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Resumen: Introducción y objetivos: El trasplante de hígado ortotópico (OLT, por sus iniciales en inglés) es el tratamiento definitivo para la mayoría de los tipos de fallo hepático. Procedimientos tales como la derivación portosistémica intrahepática transyugular (TIPS, por sus iniciales en inglés) y la derivación portocava reducen las complicaciones vasculares sistémicas de la hipertensión portal. El procedimiento de TIPS permanece como una terapia de «puente» para permitir el tratamiento de síntomas refractarios hasta que el trasplante esté disponible. Este estudio busca describir el impacto operatorio de una TIPS previo a un OLT. Material y métodos: Se realizó una revisión retrospectiva en pacientes que fueron sometidos a trasplante hepático en el Hospital San José, desde 1999 hasta febrero de 2020. Resultados: Se incluyeron 92 pacientes con OLT. Sesenta y seis fueron varones y 26 mujeres, con una edad promedio de 52 años. Nueve de los 92 pacientes (9.8%) tuvieron una TIPS previo al OLT. Los valores de clase Child, MELD, sodio en sangre y plaquetas fueron similares en el preoperatorio de ambos grupos. No encontramos diferencia en las medias de estancia en la unidad de cuidados intensivos (UCI), tiempo operatorio y transfusiones de sangre para OLT, con o sin TIPS previa. Las tasas de complicaciones vasculares y biliares, así como la necesidad de una intervención temprana no fueron significativamente diferentes entre los grupos. La mortalidad general en un año en el grupo TIPS fue del 11%. Conclusiones: La TIPS es un puente terapéutico apropiado para el trasplante de hígado. No encontramos mayores complicaciones operatorias o postoperatorias en los pacientes con TIPS antes del OLT, en comparación con los pacientes con OLT sin TIPS. La necesidad de transfusión, el tiempo operatorio y la estancia en la UCI fueron similares en ambos grupos. Abstract: Introduction and objectives: Orthotopic liver transplant (OLT) is the definitive treatment of most types of liver failure. Transjugular intrahepatic portosystemic shunt (TIPS) and portocaval shunt placement procedures reduce the systemic vascular complications of portal hypertension. TIPS placement remains a “bridge” therapy that enables treatment of refractory symptoms until transplantation becomes available. The aim of the present study was to describe the operative impact of TIPS prior to OLT. Materials and methods: A retrospective review was conducted on patients that underwent liver transplant at the Hospital San José within the timeframe of 1999 and February 2020. Results: We reviewed a total of 92 patients with OLT. Sixty-six patients were male and 26 were female, with a mean age of 52 years. Nine (9.8%) of the 92 patients had a TIPS, before the OLT. Preoperative Child-Pugh class, MELD score, and sodium and platelet levels were similar between groups. We found no difference in the means of intensive care unit stay, operative time, or blood transfusions for liver transplant, with or without previous TIPS. There was no significant difference between groups regarding vascular and biliary complication rates or the need for early intervention. The overall one-year mortality rate in the TIPS group was 11%. Conclusions: TIPS is an appropriate therapeutic bridge towards liver transplant. We found no greater operative or postoperative complications in patients with TIPS before OLT, when compared with OLT patients without TIPS. The need for transfusion, operative time, and ICU stay were similar in both groups.

Introduction and aims: Orthotopic liver transplant (OLT) is the definitive treatment of most types of liver failure. Transjugular intrahepatic portosystemic shunt (TIPS) and portocaval shunt placement procedures reduce the systemic vascular complications of portal hypertension. TIPS placement remains a “bridge” therapy that enables treatment of refractory symptoms until transplantation becomes available. The aim of the present study was to describe the operative impact of TIPS prior to OLT. Materials and methods: A retrospective review was conducted on patients that underwent liver transplant at the Hospital San José within the timeframe of 1999 and February 2020. Results: We reviewed a total of 92 patients with OLT. Sixty-six patients were male and 26 were female, with a mean age of 52 years. Nine (9.8%) of the 92 patients had a TIPS, before the OLT. Preoperative Child-Pugh class, MELD score, and sodium and platelet levels were similar between groups. We found no difference in the means of intensive care unit stay, operative time, or blood transfusions for liver transplant, with or without previous TIPS. There was no significant difference between groups regarding vascular and biliary complication rates or the need for early intervention. The overall one-year mortality rate in the TIPS group was 11%. Conclusions: TIPS is an appropriate therapeutic bridge towards liver transplant. We found no greater operative or postoperative complications in patients with TIPS before OLT, when compared with OLT patients without TIPS. The need for transfusion, operative time, and ICU stay were similar in both groups. Resumen: Introducción y objetivos: El trasplante de hígado ortotópico (OLT, por sus iniciales en inglés) es el tratamiento definitivo para la mayoría de los tipos de falla hepática. Procedimientos tales como la derivación portosistémica intrahepática transyugular (TIPS, por sus iniciales en inglés) y la derivación portocava, reducen las complicaciones vasculares sistémicas de la hipertensión portal. El procedimiento de TIPS permanece como una terapia de “puente”, para permitir el tratamiento de síntomas refractarios hasta que el trasplante esté disponible. Este estudio busca describir el impacto operatorio de una TIPS previo a un OLT. Material y métodos: Se realizó una revisión retrospectiva en pacientes que fueron sometidos a trasplante hepático en el Hospital San José, de 1999 hasta febrero del 2020. Resultados: Se incluyeron 92 pacientes con OLT. Sesenta y seis fueron masculinos y 26 femeninos, con una edad promedio de 52 años. Nueve de los 92 pacientes (9.8%) tuvieron una TIPS previo al OLT. Los valores de clase Child, MELD, sodio en sangre y plaquetas fueron similares en el preoperatorio de ambos grupos. No encontramos diferencia en las medias de estancia en la unidad de cuidados intensivos (UCI), tiempo operatorio y transfusiones de sangre para OLT, con o sin TIPS previa. Las tasas de complicaciones vasculares y biliares, así como la necesidad de una intervención temprana, no fueron significativamente diferentes entre los grupos. La mortalidad general en un año en el grupo TIPS fue del 11%. Conclusiones: La TIPS es un puente terapéutico apropiado para el trasplante de hígado. No encontramos mayores complicaciones operatorias o postoperatorias en los pacientes con TIPS antes del OLT, en comparación con los pacientes con OLT sin TIPS. La necesidad de transfusión, el tiempo operatorio y la estancia en la UCI fueron similares en ambos grupos.

Helicobacter pylori (H. pylori) infection is the most widespread infectious-contagious disease worldwide, reaching a prevalence of 50–80% in developing countries. Chronic infection is considered the main cause of chronic gastritis and has been related to other diseases, such as peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer. The most common treatment is with eradication regimens that utilize three or four drugs, including a proton pump inhibitor (PPI) and the antibiotics, clarithromycin and amoxycillin or metronidazole. Empiric antibiotic use for eradicating the bacterium has led to a growing resistance to those drugs, reducing regimen efficacy and increasing costs for both the patient and the healthcare sector. In such a context, the development of noninvasive next-generation molecular methods holds the promise of revolutionizing the treatment of H. pylori. The genotypic and phenotypic detection of the resistance of the bacterium to antibiotics enables personalized treatment regimens to be provided, reducing costs and implementing an antibiotic stewardship program.The aims of the present narrative review were to analyze and compare the traditional and next-generation methods for diagnosing H. pylori, explain the different factors associated with eradication failure, and emphasize the impact of the increasing antibiotic resistance on the reversal and prevention of H. pylori-associated diseases. Resumen: La infección por Helicobacter pylori (H. pylori) es la enfermedad infecto-contagiosa más diseminada a nivel mundial, alcanzando una prevalencia del 50–80% en países en vías de desarrollo. La infección crónica es considerada como la principal causa de gastritis crónica, y se ha relacionado con otras enfermedades como úlcera péptica, linfoma de tejido linfoide asociado a mucosa gástrica y cáncer gástrico. El tratamiento más común son los esquemas de erradicación que utilizan tres o cuatros fármacos, entre ellos un inhibidor de bomba de protones (IBP) y dos antibióticos, claritromicina y amoxicilina o metronidazol. El uso empírico de antibióticos para la erradicación de la bacteria ha propiciado una creciente resistencia a dichos fármacos, disminuyendo la eficacia de los esquemas y aumentando los costos para el paciente y sector salud. Es por esto que el desarrollo de métodos moleculares no invasivos de siguiente generación promete ser una herramienta que revolucione la terapéutica en H. pylori. La detección genotípica y fenotípica de resistencia a antibióticos de la bacteria permite brindar esquemas personalizados de tratamiento, disminuir costos e implementar un programa de administración de antibióticos.Los objetivos de esta revisión narrativa son analizar y comparar los métodos diagnósticos tradicionales y de siguiente generación para el diagnóstico de H. pylori, explicar los diversos factores asociados a falla de erradicación y puntualizar sobre el impacto de la creciente resistencia a antibióticos sobre la reversión y prevención de enfermedades asociados a H. pylori.

Resumen: La infección por Helicobacter pylori es la enfermedad infecto-contagiosa más diseminada a nivel mundial, alcanzando una prevalencia del 50-80% en países en vías de desarrollo. La infección crónica es considerada como la principal causa de gastritis crónica, y se ha relacionado con otras enfermedades como úlcera péptica, linfoma de tejido linfoide asociado a mucosa gástrica y cáncer gástrico. El tratamiento más común son los esquemas de erradicación que utilizan tres o cuatros fármacos, entre ellos un inhibidor de la bomba de protones (IBP) y dos antibióticos, claritromicina y amoxicilina o metronidazol. El uso empírico de antibióticos para la erradicación de la bacteria ha propiciado una creciente resistencia a dichos fármacos, disminuyendo la eficacia de los esquemas y aumentando los costos para el paciente y para el sector salud. Es por esto que el desarrollo de métodos moleculares no invasivos de siguiente generación promete ser una herramienta que revolucione la terapéutica en H. pylori. La detección genotípica y fenotípica de resistencia a antibióticos de la bacteria permite brindar esquemas personalizados de tratamiento, disminuir costos e implementar un programa de administración de antibióticos.Los objetivos de esta revisión narrativa son analizar y comparar los métodos diagnósticos tradicionales y de siguiente generación para el diagnóstico de H. pylori, explicar los diversos factores asociados a falla de erradicación y puntualizar sobre el impacto de la creciente resistencia a antibióticos sobre la reversión y la prevención de enfermedades asociados a H. pylori. Abstract: Helicobacter pylori infection is the most widespread infectious-contagious disease worldwide, reaching a prevalence of 50-80% in developing countries. Chronic infection is considered the main cause of chronic gastritis and has been related to other diseases, such as peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer. The most common treatment is with eradication regimens that utilize three or four drugs, including a proton pump inhibitor (PPI) and the antibiotics, clarithromycin and amoxycillin or metronidazole. Empiric antibiotic use for eradicating the bacterium has led to a growing resistance to those drugs, reducing regimen efficacy and increasing costs for both the patient and the healthcare sector. In such a context, the development of noninvasive next-generation molecular methods holds the promise of revolutionizing the treatment of H. pylori. The genotypic and phenotypic detection of the resistance of the bacterium to antibiotics enables personalized treatment regimens to be provided, reducing costs and implementing an antibiotic stewardship program.The aims of the present narrative review were to analyze and compare the traditional and next-generation methods for diagnosing H. pylori, explain the different factors associated with eradication failure, and emphasize the impact of the increasing antibiotic resistance on the reversal and prevention of H. pylori-associated diseases.

Introduction: Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. Aim: To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. Materials and methods: Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support.The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. Results: The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. Conclusions: This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD. Resumen: Introducción: La enfermedad inflamatoria intestinal (EII) es una entidad crónica e incurable. La Pan American Crohn's and Colitis Organisation (PANCCO) tiene como objetivo generar concientización sobre la EII, con especial énfasis en Latinoamérica, y el Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) tiene por objetivo primordial procurar la homologación de criterios clínico-terapéuticos para el diagnóstico y tratamiento de la EII. Objetivo: Realizar un consenso para la evaluación de los criterios de aprobación que debe cumplir una Clínica de Atención Integral de pacientes con EII a nivel latinoamericano para ser considerada un centro de excelencia. Material y métodos: Se contó con la participación de 14 expertos clínicos especialistas en gastroenterología, con amplia experiencia clínica de varios años en el manejo de la atención a numerosos pacientes con EII, así como también aquellos que tuvieran la formación de alta especialidad en EII. Todos pertenecientes a 11 países latinoamericanos: Argentina, Brasil, Colombia, Ecuador, Guatemala, México, Perú, Puerto Rico, República Dominicana, Uruguay y Venezuela, en donde tienen clínicas de EII; así mismo, también participó un experto de España como apoyo metodológico, representante de GETECCU.El consenso consistió de 52 enunciados divididos en tres secciones: 1) Indicadores de estructura; 2) Indicadores de proceso y 3) Indicadores de resultados. Se aplicó el método de panel Delphi. Resultados: El consenso latinoamericano muestra los indicadores de calidad que debe cumplir una Clínica de Atención Integral de pacientes con EII para ser considerada un centro de excelencia teniendo en cuenta las necesidades de nuestra región. Conclusiones: Es el primer consenso latinoamericano realizado de manera conjunta por la PANCCO y GETECCU para presentar los estándares para aprobar centros de excelencia en la atención de pacientes con EII.

Resumen: Introducción: La enfermedad inflamatoria intestinal (EII) es una entidad crónica e incurable. La Pan American Crohn's and Colitis Organisation (PANCCO) tiene como objetivo generar concientización sobre la EII, con especial énfasis en Latinoamérica, y el Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) tiene por objetivo primordial procurar la homologación de criterios clínico-terapéuticos para el diagnóstico y tratamiento de la EII. Objetivo: Realizar un consenso para la evaluación de los criterios de aprobación que debe cumplir una Clínica de Atención Integral de pacientes con EII a nivel latinoamericano para ser considerada un centro de excelencia. Material y métodos: Se contó con la participación de 14 expertos clínicos especialistas en gastroenterología, con amplia experiencia clínica de varios años en el manejo de la atención a numerosos pacientes con EII, así como también aquellos que tuvieran la formación de alta especialidad en EII. Todos pertenecientes a 11 países latinoamericanos: Argentina, Brasil, Colombia, Ecuador, Guatemala, México, Perú, Puerto Rico, República Dominicana, Uruguay y Venezuela, en donde tienen clínicas de EII; así mismo, también participó un experto de España como apoyo metodológico, representante de GETECCU.El consenso consistió de 52 enunciados divididos en tres secciones: 1) Indicadores de estructura; 2) Indicadores de proceso y 3) Indicadores de resultados. Se aplicó el método de panel Delphi. Resultados: El consenso latinoamericano muestra los indicadores de calidad que debe cumplir una Clínica de Atención Integral de pacientes con EII para ser considerada un centro de excelencia teniendo en cuenta las necesidades de nuestra región. Conclusiones: Es el primer consenso latinoamericano realizado de manera conjunta por la PANCCO y GETECCU para presentar los estándares para aprobar centros de excelencia en la atención de pacientes con EII. Abstract: Introduction: Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. Aim: To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. Materials and methods: Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support.The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. Results: The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. Conclusions: This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.

Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak.This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease. Resumen: La enfermedad por hígado graso no alcohólico (EHGNA) afecta prácticamente a un tercio de la población mundial. México es uno de los países cuya población reúne varios factores de riesgo para esta enfermedad y su prevalencia podría superar el 50%; es por eso que el panorama a mediano plazo es muy pesimista si no se toman acciones inmediatas para contrarrestar lo que ya se considera un problema de salud nacional.De ahí el interés de la Asociación Mexicana de Gastroenterología y de la Asociación Mexicana de Hepatología para realizar el Consenso mexicano de EHGNA, en el cual se hizo una revisión actualizada y a fondo de temas como epidemiología, fisiopatología, formas clínicas, diagnóstico y tratamiento, con el objetivo de ofrecer al médico mexicano una herramienta útil para la prevención y el manejo de esta enfermedad. Keywords: Nonalcoholic fatty liver disease, Mexican consensus, Palabras clave: Enfermedad por hígado graso no alcohólico, Consenso mexicano

Resumen: La enfermedad por hígado graso no alcohólico (EHGNA) afecta prácticamente a un tercio de la población mundial. México es uno de los países cuya población reúne varios factores de riesgo para esta enfermedad y su prevalencia podría superar el 50%; es por eso que el panorama a mediano plazo es muy pesimista si no se toman acciones inmediatas para contrarrestar lo que ya se considera un problema de salud nacional.De ahí el interés de la Asociación Mexicana de Gastroenterología y de la Asociación Mexicana de Hepatología para realizar el Consenso mexicano de EHGNA, en el cual se hizo una revisión actualizada y a fondo de temas como epidemiología, fisiopatología, formas clínicas, diagnóstico y tratamiento, con el objetivo de ofrecer al médico mexicano una herramienta útil para la prevención y el manejo de esta enfermedad. Abstract: Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak.This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease. Palabras clave: Enfermedad por hígado graso no alcohólico, Consenso mexicano, Keywords: Nonalcoholic fatty liver disease, Mexican consensus

Resumen: El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario. Abstract: The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary. Palabras clave: Consenso, Agentes antivirales de acción directa, Regímenes libres de interferón, Ribavirina, Keywords: Consensus, Direct-acting antiviral agents, Interferon-free regimens, Ribavirin

The guidelines presented herein are an updated version of the recommendations published in 2007. Since then, there has been a rapid advance in the knowledge about the pathophysiology of ulcerative colitis and its therapeutic options. New drugs have been approved, novel targeted therapies have emerged, and new strategies have been developed to improve the previously available approaches to the disease.The aim of the present consensus is to promote the current knowledge of and Mexican perspective on the epidemiology, diagnosis, and medical and surgical treatment of chronic idiopathic ulcerative colitis.The final vote on the statements and their ultimate modifications were carried out at the consensus working group meeting. Evidence was evaluated through the GRADE classification. Resumen: Estas guías constituyen una actualización de las guías publicadas en 2007. Desde ese año, los conocimientos acerca de la fisiopatología, así como las opciones terapéuticas, han evolucionado rápidamente, con la aprobación de nuevos agentes, la aparición de nuevos blancos terapéuticos y nuevas estrategias para mejorar los abordajes disponibles previamente.El objetivo de este consenso es promover una actualización y perspectiva mexicana sobre la epidemiología, el diagnóstico así como el tratamiento médico y quirúrgico de la colitis ulcerosa crónica idiopática.Los enunciados fueron finalmente votados y se realizaron las modificaciones finales en la junta de consenso. La evaluación de la evidencia por la clasificación GRADE se realizó al momento del consenso. Keywords: Chronic idiopathic ulcerative colitis, Diagnosis, Treatment, Epidemiology, Colectomy, Pouchitis, Palabras clave: Colitis ulcerosa crónica idiopática, Diagnóstico, Tratamiento, Epidemiología, Colectomía, Pouchitis

Resumen: Estas guías constituyen una actualización de las guías publicadas en 2007. Desde ese año, los conocimientos acerca de la fisiopatología, así como las opciones terapéuticas, han evolucionado rápidamente, con la aprobación de nuevos agentes, la aparición de nuevos blancos terapéuticos y nuevas estrategias para mejorar los abordajes disponibles previamente.El objetivo de este consenso es promover una actualización y perspectiva mexicana sobre la epidemiología, el diagnóstico así como el tratamiento médico y quirúrgico de la colitis ulcerosa crónica idiopática.Los enunciados fueron finalmente votados y se realizaron las modificaciones finales en la junta de consenso. La evaluación de la evidencia por la clasificación GRADE se realizó al momento del consenso. Abstract: The guidelines presented herein are an updated version of the recommendations published in 2007. Since then, there has been a rapid advance in the knowledge about the pathophysiology of ulcerative colitis and its therapeutic options. New drugs have been approved, novel targeted therapies have emerged, and new strategies have been developed to improve the previously available approaches to the disease.The aim of the present consensus is to promote the current knowledge of and Mexican perspective on the epidemiology, diagnosis, and medical and surgical treatment of chronic idiopathic ulcerative colitis.The final vote on the statements and their ultimate modifications were carried out at the consensus working group meeting. Evidence was evaluated through the GRADE classification. Palabras clave: Colitis ulcerosa crónica idiopática, Diagnóstico, Tratamiento, Epidemiología, Colectomía, Pouchitis, Keywords: Ulcerative colitis, Diagnosis, Treatment, Epidemiology, Colectomy, Pouchitis

Introduction: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. Aim: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. Materials and methods: Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement of >70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. Results and conclusions: Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis (UC) and pouchitis, and the treatment of covert and overt hepatic encephalopathy.

This is the first Latin American Consensus of the Pan American Crohn's and Colitis Organisation (PANCCO) regarding special situations in patients with inflammatory bowel disease (IBD). The aim of this consensus is to raise awareness in the medical community in all Latin American countries with respect to pregnancy, vaccinations, infections, neoplasms, including colorectal cancer, and pediatric issues in patients with IBD.

Este es el primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation (PANCCO) que corresponde a situaciones especiales en pacientes con enfermedad inflamatoria intestinal (EII). El objetivo de este consenso es concientizar a la comunidad médica de todos los países de América Latina acerca del embarazo, la vacunación, las infecciones y las neoplasias, incluyendo el cáncer colorrectal, así como los aspectos pediátricos en pacientes con EII.

Introducción: El uso de los probióticos es común en la práctica clínica. Existe un número significativo de estudios que apoyan la eficacia de los probióticos en algunos trastornos digestivos. Sin embargo, el desconocimiento de la evidencia científica y las diferentes presentaciones y composiciones microbianas de los probióticos disponibles dificultan su prescripción. Objetivo: Proveer al clínico de una revisión consensuada sobre los probióticos y recomendaciones de su uso en gastroenterología. Material y métodos: Se seleccionaron los ensayos clínicos controlados, metaanálisis y revisiones sistemáticas publicados hasta 2015, usando los términos MESH: probiotics, gastrointestinal diseases, humans, adults and children. Se utilizó la metodología Delphi. Diecisiete gastroenterólogos de adultos y 12 de niños elaboraron enunciados los cuales fueron votados hasta obtener acuerdo > 70%. Para cada enunciado se evaluó el nivel de evidencia basado en el sistema GRADE. Resultados y conclusiones: Se generaron 11 enunciados sobre conceptos generales de probióticos y 27 enunciados sobre uso de probióticos en enfermedades gastrointestinales tanto en niños como en adultos. El grupo de consenso recomienda el uso de probióticos en las siguientes condiciones clínicas: prevención de la diarrea asociada a antibióticos, tratamiento de la diarrea aguda infecciosa, prevención de infección por Clostridium difficile y enterocolitis necrosante, para disminuir los eventos adversos de la terapia de erradicación del Helicobacter pylori, el alivio de los síntomas del síndrome de intestino irritable, en el estreñimiento funcional del adulto, para inducir y mantener la remisión en pacientes con colitis ulcerosa crónica idiopática y pouchitis, y en la encefalopatía hepática oculta y manifiesta.

The incidence and prevalence of inflammatory bowel disease (IBD) has increased in recent years in several Latin American countries. There is a need to raise awareness in gastroenterologists and the population in general, so that early diagnosis and treatment of ulcerative colitis (UC) and Crohn's Disease (CD) can be carried out. It is important for all physicians to have homogeneous criteria regarding the diagnosis and treatment of IBD in Latin America. The Pan American Crohn's and Colitis Organisation (PANCCO) is an organization that aims to include all the countries of the Americas, but it specifically concentrates on Latin America. The present Consensus was divided into two parts for publication: 1) Diagnosis and treatment and 2) Special situations. This is the first Latin American Consensus whose purpose is to promote a perspective adapted to our Latin American countries for the diagnosis, treatment, and monitoring of patients with UC and CD.

La incidencia y la prevalencia de la enfermedad inflamatoria intestinal (EII) se han incrementado en los últimos años en varios países de Latinoamérica. Existe una necesidad de concientizar a gastroenterólogos y a la población en general para poder tener un diagnóstico y tratamiento oportunos en la colitis ulcerosa crónica idiopática (CUCI) y enfermedad de Crohn (EC). Es importante que todos los médicos tengan un criterio homogéneo acerca del diagnóstico y el tratamiento de la EII en América Latina. La Pan American Crohn's and Colitis Organisation (PANCCO) es un organismo con el propósito de incluir a todos los países del continente americano pero se enfoca de manera específica a los países latinos. Este Consenso está dividido en 2 partes para su publicación: 1) diagnóstico y tratamiento, y 2) situaciones especiales. Este es el primer Consenso latinoamericano cuyo objetivo es promover una perspectiva adaptada a nuestros países latinos para el diagnóstico, el tratamiento y la monitorización de pacientes con CUCI y EC.

Background: Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociación Mexicana de Gastroenterología (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. Aims: To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. Methods: The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. Results: Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. Conclusions: We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included.

Antecedentes: Desde la publicación de las guías de diagnóstico y tratamiento del síndrome del intestino irritable (SII) de la Asociación Mexicana de Gastroenterología en el 2009 (Guías 2009) se han producido avances significativos en el conocimiento de la epidemiología, fisiopatogenia, diagnóstico y tratamiento de esta enfermedad. Objetivos: Presentar una revisión consensuada del estado actual de los conocimientos sobre el SII que actualicen las Guías 2009, integrando las nuevas evidencias científicas publicadas a nivel mundial con énfasis en estudios realizados en México. Métodos: Se realizó una revisión de la bibliografía en PubMed de enero del 2009 a marzo del 2015, que se complementó en forma manual. Se incluyeron todas las publicaciones en inglés y español, con preferencia por los consensos, guías, revisiones sistemáticas y metaanálisis. Se generaron enunciados en los diferentes aspectos de la enfermedad que fueron votados por 24 gastroenterólogos con el método Delphi. Una vez consensuado cada enunciado, se calificó el nivel de la evidencia y se otorgó la fuerza de la recomendación utilizando el sistema GRADE. Resultados: Se generaron 48 enunciados que actualizaron la información sobre el SII y complementaron la información que no había sido incluida en las Guías 2009 con referencia al papel del ejercicio y la dieta, las estrategias diagnósticas, así como alternativas de tratamiento existentes que fueron evaluadas con mayor rigor o que surgieron en los 5 últimos años. Conclusiones: Presentamos una revisión consensuada de los progresos más relevantes en el SII, que actualizan y complementan las Guías 2009. Se incluyen diversos estudios realizados en México.

Antecedentes: La frecuencia y la etiología de la pancreatitis aguda (PA) varían de acuerdo a la región geográfica. Objetivo: Determinar la frecuencia, etiología y mortalidad de la PA en una población mexicana. Pacientes y métodos: En un periodo de seis años estudiamos prospectivamente a todos los pacientes con un primer episodio de PA. Resultados: Se incluyeron a 605 pacientes con edad promedio de 40 años. El 64,00% tenían sobrepeso y/o obesidad por índice de masa corporal (IMC). La etiología fue biliar en 66,60%, ingesta de alcohol en 15,90%, hipertrigliceridemia en 7,80%, poscolangiopancreatografía retrógrada endoscópica (CPRE) en 2,10% y de etiología no determinada en 7,20%. Se sospechó infección pancreática en 70 pacientes, los cuales fueron puncionados por tomografía axial computarizada (TAC) y en 32 se diagnosticó infección pancreática, siendo el Staphylococcus spp el microorganismo más común. La mortalidad global fue del 5,00% (< 30 años con 2,60% y > 70 años con 10,00%). La etiología alcohólica tuvo una mayor frecuencia de necrosis, infección pancreática y mortalidad. Conclusiones: La etiología de la PA más frecuente es la biliar, pero la causada por alcohol tiene más complicaciones. La mortalidad global fue del 5,00% y ésta se incremento en los pacientes de mayor edad.

Objective: Patients with alcohol-associated hepatitis (AH) have a high mortality. Alcohol exacerbates liver damage by inducing gut dysbiosis, bacterial translocation and inflammation, which is characterised by increased numbers of circulating and hepatic neutrophils., Design: In this study, we performed tandem mass tag (TMT) proteomics to analyse proteins in the faeces of controls (n=19), patients with alcohol-use disorder (AUD; n=20) and AH (n=80) from a multicentre cohort (InTeam). To identify protein groups that are disproportionately represented, we conducted over-representation analysis using Reactome pathway analysis and Gene Ontology to determine the proteins with the most significant impact. A faecal biomarker and its prognostic effect were validated by ELISA in faecal samples from patients with AH (n=70), who were recruited in a second and independent multicentre cohort (AlcHepNet)., Result: Faecal proteomic profiles were overall significantly different between controls, patients with AUD and AH (principal component analysis p=0.001, dissimilarity index calculated by the method of Bray-Curtis). Proteins that showed notable differences across all three groups and displayed a progressive increase in accordance with the severity of alcohol-associated liver disease were predominantly those located in neutrophil granules. Over-representation and Reactome analyses confirmed that differentially regulated proteins are part of granules in neutrophils and the neutrophil degranulation pathway. Myeloperoxidase (MPO), the marker protein of neutrophil granules, correlates with disease severity and predicts 60-day mortality. Using an independent validation cohort, we confirmed that faecal MPO levels can predict short-term survival at 60 days., Conclusions: We found an increased abundance of faecal proteins linked to neutrophil degranulation in patients with AH, which is predictive of short-term survival and could serve as a prognostic non-invasive marker., Competing Interests: Competing interests: BS has been consulting for Ferring Research Institute, HOST Therabiomics, Intercept Pharmaceuticals, Mabwell Therapeutics, Patara Pharmaceuticals, Surrozen and Takeda. BS’s institution UC San Diego has received research support from Axial Biotherapeutics, BiomX, ChromoLogic, CymaBay Therapeutics, NGM Biopharmaceuticals, Prodigy Biotech and Synlogic Operating Company. BS is founder of Nterica Bio. UC San Diego has filed several patents with CLH and BS as inventors related to this work. DLS has consulted for EnteroBiotix and delivered paid lectures for Norgine. J Abraldes received grants from Cook and Gilead (paid to the University of Alberta) and received consulting fees from Boehringer Ingelheim, AstraZeneca, Advanz and 89Bio., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background and Aims: Alcohol-associated hepatitis (AH) is associated with very high mortality despite abstinence from alcohol; up to 40% of patients die within 6 months of diagnosis. Patients with AH are especially prone to infections, which can lead to multiorgan dysfunction and poorer prognosis., Approach and Results: We performed comprehensive serological profiling of the viral and bacterial infection history of 36 healthy controls, 48 patients with alcohol use disorder, and 224 patients with AH from 2 multicenter observational studies. We used systematic viral and bacterial epitope scanning by VirScan, a phage-display immunoprecipitation and sequencing technology that detects the peptides recognized by antibodies in patient sera, to comprehensively analyze antiviral and antibacterial antibodies and identify serologic biomarkers to predict patient outcomes. We found significant differences in the serological profiles of the 3 populations. The number of serum antibody epitopes in patients with alcohol use disorder during abstinence was increased compared with during active alcohol use. A decreased number and diversity of viral and bacterial antibody targets were detected in the sera of patients with AH, particularly those with a higher Child-Pugh score. In patients with AH, a decrease in the serum antiviral, but not antibacterial, antibody repertoire was associated with decompensation and mortality. Ninety-day mortality in AH could be predicted using a serum viral epitope signature., Conclusions: Abstinence from alcohol is associated with a significant increase in serum viral and bacterial antibody response. Decreased serum antiviral antibody repertoire is predictive of decompensation of liver disease and mortality in patients with AH., (Copyright © 2024 American Association for the Study of Liver Diseases.)

Biliary tract complications after orthotopic liver transplantation (OLT) are frequently reported. The diagnosis and management of these complications have become increasingly crucial, with digital single operator cholangioscopy (DSOC) emerging as an essential tool. We describe the approach to biliary complications using DSOC in 5 patients post-OLT. Inflammatory and ischemic stricture, a stricture secondary to post-transplant lymphoproliferative disease, and common bile duct lithiasis were the main findings. The exceptional image quality provided by the DSCO allowed us to precisely characterize strictures, observe epithelial changes, and identify obstructions due to bile casts that remained undetectable through ERCP. DSOC is a viable method for evaluating post-OLT biliary complications, offering alternative therapies beyond ERCP, thus improving care precision and outcomes.

Background and Aims: Patients with alcohol-associated hepatitis (AH) have an altered fecal metabolome, including reduced microbiota-derived tryptophan metabolites, which function as ligands for aryl hydrocarbon receptor (AhR). The aim of this study was to assess serum AhR ligand activity in patients with AH., Approach and Results: The study included 74 controls without AUD, 97 patients with AUD, and 330 patients with AH from 2 different multicenter cohorts (InTeam: 134, AlcHepNet: 196). Serum AhR activity was evaluated using an AhR reporter assay with HepG2-Lucia cells incubated with serum for 24 hours. Serum AhR activity was significantly higher in patients with AH compared with both controls (1.59 vs. 0.96-fold change, p < 0.001) and patients with AUD (1.59 vs. 0.93, p < 0.001). In both AH cohorts, patients with AhR activity ≥ 2.09 had significantly lower cumulative survival rates at 30, 60, 90, and 180 days compared to those with AhR activity < 2.09. When serum AhR activity was used to further stratify patients with severe AH, the cumulative 30, 60, 90, and 180-day survival rates for patients with severe AH and the AhR activity ≥ 2.09 group were all significantly lower than those with an AhR activity < 2.09 group., Conclusions: Serum AhR activity was significantly higher in patients with AH compared with controls and individuals with AUD, and this increased activity was associated with higher mortality. Consequently, serum AhR activity holds potential as a prognostic marker., (Copyright © 2024 American Association for the Study of Liver Diseases.)

Background & Aims: Alcoholic hepatitis (AH) is associated with a high incidence of infection and mortality. Rifaximin reduces bacterial overgrowth and translocation. We aimed to study whether the administration of rifaximin as an adjuvant treatment to corticosteroids decreases the number of bacterial infections at 90 days in patients with severe AH compared to a control cohort., Methods: This was a multicentre, open, comparative pilot study of the addition of rifaximin (1200 mg/day/90 days) to the standard treatment for severe AH. The results were compared with a carefully matched historical cohort of patients treated with standard therapy and matching by age and model of end-stage liver disease (MELD). We evaluated bacterial infections, liver-related complications, mortality and liver function tests after 90 days., Results: Twenty-one and 42 patients were included in the rifaximin and control groups respectively. No significant baseline differences were found between groups. The mean number of infections per patient was 0.29 and 0.62 in the rifaximin and control groups, respectively (p = .049), with a lower incidence of acute-on-chronic liver failure (ACLF) linked to infections within the treatment group. Liver-related complications were lower within the rifaximin group (0.43 vs. 1.26 complications/patient respectively) (p = .01). Mortality was lower in the treated versus the control groups (14.2% vs. 30.9, p = .15) without significant differences. No serious adverse events were associated with rifaximin treatment., Conclusions: Rifaximin is safe in severe AH with a significant reduction in clinical complications. A lower number of infections and a trend towards a lower ACLF and mortality favours its use in these patients., (© 2022 The Authors. Liver International published by John Wiley & Sons Ltd.)

Background and Aims: Alcoholic hepatitis (AH) is a severe condition with poor short-term prognosis. Specific treatment with corticosteroids slightly improves short-term survival but is associated with infection and is not used in many centers. A reliable method to identify patients who will recover spontaneously will minimise the numbers of patients who experience side effects of available treatments., Methods: We analysed the trajectory of serum bilirubin concentration over the course of hospital admissions in patients with AH to predict spontaneous survival and the need for treatment., Results: data from 426 patients were analysed. Based on bilirubin trajectory, patients were categorized into three groups: 'fast fallers' (bilirubin <0.8 x admission value at day 7), 'static' (bilirubin of >0.9 - <1.2 x admission value) and 'rapid risers' (bilirubin of ≥1.2 x admission bilirubin). Fast fallers had significantly better 90-day survival compared to other groups (log rank p < .001), and showed no benefit of corticosteroid therapy (OR for survival at 28 days of treatment, 0.94, 95% CI 0.06 - 8.41). These findings remained even amongst patients with severe disease based on initial DF, GAHS or MELD scores., Conclusions: We present an intuitive method of classifying patients with AH based on the trajectory of bilirubin over the first week of admission. It is complimentary to existing scores that identify candidates for corticosteroid treatment or assess response to treatment. This method identifies a group of patients with AH who recover spontaneously and can avoid corticosteroid therapy., (Copyright © 2022 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Abstract: The aim of the present study was to describe the epidemiological and clinical characteristics of inflammatory bowel disease (IBD), including medical and surgical treatments, in several countries in Latin America and the Caribbean.IBD is recognized as a global health problem because its incidence and prevalence have increased significantly over the last few years.This multicenter retrospective cohort study included 4714 patients with IBD diagnosed from 9 countries in Latin America and the Caribbean: Colombia, Cuba, Dominican Republic, Ecuador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela.Crohn disease (CD) was more frequent in Puerto Rico (71.9%), the Dominican Republic (61.0%), and Peru (53.1%). Ulcerative colitis was more frequent in Colombia (78.6%), Venezuela (78.2%), Mexico (75.5%), Cuba (69.9%), Ecuador (64.1%), and Uruguay (60.9%). The following clinical characteristics were more frequent in the Caribbean: penetrating behavior in CD, steroid dependence, steroid resistance, intolerance to thiopurines, extraintestinal manifestations, surgeries, hospitalizations due to IBD, and family history of IBD. The factors associated with the use of biological therapy were pancolitis in ulcerative colitis, penetrating behavior in CD, steroid resistance and dependence, presence of extraintestinal manifestations, and the need for surgery.This study from Latin America and the Caribbean demonstrated the different epidemiological and clinical characteristics of IBD., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

The 10-item Alcohol Use Disorders Identification Test (AUDIT-10) and its shorter form, AUDIT-Consumption (AUDIT-C), are questionnaires used to characterize severity of drinking. We hypothesized that liver injury and short-term outcomes of alcohol-associated hepatitis (AH) would correlate with a patient's recent alcohol consumption as determined by AUDIT-10 and AUDIT-C. We analyzed a prospective international database of patients with AH diagnosed based on the National Institute on Alcohol Abuse and Alcoholism (NIAAA) standard definitions. All patients were interviewed using AUDIT-10. Primary outcomes included the discriminatory ability of the AUDIT-10 and AUDIT-C scores for predicting survival status at 28 and 90 days and severity of liver injury, as measured by Model for End-Stage Liver Disease-sodium (MELD-Na). The relationship between AUDIT scores and survival status was quantified by calculating the area under the curve of the receiver operating characteristic analysis. The relationship between AUDIT scores and MELD-Na was examined using correlation coefficients. In 245 patients (age range 25-75 years; 35% female), we found no correlation between AUDIT-10 or AUDIT-C scores and either 28- or 90-day mortality. Similarly, there was no correlation between AUDIT-10 and AUDIT-C and MELD-Na scores. There was a strong positive correlation between MELD-Na and 28- and 90-day mortality. Additional measures of severity of alcohol use (average grams of alcohol consumed per day, years of drinking, convictions for driving under the influence, and rehabilitation attempts) and psychosocial factors (marriage, paid employment, and level of social support) had no influence on MELD-Na. In patients presenting with AH, AUDIT-10 and AUDIT-C were predictors of neither clinical severity of liver disease nor short-term mortality, suggesting that level of alcohol consumption in the prior year is not key to the presenting features or outcome of AH., (Copyright © 2021 by the American Association for the Study of Liver Diseases.)

Background and Aims: Alcoholic hepatitis (AH) is a severe manifestation of alcohol-associated liver disease (ALD) with high mortality. Although gut bacteria and fungi modulate disease severity, little is known about the effects of the viral microbiome (virome) in patients with ALD., Approach and Results: We extracted virus-like particles from 89 patients with AH who were enrolled in a multicenter observational study, 36 with alcohol use disorder (AUD), and 17 persons without AUD (controls). Virus-like particles from fecal samples were fractionated using differential filtration techniques, and metagenomic sequencing was performed to characterize intestinal viromes. We observed an increased viral diversity in fecal samples from patients with ALD, with the most significant changes in samples from patients with AH. Escherichia-, Enterobacteria-, and Enterococcus phages were over-represented in fecal samples from patients with AH, along with significant increases in mammalian viruses such as Parvoviridae and Herpesviridae. Antibiotic treatment was associated with higher viral diversity. Specific viral taxa, such as Staphylococcus phages and Herpesviridae, were associated with increased disease severity, indicated by a higher median Model for End-Stage Liver Disease score, and associated with increased 90-day mortality., Conclusions: In conclusion, intestinal viral taxa are altered in fecal samples from patients with AH and associated with disease severity and mortality. Our study describes an intestinal virome signature associated with AH., (© 2020 by the American Association for the Study of Liver Diseases.)

Background and Aims: Pirfenidone (PFD), an oral antifibrotic drug, has been authorized by the EMA and FDA for treatment of idiopathic pulmonary fibrosis. Few studies have addressed its use in advanced liver fibrosis (ALF). We evaluated a prolonged-release formulation (PR-PFD) plus standard of care on disease progression in ALF., Methods: 281 ALF patients from 12 centers receiving PR-PFD (600 mg bid) were screened; 122 completed 1 year of treatment. Additionally, 74 patients received only standard of care regimen. Average age was 64 ± 12 years, 58% female. 43.5% had fatty liver disease (NAFLD), 22.5% viral hepatitis C (VHC), 17% autoimmune hepatitis (AIH), and 17% alcoholic liver disease (ALD). Baseline fibrosis was F4 in 74% and F3 in 26%. Antifibrotic effects were assessed by transient elastography (Fibroscan ® ) and Fibro Test ® (FT); Cytokines and PFD plasma levels were tracked and quality of life evaluated., Results: We found a significant reduction in fibrosis in 35% of PR-PFD patients and only in 4.1% in non PR-PFD patients. Child-Pugh score improved in 29.7%. Biochemical values remained stable; 40.6% and 43.3% decreased ALT or AST, respectively. TGFβ1 (pg/mL) levels were lower in PFD-treated patients. PFD serum concentration (µg/mL) was higher (8.2 ± 1.7) in fibrosis regression profile (FRP) patients compared to fibrosis progression profile (FPP) patients (4.7 ± 0.3 µg/mL, p < 0.01). 12% reported transient burning or nausea and 7% photosensitivity. Quality of life (Euro-Qol scale) improved from 62 ± 5 to 84 ± 3 (p < 0.001) and from 32 ± 3 to 42 ± 2 (p < 0.008) (FACIT scale)., Conclusions: PR-PFD is efficacious and safe in ALF and associated with promising antifibrotic effects., Trial Registration: Clinical trial number: NCT04099407.

Background & Aims: Alcohol-associated liver disease is a leading indication for liver transplantation and a leading cause of mortality. Alterations to the gut microbiota contribute to the pathogenesis of alcohol-associated liver disease. Patients with alcohol-associated liver disease have increased proportions of Candida spp. in the fecal mycobiome, yet little is known about the effect of intestinal Candida on the disease. Herein, we evaluated the contributions of Candida albicans and its exotoxin candidalysin in alcohol-associated liver disease., Methods: C. albicans and the extent of cell elongation 1 (ECE1) were analyzed in fecal samples from controls, patients with alcohol use disorder and those with alcoholic hepatitis. Mice colonized with different and genetically manipulated C. albicans strains were subjected to the chronic-plus-binge ethanol diet model. Primary hepatocytes were isolated and incubated with candidalysin., Results: The percentages of individuals carrying ECE1 were 0%, 4.76% and 30.77% in non-alcoholic controls, patients with alcohol use disorder and patients with alcoholic hepatitis, respectively. Candidalysin exacerbates ethanol-induced liver disease and is associated with increased mortality in mice. Candidalysin enhances ethanol-induced liver disease independently of the β-glucan receptor C-type lectin domain family 7 member A (CLEC7A) on bone marrow-derived cells, and candidalysin does not alter gut barrier function. Candidalysin can damage primary hepatocytes in a dose-dependent manner in vitro and is associated with liver disease severity and mortality in patients with alcoholic hepatitis., Conclusions: Candidalysin is associated with the progression of ethanol-induced liver disease in preclinical models and worse clinical outcomes in patients with alcoholic hepatitis., Lay Summary: Candidalysin is a peptide toxin secreted by the commensal gut fungus Candida albicans. Candidalysin enhances alcohol-associated liver disease independently of the β-glucan receptor CLEC7A on bone marrow-derived cells in mice without affecting intestinal permeability. Candidalysin is cytotoxic to primary hepatocytes, indicating a direct role of candidalysin on ethanol-induced liver disease. Candidalysin might be an effective target for therapy in patients with alcohol-associated liver disease., (Published by Elsevier B.V.)

Background & Aims: The incidence of inflammatory bowel diseases (IBD) is increasing in Latin America. We performed a systematic review to identify clinical and epidemiologic features of IBD in Latin America (including Mexico, Central America, and South America) and the Caribbean., Methods: We searched MEDLINE, EMBASE, and SciELO databases for clinical or epidemiologic studies of Crohn's disease (CD) or ulcerative colitis (UC) from Latin American and Caribbean countries and territories that reported incidence, prevalence, ratio of UC:CD, IBD phenotype, and treatment, through September 12, 2018. Data were extracted from 61 articles for analysis., Results: The incidence and prevalence of IBD have been steadily increasing in Latin America and the Caribbean. The incidence of CD in Brazil increased from 0.08 per 100,000 person-years in 1988 to 0.68 per 100,000 person-years in 1991-1995 to 5.5 per 100,000 person-years in 2015. The highest reported prevalence of IBD was in Argentina, in 2007, at 15 and 82 per 100,000 person-years for CD and UC, respectively. The ratio of UC:CD exceeded 1 in all regions throughout Latin America and the Caribbean with the exception of Brazil. Treatment with tumor necrosis factor antagonists increased steadily for patients with CD (43.4% of all patients in Brazil were treated in 2014) but less so for patients with UC (4.5% of all patients were treated in 2014). Surgery for IBD decreased with time. In Chile, surgeries were performed on 57.0% of patients with CD and 18.0% of patients with UC during the period of 1990-2002; these values decreased to 38.0% and 5.0%, respectively, during the period of 2012-2015. In Peru, 6.9% of patients with UC received colectomies in the period of 2001-2003 and 6.2% in 2004-2014., Conclusions: In a systematic review, we found the incidence of IBD to be increasing throughout Latin America and the Caribbean. Population-based epidemiology studies are needed to evaluate the increase in IBD in these regions, which differ from other global regions in climate, culture, demographics, diet, healthcare delivery and infrastructure, and socioeconomic status., (Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Chronic alcohol consumption causes increased intestinal permeability and changes in the intestinal microbiota composition, which contribute to the development and progression of alcohol-related liver disease. In this setting, little is known about commensal fungi in the gut. We studied the intestinal mycobiota in a cohort of patients with alcoholic hepatitis, patients with alcohol use disorder, and nonalcoholic controls using fungal-specific internal transcribed spacer amplicon sequencing of fecal samples. We further measured serum anti-Saccharomyces cerevisiae antibodies (ASCA) as a systemic immune response to fungal products or fungi. Candida was the most abundant genus in the fecal mycobiota of the two alcohol groups, whereas genus Penicillium dominated the mycobiome of nonalcoholic controls. We observed a lower diversity in the alcohol groups compared with controls. Antibiotic or steroid treatment was not associated with a lower diversity. Patients with alcoholic hepatitis had significantly higher ASCA levels compared to patients with alcohol use disorder and to nonalcoholic controls. Within the alcoholic hepatitis cohort, patients with levels of at least 34 IU/mL had a significantly lower 90-day survival (59%) compared with those with ASCA levels less than 34 IU/mL (80%) with an adjusted hazard ratio of 3.13 (95% CI, 1.11-8.82; P = 0.031). Conclusion: Patients with alcohol-associated liver disease have a lower fungal diversity with an overgrowth of Candida compared with controls. Higher serum ASCA was associated with increased mortality in patients with alcoholic hepatitis. Intestinal fungi may serve as a therapeutic target to improve survival, and ASCA may be useful to predict the outcome in patients with alcoholic hepatitis., (© 2019 by the American Association for the Study of Liver Diseases.)

Chronic liver disease due to alcohol-use disorder contributes markedly to the global burden of disease and mortality 1-3 . Alcoholic hepatitis is a severe and life-threatening form of alcohol-associated liver disease. The gut microbiota promotes ethanol-induced liver disease in mice 4 , but little is known about the microbial factors that are responsible for this process. Here we identify cytolysin-a two-subunit exotoxin that is secreted by Enterococcus faecalis 5,6 -as a cause of hepatocyte death and liver injury. Compared with non-alcoholic individuals or patients with alcohol-use disorder, patients with alcoholic hepatitis have increased faecal numbers of E. faecalis. The presence of cytolysin-positive (cytolytic) E. faecalis correlated with the severity of liver disease and with mortality in patients with alcoholic hepatitis. Using humanized mice that were colonized with bacteria from the faeces of patients with alcoholic hepatitis, we investigated the therapeutic effects of bacteriophages that target cytolytic E. faecalis. We found that these bacteriophages decrease cytolysin in the liver and abolish ethanol-induced liver disease in humanized mice. Our findings link cytolytic E. faecalis with more severe clinical outcomes and increased mortality in patients with alcoholic hepatitis. We show that bacteriophages can specifically target cytolytic E. faecalis, which provides a method for precisely editing the intestinal microbiota. A clinical trial with a larger cohort is required to validate the relevance of our findings in humans, and to test whether this therapeutic approach is effective for patients with alcoholic hepatitis.

Background & Aims: The degree of cholestasis is an important disease driver in alcoholic hepatitis, a severe clinical condition that needs new biomarkers and targeted therapies. We aimed to identify the largely unknown mechanisms and biomarkers linked to cholestasis in alcoholic hepatitis., Methods: Herein, we analyzed a well characterized cohort of patients with alcoholic hepatitis and correlated clinical and histological parameters and outcomes with serum bile acids and fibroblast growth factor 19 (FGF19), a major regulator of bile acid synthesis., Results: We found that total and conjugated bile acids were significantly increased in patients with alcoholic hepatitis compared with controls. Serum FGF19 levels were strongly increased and gene expression of FGF19 was induced in biliary epithelial cells and ductular cells of patients with alcoholic hepatitis. De novo bile acid synthesis (CYP7A1 gene expression and C4 serum levels) was significantly decreased in patients with alcoholic hepatitis. Importantly, total and conjugated bile acids correlated positively with FGF19 and with disease severity (model for end-stage liver disease score). FGF19 correlated best with conjugated cholic acid, and model for end-stage liver disease score best with taurine-conjugated chenodeoxycholic acid. Univariate analysis demonstrated significant associations between FGF19 and bilirubin as well as gamma glutamyl transferase, and negative correlations between FGF19 and fibrosis stage as well as polymorphonuclear leukocyte infiltration, in all patients with alcoholic hepatitis., Conclusion: Serum FGF19 and bile acids are significantly increased in patients with alcoholic hepatitis, while de novo bile acid synthesis is suppressed. Modulation of bile acid metabolism or signaling could represent a promising target for treatment of alcoholic hepatitis in humans., Lay Summary: Understanding the underlying mechanisms that drive alcoholic hepatitis is important for the development of new biomarkers and targeted therapies. Herein, we describe a molecule that is increased in patients with alcoholic hepatitis. Modulating the molecular pathway of this molecule might lead to promising targets for the treatment of alcoholic hepatitis., (Published by Elsevier B.V.)