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Caustic ingestion management could be improved with a diagnostic approach based on risk factors. This study aimed to develop an algorithm derived from predictive factors of a poor clinical course, to evaluate its diagnostic accuracy and resource consumption, and to compare it with 2 other approaches, a radiological one based on computed tomography and a classical one based on symptoms and endoscopy.All patients older than 15 years presenting with caustic ingestion in our tertiary care hospital between 1995 and 2021 were prospectively included. Adverse outcome was defined as intensive care unit admission, emergency surgery, or death. Ingestion characteristics, symptoms, and laboratory and endoscopic findings were analyzed to determine the most relevant risk factors. Diagnostic accuracy and the number of examinations required were estimated and compared with the other 2 algorithms applied to our series.The sample included 532 cases of caustic ingestion, 13.2% (95% confidence interval [CI]: 10.3-16.0) of which had adverse outcomes. Volume and type of caustic substance; presence of symptoms and pharyngolaryngeal involvement; and neutrophilia, acidosis, and endoscopic injury were combined to develop an algorithm that would provide the highest diagnostic odds ratio (167.2; 95% CI: 71.9-388.7). Following this approach, half of the patients (50.6%; 95% CI: 46.2-55.1) would not require any examination and, overall, the need for endoscopy (20.0%; 95% CI: 16.4-23.5) and computed tomography (16.3%; 95% CI: 13.0-19.5) would be lower than that for the other 2 algorithms.A risk-based algorithm could improve caustic ingestion management by maintaining high diagnostic accuracy while reducing diagnostic test requirements.

Loss-of-response and adverse events (AE) to biologics have been linked to HLA-DQA1*05 allele. However, the clinical factors or biologic used may influence treatment duration. Our objective was to evaluate the influence of clinical and therapeutic factors, along with HLA, in biological treatment discontinuation.A retrospective study of consecutive IBD patients treated with biologics between 2007 and 2011 was performed. Main outcome was treatment discontinuation due to primary non-response (PNR), secondary loss of response (SLR) or AE. HLA-DQA1 genotyping was done in all patients. Regression analyses were used to assess risk factors of treatment discontinuation.One hundred fifty patients (61% male) with 312 biologic treatments were included. 147 (47%) were discontinued with a cumulative probability of 30%, 41% and 56% at 1, 2 and 5 years. The use of infliximab (p=0.006) and articular manifestations (p0.05) were associated with treatment discontinuation. Considering cause of withdrawal, Ulcerative Colitis (UC) had a higher proportion of PNR (HR=4.99; 95% CI=1.71-14.63; p=0.003), SLR was higher if biologics had been indicated due to disease flare (HR=2.32; 95% CI=1.05-5.09; p=0.037) while AE were greater with infliximab (HR=2.46; 95% CI=1.48-4.08; p0.001) or spondylitis (HR=2.46; 95% CI=1.78-6.89; p0.001). According to the biological drug, HLA-DQA1*05 with adalimumab showed more SLR in cases with Crohn's disease (HR=3.49; 95% CI=1.39-8,78; p=0.008) or without concomitant immunomodulator (HR=2.8; 95% CI=1.1-6.93; p=0.026).HLA-DQ A1*05 was relevant in SLR of IBD patients treated with adalimumab without immunosupression. In patients treated with other biologics, clinical factors were more important for treatment interruption, mainly extensive UC or extraintestinal manifestations and having indicated the biologic for flare.

Background: A treat-to-target strategy, in which strictly defined treatment targets facilitate decision making in clinical practice, is advocated as an optimised management approach for some chronic disorders. The aim of the STARDUST trial was to assess whether a treat-to-target strategy with early endoscopy, regular biomarker and clinical symptom monitoring, and dose intensification for persistent inflammatory activity, was more successful in achieving endoscopic improvement at week 48 than a clinically driven maintenance strategy in patients with moderate-to-severe active Crohn's disease receiving ustekinumab. Methods: This open-label, multicentre, randomised phase 3b trial included adults with active, moderate-to-severe Crohn's disease (Crohn's Disease Activity Index [CDAI] 220–450 and Simple Endoscopic Score in Crohn's Disease [SES-CD] ≥3) for whom conventional therapy or one biologic therapy, or both, had failed. Patients received intravenous ustekinumab approximating 6 mg/kg at baseline and subcutaneous ustekinumab 90 mg at week 8. At week 16, patients with a CDAI improvement of 70 or more points from baseline were randomly assigned (1:1) to receive standard-of-care or treat-to-target maintenance treatment through week 48. Randomisation was balanced by using randomly permuted blocks and was stratified by biologic history status and baseline SES-CD score. All patients who signed informed consent, who were not screening failures, and who received at least one dose of study treatment were included in week 16 analyses. All patients included in week 16 analyses and randomly assigned to one of the maintenance treatment regimens were included in the week 48 efficacy and safety analyses (ie, on an intention-to-treat basis). Patients assigned to the treat-to-target arm received ustekinumab every 12 weeks or every 8 weeks based on SES-CD improvement from baseline and could escalate to every 4 weeks through week 48 if prespecified targets were missed. Patients assigned to the standard-of-care arm received ustekinumab every 12 weeks or every 8 weeks; those receiving treatment every 12 weeks could escalate per European labelling. The primary efficacy endpoint was endoscopic response at week 48 (SES-CD score ≥50% decrease from baseline), analysed by non-responder imputation. This trial is registered at ClinicalTrials.gov, NCT03107793, and is active but not recruiting. Findings: 498 patients received standard induction treatment, of whom 440 were randomly assigned to the treat-to-target group (n=219) or the standard-of-care group (n=221). At week 48, there was no significant difference in endoscopic response (83 [38%] of 219 patients vs 66 [30%] of 221 patients; p=0·087), endoscopic remission (25 [11%] vs 32 [15%]; p=0·334), mucosal healing (31 [14%] vs 37 [17%]; p=0·449), and clinical remission (135 [62%] vs 154 [70%]; p=0·072) between the two groups; clinical response was significantly lower in the treat-to-target group than in the standard-of-care group (149 [68%] vs 172 [78%]; p=0·020). Other endoscopic, clinical, and biomarker outcomes were generally not significantly different between groups. The most commonly reported treatment-emergent adverse events were nasopharyngitis (29 [13%] of 219 patients in the treat-to-target group vs 29 [13%] of 221 patients in the standard-of-care group), abdominal pain (23 [11%] vs 19 [9%]), arthralgia (24 [11%] vs 19 [9%]), and headache (24 [11%] vs 21 [10%]). Interpretation: Timely escalation of ustekinumab therapy for patients with Crohn's disease, based on early endoscopic response, clinical symptoms, and biomarkers, did not result in significantly better endoscopic outcomes at week 48 than symptom-driven decisions alone. Future studies need to confirm if some subgroups of patient might benefit from a treat-to-target strategy with ustekinumab. Funding: Janssen-Cilag.

Background and Aims The development programm UNIFI has shown promising results of ustekinumab in ulcerative colitis [UC] treatment which should be confirmed in clinical practice. We aimed to evaluate the durability, effectiveness, and safety of ustekinumab in UC in real life. Methods Patients included in the prospectively maintained ENEIDA registry, who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score [PMS]>2], were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at Week 16. Results A total of 95 patients were included. At Week 16, 53% of patients had response [including 35% of patients in remission]. In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at Weeks 24 and 52, respectively; 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at Week 16, 63% at Week 56, and 59% at Week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. Conclusions Ustekinumab is effective in both the short and the long term in real life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.

Introduction Thiopurines are used as maintenance therapy in patients with ulcerative colitis (UC). There are contradictory results regarding the relationship between adherence to treatment and risk of relapse. Objectives To quantify and evaluate the trends in thiopurines prescription rates, and to determine the impact and risk factors of non-adherence. Methods Analytical, observational and retrospective study of UC patients, on thiopurines, included in the ENEIDA single-center registry from October 2017 to October 2019. We included adult patients under clinical remission at the beginning of the study on thiopurines maintenance treatment for at least 6 months before recruitment. Adherence was evaluated with an electronic pharmaceutical prescription system. Adherence was considered when 80% or more of the prescribed medication was dispensed at the pharmacy. Kaplan-Meier curves and a regression model were used to examine year-to-year treatment dispensation and identify factors associated to non-adherence. Results A total of 41 patients were included, of whom 71% were males with a mean age of 44 (14) and 26.8% were concomitantly managed with biological therapy. Overall, 22% were non-adherent to thiopurines. No predictive factors of non-adherence were identified. Adherence rate did not correlate with disease activity for two years follow-up (OR 1.6; 95CI =0.3-9.1). Left-sided colitis and concomitant biological treatment were related with disease relapses (p ≤0.01). Conclusion The adherence to thiopurines in UC patients is high (78%). Non-adherence is not related to clinical or pharmacological factors. Adherence rate was not associated with disease activity.

We present the case of a 60-year-old woman with no drug allergies or toxic habits, with hypothyroidism and receiving treatment with levothyroxine.

Resumen La enfermedad de Crohn es una enfermedad inflamatoria intestinal cronica de etiologia desconocida asociada a una respuesta inmunologica alterada que cursa con periodos de actividad y remision. Puede afectar a cualquier tramo del tracto gastrointestinal, desde la boca hasta el ano, principalmente de forma transmural y parcheada. Los sintomas mas frecuentes son el dolor abdominal y la diarrea, pudiendo afectar gravemente la calidad de vida de los pacientes. El aumento de su incidencia y prevalencia en nuestro medio ha condicionado un creciente impacto en la practica clinica habitual asi como un rapido desarrollo de tecnicas diagnosticas y terapeuticas. Es por ello que tanto medicos de familia como especialistas deben estar familiarizados con el manejo de la enfermedad.

espanolEn esta Guia de Practica Clinica analizamos el manejo diagnostico y terapeutico de pacientes adultos con estrenimiento y molestias abdominales, bajo la confluencia del espectro del sindrome del intestino irritable y el estrenimiento funcional. Ambas patologias estan encuadradas en los trastornos funcionales intestinales y tienen una importante repercusion personal, sanitaria y social, afectando a la calidad de vida de los pacientes que las padecen. La primera es el subtipo de sindrome del intestino irritable en el que el estrenimiento es la alteracion deposicional predominante junto con dolor abdominal recurrente, hinchazon y distension abdominal frecuente. El estrenimiento se caracteriza por la dificultad o la escasa frecuencia en relacion con las deposiciones, a menudo acompanado por esfuerzo excesivo durante la defecacion o sensacion de evacuacion incompleta. En la mayoria de los casos no tiene una causa organica subyacente, siendo considerado un trastorno funcional intestinal. Son muchas las similitudes clinicas y fisiopatologicas entre ambos trastornos, con respuesta similar del estrenimiento a farmacos comunes, siendo la diferencia fundamental la presencia o ausencia de dolor, pero no de un modo evaluable como “todo o nada”. La gravedad de estos trastornos depende no solo de la intensidad de los sintomas intestinales sino tambien de otros factores biopsicosociales: asociacion de sintomas gastrointestinales y extraintestinales, grado de afectacion, y formas de percepcion y comportamiento. Mediante los criterios de Roma, se diagnostican los trastornos funcionales intestinales. Esta Guia de Practica Clinica esta adaptada a los criterios de Roma IV difundidos a finales de mayo de 2016. En una primera parte96-98 se analizaron, los aspectos conceptuales y fisiopatologicos, los criterios de alarma, las pruebas diagnosticas y los criterios de derivacion entre Atencion Primaria y Aparato Digestivo. En esta segunda parte, se revisan todas las alternativas terapeuticas disponibles (ejercicio, ingesta de liquidos, dieta con alimentos ricos en fibra soluble, suplementos de fibra, otros componentes de la dieta, laxantes osmoticos o estimulantes, probioticos, antibioticos, espasmoliticos, esencia de menta, prucaloprida, linaclotida, lubiprostona, biofeedback, antidepresivos, tratamiento psicologico, acupuntura, enemas, neuroestimulacion de raices sacras o cirugia), efectuando recomendaciones practicas para cada una de ellas. EnglishIn this Clinical Practice Guide, we analyze diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, under the confluence of the spectrum of the irritable bowel syndrome and functional constipation. Both conditions are located within intestinal functional disorders and have a significant personal, health and social repercussion, affecting quality of life of the patients who suffer them. The former is the subtype of irritable bowel syndrome in which constipation is the predominant bowel movement alteration together with recurrent abdominal pain, swelling and frequent abdominal distension. The constipation is characterized by difficulty or scarce frequency in relation with bowel movements, often accompanied by excessive effort during defecation or sensation of incomplete evaluation. There is no underlying organic cause in most of the cases, it being considered a functional intestinal disorder. There are many clinical and physiopathological clinical similarities between both disorders, with similar response of the constipation to common drugs, the fundamental difference being the presence or absence of pain, but not in an “all or nothing” evaluable way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, grade of impairment, forms of perception and behavior. Using the Rome criteria, the functional gastrointestinal disorders are diagnosed. The Clinical Practice Guide is adapted to the Rome IV criteria dissiminated at the end of May 2016. In a first part, the conceptual and pathophysio aspects, alarm criteria, diagnostic tests and referral criteria between Primary Care and Digestive Tract Department were analyzed. In this second part, all the available therapeutic alternatives (exercise, fluid intake, diet with soluble fiber rich foods, fiber supplements, other components of the diet, osmotic or stimulants laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychotherapy, acupuncture, enemas, sacral nerve stimulation or surgery) are reviewed, making practical recommendations for each one of them.

Background and Aims Although commonly used in inflammatory bowel disease [IBD], thiopurines frequently cause intolerance, and switching to a second thiopurine has only been reported in some small series. Ours aims in this study were to evaluate the safety of switching to a second thiopurine in a large cohort, and to assess the impact of age on tolerance. Methods Adult IBD patients from the ENEIDA registry, who were switched to a second thiopurine due to adverse events [excluding malignancies and infections], were identified. At the beginning of thiopurine treatment, patients were divided by age into two groups: 18–50 and over 60 years of age. The rate and concordance of adverse events between the first and second thiopurines, treatment intolerance, and persistence with the second thiopurine were evaluated. Results A total of 1278 patients [13% over 60 years of age] were switched to a second thiopurine. At 12 months, the cumulative probability of switch intolerance was 43%, and persistence with treatment was 49%. Independent risk factors of switch intolerance were age over 60 years (odds ratio [OR] 1.49; 95% confidence interval [CI] 1.07–2.07; p = 0.017) , previous gastrointestinal toxicity [OR 1.4; 95% CI 1.11–1.78; p = 0.005], previous acute pancreatitis [OR 6.78; 95% CI 2.55–18.05; p Conclusions In a large series in clinical practice, switching to a second thiopurine proved to be a valid strategy. Tight monitoring of elderly IBD patients switching to a second thiopurine because of adverse events is recommended.

BACKGROUND Thiopurines are the most widely used immunosuppressants in IBD although drug-related adverse events (AE) occur in 20%-30% of cases. AIM To evaluate the safety of thiopurines in elderly IBD patients METHODS: Cohort study including all adult patients in the ENEIDA registry who received thiopurines. Patients were grouped in terms of age at the beginning of thiopurine treatment, specifically in those who started thiopurines over 60 years or between 18 and 50 years of age. Thiopurine-related AEs registered in the ENEIDA database were compared. RESULTS Out of 48 752 patients, 1888 started thiopurines when over 60 years of age and 15 477 under 50 years of age. Median treatment duration was significantly shorter for those who started thiopurines >60 years (13 [IQR 2-55] vs 32 [IQR 5-82] months; P 60 years had higher rates of all types of myelotoxicity, digestive intolerance and hepatotoxicity. Thiopurines were discontinued due to AEs (excluding malignancies and infections) in more patients starting >60 years (67.2% vs 63.1%; P

espanolEn esta Guia de Practica Clinica analizamos el manejo diagnostico y terapeutico de pacientes adultos con estrenimiento y molestias abdominales, bajo la confluencia del espectro del sindrome del intestino irritable y el estrenimiento funcional. Ambas patologias estan encuadradas en los trastornos funcionales intestinales y tienen una importante repercusion personal, sanitaria y social, afectando a la calidad de vida de los pacientes que las padecen. La primera es el subtipo de sindrome del intestino irritable en el que el estrenimiento es la alteracion deposicional predominante junto con dolor abdominal recurrente, hinchazon y distension abdominal frecuente. El estrenimiento se caracteriza por la dificultad o la escasa frecuencia en relacion con las deposiciones, a menudo acompanado por esfuerzo excesivo durante la defecacion o sensacion de evacuacion incompleta. En la mayoria de los casos no tiene una causa organica subyacente, siendo considerado un trastorno funcional intestinal. Son muchas las similitudes clinicas y fisiopatologicas entre ambos trastornos, con respuesta similar del estrenimiento a farmacos comunes, siendo la diferencia fundamental la presencia o ausencia de dolor, pero no de un modo evaluable como “todo o nada”. La gravedad de estos trastornos depende no solo de la intensidad de los sintomas intestinales sino tambien de otros factores biopsicosociales: asociacion de sintomas gastrointestinales y extraintestinales, grado de afectacion, y formas de percepcion y comportamiento. Mediante los criterios de Roma, se diagnostican los trastornos funcionales intestinales. Esta Guia de Practica Clinica esta adaptada a los criterios de Roma IV difundidos a finales de mayo de 2016 y analiza, en esta primera parte, los aspectos conceptuales y fisiopatologicos, los criterios de alarma, las pruebas diagnosticas y los criterios de derivacion entre Atencion Primaria y Aparato Digestivo. En una segunda parte, se revisaran todas las alternativas terapeuticas disponibles (ejercicio, ingesta de liquidos, dieta con alimentos ricos en fibra soluble, suplementos de fibra, otros componentes de la dieta, laxantes osmoticos o estimulantes, probioticos, antibioticos, espasmoliticos, esencia de menta, prucaloprida, linaclotida, lubiprostona, biofeedback, antidepresivos, tratamiento psicologico, acupuntura, enemas, neuroestimulacion de raices sacras o cirugia), efectuando recomendaciones practicas para cada una de ellas. EnglishIn this Clinical Practice Guide, we analyze diagnostic and therapeutic management of adult patients with constipation and abdominal discomfort, under the confluence of the spectrum of the irritable bowel syndrome and functional constipation. Both conditions are located within intestinal functional disorders and have a significant personal, health and social repercussion, affecting quality of life of the patients who suffer them. The former is the subtype of irritable bowel syndrome in which constipation is the predominant bowel movement alteration together with recurrent abdominal pain, swelling and frequent abdominal distension. The constipation is characterized by difficulty or scarce frequency in relation with bowel movements, often accompanied by excessive effort during defecation or sensation of incomplete evaluation. There is no underlying organic cause in most of the cases, it being considered a functional intestinal disorder. There are many clinical and physiopathological clinical similarities between both disorders, with similar response of the constipation to common drugs, the fundamental difference being the presence or absence of pain, but not in an “all or nothing” evaluable way. The severity of these disorders depends not only on the intensity of the intestinal symptoms but also on other biopsychosocial factors: association of gastrointestinal and extraintestinal symptoms, grade of impairment, forms of perception and behavior. Using the Rome criteria, the functional gastrointestinal disorders are diagnosed. The Clinical Practice Guide is adapted to the Rome IV criteria dissiminated at the end of May 2016 and analyzes, in this first part, the conceptual and pathophysio aspects, alarm criteria, diagnostic tests and referral criteria between Primary Care and Digestive Tract Department. In a second part, all the available therapeutic alternatives will be reviewed (exercise, fluid intake, diet with soluble fiber rich foods, fiber supplements, other components of the diet, osmotic or stimulants laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychotherapy, acupuncture, enemas, sacral nerve stimulation or surgery), with practical recommendations for each one of them.

Crohn’s disease is one of the two commonly seen inflammatory bowel diseases. As opposed to ulcerative colitis, which only directly affects the colon and rectum, Crohn’s disease can affect any part of the intestinal tract. It can also involve the full thickness of the bowel wall, which accounts for many of the complications seen with the disease. Surgery is not curative but is reserved for the treatment of complications that are refractory to medical management. The etiology is unknown but it is increasingly clear that most patients have a genetic predisposition, though what purported environmental triggers are involved is less clear. Medical therapy has improved significantly, especially with the development of infliximab and adalimumab, but the prevalence of the disease is increasing, more patients are being identified at a younger age, and many still develop complications that require surgical intervention.

To establish recommendations for the management of psychological problems affecting patients with inflammatory bowel disease (IBD).A meeting of a group of IBD experts made up of doctors, psychologists, nurses and patient representatives was held. The following were presented: 1) Results of a previous focal group, 2) Results of doctor and patient surveys, 3) Results of a systematic review of tools for detecting anxiety and depression. A guided discussion was then held about the most important psychological and emotional problems associated with IBD, appropriate referral criteria and situations to be avoided. The validated instrument most applicable to clinical practice was selected. A recommendations document and a Delphi survey were designed. The survey was sent to the group and to a scientific committee of the GETECCU group in order to establish the level of agreement with these recommendations.Fifteen recommendations were established linked to 3 key processes: 1) What steps should be taken to identify psychological problems at an IBD appointment; 2) What are the criteria for referring patients to a mental health specialist; 3) How to approach psychological problems.Resources should be made available to healthcare professionals so that they can treat these problems during consultations, identify the disorders which could affect the clinical course of the disease and determine their impact on the patient's life in order that these can be treated and followed up by the most suitable professional. These recommendations could serve as a basis for redesigning IBD services or processes and as justification for the training of healthcare personnel.

We present the case of a pair of 45-year-old monozygotic twins (A and B) diagnosed with Crohn's disease (CD) at age 20 (A) and 22 (B) with similar presenting symptoms: diarrhea, fever and weight loss. Both of them had duodenal and ileocolonic disease (A2, L3+L4 according to Montreal classification); twin B also presented jejunal involvement and perianal disease (B1p). They received treatment with antibiotics, corticosteroids, 5-ASA, azathioprine and anti-TNF with a poor control of activity. They both developed a coloduodenal fistula that required surgery. Twin A developed the fistula 12 years after the first presentation; fistula closure with duodenorraphy and ileocolonic resection with gastrojejunostomy was performed. Twin B developed the fistula 22 years after the first presentation, and right colectomy, partial duodenectomy and duodenorraphy was carried out. Both developed an enterocutaneous fistula during the postoperative period. With intensive medical treatment, both twins remain asymptomatic.

Glioblastomas express a notable heterogeneity in both the histological and cell patterns with glial astrocytic differentiation. Primary glioblastoma, which is the most frequent presentation (90-95%), occurs mainly in older patients and arises de novo, without any clinical or histological evidence of a less malignant precursor lesion. EGFR amplification has been identified as a genetic hallmark of primary glioblastomas and occurs in 40-60% of cases. However, there exist primary glioblastomas without EGFR amplification/overexpression. The purpose of this study was to stabilize the association between cases with and without EGFR gene amplification with clinical and genetic parameters in 45 cases of primary glioblastomas. EGFR amplification was observed in 24 cases (53%), while in the remaining 21 cases (47%) this alteration was not displayed. And whereas EGFR was overexpressed in 79% of cases with EGFR amplification, only 33% of the cases without EGFR amplification showed overexpression. The amplification of EGFR was associated with amplifications in MDM2 and CDK4 and a higher percentage of cases with promoter methylation of INK4a. Only one case of glioblastoma with EGFR amplification presented TP53 mutation simultaneously. Seven remaining cases with TP53 mutations were glioblastomas without EGFR amplification. The INK4a, INK4b and ARF deletions were similar in the two groups. Primary glioblastomas with and without EGFR amplification did not show any significant differences in average survival. The genetic studies suggest the existence of molecular subtypes within primary glioblastoma that may, when fully defined, contribute toward the development of drugs that specifically target tumors with divergent genetic profiles.

Resumen Objetivos Adaptar al espanol la terminologia del tracto urinario inferior en el ambito pediatrico con motivo del informe de la ICCS de 2006 Material y metodologia se han mantenido discusiones en la Reunion de Consenso en conceptos y terminologia en la que han participado miembros de Grupos Espanol de Urodinamica y de la Sociedad Iberoamericana de Neurourologia y Uroginecologia (SINUG) Resultados y conclusiones Se ofrecen las nuevas definiciones y terminologia estandarizada en espanol, que tiene en cuenta los cambios realizados en el ambito de los adultos y los nuevos resultados en la investigacion. Se presentan los terminos ingleses (frecuentemente entre parentesis). Se discuten algunas propuestas (usualmente en las notas al pie)

Background and Aims: Amyloidosis is a rare complication of inflammatory bowel disease [IBD]; its low prevalence has hindered both descriptive and therapeutic studies. The aim of this study was to estimate the prevalence of amyloidosis in IBD and the risk factors associated with this complication. Methods: This paper presents an observational study, followed by a systematic review of the epidemiological and clinical characteristics of the disease and a review of the diagnostic and therapeutic options. Results: The prevalence of amyloidosis among IBD patients is 0.53% (95% confidence interval [CI]: 0.32–0.75), although epidemiological data suggest that it may be under-diagnosed. The phenotype most frequently associated with amyloidosis is males with aggressive and extensive Crohn’s disease, fistulising behaviour, perianal disease, and extra-intestinal complications, with the development of proteinuria and renal failure. Conclusions: Identifying risk factors of amyloidosis in IBD patients and screening for proteinuric renal dysfunction are useful to improve diagnostic accuracy. Referral of biopsies to a tertiary centre should also be considered, to improve diagnostic accuracy. Although there is no reliable evidence on the effectiveness of treatment, it seems reasonable to treat the underlying disease with potent immunosuppression to minimise inflammatory activity, thereby switching off amyloidogenesis.

The aetiological diagnosis of obstructive defaecation syndrome (ODS) requires, among others, imaging tests. The purpose of this study is to descriptively analyse and compare the findings of dynamic pelvic magnetic resonance imaging (DPMRI) with the clinical examinations in patients with ODS.A prospective comparative study was made between the physical examination and the DPMRI, with a descriptive analysis of the results. A total of 30 patients were included (2 males and 28 females), with a median age of 60 (range 23-76) years, with symptoms of ODS. An anamnesis and detailed physical examination and a DPMRI were performed on all of them. Functional (anismus) and morphological changes (rectocele, enterocele, intussusception, etc.), were analysed.The physical examination did not detect anomalies in 6 (20%) patients. A rectocele was diagnosed in 21 (70%) of the cases, and 2 (6.7%) a rectal mucosal prolapse. The DPMRI showed evidence of pelvic floor laxity in 22 (73.3%) cases, an enterocele in 4 (13.3%), a sigmoidocele in 2 (6.7%), intussusception in 8 (26.7%), rectal mucosal prolapse in 4 (13.3%), anismus in 3 (10%), and a cystocele in 4 (13.3%). The rectocele was the most frequent diagnosis, being given in 26 (86.6%) patients.Magnetic resonance imaging provides an overall pelvic assessment with good definition of the tissues, and does not use ionising radiation, is well tolerated, and provides us with complementary information to arrive at the diagnosis, and establish the best treatment for ODS. Larger studies comparing videodefaecography (VD), currently considered the Gold Standard technique, are needed to be able to demonstrate whether it is superior or not to DPMRI.

Como educadores, queremos que los alumnos desarrollen competencias que les permitan afrontar las situaciones que van a encontrar en su vida real y a mantener un proceso de aprendizaje continuo. Por ello, es necesario realizar actividades que conecten los conocimientos impartidos en la asignatura con la realidad, y fomenten en los alumnos el desarrollo de competencias de Automotivación, Orientación al aprendizaje y Pensamiento lógico. En base a la información recogida en los medios de comunicación, sobre la puesta en servicio de radares de tramo y el accidente nuclear en Fukushima (Japón), se han creado actividades que han sido realizadas por los alumnos, fara fomentar el desarrollo de estas competencias. En este artículo se muestra el proceso seguido, la medida de indicadores que reflejan el efecto apreciado en los alumnos, y los resultados obtenidos. SIN FINANCIACIÓN No data 2011 UEM

Limited information suggests the existence of a high prevalence of hepatitis B (HBV) and C virus (HCV) infection in inflammatory bowel disease (IBD). This knowledge is relevant because the viruses may reactivate under immunosuppressive therapy. The objectives of this study are to assess the prevalence of HBV and HCV infection in IBD, in a nationwide study, and to evaluate associated risk factors.This cross-sectional multicenter study included 2,076 IBD patients, consecutively recruited in 17 Spanish hospitals. Factors related to IBD (severity, invasive procedures, etc.) and to infection (transfusions, drug abuse, etc.) were registered. Independent risk factors for viral infection were evaluated using logistic regression analysis.Present and/or past HBV and HCV infection was found in 9.7% of patients of both ulcerative colitis (UC) and Crohn's disease (CD) (UC: HBsAg 0.8%, anti-HBc 8%, anti-HCV 1.3%; CD: HBsAg 0.6%, anti-HBc 7.1%, anti-HCV 2.3 %). Effective vaccination (anti-HBs, without anti-HBc) was present in 12% of patients. In multivariate analysis, age (odds ratio (OR) 1.04; 95% confidence interval (CI) 1.02-1.06; P=0.000), family history of hepatitis (OR 2.48; 95% CI 1.3-4.74; P=0.006) and moderate-to-severe IBD disease (OR 2.5; 95% CI 1.02-6.15; P=0.046) were significantly related to HBV, whereas transfusions (OR 2.66; 95% CI 1.2-5.87; P=0.015) and antibiotic use (OR 2.66; 95% CI 1.1-6.3; P=0.03) were significantly related to HCV. The significance for transfusions was lost if they were administered after 1991, when HCV markers became mandatory in blood banks.Prevalence of HBV and HCV infection in IBD is similar to that of the general population of reference and lower than that in previously published series. This fact, in addition to the lack of association with invasive procedures, suggests the existence of adequate preventive measures in centers attending to these patients. The low percentage of effective vaccination makes it mandatory to intensify B virus vaccination in IBD.

Although constipation affects quality of life, questionnaires hardly exist for its evaluation. We aimed to develop and validate a questionnaire able to measure the quality of life in patients with constipation.A Spanish multicenter study was performed in 2 stages: a) questionnaire development (open interview to patients with constipation, pilot questionnaire, quantitative and factorial analysis, Rasch analysis, and specific questionnaire design), and b) questionnaire validation in 136 patients. These patients were divided in 2 groups: a) reliability group (n = 55; no need to begin or change treatment; re-tested after 15 days), and b) sensibility to change group (n = 81; need to begin or change treatment; re-tested after 3 months). We collected clinical and socio-demographic data and we evaluated the quality of life through the general questionnaire EuroQoL-5D (EQ-5D) and the specific one, design in the previous stage (25 items). After that, we analysed feasibility, reliability and validity (of content, convergent and longitudinal).The trial questionnaire was obtained during the development stage and the results were 51 items that were later reduced to 25 in the validation stage. A total of 126 patients (93% women; mean age [standard deviation]: 43.4 [1] years) completed the study properly. The answer average time was 12 min. The content validity process reduced the questionnaire to 20 items (CVE-20) within 4 domains: emotional, general physical, rectal physical and social. The reliability was good in relation to the general punctuation (Cronbach alpha coefficient = 0.87), being in the different domains of 0.79, 0.73, 0.75 and 0.60, respectively. The construct validity showed a good correlation between the CVE-20 results and constipation severity. The CVE-20 score positively correlated with EQ -5D changes. The test and re-test reliability were good: interclass correlation coefficient = 0.89 (ranging from 0.80 to 0.88 in the different domains). The clinically relevant and minimal difference was 17 points (95% confidence interval, 11-23). The content validity showed a strong correlation between CVE-20 and constipation severity.The CVE-20 is the first specific questionnaire in Spanish language for constipated patients; it is valid, reliable, sensitive to changes and it meets the psychometric requirements to be applied in daily practice and clinical trials.

Gastroparesis is a chronic alteration of gastric motility characterized by symptoms suggestive of mechanical obstruction and delayed gastric emptying in the absence of obstruction. Gastroparesis can be idiopathic or attributable to neuropathy or myopathy as in diabetes mellitus and scleroderma or can occur after vagotomy. Diagnosis is based on symptoms (nausea, vomiting, abdominal distension and early satiety), physical examination (capotement) and on complementary investigations, the procedure of choice being isotope gastric emptying tests. Treatment depends on the clinical repercussions. In most patients, gastroparesis can be controlled by prokinetic drugs, dietary measures, exclusion of drugs that alter gastric emptying, and exhaustive control of blood glucose levels. In patients with severe gastroparesis, hospital nutritional measures (intravenous and/or enteral), gastric decompression and intravenous antiemetic and prokinetic agents are required. Aggressive nutritional therapies (parenteral or enteral nasojejunal nutrition), intrapyloric injection of botulinum toxin, implantation of a gastric stimulation device, or gastrectomy should only be used in patients unresponsive to conservative treatment or if there is selective alteration of gastric motility.