A New Comorbidity in Periodontitis: Fusobacterium nucleatum and Colorectal Cancer

There is very recent and strong evidence relating Fusobacterium nucleatum to colorectal cancer. In this narrative review, we update the knowledge about gingival dysbiosis and the characteristics of Fusobacterium nucleatum as one of the main bacteria related to periodontitis. We provide data on microbiome, epidemiology, risk factors, prognosis, and treatment of colorectal cancer, one of the most frequent tumours diagnosed and whose incidence increases every year. We describe, from its recent origin, the relationship between this bacterium and this type of cancer and the knowledge and emerging mechanisms that scientific evidence reveals in an updated way. A diagram provided synthesizes the pathogenic mechanisms of this relationship in a comprehensive manner. Finally, the main questions and further research perspectives are presented

Small Bowel Enteroscopy - A Joint Clinical Guideline by the Spanish and Portuguese Small-Bowel Study Groups

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly.info:eu-repo/semantics/publishedVersio

Small bowel enteroscopy - A joint clinical guideline from the spanish and portuguese small bowel study groups

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.Estas recomendações baseadas na evidência detalham o uso da enteroscopia assistida por dispositivo no manejo clínico das doenças do intestino delgado. Um conjunto de Gastrenterologistas diferenciados em patologia do intestino delgado foi selecionado pelos grupos de estudos Espanhol e Português de intestino delgado para rever a evidência disponível sobre as principais indicações desta técnica, o seu papel nos algoritmos de manejo de cada indicação e sobre o seu rendimento diagnóstico e terapêutico. Foi gerado um conjunto de recomendações pelos autores

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Factores asociados al rendimiento diagnóstico de la cápsula endoscópica de intestino delgado en pacientes con sospecha de enfermedad de Crohn

La cápsula endoscópica es la técnica de primera elección para el estudio de pacientes con sospecha de enfermedad de Crohn de intestino delgado, tal como se recoge en las recomendaciones de las guías de práctica clínica de las más importantes sociedades científicas europeas y americanas. Aunque es una técnica asociada a altos costes económicos, apenas hay unos pocos estudios acerca de los factores clínicos y analíticos que se asocian a un mejor rendimiento diagnóstico de la misma, sin que haya podido definir hasta la fecha el perfil de paciente que más se puede beneficiar de esta modalidad diagnóstica en esta indicación concreta. Para dar respuesta a estas cuestiones se ha realizado un estudio retrospectivo sobre una serie de 124 pacientes sometidos a estudios de cápsula endoscópica por sospecha de enfermedad de Crohn de intestino delgado. Se ha hecho un análisis estadístico (descriptivo, univariante, multivariante y de capacidad diagnóstica) incluyendo los datos demográficos de los pacientes, sus síntomas y los parámetros analíticos más frecuentemente relacionados con la enfermedad de Crohn para valorar cuál o cuáles de ellos se asociaban a un mayor riesgo de presentar lesiones inflamatorias en los estudios de cápsula endoscópica. De entre todas las variables estudiadas sólo la proteína C reactiva y la calprotectina fecal se asocian de forma significativa e independiente a la presencia de lesiones inflamatorias en los estudios de cápsula de intestino delgado. Son también estos dos parámetros lo que mejores resultados obtienen en el análisis de capacidad diagnóstica, siendo la asociación de ambos la que mejor valor predictivo positivo presenta. Finalmente se ha diseñado una escala, dando a cada variable una puntuación, para estimar el riesgo individual de cada paciente de presentar lesiones intestinales en base a sus datos analíticos. Esta escala se ha puesto a prueba aplicándose a los pacientes de nuestra propia serie. Aunque los resultados de este análisis son buenos y prometedores, esta escala deberá ser validad mediante su aplicación a series distintas de la presente, y preferiblemente en estudios prospectivos. En conclusión, el perfil de paciente que más se puede beneficiar de un estudio de cápsula endoscópica de intestino delgado en caso de sospecha de enfermedad de Crohn es aquel que presentando síntomas de la enfermedad, independientemente de su sexo y edad, presente al menos dos parámetros analíticos alterados entre los que se encuentren la proteína C reactiva y la calprotectina fecal. Aquellos pacientes con un solo marcador bioquímico alterado, o aquellos con niveles normales de proteína C reactiva y calprotectina fecal presentan un riesgo significativamente menor de tener lesiones inflamatorias en intestino delgado. Capsule endoscopy is the election tool for the study of patients with suspected Crohn’s disease of the small bowel, as it is recommended in the guidelines by the most important European and American scientific societies. Capsule endoscopy is related to high economic costs but there is a lack of studies regarding clinical factors or biomarkers associated with a better diagnostic yield of the technique. It has not been described yet the profile of the patients who can benefit the most from capsule endoscopy studies in this indication. Our aim was to answer these questions and we designed a retrospective study over a 124 patients series. All these came for capsule endoscopy due to suspected Crohn’s disease of the small bowel. We have made a statistical analysis (descriptive, univariate, multivariate and diagnostic yield) including demographic data, symptoms of the patients and the most frequent biomarkers in Crohn’s disease to check which of these were associated with a higher risk of presenting inflammatory lesions in capsule endoscopy studies. Among all the analyzed variables only C-reactive protein and fecal calprotectin presented significant and independent association with the presence of lesions in the small bowel of the patients. Also these parameters showed the best results in the diagnostic yield analysis, and the association of both had the best positive predictive value. Finally a score has been designed. Every variable has a numeric value and, depending on the laboratory tests results, every single patient can be assigned an estimated risk of presenting inflammatory lesions. This score has been applied to the patients of our series for testing. The results of these tests were good and promising, but this score will need to be validated by application on other patient series, in prospective studies if possible. In conclusion the patient who can benefit the most from small bowel capsule endoscopy in cases of suspected Crohn´s disease is a symptomatic individual, of any age and sex, who presents at least two altered biomarkers including C-reactive protein and fecal calprotectin. Patients with only one altered biomarker or patients with normal levels of C-reactive protein a fecal calprotectin are less likely to present inflammatory lesions in the small bowel

Management of refractory esophageal stenosis in the pediatric age

Introduction: Refractory esophageal stenosis (RES) is a major health problem in the pediatric population. Several techniques such as stent placement or C-mitomycin (CM) have been described as alternative treatments. We present our experience with both techniques, in our case with biodegradable stents (BS) and sometimes the association with stents and CM. Material and methods: Six patients have been included: 2 post-operative fistulas in patients with type I esophageal atresia; 1 operated atresia without fistula; and 3 caustic strictures. 5 BS were placed in 4 children: 3 of them in cases of atresia (2 prosthesis in one case) and the other one in a case of stricture. CM was used in 5 cases: in 2 of them from the beginning, and in the other 3 cases after failure of the stent. Results: When placed in fistulas, BS were fully covered. One of them successfully treated the fistula, but the other one was not effective. One stenosis was successfully treated with SB (in the case of persistent fistula), but recurrence was observed in the other 2 cases. One of these was solved with CM, and the other one needed a second stent. In the remaining 2 cases (one atresia and one caustic stricture) CM was effective after 1 and 2 sessions respectively. Overall, 5 out of 6 stenosis have been successfully treated (83.3%), and 1 out of 2 fistulas (50%). Conclusions: Association of BS and CM has been effective in the management of RES in children

Bleeding risk in endoscopic retrograde cholangiopancreatography: impact of the use of antithrombotic drugs

Aims: To analyze the risk factors for hemorrhage during endoscopic retrograde cholangiopancreatography and the impact of antithrombotic drugs. Material and methods: Data sources: papers indexed in PubMed have been reviewed, as well as those found during the analysis of the bibliography of meta-analysis and reviews. Selection criteria: the references have been firstly evaluated by review of the abstract. After selecting the most significant articles (mainly randomized trials and well-designed case series) these have been deeply analyzed. Evaluation of the studies and synthesis: criteria by the Oxford Centre for Evidence-Based Medicine have been used for the analysis of the references and elaboration of evidence levels. Results: Seven hundred and sixty-five references were found, 753 in PubMed and the Cochrane Library. Twelve studies were selected during the analysis of other published articles (systematic reviews, meta-analysis and clinical practice guidelines). After analyzing the title or the abstract, 655 studies were excluded. Finally, 83 high quality trials or descriptive studies have been included in the analysis. Conclusions: Seven conclusions regarding the risk factors for bleeding and the impact of antithrombotic drugs have been defined

Diagnostic and therapeutic features of small bowel involvement in portal hypertension

Enteropathy is a lesser known complication of portal hypertension and consists of different changes in the mucosal layer of the small bowel which lead to the appearance of vascular and inflammatory lesions. It can be an important co-factor in the development of anemia in the cirrhotic population, and nowadays an easy and non-invasive diagnosis can be made thanks to capsule endoscopy. However, it is rarely considered in the management of patients with portal hypertension. Some aspects such as pathogenesis or incidence remain unclear and no specific recommendations are included in the guidelines regarding diagnosis or treatment. A review of the available literature was performed with regards to the most relevant aspects of this entity