Sempere
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Niels Teich
- Practice for Internal Medicine, Leipzig, Germany
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, [IIS-IP], UAM, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBERehd], Madrid, Spain
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7
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Muñoz-Fernández S, Cebrian L, Thuissard IJ, Steiner M, García-Yubero C, Esteban AV, Sánchez F, Gómez A, Matías MA, Cobo-Ibáñez T, Esteban M, Manceñido N, Pajares R, Arribas MR, Martínez A, Andreu C, Esteban C, Romero L, Navío T. Incidence of COVID-19 in 902 Patients With Immunomediated Inflammatory Diseases Treated With Biologics and Targeted Synthetic Disease-Modifying Antirheumatic Drugs-Findings From the BIOCOVID Study. J Clin Rheumatol 2022; 28:e348-e352. [PMID: 33657593 DOI: 10.1097/rhu.0000000000001716] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to examine the incidence of coronavirus disease 2019 (COVID-19) among patients with immunomediated inflammatory diseases (IMIDs) treated with biologic or targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) and to evaluate the influence of either IMIDs or related therapies on the incidence and evolution of COVID-19. METHODS This observational, cross-sectional study was conducted from January 31, 2020, to May 15, 2020. Data of 902 patients were obtained from clinical records in hospitals, primary care units, and community pharmacies. Inclusion criteria were adults with IMIDs treated with bDMARDs or tsDMARDs who started therapy 3 months prior to study commencement. Patients with poor adherence to treatments were excluded. COVID-19 was classified as "definitive" (severe acute respiratory syndrome coronavirus 2 polymerase chain reaction [PCR]-positive), "possible" (characteristic symptoms and negative PCR), and "suspected" (characteristic symptoms but PCR not performed). RESULTS COVID-19 was diagnosed in 70 patients (11 definitive, 19 possible, and 40 suspected). The cumulative incidence of definitive COVID-19 was 1.2%. When considering all cases, the incidence was 7.8%. Patients on biosimilars tumor necrosis factor blockers were more likely to have a diagnosis of COVID-19 (odds ratio, 2.308; p < 0.001). Patients on anti-B-cell therapies had a lower incidence of infections (p = 0.046). Low rates of hospitalization (14.3%), pneumonia (14.3%), death (2.9%), or thrombosis (2.9%) were observed, and 94.3% of patients recovered. CONCLUSIONS The cumulative incidence of confirmed cases of COVID-19 was similar to the general population, with generally low hospitalization, intensive care management, and mortality rates. COVID-19 incidence was less frequent in patients with more severe immunosuppression.
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Affiliation(s)
- Santiago Muñoz-Fernández
- From the Rheumatology Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | - Laura Cebrian
- Rheumatology Section, Hospital Universitario Infanta Leonor
| | | | - Martina Steiner
- From the Rheumatology Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | | | | | | | - Alejandro Gómez
- From the Rheumatology Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | | | - Tatiana Cobo-Ibáñez
- From the Rheumatology Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | | | - Noemí Manceñido
- Gastroenterology Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | - Ramón Pajares
- Gastroenterology Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | - María Rosario Arribas
- Gastroenterology Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | - Alicia Martínez
- Pharmacy Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | - Cristina Andreu
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid
| | | | - Liz Romero
- From the Rheumatology Section, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid
| | - Teresa Navío
- Rheumatology Section, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
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8
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Gutiérrez A, Zapater P, Ricart E, González-Vivó M, Gordillo J, Olivares D, Vera I, Mañosa M, Gisbert JP, Aguas M, Sánchez-Rodríguez E, Bosca-Watts M, Laredo V, Camps B, Marín-Jiménez I, Zabana Y, Martín-Arranz MD, Muñoz R, Navarro M, Sierra E, Madero L, Vela M, Pérez-Calle JL, Sainz E, Calvet X, Arias L, Morales V, Bermejo F, Fernández-Salazar L, Van Domselaar M, De Castro L, Rodríguez C, Muñoz-Villafranca C, Lorente R, Rivero M, Iglesias E, Herreros B, Busquets D, Riera J, Martínez-Montiel MP, Roldón M, Roncero O, Hinojosa E, Sierra M, Barrio J, De Francisco R, Huguet J, Merino O, Carpio D, Ginard D, Muñoz F, Piqueras M, Almela P, Argüelles-Arias F, Alcaín G, Bujanda L, Manceñido N, Lucendo AJ, Varela P, Rodríguez-Lago I, Ramos L, Sempere L, Sesé E, Barreiro-de Acosta M, Domènech E, Francés R. Immigrant IBD Patients in Spain Are Younger, Have More Extraintestinal Manifestations and Use More Biologics Than Native Patients. Front Med (Lausanne) 2022; 9:823900. [PMID: 35178413 PMCID: PMC8844561 DOI: 10.3389/fmed.2022.823900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Previous studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain. Methods Prospective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients. Results We included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 ± 12 vs. 54 ± 16 years, p < 0.001), had been diagnosed younger (31 ± 12 vs. 36 ± 15 years, p < 0.001), and had a shorter disease duration (14 ± 7 vs. 18 ± 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92–2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0–1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses. Conclusions Compared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe.
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Affiliation(s)
- Ana Gutiérrez
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain.,IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Zapater
- IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Unidad Farmacología Clínica, Hospital General Universitario Alicante, Alicante, Spain.,Instituto IDIBE, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Medicina Digestiva Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María González-Vivó
- Servicio Medicina Digestiva, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jordi Gordillo
- Servicio Patología Digestiva, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - David Olivares
- Servicio Medicina Digestiva, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Isabel Vera
- Servicio Aparato Digestivo, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Míriam Mañosa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Aparato Digestivo, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Mariam Aguas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitario La Fé, Valencia, Spain
| | | | - Maia Bosca-Watts
- Servicio Medicina Digestiva, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Viviana Laredo
- Servicio Medicina Digestiva, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Blau Camps
- Servicio Medicina Digestiva, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Ignacio Marín-Jiménez
- Servicio Medicina Digestiva, Hospital Gregorio Marañón, Madrid, Spain.,Gastroenterology Department, Instituto de Investigación Biomédica Gregorio Marañón IiSGM, Madrid, Spain
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | | | - Roser Muñoz
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain
| | - Mercè Navarro
- Servicio Medicina Digestiva, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Eva Sierra
- Servicio Medicina Digestiva, Hospital Universitario Miguel Servert, Zaragoza, Spain
| | - Lucía Madero
- Servicio Medicina Digestiva, Hospital General Universitario de Elche, Elche, Spain
| | - Milagros Vela
- Servicio Medicina Digestiva, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Empar Sainz
- Servicio Medicina Digestiva, Hospital Sant Joan de Déu - Althaia, Manresa, Spain
| | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Unitat Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Tauli, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Lara Arias
- Servicio Medicina Digestiva, Hospital Universitario de Burgos, Burgos, Spain
| | - Victor Morales
- Servicio Medicina Digestiva, Hospital General de Granollers, Barcelona, Spain
| | - Fernando Bermejo
- Servicio Medicina Digestiva, Hospital de Fuenlabrada, Fuenlabrada, Spain.,IIS Hospital La Paz IdiPaz-Madrid, Madrid, Spain
| | | | | | - Luisa De Castro
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo- SERGAS. IIS Galicia Sur. SERGAS-UVIG, Vigo, Spain
| | - Cristina Rodríguez
- Servicio Medicina Digestiva, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Rufo Lorente
- Servicio Medicina Digestiva, Hospital General Ciudad Real, Ciudad Real, Spain
| | - Montserrat Rivero
- Servicio Medicina Digestiva, Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Eva Iglesias
- Servicio Medicina Digestiva, Hospital Universitario Reina Sofía, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Belén Herreros
- Servicio Medicina Digestiva, Hospital Marina Baixa, Villajoyosa, Spain
| | - David Busquets
- Servicio Medicina Digestiva, Hospital de Girona Dr. Trueta/ICO, Girona, Spain
| | - Joan Riera
- Servicio Medicina Digestiva, Hospital Universitario Son LLàtzer, Palma de Mallorca, Spain
| | | | - Marta Roldón
- Servicio Cirugía General y del Aparato Digestivo, Hospital San Jorge, Huesca, Spain
| | - Oscar Roncero
- Servicio Medicina Digestiva, Hospital General La Mancha Centro, Ciudad Real, Spain
| | - Esther Hinojosa
- Servicio Medicina Digestiva, Hospital de Manises, Valencia, Spain
| | - Mónica Sierra
- Servicio Medicina Digestiva, Complejo Asistencial Universitario de León, León, Spain
| | - Jesús Barrio
- Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - José Huguet
- Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Olga Merino
- Servicio Medicina Digestiva, Hospital de Cruces, Bilbao, Spain
| | - Daniel Carpio
- Complejo Hospitalario Universitario Pontevedra, Pontevedra, Spain
| | - Daniel Ginard
- Servicio Medicina Digestiva, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Fernando Muñoz
- Servicio Medicina Digestiva, Hospital Clínico Universitario Salamanca, Salamanca, Spain
| | - Marta Piqueras
- Servicio Medicina Digestiva, Consorci Sanitari Terrasa, Barcelona, Spain
| | - Pedro Almela
- Servicio Medicina Digestiva, Hospital General Universitario Castellón, Castellón de la Plana, Spain
| | | | - Guillermo Alcaín
- Servicio Medicina Digestiva, Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital Universitario Donostia, San Sebastián, Spain.,Instituto Biodonostia, Universidad Pais Vasco, San Sebastián, Spain
| | - Noemí Manceñido
- Servicio Medicina Digestiva, Hospital Infanta Sofía, Madrid, Spain
| | - Alfredo J Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Medicina Digestiva, Hospital General Tomelloso, Ciudad Real, Spain
| | - Pilar Varela
- Servicio Medicina Digestiva, Hospital Cabueñes, Gijón, Spain
| | - Iago Rodríguez-Lago
- Servicio de Aparato Digestivo, Hospital Universitario de Galdakao, IIS Biocruces, Galdakao, Spain.,Facultad de Medicina, University of Deusto, Bilbao, Spain
| | - Laura Ramos
- Servicio Medicina Digestiva, Hospital Universitario La Laguna, Santa Cruz Tenerife, Spain
| | - Laura Sempere
- Servicio Medicina Digestiva, Hospital General Universitario Alicante, Alicante, Spain.,IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain
| | - Eva Sesé
- Servicio Medicina Digestiva, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Servicio Aparato Digestivo, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Rubén Francés
- IIS Isabial, Hospital General Universitario Alicante, Alicante, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.,Hepatic and Intestinal Immunobiology Group, Dpto. Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Spain.,Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universidad Miguel Hernández, Elche, Spain
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Zabana Y, Marín-Jiménez I, Rodríguez-Lago I, Vera I, Martín-Arranz MD, Guerra I, Gisbert JP, Mesonero F, Benítez O, Taxonera C, Ponferrada-Díaz Á, Piqueras M, Lucendo AJ, Caballol B, Mañosa M, Martínez-Montiel P, Bosca-Watts M, Gordillo J, Bujanda L, Manceñido N, Martínez-Pérez T, López A, Rodríguez-Gutiérrez C, García-López S, Vega P, Rivero M, Melcarne L, Calvo M, Iborra M, Barreiro de-Acosta M, Sicilia B, Barrio J, Pérez JL, Busquets D, Pérez-Martínez I, Navarro-Llavat M, Hernández V, Argüelles-Arias F, Ramírez Esteso F, Meijide S, Ramos L, Gomollón F, Muñoz F, Suris G, de Zarate JO, Huguet JM, Llaó J, García-Sepulcre MF, Sierra M, Durà M, Estrecha S, Fuentes Coronel A, Hinojosa E, Olivan L, Iglesias E, Gutiérrez A, Varela P, Rull N, Gilabert P, Hernández-Camba A, Brotons A, Ginard D, Sesé E, Carpio D, Aceituno M, Cabriada JL, González-Lama Y, Jiménez L, Chaparro M, López-San Román A, Alba C, Plaza-Santos R, Mena R, Tamarit-Sebastián S, Ricart E, Calafat M, Olivares S, Navarro P, Bertoletti F, Alonso-Galán H, Pajares R, Olcina P, Manzano P, Domènech E, Esteve M. Nationwide COVID-19-EII Study: Incidence, Environmental Risk Factors and Long-Term Follow-Up of Patients with Inflammatory Bowel Disease and COVID-19 of the ENEIDA Registry. J Clin Med 2022; 11:421. [PMID: 35054116 PMCID: PMC8781643 DOI: 10.3390/jcm11020421] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/23/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
We aim to describe the incidence and source of contagion of COVID-19 in patients with IBD, as well as the risk factors for a severe course and long-term sequelae. This is a prospective observational study of IBD and COVID-19 included in the ENEIDA registry (53,682 from 73 centres) between March-July 2020 followed-up for 12 months. Results were compared with data of the general population (National Centre of Epidemiology and Catalonia). A total of 482 patients with COVID-19 were identified. Twenty-eight percent were infected in the work environment, and 48% were infected by intrafamilial transmission, despite having good adherence to lockdown. Thirty-five percent required hospitalization, 7.9% had severe COVID-19 and 3.7% died. Similar data were reported in the general population (hospitalisation 19.5%, ICU 2.1% and mortality 4.6%). Factors related to death and severe COVID-19 were being aged ≥ 60 years (OR 7.1, 95% CI: 1.8-27 and 4.5, 95% CI: 1.3-15.9), while having ≥2 comorbidities increased mortality (OR 3.9, 95% CI: 1.3-11.6). None of the drugs for IBD were related to severe COVID-19. Immunosuppression was definitively stopped in 1% of patients at 12 months. The prognosis of COVID-19 in IBD, even in immunosuppressed patients, is similar to that in the general population. Thus, there is no need for more strict protection measures in IBD.
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Affiliation(s)
- Yamile Zabana
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
| | | | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao, 48960 Galdakao, Spain; (I.R.-L.); (J.L.C.)
- Biocruces Bizkaia Health Research Institute, 48960 Galdakao, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.V.); (Y.G.-L.)
| | | | - Iván Guerra
- Hospital Universitario de Fuenlabrada, 28942 Fuenlabrada, Spain; (I.G.); (L.J.)
- Instituto de Investigación Hospital Universitario La Paz (IdiPaz), 28046 Madrid, Spain
| | - Javier P. Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Department of Gastroenterology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | - Francisco Mesonero
- Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (F.M.); (A.L.-S.R.)
| | - Olga Benítez
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
| | - Carlos Taxonera
- Hospital Clínico San Carlos, 28040 Madrid, Spain; (C.T.); (C.A.)
- Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], 28040 Madrid, Spain
| | | | - Marta Piqueras
- Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (M.P.); (R.M.)
| | - Alfredo J. Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
- Hospital General de Tomelloso, 13700 Tomelloso, Spain;
| | - Berta Caballol
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínic de Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Míriam Mañosa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Pilar Martínez-Montiel
- Fundación Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (P.M.-M.); (S.O.)
| | - Maia Bosca-Watts
- Hospital Clinic Universitari de Valencia, 46010 Valencia, Spain; (M.B.-W.); (P.N.)
| | - Jordi Gordillo
- Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.G.); (F.B.)
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitario Donostia, Instituto Biodonostia, 20014 San Sebastián, Spain;
- Universidad del País Vasco (UPV/EHU), 48940 Leioua, Spain
| | - Noemí Manceñido
- Hospital Universitario Infanta Sofía, 28703 San Sebastián de los Reyes, Spain; (N.M.); (R.P.)
| | | | - Alicia López
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Hospital del Mar, 08003 Barcelona, Spain;
| | | | | | - Pablo Vega
- Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Montserrat Rivero
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Luigi Melcarne
- Hospital Universitari Parc Taulí, 08208 Sabadell, Spain;
| | - Maria Calvo
- Hospital San Pedro-Logroño, 26006 Logroño, Spain;
| | - Marisa Iborra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitario y Politécnico de la Fe de Valencia, 46026 Valencia, Spain
| | | | | | - Jesús Barrio
- Hospital Universitario Río Hortega (HURH), 47012 Valladolid, Spain;
| | - José Lázaro Pérez
- Hospital Universitario Fundación de Alcorcón, 28922 Alcorcón, Spain;
| | - David Busquets
- Hospital Universitari de Girona Doctor Josep Trueta, 17007 Girona, Spain;
| | - Isabel Pérez-Martínez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | | | | | | | | | - Susana Meijide
- Hospital Universitario de Cruces, 48903 Barakaldo, Spain;
| | - Laura Ramos
- Hospital Universitario de Canarias, 38320 San Cristobal de la Laguna, Spain;
| | - Fernando Gomollón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínico Universitario “Lozano Blesa” and IIS Aragón, 50009 Zaragoza, Spain
| | - Fernando Muñoz
- Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | - Gerard Suris
- Hospital Universitari de Bellvitge, 08907 L’Hospitalet de Llobregat, Spain;
| | | | - José María Huguet
- Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain;
| | - Jordina Llaó
- Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain;
| | | | - Mónica Sierra
- Complejo Asistencial Universitario de León, 24071 León, Spain;
| | - Miguel Durà
- Hospital Clínico de Valladolid, 47003 Valladolid, Spain;
| | | | | | | | | | - Eva Iglesias
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, 14004 Cordoba, Spain;
| | - Ana Gutiérrez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Pilar Varela
- Hospital Universitario de Cabueñes, 33394 Gijón, Spain;
| | - Núria Rull
- Hospital Universitario Son Llàtzer, 07198 Palma, Spain;
| | - Pau Gilabert
- Hospital de Viladecans, 08840 Viladecans, Spain;
| | | | | | - Daniel Ginard
- Hospital Universitario Son Espases, 07120 Palma, Spain;
| | - Eva Sesé
- Hospital Universitari Arnau de Vilanova de Lleida, 25198 Lleida, Spain;
| | - Daniel Carpio
- Complexo Hospitalario de Pontevedra, 36071 Pontevedra, Spain;
| | - Montserrat Aceituno
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
| | - José Luis Cabriada
- Gastroenterology Department, Hospital Universitario de Galdakao, 48960 Galdakao, Spain; (I.R.-L.); (J.L.C.)
- Biocruces Bizkaia Health Research Institute, 48960 Galdakao, Spain
| | - Yago González-Lama
- Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.V.); (Y.G.-L.)
| | - Laura Jiménez
- Hospital Universitario de Fuenlabrada, 28942 Fuenlabrada, Spain; (I.G.); (L.J.)
- Instituto de Investigación Hospital Universitario La Paz (IdiPaz), 28046 Madrid, Spain
| | - María Chaparro
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Department of Gastroenterology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
| | | | - Cristina Alba
- Hospital Clínico San Carlos, 28040 Madrid, Spain; (C.T.); (C.A.)
- Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], 28040 Madrid, Spain
| | - Rocío Plaza-Santos
- Hospital Universitario Infanta Leonor, 28031 Madrid, Spain; (Á.P.-D.); (R.P.-S.)
| | - Raquel Mena
- Consorci Sanitari de Terrassa, 08227 Terrassa, Spain; (M.P.); (R.M.)
| | | | - Elena Ricart
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Clínic de Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Margalida Calafat
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Sonsoles Olivares
- Fundación Hospital Universitario Doce de Octubre, 28041 Madrid, Spain; (P.M.-M.); (S.O.)
| | - Pablo Navarro
- Hospital Clinic Universitari de Valencia, 46010 Valencia, Spain; (M.B.-W.); (P.N.)
| | - Federico Bertoletti
- Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (J.G.); (F.B.)
| | - Horacio Alonso-Galán
- Hospital Universitario Donostia, Instituto Biodonostia, 20014 San Sebastián, Spain;
- Universidad del País Vasco (UPV/EHU), 48940 Leioua, Spain
| | - Ramón Pajares
- Hospital Universitario Infanta Sofía, 28703 San Sebastián de los Reyes, Spain; (N.M.); (R.P.)
| | - Pablo Olcina
- Hospital Virgen de la Luz, 16002 Cuenca, Spain; (T.M.-P.); (P.O.)
| | - Pamela Manzano
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
| | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Maria Esteve
- Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain; (O.B.); (M.A.); (P.M.); (M.E.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain; (J.P.G.); (A.J.L.); (B.C.); (M.M.); (L.B.); (M.I.); (F.G.); (A.G.); (M.C.); (E.R.); (M.C.); (E.D.)
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10
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Chaparro M, Garre A, Iborra M, Sierra M, Barreiro-de Acosta M, Fernández-Clotet A, de Castro L, Boscá-Watts M, Casanova MJ, López-García A, Lorente R, Rodríguez C, Carbajo AY, Arroyo MT, Gutiérrez A, Hinojosa J, Martínez-Pérez T, Villoria A, Bermejo F, Busquets D, Camps B, Cañete F, Manceñido N, Monfort D, Navarro-Llavat M, Pérez-Calle JL, Ramos L, Rivero M, Angueira T, Camo P, Carpio D, García-de-la-Filia I, González-Muñoza C, Hernández L, Huguet JM, Morales VJ, Sicilia B, Vega P, Vera I, Zabana Y, Nos P, Suárez Álvarez P, Calviño-Suarez C, Ricart E, Hernández V, Mínguez M, Márquez L, Hervías Cruz D, Rubio Iturria S, Barrio J, Gargayo-Puyuelo C, Francés R, Hinojosa E, del Moral M, Calvet X, Algaba A, Aldeguer X, Guardiola J, Mañosa M, Pajares R, Piqueras M, García-Bosch O, Lopez Serrano P, Castro B, Lucendo AJ, Montoro M, Castro Ortiz E, Mesonero F, García-Planella E, Fuentes DA, Bort I, Delgado-Guillena P, Arias L, Iglesias A, Calvo M, Esteve M, Domènech E, Gisbert JP. Effectiveness and Safety of Ustekinumab in Ulcerative Colitis: Real-world Evidence from the ENEIDA Registry. J Crohns Colitis 2021; 15:1846-1851. [PMID: 33860795 PMCID: PMC8083263 DOI: 10.1093/ecco-jcc/jjab070] [Citation(s) in RCA: 31] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The development programm UNIFI has shown promising results of ustekinumab in ulcerative colitis [UC] treatment which should be confirmed in clinical practice. We aimed to evaluate the durability, effectiveness, and safety of ustekinumab in UC in real life. METHODS Patients included in the prospectively maintained ENEIDA registry, who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score [PMS]>2], were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at Week 16. RESULTS A total of 95 patients were included. At Week 16, 53% of patients had response [including 35% of patients in remission]. In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at Weeks 24 and 52, respectively; 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at Week 16, 63% at Week 56, and 59% at Week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. CONCLUSIONS Ustekinumab is effective in both the short and the long term in real life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.
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Affiliation(s)
- María Chaparro
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain,CORRESPONDENCE: María Chaparro, M.D., Ph.D, Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Universitario de La Princesa, Diego de León, 62. 28006 Madrid, Spain, Tel.: 34-913093911; Fax: 34-915204013, e-mail:
| | - Ana Garre
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
| | - Marisa Iborra
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | - Mónica Sierra
- Complejo Asistencial Universitario de León, León, Spain
| | | | | | - Luisa de Castro
- Xerencia Xestion Integrada de Vigo, SERGAS. Vigo. Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO. Spain
| | - Maia Boscá-Watts
- Hospital Clinico de Valencia. Universitat de València, Valencia, Spain
| | - María José Casanova
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
| | - Alicia López-García
- Hospital del Mar and Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | - Rufo Lorente
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Ana Y Carbajo
- Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL). Valladolid, Spain
| | | | - Ana Gutiérrez
- Hospital General Universitario de Alicante and CIBERehd, IIS ISABIAL Alicante, Spain
| | | | | | - Albert Villoria
- Hospital Parc Taulí, Sabadell. Depàrtament de Medicina. Universitat Autònoma de Barcelona and CIBERehd, Spain
| | - Fernando Bermejo
- Hospital Universitario Fuenlabrada and Instituto de Investigación Sanitaria del Hospital La Paz (IdiPAZ), Madrid, Spain
| | - David Busquets
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
| | - Blau Camps
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Fiorella Cañete
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | | | | | | | | | - Laura Ramos
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Montserrat Rivero
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Teresa Angueira
- Hospital General de Tomelloso and CIBERehd, Ciudad Real, Spain
| | | | - Daniel Carpio
- Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | | | - José M Huguet
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Pablo Vega
- Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Yamile Zabana
- Hospital Universitario Mútua Terrassa and CIBERehd, Terrassa, Spain
| | - Pilar Nos
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | | | | | - Elena Ricart
- Hospital Clìnic i Provincial and CIBERehd, IDIBAPS, Barcelona, Spain
| | - Vicent Hernández
- Xerencia Xestion Integrada de Vigo, SERGAS. Vigo. Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO. Spain
| | - Miguel Mínguez
- Hospital Clinico de Valencia. Universitat de València, Valencia, Spain
| | - Lucía Márquez
- Hospital del Mar and Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | | | | | - Jesús Barrio
- Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL). Valladolid, Spain
| | | | - Rubén Francés
- Hepatic and intestinal Immunobiology group Clinical Medicina, Department Miguel Hernández University, IIS ISABIAL, Hospital General Universitario de Alicante and CIBERehd, Alicante, Spain
| | | | | | - Xavier Calvet
- Hospital Parc Taulí, Sabadell. Depàrtament de Medicina. Universitat Autònoma de Barcelona and CIBERehd, Spain
| | - Alicia Algaba
- Hospital Universitario Fuenlabrada and Instituto de Investigación Sanitaria del Hospital La Paz (IdiPAZ), Madrid, Spain
| | - Xavier Aldeguer
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
| | | | - Miriam Mañosa
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | - Ramón Pajares
- Hospital Infanta Sofía, San Sebastián de los Reyes, Spain
| | | | | | | | - Beatriz Castro
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | | | | | | | | | | | | | - Lara Arias
- Hospital Universitario de Burgos, Burgos, Spain
| | - Agueda Iglesias
- Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Marta Calvo
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Maria Esteve
- Hospital Universitario Mútua Terrassa and CIBERehd, Terrassa, Spain
| | - Eugeni Domènech
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | - Javier P Gisbert
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
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Chaparro M, Garre A, Mesonero F, Rodríguez C, Barreiro-de Acosta M, Martínez-Cadilla J, Arroyo MT, Manceñido N, Sierra-Ausín M, Vera-Mendoza I, Casanova MJ, Nos P, González-Muñoza C, Martínez T, Boscá-Watts M, Calafat M, Busquets D, Girona E, Llaó J, Martín-Arranz MD, Piqueras M, Ramos L, Surís G, Bermejo F, Carbajo AY, Casas-Deza D, Fernández-Clotet A, García MJ, Ginard D, Gutiérrez-Casbas A, Hernández L, Lucendo AJ, Márquez L, Merino-Ochoa O, Rancel FJ, Taxonera C, López Sanromán A, Rubio S, Domènech E, Gisbert JP. Tofacitinib in Ulcerative Colitis: Real-world Evidence From the ENEIDA Registry. J Crohns Colitis 2021; 15:35-42. [PMID: 32969471 DOI: 10.1093/ecco-jcc/jjaa145] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the effectiveness and safety of tofacitinib in ulcerative colitis [UC] in real life. METHODS Patients from the prospectively maintained ENEIDA registry and treated with tofacitinib due to active UC were included. Clinical activity and effectiveness were defined based on Partial Mayo Score [PMS]. Short-term response/remission was assessed at Weeks 4, 8, and 16. RESULTS A total of 113 patients were included. They were exposed to tofacitinib for a median time of 44 weeks. Response and remission at Week 8 were 60% and 31%, respectively. In multivariate analysis, higher PMS at Week 4 (odds ratio [OR] = 0].2; 95% confidence interval [CI] = 0].1-0.4) was the only variable associated with lower likelihood of achieving remission at Week 8. Higher PMS at Week 4 [OR = 0.5; 95% CI = 0.3-0.7] and higher PMS at Week 8 [OR = 0.2; 95% CI = 0.1-0.5] were associated with lower probability of achieving remission at Week 16. A total of 45 patients [40%] discontinued tofacitinib over time. Higher PMS at Week 8 was the only factor associated with higher tofacitinib discontinuation [hazard ratio = 1.5; 95% CI = 1.3-1.6]. A total of 34 patients had remission at Week 8; of these, 65% had relapsed 52 weeks after achieving remission; the dose was increased to 10 mg/12 h in nine patients, and five of them reached remission again. Seventeen patients had adverse events. CONCLUSIONS Tofacitinib is effective and safe in UC patients in real practice, even in a highly refractory cohort. A relevant proportion of patients discontinue the drug over time, mainly due to primary failure.
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Affiliation(s)
- María Chaparro
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Ana Garre
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Francisco Mesonero
- Gastroenterology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Rodríguez
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Manuel Barreiro-de Acosta
- Gastroenterology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Jesús Martínez-Cadilla
- Gastroenterology Department, Hospital Álvaro Cunqueiro-Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - María T Arroyo
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa and CIBERehd, IIS Aragón, Zaragoza, Spain
| | - Noemí Manceñido
- Gastroenterology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Mónica Sierra-Ausín
- Gastroenterology Department, Complejo Asistencial Universitario de León, León Spain
| | - Isabel Vera-Mendoza
- Gastroenterology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - María José Casanova
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Pilar Nos
- Gastroenterology Department, Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | - Carlos González-Muñoza
- Gastroenterology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Teresa Martínez
- Gastroenterology Department, Hospital Virgen de la Luz, Cuenca, Spain
| | - Maia Boscá-Watts
- Gastroenterology Department, Hospital Clinico de Valencia and Universitat de Valencia, Valencia, Spain
| | - Margalida Calafat
- Gastroenterology Department, Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Barcelona, Spain
| | - David Busquets
- Gastroenterology Department, Hospital Universitario de Gerona Dr Josep Trueta, Girona, Spain
| | - Eva Girona
- Gastroenterology Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Jordina Llaó
- Gastroenterology Department, Hospital Sant Joan de Déu, Althaia, Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | - María Dolores Martín-Arranz
- Department of Gastroenterology, and Innate Immunity Group, IdiPAZ Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - Marta Piqueras
- Gastroenterology Department, Consorci Sanitari de Terrasa, Barcelona, Spain
| | - Laura Ramos
- Gastroenterology Department, Hospital Universitario de Canarias, Islas Canarias, Spain
| | - Gerard Surís
- Gastroenterology Department, Hospital de Bellvitge and IDIBELL, L'Hospitalet, Spain
| | - Fernando Bermejo
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, Instituto de Investigación Sanitaria del Hospital La Paz [IdiPaz], Madrid, Spain
| | - Ana Y Carbajo
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Diego Casas-Deza
- Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - María J García
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Daniel Ginard
- Gastroenterology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Ana Gutiérrez-Casbas
- Gastroenterology Department, Hospital General Universitario de Alicante and CIBERehd, Alicante, Spain
| | - Luis Hernández
- Gastroenterology Department, Hospital Santos Reyes de Aranda del Duero, Burgos, Spain
| | - Alfredo J Lucendo
- Gastroenterology Department, Hospital General de Tomelloso, IIS-IP and CIBEREHD Ciudad Real, Spain
| | - Lucía Márquez
- Gastroenterology Department, Hospital del Mar and Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Olga Merino-Ochoa
- Gastroenterology Department, Hospital Universitario de Cruces, Vizcaya, Spain
| | - Francisco J Rancel
- Gastroenterology Department, Complejo Hospitalario de Palencia, Palencia, Spain
| | - Carlos Taxonera
- Gastroenterology Department, Hospital Clínico San Carlos and IdISSC, Madrid, Spain
| | | | - Saioa Rubio
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Eugeni Domènech
- Gastroenterology Department, Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Barcelona, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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12
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Taxonera C, Iborra M, Bosca-Watts MM, Rubio S, Nantes Ó, Higuera R, Bertoletti F, Martínez-Montiel P, Sierra-Ausin M, Manceñido N, Lázaro Pérez-Calle J, Algaba A, Olivares D, Alba C. Early dose optimization of golimumab induces late response and long-term clinical benefit in moderately to severely active ulcerative colitis. Curr Med Res Opin 2019; 35:1297-1304. [PMID: 30722703 DOI: 10.1080/03007995.2019.1579557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/12/2022]
Abstract
Aim: To evaluate outcomes of early dose optimization of golimumab in ulcerative colitis (UC) patients with inadequate response to golimumab induction treatment. Methods: This observational, multicenter, cohort study included patients with moderate-to-severe active UC and with inadequate response to subcutaneous golimumab induction doses, in whom weight-based golimumab maintenance dose (European labeling) of 50 mg every 4 weeks (q4wk) was optimized before week 14 to 100 mg q4wk. At week 14, we assessed clinical response and remission using the partial Mayo score. In the long term we evaluate the cumulative probabilities of golimumab failure-free survival and colectomy-free survival. Results: A total of 209 patients who received golimumab induction doses were eligible. Of these, 151 patients (72.2%) weighing less than 80 kg were assigned to a golimumab maintenance dose of 50 mg q4wk. Twenty-four patients (15.9% [12.5% overall]), in whom scheduled doses of 50 mg q4wk were optimized to 100 mg q4wk before week 14, compose the study population. At week 14, 16 patients (66.7%, 95% CI 45.7-87.6) had clinical response, of these 12 were corticosteroid free. Four patients (16.7%) achieved corticosteroid-free remission. After a median follow-up of 12 months (IQR 10-22), 13 patients (54.2%) maintained clinical benefit. Thirteen of 16 patients (81.2%) with clinical response at week 14 maintained clinical benefit at last follow-up. All patients avoided colectomy. In none of the patients was golimumab dose de-escalated. There were no adverse events leading to golimumab withdrawal. Conclusion: Early optimization of golimumab dose induces clinical response at week 14 in two thirds of UC patients and leads to long-term clinical benefit in over half of patients.
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Affiliation(s)
- Carlos Taxonera
- a Department of Gastroenterology, Inflammatory Bowel Disease Unit , Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC) , Madrid , Spain
| | - Marisa Iborra
- b Department of Gastroenterology and CIBERehd , Hospital Universitario La Fe , Valencia , Spain
| | - Marta Maia Bosca-Watts
- c Department of Gastroenterology, Inflammatory Bowel Disease Unit , Hospital Clínico de Valencia , Valencia , Spain
| | - Saioa Rubio
- d Department of Gastroenterology , Complejo Hospitalario de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona , Spain
| | - Óscar Nantes
- d Department of Gastroenterology , Complejo Hospitalario de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona , Spain
| | - Rebeca Higuera
- e Department of Gastroenterology , Hospital Urduliz , Vizcaya , Spain
| | - Federico Bertoletti
- f Department of Gastroenterology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | | | | | - Noemí Manceñido
- i Department of Gastroenterology , Hospital Universitario Infanta Sofía, San Sebastián de los Reyes , Madrid , Spain
| | - José Lázaro Pérez-Calle
- j Department of Gastroenterology , Hospital Universitario Fundación Alcorcón , Madrid , Spain
| | - Alicia Algaba
- k Department of Gastroenterology , Hospital Universitario de Fuenlabrada , Madrid , Spain
| | - David Olivares
- a Department of Gastroenterology, Inflammatory Bowel Disease Unit , Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC) , Madrid , Spain
| | - Cristina Alba
- a Department of Gastroenterology, Inflammatory Bowel Disease Unit , Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC) , Madrid , Spain
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13
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Barreiro-de Acosta M, Marín-Jiménez I, Panadero A, Guardiola J, Cañas M, Gobbo Montoya M, Modino Y, Alcaín G, Bosca-Watts MM, Calvet X, Casellas F, Chaparro M, Fernández Salazar L, Ferreiro-Iglesias R, Ginard D, Iborra M, Manceñido N, Mañosa M, Merino O, Rivero M, Roncero O, Sempere L, Vega P, Zabana Y, Mínguez M, Nos P, Gisbert JP. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) and the Association of Crohn's Disease and Ulcerative Colitis Patients (ACCU) in the management of psychological problems in Inflammatory Bowel Disease patients. Gastroenterol Hepatol 2017; 41:118-127. [PMID: 29275001 DOI: 10.1016/j.gastrohep.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/05/2017] [Accepted: 10/18/2017] [Indexed: 02/07/2023]
Abstract
AIMS To establish recommendations for the management of psychological problems affecting patients with inflammatory bowel disease (IBD). METHODS A meeting of a group of IBD experts made up of doctors, psychologists, nurses and patient representatives was held. The following were presented: 1) Results of a previous focal group, 2) Results of doctor and patient surveys, 3) Results of a systematic review of tools for detecting anxiety and depression. A guided discussion was then held about the most important psychological and emotional problems associated with IBD, appropriate referral criteria and situations to be avoided. The validated instrument most applicable to clinical practice was selected. A recommendations document and a Delphi survey were designed. The survey was sent to the group and to a scientific committee of the GETECCU group in order to establish the level of agreement with these recommendations. RESULTS Fifteen recommendations were established linked to 3 key processes: 1) What steps should be taken to identify psychological problems at an IBD appointment; 2) What are the criteria for referring patients to a mental health specialist; 3) How to approach psychological problems. CONCLUSIONS Resources should be made available to healthcare professionals so that they can treat these problems during consultations, identify the disorders which could affect the clinical course of the disease and determine their impact on the patient's life in order that these can be treated and followed up by the most suitable professional. These recommendations could serve as a basis for redesigning IBD services or processes and as justification for the training of healthcare personnel.
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Affiliation(s)
- Manuel Barreiro-de Acosta
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Complexo Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - Ignacio Marín-Jiménez
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato digestivo e Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital Gregorio Marañón, Madrid, España
| | | | - Jordi Guardiola
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato digestivo, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Mercedes Cañas
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Clínico San Carlos, Madrid, España
| | | | - Yolanda Modino
- Confederación de Asociaciones de Enfermos de Crohn y Colitis Ulcerosa de España (ACCU España), Madrid
| | - Guillermo Alcaín
- Unidad de Enfermedad Inflamatoria Intestinal, UGC Aparato Digestivo, Hospital Virgen de la Victoria, Málaga, España
| | | | | | - Francesc Casellas
- Unidad de Atención Crohn-Colitis, Servicio de Aparato Digestivo, Hospital Universitario Valld'Hebron, Barcelona, España
| | - María Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
| | | | - Rocío Ferreiro-Iglesias
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Complexo Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Daniel Ginard
- Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Marisa Iborra
- Hospital Universitari i Politècnic La Fe, CIBEREHD, Valencia, España
| | - Noemí Manceñido
- Servicio de Aparato Digestivo, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Miriam Mañosa
- Hospital Universitario GermansTrias i Pujol, Badalona, España
| | - Olga Merino
- Hospital Universitario de Cruces, Baracaldo, España
| | - Montserrat Rivero
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Oscar Roncero
- Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, España
| | - Laura Sempere
- Hospital General Universitario de Alicante, Alicante, España
| | - Pablo Vega
- Complexo Hospitalario Universitario de Ourense, Orense, España
| | - Yamile Zabana
- Hospital Universitario Mutua de Terrassa CIBERehd, Terrasa, España
| | - Miguel Mínguez
- Hospital Clínico Universitario de Valencia, Universitat de Valencia, Valencia, España
| | - Pilar Nos
- Hospital Universitari i Politècnic La Fe, CIBEREHD, Valencia, España
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España
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14
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Fernández-Bañares F, Casanova MJ, Arguedas Y, Beltrán B, Busquets D, Fernández JM, Fernández-Salazar L, García-Planella E, Guagnozzi D, Lucendo AJ, Manceñido N, Marín-Jiménez I, Montoro M, Piqueras M, Robles V, Ruiz-Cerulla A, Gisbert JP. Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group. Aliment Pharmacol Ther 2016; 43:400-26. [PMID: 26597122 DOI: 10.1111/apt.13477] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 09/14/2015] [Revised: 10/01/2015] [Accepted: 10/23/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Microscopic colitis (MC) is an underdiagnosed inflammatory bowel disease. AIM To develop an evidence-based clinical practice guide on MC current concepts. METHODS Literature search was done on the Cochrane Library, EMBASE and MEDLINE electronic databases, which were consulted covering the period up until March 2015. Work groups were selected for each of the reviewed topics, with the purpose of drafting the initial statements and recommendations. They subsequently underwent a voting process based on the Delphi method. Each statement/recommendation was accompanied by the result of the vote the level of evidence, and discussion of the corresponding evidence. The grade of recommendation (GR) using the GRADE approach was established for diagnosis and treatment recommendations. RESULTS Some key statements and recommendations are: advancing age increases the risk of developing MC, mainly in females. The symptoms of MC and IBS-D may be similar. If MC is suspected, colonoscopy taking biopsies is mandatory. Treatment with oral budesonide is recommended to induce clinical remission in patients with MC. Oral mesalazine is not recommended in patients with collagenous colitis for the induction of clinical remission. The use of anti-TNF-alpha drugs (infliximab, adalimumab) is recommended for the induction of remission in severe cases of MC that fail to respond to corticosteroids or immunomodulators, as an alternative to colectomy. CONCLUSIONS This is the first consensus paper on MC based on GRADE methodology. This initiative may help physicians involved in care of these patients in taking decisions based on evidence.
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Affiliation(s)
- F Fernández-Bañares
- Hospital Universitari Mutua Terrassa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - M J Casanova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - B Beltrán
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital La Fe, Valencia, Spain
| | - D Busquets
- Hospital Doctor Josep Trueta, Girona, Spain
| | - J M Fernández
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | | | | | - A J Lucendo
- Hospital General de Tomelloso, Ciudad Real, Spain
| | - N Manceñido
- Hospital Infanta Sofía, San Sebastián de los Reyes, Spain
| | - I Marín-Jiménez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - V Robles
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | - J P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
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15
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Algaba A, Guerra I, Marín-Jiménez I, Quintanilla E, López-Serrano P, García-Sánchez MC, Casis B, Taxonera C, Moral I, Chaparro M, Martín-Rodríguez D, Martín-Arranz MD, Manceñido N, Menchén L, López-Sanromán A, Castaño Á, Bermejo F. Incidence, management, and course of cancer in patients with inflammatory bowel disease. J Crohns Colitis 2015; 9:326-33. [PMID: 25687203 DOI: 10.1093/ecco-jcc/jjv032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease [IBD] are at increased risk for developing some types of neoplasia. Our aims were to determin the risk for cancer in patients with IBD and to describe the relationship with immunosuppressive therapies and clinical management after tumor diagnosis. METHODS Retrospective, multicenter, observational, 5-year follow-up, cohort study. Relative risk [RR] of cancer in the IBD cohort and the background population, therapeutic strategies, and cancer evolution were analyzed. RESULTS A total of 145 cancers were diagnosed in 133 of 9100 patients with IBD (global cumulative incidence 1.6% vs 2.4% in local population; RR = 0.67; 95% confidence interval [CI]: 0.57-0.78). Patients with IBD had a significantly increased RR of non-melanoma skin cancer [RR = 3.85; 2.53-5.80] and small bowel cancer [RR = 3.70; 1.23-11.13]. After cancer diagnosis, IBD treatment was maintained in 13 of 27 [48.1%] patients on thiopurines, in 2 of 3 on methotrexate [66.6%], none on anti-TNF-α monotherapy [n = 6] and 4 of 12 [33.3%] patients on combined therapy. Rate of death and cancer remission during follow-up did not differ [p > 0.05] between patients who maintained the treatment compared with patients who withdrew [5% vs 8% and 95% vs 74%, respectively]. An association between thiopurines [p = 0.20] or anti-TNF-α drugs [p = 0.77] and cancer was not found. CONCLUSIONS Patients with IBD have an increased risk for non-melanoma skin cancer and small bowel cancer. Immunosuppresive therapy is not related to a higher overall risk for cancer or worse tumor evolution in patients who maintain these drugs after cancer diagnosis.
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Affiliation(s)
- Alicia Algaba
- Departments of Gastroenterology: Hospital Universitario de Fuenlabrada
| | - Iván Guerra
- Departments of Gastroenterology: Hospital Universitario de Fuenlabrada
| | | | | | | | | | | | | | | | - María Chaparro
- Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa [IP] and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD]
| | | | | | | | | | | | - Ángel Castaño
- Department of Pathology. Hospital Universitario de Fuenlabrada; Madrid, Spain
| | - Fernando Bermejo
- Departments of Gastroenterology: Hospital Universitario de Fuenlabrada
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16
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Guerra I, Algaba A, Pérez-Calle JL, Chaparro M, Marín-Jiménez I, García-Castellanos R, González-Lama Y, López-Sanromán A, Manceñido N, Martínez-Montiel P, Quintanilla E, Taxonera C, Villafruela M, Romero-Maté A, López-Serrano P, Gisbert JP, Bermejo F. Induction of psoriasis with anti-TNF agents in patients with inflammatory bowel disease: a report of 21 cases. J Crohns Colitis 2012; 6:518-23. [PMID: 22398059 DOI: 10.1016/j.crohns.2011.10.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [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: 09/06/2011] [Revised: 10/19/2011] [Accepted: 10/19/2011] [Indexed: 12/15/2022]
Abstract
AIM Anti-tumor necrosis factor (TNF)-alpha agents are widely used for the treatment of both inflammatory bowel disease (IBD) and psoriasis. Psoriatic skin lesions induced by anti-TNF have been described in patients with IBD. We report a case series of psoriasis induced by anti-TNF agents in IBD patients. METHODS Systematic analysis of cases of psoriasis induced by anti-TNF in an IBD patient cohort in tertiary hospitals of Madrid. RESULTS A total of 21 of 1294 patients with IBD treated with anti-TNF-alpha agents developed drug-induced psoriasis (cumulative incidence 1.62%; 95% CI 1.06%-2.47%): 14 patients with infliximab and 7 with adalimumab; seventeen with Crohn's disease, 4 with ulcerative colitis. The onset of skin lesions varied in a wide range of time (after a mean 13±8 doses). The most frequent site of skin lesions was the limbs (62%) followed by the trunk (48%) and the scalp (43%). The psoriasis phenotypes were plaque psoriasis (57%), scalp (14%), palmoplantar pustulosis (14%), pustular generalized psoriasis (5%), guttate (5%) and inverse (5%). Four patients interrupted the anti-TNF treatment, and that led to the complete regression of lesions in 1 of them. The other 17 patients were maintained on anti-TNF therapy and managed with topical steroids. CONCLUSION Psoriatic lesions can be induced by anti-TNF drugs. Plaque psoriasis on the extremities and trunk were the most frequent presentations in our series. Topical steroid treatment is effective in most patients. Anti-TNF discontinuance may be reserved for patients with severe psoriasis or patients without response to topical therapy.
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Affiliation(s)
- Iván Guerra
- Digestive Diseases Department, Hospital de Fuenlabrada, Spain.
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17
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González-Lama Y, Bermejo F, López-Sanromán A, García-Sánchez V, Esteve M, Cabriada JL, McNicholl AG, Pajares R, Casellas F, Merino O, Carpio D, Vera MI, Muñoz C, Calvo M, Benito LM, Bujanda L, García-Fernández FJ, Ricart E, Ginard D, Velasco M, Carneros JA, Manceñido N, Calvo M, Algaba A, Froilan C, Cara C, Maté J, Abreu L, Gisbert JP. Thiopurine methyl-transferase activity and azathioprine metabolite concentrations do not predict clinical outcome in thiopurine-treated inflammatory bowel disease patients. Aliment Pharmacol Ther 2011; 34:544-54. [PMID: 21722149 DOI: 10.1111/j.1365-2036.2011.04756.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low thiopurine-methyl-transferase (TPMT) activity and high 6-thioguanine-nucleotide (6TGN) concentrations have been linked to therapeutic success in inflammatory bowel disease patients treated with thiopurines; however, this has not been implemented in clinical practice. AIM To identify a therapeutic threshold value for TPMT or 6TGN concentrations, and their capability to predict treatment safety and efficacy. METHODS Prospective multicentre study including steroid-resistant/dependent patients starting thiopurines. The TPMT activity was determined at inclusion (>5 U/mL required). Azathioprine metabolites [6TGN, 6-methyl-mercaptopurine ribonucleotides (6MMP), and 6TGN/6MMP and 6TGN/TPMT ratios] were periodically monitored during steroid tapering and after withdrawal for 6 months or until a new flare occurred. RESULTS A total of 113 patients were analysed (62% clinical response). Areas under the receiver operating characteristic (ROC) curve (AUC) relating clinical response and metabolite levels at 2, 4 and 6 months after steroid withdrawal were less than 0.7. The AUCs relating final response and initial TPMT activity or metabolite concentrations at 2, 4, 8 and 16 weeks after starting thiopurines were less than 0.7. No cut-off point with worthwhile sensitivity/specificity was found. Eight (7%) patients developed thiopurine-related toxicity that could not be linked to TPMT activity or 6TGN levels. CONCLUSIONS Our results do not support determination of TPMT activity or 6TGN concentrations to predict treatment outcome, and no useful serum metabolites threshold value to adjust the drug's dose was identified.
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Affiliation(s)
- Y González-Lama
- La Princesa and Instituto de Investigación Sanitaria Princesa, Madrid, Spain
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18
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Casado E, García VM, Sánchez JJ, Blanco M, Maurel J, Feliu J, Fernández-Martos C, de Castro J, Castelo B, Belda-Iniesta C, Sereno M, Sánchez-Llamas B, Burgos E, García-Cabezas MÁ, Manceñido N, Miquel R, García-Olmo D, González-Barón M, Cejas P. A combined strategy of SAGE and quantitative PCR Provides a 13-gene signature that predicts preoperative chemoradiotherapy response and outcome in rectal cancer. Clin Cancer Res 2011; 17:4145-54. [PMID: 21467161 DOI: 10.1158/1078-0432.ccr-10-2257] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Preoperative chemoradiotherapy (CRT) is the treatment of choice for rectal cancer (RC), but half of the patients do not respond, suffer unnecessary toxicities, and surgery delays. We aimed to develop a model that could predict a clinically meaningful response to CRT by using formalin-fixed paraffin-embedded (FFPE) biopsies. EXPERIMENTAL DESIGN We first carried out an exploratory screening of candidate genes by using SAGE technology to evaluate dynamic changes in the RC transcriptome in selected refractory patients before and after CRT. Next, 53 genes (24 from SAGE and 29 from the literature) were analyzed by qPCR arrays in FFPE initial biopsies from 94 stage II/III RC patients who were preoperatively treated with CRT. Tumor response was defined by using Dworak's tumor regression grade (2-3-4 vs. 0-1). Multivariate Cox methods and stepwise algorithms were applied to generate an optimized predictor of response and outcome. RESULTS In the training cohort (57 patients), a 13-gene signature predicted tumor response with 86% accuracy, 87% sensitivity, and 82% specificity. In a testing cohort (37 patients), the model correctly classified 6 of 7 nonresponders, with an overall accuracy of 76%. A signature-based score identified patients with a higher risk of relapse in univariate (3-year disease-free survival 64% vs. 90%, P = 0.001) and multivariate analysis (HR = 4.35 95% CI: 1.2-15.75, P = 0.02), in which it remained the only statistically significant prognostic factor. CONCLUSIONS A basal 13-gene signature efficiently predicted CRT response and outcome. Multicentric validation by the GEMCAD collaborative group is currently ongoing. If confirmed, the predictor could be used to improve patient selection in RC studies.
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Affiliation(s)
- Enrique Casado
- Unidad de Oncología; Unidad de Gastroenterología, Hospital Infanta Sofía, Spain.
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19
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Lucendo AJ, Castillo P, Martín-Chávarri S, Carrión G, Pajares R, Pascual JM, Manceñido N, Erdozain JC. Manometric findings in adult eosinophilic oesophagitis: a study of 12 cases. Eur J Gastroenterol Hepatol 2007; 19:417-24. [PMID: 17413294 DOI: 10.1097/meg.0b013e328010bd69] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [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: 01/22/2023]
Abstract
OBJECTIVE To describe the manometric findings detected in adult patients with dysphagia that were diagnosed of eosinophilic oesophagitis, and to compare with the cases of eosinophilic infiltration of the oesophagus reported in the literature. PATIENTS AND METHODS We present 12 adult patients diagnosed as suffering from this disorder in our department in a 1.5-year period, according to histological criteria and discarding any other cause of eosinophilic infiltration of the oesophagus. Stationary oesophageal manometry using a hydropneumocapillary perfusion system was performed in every case. The recommendations of the Spanish Group of Digestive Motility were followed for the interpretation of the results. In seven patients who presented motor disorder in manometric evaluation, treatment with steroid oesophageal lavage using fluticasone propionate was carried out and these patients were subsequently re-evaluated. RESULTS All patients were young predominantly men, and the first endoscopic examination showed regular concentric stenosis or a 'ring oesophagus'. Six patients had a severe nonspecific oesophageal motor disorder characterized by up to 80% of nontransmitted or very low-amplitude waves in the lower two-thirds of the organ. Three patients presented a manometric disturbance characterized by hyperkinetic peristaltic waves in distal oesophageal third. One patient had an alteration of the oesophageal motor dynamics characterized by 80% of deglutory complexes formed by a primary simultaneous wave in the two lower oesophageal thirds followed by a secondary peristaltic wave in 50% of cases that had a normal duration and amplitude. The remaining two patients had normal oesophageal motility. The upper oesophageal sphincter showed no alterations, and the manometric evaluation of the lower oesophageal sphincter tone proved normal in 10 patients, with slight hypotension in two cases. In seven of the nine patients who presented an oesophageal motor disorder, treatment with steroid oesophageal lavage using fluticasone propionate was administered and a new oesophageal manometry was performed afterwards, in which the motor disorder was clearly improved as soon as dysphagia, endoscopic lesions and histopathologic alteration disappeared. DISCUSSION In the literature, 61 cases of eosinophilic infiltration of the oesophageal mucosa subjected to oesophageal manometric study had been described, and 60.6% of them showed evidence of different types of manometric alterations, mainly with spastic or hypercontractility characteristics. Although six of our cases showed very deficient peristalsis with very low-amplitude or nontransmitted waves, and in another three high-amplitude peristaltic waves were recorded. Motor disorders improved parallel to the disappearance of the eosinophilic infiltration of the mucosa. These data suggest that motor disorders in eosinophilic oesophagitis are a consequence of eosinophil infiltration of the oesophagus and should be considered in the differential diagnosis of dysphagia. These manometric alterations could be considered as primary nonspecific disorders and included in the 'ineffective oesophageal motility' group.
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Affiliation(s)
- Alfredo J Lucendo
- Department of Gastroenterology, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain.
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20
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Casado E, Cejas P, de Castro J, Vaquez P, Sanchez B, Feliu Belda J, Singh B, Castelo Ja Fresno B, Manceñido N, Perona R, Gonzalez Baron M. Dynamic evaluation of tumoral transcriptome for a blind study of mechanisms of chemoradiotherapy resistance in rectal cancer patients. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Casado
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - P. Cejas
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - J. de Castro
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - P. Vaquez
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - B. Sanchez
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - J. Feliu Belda
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - B. Singh
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - B. Castelo Ja Fresno
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - N. Manceñido
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - R. Perona
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
| | - M. Gonzalez Baron
- Servicio de Oncologia Medica, Hosp La Paz, Madrid, Spain; Hosp La Paz, Madrid, Spain; Inst del Cancer, Jalisco, Mexico; Oxford Univ, Oxford, United Kingdom; Inst de Investigaciones Biomed AS, Madrid, Spain
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Hervías D, Turrión JP, Herrera M, Navajas León J, Pajares Villarroya R, Manceñido N, Castillo P, Segura JM. Diffuse cavernous hemangioma of the rectum: an atypical cause of rectal bleeding. Rev Esp Enferm Dig 2004; 96:346-52. [PMID: 15180446 DOI: 10.4321/s1130-01082004000500008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE cavernous hemangioma of the rectosigmoid colon is a rare disease, with no more than 200 cases reported in the literature. The rectosigmoid is the most common site of this disease in the gastrointestinal tract. CASE REPORT we report the case of a 31-year-old male with recurrent episodes of rectal bleeding, who was finally diagnosed of diffuse cavernous hemangioma of the rectum. The tumor, of 12 x 10 x 9 cm in size, occupied the rectum to the margin of the anal sphincter. A surgical procedure was ruled out because of the inability to carry out a safe anastomosis while preserving anal sphincters. DISCUSSION rectal hemangiomas are less frequent vascular malformations. The clinical presentation of a cavernous hemangioma of the rectum is usually acute, recurrent or chronic rectal bleeding. Other symptoms stem from the possible compression or invasion of adjacent structures, such as lumbar or perianal pain, metrorrhage, hematuria, etc. This diagnosis is commonly made in younger patients. Colonoscopy is without doubt the diagnostic technique of choice, and it allows to establish the localization, morphology, and total extension of the lesion; its characteristic image is a red-purplish nodule with great vascular congestion. According to the opinion of most authors, biopsy is not advisable during colonoscopy, since imaging techniques are sufficient for an accurate diagnosis, and the risk of bleeding while manipulating this lesion is not negligible. Computed tomography and particularly magnetic resonance imaging, given their high precision to delimit the lesion and its relations to adjacent structures, are imaging studies that are mandatory before surgical treatment. Other techniques such as selective angiography, barium enema, gastrointestinal transit, and upper-tract endoscopy may be supplementary and help locate more lesions along the gastrointestinal tract. Failure to recognize the exact diagnosis and extent of diffuse cavernous hemangioma may lead to failed surgical treatment and severe complications. Complete surgical excision of the lesion with a sphincter-saving procedure is the primary mode of treatment: conservative proctectomy with coloanal anastomosis.
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Affiliation(s)
- D Hervías
- Service of Digestive Diseases, Hospital Universitario La Paz, Madrid, Spain.
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22
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Herruzo R, Chamorro L, García ME, González MC, López AM, Manceñido N, Yébenes L. Prevalence and antimicrobial-resistance of S. pneumoniae and S. pyogenes in healthy children in the region of Madrid. Int J Pediatr Otorhinolaryngol 2002; 65:117-23. [PMID: 12176181 DOI: 10.1016/s0165-5876(02)00145-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED Streptococcus pneumoniae and Streptococcus pyogenes are common agents of respiratory or ORL pathology. Pneumococcus sensitivity has progressively decreased to penicillin and other antimicrobial agents, mainly in south of Europe, but this resistance report can be erroneous by a selection bias, because they sampled only hospital cases. OBJECTIVES To determine the prevalence, antimicrobial susceptibility and risk factors of S. pneumoniae and S. pyogenes in healthy children under 5 years of age who go to infant school. SUBJECT AND METHODS Cross sectional study in six infant schools. An epidemiological inquiry (risk factors of carrier state) was filled out and a nasopharyngeal specimen was taken from each child, S. pneumoniae and S. pyogenes were identified and antimicrobial tests were performed. RESULTS We have studied 156 children with a mean age of 2.24 (standard deviation (S.D.), 0.85) and 58% have been treated with antibiotic in the last 3 months. The prevalence of S. pneumoniae or S. pyogenes were 12.2 and 5.1%, respectively. S. pyogenes only was isolated in two schools. Age was associated with S. pyogenes carrier but the rest of studied factors have no statistical significance with both microorganisms. All the S. pneumoniae showed resistance to one or more antibiotic (mainly to clavunate-amoxycillin: 94.7%), while S. pyogenes only was resistant to clavunate-amoxycillin. CONCLUSION Healthy children (0-4 years) with antibiotherapy in last 3 months have a great frequency of resistant S. pneumoniae. It is necessary to reduce the antibiotic use at home (Medical education).
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Affiliation(s)
- R Herruzo
- Departamento de Medicina Preventiva, Universidad Autonoma de Madrid, C/Arzobispo Morcillo number 4, 28029 Madrid, Spain.
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