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Adenocarcinoma is preceded by chronic atrophic gastritis, gastric intestinal metaplasia and dysplasia. Trefoil factor 3 (TFF3) is a peptide secreted by goblet cells, which is abundantly present in intestinal metaplasia.To evaluate the utility of serum TFF3 as a non-invasive biomarker for the diagnosis of intestinal metaplasia and gastric cancer.Single-center, cross-sectional study of 274 patients who consecutively underwent upper gastrointestinal endoscopy with gastric biopsies (updated Sydney system). TFF3 levels were measured in serum by a commercial ELISA kit. Patients with normal histology or chronic atrophic gastritis without intestinal metaplasia comprised the control group. In addition, 14 patients with invasive gastric cancer were included as a reference group. The association between TFF3 levels and intestinal metaplasia was assessed by logistic regression.Patients with intestinal metaplasia (n=110) had a higher median TFF3 level as compared to controls (n=164), 13.1 vs. 11.9ng/mL, respectively (p=0.024). Multivariable logistic regression showed a no significant association between TFF3 levels and intestinal metaplasia (OR=1.20; 95%CI: 0.87-1.65; p-trend=0.273). The gastric cancer group had a median TFF3 level of 20.5ng/mL, and a significant association was found (OR=3.26; 95%CI: 1.29-8.27; p-trend=0.013).Serum levels of TFF3 do not discriminate intestinal metaplasia in this high-risk Latin American population. Nevertheless, we confirmed an association between TFF3 levels and invasive gastric cancer.

Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19.This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p0.05 was considered significant.Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms.GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.

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.

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.

To study the serological response (SR) and tolerability of COVID-19 vaccine in patients with inflammatory bowel disease (IBD) and its relation with IBD treatment and type of vaccine.Observational, cross-sectional study in patients with IBD vaccinated against COVID-19 without known previous infection. SR was analyzed by the determination of IgG antibodies against the S1 subunit. Safety was studied using a questionnaire to identify adverse effects (AE).280 patients with IBD were included. Type of vaccines: Comirnaty® 68.8%; Spikevax® 10.8%, Vaxzevria® 18.3%, Ad26.COV2-S® 2.2%. 51.3% had AE, being 100% mild. 65% developed IgG antibodies after vaccination. The SR was higher for vaccines with mRNA technology (100% Spikevax®, 68.5% Comirnaty®) compared to those based on adenovirus vector (38.0% Vaxzevria®, 33.3% Ad26.COV2-S®) (P.001). In the multivariate analysis, SR was related to age (60 years; OR: 3.8, 95% CI 1.9-7.0; P.001). The SR in patients with aminosalicylates was 65.4%, 61.4% with immunosuppressants, 65.8% with anti-TNF, and 68.7% with non-anti-TNF biologicals (P=.9).One third of patients with IBD did not develop antibodies with the initial vaccination against SARS-CoV-2. The SR to vaccines based on mRNA technology was higher, and it was related to age (higher in younger patients). Immunosuppressants and biologicals did not decrease SR. More than half of the patients presented AD, being mild in all cases.

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.

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.

Resumen La esteatohepatitis no alcoholica (EHNA) es la forma mas agresiva de higado graso no alcoholico (HGNA) e involucra el riesgo de progresion a etapas mas avanzadas de enfermedad hepatica. Se requieren metodos no invasivos para identificar a pacientes con EHNA. Objetivo Evaluar el rendimiento diagnostico de la determinacion de los niveles sericos de citoqueratina-18 como marcador no invasivo de EHNA en poblacion chilena. Metodos Se determinaron los niveles sericos de CK-18 en un grupo de 41 pacientes con HGNA-probado por biopsia. El diagnostico de EHNA se baso en los criterios histologicos recomendados (presencia de balonamiento) y se calculo el puntaje de actividad del HGNA (PAH) y grado de fibrosis. Mediante correlacion de Spearman se evaluo la asociacion entre CK-18 y PAH. Se confecciono una curva ROC para evaluar la capacidad de CK-18 como test diagnostico para EHNA. Ademas, se evaluo el rendimiento del puntaje de fibrosis en higado graso no alcoholico (NFS) para pesquisa de fibrosis y EHNA y se lo comparo con CK-18 por regresion lineal simple. Los datos son expresados en medianas [percentil 25-75] y evaluados con test de rangos de Wilcoxon. Resultados La edad promedio del grupo estudiado (23% hombres) fue de 50,4 ± 11,1 anos. Un 34,2% fue diagnosticado con EHNA (PAH≥5). Los niveles de CK-18 fueron mayores en los pacientes con EHNA versus los sin EHNA (183,6 UI/l [97,4-734,4] vs. 117,2 UI/l [83,8-954,8], p = 0,016). Los niveles de CK-18 fueron buenos predictores de la presencia de EHNA en la biopsia con un area bajo la curva (AUC) de 0,732 (IC95% 0,572-0,897). Un punto de corte de 130,5 UI/l de CK-18 exhibio una sensibilidad de 92,9% y una especificidad de 63%, con un VPP de 56,5% y un VPN 94,4%, y clasifico correctamente al 73,2% de los pacientes con EHNA. El NFS tuvo un buen rendimiento para diagnostico de fibrosis avanzada (AUC 0,739, IC95% 0,56–0,91), pero limitado para identificar EHNA (AUC 0,413, IC95% 0,21-0,61). Conclusion La determinacion de CK-18 es un buen marcador no invasivo de EHNA. Si bien, NFS tiene un buen rendimiento en la identificacion de pacientes con fibrosis avanzada, no fue de utilidad para diagnosticar EHNA. En pacientes con HGNA, la determinacion de CK-18 y NFS es util en la pesquisa de EHNA y fibrosis hepatica respectivamente.