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Objective: the hepatocyte growth factor (HGF) is a pleiotropic cytokine produced by hepatic stellate cells and implicated in liver regeneration and fibrosis. Serum levels of HGF vary in liver diseases, reflecting hepatic damage and hepatocellular dysfunction. In this study, serum levels of HGF and the relationship between HGF and biochemical, histological and virological data, have been analysed in patients suffering from chronic hepatitis C (CHC). Patients and methods: serum HGF concentration was measured by ELISA in sandwich in 45 patients with CHC. Correlation between HGF levels and histological (necroinflammatory activity and fibrosis score) and biochemical (transaminases, prothrombin activity, albumin, bilirubin), or virological (hepatitis C virus load) parameters was analyzed. Serum HGF concentration was also studied in a subgroup of the original sample treated with interferon and ribavirin. Results: serum HGF concentrations of patients with CHC were significantly higher than those detected in healthy controls. Patients with significant fibrosis (F ≥ 2) had a significantly older age, lower count of platelets and higher values of AST, GGT and HGF, than those patients with a fibrosis score F < 2. HGF concentration was identified by multivariate analysis as the only independent factor associated with significant fibrosis. Moreover, area under receiver operating curve, using HCG levels, showed similar values to those of previously validated non-invasive indexes of fibrosis. However, levels of HGF did not show a significant decrease in patients with a sustained response to anti-virus C therapy. Conclusion: serum HGF concentration correlates with fibrosis score in patients with CHC, but is insensitive to monitor changes induced by anti-virus C therapy.Objetivo: el factor de crecimiento hepatocitario (HGF) es una citocina pleiotrópica producida por las células estrelladas hepáticas, que está implicada en la regeneración y la fibrosis hepática. La concentración sérica del HGF en las enfermedades hepáticas es variable, reflejando daño hepático y disfunción hepatocelular. En este estudio se ha analizado la concentración sérica del HGF en pacientes con hepatitis crónica por virus de la hepatitis C (VHC) y su relación con los datos bioquímicos, histológicos y virológicos. Pacientes y métodos: se determinó la concentración sérica de HGF mediante ELISA en sándwich y se analizó la correlación entre los niveles del HGF y los datos histológicos (actividad necroinflamatoria, estadio de fibrosis), bioquímicos (transaminasas, actividad de protrombina, albúmina, bilirrubina) y virológicos (carga viral VHC) en 45 pacientes con hepatitis crónica C (HCC). También fueron evaluadas las cifras del HGF en el suero de un subgrupo de pacientes de la muestra original sometidos a tratamiento antiviral con interferón y ribavirina. Resultados: la concentración sérica del HGF en pacientes con HCC fue significativamente mayor que la medida en controles sanos. Los pacientes con fibrosis hepática significativa (F ≥ 2) tenían una edad significativamente mayor, unas cifras plaquetarias significativamente inferiores y concentraciones séricas significativamente superiores de AST, GGT y HGF, en comparación con aquellos pacientes con un índice de fibrosis F < 2. En el análisis multivariante la concentración de HGF fue la única variable independiente asociada a la fibrosis significativa. El área bajo la curva ROC (receiver operating curve), usando las concentraciones séricas de HGF, mostró valores similares a los obtenidos con otros índices, previamente validados, que estiman fibrosis significativa en pacientes con HCC. Sin embargo, las cifras del HGF no descendieron de modo significativo en aquellos pacientes con respuesta sostenida a tratamiento antiviral. Conclusión: la concentración sérica del HGF se correlaciona con el índice de fibrosis en pacientes con HCC, pero es un marcador poco sensible para monitorizar la respuesta inducida por el tratamiento antiviral.

Background and aims: more than half of patients with genotype 1 chronic hepatitis C (CHC) do not achieve a sustained viral response (SVR) to current antiviral therapy due to primary non-response, relapse or intolerance. Factors related to each of these unfavorable outcomes are different and the last two may be partially prevented. Our aim was to identify basal criteria to predict the risk of primary failure. Patients and methods: we included 251 consecutive patients (152 males) from a single centre, infected with HCV genotype 1 and not previously treated. SVR was achieved in 141 patients and primary failure in 110. Results: high vs. low viral load (> 400,000 IU/mL, OR = 6.17; 95% CI: 2.50-15.23), high serum GGT (> 60 IU/mL, OR = 4.25; 95% CI: 2.49-7.24), low serum cholesterol (< 178 mg/dL, OR = 2.93; 95% CI: 1.75-4.92) and older age (> 47 yrs., OR = 1.79; 95% CI: 1.08-2.96) were associated to the risk of primary failure in the lineal logistic regression analysis. From the 58 patients carrying all the first three negative criteria, 46 (79.3%) were primary non-responders. Conclusions: the negative basal profile identified in this study is based on easily available data and provides information about the risk of primary therapeutic failure, and may help to decide whether antiviral therapy should be offered to a single patient.

Background: angiogenesis plays an important role in tumor progression. The vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis. In the present study we evaluated single nucleotide polymorphisms (SNPs) -2578C > A, -1154G > A, and +936C > T in the VEGF gene, and their prognostic value for patients operated on for colorectal cancer (CRC). Patients and method: VEGF polymorphisms have been analyzed in 177 patients who had undergone surgical resection at Hospital Clínico San Carlos. The analysis of these polymorphisms was performed with specific probes for each nucleotide in a multiplex reaction using real-time PCR. Results: we only found a statistically significant relationship for one of these three polymorphisms, +936C > T, with gender and tumor location; 10.7% of patients heterozygotes for this SNP had tumors located in proximal colon, 35.2% in distal segment and 54.1% in rectum (p = 0.03). Patients with the +936T/T genotype had 100% overall survival (OS). Conclusion: patients with a +936T/T genotype showed increased survival, therefore the +936C > T SNP could be a useful marker in the follow-up and clinical management of patients with colorectal cancer.Introducción: la angiogénesis juega un papel importante en la progresión de los tumores. El factor de crecimiento endotelial vascular (VEGF) es un importante regulador de la angiogénesis. En este trabajo se han analizado los polimorfismos de único nucleó-tido (SNP) -2578C > A, -1154G > A y +936C > T del gen VEGF en pacientes intervenidos de carcinoma colorrectal, así como su posible implicación pronóstica. Pacientes y método: el estudio de estos SNP se ha realizado en 177 pacientes intervenidos quirúrgicamente de carcinoma colorrectal (CCR) en el Hospital Clínico San Carlos. El análisis de los polimorfismos se realizó con sondas específicas para cada nucleótido y se determinó mediante una reacción multiplex mediante real time PCR. Resultados: de los 3 polimorfismos estudiados sólo encontramos relación estadísticamente significativa del SNP +936C > T con el sexo y la localización. El 10,7% de los pacientes heterocigotos para este SNP tenían como localización el tumor en colon proximal, el 35,2% en colon distal y el resto en recto (p = 0,03). La supervivencia global (SG) de los pacientes con el genotipo +936T/T fue del 100%. Conclusión: los pacientes con el genotipo +936T/T presentan mayor supervivencia y el polimorfismo +936C > T podría ser una herramienta de ayuda en el seguimiento y terapéutica de este grupo de pacientes.

Aim: to evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used. Patients and methods: data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis. Results: a total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case. Conclusions: brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended.Objetivo: evaluar la rentabilidad de la citología por cepillado de las estenosis biliares diagnosticadas por CPRE cuando se aplica una metodología sistemática. Pacientes y métodos: se recogieron muestras de 62 pacientes consecutivos con estenosis biliares diagnosticadas mediante CPRE. Las muestras citológicas eran procesadas en la sala de endoscopias inmediatamente a su obtención y analizadas por el mismo patólogo. Para el análisis estadístico se clasificaron los casos como positivos o negativos para malignidad, sospechosos (presencia de atipias) y no válidos. Los patrones de referencia fueron el estudio de las piezas quirúrgicas, biopsias por otros métodos, o la evolución clínica y/o radiológica compatible. Resultados: fueron incluidas un total de 71 citologías. El diagnóstico fue malignidad en 49 casos, benignidad en 22 casos, y 3 muestras fueron excluidas por material insuficiente o artefactos de procesamiento. La sensibilidad de la técnica fue del 62% (IC 95% 0,47-0,77), la especificidad del 100%, el valor predictivo positivo del 100% y el valor predictivo negativo del 58% (IC 95% 0,43-0,75). Al incluir las citologías sospechosas como malignas la sensibilidad fue del 67% (IC 95% 0,54-0,81) sin modificarse el resto de parámetros. En ocho pacientes fueron necesarias nuevas CPRE durante las cuales se repitieron las tomas citológicas, llegando a un diagnóstico de certeza en todos ellos. Conclusiones: la citología biliar presenta una sensibilidad intermedia con elevada especificidad. Una metodología sistemática con un patólogo dedicado y la inclusión de las citologías con atipias celulares como malignas mejora la sensibilidad de la técnica. Dada su sencillez creemos que debe de realizarse en todos los casos de estenosis biliar observada durante una CPRE, incluyendo la repetición de las tomas citológicas siempre que sea necesario practicar más de una CPRE en el mismo paciente.

Objetivos: la enfermedad tromboembólica venosa (ETV) es poco frecuente en la cirrosis hepática, no estando su tratamiento contemplado en las guías del American College of Chest Physicians. El objetivo del presente trabajo es aportar la experiencia de pacientes cirróticos con ETV hospitalizados en nuestro centro en los últimos 15 años. Material y método: de enero de 1992 a diciembre de 2007 fueron hospitalizados en nuestro centro 2.074 pacientes con cirrosis hepática. Presentaron una ETV no esplácnica 17, siendo ellos la población a estudio. Se recogen datos epidemiológicos y analíticos: hemograma, VSG, química hemática, coagulación, trombofilia congénita, anticuerpos antifosfolípidos (AAFL) y homocisteinemia. Se valoran factores de riesgo adquiridos, características de la trombosis, el tratamiento y las complicaciones. Resultados y conclusiones: la ETV no esplácnica se observa en el 0,8% de pacientes cirróticos. En ellos es frecuente observar hipoalbuminemia, disminución de factores anticoagulantes (ATIII, PC, y PS), presencia de AAFL e hiperhomocisteinemia, así como la presencia de factores de riesgo adquiridos: intervenciones quirúrgicas, insuficiencia venosa, inmovilización e infecciones. Tras la anticoagulación, se observan complicaciones hemorrágicas mayores en el 35% de los pacientes.Objective: despite the endogenous coagulopathy of cirrhosis, some patients do experience thrombophilic states. The American College of Chest Physicians failed to address the prevention and treatment of venous thromboembolism (VTE) occurring among these patients. This study aims to describe the characteristics of cirrhotics patients hospitalized in the last 15 years, and to use the experience gained. Material and method: we retrospectively reviewed all admissions for cirrhosis in our hospital from 1992 to 2007. A total of 17 patients had non-portal venous thromboembolic disease. We recorded risk factors, epidemiological and laboratory data, thrombosis characteristics, and treatment complications. Results and conclusions: approximately 0.8% of all hospitalized patients with cirrhosis had a non-portal VTE despite the elevated INR and low platelet count. We found low serum albumin, acquired antithrombin III, protein C and protein S deficiency, presence of antiphospholipid antibodies, and hyperhomocisteinemia in blood tests. Many patients had hemorragic complications during anticoagulation therapy, and 35% needed blood transfusions.

Presentamos un caso de tumor de colisión periampular en el que coexisten un tumor carcinoide de pared duodenal y un adenocarcinoma de cabeza de páncreas. El paciente era un varón de 64 años con historia reciente de diarreas al que se diagnosticó una ictericia obstructiva. Histopatológicamente el tumor resecado mostraba dos neoplasias independientes. Una de ellas constituida por cordones sólidos de células neuroendocrinas que afectaba pared duodenal. La otra está formada por un adenocarcinoma bien diferenciado procedente del páncreas. Ambas neoplasias fueron confirmadas inmunohistoquímicamente. Según la literatura anglosajona revisada tan sólo hemos encontrado seis casos de esta rara coexistencia neoplásica.We report the case of a periampullary collision tumor, in which a duodenal-wall carcinoid and an adenocarcinoma of the head of the pancreas coexisted. We describe the case of a 64-year-old man with a recent history of diarrhea, who was diagnosed with obstructive jaundice. A duodeno-pancreatectomy was performed, and the specimen showed two independent neoplasms in the histopathologic study. Solid cords and nests of neuroendocrine cells in the duodenal wall formed the carcinoid tumor, whereas the other neoplasm was made up of a well-differentiated adenocarcinoma of the pancreas. Both were confirmed by immunohistochemical analysis. According to the literature reviewed, this is the sixth reported case of this rare neoplastic association.

Background: hyperhomocysteinemia has been recently described in patients with inflammatory bowel disease (IBD), that could be related to the increased risk for thrombosis that exists in this disease. The aim of this study was the assessment of hyperhomocysteinemia in patients with IBD and its relation among vitamin B12 and folate levels, and methylenetetrahydrofolate reductase (MTHFR) 677C→ T and 1298A→C mutations. Patients and methods: fifty two consecutive patients with IBD were studied (29 women and 23 men); age: mean (standard deviation 41.7 [11.9] years) and 186 controls with no difference in age and gender. Hyperhomocysteinemia was considered as homocysteine levels higher than mean plus two standard deviations of the control group (≥ 13 μmol/l). Results: patients had an elevated prevalence of hyperhomocysteinemia (17.3 vs. 3.7%; p = 0.002) and lower folate (7.6 [4.1] vs. 8.9 [3.7] ng/ml; p = 0.01) and B12 vitamin levels (499 [287] vs. 603 [231] pg/ml; p = 0.003). Homocysteinemia was higher (14.3 [5.8] vs. 9.1 [3.9] μmol/l; p = 0.006) in 6 patients (11.5%) that had suffered thromboembolism. Frequency of MTHFR 677C→T (13.5 vs. 11.3%; p = 0.66) and 1298A→C (7.8 vs. 7.0%; p = 0.76) mutations was not increased in patients. Odds ratio (OR) for IBD in hyperhomocysteinemic patient was 5.51, 95% confidence interval (CI), 1.81-16.76; p = 0.002). Hyperhomocysteinemia was negatively associated with feminine gender (OR 0.08, 95% CI 0.01-0.49; p = 0.006) and folate levels (OR 0.04, 95%CI: 0.007-0.20; p < 0.001). Conclusions: hyperhomocysteinemia is associated with IBD and low folate levels, and could be involved in development of thromboembolism. MTHFR 677C→T and 1298A→C mutations are not related with the disease.Fundamento: recientemente se ha descrito la existencia de hiperhomocisteinemia en la enfermedad inflamatoria intestinal (EII), que podría estar relacionada con el mayor riesgo de trombosis en esta enfermedad. El objetivo del estudio ha sido evaluar la hiperhomocisteinemia en los pacientes con EII y su relación con las concentraciones de vitamina B12 y folato séricos y con las mutaciones de la metilentetrahidrofolato reductasa (MTHFR) 677C→T y 1298A→C. Pacientes y métodos: se estudiaron consecutivamente 52 pacientes con EII (29 mujeres y 23 varones; edad: media [desviación estándar] 41,7 [11,9] años) y 186 controles con edad y sexo similares. Se consideró hiperhomocisteinemia cuando los valores de homocisteína eran superiores a la media más dos desviaciones estándar del grupo control (≥ 13 mmol/l). Resultados: los pacientes presentaban una mayor prevalencia de hiperhomocisteinemia (17,3 frente a 3,7%; p = 0,002) y unos valores más bajos de folato (7,6 [4,1] frente a 8,9 [3,7] ng/ml; p = 0,01) y de vitamina B12 (499 [287] frente a 603 [231] pg/ml; p = 0,003). En 6 pacientes (11,5%) que habían padecido episodios tromboembólicos la homocisteinemia era más elevada (14,3 [5,8] frente a 9,1 [3,9] µmol/l; p = 0,006). La frecuencia de las mutaciones MTHFR 677C→T (13,5% frente a 11,3%; p = 0,66) y de la 1298A→C (7,8 frente a 7,0%; p=0,76) no fue mayor en los pacientes. La odds ratio (OR) de EII en los pacientes hiperhomocisteinémicos fue 5,51, intervalo de confianza [IC] del 95%: 1,81-16,76; (p = 0,002). La hiperhomocisteinemia se asoció negativamente con el sexo femenino (OR 0,08, IC del 95%, 0,01-0,49; p = 0,006) y con los valores de folato (OR 0,04,IC del 95%: 0,007-0,20; p < 0,001). Conclusiones: la hiperhomocisteinemia se asocia a la EII y a las concentraciones bajas de folato, y puede estar implicada en el desarrollo de tromboembolia. Las mutaciones MTHFR 677C→ T y 1298A→ C no se relacionan con la enfermedad.

The amplification and/or overexpression of the c-erbB-2/neu oncogene may play a role in tumor development and progression. The aim of this prospective study was to evaluate the prognostic value of p185 protein in colorectal cancer using immunohistochemical techniques. We analyzed 106 colorectal tumor tissue specimens from patients who had been operated on by the same surgeon and subjected to a median follow-up of 3 years. Thirty-three per cent of patients showed p185 overexpression related to an advanced stage of the disease. In patients with adenocarcinoma tumors of the colon without distant metastases, p185 detection was found to be of clinical prognostic relevance (p = 0.06).La amplificación y/o sobre-expresión del oncogén c-erbB2/neu puede contribuir al desarrollo y progresión tumoral. El objetivo de este trabajo es el estudio del valor pronóstico de la proteína p185 mediante técnicas de inmunohistoquímica en el carcinoma colorrectal. Se trata de un estudio de cohortes prospectivo en 106 muestras de tejido tumoral colorrectal de pacientes intervenidos quirúrgicamente por un mismo cirujano y con una mediana de tiempo de seguimiento de 3 años. El 33% de los pacientes presenta sobre-expresión de p185, que se relaciona con estadios avanzados de la enfermedad. En los pacientes con tumores adenocarcinoma localizados en colon y sin metástasis a distancia, la determinación de p185 muestra valor pronóstico clínicamente relevante (p=0,06).

Introduction: liver segmental resection and liver transplantation are both treatments intended for healing liver cancer. An adequate selection of patients eligible for transplantation is crucial, since organs available for transplants are usually scarce. For this reason, awareness of the prognostic factors of relapse is of great importance. We present a comprehensive review of our series in order to better understand these prognostic factors. Material and methods: we revised the cases of patients with hepatocellular carcinoma who underwent liver transplantation during the period 1994-2000, and present a detailed analysis of a series of variables which may be probably implicated in the appear-ance of relapse and which have an effect on survival. Results: after a mean follow-up of 33 months, the mortality rate was 27.5% and relapse occurred in 18.75% of cases. No history of alcohol abuse, the number and size of the nodules, the presence of macro and microscopic vascular invasion, and pTNM stage T4 were all factors associated with a significantly increased risk of relapse (pIntroducción: tanto la resección hepática segmentaria como el trasplante hepático son tratamientos con intención curativa para el hepatocarcinoma. La adecuada selección de los pacientes para el trasplante es de vital importancia dada la escasa disponibilidad de órganos. Por ello resulta fundamental el conocer los factores predictivos de recidiva tumoral, motivo por el que hacemos una exhaustiva revisión de nuestra serie. Material y métodos: revisamos los pacientes con hepatocarcinoma trasplantados en el periodo 1994-2000, y analizamos detalladamente una serie de variables con probable implicación en la recidiva tumoral y repercusión sobre la supervivencia. Resultados: tras un seguimiento medio de 33 meses, la mortalidad fue del 27,5% y la tasa de recidiva del 18,75%. La ausencia de alcoholismo, el número y el tamaño de nódulos, la invasión vascular macro y microscópica, y un estadio T4 en el clásico pTNM, se asociaban con un riesgo significativamente mayor de recidiva (p

We report the case of a 91-year-old female with acute cholangitis and long-standing symptoms of recurrent colic- related abdominal pain after cholecystectomy. She was diagnosed by abdominal CT of saccular dilation of the intramural bile duct in the duodenum suggesting choledococele. ERCP was performed in which the presumptive diagnosis was confirmed, and choledochotomy and choledochoplasty were done with excellent subsequent progress. Choledococele is the least common type of biliary cyst. It consists of a cystic dilation of the intramural portion of the common bile duct that protrudes into the duodenal lumen and causes symptoms of recurrent abdominal pain and biliary events. ERCP is a key test in both diagnosis and treatment except when they cannot be approached by this technique or malignancy is suspected.

A 76-year-old woman was being followed up for chronic anemia secondary to bleeding from vascular ectasias at the gastric antrum and the cardial and subcardial region. On several occasions the patient required fulguration of these lesions with conventional APC, which resulted in no clear improvement. Radiofrequency ablation of these lesions was then attempted using a 90-degree probe, which was successful on antral angiodysplasias but failed to remove lesions in the cardial and subcardial region since anatomy there prevented proper apposition of the probe onto the target mucosa. Given the absence of any improvement, it was decided to use fulguration for angiectasias at the cardial and subcardial level by means of Hybrid-APC, which consists of lifting the mucosa with an injection through the APC probe and then fulgurating in the pulsedAPC® mode, thus achieving a broader ablation area in a shorter time. During the subsequent review a clear reduction of vascular ectasias was observed.

Back in January 2022, an EASL-Lancet Commission on the impact of liver disorders in the European region commissioned by the WHO demonstrated that this condition is, actually, the second leading cause of loss of labor years in Europe after ischemic heart disease (1). This is a very relevant piece of information since this is something that is going to impact the new generations of Europeans unless a significant change is made in public health policies. Despite the advances made over the last few years in hepatitis C virus clearance-understood as a significant reduction of morbidity and mortality associated with Hepatitis B and C viruses-there are still challenges ahead to improve liver health due to the high use of alcohol, and the inseparable triad obesity / diabetes mellitus / metabolic associated fatty liver disease. Also, access to healthcare for several population groups at risk of presenting higher rates of liver disease has become a problem.

Introduction: liver enzyme elevation has been reported in SARS-CoV-2 disease (COVID-19) in heterogeneous cohorts, mainly from China. Comprehensive reports from other countries are needed. In this study, we dissect the pattern, evolution, and predictive value of such abnormalities in a cohort from Madrid, Spain., Methods: a retrospective study with a prospective 14-day follow-up of 373 patients with confirmed COVID-19 in five Madrid hospitals, including 50 outpatients. A COVID-19 severe course was defined as the need for mechanical ventilation., Results: a total of 33.1 % of hospitalized patients showed baseline AST elevation and 28.5 % showed ALT elevation, compared with 12 % and 8 % of outpatients (p ≤ 0.001). Baseline AST, ALT and GGT levels correlated with LDH and C-reactive protein (CRP) levels (r ≤ 0.598, p < 0.005). AST elevation was associated with other severity markers such as male sex, lymphopenia, and pneumonia on X-Ray (p < 0.05 for all). ALP and bilirubin levels were rarely increased. Patients with elevated baseline AST showed a progressive normalization of this enzyme and an increase in ALT and GGT levels. Patients with normal baseline AST showed a flattened evolution pattern with levels within the range. Patients with a severe course of COVID-19 more frequently showed elevated baseline AST than those with a milder evolution (54.2 % vs. 25.4 %, p < 0.001). Age, AST and CRP were independent risk factors for a severe course of COVID-19., Conclusion: mild liver enzyme elevation is associated with COVID-19 severity. Baseline AST is an independent predictor of severe COVID-19 course, and tends to normalize over time. ALT and GGT show a late elevation.

A 32-year-old male patient with common variable immunodeficiency (CVI), under treatment with human immunoglobulin G, experienced recurrent episodes of intestinal pseudo-obstruction that were medically treated. Imaging tests showed a non-obstructive ileal stenosis and biopsies performed during ileocolonoscopy revealed nod-ular lymphoid hyperplasia.

The purpose of this rapid review is to provide an update on the impact of SARS-CoV-2 infection on Gastroenterology and Hepatology departments, our patients, and our new way of working. The gastrointestinal tract and the liver are affected by SARS-CoV-2, especially in patients with immunosuppressive therapies. Patients with liver transplantation should be followed closely. Digestive endoscopy is a high-risk procedure for the transmission of SARS-CoV-2. While the pandemic lasts, we must adapt its indications and promote protective measures for patients and healthcare professionals alike. The COVID-19 pandemic has changed our priorities and the way we work, although we do not know what the repercussions will be after normality is reinstated.

The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitis C virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1) Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of microelimination strategies in vulnerable populations; 2) Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3) Simplification of patient treatment and improvement of care circuits; 4) Health policy measures, and, finally, 5) Establishment of HCV elimination indicators.

Background and Aims: non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder in the western world. Although NAFLD prevalence is higher in patients with a BMI > 25 kg /m2, it is unclear if there are differences between overweight and obese patients. The associated biochemical, dietary and genetic parameters were compared between overweight and obese patients with NAFLD., Methods: patients with biopsy-proven NAFLD (n = 203) were enrolled in a cross-sectional study. The MEDAS questionnaire was used to assess adherence to the Mediterranean diet. Biochemical, anthropometrical parameters and the I148M variant (rs738409) of the PNPLA3 gene and rs180069 of the TNF-α gene were evaluated., Results: overweight patients had higher serum adiponectin levels (22.5 ± 21.9 vs 11.2 ± 18.1 ng/ml; p < 0.05) and lower resistin (3.3 ± 1.7 vs 8.1 ± 8 ng/ml; p < 0.001) and leptin concentrations (22.9 ± 21.9 vs 55.8 ± 45 ng/ml; p < 0.001) than obese patients. Non-alcoholic steatohepatitis (NASH) was more frequent in the obese group (59.3% vs 41.3%; p = 0.02). The multivariate analysis showed adherence to the Mediterranean diet to be an independent protective factor for NASH and liver fibrosis in overweight patients (OR 0.7, 95% CI 0.5-0.8)., Conclusions: NASH was more prevalent in obese patients than in overweight subjects. HOMA-IR and adherence to the Mediterranean diet provided protection against fibrosis in overweight patients. Adherence to the Mediterranean diet was the only independent factor associated with NASH in these patients.

Objectives: To reach a situation diagnosis on the status of patient management at digestive care units (DCUs) in Spain., Material and Methods: A cross-sectional descriptive study across DCUs in general acute care hospitals within the Spanish National Health System (data referred to 2015). The study variables were collected with a questionnaire including items on structure, services portfolio, activity, education, research, and good practice. Hospital discharge rates for digestive diseases were also assessed using the minimum basic data set (2005-2014)., Results: Two hundred and nine hospitals invited, 55 responders (26.3%). Average discharges from hospital were 1,139 ± 653 per DCU/year, and 100 ± 66 per year per dedicated gastroenterologist. In 2014, admission rate to DCUs per 1,000 population and year was 280, with a mean stay of 7.4 days. The analysis of the MBDS for 2005-2014 reveals a progressive increase in the number of discharges (37% more in 2014 versus 2005), with a 28% decrease in hospital gross mortality rate (3.7% in 2014) and a slightly reduced (14%) mean stay (7.6 days in 2014). Considerable variability may be seen in structure, activity, and results indicators. Mortality and readmission rates, as well as mean stay, vary more than 100% amongst DCUs, and major dispersions also exist in frequentation and results amongst autonomous communities., Conclusions: The RECALAD 2015 survey unveiled relevant aspects related to DCUs organization, structure, and management. The notable variability encountered likely reflects relevant differences in efficiency and productivity, and thus points out there is ample room for improvement.

We report the case of a 14 year-old woman, who presents epigastric abdominal pain, abundant vomits and an important abdominal distension. Previously, she presented similar episodes. She has not any significant prior medical history. CT is performed and the imaging findings are consistent with Wilkie´s syndrome. Wilkie´s syndrome is a rare condition, that results from a intestinal obstruction caused by third portion duodenal compression between the abdominal aorta and the superior mesenteric artery. When the angle between both structures diminishes and the distance between the SMA and the aorta decreases (the most diagnostic value), duodenal obstruction occurs. Initially conservative management is adopted, but in some cases surgical treatment is necessary. Multislice CT has demonstrated an excellent diagnostic value when this entity is suspected. It provides multiplanar reconstructions, which are useful to measure the distance and the aortomesenteric angle and to rule out other possible etiologies.

Interventional endoscopy is a field that continues to grow rapidly. A novel prototype forward-viewing echoendoscope (FV-EUS) has been recently developed in an attempt to overcome some of the limitations of conventional curved linear-array echoendoscopes (OV-EUS). We present a case of a successful endoscopic ultrasound-guided drainage of a pancreatic pseudocyst using a forward-viewing echoendoscope. Although the utilization use of this newly developed echoendoscope has not yet become widespread, its unique characteristics can help to easily perform routine therapeutic procedures and contribute to the expansion of interventional endoscopic utrasoundultrasound.

Introduction: p16 gene plays an important role in the cell cycle regulation and is considered an important tumor suppressor gene. Several mechanisms of gene inactivation have been described; in this study we have focused on p16 gene promoter methylation. In colorectal cancer p16 gene methylation is a frequent event., Methods: 326 patients with sporadic colorectal cancer were included. DNA was extracted from tumor tissue samples obtained during the surgical procedure. Promoter methylation was analyzed using bisulfite modification and was detected by quantitative methylation-specific PCR. Frequency of p16 methylation was analyzed and compared with other clinicopathological variables., Results: p16 gene methylation was detected in 24.8% of patients. Methylation was associated with differentiation grade and with tumor location: methylation was frequent in poorly differentiated tumors and had low frequency in distal colon. The p16 promoter methylation discriminated a subgroup of patients with better prognosis in poorly differentiated tumors., Conclusions: p16 methylation was a frequent event in our population and was able to induce differences in the overall survival of patients with poorly differentiated tumors.

Objective: The hepatocyte growth factor (HGF) is a pleiotropic cytokine produced by hepatic stellate cells and implicated in liver regeneration and fibrosis. Serum levels of HGF vary in liver diseases, reflecting hepatic damage and hepatocellular dysfunction. In this study, serum levels of HGF and the relationship between HGF and biochemical, histological and virological data, have been analysed in patients suffering from chronic hepatitis C (CHC)., Patients and Methods: Serum HGF concentration was measured by ELISA in sandwich in 45 patients with CHC. Correlation between HGF levels and histological (necroinflammatory activity and fibrosis score) and biochemical (transaminases, prothrombin activity, albumin, bilirubin), or virological (hepatitis C virus load) parameters was analyzed. Serum HGF concentration was also studied in a subgroup of the original sample treated with interferon and ribavirin., Results: Sserum HGF concentrations of patients with CHC were significantly higher than those detected in healthy controls. Patients with significant fibrosis (F > or = 2) had a significantly older age, lower count of platelets and higher values of AST, GGT and HGF, than those patients with a fibrosis score F < 2. HGF concentration was identified by multivariate analysis as the only independent factor associated with significant fibrosis. Moreover, area under receiver operating curve, using HCG levels, showed similar values to those of previously validated non-invasive indexes of fibrosis. However, levels of HGF did not show a significant decrease in patients with a sustained response to anti-virus C therapy., Conclusion: Serum HGF concentration correlates with fibrosis score in patients with CHC, but is insensitive to monitor changes induced by anti-virus C therapy.

Background and Aims: more than half of patients with genotype 1 chronic hepatitis C (CHC) do not achieve a sustained viral response (SVR) to current antiviral therapy due to primary non-response, relapse or intolerance. Factors related to each of these unfavorable outcomes are different and the last two may be partially prevented. Our aim was to identify basal criteria to predict the risk of primary failure., Patients and Methods: we included 251 consecutive patients (152 males) from a single centre, infected with HCV genotype 1 and not previously treated. SVR was achieved in 141 patients and primary failure in 110., Results: high vs. low viral load (> 400,000 IU/mL, OR = 6.17; 95% CI: 2.50-15.23), high serum GGT (> 60 IU/mL, OR = 4.25; 95% CI: 2.49-7.24), low serum cholesterol ( < 178 mg/dL, OR = 2.93; 95% CI: 1.75-4.92) and older age (> 47 yrs., OR = 1.79; 95% CI: 1.08-2.96) were associated to the risk of primary failure in the lineal logistic regression analysis. From the 58 patients carrying all the first three negative criteria, 46 (79.3%) were primary non-responders., Conclusions: the negative basal profile identified in this study is based on easily available data and provides information about the risk of primary therapeutic failure, and may help to decide whether antiviral therapy should be offered to a single patient.

Background: Angiogenesis plays an important role in tumor progression. The vascular endothelial growth factor (VEGF) is an important regulator of angiogenesis. In the present study we evaluated single nucleotide polymorphisms (SNPs) -2578C > A, -1154G > A, and +936C > T in the VEGF gene, and their prognostic value for patients operated on for colorectal cancer (CRC)., Patients and Method: VEGF polymorphisms have been analyzed in 177 patients who had undergone surgical resection at Hospital Clínico San Carlos. The analysis of these polymorphisms was performed with specific probes for each nucleotide in a multiplex reaction using real-time PCR., Results: We only found a statistically significant relationship for one of these three polymorphisms, +936C > T, with gender and tumor location; 10.7% of patients heterozygotes for this SNP had tumors located in proximal colon, 35.2% in distal segment and 54.1% in rectum (p = 0.03). Patients with the +936T/T genotype had 100% overall survival (OS)., Conclusion: Patients with a +936T/T genotype showed increased survival, therefore the +936C > T SNP could be a useful marker in the follow-up and clinical management of patients with colorectal cancer.

Aim: To evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used., Patients and Methods: Data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis., Results: A total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case., Conclusions: Brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended.

Objective: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features., Methods: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005., Results: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%, and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate., Conclusions: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson's morbidity index > or =5; Quick index < 60% and development of complications. Drainage indication has to be individualized.

Objective: despite the endogenous coagulopathy of cirrhosis, some patients do experience thrombophilic states. The American College of Chest Physicians failed to address the prevention and treatment of venous thromboembolism (VTE) occurring among these patients. This study aims to describe the characteristics of cirrhotics patients hospitalized in the last 15 years, and to use the experience gained., Material and Method: we retrospectively reviewed all admissions for cirrhosis in our hospital from 1992 to 2007. A total of 17 patients had non-portal venous thromboembolic disease. We recorded risk factors, epidemiological and laboratory data, thrombosis characteristics, and treatment complications., Results and Conclusions: approximately 0.8% of all hospitalized patients with cirrhosis had a non-portal VTE despite the elevated INR and low platelet count. We found low serum albumin, acquired antithrombin III, protein C and protein S deficiency, presence of antiphospholipid antibodies, and hyperhomocisteinemia in blood tests. Many patients had hemorragic complications during anticoagulation therapy, and 35% needed blood transfusions.

We report the case of a periampullary collision tumor, in which a duodenal-wall carcinoid and an adenocarcinoma of the head of the pancreas coexisted. We describe the case of a 64-year-old man with a recent history of diarrhea, who was diagnosed with obstructive jaundice. A duodeno-pancreatectomy was performed, and the specimen showed two independent neoplasms in the histopathologic study. Solid cords and nests of neuroendocrine cells in the duodenal wall formed the carcinoid tumor, whereas the other neoplasm was made up of a well-differentiated adenocarcinoma of the pancreas. Both were confirmed by immunohistochemical analysis. According to the literature reviewed, this is the sixth reported case of this rare neoplastic association.

In arterial hypertension besides reducing blood pressure, we should think about the circadian pressure profile that the patient presents, since the patients non depressors (not descent of arterial pressure during the night with regard to the day) (non-dipper) they associate to a worse cardiovascular prognosis. The purpose of the present study was to determine the circadian pressure profile in patient treated arterial hypertension and never previously treated with antihypertensive medication; and its relationship with the organic damage. They were included in the study to 702 patients with clinical indication for 24 hour ambulatory blood pressure monitoring. The 39% was dipper, 2% extreme dipper, 49.6% non-dipper and 9.4% riser. The patient non dipper had bigger levels of 24 hours systolic blood pressure, night blood pressure and bigger organic damage. The main factors associated to this pattern were the clinic systolic blood pressure, obesity and overalls a filtrate smaller glomerular to 60 ml/min.

Objectives: Fever in hospitalized patients (FHP) is a difficult problem. We study clinical characteristics and predictive parameters of infection, sepsis and outcome., Patients and Methods: Prospective study of 204 patients with fever > 38 degrees C admitted in an Internal Medicine ward. In each patient clinical evaluation, complete blood count (CBC) urinalysis (UA), C-reactive protein (CRP), chest X- ray (CXR), blood and urine cultures were performed., Results: 115 patients suffered infection (75.9% nosocomial, 7.4% sepsis), 35 had a non-infectious etiology and 54 an unknown cause. CBC and CRP did not distinguish infection, bacteremia or sepsis. In UA, positive nitrites, leukocytes and bacteriuria were predictive of infection. 18.6% of the patients were diagnosed by CXR. 18% of urine cultures and 13% of blood cultures were positive. 71.6% received antibiotics (deemed unnecessary in 18%). Microbiological results modified 25% of initial treatments. Average hospital stay was 17 days; 16.7% died. Chronic lung disease, fever duration, dysphagia and urinary tract alterations predict infection. Obesity, diabetes mellitus, liver failure, immunocompromised host, central vascular access, fever duration and nosocomial infection predict bacteremia. Sepsis is more prevalent in males, with malignancy and vascular or nosocomial infection. Chronic liver disease, nosocomial infection, severe lung infection and sepsis increase mortality., Conclusions: Clinical diagnosis of FHP is inaccurate. Infection is it s most frequent cause; UA, CXR, and blood and urine cultures are useful. FHP increases mortality and hospital stay. We have established predictable models of infection, bacteremia, sepsis and mortality. However, its sensibility and specificity are low.