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Introduction: The possibility of developing idiopathic portal hypertension has been described with thiopurine treatment despite compromises the prognosis of these patients, the fact its true prevalence is unknown. Material and methods: A cross-sectional study was conducted in a cohort of inflammatory bowel disease (IBD) patients followed at our unit, to determine the prevalence of diagnosis of idiopathic portal hypertension (IPH) and its relationship with thiopurine treatment. Results: At the time of the analysis, 927/1,419 patients were under treatment with thiopurine drugs (65%). A total of 4 patients with IBD type Crohn's disease with idiopathic portal hypertension probably related to the thiopurine treatment were identified (incidence of 4.3 cases per 1,000). Seventy-five percent of patients started with signs or symptoms of portal hypertension. Only one patient was asymptomatic but the diagnosis of IPH because of isolated thrombocytopenia is suspected. However, note that all patients had thrombocytopenia previously. Abdominal ultrasound with fibroscan, hepatic vein catheterization and liver biopsy were performed on all of them as part of the etiology of portal hypertension. In the abdominal ultrasound, indirect portal hypertension data were observed in all patients (as splenomegaly) cirrhosis was also ruled out. The fibroscan data showed significant liver fibrosis (F2-F3). Conclusion: Idiopathic portal hypertension following thiopurine treatment in IBD patients is a rare occurrence, but it must be borne in mind in the differential diagnosis for early diagnosis, especially in patients undergoing thiopurine treatment over a long period. The presence of thrombocytopenia is often the only predictor of its development in the preclinical stage.

Objective: to describe the experience at two tertiary centres during the first year of use of magnetic resonance enterography (MRE) for the management of Crohn's disease (CD): indications and influence of the technique in clinical decision making. Material and method: retrospective descriptive study in which patients who underwent MRE were included consecutively. Epidemiological and clinical data were collected from the patients, as well as the indication for the study and how it influenced clinical decision making in the 10 days following the radiological study. Results: 24 MREs were performed in suspected CD and 126 known CD; partial bowel obstruction in 53 patients (42%), monitoring of medical treatment in 34 (27%), due to incomplete ileocolonoscopy in 16 (13%), extension study of the small intestine in 15 (12%) and suspected complicated CD in 8 patients (6%). The MRE influenced in a change in treatment in 83 (55.3%) patients: 16 (10.7%) started with immunosuppressants, 41 (27.3%) with anti-TNFα were started on or switched, 15 (10%) were ordered surgery and in 3 (2%) changed from combined therapy to monotherapy. The MRE had less influence on clinical decision making in the group in which the indication was suspected CD (p < 0.05). Conclusions: the use of MRE helped on decision making in more than half of patients, especially with regards to decisions related to the use of biological therapies and the indication for surgery. MRE was less useful in suspected CD patients.Objetivo: describir la experiencia de dos centros terciarios durante el primer año de uso de la enterografía por resonancia magnética (enteroRM) para el manejo de la enfermedad de Crohn (EC): indicaciones e influencia en la toma de decisiones clínicas. Material y métodos: estudio descriptivo retrospectivo. Se incluyeron de forma consecutiva a pacientes a los que se realizaba una enteroRM. Se recogieron los datos epidemiológicos y clínicos de los pacientes, la indicación de la prueba y como influyó sobre la toma de decisiones clínicas en los 10 días posteriores a la realización de la prueba radiológica. Resultados: se realizaron 24 enteroRM por sospecha de EC y 126 por seguimiento clínico en pacientes con EC conocida: clínica suboclusiva en 53 (42%), monitorización de los tratamientos médicos en 34 (27%), completar el estudio por ileocolonoscopia incompleta en 16 (13%), estudio de extensión en intestino delgado en 15 (12%) y finalmente la sospecha de EC complicada en 8 pacientes (6%). La realización de la enteroRM influyó en el tratamiento en 83 (55,3%) pacientes. Dieciséis (10,7%) pacientes con inmunosupresores, 41 pacientes (27,3%) iniciaron o cambiaron de anti-TNFα, en 15 pacientes (10%) se indicó la cirugía y en 3 pacientes (2%) la enteroRM indujo a cambiar de terapia combinada a monoterapia. La enteroRM en la sospecha de EC influyó menos en las decisiones clínicas que cuando se indicaba por seguimiento (p < 0,05). Conclusiones: la enteroRM ayudó a decidir en más de la mitad de los pacientes, en especial en el seguimiento clínico para el manejo de las terapias biológicas y la indicación de la cirugía. Fue menos útil cuando la indicación fue la sospecha de EC.

Background and aims Diagnosis and monitoring of ulcerative colitis (UC) includes conventional colonoscopy. This procedure is invasive and does not exclude small-bowel Crohn’s disease (CD). Current therapeutic goals include mucosal healing which may lead to an increased number of endoscopic procedures in many patients. The small-bowel colon capsule endoscopy (SBC-CE) system visualizes the small bowel and colon. The aim of this study was to evaluate the performance and adverse events of SBC-CE in patients with UC. Methods This was a prospective, feasibility study involving two study sites. Patients with active UC underwent SBC-CE and colonoscopy. Kappa statistics were performed to assess the agreement between SBC-CE and colonoscopy. Adverse events (AEs) data were collected throughout and following the procedure. Results In total, 30 consecutive patients were recruited, and 23 of those were included in the final analysis. For the primary end point, evaluation of the extent of UC disease in the colon, the percent agreement between SBC-CE and colonoscopy was moderate (56.5 %); kappa coefficient 0.42. The percent agreement between SBC-CE and colonoscopy for UC disease activity, based on Mayo endoscopic sub-score, was 95.7 %; kappa coefficient 0.86. Disease activity in the more proximal small bowel was detected in two patients with SBC-CE. No SBC-CE device-related AEs were reported. Conclusions When comparing SBC-CE to conventional colonoscopy, there was a moderate agreement for the extent of UC disease and a very good overall agreement between the two modalities for UC disease activity.