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Resumen: La enfermedad inflamatoria intestinal (EII), cuyos fenotipos más frecuentes son la enfermedad de Crohn (EC) y la colitis ulcerosa (CU), tiene una etiología multifactorial, que resulta de la interacción de factores genéticos, ambientales y del microbioma. Su incidencia ha aumentado en las últimas décadas, así como también lo ha hecho la occidentalización de la dieta: alta en grasas, carbohidratos refinados, azúcar, carnes rojas y alimentos procesados. Una dieta occidental es considerada como factor de riesgo para el desarrollo de EII, ya que está asociada a disbiosis, alteración de la barrera intestinal y de la inmunidad del huésped. Existen diversas dietas de eliminación que podrían ejercer un rol en la inducción/mantención de la remisión. Sin embargo, la mayoría requiere estudios de mejor calidad científica para poder recomendarlas. A su vez, existen suplementos nutricionales que estarían asociados a la incidencia y curso de la enfermedad. El objetivo de esta revisión es mostrar el posible rol de la dieta en la incidencia de la EII, y las estrategias dieto-terapéuticas, incluyendo suplementos específicos y nutrición enteral, considerando periodos de crisis y remisión. Summary: Inflammatory bowel diseases (IBD), most frequent phenotypes Crohn's disease and Ulcerative colitis, have a multifactorial etiology, resulting from genetics, environmental triggers and microbiome alterations. Its incidence has been increasing as well as the western diet, high in fat, refined carbohydrates, sugar, red meat and processed foods. A western diet is considered a risk factor for the development of IBD, since it is associated with dysbiosis, alteration of the intestinal barrier and host immunity. There are several elimination diets that could play a role in induction/maintenance of remission. However, most of them require better quality scientific studies. Also, there are nutritional supplements associated with the incidence and evolution of the disease. The aim of this review is to show the possible role of the diet in the incidence, and diet-therapeutic strategies, including specific supplements and enteral nutrition, considering periods of active disease and remission.

To achieve WHO's goal of eliminating hepatitis C virus (HCV), innovative strategies must be designed to diagnose and treat more patients. Therefore, we aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to HCV care. We conducted an implementation study utilizing a strategy to contact patients with HCV who were not under regular follow-up in 13 countries from Latin America. Patients with HCV were identified by the international classification of diseases (ICD-9/10) or equivalent. Medical records were then reviewed to confirm the diagnosis of chronic HCV infection defined by anti-HCV+ and detectable HCV-RNA. Identified patients who were not under follow-up by a liver specialist were contacted by telephone or email, and offered a medical reevaluation. A total of 10,364 patients were classified to have HCV. After reviewing their medical charts, 1349 (13%) had undetectable HCV-RNA or were wrongly coded. Overall, 9015 (86.9%) individuals were identified with chronic HCV infection. A total of 5096 (56.5%) patients were under routine HCV care and 3919 (43.5%) had been LTFU. We were able to contact 1617 (41.3%) of the 3919 patients who were LTFU at the primary medical institution, of which 427 (26.4%) were cured at a different institutions or were dead. Of the remaining patients, 906 (76.1%) were candidates for retrieval. In our cohort, about one out of four patients with chronic HCV who were LTFU were candidates to receive treatment. This strategy has the potential to be effective, accessible and significantly impacts on the HCV care cascade.

To determine the effect of intramuscular administration of Neostigmine® on the visualization of the pancreatic duct on magnetic resonance cholangiopancreatography in patients with recurrent acute pancreatitis or abdominal pain.We reviewed patients undergoing magnetic resonance cholangiopancreatography followed by a Neostigmine®-enhanced magnetic resonance cholangiopancreatography. Patients with a history of recurrent acute pancreatitis or abdominal pain who had a magnetic resonance cholangiopancreatography where the pancreatic duct was not entirely seen, were selected to undergo a second magnetic resonance cholangiopancreatography 40 minutes after 0.5 mg Neostigmine®. Images were analyzed by 2 radiologists. The diameter of the pancreatic duct was measured in the head, body, and tail of the pancreas on the baseline images and after Neostigmine®.Ten patients were included, with a median age of 33 years (range 15-61). The maximum diameter of the pancreatic duct increased significantly after Neostigmine® administration in all patients, from 1.84 ± 0.98 to 3.41 ± 1.27 mm in the head, 1.34 ± 0.42 mm to 2.5 ± 0.49 mm in the body and 0.72 ± 0.52 mm to 1.78 ± 0.43 mm in the tail (mean ± SD, P.0001). Neostigmine® helped to provide better detail of the pancreatic duct anatomy in 4 patients. In 2 patients we confirmed pancreas divisum, in another the Santorini duct was not seen on the baseline images but it was clearly visualized after Neostigmine®, and in the fourth patient, Neostigmine® improved visualization of multiple pancreatic duct stenosis.Neostigmine®-magnetic resonance cholangiopancreatography significantly increases the diameter of the pancreatic duct, allowing an accurate morphological evaluation. It could be a cheap alternative to secretin, which is expensive and hardly available.

Resumen Introduccion El diagnostico de enfermedad inflamatoria intestinal (EII) se realiza, en un alto porcentaje, durante la edad reproductiva. La EII en remision es el mejor escenario para planificar el embarazo. Objetivos Describir las caracteristicas clinicas del embarazo y del recien nacido, evaluando la actividad de la enfermedad en el momento de la concepcion y en la evolucion del embarazo en un centro terciario en Chile. Metodos Estudio observacional, retrospectivo, incluyo a mujeres con EII que habian tenido un parto durante 2017-2020. Los datos demograficos, clinicos y obstetricos se obtuvieron del Registro de EII. Se realizo analisis estadistico descriptivo y de asociacion (χ2, p ≤ 0,05). Resultados Se incluyeron 60 mujeres en el estudio. Al inicio del embarazo, 21 (35%) presentaban actividad inflamatoria y 39 (65%) estaban en remision. Del grupo con actividad, 16 (66%) permanecieron activas y seis tuvieron un aborto espontaneo. Aquellas en remision, 26 (69%) permanecieron en esta condicion; nueve pacientes (15%) habian suspendido el tratamiento, seis de las cuales presentaron actividad durante el embarazo. El consejo preconcepcional fue realizado en 23/60 pacientes, siendo mayor en el grupo que permanecio en remision durante el embarazo (65% vs. 35%, p = 0,02). Pacientes con brotes durante el embarazo tuvieron mayor probabilidad de embarazo pretermino ( Conclusion La remision durante el embarazo presenta los mejores resultados y el consejo preconcepcional permite un mejor control de la EII durante el embarazo.

Colorectal cancer (CRC) is the one of the most frequent and deadly cancer worldwide. The regulation mediated by the N6methyladenosine (m6A) demethylase protein called FTO in CRC is quite controversial. As previously studied in obesity and food intake, currently is being linked to stemness, epithelial-mesenchymal transition, chemotherapy resistance and proliferation in colon cancer cells, however, its localization and function in the tumor microenvironment (TME) and how it connects with progression remains unclear. The aim of this study was to evaluate FTO protein in tumor and healthy corresponding tissue from 22 colorectal cancer patients with different histological TNM stages (hTNM) by immunohistochemistry and multiple immunofluorescence analysis; classifying the tumor and stromal FTO localization and associating this data with clinical and histopathological features. As for content, the frequency of FTO+ cells in stromal compartments increases in more invasive stages compared to non-tumor tissue and in tumors with low desmoplasia. Regarding to localization, FTO is mostly nuclear and present in the lamina propria cells in non-tumor tissues and in immune and fibro-immune compartments in the TME, such as T cells, cancer associated fibroblasts and macrophages. In tumor cells, the percentage of FTO+ cells increase in early carcinogenic stages (hTNM I vs healthy tissue) and in moderately differentiated tumors. In addition, nuclear FTO expression increases in normal T cells and fibroblasts with a particular pattern after exposure for 24h to a colon adenocarcinoma cell-derived conditioned media, suggesting FTO activity in the TME interaction following a paracrine signal. In conclusion, the increase of the FTO protein in both tumor and stroma from CRC suggests its participation mediating TME communication. Citation Format: Glauben T. Landskron-Ramos, Antonia L. Domínguez-Beltrando, Mauricio Zambra-Rojas, Antonella Sanguineti, Gonzalo Vasquez, Marjorie De la Fuente, Daniela Simian, Silvana Valdebenito-Silva, Juan Saavedra, Solange Gouet, Ricardo Soto-Rifo, Daniela Sauma, Eliseo Eugenin, Mario Abedrapo, Marcela A. Hermoso, Marcela A. Hermoso. Novel potential role of m6A-demethylase FTO (fat mass and obesity) protein in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1251.

espanolIntroduccion El tratamiento de la enfermedad inflamatoria intestinal (EII) puede aumentar el riesgo de infeccion. La inmunizacion es parte del manejo integral de la atencion de estos pacientes. El objetivo de este estudio es describir la prescripcion y adherencia a la vacunacion en pacientes con EII e identificar los posibles factores asociados a esta. Metodos Estudio analitico, descriptivo, transversal en pacientes de un Programa de EII de Chile, entre abril y junio de 2019. A los pacientes se les solicito responder un cuestionario acerca de la adherencia a la vacunacion. La informacion de las vacunas se obtuvo del Registro Nacional de Inmunizaciones. Se realizo analisis estadistico descriptivo y de asociacion (χ2; p Resultados Se incluyeron 243 pacientes con EII (148 colitis ulcerosa [CU], 86 enfermedad de Crohn [EC] y 9 EII no clasificable). Solo 6 pacientes (2%) recibieron el esquema de inmunizacion completo. Las vacunas con los mayores porcentajes fueron contra la influenza (67%), virus hepatitis B (40%), neumococica 13-valente (34%) y neumococica 23-polisacarida (16%), siendo las dos primeras mas frecuentes en EC vs. CU (p ≤ 0,05). La administracion de la vacuna contra la influenza ha aumentado significativamente, alcanzando un 67% el 2019. La encuesta mostro que el 23% no ha sido inmunizado con ninguna vacuna, principalmente por falta de tiempo, falta de prescripcion medica y el alto costo economico. Conclusiones En esta cohorte, aunque las tasas de vacunacion son mas altas que las reportadas previamente, la adherencia al programa de inmunizacion debe mejorar, siendo consideradas desde el diagnostico por el equipo multidisciplinario. EnglishIntroduction Inflammatory Bowel Disease (IBD) treatment may increase the risk of infections. Vaccines are part of the comprehensive IBD patient care. The aim of this study was to describe indications and adherence of immunizations in IBD and identify possible associated factors. Methods A cross-sectional, analytic study was conducted in patients from an IBD Program of a tertiary center in Chile, between April – June 2019. Patients were asked to answer a vaccine survey and information also was obtained from the National Immunization Registry. Descriptive and association statistic were used (χ2; p Results A total of 243 patients were included (148 ulcerative colitis (UC), 86 Crohn's disease (CD) and 9 non-classifiable IBD). Only six patients (2%) of IBD patients received a complete immunization schedule. The highest vaccine rates were against influenza (67%), hepatitis B virus (40%), 13-valent pneumococcal (34%) and 23-polysaccharide pneumococcal (16%). The influenza vaccine rate has significantly increased, reaching 67% in 2019. The survey showed that 23% of patients have not been immunized with any vaccine, mainly due to lack of time, lack of medical prescription and high cost. Conclusions In this cohort, although vaccination rates are higher than previously reported, adherence to IBD immunization program would be improved, being considered since diagnosis by the multidisciplinary team.

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) and can be treated with glucocorticoids (GC), although some patients are unresponsive to this therapy. The transcription factor LRH-1/NR5A2 is critical to intestinal cortisol production (intestinal steroidogenesis), being reduced in UC patients. However, the relationship between LRH-1 expression and distribution with altered corticosteroid responses is unknown. To address this, we categorized UC patients by their steroid response. Here, we found that steroid-dependent and refractory patients presented reduced glucocorticoid receptor (GR)-mediated intestinal steroidogenesis compared to healthy individuals and responder patients, possibly related to increased colonic mucosa GR isoform beta (GRβ) content and cytoplasmic LRH-1 levels in epithelial and lamina propria cells. Interestingly, an intestinal epithelium-specific GR-induced knockout (GRiKO) dextran sodium sulfate (DSS)-colitis mice model presented decreased epithelial LRH-1 expression, whilst it increased in the lamina propria compared to DSS-treated control mice. Mechanistically, GR directly induced NR5A2 gene expression in CCD841CoN cells and human colonic organoids. Furthermore, GR bound to two glucocorticoid-response elements within the NR5A2 promoter in dexamethasone-stimulated CCD841CoN cells. We conclude that GR contributes to intestinal steroidogenesis by inducing LRH-1 in epithelial cells, suggesting LRH-1 as a potential marker for glucocorticoid-impaired response in UC. However, further studies with a larger patient cohort will be necessary to confirm role of LRH-1 as a therapeutic biomarker.

Resumen: Actualmente, existe una mayor evidencia acerca de los efectos positivos de la actividad física, y en especial del ejercicio, sobre algunas enfermedades del sistema gastrointestinal, lo cual tiene relación principalmente con su rol antiinflamatorio a nivel sistémico. Sin embargo, es necesario considerar algunas variables del ejercicio, tales como el volumen e intensidad de éste. Específicamente, el realizar ejercicios de larga duración y alta intensidad, asociados a estados de deshidratación, postprandiales y con altas temperaturas ambientales, podría contribuir a la expresión fisiológica del síndrome gastrointestinal inducido por el ejercicio y a la aparición y/o empeoramiento de los síntomas en las enfermedades del tracto gastrointestinal. Si se controlan dichas variables, realizar ejercicio aeróbico de moderada intensidad y, adicionalmente, durante menos de 60 minutos, serían seguros para disminuir el riesgo y controlar de mejor manera los síntomas de algunas patologías gastrointestinales.El Propósito De La Siguiente Revisión, Es Presentar Los Avances Respecto A Los Potenciales Beneficios Del Ejercicio Físico En El Reflujo Gastroesofágico, Cáncer Gastrointestinal, Enfermedad Inflamatoria Intestinal Y El Síndrome De Intestino Irritable, Considerando Los Mecanismos Fisiológicos Implicados, Y Establecer Las Variables Del Ejercicio Que Pueden Repercutir Negativamente En Los Síntomas Gastrointestinales. Summary: Currently, there is an increase evidence about the beneficial effects of physical activity, particularly of physical exercise in some diseases of the gastrointestinal system, related to its systemic anti-inflammatory role. However, it is necessary to consider some of the exercise variables such as volume and exercise intensity. Specifically, the execution of long duration and high intensity exercises, together with a state of dehydration, postprandial and high environmental temperature, could contribute to the physiological expression of the exercise-induced gastrointestinal syndrome and the expression and/or worsening of gastrointestinal diseases symptoms.

BackgroundA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak affecting 52 people from a large school community in Santiago, Chile, was identified (12 March) 9 days after the first case in the country. We assessed the magnitude of the outbreak and the role students and staff played using self-administered antibody detection tests and a self-administered survey.MethodsThe school was closed on 13 March, and the entire community was placed under quarantine. We implemented a home-delivery, self-administered, immunoglobin (Ig) G/IgM antibody test and survey to a classroom-stratified sample of students and all staff from 4–19 May. We aimed to determine the overall seroprevalence rates by age group, reported symptoms, and contact exposure, and to explore the dynamics of transmission.ResultsThe antibody positivity rates were 9.9% (95% confidence interval [CI], 8.2–11.8) for 1009 students and 16.6% (95% CI, 12.1–21.9) for 235 staff. Among students, positivity was associated with a younger age (P = .01), a lower grade level (P = .05), prior real-time polymerase chain reaction (RT-PCR) positivity (P = .03), and a history of contact with a confirmed case (P ConclusionsTeachers were more affected during the outbreak and younger children were at a higher risk for infection, likely because index case(s) were teachers and/or parents from the preschool. Self-administered antibody testing, supervised remotely, proved to be a suitable and rapid tool. Our study provides useful information for school reopenings.

El nuevo coronavirus (SARS-CoV-2) apareció en China en diciembre de 2019. Desde su inicio hasta abril de 2020 se ha expandido por todo el mundo, afectando a más de tres millones de personas. Su ascenso exponencial sigue creciendo, generando miles de muertes. Su contagiosidad es persona a persona por gotitas, pudiendo llegar a generar un cuadro clínico de infección respiratoria conocido como COVID-19. Algunos pacientes tienen más riesgos de tener un curso desfavorable; adultos mayores, pacientes con enfermedad cardiovascular, hipertensos y diabéticos. Nuestros pacientes con enfermedad inflamatoria intestinal son un grupo de pacientes con características particulares, muchos de ellos reciben tratamiento inmunosupresor por largos períodos, lo que pudiese suponer un riesgo específico. Las sociedades científicas de Europa y Norteamérica han realizado un esfuerzo conjunto para generar datos, compartir experiencias y dictar recomendaciones de buen manejo clínico. Esta es una revisión de la evidencia disponible, opiniones de expertos y formas de trabajo propuestos durante la pandemia.

Introduction: Despite the introduction of novel therapies and treatment strategies for ulcerative colitis (UC), many patients develop acute, severe episodes, warranting prompt care and aggressive management. There is a significant unmet need to improve outcomes in these patients. Clinicians must be able to identify those that will have worse prognosis and plan an aggressive therapy with an early/proactive adjustments in management if needed.Areas covered: The aim of this review is to evaluate the most recent evidence on the assessment and management of patients with acute severe ulcerative colitis. We searched the mainstream literature search engines for the most recent evidence on diagnosis and management of acute UC.Expert Opinion: The approach to patients with severe UC includes clinical and endoscopic assessment of disease severity and ruling out over-infections. While intravenous corticosteroids remain the first line therapy for acute severe colitis, many patients do not respond and require escalation to calcineurin inhibitors or infliximab, and may ultimately require colectomy. Even though several novel therapies are available or in development, their role in acute severe episodes of colitis is unknown.

Environmental factors may influence the development of Inflammatory Bowel Disease and modify its natural history. The objective of this review is to evaluate current evidence about environmental factors associated with the disease. A better knowledge about the pathogenesis of the disease can lead to better treatment strategies and suggestions to prevent the disease.

Anti-tumour necrosis factor α therapy in inflammatory bowel disease has been shown to be effective in clinical practice. After more than a decade using these therapies the question arises about whether there is an appropriate time to suspend these therapies, and how this should be done. This review aims to evaluate the current evidence on these topics concerning anti-tumour necrosis factor α therapies, and eventually identify conditions and subgroups of patients that could potentially be candidates for withdrawal.

Resumen La efectividad de la terapia con farmacos antifactor de necrosis tumoral α en la enfermedad inflamatoria intestinal ha sido probada en la practica clinica. Tras mas de una decada de uso de este tipo de farmacos, surge la interrogante acerca de si existe un momento apropiado para suspender estas terapias, y de que manera esta debiera realizarse. Esta revision tiene por objetivo evaluar la evidencia actual acerca del retiro de la terapia con antifactor de necrosis tumoral α y, eventualmente, identificar las condiciones o los subgrupos de pacientes potencialmente candidatos a la suspension o el retiro de esta.

RESUMEN: La legislación en Chile ha regulado el desarrollo de investigación clínica aplicada. Actualmente, es posible utilizar los datos de la ficha clínica de los pacientes, con fines de investigación, previa autorización del sujeto a través del proceso de consentimiento informado respectivo. La gran cantidad de datos clínicos acumulados en los registros de salud representan una oportunidad para el desarrollo de investigación, más aún cuando los registros son electrónicos.En el año 2012, la Subdirección de Investigación en conjunto con el Comité de Ética de Clínica Las Condes, elaboraron un documento para regular, orientar y potenciar el uso de registros con fines de investigación biomédica por los profesionales de la salud de la institución.El objetivo de este artículo es compartir la experiencia en la creación de registros con fines de investigación científica, su desarrollo y la modalidad de funcionamiento en base a la regulación ético-legal chilena. ABSTRACT: Legislation in Chile has regulated the development of clinical research. At present, it is possible to use patient's health clinical records for research purposes, with prior authorization of the subject through the respective informed consent process. The large amount of clinical data accumulated in health records represents an opportunity for research development, especially when the records are electronic.In 2012, the Academic Research Unit and the Ethics Committee of Clínica Las Condes, developed a Protocol to regulate, guide and enhance the use of health clinical records for biomedical research purposes by healthcare professionals of the institution.The aim of this article is to share the experience of the development of clinical registries for scientific research, based on the local ethics and legal regulation. Palabras clave: Investigación, registros en salud, ficha clínica, base de datos, Keywords: Biomedical research, electronic health records, registries, data collection

RESUMEN: La investigación científica se ha consolidado como el mejor modo de generar conocimiento confiable, válido, verificable y reproducible. En el ámbito de la salud humana, la investigación biomédica ha permitido ampliar la comprensión de las enfermedades y avanzar en su prevención y en el tratamiento y rehabilitación de las personas en situación de enfermedad. El método científico es un sistema ordenado de generación de conocimiento mediante pasos secuenciales, que brindan mayor certidumbre a un resultado y permiten obtener conclusiones válidas, que aporten verosimilitud al nuevo conocimiento generado. Al planificar un proyecto de investigación, se debe tener presente que existe el riesgo de dilapidar tiempo, energía y recursos para finalmente obtener resultados pobres, decepcionantes y a veces inútiles. Para minimizar estos riesgos, la planificación ofrece un modo de anticipar eventos y obstáculos, a la vez de reconocer alternativas que hagan del proyecto, un producto útil, que logre su objetivo y que sea eficiente en el uso de los recursos. Respecto a estos recursos, el análisis de factibilidad del proyecto permitirá conocer en detalle los recursos necesarios para su mejor ejecución y cumplir así, los objetivos del estudio. ABSTRACT: Scientific research is the best way to generate reliable, valid, verifiable and reproducible knowledge. In human health, biomedical research has allowed a better understanding of human diseases and to make progress in the prevention, treatment and rehabilitation of persons suffering from diseases. The scientific method is a sorted and structured system of generation of knowledge, through a series of sequential steps, that provide greater certainty to a result and allows to obtain valid conclusions, that provide credibility to new knowledge. When planning a research project, it should be noted that, there is actual risk to waste time, energy and resources to finally get a poorer, disappointing and sometimes useless outcome than expected. To minimize these risks, the planning gives a way of anticipating events and obstacles, and at the same time recognizing alternatives that make project, a useful product, which achieved its objective and to be efficient in the use of resources. With respect to these resources, the project feasibility analysis allows to recognize in detail the resources needed for its best execution and to meet the objectives of the study. Palabras clave: Proyecto, investigación, planificación, factibilidad, ejecución, Keywords: Project, research, planning, implementing, execution

RESUMEN: La escasez de investigación en Chile nos hace depender de manera excesiva de los resultados de la investigación foránea, los cuales no siempre son aplicables a la realidad nacional. Investigar siempre será necesario, sobre todo cuando los resultados están destinados a resolver los problemas de nuestra población. Los integrantes de un equipo multidisciplinario requieren de un pensamiento crítico frente al crecimiento explosivo del conocimiento, necesitando además un juicio científico para decidir la incorporación de nuevas estrategias diagnósticas y terapéuticas. La Enfermedad Inflamatoria Intestinal (EII) ha aumentado de manera creciente en nuestro país, esta tendencia plantea la opción de realizar proyectos de investigación local que permitan determinar la presencia de factores que influyan en su desarrollo y evolución. Para establecer las prioridades de investigación en EII se requiere una asociación entre los profesionales de la salud, los pacientes, las instituciones de salud y los organismos gubernamentales. ABSTRACT: The scarcity of local research makes us depend too much on the results of foreign research, which are not always applicable to the local health situation. Research is always necessary, especially when the results are intended to solve problems of our population. All the members of a multidisciplinary team require critical thinking in face of the explosive growth of knowledge, in addition to needing a scientific judgment to decide on the incorporation of new diagnostic and therapeutic strategies. Intestinal Inflammatory Disease (IBD) has increased progressively in our country; this trend raises the option of carrying out local research projects to determine the presence of factors that influence its development and evolution. Setting research priorities in IBD requires a partnership between health care professionals, patients, health institutions, and government agencies. Palabras clave: Enfermedad inflamatoria intestinal, investigación, educación médica, centros académicos, Keywords: Inflammatory bowel disease, research, medical education, academic medical centers

Objective: To describe baseline characteristics of outpatients with a positive RT-PCR for SARS-CoV-2 and to define whether "red flags" (new-onset fever, dyspnea, and chest pain) can predict clinical worsening during the isolation period. Methods: This was an epidemiological, observational, descriptive study. Between March and September of 2020, all outpatients who tested positive for SARS-CoV-2 at a tertiary medical center located in Santiago de Chile were included. Demographic variables, comorbidities, red flags, and other symptoms were compiled using follow-up surveys at specific time points. The risk of clinical worsening (hospitalization) and adjusted hazard ratios (HRs) were calculated. Results: A total of 7,108 patients were included. The median age was 38 years (range, 0-101), and 52% were men. At baseline, 77% of the patients reported having characteristic symptoms of SARS-CoV-2 infection. The most prevalent onset symptoms were headache (53%), myalgia (47%), and fever (33%). According to the follow-up surveys, the incidence of symptoms decreased during the isolation period; however, 28% of the patients still presented with symptoms on day 14. The risk of hospitalization for patients with new-onset fever and dyspnea during the follow-up period was HR = 7.43 (95% CI, 3.85-14.3, p

Molecular classification of colorectal cancer is difficult to implement in clinical settings where hundreds of genes are involved, and resources are limited. This study aims to characterize the molecular subtypes of patients with sporadic colorectal cancer based on the three main carcinogenic pathways microsatellite instability (MSI), CpG island methylator phenotype (CIMP), and chromosomal instability (CIN) in a Chilean population. Although several reports have characterized colorectal cancer, most do not represent Latin-American populations. Our study includes 103 colorectal cancer patients who underwent surgery, without neoadjuvant treatment, in a private hospital between 2008 and 2017. MSI, CIN, and CIMP status were assessed. Frequent mutations in KRAS, BRAF, and PIK3CA genes were analyzed by Sanger sequencing, and statistical analysis was performed by Fisher’s exact and/or chi-square test. Survival curves were estimated with Kaplan–Meier and log-rank test. Based on our observations, we can classify the tumors in four subgroups, Group 1: MSI-high tumors (15%) are located in the right colon, occur at older age, and 60% show a BRAF mutation; Group 2: CIN-high tumors (38%) are in the left colon, and 26% have KRAS mutations. Group 3: [MSI/CIN/CIMP]-low/negative tumors (30%) are left-sided, and 39% have KRAS mutations; Group 4: CIMP-high tumors (15%) were more frequent in men and left side colon, with 27% KRAS and 7% presented BRAF mutations. Three percent of patients could not be classified. We found that CIMP-high was associated with a worse prognosis, both in MSI-high and MSI stable patients (p = 0.0452). Group 3 (Low/negative tumors) tend to have better overall survival compared with MSI-high, CIMP-high, and CIN-high tumors. This study contributes to understanding the heterogeneity of tumors in the Chilean population being one of the few characterizations performed in Latin-America. Given the limited resources of these countries, these results allow to improve molecular characterization in Latin-American colorectal cancer populations and confirm the possibility of using the three main carcinogenic pathways to define therapeutic strategies.

In inflammatory bowel disease (IBD) a high percentage of women are diagnosed during their reproductive age. IBD in remission is the ideal scenario when planning a pregnancy.To describe the clinical characteristics of pregnancy/newborn and assess disease activity at the time of conception and throughout the pregnancy in patients with IBD treated at a tertiary centre in Chile.We retrospectively reviewed women diagnosed with IBD who were pregnant or delivered between 2017 and 2020. Demographic, clinical, obstetric and delivery data were obtained from the IBD registry, approved by the local IRB. Descriptive statistics and association tests were performed (χ2, p ≤ 0.05).Sixty women with IBD were included. At the beginning of pregnancy, 21 (35%) had active disease and 39 (65%) were in remission. Of those with active disease, 16 (66%) remained active and 6 had spontaneous abortions. In those who were in remission, 26 (69%) remained in this condition. Nine patients (15%) discontinued treatment, and 6 of these had inflammatory activity during pregnancy. Preconception counselling was performed in 23 of the 60 patients, being higher in the group that remained in remission during pregnancy (65% vs. 35%, p = 0.02). Patients who had a flare during pregnancy had more probability of preterm birth (37 weeks) and newborn with lower weight compared with the group that always remained in remission (89% vs. 74%, p = 0.161) and (2.885 vs 3.370 g; p = 0.0014).Remission presents better outcomes in pregnancy and preconception counselling would allow a better IBD control during pregnancy.

Background The use of infliximab (IFX) in inflammatory bowel disease (IBD) has been associated with a 1–6% risk of infusion reactions. The usefulness of premedication with corticosteroids, paracetamol and /or antihistamines is controversial. Aim The aim of this study is to assess, in IBD patients on IFX, whether there are differences in secondary reactions to the infusion between those who use premedication or not. Methods A retrospective cohort study was performed identifying patients with a diagnosis of IBD who received IFX at our institution between January 2009 and July 2019. Acute reactions were defined as those that occurred in the first 24 h post infusion and late reactions for more than 24 h. Infusion reactions were classified as mild, moderate and severe. Descriptive and association statistics were used (χ2; p Results Sixty-four patients were included with 1,263 infusions in total, 52% men. Median infusions per patient was 22 (2–66). All induction infusions were administered with premedication, and in maintenance in 57% of them. Premedication was given with hydrocortisone, chlorphenamine and paracetamol. Most of reactions were acute, mild or moderate in severity and no patient needed to discontinue IFX. In the maintenance group, there were 9/718 (1.2%) infusion reactions with premedication and 4/358 (1.1%) without it (p = 0.606). In the induction group, there were 8/187 (4.3%) infusion reactions, significantly higher when compared with both maintenance groups. Conclusions In this group, premedication use during maintenance was not effective at reducing the rate of infusion reactions. These results suggest that premedication would not be necessary.

Background Inflammatory Bowel Disease (IBD) treatment may increase the risk of infections. Vaccines are part of the comprehensive IBD patient care. The aim of this study was to describe indications and adherence of immunizations in IBD and identify possible associated factors. Methods A cross-sectional, analytic study was conducted in patients from an IBD Program of a tertiary center in Chile, between April – June 2019. Patients were asked to answer a vaccine survey and information also was obtained from the National Immunization Registry. Descriptive and association statistic were used (χ2; p Results A total of 243 patients were included (148 ulcerative colitis (UC), 86 Crohn´s disease (CD) and 9 non-classifiable IBD). Only six patients (2%) of IBD patients received a complete immunization schedule. The highest vaccine rates were against influenza (67%), hepatitis B virus (40%), 13-valent pneumococcal (34%) and 23-polysaccharide pneumococcal (16%). The influenza vaccine rate has significantly increased, reaching 67% in 2019. The survey showed that 23% of patients have not been immunized with any vaccine, mainly due to lack of time, lack of medical prescription and high cost. Conclusion In this cohort, although vaccination rates are higher than previously reported, adherence to IBD immunization program would be improved, being considered since diagnosis by the multidisciplinary team.

Inflammatory bowel disease requires long-term treatment to maintain disease control. Favorable follow-up of patients indicates attention from a multidisciplinary team, in which the nurse's responsibilities have great importance. The aim of this observational, descriptive study was to describe the role of an inflammatory bowel disease nurse in the management of patients in a tertiary center in Chile, including all patients in follow-up between January 2016 and April 2017. Inflammatory bowel disease nurse contacts were recorded and classified. Demographic data, clinical variables, and patient satisfaction were also analyzed. A total of 597 patients (51%) were in follow-up over the 16-month period; 63% had ulcerative colitis, with a median age of 35 years. The inflammatory bowel disease nurse performed 760 contacts in 253 patients (42% of the follow-up patients). The most frequent nurse interventions were reinforcement of medical indications (42%), assessment of laboratory results (17%), and disease follow-up (12%); 49% related to education. Nurse interventions were focused in more severely ill patients; flares during the follow-up, biological therapy, immunomodulators, and steroids were all statistically significant. Of a sample of 107 patients surveyed, 96% perceived the inflammatory bowel disease program as excellent/good. The inflammatory bowel disease nurse plays an important role in the follow-up and management, specifically in education, of more severely ill patients.

RESUMEN: La Enfermedad de Crohn es una enfermedad crónica progresiva que afecta el tubo digestivo. El objetivo de tratamiento es un control adecuado de la enfermedad para evitar progresión y deterioro de la calidad de vida, pudiendo con una terapia personalizada lograr un buen pronóstico. En este artículo se proponen algoritmos de tratamiento y de seguimiento de los escenarios más frecuentes que presentan los pacientes con Enfermedad de Crohn. ABSTRACT: Crohn's disease is a chronic and progressive disease that affects the gut. Currently treatment should be based on treat to target concept to prevent progression and deterioration of the quality of life. With a personalized therapy it could be possible to achieve a good prognosis. In this article we propose algorithms for treatment and follow-up of the most frequent scenarios presented by patients with Crohn's disease. Palabras clave: Enfermedad de Crohn, enfermedad inflamatoria intestinal, biomarcadores, tratamiento individualizado, terapia según objetivos, Keywords: Crohn's Disease, inflammatory bowel disease, biomarkers, individualized therapy, treat to target

Background: Primary non-response and secondary loss of response (LOR) are significant problems of biological therapy for inflammatory bowel disease (IBD). Therapeutic drug monitoring (TDM) in IBD patients receiving these drugs can improve outcomes. Aim: To measure serum infliximab levels and anti-infliximab antibodies (ATI) in patients with IBD post-induction phase and during maintenance therapy assessing the clinical course of IBD. Patients and Methods: Prospective study of IBD patients receiving infliximab between July 2016-May 2017. Group-A included patients who received induction therapy while Group-B included patients who were in maintenance therapy. TDM was performed in serum samples collected at weeks-14 and 30 in Group-A and before the infliximab maintenance dose in Group-B. Clinical scores, fecal calprotectin and endoscopic score were also evaluated. Results: Of 14 patients in Group-A, 57% achieved endoscopic response. Median serum infliximab concentrations at week-14 and 30 were 2.65 AU/mL (0.23-32.58) and 2.3 AU/mL (0.3-16.8), respectively. Patients with mucosal healing had non-significantly higher median infliximab concentrations at week- 14, as compared to week 30 (median 3.2 vs 2.2 AU/ml, respectively, p 0.6). ATI >10 ug/mL were found in one and seven patients at week-14 and 30, respectively. At 52 weeks of follow-up, four patients (31%) had LOR. Group-B included 36 patients, 33% had LOR. Median serum concentrations of infliximab were 1.4 AU/mL (0.27-7.03). No significant differences in serum infliximab concentration were observed between patients in remission and those with inflammatory activity. Seventeen patients had ATI >10 ug/mL. Conclusions: Clinical algorithms using TDM might help to optimize the pharmacological therapy of IBD.

Resumen: La colitis ulcerosa (CU) es un trastorno inflamatorio crónico mediado inmunológicamente que compromete al recto y colon. Su patogenia es multifactorial donde se ven involucrados aspectos genéticos, microbiota, respuesta inmune y factores ambientales. El objetivo actual de tratamiento no está acotado solamente a la mejoría clínica, si no que a lograr la curación de la mucosa de manera de alcanzar un mejor pronóstico y calidad de vida. En este artículo proponemos algoritmos de tratamiento y de seguimiento individualizados de la CU destinados a conseguir estos objetivos. Abstract: Ulcerative colitis (UC) is an immune mediated chronic inflammatory disorder that affects the rectum and colon. Its pathogenesis is multifactorial where genetic aspects, microbiota, immune response and environmental factors are involved. The current goals of treatment are not limited to improve clinical symptoms, but rather to heal the mucosa for a better prognosis and improve quality of life. In this article we propose treatment algorithms and personalized monitoring of UC to achieve these objectives. Palabras clave: Enfermedad inflamatoria intestinal, colitis ulcerosa, calprotectina fecal, curación mucosa, tratamiento por objetivo, Keywords: Inflammatory bowel disease, ulcerative colitis, fecal calprotectin, mucosal healing

RESUMEN: La enfermería es una profesión y como tal, profesa una vocación con una misión. Esta es, proveer el cuidado del paciente, cumpliendo los mejores estándares de calidad y seguridad en salud disponibles. La gestión y ejecución de los cuidados de enfermería deben estar sustentadas y justificadas en evidencia científica y por lo tanto, se hace necesario que las enfermeras(os) desarrollen investigación, para contribuir en los fundamentos de su quehacer.Los profesionales de enfermería entregan gran parte de su tiempo de trabajo a la labor asistencial y de gestión del cuidado, lo que dificulta detenerse a reflexionar algunos conceptos en los cuales está basada su profesión. Se hace necesario meditar sobre las bases y cimientos deontológicos de la profesión de enfermería, y considerar las responsabilidades éticas y jurídicas, todo lo cual obliga a ejercer una labor profesional consecuente a éstas. Esto implica una permanente autoevaluación y mejoramiento de su labor asistencial y a la vez, fundamentar los procedimientos en la evidencia científica. Por consiguiente, en este artículo, se describirán cómo la investigación es parte estructural y básica para la excelencia del cuidado, los campos de desarrollo de la enfermería en la investigación, las competencias del profesional de enfermería que le permiten desarrollar estudios de investigación y la relevancia del equipo para la creación, desarrollo y ejecución de la investigación. SUMMARY: Nursing is a profession and, as such a vocation with a mission. This is to provide patient care and comply with the best quality standards and greater safety. The management and execution of nursing care must be supported and justified in scientific evidence, therefore, it is necessary for nurses to develop research and to contribute in the construction of the foundations of their work.Professional nurses dedicate a large part of their time work, to caring and managing care, which makes it difficult to think over some concepts on which their profession is based. This article is a call to remind the foundations of the nursing profession, their ethical and legal responsibilities and to execute their professional work consistent with these. This implies a permanent self-evaluation and the constant improvement of their care work, basing their procedures on scientific evidence. That is the reason why this article describes how research is the bedrock to the excellence of care, shows the fields where nursing research can be develop, the professional competencies that allow it and the relevance of the research group for the creation, development and execution of investigation. Palabras clave: Investigación, enfermería, excelencia, cuidado, evidencia científica enfermería, capacidad de investigación., Keywords: Nursing research, excellence of care, nursing scientific evidence, research capacity.

OBJECTIVE To determine the correlation between clinical, fecal, endoscopic and histological activity in patients with ulcerative colitis (UC). METHODS A correlational cross-sectional analysis was performed in patients with UC who underwent colonoscopy between February and December 2016. Clinical, endoscopic, fecal and histological activities were determined using the partial Mayo subscore, Mayo endoscopic subscore and modified Mayo endoscopic subscore, fecal calprotectin and Geboes score and the presence of basal plasmacytosis, respectively. Scores were analyzed using Spearman's rank correlation test. To determine the association between scores and some clinical variables and active UC, univariate and multivariate logistic regressions were used. RESULTS Altogether 105 procedures (93 patients) were included. In 64.8% of the procedures, the mucosa was inflamed; however, 14.7% did not show histological inflammation. Endoscopic remission was observed in the other 35.2% of procedures; however, in biopsies 21.6% exhibited histological inflammation. Mayo endoscopic subscore and modified Mayo endoscopic score were well correlated but were only moderately correlated with clinical and histological scores. Furthermore, there was a moderate correlation between Mayo endoscopic score and Geboes score. Conversely, histological scores were poorly correlated with partial Mayo score. In multivariate analysis, Geboes score and basal plasmacytosis were predictive of active disease (OR 3.505, 95% CI 1.544–7.959 and OR 3.240, 95% CI 1.123–9.349, respectively), whereas biological therapy was found to be protective against UC (OR 0.021, 95% CI 0.000–0.641). CONCLUSION Clinical, endoscopic and histological activities were moderately correlated, while Geboes score and basal plasmacytosis were predictive of endoscopically active UC.

Background: Different strains of invasive Escherichia coli (E. coli), isolated from intestinal mucosa of patients, are related to the pathogenesis of inflammatory bowel diseases (IBD). Aim: To evaluate an association between intracellular E. coli and IBD; its clinical characteristics and use of steroids. Material and Methods: Sixty one patients with Crohn's disease and 83 with ulcerative colitis were studied. To determine the intracellular E. coli content, colonoscopy biopsies of these patients and 29 control subjects were processed using the gentamicin protection assay. Differences in the bacterial content between patient groups were evaluated using Mann-Whitney test, while the association between presence of E. coli with endoscopic activity, location/extension and use of corticosteroid as anti-inflammatory treatment were evaluated with Fisher's exact test or Chi-square test. Results: E. coli strains were detected in 36.1, 39.3 and 10.3% of patients with ulcerative colitis, Crohn's disease and controls, respectively. The number of bacteria per biopsy in Crohn's disease and ulcerative colitis was significantly higher than in controls (p < 0.01 between patients and controls). In ulcerative colitis, significant associations were found between the presence of bacteria and disease location and use of corticosteroids. In Crohn's disease, no association was found. Conclusions: IBD are associated with the presence of intracellular E. coli strains in the intestinal mucosa, suggesting an alteration in the microbiota or loss of integrity of the epithelial barrier. The association of intracellular E. coli with clinical features and the use of corticosteroids in ulcerative colitis suggests that different factors could promote colonization or proliferation of these bacteria.

The ST2/IL33 signalling pathway has been associated with ulcerative colitis (UC). ST2, encoded by the IL1RL1 gene, is expressed as both a membrane-anchored receptor (ST2L) activated by IL33 and as a soluble receptor (sST2) with anti-inflammatory properties. In UC patients, sST2 is further increased by corticosteroid treatment; however, the glucocorticoid-mediated molecular regulation remains unknown. We therefore tested whether genetic variants in the IL1RL1 distal promoter are involved in UC and affect glucocorticoid-mediated ST2 expression. Serum ST2 levels and genetic variants in the IL1RL1 distal promoter were examined by ELISA and PCR sequencing in UC patients receiving corticosteroids. Glucocorticoid-mediated ST2 production was evaluated in intestinal mucosa cultures. Molecular regulation of glucocorticoid-mediated ST2 was assessed by RT-qPCR, ChIP assay and luciferase reporter assay. Dexamethasone effect on ST2 transcript expression was analyzed in leukocytes and related to IL1RL1 variants. Sequencing of a distal IL1RL1 promoter region demonstrated that SNPs rs6543115(C) and rs6543116(A) are associated with increased sST2 in UC patients on corticosteroids. Dexamethasone up-regulated sST2 transcription through interaction with the glucocorticoid-response element (GRE) carrying rs6543115(C) variant. Our data indicate that IL1RL1 SNPs rs6543115(C) confer susceptibility to UC and is contained in the GRE, which may modulate glucocorticoid-induced sST2 expression.

Background: Colorectal cancer (CRC) is an heterogeneous disease. Three carcinogenic pathways determine its molecular profile: microsatellite instability (MSI), chromosomal instability (CIN) and CpG island methylator phenotype (CIMP). Based on the new molecular classification, four consensus CRC molecular subtypes (CMS) are established, which are related to clinical, pathological and biological characteristics of the tumor. Aim: To classify Chilean patients with sporadic CRC according to the new consensus molecular subtypes of carcinogenic pathways. Material and Methods: Prospective analytical study of 53 patients with a mean age of 70 years (55% males) with CRC, operated at a private clinic, without neoadjuvant treatment. From normal and tumor tissue DNA of each patient, CIN, MSI and CIMP were analyzed. Combining these variables, tumors were classified as CMS1/MSI-immune, CMS2/canonical, CMS3/metabolic and CMS4/mesenchymal. Results: CMS1 tumors (19%) were located in the right colon, were in early stages, had MMR complex deficiencies and 67% had an activating mutation of the BRAF oncogene. CMS2 tumors (31%) were located in the left colon, had moderate differentiation, absence of vascular invasion, lymphatic and mucin. CMS3 tumors (29%) were also left-sided, with absence of vascular and lymphatic invasion, and 29% had an activating mutation of the KRAS oncogene. CMS4 tumors (21%) showed advanced stages and presence of metastases. Conclusions: This new molecular classification contributes to understanding the heterogeneity of tumors. It is possible to differentiate molecular subgroups of a single pathological diagnosis of adenocarcinoma, opening the door to personalized medicine.

Anti-tumor necrosis factor-α (TNF) agents have dramatically changed the management of Crohn’s Disease (CD). However, a significant number of these patients do not respond at all or cease to respond to antibodies against TNF. In this clinical situation, the options include intensification of anti-TNF therapy by either increasing the dose or by shortening the administration interval, the use of a second anti-TNF or medications with a different mechanism of action. Among the later, Natalizumab, a humanized IgG4 monoclonal antibody against α4β1 and α4β7 integrins, is safe and effective in inducing and maintaining remission in active CD patient’s refractory to anti-TNF. In spite of this, Natalizumab use has been limited because of an increased risk of progressive multifocal leukoencephalophaty which results from reactivation of the John Cunningham (JC) virus. However, the presence of antibodies against JC virus in serum can be used to reduce the risk for this complication. We report three patients with Crohn’s disease refractory to treatment with infliximab, who responded successfully to the use of Natalizumab.

Aims and objectives To assess disease-related knowledge among patients with inflammatory bowel disease and to identify the factors that are possibly associated with the knowledge level. Background Disease-related knowledge can positively influence the acceptance of the disease, increase treatment compliance and improve the quality of life in patients with inflammatory bowel disease. Design An observational, cross-sectional study was conducted and prospectively included patients from the inflammatory bowel disease programme between October 2014–July 2015. Methods A Spanish-translated version of the 24-item Crohn's and Colitis Knowledge score was used to assess disease-related knowledge. Patients also completed a demographic and clinical questionnaire. Results A total of 203 patients were included, 62% were female, and 66% were diagnosed with ulcerative colitis; the median age was 34 years (range 18–79), and the median disease duration was four years. The median disease-related knowledge score was 9 (range 1–20). Only 29% of the patients answered more than 50% of the questions correctly. Lower disease-related knowledge was observed in questions related to pregnancy/fertility and surgery/complications. Patients older than 50 years, with ulcerative colitis, with disease durations less than five years and patients without histories of surgery exhibited lower disease-related knowledge. There was no association between the knowledge scores and the educational levels. Conclusions The patients who attended our inflammatory bowel disease programme exhibited poor disease-related knowledge that was similar to the knowledge levels that have been observed in developed countries. It is necessary to assess patient knowledge to develop educational strategies and evaluate the influences of these strategies on patient compliance and quality of life. Relevance to clinical practice These results will allow the inflammatory bowel disease team to develop educational programmes that account for the disease-related knowledge of each patient. Inflammatory bowel disease nurses should evaluate their interventions to provide evidence that educating our patients contributes to improving their treatment outcomes and overall health statuses.

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterized by mucosa damage associated with an uncontrolled inflammatory response. This immunological impairment leads to altered inflammatory mediators such as IL-33, which is shown to increase in the mucosa of active UC (aUC) patients. MicroRNAs present a distorted feature in inflamed colonic mucosa and are potential IL-33 regulating candidates in UC. Therefore, we studied the microRNA and mRNA profiles in inflamed colonic samples of UC patients, evaluating the effect of a microRNA (selected by in silico analysis and its expression in UC patients), on IL-33 under inflammatory conditions. We found that inflamed mucosa (n = 8) showed increased expression of 40 microRNAs and 2,120 mRNAs, while 49 microRNAs and 1,734 mRNAs were decreased, as determined by microarrays. In particular, IL-33 mRNA showed a 3.8-fold increase and eight members of a microRNA family (miR-378), which targets IL-33 mRNA in the 3′UTR, were decreased (−3.9 to −3.0 times). We selected three members of the miR-378 family (miR-378a-3p, miR-422a, and miR-378c) according to background information and interaction energy analysis, for further correlation analyses with IL-33 expression through qPCR and ELISA, respectively. We determined that aUC (n = 24) showed high IL-33 levels, and decreased expression of miR-378a-3p and miR-422a compared to inactive UC (n = 10) and controls (n = 6). Moreover, both microRNAs were inversely correlated with IL-33 expression, while miR-378c does not show a significant difference. To evaluate the effect of TNFα on the studied microRNAs, aUC patients with anti-TNF therapy were compared to aUC receiving other treatments. The levels of miR-378a-3p and miR-378c were higher in aUC patients with anti-TNF. Based on these findings, we selected miR-378a-3p to exploring the molecular mechanism involved by in vitro assays, showing that over-expression of miR-378a-3p decreased the levels of an IL-33 target sequence β-gal-reporter gene in HEK293 cells. Stable miR-378a-3p over-expression/inhibition inversely modulated IL-33 content and altered viability of HT-29 cells. Additionally, in an inflammatory context, TNFα decreased miR-378a-3p levels in HT-29 cells enhancing IL-33 expression. Together, our results propose a regulatory mechanism of IL-33 expression exerted by miR-378a-3p in an inflammatory environment, contributing to the understanding of UC pathogenesis.

In colorectal cancer (CRC), cancer-associated fibroblasts (CAFs) are the most abundant component from the tumor microenvironment (TM). CAFs facilitate tumor progression by inducing angiogenesis, immune suppression and invasion, thus altering the organization/composition of the extracellular matrix (i.e., desmoplasia) and/or activating epithelial-mesenchymal transition (EMT). Soluble factors from the TM can also contribute to cell invasion through secretion of cytokines and recently, IL-33/ST2 pathway has gained huge interest as a protumor alarmin, promoting progression to metastasis by inducing changes in TM. Hence, we analyzed IL-33 and ST2 content in tumor and healthy tissue lysates and plasma from CRC patients. Tissue localization and distribution of these molecules was evaluated by immunohistochemistry (using localization reference markers α-smooth muscle actin or α-SMA and E-cadherin), and clinical/histopathological information was obtained from CRC patients. In vitro experiments were conducted in primary cultures of CAFs and normal fibroblasts (NFs) isolated from tumor and healthy tissue taken from CRC patients. Additionally, migration and proliferation analysis were performed in HT29 and HCT116 cell lines. It was found that IL-33 content increases in left-sided CRC patients with lymphatic metastasis, with localization in tumor epithelia associated with abundant desmoplasia. Although ST2 content showed similarities between tumor and healthy tissue, a decreased immunoreactivity was observed in left-sided tumor stroma, associated to metastasis related factors (advanced stages, abundant desmoplasia, and presence of tumor budding). A principal component analysis (including stromal and epithelial IL-33/ST2 and α-SMA immunoreactivity with extent of desmoplasia) allowed us to distinguish clusters of low, intermediate and abundant desmoplasia, with potential to develop a diagnostic signature with benefits for further therapeutic targets. IL-33 transcript levels from CAFs directly correlated with CRC cell line migration induced by CAFs conditioned media, with rhIL-33 inducing a mesenchymal phenotype in HT29 cells. These results indicate a role of IL-33/ST2 in tumor microenvironment, specifically in the interaction between CAFs and epithelial tumor cells, thus contributing to invasion and metastasis in left-sided CRC, most likely by activating desmoplasia.

The relationship between Microscopic Colitis and Inflammatory Bowel Disease is unclear. However, when both are diagnosed they seem to be part of a broader spectrum of the same disease, more than just a coincidence. We report a 55 years old woman with Ulcerative Colitis limited to the rectum with complete clinical and endoscopic response to standard treatment and adequate surveillance for 13 years, who abandoned treatment and control. After eight years, she consulted for mild-to-moderate non-bloody diarrhea lasting several months. Colonoscopy and basic laboratory did not show any alterations. Nevertheless, random biopsies had a characteristically pattern compatible with Lymphocytic Colitis. After the first week of treatment with budesonide the patient was asymptomatic and still in clinical remission, with negative fecal calprotectin at 6 months’ follow-up.

Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract with medical and psychological complications. Addressing psychosocial aspects of treatment, such as quality of care and disability remains a challenge. The quality of care for IBD patients is not optimal at the present time and there is a variation in the care provided by specialists. Therefore, it is necessary to develop well defined quality indicators to assure the delivery of an adequate care to these patients. The delivery of healthcare for IBD patients is often complex and requires multidisciplinary teams. The ultimate objectives in the treatment of IBD should be to prevent bowel damage, reduce long-term disability and maintain a normal quality of life.

Background: Most cases of Clostridium difficile infection (CDI) respond to a standard course of antibiotics, however recurrent CDI is becoming common and alternative therapeutic strategies are needed. In this scenario, fecal microbiota transplantation (FMT) has been suggested. Aim: To describe the efficacy and safety of FMT for the treatment of recurrent CDI. Patients and Methods: Review of medical records of all patients with recurrent CDI treated with FMT between April 2013 and April 2017. Demographic and clinical data were abstracted including details of treatment prior to FMT, rate of FMT treatment success and clinical course during follow-up period. Telephone surveys were conducted to determine patient satisfaction. Results: Eight patients aged 19 to 82 years (six women) underwent FMT. They experienced a median of four previous episodes of CDI (range 3-8). The mean duration of CDI was 18 days (range 3-36) before FMT. All procedures were performed by colonoscopy. Effectiveness with one session of FMT was 100%. During the follow-up period (median 24 months, range 7-55), two patients developed CDI, one of them after using antibiotics. Adverse events were reported in three patients. Two had bloating and one patient with Crohn's disease and a history of bacteremia had an episode of Escherichia coli bacteremia. All patients would use FMT again if necessary. Conclusions: FMT through colonoscopy appears to be a safe, effective and long-lasting therapy in cases of recurrent CDI.

Objectives The aim of this study was to assess the type and prevalence of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease (IBD) who are treated at our center. Design Observational, cross-sectional questionnaire-based study that included patients from the IBD program of our center. Setting Tertiary clinical center in Santiago, Chile. Main outcome measures Types of CAM being used by patients with IBD. Results A total of 200 patients were included, 68% ulcerative colitis, 29% Crohn’s disease, and 3% non-classifiable IBD. Overall, 25% of the patients reported current use of CAM, 30% reported using in it the past, and 45% indicated that they had never used it before. The use of CAM was recommended in 20% of the patients by other healthcare professionals and in 10% of the patients by the gastroenterologist. Forty-nine percent of the patients informed the gastroenterologist that they were using CAM. Overall, 86% of the patients did not modify the conventional medical treatment (CMT). None of the patients who were using curcumin, homeopathic medicine, acupuncture or biomagnetism modified the CMT. Conclusions The type of CAM being used plays an important role when the patient makes the decision to inform the gastroenterologist. Other healthcare professionals play an important role in providing the advice to start CAM. Gastroenterologists must be aware of the high prevalence of CAM use in IBD patients, actively ask about CAM use and guide the patients who want to use CAM in a responsible and safe manner.