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Bastón-Rey I, Rodríguez-Lago I, Luque AM, Caballol B, Soutullo-Castiñeiras C, Bravo A, Castaño A, Gros B, Bernal L, Diz-Lois MT, Alonso-Galán H, Cañete F, Castro B, Pérez-Galindo P, González-Muñoza C, El Hajra I, Martínez-Montiel P, Alonso-Abreu I, Mesonero F, González-Vivo M, Peries L, Martín-Arranz E, Abril C, Marín-Jiménez I, Baltar R, Vicuña M, Moreno N, Brunet E, Rubín de Célix C, Fajardo I, Cruz N, Calvino-Suárez C, Rojas-Feria M, Fernández-Clotet A, Gimeno-Torres M, Nieto-Garcia L, de la Iglesia D, Zabana Y, Suárez-Ferrer C, Barreiro de Acosta M. The Natural History of Patients With Pre-Existing and De Novo Inflammatory Bowel Disease After Solid Organ Transplantation: EITOS Study of GETECCU. Inflamm Bowel Dis 2024:izae041. [PMID: 38518109 DOI: 10.1093/ibd/izae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Limited data are available on the outcome of inflammatory bowel disease (IBD) in patients with solid organ transplantation (SOT). We describe the natural history of pre-existing IBD and de novo IBD after SOT. METHODS This was a retrospective, multicenter study that included patients with pre-existing IBD at the time of SOT and patients with de novo IBD after SOT. The primary outcome was IBD progression, defined by escalation of medical treatment, surgical therapy, or hospitalization due to refractory IBD. Risk factors were identified using multivariate Cox proportional hazard analysis. RESULTS A total of 177 patients (106 pre-existing IBD and 71 de novo IBD) were included. Most patients with pre-existing IBD (92.5%) were in remission before SOT. During follow-up, 32% of patients with pre-existing IBD had disease progression, with a median time between SOT and IBD progression of 2.2 (interquartile range, 1.3-4.6) years. In the de novo cohort, 55% of patients had disease progression with a median time to flare of 1.9 (interquartile range, 0.8-3.9) years after diagnosis. In the pre-existing IBD cohort, active IBD at the time of SOT (hazard ratio, 1.80; 95% confidence interval, 1.14-2.84; P = .012) and the presence of extraintestinal manifestations (hazard ratio, 3.10; 95% confidence interval, 1.47-6.54; P = .003) were predictive factors for IBD progression. CONCLUSIONS One-third of patients with pre-existing IBD and about half of patients with de novo IBD have disease progression after SOT. Active IBD at the time of SOT and the presence of extraintestinal manifestations were identified as risk factors for IBD progression.
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Affiliation(s)
- Iria Bastón-Rey
- Gastroenterology Department, Complexo Hospitalario Universitario de Santiago de Compostela and Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
| | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao and Biocruces Bizkaia Health Research Institute, Galdakao, Spain
| | - Ana María Luque
- Gastroenterology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Berta Caballol
- Gastroenterology Department, Hospital Clínic i Provincial, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | | | - Ana Bravo
- Gastroenterology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Andrés Castaño
- Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Beatriz Gros
- Gastroenterology Department, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, Córdoba, Spain
| | - Lorena Bernal
- Gastroenterology Department, Hospital General de Alicante and Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL, Alicante, Spain
| | - María Teresa Diz-Lois
- Gastroenterology Department, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Horacio Alonso-Galán
- Gastroenterology Department, Hospital Universitario Donostia and Biodonostia Health Research Institute, San Sebastián- Gipuzkoa, Spain
| | - Fiorella Cañete
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Beatriz Castro
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Pablo Pérez-Galindo
- Gastroenterology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Ismael El Hajra
- Gastroenterology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | - Francisco Mesonero
- Gastroenterology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Laia Peries
- Gastroenterology Department, Hospital Josep Trueta, Girona, Spain
| | | | - Carlos Abril
- Gastroenterology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ignacio Marín-Jiménez
- Gastroenterology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ruth Baltar
- Gastroenterology Department, Hospital Universitario de Álava, Vitoria, Spain
| | - Miren Vicuña
- Gastroenterology Department, Hospital Universitario de Navarra, Navarra, Spain
| | - Nadia Moreno
- Gastroenterology Department, Hospital Doctor Peset, Valencia, Spain
| | - Eduard Brunet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Gastroenterology Department, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Cristina Rubín de Célix
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa and Universidad Autónoma de Madrid, Madrid, Spain
| | - Ingrid Fajardo
- Gastroenterology Department, Hospital Universitari Mútua Terrasa, Barcelona, Spain
| | - Noelia Cruz
- Gastroenterology Department, Lanzarote, Spain
| | - Cristina Calvino-Suárez
- Gastroenterology Department, Complexo Hospitalario Universitario de Santiago de Compostela and Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
| | - María Rojas-Feria
- Gastroenterology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Agnes Fernández-Clotet
- Gastroenterology Department, Hospital Clínic i Provincial, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Marta Gimeno-Torres
- Gastroenterology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Laura Nieto-Garcia
- Gastroenterology Department, Complexo Hospitalario Universitario de Santiago de Compostela and Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
| | - Daniel de la Iglesia
- Gastroenterology Department, Complexo Hospitalario Universitario de Santiago de Compostela and Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
- Gastroenterology Department, Hospital Universitari Mútua Terrasa, Barcelona, Spain
| | | | - Manuel Barreiro de Acosta
- Gastroenterology Department, Complexo Hospitalario Universitario de Santiago de Compostela and Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
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Uribarri-Gonzalez L, Nieto-Garcia L, Martis-Sueiro A, Dominguez-Muñoz JE. Impact of gastrointestinal symptoms and psychological disturbances on patients' quality of life after restrictive or malabsorptive bariatric surgery. Gastroenterol Hepatol 2023; 46:92-101. [PMID: 35292333 DOI: 10.1016/j.gastrohep.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to evaluate and compare the presence and impact of Gastrointestinal (GI) symptoms, physical and psychological disturbances on patients' QoL after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS). METHODS A prospective, observational, cross-sectional, comparative study was carried-out. GI symptoms and patients' QoL were evaluated by the SF-36 questionnaire and the GI quality of life index (GIQLI). Correlation between GI symptoms, psychological disturbances and QoL scores was analysed. RESULTS 95 patients were included (mean age 50.5 years, range 22-70; 76 females). Presence of GI symptoms was a consistent finding in all patients, and postprandial fullness, abdominal distention and flatulence had a negative impact on patients' QoL. Patients after SG showed a worsening of their initial psychological condition and the lowest QoL scores. Patients after RYGB showed the best GI symptoms-related QoL. CONCLUSIONS Both restrictive and malabsorptive bariatric surgical procedures are associated with GI symptoms negatively affecting patients' QoL. Compared to SG and BPD/DS, patients after RYGB showed the best GI symptoms-related QoL, which can be used as additional information to help in the clinical decision making of the bariatric procedure to be performed.
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Affiliation(s)
| | | | | | - J Enrique Dominguez-Muñoz
- Department of Gastroenterology, University Hospital of Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Spain
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Domínguez-Muñoz JE, Nieto-Garcia L, López-Díaz J, Lariño-Noia J, Abdulkader I, Iglesias-Garcia J. Impact of the treatment of pancreatic exocrine insufficiency on survival of patients with unresectable pancreatic cancer: a retrospective analysis. BMC Cancer 2018; 18:534. [PMID: 29728096 PMCID: PMC5935964 DOI: 10.1186/s12885-018-4439-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/26/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malnutrition and weight loss are commonly observed in patients with pancreatic cancer and contribute to poor survival. Pancreatic exocrine insufficiency (PEI), which can be caused by ductal obstruction by a tumor, causes maldigestion and malabsorption of nutrients, thus contributing to malnutrition in these patients. In this study, we evaluated the effects of pancreatic enzyme replacement therapy (PERT) on survival in patients with unresectable pancreatic cancer. METHODS A retrospective analysis was conducted on a database of patients with unresectable, pathologically confirmed pancreatic cancer. All patients were evaluated for palliative chemotherapy and received the optimal palliative care. Patients were divided into two groups: Group 1 received standard therapy; Group 2 underwent additional evaluation of the pancreatic function and therapy with PERT, if needed. Survival (median and 95% confidence interval [CI]) was analyzed using Kaplan-Meier and Cox regression; groups were compared using the log-rank test. RESULTS Overall, 160 patients with unresectable pancreatic cancer were included in the analysis (mean age: 70.5 years [range 28-100]; gender: 57.5% male; tumor stage: 78.7% Stage IV). Eighty-six patients (53.75%) were in Group 1 and 74 (46.25%) were in Group 2. Age, gender, tumor size, location and stage, weight loss, and serum CA 19-9 were similar between groups. Ninety-three (58.1%) patients received palliative chemotherapy; 46.5% in Group 1 and 71.6% in Group 2 (P < 0.001). Forty-nine (66.2%) patients in Group 2 and none in Group 1 received PERT. Survival in Group 2 (189 days, 95% CI 167.0-211.0 days) was significantly longer than in Group 1 (95.0 days, 95% CI 75.4-114.6 days) (HR 2.117, 95% CI 1.493-3.002; P < 0.001). Chemotherapy and PERT were significantly and independently associated with longer survival in a model controlled by age and tumor stage. In patients with significant weight loss at diagnosis (> 10% bodyweight within 6 months), PERT was associated with longer survival (HR 2.52, 95% CI 1.55-4.11; P < 0.001). CONCLUSIONS In patients with unresectable pancreatic cancer, PERT in patients with PEI was associated with longer survival compared with those not receiving PERT, especially in those experiencing significant weight loss. This finding should guide future prospective clinical trials of similar interventions.
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Affiliation(s)
- Juan Enrique Domínguez-Muñoz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
- Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Laura Nieto-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
- Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Javier López-Díaz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
- Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Jose Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
- Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Ihab Abdulkader
- Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
- Department of Pathology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
- Health Research Institute (IDIS), University Hospital of Santiago de Compostela, C/ Choupana s/n, 15706 Santiago de Compostela, Spain
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Lindkvist B, Domínguez-Muñoz JE, Luaces-Regueira M, Castiñeiras-Alvariño M, Nieto-Garcia L, Iglesias-Garcia J. Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreatology 2012; 12:305-10. [PMID: 22898630 DOI: 10.1016/j.pan.2012.04.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/25/2012] [Accepted: 04/26/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Methods for evaluation of pancreatic exocrine insufficiency (PEI) are expensive, labor intensive, and not available at many institutions. The aim of this study was to investigate if PEI in chronic pancreatitis (CP) can by predicted by nutritional markers in blood. METHODS A retrospective analysis of a prospectively collected database of CP patients was performed. Diagnosis of CP was based on endoscopic ultrasonography or magnetic resonance imaging. PEI was investigated by the (13)C-mixed triglyceride breath test. Hemoglobin, mean corpuscular volume, lymphocytes, prothrombin time, and serum levels of total protein, albumin, prealbumin, retinol binding protein, cholesterol, triglycerides, amylase, folic acid, vitamin B12, HbA1C, transferrin, ferritin, magnesium and zinc were analyzed. RESULTS 114 patients were included in the study (97 males, mean age 48.1 years, 54 with alcohol etiology), 38 (33%) suffered from PEI. Magnesium below 2.05 mg/dL, hemoglobin, albumin, prealbumin and retinol binding protein below lower limit of normal and HbA1C above upper limit of normal were associated with PEI in univariate analysis. Magnesium below 2.05 mg/dL detected PEI with a sensitivity, specificity and positive and negative predictive values of 0.88 (95% confidence interval, 0.66-0.97), 0.66 (0.48-0.80), 0.58 (0.39-0.75) and 0.91 (0.73-0.98), respectively. The corresponding values were 1.00 (0.80-1.00), 0.55 (0.38-0.71), 0.52 (0.34-0.69) and 1.00 (0.82-1.00)) if one or more pathological tests among parameters significantly associated with PEI in was used as a positive test for PEI. CONCLUSION Serum nutritional markers can be used to predict the probability of PEI in CP and provide guidance in decisions on enzyme replacement therapy.
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Affiliation(s)
- Björn Lindkvist
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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