RESUMEN
BACKGROUND: The treatment of severe ulcerative colitis (UC) flares includes measures such as hospitalization and intravenous steroids. Despite this, a quarter of patients are refractory to treatment. Given the availability of new therapeutic strategies in patients with steroid-refractory UC (cyclosporine, infliximab, apheresis, surgery) it is necessary to predict which treatment will be most effective for each patient. OBJECTIVES: To determine which clinical or biological factors discriminate the lack of response to cyclosporine in steroid-refractory UC. METHODS: Forty one flares of steroid-refractory UC in 35 patients treated with intravenous cyclosporine have been included. The response to cyclosporine was assessed at day 10 of treatment by using the modified Truelove and Witts disease activity score. Variables with prognostic significance were determined by a univariate analysis comparing groups with complete response and no-response, and an analysis of multiple linear regression. RESULTS: Complete response was obtained in 41 flares (48%), partial response in 22%, and lack of response in 29%. The univariate analysis showed a significant difference in four predictive factors: higher age (p = 0.008), thrombocytosis (p = 0.01), disease extent (pancolitis vs. left-sided disease (p = 0.04)), and having received cyclosporine previously (p = 0.01). A multiple linear regression analysis confirmed the significance of higher age, thrombocytosis, and having received cyclosporine previously as predictive factors of poor response. CONCLUSION: Higher age, thrombocytosis and previous use of cyclosporine predispose to poor response to intravenous cyclosporine in severe flares of steroid-refractory UC.
Asunto(s)
Colitis Ulcerosa/tratamiento farmacológico , Ciclosporina/administración & dosificación , Inmunosupresores/administración & dosificación , Corticoesteroides/uso terapéutico , Adulto , Femenino , Predicción , Humanos , Inyecciones Intravenosas , Masculino , Insuficiencia del TratamientoRESUMEN
UNLABELLED: Iron deficiency may be the only presenting sign of malabsorption due to the presence of intestinal villous atrophy. Once gastrointestinal blood losses have been excluded, intestinal malabsorption should be investigated. OBJECTIVES: To determine the utility of jejunal biopsy in the evaluation of iron deficiency due to a defective absorption and the different diseases that may cause malabsortive iron deficiency. METHODS: Seventy patients with iron deficiency (ferritin<25 ng/ml), referred to the Unitat de Proves Funcionals Digestives to perform a jejunal biopsy were included. Jejunal biopsy was obtained distal to Treitz with a Watson capsule. Histological changes were classified according to the criteria proposed by Marsh. RESULTS: Jejunal biopsy was performed in 66 patients. Histology was normal in 25, unespecific in 1, showed inflammatory infiltrate in 12, hyperplastic changes in 2 and atrophy in 25. In one patient showed intestinal giardiasis. The clinical diagnosis was celiac sprue in 21 patients (32%), aclorhydria in 7 (10.5%), bacterial overgrowth in 1 (1.5%), intestinal giardiasis in 1 (1.5%), menstrual blood loss in 1 (1.5%) and 35(53%) patients remained without a definitive diagnosis. CONCLUSIONS: Jejunal biopsy is useful in the evaluation of iron deficiency due to intestinal malabsorption and reveals intestinal abnormalities in a significant number of cases.
Asunto(s)
Aclorhidria/complicaciones , Anemia Hipocrómica/etiología , Enfermedad Celíaca/complicaciones , Deficiencias de Hierro , Yeyuno/patología , Aclorhidria/diagnóstico , Aclorhidria/patología , Adulto , Anemia Hipocrómica/epidemiología , Atrofia , Biopsia , Enfermedad Celíaca/diagnóstico , Enfermedad Celíaca/patología , Femenino , Ferritinas/sangre , Humanos , Mucosa Intestinal/ultraestructura , Hierro/farmacocinética , Masculino , Microvellosidades/ultraestructura , España/epidemiologíaRESUMEN
La ferropenia puede ser la única manifestación de un síndrome malabsortivo, secundario a la presencia de una atrofia intestinal. Por ello, descartadas las pérdidas gastrointestinales, debería tenerse en cuenta esta posibilidad en el estudio de la ferropenia. Objetivos: Evaluar la utilidad de la biopsia yeyunal en el diagnóstico de la malabsorción intestinal como causa de ferropenia y analizar cuales son las causas de ferropenia malabsortiva. Método: Se han incluido 70 pacientes con ferropenia (ferritina < 25 ng/ml) remitidos a la Unitat de Proves Funcionals Digestives, para la valoración de una posible malabsorción intestinal mediante la realización de una biopsia yeyunal. La biopsia yeyunal se obtuvo distal al ángulo de Treitz mediante cápsula de Watson. Se clasificaron los resultados histológicos según los criterios de Marsh. Resultados: La biopsia yeyunal se realizó en 66 pacientes. Fue normal en 25 pacientes, inespecífica en 1, en 12 se evidenciaron lesiones grado 1 (infiltrado linfocitario), en 2 lesiones grado 2 (hiperplasia de criptas) y en 25 lesiones grado 3 (atrofia). En otro paciente se objetivó una giardiasis intestinal. El diagnóstico clínico de los pacientes incluídos fue de enfermedad celíaca en 21 (32 por ciento), aclorhidria en 7 (10,5 por ciento), sobrecrecimiento bacteriano en 1 (1,5 por ciento), giardiasis intestinal en otro (1,5 por ciento), pérdidas ginecológicas en otra (1,5 por ciento) y 35 (53 por ciento) quedaron sin diagnóstico definitivo. Conclusiones: La biopsia yeyunal es una prueba útil en el diagnóstico de malabsorción como causa de ferropenia, permitiendo poner de manifiesto la existencia de patología intestinal en un alto porcentaje de casos (AU)