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Papers by Alfredo J Lucendo
by Joaquín Rodríguez-Sánchez, Alfredo J Lucendo, Javier Infante, Ulrike Von Arnim, Jorge Amil, Helen Larsson, Stephan Miehlke, Jukka Ronkainen, Cecilio Santander, Alain Schoepfer, and Alex Straumann
Introduction: Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and... more Introduction: Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. This underlines the importance of optimizing diagnosys and treatment of the condition, especially after the increasing amount of knowledge on EoE recently published. Therefore, the UEG, EAACI ESPGHAN, and EUREOS deemed it necessary to update the current guidelines regarding conceptual and epidemiological aspects, diagnosis, and treatment of EoE. Methods: General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted up to August 2015 and periodically updated. The working group consisted of gastroenterologists, allergists, pediatricians, otolaryngologists, pathologists, and epidemiologists. Systematic evidence-based reviews were performed based upon relevant clinical questions with respect to patient-important outcomes.
Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral... more Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiological, epidemiological and therapeutic aspects. Studies examining the most relevant information concerning the prevalence, etiological factors, diagnostic and therapeutic aspects involved in HO were identified by a systematic literature search of the PubMed database. HO generically defines overall alterations in bone mineral density (BMD) (osteoporosis or osteopenia) which appear as a possible complication of chronic liver disease. The origin of HO is multifactorial and its etiology and severity vary in accordance with the underlying liver disease. Its exact prevalence is unknown, but different studies estimate that it could affect from 20% to 50% of patients. The reported mean prevalence of osteoporosis ranges from 13%-60% in chronic cholestasis to 20% in chronic viral hepatitis and 55% in viral cirrhosis. Alcoholic liver disease is not always related to osteopenia. HO has been commonly studied in chronic cholestatic disease (primary biliary cirrhosis and primary sclerosing cholangitis). Several risk factors and pathogenic mechanisms have been associated with the loss of BMD in patients with chronic liver disease. However, little information has been discovered in relationship to most of these mechanisms. Screening for osteopenia and osteoporosis is recommended in advanced chronic liver disease. There is a lack of randomized studies assessing specific management for HO.
Gastroenterology, 2009
or "colon". The final selection of cases was made upon verifying individual medical records from ... more or "colon". The final selection of cases was made upon verifying individual medical records from all cooperative hospitals. In addition, data on IBD characteristics, -outcome, medication and lymphoma were collected in CRFs. If possible, pathology specimens were tested for EBV. The Dutch, age-adjusted incidence of malignant lymphoma was retrieved from the Central Bureau of Statistics of the Netherlands (2004). The total number of IBD cases was determined per participating hospital. Results: The database search identified 259 cases with both IBD and malignant lymphoma in a total estimated cohort of 16945 IBD cases. Only 186 case histories were available for full analysis, a total of 35 lymphomas were identified, 151 cases were excluded because of lacking the objective diagnosis of IBD or lymphoma. The expected and age-adjusted lymphoma incidence was 6.28, with an observed incidence of 35, the relative risk for lymphoma was 5.57. Of the 35 cases, 17 patients were exposed to AZA/6MP (min 3 months -max 12 yrs) and 18 cases never used AZA/6MP. Remarkably, 10/13 (77%) lymphoma tissue specimens of IBD patients using AZA/6MP tested positive for EBV versus only 1/17 (6%) EBV+ in patients with no AZA/6MP use. Also, all EBV positive lymphoma's were diffuse large B cell lymphoma's whereas EBV negative tumors were lymphoma's of different origin. Infliximab was not used in any of the studied cases. Conclusion: This retrospective nationwide cohort study suggests an increased risk for malignant lymphoma in IBD patients. In IBD patients using AZA/6MP there seems to be a strong correlation with the development of EBV-positive diffuse large B cell lymphoma's.
Gastroenterology, 2009
Introduction: Refractory GERD describes those patients who continue to have symptoms despite trea... more Introduction: Refractory GERD describes those patients who continue to have symptoms despite treatment with proton-pump inhibitors (PPI)1. The participation of eosinophilic esophagitis (EE) in the refractory GERD has been scarcely studied. When both disorders are simultaneously present, the clinical, endoscopic and histologic findings may be nonspecific and as such the overlap of refractory GERD and EE has been matter of debate. Aim: To study the occurrence of EE in patients with refractory GERD. Methods: Upper digestive endoscopies (UDE) were performed, obtaining mucosal biopsies of distal, middle and lower esophagus and stomach (body and antrum) in 97 adult consecutive patients. Erosive esophagitis was classified according to Los Angeles classification. Seventy three (75.3%) were female, with mean age of 44,4 (+ 9.09) of years. Eighty seven patients (89.6%) were submitted to esophageal manometry and pHmetry. The patients (82, 84%) have been receiving high doses of PPI (40 mg omeprazol b.i.d.) for at least 6 weeks. The main complaint was heartburn and regurgitation. The diagnosis of GERD was based on UDE and pHmetry. The diagnosis of EE was based on the presence of ≥20 eosinophils per high power field (eo/hpf) in the esophageal biopsies. Results: UDE was normal in 78 patients (81%). Erosive esophagitis (grade A in 9, B in 2 and C in 2 of LA) was found in 13 (13%) patients. All the others 6 (6%) were classified as non-erosive esophagitis (NERD). One patient ( 1 %) presented > 20 eo/hpf. In 25 (27.8%) patients the pHmetry was altered during PPI treatment (80 mg/day). The manometry showed hypomotility before the treatment for EE and, inespecific motor disturbances after the decreasing of eosinophils post the appropriate treatment. Conclusions: There was a very low prevalence of EE in patients with refractory GERD.
Background and aim A growing incidence of inflammatory bowel disease (IBD) has been reported rece... more Background and aim A growing incidence of inflammatory
bowel disease (IBD) has been reported recently in southern
Europe, with records of pediatric cases confirming these
tendencies in Spain. Data on adult populations, however,
have not been provided for over 10 years and need to be
updated.
Patients and methods A multicenter retrospective registry
of all adult patients with a diagnosis of IBD, including both
Crohn’s disease (CD) and ulcerative colitis (UC), attending
five public hospitals covering a population of 514 368
inhabitants, was assessed.
Results In 2012, the prevalence of CD and UC in adults was
137.17/100 000 inhabitants (95% confidence interval
114–160) and 99.84/100 000 inhabitants (95% confidence
interval 79–119), respectively. The mean incidence rate
during the period 2000–2012 of CD and UC was 8.9 and
5.6/100 000 inhabitants per year, respectively. Most of our
patients (75.55%) had been diagnosed during the last
13 years. CD affected both sexes equally; a trend toward a
progressive increase in the age at diagnosis, ileal location,
and inflammatory behavior was documented for CD
patients. In contrast, UC affected male patients with a
higher frequency (57.8%; P=0.015), specifically those older
than 40 years of age. Age at UC onset tended to increase
progressively from 2000 to 2012 (P<0.001), but the
extension on the disease remained unchanged.
Conclusion IBD is a highly prevalent disorder in our region,
reaching the incidence of CD similar to the figures provided
for Northern Europe. Changes in IBD localization, behavior,
and age at diagnosis were documented during the period
2000–2012.
Revista española de enfermedades digestivas : organo oficial de la Sociedad Española de Patología Digestiva, 2014
No nation-wide epidemiological study on the incidence and prevalence of chronic pancreatitis (CP)... more No nation-wide epidemiological study on the incidence and prevalence of chronic pancreatitis (CP) had been thus far carried out in Spain. Our goal is to estimate the prevalence and incidence of CP, as well as to determine the diagnostic and therapeutic criteria used in Spanish pancreas units. An observarional, descriptive study of hospital pancreas units in Spain. CP-related epidemiology, etiology, manifestations, diagnostic tests, functional complications, and treatments were all assessed using a structured questionnaire. Overall results were estimated by weighting cases in each site. Information was collected from six pancreas units with a sample frame of 1,900,751 inhabitants. Overall prevalence was 49.3 cases per 105 population (95 % CI, 46 to 52) and incidence was 5.5 cases per 105 inhabitant-years (95 % CI, 5.4 to 5.6). Most common etiologies included tobacco and alcoholism, which were associated with three in every four cases. The most prevalent symptoms were recurring pain (...
International Clinical Psychopharmacology, 2011
Endoscopy, 2007
Eosinophilic esophagitis can be associated with a wide range of endoscopic patterns. The aim of t... more Eosinophilic esophagitis can be associated with a wide range of endoscopic patterns. The aim of the present case series report is to describe and classify endoscopic appearances before and after corticoid therapy in relation to histopathology and manometry. In 30 patients (m : f, 27 : 3; mean age 36.2 years) with eosinophilic esophagitis, endoscopic findings were prospectively classified according to luminal diameter and mucosal pattern. Manometric and bioptic histopathologic findings were also recorded. Endoscopy was repeated following a 3-month course of steroid therapy. In total, 20 % of patients showed a concentric esophageal stricture, and in 57 % simultaneous contraction rings were visible. Mucosal alterations consisted of granular mucosa (20 %), longitudinal furrows (33 %) and transversal undulations (3 %). Lower esophageal sphincter dysfunction and distal esophageal dysfunctional manometry were seen in 73 % and 57 % of cases, respectively. Following steroids, the esophagus showed a normal caliber in 97 % of patients, and 63 % of patients had normal mucosa. The most frequent findings were narrowing of the esophageal lumen, which returned to normal following steroid treatment to a larger extent than mucosal alterations.
Gastroenterología y Hepatología, 2009
ABSTRACT Introducción El tratamiento precoz con inmunomoduladores podría modificar la historia na... more ABSTRACT Introducción El tratamiento precoz con inmunomoduladores podría modificar la historia natural de la enfermedad de Crohn (EC). Es importante definir el subgrupo de pacientes con una enfermedad más agresiva. Un estudio publicado en una cohorte francesa se ha realizado con este objetivo (Beaugerie L. Gastroenterology 2006;130(3):650–6). Objetivo Validar los marcadores predictivos identificados en la serie francesa en una cohorte española y valorar un mayor número de variables asociadas con el desarrollo de enfermedad de EC grave con un seguimiento mayor. Métodos Se incluyeron pacientes con EC y un seguimiento mínimo de 5 años. Se excluyeron aquellos pacientes tratados con inmunomoduladores o que requirieron cirugía en el mes inmediato al diagnóstico. Se definió EC grave según los criterios previamente propuestos: más de dos tantas de esteroides, desarrollo de corticodependencia, hospitalizaciones tras el diagnóstico por brote o complicaciones de la enfermedad, necesidad de tratamiento con inmunomoduladores, necesidad de resección intestinal o de cirugía de enfermedad perianal (EPA). Resultados Se incluyeron 511 pacientes, media de edad 29,6 (DE 11,6) años, mediana de seguimiento 109 meses, rango 60–438. El porcentaje de EC grave en los cinco años siguientes al diagnóstico fue de 70,2%. La edad menor de 40 años al diagnóstico (OR: 1,95 (95% CI: 1,1–3,42)), la necesidad de esteroides para tratar el primer brote (OR: 1,6 (95% CI: 1,05–2,3)), la localización íleo-cólica (OR: 1,84 (95% CI: 1,1–2,9)), y la presencia de EPA al diagnóstico (OR: 1,8 (95% CI: 1,01–3,5)) se confirmaron como marcadores predictivos independientes de desarrollar EC grave en los 5 años tras el diagnóstico. El valor predictivo positivo (VPP) fue de 0,82 y 0,89 respectivamente en los pacientes que tenían 3 o 4 factores de riesgo. Durante toda la evolución de la enfermedad el porcentaje de pacientes con EC grave fue de 84,5%. Por regresión logística se identificaron 6 factores independientes predictivos de EC grave: patrón estenosante o fistulizante al diagnóstico (OR: 2,3 (95% CI: 1,2–4,2)), fumador activo (OR: 1,7 (95% CI: 1,1–2,9)), edad menor de 40 años (OR: 2,3 (95% CI: 1,2–4,2)), la necesidad de esteroides para tratar el primer brote (OR: 1,8 (95% CI: 1,1–2,9)), la localización íleo-cólica (OR: 2,3 (95% CI: 1,2–4,3)), y EPA en el momento del diagnóstico (OR: 5,8 (95% CI: 1,8–19.2)). El VPP de estos factores fue de 0,91 en aquellos pacientes que tenían 4 factores, todos los que presentaban 5 ó 6 en el momento del diagnóstico desarrollaron una EC grave. Conclusiones Se confirman y se validan en población española la edad menor de 40 años, la presencia de EPA al diagnóstico y la necesidad de esteroides para el tratamiento inicial de la enfermedad como predictivos de desarrollo de EC grave. Este subgrupo de pacientes es subsidiario de ser tratado de una manera más agresiva. El resto de factores identificados necesitan ser corroborados por otros estudios. Enfermedad celíaca
by Joaquín Rodríguez-Sánchez, Alfredo J Lucendo, Javier Infante, Ulrike Von Arnim, Jorge Amil, Helen Larsson, Stephan Miehlke, Jukka Ronkainen, Cecilio Santander, Alain Schoepfer, and Alex Straumann
Introduction: Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and... more Introduction: Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. This underlines the importance of optimizing diagnosys and treatment of the condition, especially after the increasing amount of knowledge on EoE recently published. Therefore, the UEG, EAACI ESPGHAN, and EUREOS deemed it necessary to update the current guidelines regarding conceptual and epidemiological aspects, diagnosis, and treatment of EoE. Methods: General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted up to August 2015 and periodically updated. The working group consisted of gastroenterologists, allergists, pediatricians, otolaryngologists, pathologists, and epidemiologists. Systematic evidence-based reviews were performed based upon relevant clinical questions with respect to patient-important outcomes.
Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral... more Hepatic osteodystrophy (HO) is the generic term defining the group of alterations in bone mineral metabolism found in patients with chronic liver disease. This paper is a global review of HO and its main pathophysiological, epidemiological and therapeutic aspects. Studies examining the most relevant information concerning the prevalence, etiological factors, diagnostic and therapeutic aspects involved in HO were identified by a systematic literature search of the PubMed database. HO generically defines overall alterations in bone mineral density (BMD) (osteoporosis or osteopenia) which appear as a possible complication of chronic liver disease. The origin of HO is multifactorial and its etiology and severity vary in accordance with the underlying liver disease. Its exact prevalence is unknown, but different studies estimate that it could affect from 20% to 50% of patients. The reported mean prevalence of osteoporosis ranges from 13%-60% in chronic cholestasis to 20% in chronic viral hepatitis and 55% in viral cirrhosis. Alcoholic liver disease is not always related to osteopenia. HO has been commonly studied in chronic cholestatic disease (primary biliary cirrhosis and primary sclerosing cholangitis). Several risk factors and pathogenic mechanisms have been associated with the loss of BMD in patients with chronic liver disease. However, little information has been discovered in relationship to most of these mechanisms. Screening for osteopenia and osteoporosis is recommended in advanced chronic liver disease. There is a lack of randomized studies assessing specific management for HO.
Gastroenterology, 2009
or "colon". The final selection of cases was made upon verifying individual medical records from ... more or "colon". The final selection of cases was made upon verifying individual medical records from all cooperative hospitals. In addition, data on IBD characteristics, -outcome, medication and lymphoma were collected in CRFs. If possible, pathology specimens were tested for EBV. The Dutch, age-adjusted incidence of malignant lymphoma was retrieved from the Central Bureau of Statistics of the Netherlands (2004). The total number of IBD cases was determined per participating hospital. Results: The database search identified 259 cases with both IBD and malignant lymphoma in a total estimated cohort of 16945 IBD cases. Only 186 case histories were available for full analysis, a total of 35 lymphomas were identified, 151 cases were excluded because of lacking the objective diagnosis of IBD or lymphoma. The expected and age-adjusted lymphoma incidence was 6.28, with an observed incidence of 35, the relative risk for lymphoma was 5.57. Of the 35 cases, 17 patients were exposed to AZA/6MP (min 3 months -max 12 yrs) and 18 cases never used AZA/6MP. Remarkably, 10/13 (77%) lymphoma tissue specimens of IBD patients using AZA/6MP tested positive for EBV versus only 1/17 (6%) EBV+ in patients with no AZA/6MP use. Also, all EBV positive lymphoma's were diffuse large B cell lymphoma's whereas EBV negative tumors were lymphoma's of different origin. Infliximab was not used in any of the studied cases. Conclusion: This retrospective nationwide cohort study suggests an increased risk for malignant lymphoma in IBD patients. In IBD patients using AZA/6MP there seems to be a strong correlation with the development of EBV-positive diffuse large B cell lymphoma's.
Gastroenterology, 2009
Introduction: Refractory GERD describes those patients who continue to have symptoms despite trea... more Introduction: Refractory GERD describes those patients who continue to have symptoms despite treatment with proton-pump inhibitors (PPI)1. The participation of eosinophilic esophagitis (EE) in the refractory GERD has been scarcely studied. When both disorders are simultaneously present, the clinical, endoscopic and histologic findings may be nonspecific and as such the overlap of refractory GERD and EE has been matter of debate. Aim: To study the occurrence of EE in patients with refractory GERD. Methods: Upper digestive endoscopies (UDE) were performed, obtaining mucosal biopsies of distal, middle and lower esophagus and stomach (body and antrum) in 97 adult consecutive patients. Erosive esophagitis was classified according to Los Angeles classification. Seventy three (75.3%) were female, with mean age of 44,4 (+ 9.09) of years. Eighty seven patients (89.6%) were submitted to esophageal manometry and pHmetry. The patients (82, 84%) have been receiving high doses of PPI (40 mg omeprazol b.i.d.) for at least 6 weeks. The main complaint was heartburn and regurgitation. The diagnosis of GERD was based on UDE and pHmetry. The diagnosis of EE was based on the presence of ≥20 eosinophils per high power field (eo/hpf) in the esophageal biopsies. Results: UDE was normal in 78 patients (81%). Erosive esophagitis (grade A in 9, B in 2 and C in 2 of LA) was found in 13 (13%) patients. All the others 6 (6%) were classified as non-erosive esophagitis (NERD). One patient ( 1 %) presented > 20 eo/hpf. In 25 (27.8%) patients the pHmetry was altered during PPI treatment (80 mg/day). The manometry showed hypomotility before the treatment for EE and, inespecific motor disturbances after the decreasing of eosinophils post the appropriate treatment. Conclusions: There was a very low prevalence of EE in patients with refractory GERD.
Background and aim A growing incidence of inflammatory bowel disease (IBD) has been reported rece... more Background and aim A growing incidence of inflammatory
bowel disease (IBD) has been reported recently in southern
Europe, with records of pediatric cases confirming these
tendencies in Spain. Data on adult populations, however,
have not been provided for over 10 years and need to be
updated.
Patients and methods A multicenter retrospective registry
of all adult patients with a diagnosis of IBD, including both
Crohn’s disease (CD) and ulcerative colitis (UC), attending
five public hospitals covering a population of 514 368
inhabitants, was assessed.
Results In 2012, the prevalence of CD and UC in adults was
137.17/100 000 inhabitants (95% confidence interval
114–160) and 99.84/100 000 inhabitants (95% confidence
interval 79–119), respectively. The mean incidence rate
during the period 2000–2012 of CD and UC was 8.9 and
5.6/100 000 inhabitants per year, respectively. Most of our
patients (75.55%) had been diagnosed during the last
13 years. CD affected both sexes equally; a trend toward a
progressive increase in the age at diagnosis, ileal location,
and inflammatory behavior was documented for CD
patients. In contrast, UC affected male patients with a
higher frequency (57.8%; P=0.015), specifically those older
than 40 years of age. Age at UC onset tended to increase
progressively from 2000 to 2012 (P<0.001), but the
extension on the disease remained unchanged.
Conclusion IBD is a highly prevalent disorder in our region,
reaching the incidence of CD similar to the figures provided
for Northern Europe. Changes in IBD localization, behavior,
and age at diagnosis were documented during the period
2000–2012.
Revista española de enfermedades digestivas : organo oficial de la Sociedad Española de Patología Digestiva, 2014
No nation-wide epidemiological study on the incidence and prevalence of chronic pancreatitis (CP)... more No nation-wide epidemiological study on the incidence and prevalence of chronic pancreatitis (CP) had been thus far carried out in Spain. Our goal is to estimate the prevalence and incidence of CP, as well as to determine the diagnostic and therapeutic criteria used in Spanish pancreas units. An observarional, descriptive study of hospital pancreas units in Spain. CP-related epidemiology, etiology, manifestations, diagnostic tests, functional complications, and treatments were all assessed using a structured questionnaire. Overall results were estimated by weighting cases in each site. Information was collected from six pancreas units with a sample frame of 1,900,751 inhabitants. Overall prevalence was 49.3 cases per 105 population (95 % CI, 46 to 52) and incidence was 5.5 cases per 105 inhabitant-years (95 % CI, 5.4 to 5.6). Most common etiologies included tobacco and alcoholism, which were associated with three in every four cases. The most prevalent symptoms were recurring pain (...
International Clinical Psychopharmacology, 2011
Endoscopy, 2007
Eosinophilic esophagitis can be associated with a wide range of endoscopic patterns. The aim of t... more Eosinophilic esophagitis can be associated with a wide range of endoscopic patterns. The aim of the present case series report is to describe and classify endoscopic appearances before and after corticoid therapy in relation to histopathology and manometry. In 30 patients (m : f, 27 : 3; mean age 36.2 years) with eosinophilic esophagitis, endoscopic findings were prospectively classified according to luminal diameter and mucosal pattern. Manometric and bioptic histopathologic findings were also recorded. Endoscopy was repeated following a 3-month course of steroid therapy. In total, 20 % of patients showed a concentric esophageal stricture, and in 57 % simultaneous contraction rings were visible. Mucosal alterations consisted of granular mucosa (20 %), longitudinal furrows (33 %) and transversal undulations (3 %). Lower esophageal sphincter dysfunction and distal esophageal dysfunctional manometry were seen in 73 % and 57 % of cases, respectively. Following steroids, the esophagus showed a normal caliber in 97 % of patients, and 63 % of patients had normal mucosa. The most frequent findings were narrowing of the esophageal lumen, which returned to normal following steroid treatment to a larger extent than mucosal alterations.
Gastroenterología y Hepatología, 2009
ABSTRACT Introducción El tratamiento precoz con inmunomoduladores podría modificar la historia na... more ABSTRACT Introducción El tratamiento precoz con inmunomoduladores podría modificar la historia natural de la enfermedad de Crohn (EC). Es importante definir el subgrupo de pacientes con una enfermedad más agresiva. Un estudio publicado en una cohorte francesa se ha realizado con este objetivo (Beaugerie L. Gastroenterology 2006;130(3):650–6). Objetivo Validar los marcadores predictivos identificados en la serie francesa en una cohorte española y valorar un mayor número de variables asociadas con el desarrollo de enfermedad de EC grave con un seguimiento mayor. Métodos Se incluyeron pacientes con EC y un seguimiento mínimo de 5 años. Se excluyeron aquellos pacientes tratados con inmunomoduladores o que requirieron cirugía en el mes inmediato al diagnóstico. Se definió EC grave según los criterios previamente propuestos: más de dos tantas de esteroides, desarrollo de corticodependencia, hospitalizaciones tras el diagnóstico por brote o complicaciones de la enfermedad, necesidad de tratamiento con inmunomoduladores, necesidad de resección intestinal o de cirugía de enfermedad perianal (EPA). Resultados Se incluyeron 511 pacientes, media de edad 29,6 (DE 11,6) años, mediana de seguimiento 109 meses, rango 60–438. El porcentaje de EC grave en los cinco años siguientes al diagnóstico fue de 70,2%. La edad menor de 40 años al diagnóstico (OR: 1,95 (95% CI: 1,1–3,42)), la necesidad de esteroides para tratar el primer brote (OR: 1,6 (95% CI: 1,05–2,3)), la localización íleo-cólica (OR: 1,84 (95% CI: 1,1–2,9)), y la presencia de EPA al diagnóstico (OR: 1,8 (95% CI: 1,01–3,5)) se confirmaron como marcadores predictivos independientes de desarrollar EC grave en los 5 años tras el diagnóstico. El valor predictivo positivo (VPP) fue de 0,82 y 0,89 respectivamente en los pacientes que tenían 3 o 4 factores de riesgo. Durante toda la evolución de la enfermedad el porcentaje de pacientes con EC grave fue de 84,5%. Por regresión logística se identificaron 6 factores independientes predictivos de EC grave: patrón estenosante o fistulizante al diagnóstico (OR: 2,3 (95% CI: 1,2–4,2)), fumador activo (OR: 1,7 (95% CI: 1,1–2,9)), edad menor de 40 años (OR: 2,3 (95% CI: 1,2–4,2)), la necesidad de esteroides para tratar el primer brote (OR: 1,8 (95% CI: 1,1–2,9)), la localización íleo-cólica (OR: 2,3 (95% CI: 1,2–4,3)), y EPA en el momento del diagnóstico (OR: 5,8 (95% CI: 1,8–19.2)). El VPP de estos factores fue de 0,91 en aquellos pacientes que tenían 4 factores, todos los que presentaban 5 ó 6 en el momento del diagnóstico desarrollaron una EC grave. Conclusiones Se confirman y se validan en población española la edad menor de 40 años, la presencia de EPA al diagnóstico y la necesidad de esteroides para el tratamiento inicial de la enfermedad como predictivos de desarrollo de EC grave. Este subgrupo de pacientes es subsidiario de ser tratado de una manera más agresiva. El resto de factores identificados necesitan ser corroborados por otros estudios. Enfermedad celíaca