Ventajas de la medición de niveles plasmáticos de infliximab en pacientes con enfermedad inflamatoria intestinal

Inflammatory bowel disease includes Crohn ́s disease, ulcerative colitis and unclassified colitis. Conventional therapies used for treating these diseases are often insufficient or contraindicated and biological agents have proved to be effective and safe in these cases. Infliximab is a quimeric IgG1 monoclonal anti-tumor necrosis factor antibody that is capable of inducing and mantaining clinical remission in patients with inflammatory bowel disease. Despite its proven efficacy a considerable group of patients lose response requiring changes in therapy. Serum Infliximab trough levels are correlated with clinical response, endoscopic remission and mucosal healing in patients with inflammatory bowel disease. Monitoring and adjusting therapy guided by drug serum levels have proved to be more cost-effective and safer than empiric adjustments. Current international guidelines recommend the measurement of Infliximab trough levels in the global evaluation and management of these patients to improve treatment, avoid adverse events and unnecessary costs

Mindfulness en el síndrome de intestino irritable

The Irritable Bowel Syndrome (IBS) is a functional digestive disorder recognised as a Biopsychosocial model, because psychological, social and biological factors influence the development of its symptomatology. A high psychiatric comorbidity is frequently observed in patients with IBS associated to an increase in the severity of symptoms and a low-grade of inflammatory response. Although its pathophysiological mechanism has not been fully understood, an imbalance in bidirectional communication is described in the gut-brain axis that affects psychoneuroimmune status of IBS patients. Diverse psychotherapeutic interventions have been shown to be effective in reducing the psychosocial impact in IBS patients, as well as in reducing their intestinal symptoms. However, at the clinical practice, it is not routinely applied because of its high cost. The Mindfulness-Based Stress Reduction (MBSR) is an alternative program that shown to be effective in reducing the clinical severity and improving the quality of life of patients with IBS. Although MBSR has demonstrated to reduce the levels of pro-inflammatory cytokines, including IL-6, in healthy subjects and cancer’s patients, its effect on the immune response in IBS patients remains unknown. This review discusses the pathophysiological mechanisms underlying the relationship between psychosocial disturbances, clinical symptomatology and low-grade inflammation in IBS. Based on that, we present the arguments that allow proposing the use of MBSR for the IBS treatment

Las alteraciones de la microbiota intestinal en la patogenia del hígado graso no alcohólico

Non-alcoholic fatty liver disease (NAFLD) is currently considered in Chile and worldwide, as the main cause of cirrhosis and liver transplantation. It is therefore one of the main public health objectives for reducing its prevalence. In last years, it was suggested that the intestinal microbiota (IM) might contribute to the pathophysiology of NAFLD, as well as in the progression toward nonalcoholic steatohepatitis (NASH) and cirrhosis. It is known that changes in the composition of IM are associated with alterations in intestinal permeability and the production of inflammatory metabolites. These alterations are part of the pathophysiological mechanisms leading to the development of NASH. However studies on MI in patients with NAFLD and NASH in Chile are scarce. Through a research grant, recently awarded at the Hospital Clínico Universidad de Chile, we aim to confirm and characterize the intestinal dysbiosis associated with NAFLD in Chilean patients and to establish the relationship between the changes in microbial composition with the progression of liver damage. The description of these alterations represents an opportunity to explore new therapeutic approaches for future interventions. In effect, through the restoration of an intestinal microbial environment towards homeostasis in these patients, we expect to reverse or improve the progression of damage provoked by this disease