Health care costs of complex perianal fistula in Crohn's disease

AIM

To evaluate the use of health care resources and the associated costs of complex perianal Crohn's disease (CD) from the National Health System perspective.

METHODS

We conducted a multicenter, retrospective, observational study in which gastroenterologists from 11 hospitals in the Community of Madrid took part. Data was collected on the direct healthcare resources (pharmacological treatments, surgical procedures, laboratory/diagnostic tests, visits to specialists and emergency departments, and hospitalizations) consumed by 97 adult patients with complex perianal CD which was active at some point between January 1, 2005, and case history review.

RESULTS

We recorded 527 treatments: 73.1% pharmacological (32.3% antibiotic, 20.5% immunomodulator, 20.3% biological) and 26.9% surgical. Mean annual global cost was €8,289/patient, 75.3% (€6,242) of which was accounted for by pharmacological treatments (€13.44 antibiotics; €1,136 immunomodulators; €5,093 biological agents), 12.4% (€1,027) by hospitalizations and surgery, 7.7% (€640) by medical visits, 4.2% (€350) by laboratory/diagnostic tests, and 0.4% (€30) by emergency department visits.

CONCLUSIONS

Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.

[Celiac disease and Bud-Chiari syndrome: an uncommon association]

Celiac disease can present great clinical heterogeneity. Its association with a series of intestinal and non-intestinal diseases, whether immunologically mediated or otherwise, presents a higher than normal frequency. We present a patient with celiac disease and Budd-Chiari syndrome of unknown cause. This association has previously been described only in isolated cases in northern Africa. The appearance of this case in Spain reveals that the coexistence of both processes in a single patient is unlikely to be due to environmental or geographical factors.

Romantic beliefs and myths in Spain

Data from a representative sample of the Spanish population (1,949 participants between ages 18 and 65) were analyzed to examine the strength of the principal romantic myths and the link between sex, love, and marriage in Spain. A survey was made up and was administered by interviewers. The results show the strength of these myths and the relationship between the three above-mentioned variables. Women, people with fewer years of formal education, and older people were more likely to believe in the myths and the relation between sex, love, and marriage was stronger in these groups. The findings are discussed in terms of different psychosocial theories.

[Eosinophilic cholecystitis: an infrequent cause of cholecystectomy]

Eosinophilic cholecystitis is a rare form of cholecystitis. Histologically, it is characterized by a dense, transmural leukocyte infiltrate composed of more than 90% eosinophils. The etiology remains obscure, although it had been associated with allergies, parasites, hypereosinophilic syndromes, eosinophilic gastroenteritis, cholelithiasis, and acalculous cholecystitis. Here we report an eosinophilic cholecystitis gallstone-associated case, the only one with this histopathologic diagnosis among 5,537 cholecystectomies made in our hospital in the last years.

[Direct percutaneous endoscopic jejunostomy, variation of the technique of gastrostomy]

Percutaneous endoscopic gastrojejunostomy is a percutaneous endoscopic gastrostomy derived technique, that is widely employed. However it has a high incidence of mechanic complications. Percutaneous endoscopic jejunostomy direct access, improves these problems and allows to apply this technique in patients with previous gastric resection or with other gastric diseases that contraindicate percutaneous endoscopic gastrostomy. We describe, for the first time in our country, a direct percutaneous endoscopic jejunostomy placement.