Proctitis ulcerosa refractaria: Tratamiento alternativo con enema de tacrólimus

5-aminosalicylates (5-ASA) and corticosteroids are the usual first-choice treatments for inducing ul-cerative proctitis remission. However, in those patients that do not respond to those treatments, additional therapies such as immunomodulators, TNFα antago-nists and some other potentially efficacious alternati-ves like calcineurin inhibitors can be administered.We report the case of a 59 year-old woman diag-nosed with treatment-resistant ulcerative proctitis. Due to the limited disease extent and the potential side effects of systemic therapy, we decided to apply a topical tacrolimus enema. The application of tacro-limus directly on the inflamed tissues could achieve a local effect and may minimize systemic side effects.Rectal tacrolimus administration was effective for inducing a clinical remission in this patient and be-sides, for maintaining its response during 19 months of treatment without presenting any safety issues. Rectal tacrolimus may be regarded as an alternative treatment for resistant ulcerative proctitis when syste-mic therapy is not indicated.El tratamiento de elección para proctitis ulcerosa se basa en fármacos derivados del ácido 5-aminosali-cílico y corticoides. En pacientes con proctitis ulcerosa refractaria a estos fármacos existen diversas opciones terapéuticas incluyendo tiopurinas, anti-TNFα y otras alternativas menos estudiadas como inhibidores de calcineurina.Presentamos el caso de una mujer de 59 años diagnosticada de proctitis ulcerosa refractaria al tra-tamiento convencional. Dada la delimitada afectación y el perfil de efectos adversos de la terapia sistémica, se plantea la terapia tópica con enemas de tacrólimus. La administración de tacrólimus por vía rectal permite actuar directamente en el lugar de la inflamación, dis-minuyendo el riesgo de efectos adversos sistémicos.El uso de enema de tacrólimus ha permitido lo-grar la remisión clínica y mantener la respuesta duran-te 19 meses, siendo una terapia bien tolerada. Podría ser una alternativa eficaz en pacientes con proctitis ulcerosa resistente en los que no esté indicado iniciar una terapia sistémica

Determinants of Severity in Acute Pancreatitis : A Nation-wide Multicenter Prospective Cohort Study

OBJECTIVE: The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated with worse outcomes. SUMMARY OF BACKGROUND DATA: AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease. METHODS: A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity. RESULTS: A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality. CONCLUSION: The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications