23 results on '"Alexandra Ruiz-Cerulla"'
Search Results
2. A high adalimumab induction dosing regimen achieves clinical and endoscopic remission in super-refractory ulcerative colitis
- Author
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Alexandra Ruiz-Cerulla, Lorena Rodríguez-Alonso, Francisco Rodríguez-Moranta, and Jordi Guardiola
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Hepatology ,Gastroenterology - Published
- 2022
3. SEGURIDAD DE LAS VACUNAS DE VIRUS VIVOS EN NIÑOS EXPUESTOS A FÁRMACOS BIOLÓGICOS PARA LA ENFERMEDAD INFLAMATORIA INTESTINAL (EII) EN EL ÚTERO O DURANTE LA LACTANCIA MATERNA
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María Chaparro, María García Donday, Saioa Rubio, Cristina Calviño Suarez, Andrea Núñez Ortiz, Montserrat Figueira, Sandra Marín Pedrosa, Montserrat Rivero, Agnes Fernández-Clotet, Lucía Madero, María Teresa Diz-Lois Palomares, Isabel Pérez-Martínez, Alexandra Ruiz-Cerulla, Maite Arroyo, Marta Piqueras, Cristina Suárez Ferrer, Mariam Aguas, Marta Calvo Moya, Iván Guerra, Pilar López Serrano, Juan María Vázquez Morón, Lara Arias García, María José Casanova, José María Huguet, Gemma Valldosera Gomis, Beatriz Zúñiga de Mora-Figueroa, Rubén Armesto, Pilar Martínez Montiel, Iago Rodríguez-Lago, Pau Sendra Rumbeu, Raquel Camargo Camero, Daniel Hervías Cruz, Gema Molina Arriero, Carlos Tardillo Marín, Miguel Ángel de Jorge Turrión, Raquel Vicente Lidón, Luis Bujanda, Patricia Ramírez de la Piscina, Virginia Robles Alonso, Laura Ramos, Raúl Rodríguez Insa, Manuel van Domselaar, David Busquets Casals, Noemí Manceñido Marcos, María Carmen Rodríguez Grau, Edisa María Armesto González, Alfredo J Lucendo, Lucía Márquez-Mosquera, Víctor Manuel Navas López, Vanessa Prieto, Yolanda Ber Nieto, Esther Bernardos Martín, Carlos Castaño Milla, Luis Hernández, Empar Sáinz Arnau, Miquel Sans, Belén Herreros Martínez, Víctor Jair Morales, Miguel Mínguez, Manuel Barreiro-de Acosta, Diana Acosta, Yanire Brenes, Sandra Hermida, Pablo Parra, Ana Garre, and Javier P. Gisbert
- Subjects
Hepatology ,Gastroenterology - Published
- 2023
4. Collagenous colitis: Requirement for high-dose budesonide as maintenance treatment
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María José Casanova, Javier P. Gisbert, M Piqueras, Virginia Robles, Yolanda Arguedas, Fernando Fernández-Bañares, Ángeles Pérez-Aisa, Alexandra Ruiz-Cerulla, David Busquets, Danila Guagnozzi, Alfredo J. Lucendo, and Luis Fernández-Salazar
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Male ,Budesonide ,medicine.medical_specialty ,Multivariate analysis ,Colitis, Collagenous ,Anti-Inflammatory Agents ,Azathioprine ,Logistic regression ,Gastroenterology ,Maintenance Chemotherapy ,03 medical and health sciences ,0302 clinical medicine ,Maintenance therapy ,Recurrence ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Dose-Response Relationship, Drug ,Hepatology ,Collagenous colitis ,Mercaptopurine ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Remission Induction ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Logistic Models ,Spain ,Multivariate Analysis ,Female ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
Background Controlled studies show high efficacy of budesonide in inducing short-term clinical remission in collagenous colitis (CC), but relapses are common after its withdrawal. Aim To evaluate the need for high-dose budesonide (≥6 mg/d) to maintain clinical remission in CC. Methods Analysis of a multicentre retrospective cohort of 75 patients with CC (62.3 ± 1.5 years; 85% women) treated with budesonide in a clinical practice setting between 2013 and 2015. Frequency of budesonide (9 mg/d) refractoriness and safety, and the need for high-dose budesonide to maintain clinical remission, were evaluated. Drugs used as budesonide-sparing, including azathioprine and mercaptopurine, were recorded. Logistic regression analysis was performed to evaluate the risk factors associated with the need for high-dose budesonide (≥6 mg/d) to maintain clinical remission. Results Budesonide induced clinical remission in 92% of patients, with good tolerance. Fourteen of 68 patients (21%; 95% CI, 13–32%) needed high-dose budesonide to maintain remission. Only intake of NSAIDs at diagnosis (OR, 8.6; 95% CI, 1.6–44) was associated with the need for high-dose budesonide in the multivariate analysis. Treatment with thiopurines was effective in 5 out of 6 patients (83%; 95% CI, 44–97%), allowing for withdrawal from or a dose decrease of budesonide. Conclusions One fifth of CC patients, especially those with NSAID intake at diagnosis, require high-dose budesonide (≥6 mg/d) to maintain clinical remission. In this setting, thiopurines might be effective as budesonide-sparing drugs.
- Published
- 2017
5. Tratamiento de mantenimiento con azatioprina o infliximab en pacientes con colitis ulcerosa corticorrefractarios respondedores a las 3 dosis de inducción de infliximab
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T. Lobatón, C. Romero, Jordi Guardiola, Esther Garcia-Planella, E. Cabré, Juan E. Naves, Jordina Llaó, Alexandra Ruiz-Cerulla, E. Domènech, and M. Mañosa
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Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,Automotive Engineering ,medicine ,030211 gastroenterology & hepatology ,Steroid refractory ,business ,Infliximab ,medicine.drug - Abstract
Resumen Introduccion Infliximab ha demostrado su eficacia en evitar la colectomia a corto y medio plazo en los pacientes con colitis ulcerosa corticorrefractarios (CUCR). No obstante, existen pocos datos acerca del tratamiento de mantenimiento mas adecuado en los pacientes con CUCR que han respondido al tratamiento de induccion a infliximab. El objetivo del estudio es comparar la evolucion a largo plazo de los pacientes corticorrefractarios que han respondido al tratamiento de induccion a infliximab segun hayan seguido tratamiento de mantenimiento con azatioprina en monoterapia o infliximab. Pacientes y metodos Se seleccionaron los pacientes ingresados en 3 centros entre enero de 2005 y diciembre de 2011 por un brote moderado-grave de CUCR que habian respondido a las 3 dosis de induccion de infliximab sin necesidad de colectomia antes de la semana 22 despues de la primera infusion. Resultados Se incluyeron 22 pacientes, 9 (37%) siguieron tratamiento con azatioprina y 15 (63%) con infliximab. Despues de una mediana de 18 meses de seguimiento, los corticoides se pudieron retirar en todos. De los que siguieron tratamiento con azatioprina, infliximab tuvo que ser reintroducido en 4 (44%). No hubo ninguna colectomia. De los 15 pacientes que siguieron tratamiento con infliximab, este requirio ser intensificado en el 53%, aunque en 9 (65%) pudo retirarse por remision clinica. Cuatro pacientes (16%) requirieron colectomia. Conclusiones Segun los resultados del estudio parece recomendable seguir tratamiento con infliximab, incluso en los pacientes no expuestos previamente a tiopurinas, dada la necesidad de reintroduccion de infliximab si se sigue tratamiento con azatioprina en monoterapia.
- Published
- 2017
6. Diarrea crónica: definición, clasificación y diagnóstico
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Alexandra Ruiz-Cerulla, Eugeni Domènech, Esther Garcia-Planella, Eva C. Vaquero, Jordi Guardiola, Maria Esteve, Alba Rodríguez-Luna, Fernando Fernández-Bañares, Xavier Molero, Javier Santos, Anna Accarino, and Agustín Balboa
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medicine.medical_specialty ,education.field_of_study ,Hepatology ,Referral ,business.industry ,Population ,Gastroenterology ,Grade system ,Diagnostic algorithms ,Chronic diarrhoea ,Primary care ,Scientific evidence ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Family medicine ,medicine ,030211 gastroenterology & hepatology ,business ,education - Abstract
Chronic diarrhoea is a common presenting symptom in both primary care medicine and in specialized gastroenterology clinics. It is estimated that >5% of the population has chronic diarrhoea and nearly 40% of these patients are older than 60 years. Clinicians often need to select the best diagnostic approach to these patients and choose between the multiple diagnostic tests available. In 2014 the Catalan Society of Gastroenterology formed a working group with the main objective of creating diagnostic algorithms based on clinical practice and to evaluate diagnostic tests and the scientific evidence available for their use. The GRADE system was used to classify scientific evidence and strength of recommendations. The consensus document contains 28 recommendations and 6 diagnostic algorithms. The document also describes criteria for referral from primary to specialized care.
- Published
- 2016
7. P711 Carriage of the HLA-DQA1*05 allele is associated with a high risk of loss of response to adalimumab in patients with Crohn’s disease
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J Guardiola Capón, A Padró, Francisco Rodríguez-Moranta, N Padullés, K Serra, Blau Camps, J Orobitg, E Santacana, C Arajol, Alexandra Ruiz-Cerulla, G Surís, and Lorena Rodríguez-Alonso
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Crohn's disease ,business.industry ,Gastroenterology ,Genome-wide association study ,General Medicine ,Human leukocyte antigen ,medicine.disease ,Inflammatory bowel disease ,Infliximab ,Carriage ,Immunology ,medicine ,Adalimumab ,Allele ,business ,medicine.drug - Abstract
Background Loss of response (LOR) to tumour necrosis factor antagonists (anti-TNF) occurs in up to 50% of patients with inflammatory bowel disease (IBD). The ability to predict which patients are likely to lose response would allow therapies to be tailored to the patient’s characteristics. Immunogenicity is a common cause of LOR. Recently, a GWAS performed using the PANTS cohort demonstrated that carriage of one or more HLA-DQA1*05 alleles confers an increased risk of immunogenicity to anti-TNF therapy (Sazonovs et al. Gastroenterology 2019). We found that HLA-DQA1*05 carriage also identified patients at increased risk of clinical LOR to infliximab (Guardiola et al. ECCO 2019). The aim of our study was to know if carriage of a HLA-DQA1*05 allele is also associated with secondary LOR to adalimumab (ADA) in patients with Crohn’s disease (CD). Methods This is a retrospective cohort study from a prospectively maintained data base. Patients were included if they had achieved response to ADA. LOR was defined as recurrence or worsening of IBD-related symptoms that required a change or intensification in treatment, hospitalisation or surgery. Independent predictors of LOR were identified using univariate and multivariable Cox proportional hazard regression. Results We included 53 patients with Crohn’s disease, followed up to LOR (n = 31, 58%) or a median of 51 months (IQR 35–74). Forty-five per cent were carriers of an HLA-QA1*05 allele. HLA-DQA1*05 carriage was associated with LOR both, upon univariate analysis (HR 2.1 (95% CI 1.1–4.3), p = 0.04) and upon multivariate analysis, after adjusting for immunomodulators use, smoking status and BMI (HR 2.74 (95% CI 1.2–6.2), p = 0.02) (Figure 1). The cumulative persistence rates of ADA after adjusting for immunomodulators use was significantly lower in HLA-DQA1*05 carriers compared with non-carriers (HR 4 (95% CI 1.2–15.5), p = 0.02) (Figure 2). Conclusion HLA-DQA1*05 carriage is frequent and it is associated with a marked increase in the risk of LOR to ADA. HLA-DQA1*05 may become a clinically meaningful genetic marker that could allow for treatment to be tailored according to the risk of LOR, which is a step towards personalised medicine.
- Published
- 2020
8. P642 Serum adalimumab levels measured between days 9 and 13 from drug injection can be interpreted clinically in a similar way to trough levels in patients with inflammatory bowel disease
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N Padullés, J Guardiola Capón, Lorena Rodríguez-Alonso, E Sanchez, K Serra, E Santacana, G Surís, Blau Camps, Francisco Rodríguez-Moranta, C Arajol, and Alexandra Ruiz-Cerulla
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Drug injection ,medicine.medical_specialty ,business.industry ,Gastroenterology ,General Medicine ,Trough (economics) ,medicine.disease ,Inflammatory bowel disease ,Internal medicine ,medicine ,Adalimumab ,In patient ,business ,medicine.drug - Abstract
Background AntiTNF therapeutic drug monitoring is currently performed at trough, immediately before drug administration. However, in clinical practice when subcutaneous medications are used, blood extractions often do not coincide with that moment. The aim of this study was to know if adalimumab levels measured between injections are sufficiently similar to trough levels to be used in clinical practice in a similar way. Methods 295 adalimumab level determinations performed at different time points of 99 injection cycles in 55 patients with inflammatory bowel disease (IBD) were included in the study. 51 patients received 40mg every 2 weeks and 4 patients received 80mg every 2 weeks. Results Median adalimumab levels (IQR) at trough, between days 1–4, 5–8 and 9–13 were 10.6 (6–12), 12.3 (7–18), 13 (7–19) and 10.8 (8–12), respectively. The median differences between trough level and days 1–4, 5–8 and 9–13 were 1.7 (IC 95% 1–2.3) (p < 0.001), 2.3 (IC 95% 1.5–3.1) (p < 0.001), 0.6 (IC 95% –0.2–1.3) (p = 0.13), respectively. Conclusion Adalimumab levels between days 9 and 13 from drug injection are very similar to trough level and could be interpreted clinically at the same way. Adalimumab levels between days 1 and 8 are significantly higher, although, differences are small.
- Published
- 2020
9. P635 Carriage of the HLA-DQA1*05 allele is associated with a high risk of loss of response to infliximab in patients with inflammatory bowel disease
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L. Rodriguez Alonso, A Padró, J Orobitg, G Ibáñez-Sanz, K Serra, Blau Camps, L de la Peña, F. Rodriguez Moranta, Pau Gilabert, Ana Berrozpe, C Arajol, Alexandra Ruiz-Cerulla, E Santacana, A Serracarbasa, Jordi Guardiola, and N Padullés
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medicine.medical_specialty ,business.industry ,Gastroenterology ,General Medicine ,Human leukocyte antigen ,medicine.disease ,Inflammatory bowel disease ,Infliximab ,Carriage ,Internal medicine ,medicine ,In patient ,Allele ,business ,medicine.drug - Published
- 2019
10. An urgent referral strategy for symptomatic patients with suspected colorectal cancer based on a quantitative immunochemical faecal occult blood test
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Gemma Binefa, Alexandra Ruiz-Cerulla, Triana Lobatón, Jordi Guardiola, Francisco Rodríguez-Moranta, Victor Moreno, C Arajol, and Lorena Rodríguez-Alonso
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Adult ,Male ,medicine.medical_specialty ,Urgent referral ,Referral ,Colorectal cancer ,Cost effectiveness ,Colonoscopy ,Diagnostic accuracy ,Sensitivity and Specificity ,Internal medicine ,Humans ,Mass Screening ,Medicine ,Prospective Studies ,Referral and Consultation ,Aged ,Gynecology ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Cancer ,Middle Aged ,medicine.disease ,ROC Curve ,Occult Blood ,Multivariate Analysis ,Practice Guidelines as Topic ,Cohort ,Female ,Colorectal Neoplasms ,business - Abstract
European health systems have developed referral guidelines for the selection of patients for the urgent investigation of suspected colorectal cancer.To evaluate whether quantitative faecal immunochemical testing performs better than commonly used high-risk symptoms based strategies for fast-tracking cancer referrals.We prospectively studied 1054 symptomatic patients referred for a colonoscopy who provided a sample for faecal immunochemical testing. The usefulness of faecal immunochemical testing and two current guidelines for urgent referral were compared for their efficacy in the detection of colorectal cancer and advanced neoplasia.The guidelines detected 46.7% and 43.3% of cases of colorectal cancer while faecal haemoglobin concentration ≥15μg Hb/g detected 96.7% of cases. The diagnostic accuracy of both the guidelines and faecal haemoglobin concentration ≥15μg Hb/g for the detection of advanced neoplasia was: sensitivity 38.3%, 36.1%, 57.1% and specificity 71.8%, 69.5%, 86.6%, respectively. Male gender (OR 2.35; p0.001), age (1.34; p=0.002), and faecal haemoglobin concentration ≥10μg Hb/g (7.81; p0.001) were independent predictive factors of advanced neoplasia.A faecal immunochemical test based-strategy performs better than current high-risk symptoms based strategies for fast-tracking cancer referrals. A score that combines gender, age and a faecal immunochemical test could accurately estimate the risk of advanced neoplasia.
- Published
- 2015
11. Fecal Level of Calprotectin Identifies Histologic Inflammation in Patients With Ulcerative Colitis in Clinical and Endoscopic Remission
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Xavier Sanjuan, Jordi Guardiola, C Arajol, Francisco Rodríguez-Moranta, Carolina Loayza, Elena Sánchez, Alexandra Ruiz-Cerulla, Lorena Rodríguez-Alonso, and Triana Lobatón
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Adult ,Male ,medicine.medical_specialty ,Pathology ,Adolescent ,Biopsy ,Colonoscopy ,Inflammation ,Gastroenterology ,Feces ,Young Adult ,Interquartile range ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Risk factor ,Aged ,Hepatology ,Receiver operating characteristic ,medicine.diagnostic_test ,Histocytochemistry ,business.industry ,Middle Aged ,medicine.disease ,Ulcerative colitis ,Colitis, Ulcerative ,Female ,medicine.symptom ,Calprotectin ,business ,Leukocyte L1 Antigen Complex ,Biomarkers - Abstract
Background & Aims Histologic recovery of patients with ulcerative colitis (UC) often is incomplete, even among those in clinical and endoscopic remission. Persistent active microscopic inflammation is associated with an increased risk of relapse and colorectal neoplasia. A high level of fecal calprotectin (FC) is a reliable marker of endoscopic lesions in patients with UC. We evaluated the accuracy of FC in identifying patients with UC in clinical and endoscopic remission who still have histologic features of inflammation. Methods We performed a prospective observational study of 59 patients with UC in clinical and endoscopic remission undergoing colonoscopy. Several biopsy specimens were collected from each colonic segment. Endoscopic remission was defined as a Mayo endoscopic subscore with a grade of 0 or 1. Active histologic inflammation was defined by the presence of neutrophils infiltrating crypt epithelial cells. FC was determined by enzyme-linked immunosorbent assay analysis. Results Eighteen patients (30.5%) showed evidence of active histologic inflammation. Patients with active histologic inflammation had a significantly higher median level of FC (278 μg/g; interquartile range, 136–696 μg/g) than those without active histologic inflammation (68 μg/g; interquartile range, 30–172 μg/g) (P = .002). In multivariate analysis, the FC and Mayo endoscopic subscore (0 or 1) were each independent predictors of histologic inflammation. The level of FC identified active histologic inflammation in patients in clinical and endoscopic remission, with an area under the receiver operator characteristic curve value of 0.754. Conclusions Histologic inflammation is common among patients with UC in clinical and endoscopic remission. Patients with histologic features of inflammation can be identified reliably based on their fecal level of calprotectin.
- Published
- 2014
12. Usability of a home-based test for the measurement of fecal calprotectin in asymptomatic IBD patients
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Laurence Seidel, Edouard Louis, Catherine Reenaers, Jordi Guardiola, Alexandra Ruiz-Cerulla, Christian Reinhard, Catherine Van Kemseke, Arne Røseth, Caroline Bello, and C Arajol
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Adult ,Male ,medicine.medical_specialty ,Asymptomatic ,Severity of Illness Index ,03 medical and health sciences ,Feces ,0302 clinical medicine ,Belgium ,Predictive Value of Tests ,Internal medicine ,Surveys and Questionnaires ,Severity of illness ,Medicine ,Humans ,Hepatology ,business.industry ,Norway ,System usability scale ,Gastroenterology ,Usability ,Inflammatory Bowel Diseases ,Test (assessment) ,Self Care ,Logistic Models ,Spain ,030220 oncology & carcinogenesis ,Predictive value of tests ,Asymptomatic Diseases ,Physical therapy ,Linear Models ,Patient Compliance ,030211 gastroenterology & hepatology ,Female ,Calprotectin ,medicine.symptom ,business ,Leukocyte L1 Antigen Complex ,Biomarkers - Abstract
The aim of our work was to test the usability of fecal calprotectin (FC) home-based test in inflammatory bowel disease (IBD) patients. Methods IBD patients were prospectively recruited. They had to measure FC with a dedicated tool and smartphone application, 5 times at two weeks intervals over an 8 weeks period. They had to fill in a usability questionnaire at the first and the last FC measurement. A System Usability Scale (SUS: 0–100) and the Global Score of Usability (GSU: 0–85) were calculated. FC was also centrally measured by ELISA. Results Fifty-eight patients were recruited. Forty-two performed at least one FC measurement and 27 performed all the FC requested measurements. The median (IQR) SUS (0–100) at the first and last use were 85 (78–90) and 81 (70–88), respectively; the median (IQR) GSU (0–85) at the first and last use were 74 (69–80) and 77 (68–83), respectively. Adherence to the planned measurements and usability of the tool were higher in females and in less severe disease. The intra-class correlation coefficient between home-based and centrally measured FC was 0.88. Conclusion The adherence to home-based measurement of FC was fair. Usability scores for the home-based test were high. There was a good correlation with the centrally measured FC by ELISA.
- Published
- 2017
13. Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group
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María José Casanova, Belén Beltrán, Alexandra Ruiz-Cerulla, Ignacio Marín-Jiménez, Esther Garcia-Planella, V. Robles, Danila Guagnozzi, Noemí Manceñido, David Busquets, Yolanda Arguedas, Fernando Fernández-Bañares, Miguel Montoro, Alfredo J. Lucendo, Luis Fernández-Salazar, J. M. Fernández, M Piqueras, and Javier P. Gisbert
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medicine.medical_specialty ,Evidence-based practice ,Biopsy ,Anti-Inflammatory Agents ,Cochrane Library ,Inflammatory bowel disease ,03 medical and health sciences ,chemistry.chemical_compound ,Sex Factors ,0302 clinical medicine ,Microscopic colitis ,Mesalazine ,Adrenal Cortex Hormones ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Budesonide ,Hepatology ,Collagenous colitis ,Tumor Necrosis Factor-alpha ,business.industry ,Adalimumab ,Age Factors ,Gastroenterology ,Colonoscopy ,Evidence-based medicine ,medicine.disease ,Infliximab ,Surgery ,Colitis, Microscopic ,chemistry ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
Background Microscopic colitis (MC) is an underdiagnosed inflammatory bowel disease. Aim To develop an evidence-based clinical practice guide on MC current concepts. Methods Literature search was done on the Cochrane Library, EMBASE and MEDLINE electronic databases, which were consulted covering the period up until March 2015. Work groups were selected for each of the reviewed topics, with the purpose of drafting the initial statements and recommendations. They subsequently underwent a voting process based on the Delphi method. Each statement/recommendation was accompanied by the result of the vote the level of evidence, and discussion of the corresponding evidence. The grade of recommendation (GR) using the GRADE approach was established for diagnosis and treatment recommendations. Results Some key statements and recommendations are: advancing age increases the risk of developing MC, mainly in females. The symptoms of MC and IBS-D may be similar. If MC is suspected, colonoscopy taking biopsies is mandatory. Treatment with oral budesonide is recommended to induce clinical remission in patients with MC. Oral mesalazine is not recommended in patients with collagenous colitis for the induction of clinical remission. The use of anti-TNF-alpha drugs (infliximab, adalimumab) is recommended for the induction of remission in severe cases of MC that fail to respond to corticosteroids or immunomodulators, as an alternative to colectomy. Conclusions This is the first consensus paper on MC based on GRADE methodology. This initiative may help physicians involved in care of these patients in taking decisions based on evidence.
- Published
- 2016
14. Improved outcome of acute severe ulcerative colitis while using early predictors of corticosteroid failure and rescue therapies
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Esther Garcia-Planella, Jordi Guardiola, Sandra Maisterra, Jordi Gordillo, Jordina Llaó, Míriam Mañosa, Eduard Cabré, Eugeni Domènech, Juan E. Naves, and Alexandra Ruiz-Cerulla
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Ulcerative Colitis Flare ,Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Severity of Illness Index ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Gastrointestinal Agents ,Adrenal Cortex Hormones ,Internal medicine ,Severity of illness ,Medicine ,Humans ,Corticosteroids ,Treatment Failure ,Colectomy ,Retrospective Studies ,Gastrointestinal agent ,Hepatology ,business.industry ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Ulcerative colitis ,Infliximab ,Surgery ,Logistic Models ,Spain ,030220 oncology & carcinogenesis ,Cyclosporine ,Corticosteroid ,030211 gastroenterology & hepatology ,Administration, Intravenous ,Colitis, Ulcerative ,Female ,business ,Immunosuppressive Agents ,medicine.drug ,Follow-Up Studies - Abstract
Background and aim: Intravenous corticosteroids remain the first line therapy for severe attacks of ulcerative colitis although up to 30-40% of patients do not respond to treatment. The availability of alternative therapies to colectomy and the knowledge of early predictors of response to corticosteroids should have improved the clinical outcomes of patients with severe refractory ulcerative colitis. The aim of the study is to describe the current need, way of use, and efficacy of rescue therapies, as well as colectomy rates in patients with severe ulcerative colitis flares. Methods: Between January 2005 and December 2011, all patients admitted in three referral centres for a severe ulcerative colitis flare who received intravenous corticosteroids were identified and clinical and biological data were accurately collected. Patients were followed-up until colectomy, death, or date of data collection. Results: Sixty-two flares were included. Initial efficacy of intravenous corticosteroids (mild activity or inactive disease without rescue treatment, at day 7 after starting intravenous corticosteroids) was achieved in 50% of flares, and rescue therapies were used in 27 episodes (43%). After a median follow-up of 18 months, the colectomy rate was 6.5%. Failed oral corticosteroids for the index flare were the only baseline feature that predicted the need for rescue therapy and colectomy. Conclusions: There is a marked reduction in the colectomy rate and an increased use of medical rescue therapies as compared to historical series. Patients worsening while on oral corticosteroids for a moderate flare are at high risk of rescue therapy and colectomy and, therefore, should be directly treated with rescue therapies instead of attempting intravenous corticosteroids. (C) 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
- Published
- 2016
15. [Chronic diarrhoea: Definition, classification and diagnosis]
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Alexandra Ruiz-Cerulla, Javier Santos, Eva C. Vaquero, Esther Garcia-Planella, Agustín Balboa, Alba Rodríguez-Luna, Jordi Guardiola, Anna Accarino, Xavier Molero, Eugeni Domènech, Fernando Fernández-Bañares, and Maria Esteve
- Subjects
Diarrhea ,medicine.medical_specialty ,Pediatrics ,Referral ,Dietary Sugars ,Gastrointestinal Diseases ,Population ,Alternative medicine ,Primary care ,Scientific evidence ,03 medical and health sciences ,0302 clinical medicine ,Malabsorption Syndromes ,medicine ,Humans ,Intensive care medicine ,education ,Antidiarrheals ,education.field_of_study ,business.industry ,Grade system ,Disease Management ,Diagnostic algorithms ,Chronic diarrhoea ,Colitis ,Diet ,Gastrointestinal Microbiome ,Diagnostic Techniques, Digestive System ,030220 oncology & carcinogenesis ,Chronic Disease ,030211 gastroenterology & hepatology ,Exocrine Pancreatic Insufficiency ,business ,Gastrointestinal Motility ,Algorithms ,Food Hypersensitivity - Abstract
Chronic diarrhoea is a common presenting symptom in both primary care medicine and in specialized gastroenterology clinics. It is estimated that >5% of the population has chronic diarrhoea and nearly 40% of these patients are older than 60 years. Clinicians often need to select the best diagnostic approach to these patients and choose between the multiple diagnostic tests available. In 2014 the Catalan Society of Gastroenterology formed a working group with the main objective of creating diagnostic algorithms based on clinical practice and to evaluate diagnostic tests and the scientific evidence available for their use. The GRADE system was used to classify scientific evidence and strength of recommendations. The consensus document contains 28 recommendations and 6 diagnostic algorithms. The document also describes criteria for referral from primary to specialized care.
- Published
- 2015
16. Randomised clinical trial: colestyramine vs. hydroxypropyl cellulose in patients with functional chronic watery diarrhoea
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Maria Esteve, M Piqueras, Fernando Fernández-Bañares, Ines Modolell, Yamile Zabana, Alexandra Ruiz-Cerulla, Mercè Rosinach, and Jordi Guardiola
- Subjects
Adult ,Diarrhea ,Male ,Taurocholic Acid ,medicine.medical_specialty ,Cholestyramine Resin ,Gastroenterology ,law.invention ,Bile Acids and Salts ,chemistry.chemical_compound ,Randomized controlled trial ,Double-Blind Method ,law ,Internal medicine ,Watery diarrhoea ,medicine ,Humans ,Pharmacology (medical) ,In patient ,Adverse effect ,Cellulose ,Hepatology ,business.industry ,Hydroxypropyl cellulose ,Bile acid malabsorption ,Middle Aged ,medicine.disease ,Surgery ,Clinical trial ,chemistry ,Female ,SeHCAT ,business - Abstract
Summary Background Idiopathic bile acid malabsorption (BAM) has been suggested as a cause of chronic watery diarrhoea, with a response to colestyramine in 70% of patients. However, the efficacy of this drug has never been investigated in placebo-controlled trials. Aim To evaluate the efficacy of colestyramine as compared with hydroxypropyl cellulose in the treatment of functional chronic watery diarrhoea. Methods Patients with chronic watery diarrhoea were randomly assigned to groups given colestyramine sachets 4 g twice daily (n = 13) or identical hydroxypropyl cellulose sachets (n = 13) for 8 weeks. The primary end-point was clinical remission defined as a mean of 3 or fewer stools per day during the week before the visit, with less than 1 watery stool per day. A secondary end-point was the reduction in daily watery stool number. SeHCAT test was performed in all patients, but an abnormal test was not a prerequisite to be included. Results All included patients had a SeHCAT 7-day retention ≤20%. There were no statistical differences in the percentage of patients in clinical remission at week 8 between colestyramine and hydroxypropyl cellulose with either intention-to-treat (53.8% vs. 38.4%; P = 0.43) or per-protocol (63.6% vs. 38.4%; P = 0.22) analyses. However, the mean per cent decrease in watery stool number was significantly higher with colestyramine than with hydroxypropyl cellulose (−92.4 ± 3.5% vs. −75.8 ± 7.1%; P = 0.048). The rate of adverse events related to study drugs did not differ between groups. Conclusions Colestyramine (4 g twice daily) is effective and safe for short-term treatment of patients with chronic watery diarrhoea presumably secondary to BAM. Clinical Trials Register number EudraCT 2009-011149-14.
- Published
- 2014
17. Long-term comparative efficacy of cyclosporine- or infliximab-based strategies for the management of steroid-refractory ulcerative colitis attacks
- Author
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Míriam Mañosa, Esther Garcia-Planella, Jordi Guardiola, Eugeni Domènech, Triana Lobatón, Juan E. Naves, Jordina Llaó, Cristina Romero, Eduard Cabré, and Alexandra Ruiz-Cerulla
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Salvage therapy ,Inflammatory bowel disease ,Pharmacotherapy ,Gastrointestinal Agents ,Adrenal Cortex Hormones ,Internal medicine ,medicine ,Immunology and Allergy ,Humans ,cyclosporine ,Colectomy ,ulcerative colitis ,Aged ,refractoriness ,Thiopurine methyltransferase ,biology ,business.industry ,Gastroenterology ,Antibodies, Monoclonal ,Disease Management ,Odds ratio ,Middle Aged ,medicine.disease ,colectomy ,Prognosis ,Ulcerative colitis ,Infliximab ,Hospitalization ,Drug Resistance, Neoplasm ,biology.protein ,Cyclosporine ,Colitis, Ulcerative ,Female ,business ,infliximab ,Immunosuppressive Agents ,medicine.drug ,Follow-Up Studies - Abstract
Background: The short-term efficacy of infliximab (IFX) and cyclosporine A (CsA) in steroid-refractory ulcerative colitis (SRUC) has been recently shown to be similar, but long-term outcomes are still unclear. Moreover, the need for further rescue therapies in patients treated with IFX or CsA for SRUC has not been reported. The aims of our study were to compare short-term and long-term efficacy between 2 different strategies based on initial treatment with CsA or IFX for SRUC attacks. Patients and Methods: Between January 2005 and December 2011, all patients admitted for SRUC who required medical rescue therapy were identified from the electronic databases of 3 referral centers and grouped according to whether they received CsA or IFX as first-line rescue therapy, and retrospectively reviewed. Results: Among 50 SRUC attacks, 20 were treated with CsA as first-line rescue therapy and 30 with IFX. The CsA group had a higher proportion of patients with severe UC activity immediately before rescue therapy (P = 0.03) and a shorter median time from intravenous corticosteroids to rescue therapy (P = 0.03). A higher proportion of patients in the CsA group received second-line drug therapy (switch) as compared with the IFX group (P = 0.04). Fifteen patients (30%) were colectomized during the study period, with no between-group differences. Previous thiopurine exposure (P = 0.004; odds ratio 6.1 [1.7-20.9]) was the only independent predictor of colectomy. Conclusions: CsA- and IFX-based strategies for SRUC seem similarly effective in preventing colectomy in the short and long term, although second-line drug therapy is more often required with CsA-based strategies.
- Published
- 2014
18. Intravenous corticosteroids in moderately active ulcerative colitis refractory to oral corticosteroids
- Author
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Laura Marín, Jordina Llaó, Eugeni Domènech, Esther Garcia-Planella, Jordi Guardiola, Míriam Mañosa, Juan E. Naves, Alexandra Ruiz-Cerulla, Lorena Rodríguez-Alonso, and Eduard Cabré
- Subjects
Oral ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Anti-Inflammatory Agents ,Administration, Oral ,Methylprednisolone ,Severity of Illness Index ,Refractory ,Rescue therapy ,Internal medicine ,Medicine ,Corticosteroids ,Humans ,In patient ,Treatment Failure ,Colectomy ,Aged ,Retrospective Studies ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Gastroenterology ,Antibodies, Monoclonal ,General Medicine ,Middle Aged ,University hospital ,medicine.disease ,Ulcerative colitis ,Infliximab ,Surgery ,Retreatment ,Cyclosporine ,Prednisone ,Administration, Intravenous ,Colitis, Ulcerative ,Female ,business ,Inactive disease ,Intravenous ,hormones, hormone substitutes, and hormone antagonists ,Intravenous route ,Immunosuppressive Agents ,Follow-Up Studies - Abstract
Background: Oral corticosteroids remain the mainstay of treatment for moderately active ulcerative colitis (UC). In patients who fail to respond to oral corticosteroids, attempting the intravenous route before starting rescue therapies is an alternative, although no evidence supports this strategy. Aim: To evaluate clinical outcomes after a course of intravenous corticosteroids for moderate attacks of UC according to the failed oral corticosteroids or not. Methods: All episodes of active UC admitted to three university hospitals between January 2005 and December 2011 were identified and retrospectively reviewed. Only moderately active episodes treated with intravenous corticosteroids were included. Treatment outcome was compared between episodes which failed to outpatient oral corticosteroids for the index flare and those directly treated by intravenous corticosteroids. Results: 110 episodes were included, 45% of which failed to outpatient oral corticosteroids (median dose 60 mg/day [IQR 50-60], median length of course 10 days [IQR 7-17]). Initial response (defined as mild severity or inactive disease at day 7 after starting intravenous corticosteroids, without rescue therapy) was achieved in 75%, with no between-group differences (78% vs. 75%). After a median follow-up of 12 months (IQR 4-24), 35% of the initial responders developed steroid-dependency and up to 13% required colectomy. Unsuccessful response to oral corticosteroids was the only factor associated with steroid-dependency in the Long term (P = 0.001). Conclusions: Intravenous corticosteroids are efficient for inducing remission in moderately active UC unresponsive to oral corticosteroids, but almost half of these patients develop early steroid-dependency. Alternative therapeutic strategies should be assessed in this clinical setting. (C) 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
- Published
- 2014
19. P275 Bile acid malabsorption involvement in Crohn's disease symptoms. Its relationship with ROME III criteria
- Author
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C Arajol, Francisco Rodríguez-Moranta, Lorena Rodríguez-Alonso, Josep Martin-Comin, S. Maisterra, E. Sanchez Pastor, Alexandra Ruiz-Cerulla, Jordi Guardiola, O. Puig-Calvo, and T. Lobaton Ortega
- Subjects
medicine.medical_specialty ,Crohn's disease ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,Bile acid malabsorption ,General Medicine ,medicine.disease ,business ,Rome iii - Published
- 2014
20. P486 Intravenous corticosteroids in moderate active ulcerative colitis not responding to oral corticosteroids
- Author
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Esther Garcia-Planella, E. Cabré, Míriam Mañosa, Juan E. Naves, Laura Marín, Alexandra Ruiz-Cerulla, Lorena Rodríguez-Alonso, E. Domènech, Jordi Guardiola, and Jordina Llaó
- Subjects
medicine.medical_specialty ,business.industry ,ADRENAL CORTICOSTEROIDS ,Internal medicine ,Gastroenterology ,medicine ,General Medicine ,medicine.disease ,business ,Ulcerative colitis - Published
- 2013
21. Sa1223 Phenotypic Characteristics and Use of Therapeutic Resources in Elderly-Onset Inflammatory Bowel Disease: A Multicentre, Case-Control Study
- Author
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P. Huelin, Guillermo Bastida, Joaquín Hinojosa, Juan María Vázquez Morón, Mara Charro, José María Huguet, Daniel Hervías, R. Atienza, Esther Rodríguez, Alexandra Ruiz-Cerulla, R. Gómez, Míriam Mañosa, Francesc Martínez-Cerezo, M Calafat, María José Casanova, Maria Rojas-Feria, Rocío Plaza, David Busquets, Eugeni Domènech, Miguel Minguez, Javier P. Gisbert, Eduard Cabré, Lucía Márquez, Eva Zapata, Carmen García Caparrós, Xavier Calvet, Yamile Zabana, Manuel Barreiro-de Acosta, David Monfort, Carmen Dueñas-Sadornil, Marta Calvo, Ruth de Francisco, and Luis Fernandez Salazar
- Subjects
Hepatology ,media_common.quotation_subject ,Gastroenterology ,medicine ,Elderly onset ,Art ,medicine.disease ,Inflammatory bowel disease ,Humanities ,media_common - Abstract
Phenotypic Characteristics and Use of Therapeutic Resources in Elderly-Onset Inflammatory Bowel Disease: A Multicentre, Case-Control Study Miriam Manosa, Margalida Calafat, Ruth de Francisco, Carmen Garcia Caparros, Maria Jose Casanova, Patricia Huelin, Marta Calvo, Luis Fernandez Salazar, Miguel Minguez, Alexandra Ruiz-Cerulla, Yamile Zabana, Guillermo Bastida, Joaquin Hinojosa, Lucia Marquez, Manuel Barreiro-de Acosta, Xavier Calvet, David Monfort, Rosario Gomez, Esther Rodriguez, Jose Maria Huguet, Maria Rojas-Feria, Daniel Hervias, Ramon Atienza, David Busquets, Eva Zapata, Carmen Duenas-Sadornil, Mara Charro, Francesc J. Martinez-Cerezo, Rocio Plaza, Juan Maria Vazquez Moron, Javier P. Gisbert, Eduard Cabre, Eugeni Domenech
- Published
- 2014
22. P170 Planar radiolabelled white cell scintigraphy and Technetium-99m-HMPAO labeled leukocyte single photon emission computed tomography (SPECT) for assessing endoscopic remission in ulcerative colitis
- Author
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Alexandra Ruiz-Cerulla, Triana Lobatón, A. Lopez-Garcia, Francisco Rodríguez-Moranta, Lorena Rodríguez-Alonso, J. Guardiola-Capón, O. Puig Calvo, C Arajol, and J. Martín-Comín
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,General Medicine ,Single-photon emission computed tomography ,Scintigraphy ,medicine.disease ,University hospital ,Ulcerative colitis ,Endoscopy ,medicine ,Radiology ,Nuclear medicine ,business ,Technetium-99m - Abstract
P170 Planar radiolabelled white cell scintigraphy and Technetium-99m-HMPAO labeled leukocyte single photon emission computed tomography (SPECT) for assessing endoscopic remission in ulcerative colitis C. Arajol1 *, O. Puig Calvo2, F. Rodriguez-Moranta1, L. Rodriguez-Alonso1, A. Ruiz-Cerulla1, T. Lobaton1, A. LopezGarcia1, J. Martin-Comin2, J. Guardiola-Capon1. 1Bellvitge University Hospital, Gastroenterology, Barcelona, Spain, 2Bellvitge University Hospital, Nuclear Medicine, Barcelona, Spain
- Published
- 2014
23. P439 Management and outcome of severe attacks of ulcerative colitis in the era of biologicals
- Author
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Alexandra Ruiz-Cerulla, E. Cabré, S. Maisterra, Jordi Gordillo, Juan E. Naves, Míriam Mañosa, Esther Garcia-Planella, Jordina Llaó, Jordi Guardiola, and E. Domènech
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,General Medicine ,business ,medicine.disease ,Outcome (game theory) ,Ulcerative colitis - Published
- 2013
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