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Resumen El unico tratamiento aceptado para la enfermedad celiaca es el seguimiento de forma estricta de la dieta sin gluten. Este tipo de dieta puede ocasionar una disminucion de la calidad de vida de los pacientes, dificultades sociales y economicas. Por lo tanto, son frecuentes las transgresiones dieteticas que pueden perpetuar el dano intestinal. En los ultimos anos se han desarrollado numerosos tratamientos, dirigidos hacia diferentes dianas en la patogenia de la enfermedad celiaca: modificacion del gluten para conseguir un gluten no inmunogenico, terapias endoluminales que degraden el gluten en la luz intestinal, favorecer la tolerancia al gluten, modulacion de la permeabilidad intestinal o regulacion de la respuesta inmune adaptativa. En esta revision se evaluan estas lineas terapeuticas que se estan investigando para la enfermedad celiaca y los tratamientos enfocados al control de las complicaciones de la enfermedad, como la enfermedad celiaca refractaria.

The only accepted treatment for coeliac disease is strict adherence to a gluten-free diet. This type of diet may give rise to reduced patient quality of life with economic and social repercussions. For this reason, dietary transgressions are common and may elicit intestinal damage. Several treatments aimed at different pathogenic targets of coeliac disease have been developed in recent years: modification of gluten to produce non-immunogenic gluten, endoluminal therapies to degrade gluten in the intestinal lumen, increased gluten tolerance, modulation of intestinal permeability and regulation of the adaptive immune response. This review evaluates these coeliac disease treatment lines that are being researched and the treatments that aim to control disease complications like refractory coeliac disease.

Resumen Los perineuriomas intestinales son lesiones poco frecuentes del tracto gastrointestinal. En este estudio presentamos una serie de 9 casos hallados en la mucosa colonica y analizados desde el punto de vista clinico-patologico e inmunohistoquimico. De ellos, 5 fueron mujeres y 4 hombres con edades medias de 59,5 y 64 anos, respectivamente. Todas las lesiones eran de un tamano inferior a 1 cm y tuvieron una localizacion intramucosa, predominando las situadas en el colon distal. Las tecnicas imnunohistoquimicas para Glut-1, claudina-1 y EMA fueron de gran utilidad para determinar la naturaleza de estas lesiones.

Type II enteropathy-associated T-cell lymphoma (EATL) is an uncommon intestinal lymphoma. We report the case of a 73-year-old man with diarrhea and weight loss. Duodenal biopsy showed atrophy and infiltration of irregular lymphocytes. Immunohistochemistry was positive for CD3, CD8, and CD56 with monoclonal TCR rearrangement. The HLA-DQ genotype was DQ5/DQ9. The Epstein-Barr virus RNA test was negative. Before specific chemotherapy could be administered, the patient was admitted to hospital for a respiratory infection and died from a cause unrelated to his lymphoma. The differential diagnosis of CD56-positive lymphoproliferative processes include type II EATL, primary T-cell/natural killer-cell intestinal lymphoma and hepatosplenic T-cell lymphoma. The patient had CD8 y CD56+ markers that allowed type I EATL to be excluded. The HLA-DQ genotype did not correspond to celiac disease and the biopsy showed proliferation of lymphocytes with atypia. The primary intestinal T-cell/natural killer-cell lymphoma was characterized mainly by the absence of CD8 and monoclonal reassortment of the TCR present in this case.

Intestinal perineuriomas are uncommon tumors of the gastrointestinal tract. In this study, we analyzed the clinicopathologic and immunohistochemical features of nine colonic perineuriomas. Five patients were women and four were men (median age 59.5 years and 64 years, respectively). All lesions were smaller than 1cm and were located intramucosally, mainly in the distal colon. Immunohistochemical techniques for Glut-1, claudin-1 and EMA were especially useful in characterizing these lesions.

Type II enteropathy-associated T-cell lymphoma (EATL) is an uncommon intestinal lymphoma. We report the case of a 73-year-old man with diarrhea and weight loss. Duodenal biopsy showed atrophy and infiltration of irregular lymphocytes. Immunohistochemistry was positive for CD3, CD8, and CD56 with monoclonal TCR rearrangement. The HLA-DQ genotype was DQ5/DQ9. The Epstein-Barr virus RNA test was negative. Before specific chemotherapy could be administered, the patient was admitted to hospital for a respiratory infection and died from a cause unrelated to his lymphoma. The differential diagnosis of CD56-positive lymphoproliferative processes include type II EATL, primary T-cell/natural killer-cell intestinal lymphoma and hepatosplenic T-cell lymphoma. The patient had CD8 y CD56+ markers that allowed type I EATL to be excluded. The HLA-DQ genotype did not correspond to celiac disease and the biopsy showed proliferation of lymphocytes with atypia. The primary intestinal T-cell/natural killer-cell lymphoma was characterized mainly by the absence of CD8 and monoclonal reassortment of the TCR present in this case.

Introduccion: Los cuerpos extranos en el tubo digestivo pueden representar un problema diagnostico y de tratamiento. Provocan desde distinto grado de traumatismo local hasta perforacion y dano a los organos vecinos. Los localizados en el recto afectan en el 65% de los casos a varones entre 30-40 anos1. Presentamos el caso de un paciente en el que se manifiesta con una sintomatologia indicativa de un proceso inflamatorio intestinal finalmente secundario a cuerpo extrano rectal. Varon de 26 anos sin antecedentes de interes ...