J.R. Pineda

Safety and effectiveness of gastric balloons associated with hypocaloric diet for the treatment of obesity

Introducción: el balón gástrico produce saciedad precoz favoreciendo la pérdida de peso en un corto plazo de tiempo. El objetivo de este estudio fue evaluar la seguridad y la efectividad del tratamiento mediante balón gástrico y dieta hipocalórica en la obesidad. Material y métodos: estudio de cohortes prospectivo en 91 pacientes obesos sometidos a balón gástrico durante 6 meses. Como criterio de efectividad se consideró el porcentaje de peso perdido (PPP) ≥ 5 % 6 meses tras su colocación y 6 y 12 meses tras su retirada. Analizamos los resultados por intención de tratar, considerando significativos los valores de p < 0,05. Resultados: empleamos 73 balones rellenos de líquido (80,2 %) y 18 de aire (19,8 %). Tras 6 meses un 73,7 % de pacientes alcanzó el objetivo terapéutico mostrando descenso de peso (13,3 ± 8,8 kg) e IMC (5 ± 3,4 kg/m2) (p < 0,0001), con PPP 11 ± 7 %. Transcurridos 6 y 12 meses de la retirada un 45,1 % y 28,6 % mantenían un PPP ≥ 5 %. La efectividad a corto y medio plazo se asoció negativamente con obesidad en familiares (p = 0,003 y p = 0,04). La pérdida ponderal lograda tras 6 meses se asoció con efectividad a medio plazo (p = 0,0001). No existió mortalidad, observando 2 desinflados espontáneos y 8 retiradas complicadas, requiriendo cirugía 1 paciente. Los balones rellenos de aire presentaron más complicaciones (p = 0,0005). Conclusiones: la efectividad del tratamiento combinando balón gástrico y dieta hipocalórica en la obesidad disminuye a lo largo del tiempo. Las complicaciones ocurrieron mayoritariamente durante la retirada endoscópica y con el empleo de balones rellenos de aire.INTRODUCTION intragastric balloons provide early satiety and thereby induce short-term weight loss. The aim of this study was to evaluate safety and short and medium-term effectiveness of gastric balloons associated to hypocaloric diet in obesity. MATERIAL AND METHODS from May 2004 to June 2011 91 obese patients, body mass index (BMI) 45.2 +/- 7.2 kg/m2 were prospectively followed after endoscopic implantation of a gastric balloon associated to restricted diet. Successful therapy was defined as percent loss of total weight (%LTW) > or = 5 % at six months after balloon placement and 6 and 12 months after their withdrawal. All analyses followed intention-to treat principles considering significant p-values < 0.05. RESULTS we placed 73 fluid-filled balloons (80.2 %) and 18 air-filled ones (19.8 %). Compared to baseline values, at 6-month 73.7 % subjects succeeded, showing significant reductions in weight (13.3 +/- 8.8 kg), BMI (5 +/- 3.4 kg/m2) (p < 0.0001), with % LTW 11 +/- 7 %. Six and twelve months after retrieval 45.1 % and 28.6 % patients reached % LTW > or = 5 %. Short-term and medium-term effectiveness was negatively associated to obesity in first-grade relatives (p = 0.003 and p = 0.04). Higher weight loss 6 months after balloon placement independently predicted medium-term effectiveness (p = 0.0001). Mortality was absent but there were two spontaneous deflations of air-filled balloons and severe withdrawal difficulties in 8 patients, leading to surgery in one case. Retrieval complications associated to air-filled balloons (p = 0.0005). CONCLUSIONS in obesity, effectiveness of gastric balloons associated to hypocaloric diet decreases over time.Complications occurred mainly in the retrieval endoscopic procedure and related to air-filled balloons.

Incidence and phenotype at diagnosis of inflammatory bowel disease. Results in Spain of the EpiCom study

INTRODUCTION Incidence of inflammatory bowel disease (IBD) is increasing progressively. Few recent epidemiological prospective studies are available in Spain. The Epicom study, a population-based inception cohort of unselected IBD patients developed within the European Crohns and Colitis Organization, was started in 2010. Vigo is the only Spanish area participating. OBJECTIVE To describe the incidence of IBD in the Vigo area and the phenotypical characteristics at diagnosis and to compare them with previous data available in Spain. MATERIAL AND METHODS Epidemiological, descriptive, prospective, and population-based study. All incident cases of IBD during 2010 and living in the Vigo area at diagnosis were included. The Copenhagen Diagnostic criteria were used to define cases. Background population at the start of the study was 579,632 inhabitants. Data were prospectively entered in the EpiCom database. RESULTS A total of 106 patients were included (57.5% men, median age 39.5 years). Of them 53 were diagnosed of as Crohns disease (CD), 47 ulcerative colitis (UC) and six IBD unclassified (IBDU). The incidence rate per 100,000 per year for patients aged 15 years or older was 21.4 (10.8 for CD, 9.4 for UC, 1.2 IBDU). Including pediatric population incidence rates were 18.3 (10.3 CD, 8.7 UC, 1.2 IBDU). Median time since onset of symptoms until diagnosis was 2 months. CONCLUSIONS The incidence rate of IBD in Vigo is the highest compared to former Spanish cohorts, especially in CD patients. Median time since onset of symptoms until diagnosis is relatively short.

A comparative study of two histological techniques for the identification of cytomegalovirus infection in colorectal biopsies from patients with chronic inflammatory bowel disease

BACKGROUND the role that cytomegalovirus (CMV) plays in inflammatory bowel disease (IBD) is controversial. The diagnosis of CMV infection in IBD depends on viral identification with hematoxylin-eosin (HE) or immunohistochemistry (IHC). Our aim was to compare the sensitivity of HE and IHC for this diagnosis in IBD patients. PATIENTS AND METHODS a case-control study. Our database was searched for IBD patients with HE- or IHC-based CMV-positivity from 1997 to 2007. Controls were selected among IBD inpatients matched for age and year of diagnosis with CMV. Their clinical characteristics were analyzed. HE and IHC were performed on biopsies from cases and controls at 6 months before and after inclusion in the study. In the statistical analysis, p values below 0.05 were considered significant. RESULTS ten IBD patients with CMV infection were identified. IBD-CMV patients were more steroid-resistant or steroid-dependent (p = 0.03), and underwent a higher number of colonic biopsies (p = 0.03). From 97 biopsies analyzed, 12 were HE-negative and IHC-positive, and 3 showed reversed results. The sensitivity of HE was 58.6%, 95% CI (38.9-78.3), and that of IHC was 89.7%, 95% CI (76.8-100). We did not find a good level of agreement between both techniques: kappa value 0.55, 95% CI (0.36-0.75). CMV positivity with IHC was associated with the use of more than one immunosuppressant drug, OR 13.5, 95%CI (1.2-152.2). Antiviral treatment was useful for CMV patients with steroid-dependent and steroid-refractory IBD. CONCLUSIONS IHC shows a 30% higher sensitivity than HE for the diagnosis of CMV infection in IBD patients. There is no good level of agreement between both histological techniques.

Metaplasia intestinal en la unión esofagogástrica.Prevalencia y asociaciones en una población sometida a endoscopia

Objetivo La metaplasia intestinal (MI) de segmento corto en la union gastroesofagica es una entidad muy controvertida. Diversos estudios han comunicado amplias variaciones en su prevalencia y en los factores asociados con su desarrollo. Recientemente se diferencia entre MI esofagica y MI cardial, asumiendo una etiopatogenia y un pronostico diferentes. Pretendemos estudiar la prevalencia de esta entidad en nuestro medio y su asociacion con la enfermedad por reflujo gastroesofagico (ERGE) y con la infeccion por Helicobacter pylori. Metodos En 161 pacientes se obtuvieron biopsias en el esofago distal (2), bajo la linea Z (3) y en el antro gastrico (3) y se midieron las distancias desde los incisivos a la linea Z (ILZ) y a la union gastroesofagica (IEG). La presencia de celulas caliciformes positivas con azul alcian-PAS fue diagnostica de MI, clasificandose como MI esofagica si ILZ Resultados Presentaban MI 74 pacientes (46%), correspondiendo a 33 sujetos con metaplasia esofagica (20,5%) y 41 casos de metaplasia cardial (25,4%). La presencia de MI en la union gastroesofagica se asocio con la edad (p = 0,007) y a la toma de inhibidores de la bomba de protones (p = 0,004). No encontramos ninguna relacion entre la ERGE (clinica, endoscopica o histologica) y la presencia de MI esofagica o cardial. La infeccion por H. pylori no se asocio con la presencia de MI en el cardias, aunque si con una menor frecuencia de lesiones esofagicas por reflujo. La pH-metria ORIGINALES de 24 h no detecto diferencias en la exposicion acida entre los pacientes con MI esofagica o cardial. Conclusiones La existencia de segmentos cortos de metaplasia intestinal en la union esofagogastrica es frecuente en la poblacion sometida a endoscopia, y su relacion con la edad sugiere un origen adquirido para esta lesion. No encontramos ninguna asociacion entre MI esofagica y ERGE, evaluada mediante clinica, endoscopia, histologia o cuantificacion del pH intraesofagico. La infeccion por H. pylori no se asocio con la presencia de MI cardial.

European experience with methotrexate treatment in Crohn's disease: a multicenter retrospective analysis.

Introduction Methotrexate (MTX) has been utilized for the treatment of Crohn’s disease (CD) for decades. Nevertheless, current data provide equivocal evidence on the efficacy of MTX in CD. The aims of this study were to describe the efficacy of MTX for maintenance of remission in CD and to identify the factors associated with the probability of steroid-free clinical remission in a multicenter European referral center cohort. Patients and methods This was a retrospective cohort analysis. Consecutive patients treated with MTX for CD were included from 11 referral centers. Patients receiving concomitant treatment with tumor necrosis factor inhibitors or thiopurines were excluded. The main outcome was steroid-free clinical remission; the secondary outcomes included the rate of complications leading to MTX discontinuation and duration of relapse-free survival in patients achieving the main outcome. Results Between July 1992 and January 2012, 118 patients were identified for inclusion. MTX administration route was oral for induction in 31.4% and for maintenance in 49.1% of the patients. Steroid-free remission was achieved in 44/118 (37.2%) patients and was maintained relapse free by 28/44 (63.6%) for a median of 12 (3.5–18.5) months. At least one adverse effect was reported by 28.9% of the patients. No clinical or demographic factors were associated with either likelihood of achieving a clinical response or duration of relapse-free survival. Conclusion MTX treatment induced steroid-free clinical remission in over a third of CD patients and maintained it for a year in almost two-thirds of the responders. MTX should be considered a viable therapeutic option in CD patients refractory to other therapies.