Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery

Se trata de una publicación que detalla los factores de riesgo implicados en la recurrencia del prolapso de los órganos pélvicos (POP) cinco años después de la cirugía vaginal. En este estudio incluimos a 134 pacientes que se habían sometido a una histerectomía vaginal asociada a una colporrafia anterior o posterior en el Hospital Universitario Donostia entre los años 2000 y 2001. Entrevistamos a las pacientes sobre la sintomatología del prolapso y realizamos una exploración ginecológica utilizando el sistema “Pelvic Organ Prolapse Quantification” (POPQ) validado por la International Continence Society (ICS). Definimos la recidiva anatómica como un POPQ grado ≥ II y la recidiva funcional como la presencia del síntoma de sensación de bulto en genitales externos. La identificación de los factores asociados a la recurrencia se realizó a través de un análisis multivariante. Cinco años después de la cirugía 42 (31,3%) mujeres presentaron una recidiva anatómica y solo 10 (7,4%) tenían síntomas relacionados con el POP. Dos mujeres habían sido sometidas a una reintervención durante el periodo de seguimiento y se incluyeron en el grupo de recidiva anatómica y funcional en el análisis de los factores de riesgo. Las pacientes con mayor peso corporal (> 65 kg) y más jóvenes (<60 años) presentaron mayor riesgo de recidiva tanto anatómica como funcional. El antecedente de POP preoperatorio avanzado (grado III-IV) se asoció únicamente con la recurrencia anatómica. Además, hubo una escasa correlación entre la recurrencia anatómica y la funcional ya que solo un pequeño porcentaje de las pacientes con recurrencia anatómica manifestaron síntomas de prolapso

Differential effects of Anti-TNFα and Anti-α4β7 drugs on circulating dendritic cells migratory capacity in inflammatory bowel disease

Inflammatory bowel disease (IBD) is an idiopathic and chronic disorder that includes ulcerative colitis (UC) and Crohn’s disease (CD). Both diseases show an uncontrolled intestinal immune response that generates tissue inflammation. Dendritic cells (DCs) are antigen-presenting cells that play a key role in tolerance maintenance in the gastrointestinal mucosa. Although it has been reported that DC recruitment by the intestinal mucosa is more prominent in IBD patients, the specific mechanisms governing this migration are currently unknown. In this study, the expression of several homing markers and the migratory profile of circulating DC subsets towards intestinal chemo-attractants were evaluated and the effect of biological drugs with different mechanisms of action, such as anti-TNFα or anti-integrin α4β7 (vedolizumab), on this mechanism in healthy controls (HCs) and IBD patients was also assessed. Our results revealed that type 2 conventional DCs (cDC2) express differential homing marker profiles in UC and CD patients compared to HCs. Indeed, integrin β7 was differentially modulated by vedolizumab in CD and UC. Additionally, although CCL2 displayed a chemo-attractant effect over cDC2, while biological therapies did not modulate the expression of the homing markers, we paradoxically found that anti-TNF-treated cDC2 increased their migratory capacity towards CCL2 in HCs and IBD. Our results therefore suggest a key role for cDC2 migration towards the intestinal mucosa in IBD, something that could be explored in order to develop novel diagnostic biomarkers or to unravel new immunomodulatory targets in IBD.This study has been funded through the Instituto de Salud Carlos III (Sara Borrell fellowships, CD17/00014; CD21/00014), Asociación Española de Gastroenterología (Beca del Grupo Joven), Programa Estratégico Instituto de Biología y Genética Molecular (IBGM Junta de Castilla y León. Ref. CCVC8485), Plan Nacional (PID2019-104218RB-I00) from the Spanish Government, Janssen and MSD

Long non-coding RNA signatures in the Ileum and Colon of Crohn’s disease patients and effect of Anti-TNF-α treatment on their modulation

Biological therapies only benefit one-third of patients with Crohn’s disease (CD). For this reason, a deeper understanding of the mechanisms by which biologics elicit their effect on intestinal mucosa is needed. Increasing evidence points toward the involvement of long noncoding RNAs (lncRNAs) in the pathogenesis of CD, although their role remains poorly studied. We aimed to characterize lncRNA profiles in the ileum and colon from CD patients and evaluate the effect of anti-TNF-α treatment on their transcription. Terminal ileum and left colon samples from 30 patients (active CD = 10, quiescent CD = 10, and healthy controls (HCs) = 10) were collected for RNA-seq. The patients were classified according to endoscopic activity. Furthermore, biopsies were cultured with infliximab, and their transcriptome was determined by Illumina gene expression array. A total of 678 differentially expressed lncRNAs between the terminal ileum and left colon were identified in HCs, 438 in patients with quiescent CD, and 468 in patients with active CD. Additionally, we identified three new lncRNAs in the ileum associated with CD activity. No differences were observed when comparing the effect of infliximab according to intestinal location, presence of disease (CD vs. HC), and activity (active vs. quiescent). The expression profiles of lncRNAs are associated with the location of intestinal tissue, being very different in the ileum and colon. The presence of CD and disease activity are associated with the differential expression of lncRNAs. No modulatory effect of infliximab has been observed in the lncRNA transcriptom

Impaired esophageal motor function in eosinophilic esophagitis

Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis