Efectividad y seguridad derivados del empleo de balones intragástricos en el tratamiento de la obesidad

La obesidad es una enfermedad crónica multifactorial fruto de la interacción entre genes y ambiente. Dado que afecta a un alto porcentaje de la población de los paises desarrollados y a que su prevalencia aumenta progresivamente, la Organización Mundial de la Salud ha llegado a considerarla como “una epidemia global”. El indicador más ampliamente utilizado para su medida es el índice de Quetelet o índice de masa corporal (I.M.C.), que se define como IMC=peso (en Kg.)/ talla2 (en m.). De acuerdo con ese índice, se considera como obeso todo sujeto con un IMC>30 Kg/m2. La obesidad aumenta sustancialmente el riesgo de padecer diabetes, hipertensión arterial, dislipemia y enfermedad cardiovascular, así como ciertos tipos de cáncer. Los sujetos obesos presentan por tanto un aumento de la mortalidad, tienen una esperanza y una calidad de vida reducidas y requieren la utilización de recursos sanitarios con mayor frecuencia que las personas no obesas. El objetivo del tratamiento médico empleado en la obesidad es conseguir una reducción razonable de peso y su mantenimiento a largo plazo. Se considera que una reducción de entre el 5 y 10% del peso corporal inicial cumple estos objetivos, determinando una mejora de las comorbilidades asociadas a la obesidad que se puede objetivar en la reducción de las cifras de hipertensión arterial, y de los niveles analíticos de dislipemia y diabetes. La utilización temporal de balones gástricos en el tratamiento de los pacientes obesos se fundamenta en los efectos que estos dispositivos producen sobre la regulación gástrica del apetito, ya sea enlenteciendo el vaciamiento gástrico o modificando la liberación de hormonas que se producen en el tracto digestivo (como ghrelina o colecistoquinina), y que intervienen en la regulación neuroendocrina del apetito y de la saciedad. De esta manera, la sensación de saciedad que producen estos dispositivos permite a los pacientes mantener una ingesta reducida, posibilitando el aprendizaje de unos hábitos alimentarios adecuados que deben mantenerse tras su retirada

Effectiveness and Safety of the Switch from Remicade® to CT-P13 in Patients with Inflammatory Bowel Disease

BACKGROUND AND AIMS: To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®. METHODS: Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The ''switch cohort'' [SC] comprised patients who made the switch from Remicade® to CT-P13, and the ''non-switch'' cohort [NC] patients remained under Remicade®. RESULTS: A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2-6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05]. CONCLUSIONS: Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe

Increased Th17-Related Cytokine Serum Levels in Patients With Multiple Polyps of Unexplained Origin

OBJECTIVES: Most patients with multiple colonic polyps do not have a known genetic or hereditary origin. Our aim was to analyze the presence of inflammatory cytokines and levels of glucose, insulin, and C-reactive protein (CRP) in patients with multiple colonic polyps. METHODS: Eighty-three patients with 10 or more adenomatous or serrated polyps and 53 control people with normal colonoscopy were included. Smoking habits were registered, and glucose, CRP, and basal insulin in the serum/blood were measured. Quantification of IL-2, IL-4, IL-6, IL-10, IL-11, IL-17A, and IL-23 cytokine levels in the serum was performed by a high-sensitivity enzyme-linked immunosorbent assay. RESULTS: Smoking and diabetes were more prevalent in those with colonic polyps than in the control people (67% vs 16%, P = 0.001; 11% vs 2%, P = 0.048). In addition, the cytokine serum levels were higher, i.e., IL-2 (P = 0.001), IL-4 (P = 0.001), IL-6 (P = 0.001), IL-17A (P = 0.001), IL-23 (P = 0.014), and CRP (P = 0.003). Adjusting for sex, smoking, and diabetes in a multivariate analysis, IL-2, IL-4, IL-6, IL-17A, and IL-23 remained independently elevated in cases with multiple polyps. DISCUSSION: These results indicate that immune responses mediated by Th17 cells may be involved in the pathogenesis of multiple colonic polyps

Development and validation of a faecal immunochemical test-based model in the work-up of patients with iron deficiency anaemia

ObjectiveIn patients with iron deficiency anaemia (IDA), the diagnostic yield of gastroscopy and colonoscopy (bidirectional endoscopy) in detecting neoplastic lesions is low. This study aimed to develop and validate a faecal immunochemical test (FIT)-based model to optimise the work-up of patients with IDA.MethodsOutpatients with IDA were enrolled in a prospective, multicentre study from April 2016 to October 2019. One FIT was performed before bidirectional endoscopy. Significant gastrointestinal lesions were recorded and a combined model developed with variables that were independently associated with significant colorectal lesions in the multivariate analysis. The model cut-off was selected to provide a sensitivity of at least 95% for colorectal cancer (CRC) detection, and its performance was compared to different FIT cut-offs. The data set was randomly split into two groups (developed and validation cohorts). An online calculator was developed for clinical application.ResultsThe development and validation cohorts included 373 and 160 patients, respectively. The developed model included FIT value, age, and sex. In the development and validation cohorts, a model cut-off of 0.1375 provided a negative predictive value of 98.1 and 96.7% for CRC and 90.7 and 88.3% for significant colorectal lesions, respectively. This combined model reduced the rate of missed significant colorectal lesions compared to FIT alone and could have avoided more than one-fourth of colonoscopies.ConclusionThe FIT-based combined model developed in this study may serve as a useful diagnostic tool to triage IDA patients for early endoscopic referral, resulting in considerable reduction of unnecessary colonoscopies