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Papers by Paulina Nuñez

Revista Medica De Chile, Jul 1, 2019

Synchronous tumors detected with contrast-enhanced F18-FDG positron emission tomography/computed ... more Synchronous tumors detected with contrast-enhanced F18-FDG positron emission tomography/computed tomography (PET/CTc) in colorectal cancer Background: Colorectal cancer (CRC) is the third most prevalent cancer in the world and is the second cause of cancer death. Positron emission tomography/computed tomography (PET/CT) using 18 F-FDG is used for its staging and follow up. Aim: To assess the occurrence of synchronous colonic and extracolonic tumors detected with contrast-enhanced F18-FDG PET/CT (PET/CTc) in patients with a recently diagnosed CRC. Material and Methods: PET/CTc of 210 patients aged 16-91 years (63% men) with a recently diagnosed CRC were reviewed. PET/CTc with incidental findings, not expected to be due to CRC, were followed (laboratory, imaging and pathology) searching for synchronous tumors. Results: Ten patients (4,7%) had a second synchronous CRC. Only 70% of synchronous CRC were accessible to colonoscopy, due mainly to incomplete procedures for stenotic tumors. Extracolonic synchronous neoplasms were detected in 12 patients (5,7%), namely lung cancer in three, renal cell carcinoma in two, non-Hodgkin lymphoma in two, pancreatic cancer in one, breast cancer in one, hepatocellular carcinoma in one, bladder cancer in one and thyroid cancer in one. Conclusions: Ten percent of patients with a recently diagnosed CRC had a synchronic neoplasm detected at staging using PET/CTc.

Gastroenterología y Hepatología, Mar 1, 2021

Recibido el 3 de septiembre de 2020; aceptado el 24 de septiembre de 2020 Enfermedad inflamatoria... more Recibido el 3 de septiembre de 2020; aceptado el 24 de septiembre de 2020 Enfermedad inflamatoria intestinal; Colitis ulcerosa; Enfermedad de Crohn; Arterioesclerosis; Enfermedades cardiovasculares Resumen La enfermedad inflamatoria intestinal (EII), comprende tanto a la colitis ulcerosa como a la enfermedad de Crohn, entidades consideradas enfermedades inmunomediadas, sistémicas y de curso crónico que conllevan a menudo el desarrollo de manifestaciones extraintestinales. A pesar de que el estudio de las comorbilidades haya sido desarrollado tradicionalmente en contexto de otras enfermedades inflamatorias sistémicas, este concepto está emergiendo también en la EII. Multitud de patologías han sido vinculadas a la EII, entre las que destaca la enfermedad cardiovascular, la primera causa de muerte en los países desarrollados. Los pacientes con EII están expuestos a un mayor riesgo de entidades tales como arterosclerosis precoz e infarto de miocardio, o trombosis venosas y tromboembolismo pulmonar. El objetivo de esta revisión es hacer una aproximación a la fisiopatología de las diferentes manifestaciones de la enfermedad cardiovascular en los pacientes con EII y de cómo prevenirlas.

Digestive and Liver Disease, 2022

Journal of Crohn's and Colitis, 2020

Background In inflammatory bowel disease (IBD), a high percentage of women are diagnosed during t... more Background In inflammatory bowel disease (IBD), a high percentage of women are diagnosed during their reproductive age. IBD in remission is the ideal scenario when planning a pregnancy. Here, we describe the demographic, clinical and pregnancy/childbirth characteristics in patients with IBD treated at a tertiary centre in Chile between 2017 and 2019. Methods Observational, analytic study. We retrospectively reviewed women diagnosed with IBD who were pregnant or delivered during the study period. Demographic, clinical, obstetric and delivery data were obtained from the IBD registry, approved by the local IRB. Descriptive statistics and association tests performed (χ2, p < 0.05). Results Forty-six women with IBD were included (Tables 1). At the beginning of pregnancy, 19 (41%) had active disease and 27 (59%) were in remission. Of those with active disease, 8 (79%) remained active and six had spontaneous abortions. In those who were in remission, 20 (74%) remained in this condition....

Revista Medica De Chile, Dec 1, 2020

paulina núñez F. 1,a , patriCio iBáñez l. 2 , gonzalo pizarro J. 2 , eduardo sepúlveda s. 3 , rod... more paulina núñez F. 1,a , patriCio iBáñez l. 2 , gonzalo pizarro J. 2 , eduardo sepúlveda s. 3 , rodrigo quera p. 2 The prevalence of inflammatory bowel disease (IBD) increased in the last decades. Thus, the number of pregnant women with the condition is also increasing. Given that active disease itself is the main risk factor for complications during pregnancy, it is necessary to achieve a complete remission before planning a pregnancy. Also, pregnant women with IBD must be monitored noninvasively and be treated proactively, including escalated therapies, if needed, to prevent potential flares during pregnancy. Patients can undergo vaginal delivery in most forms of IBD. However, cesarean delivery is still preferable in women with a history of ileal pouch-anal anastomoses (IPAA) or active perianal disease.

Revista médica de Chile, 2021

Expert Opinion on Investigational Drugs, 2016

Management of patients with active ulcerative colitis (UC), one of the most frequent inflammatory... more Management of patients with active ulcerative colitis (UC), one of the most frequent inflammatory bowel diseases in human beings, is mainly based on the use of mesalamine and corticosteroids. Since in the long-term, these two drugs may be ineffective in nearly one third of the patients, immunosuppressants and/or biologics are needed to control disease activity. The marked activation of JAK/STAT molecules in inflamed mucosa of UC patients and the demonstration that UC-associated mucosal injury is driven by soluble factors that signal through JAK/STAT pathways led to investigation of JAK inhibitors for the treatment of active UC. Tofacitinib, an oral inhibitor of the cytokine-driven JAK-STAT signalling cascade, has recently been proposed for the treatment of moderate-to-severe UC. Phase 2 study showed the efficacy of tofacitinib to induce clinical and endoscopic improvement/remission and the safety profile of the drug. Herein the authors review this compound. The results obtained from clinical trials with tofacitinib suggest that this drug could be a new treatment option for patients with moderate to severe UC. However, further experimentation is needed to assess the efficacy of this drug in selected subgroups of patients as well as to maintain remission and to determine the long-term safety profile of the drug.

Drugs

In recent years, better knowledge of the pathophysiology of inflammatory bowel diseases (IBD) has... more In recent years, better knowledge of the pathophysiology of inflammatory bowel diseases (IBD) has led to a relevant expansion of the therapeutic arsenal for these conditions. Janus kinase (JAK) inhibitors are a family of small molecules that block one or more of the intracellular tyrosine kinases, including JAK-1, JAK-2, JAK-3 and TYK-2. Tofacitinib, a non-selective small molecule JAK inhibitor, and upadacitinib and filgotinib, which are selective JAK-1 inhibitors, have been approved by the US Food and Drug Administration (FDA) for moderate-to-severe active ulcerative colitis. Compared to biological drugs, JAK inhibitors have a short half-life, rapid onset of action, and no immunogenicity. Both clinical trials and real-world evidence support the use of JAK inhibitors in the treatment of IBD. However, these therapies have been linked with multiple adverse events (AEs) including infection, hypercholesterolemia, venous thromboembolism, major adverse cardiovascular events, and malignancy. While early studies recognized several potential AEs, post-marketing trials have shown that tofacitinib may increase the risk of thromboembolic diseases and major cardiovascular events. The latter are seen in patients aged 50 years or older with cardiovascular risk factors. Hence, the benefits of treatment and risk stratification need to be considered when positioning tofacitinib. Novel JAK inhibitors with a more selective effect on JAK-1 have proven to be effective in both Crohn's disease and ulcerative colitis, offering a potentially safer and efficacious therapeutic option to patients, including those with previous non-response to other therapies such as biologics. Nevertheless, long-term effectiveness and safety data are required.

Revista médica de Chile, 2021

New Microbes and New Infections, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Gastroenterología y Hepatología

Journal of Neurogastroenterology and Motility

Revista Española de Enfermedades Digestivas, 2020

Inflammatory bowel disease (IBD) is related to different liver extraintestinal manifestations and... more Inflammatory bowel disease (IBD) is related to different liver extraintestinal manifestations and occurs with or without a link to disease activity. Primary sclerosing cholangitis (PSC) is the most common hepatobiliary manifestation. Other autoimmune hepatopathies may develop during the evolution of the latter, which is known as overlap syndrome. Sequential overlap syndrome occurs when these conditions appear in subsequent stages, and it is less frequently associated with IBD. We report three cases of sequential overlap syndrome with autoimmune hepatitis as the first manifestation, followed by PSC after 7-19 years and subsequently IBD. Liver extraintestinal manifestations may precede IBD by several years. Therefore, it is crucial to keep this association in mind, thereby reducing the diagnostic delay.

Gastroenterology Research and Practice, 2012

Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inf... more Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inflammatory bowel disease (IBD). These disorders are sometimes due to a shared pathogenesis with IBD as seen in primary sclerosing cholangitis (PSC) and small-duct primary sclerosing cholangitis (small-duct PSC). There are also hepatobiliary manifestations such as cholelithiasis and portal vein thrombosis that occur due to the effects of chronic inflammation and the severity of bowel disease. Lastly, medications used in IBD such as sulfasalazine, thiopurines, and methotrexate can adversely affect the liver. It is important to be cognizant of these disorders as some do have serious long-term consequences. The management of these disorders often requires the expertise of multidisciplinary teams to achieve the best outcomes.

Gastroenterología y Hepatología, 2021

Fecal microbiota transplant (FMT) is currently recommended for recurrent Clostridioides difficile... more Fecal microbiota transplant (FMT) is currently recommended for recurrent Clostridioides difficile infection. However, it is interesting to acknowledge the potential therapeutic role in other diseases associated with dysbiosis. This review will focus on the current and potential indications of FMT in gastrointestinal diseases, evaluating the available evidence and also exposing the necessary requirements to carry it out.

Gastroenterología y Hepatología (English Edition), 2021

Abstract Background Inflammatory Bowel Disease (IBD) treatment may increase the risk of infection... more Abstract Background Inflammatory Bowel Disease (IBD) treatment may increase the risk of infections. Vaccines are part of the comprehensive IBD patient care. The aim of this study was to describe indications and adherence of immunizations in IBD and identify possible associated factors. Methods A cross-sectional, analytic study was conducted in patients from an IBD Program of a tertiary center in Chile, between April – June 2019. Patients were asked to answer a vaccine survey and information also was obtained from the National Immunization Registry. Descriptive and association statistic were used (χ2; p Results A total of 243 patients were included (148 ulcerative colitis (UC), 86 Crohn´s disease (CD) and 9 non-classifiable IBD). Only six patients (2%) of IBD patients received a complete immunization schedule. The highest vaccine rates were against influenza (67%), hepatitis B virus (40%), 13-valent pneumococcal (34%) and 23-polysaccharide pneumococcal (16%). The influenza vaccine rate has significantly increased, reaching 67% in 2019. The survey showed that 23% of patients have not been immunized with any vaccine, mainly due to lack of time, lack of medical prescription and high cost. Conclusion In this cohort, although vaccination rates are higher than previously reported, adherence to IBD immunization program would be improved, being considered since diagnosis by the multidisciplinary team.

Revista médica de Chile, 2014

Contribution of Chilean research to the formulation of national clinical guidelines Background: I... more Contribution of Chilean research to the formulation of national clinical guidelines Background: In Chile, 80 diseases were included in a health care system called Health Care Guarantees (GES) and clinical guidelines were elaborated for their management. Aim: To assess the scientific background of guidelines and if they were based on research financed by the Chilean National Commission for Science and Technology. Material and Methods: The references of the 82 guidelines developed for 80 diseases were reviewed, registering their number, authors, country of origin and funding source. Results: The guidelines had a total of 6,604 references. Of these, only 185 were Chilean (2.8%) and five (0.08%) originated from research financed by the National Commission for Science and Technology. Conclusions: The contribution of research funded by national agencies to the formulation of clinical guidelines is minimal.

Current Treatment Options in Gastroenterology, 2003

Purpose of review Roughly half of the nearly 1.6 million people with inflammatory bowel disease (... more Purpose of review Roughly half of the nearly 1.6 million people with inflammatory bowel disease (IBD) are women of reproductive age. Caring for women with IBD who are also pregnant can be challenging, particularly if with a disease flare or in remission, as there are special considerations needed. Recent findings Despite older studies concluding potential risks associated with IBD medical therapies, more recent literature reports healthier maternal and birth outcomes associated with disease control and reduction in the inflammatory burden. Most IBD therapies should generally be continued throughout all three trimesters without interruption as this is associated with better outcomes. Summary Active IBD increases risk of pregnancy complications and adverse pregnancy outcomes. Most medications have a favorable safety profile for use during pregnancy, regardless if in disease flare or remission. Short course corticosteroids for induction and management of flare is permitted. Thiopurines should not be started during pregnancy for a disease flare, but may be continued during pregnancy if previously on monotherapy. Biologics should be continued throughout pregnancy without interruption and timing of third trimester dosing made based on drug levels and estimated date of delivery. Risks/benefit assessment of therapies and disease control is important and should be individualized.

The American Journal of Case Reports, 2021

Patient: Male, 26-year-old Final Diagnosis: Herpetic esophagitis • eosinophilic esophagitis Sympt... more Patient: Male, 26-year-old Final Diagnosis: Herpetic esophagitis • eosinophilic esophagitis Symptoms: Fever • adynamia • retrosternal pain • dysphagia Medication: — Clinical Procedure: Endoscopy • pathological examination Specialty: Gastroenterology • Pathology Objective: Rare coexistence of disease or pathology Background: Gastroesophageal reflux disease, infectious esophagitis, and eosinophilic esophagitis are the most frequent causes of esophagitis, the latter 2 etiologies being generally considered independently. However, the association between both entities has been suggested through case reports in immunocompetent patients. Case Report: We present the case of an immunocompetent 26-year-old man presenting with fever, adynamia, retrosternal pain, and dysphagia. Endoscopy was performed, showing whitish lesions in circular plates with erosions, and in some depressed areas in the middle and distal esophagus. Biopsies showed the presence of ulcerated foci covered by fibrinoleukocyt...

Revista Medica De Chile, Jul 1, 2019

Synchronous tumors detected with contrast-enhanced F18-FDG positron emission tomography/computed ... more Synchronous tumors detected with contrast-enhanced F18-FDG positron emission tomography/computed tomography (PET/CTc) in colorectal cancer Background: Colorectal cancer (CRC) is the third most prevalent cancer in the world and is the second cause of cancer death. Positron emission tomography/computed tomography (PET/CT) using 18 F-FDG is used for its staging and follow up. Aim: To assess the occurrence of synchronous colonic and extracolonic tumors detected with contrast-enhanced F18-FDG PET/CT (PET/CTc) in patients with a recently diagnosed CRC. Material and Methods: PET/CTc of 210 patients aged 16-91 years (63% men) with a recently diagnosed CRC were reviewed. PET/CTc with incidental findings, not expected to be due to CRC, were followed (laboratory, imaging and pathology) searching for synchronous tumors. Results: Ten patients (4,7%) had a second synchronous CRC. Only 70% of synchronous CRC were accessible to colonoscopy, due mainly to incomplete procedures for stenotic tumors. Extracolonic synchronous neoplasms were detected in 12 patients (5,7%), namely lung cancer in three, renal cell carcinoma in two, non-Hodgkin lymphoma in two, pancreatic cancer in one, breast cancer in one, hepatocellular carcinoma in one, bladder cancer in one and thyroid cancer in one. Conclusions: Ten percent of patients with a recently diagnosed CRC had a synchronic neoplasm detected at staging using PET/CTc.

Gastroenterología y Hepatología, Mar 1, 2021

Recibido el 3 de septiembre de 2020; aceptado el 24 de septiembre de 2020 Enfermedad inflamatoria... more Recibido el 3 de septiembre de 2020; aceptado el 24 de septiembre de 2020 Enfermedad inflamatoria intestinal; Colitis ulcerosa; Enfermedad de Crohn; Arterioesclerosis; Enfermedades cardiovasculares Resumen La enfermedad inflamatoria intestinal (EII), comprende tanto a la colitis ulcerosa como a la enfermedad de Crohn, entidades consideradas enfermedades inmunomediadas, sistémicas y de curso crónico que conllevan a menudo el desarrollo de manifestaciones extraintestinales. A pesar de que el estudio de las comorbilidades haya sido desarrollado tradicionalmente en contexto de otras enfermedades inflamatorias sistémicas, este concepto está emergiendo también en la EII. Multitud de patologías han sido vinculadas a la EII, entre las que destaca la enfermedad cardiovascular, la primera causa de muerte en los países desarrollados. Los pacientes con EII están expuestos a un mayor riesgo de entidades tales como arterosclerosis precoz e infarto de miocardio, o trombosis venosas y tromboembolismo pulmonar. El objetivo de esta revisión es hacer una aproximación a la fisiopatología de las diferentes manifestaciones de la enfermedad cardiovascular en los pacientes con EII y de cómo prevenirlas.

Digestive and Liver Disease, 2022

Journal of Crohn's and Colitis, 2020

Background In inflammatory bowel disease (IBD), a high percentage of women are diagnosed during t... more Background In inflammatory bowel disease (IBD), a high percentage of women are diagnosed during their reproductive age. IBD in remission is the ideal scenario when planning a pregnancy. Here, we describe the demographic, clinical and pregnancy/childbirth characteristics in patients with IBD treated at a tertiary centre in Chile between 2017 and 2019. Methods Observational, analytic study. We retrospectively reviewed women diagnosed with IBD who were pregnant or delivered during the study period. Demographic, clinical, obstetric and delivery data were obtained from the IBD registry, approved by the local IRB. Descriptive statistics and association tests performed (χ2, p < 0.05). Results Forty-six women with IBD were included (Tables 1). At the beginning of pregnancy, 19 (41%) had active disease and 27 (59%) were in remission. Of those with active disease, 8 (79%) remained active and six had spontaneous abortions. In those who were in remission, 20 (74%) remained in this condition....

Revista Medica De Chile, Dec 1, 2020

paulina núñez F. 1,a , patriCio iBáñez l. 2 , gonzalo pizarro J. 2 , eduardo sepúlveda s. 3 , rod... more paulina núñez F. 1,a , patriCio iBáñez l. 2 , gonzalo pizarro J. 2 , eduardo sepúlveda s. 3 , rodrigo quera p. 2 The prevalence of inflammatory bowel disease (IBD) increased in the last decades. Thus, the number of pregnant women with the condition is also increasing. Given that active disease itself is the main risk factor for complications during pregnancy, it is necessary to achieve a complete remission before planning a pregnancy. Also, pregnant women with IBD must be monitored noninvasively and be treated proactively, including escalated therapies, if needed, to prevent potential flares during pregnancy. Patients can undergo vaginal delivery in most forms of IBD. However, cesarean delivery is still preferable in women with a history of ileal pouch-anal anastomoses (IPAA) or active perianal disease.

Revista médica de Chile, 2021

Expert Opinion on Investigational Drugs, 2016

Management of patients with active ulcerative colitis (UC), one of the most frequent inflammatory... more Management of patients with active ulcerative colitis (UC), one of the most frequent inflammatory bowel diseases in human beings, is mainly based on the use of mesalamine and corticosteroids. Since in the long-term, these two drugs may be ineffective in nearly one third of the patients, immunosuppressants and/or biologics are needed to control disease activity. The marked activation of JAK/STAT molecules in inflamed mucosa of UC patients and the demonstration that UC-associated mucosal injury is driven by soluble factors that signal through JAK/STAT pathways led to investigation of JAK inhibitors for the treatment of active UC. Tofacitinib, an oral inhibitor of the cytokine-driven JAK-STAT signalling cascade, has recently been proposed for the treatment of moderate-to-severe UC. Phase 2 study showed the efficacy of tofacitinib to induce clinical and endoscopic improvement/remission and the safety profile of the drug. Herein the authors review this compound. The results obtained from clinical trials with tofacitinib suggest that this drug could be a new treatment option for patients with moderate to severe UC. However, further experimentation is needed to assess the efficacy of this drug in selected subgroups of patients as well as to maintain remission and to determine the long-term safety profile of the drug.

Drugs

In recent years, better knowledge of the pathophysiology of inflammatory bowel diseases (IBD) has... more In recent years, better knowledge of the pathophysiology of inflammatory bowel diseases (IBD) has led to a relevant expansion of the therapeutic arsenal for these conditions. Janus kinase (JAK) inhibitors are a family of small molecules that block one or more of the intracellular tyrosine kinases, including JAK-1, JAK-2, JAK-3 and TYK-2. Tofacitinib, a non-selective small molecule JAK inhibitor, and upadacitinib and filgotinib, which are selective JAK-1 inhibitors, have been approved by the US Food and Drug Administration (FDA) for moderate-to-severe active ulcerative colitis. Compared to biological drugs, JAK inhibitors have a short half-life, rapid onset of action, and no immunogenicity. Both clinical trials and real-world evidence support the use of JAK inhibitors in the treatment of IBD. However, these therapies have been linked with multiple adverse events (AEs) including infection, hypercholesterolemia, venous thromboembolism, major adverse cardiovascular events, and malignancy. While early studies recognized several potential AEs, post-marketing trials have shown that tofacitinib may increase the risk of thromboembolic diseases and major cardiovascular events. The latter are seen in patients aged 50 years or older with cardiovascular risk factors. Hence, the benefits of treatment and risk stratification need to be considered when positioning tofacitinib. Novel JAK inhibitors with a more selective effect on JAK-1 have proven to be effective in both Crohn's disease and ulcerative colitis, offering a potentially safer and efficacious therapeutic option to patients, including those with previous non-response to other therapies such as biologics. Nevertheless, long-term effectiveness and safety data are required.

Revista médica de Chile, 2021

New Microbes and New Infections, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Gastroenterología y Hepatología

Journal of Neurogastroenterology and Motility

Revista Española de Enfermedades Digestivas, 2020

Inflammatory bowel disease (IBD) is related to different liver extraintestinal manifestations and... more Inflammatory bowel disease (IBD) is related to different liver extraintestinal manifestations and occurs with or without a link to disease activity. Primary sclerosing cholangitis (PSC) is the most common hepatobiliary manifestation. Other autoimmune hepatopathies may develop during the evolution of the latter, which is known as overlap syndrome. Sequential overlap syndrome occurs when these conditions appear in subsequent stages, and it is less frequently associated with IBD. We report three cases of sequential overlap syndrome with autoimmune hepatitis as the first manifestation, followed by PSC after 7-19 years and subsequently IBD. Liver extraintestinal manifestations may precede IBD by several years. Therefore, it is crucial to keep this association in mind, thereby reducing the diagnostic delay.

Gastroenterology Research and Practice, 2012

Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inf... more Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inflammatory bowel disease (IBD). These disorders are sometimes due to a shared pathogenesis with IBD as seen in primary sclerosing cholangitis (PSC) and small-duct primary sclerosing cholangitis (small-duct PSC). There are also hepatobiliary manifestations such as cholelithiasis and portal vein thrombosis that occur due to the effects of chronic inflammation and the severity of bowel disease. Lastly, medications used in IBD such as sulfasalazine, thiopurines, and methotrexate can adversely affect the liver. It is important to be cognizant of these disorders as some do have serious long-term consequences. The management of these disorders often requires the expertise of multidisciplinary teams to achieve the best outcomes.

Gastroenterología y Hepatología, 2021

Fecal microbiota transplant (FMT) is currently recommended for recurrent Clostridioides difficile... more Fecal microbiota transplant (FMT) is currently recommended for recurrent Clostridioides difficile infection. However, it is interesting to acknowledge the potential therapeutic role in other diseases associated with dysbiosis. This review will focus on the current and potential indications of FMT in gastrointestinal diseases, evaluating the available evidence and also exposing the necessary requirements to carry it out.

Gastroenterología y Hepatología (English Edition), 2021

Abstract Background Inflammatory Bowel Disease (IBD) treatment may increase the risk of infection... more Abstract Background Inflammatory Bowel Disease (IBD) treatment may increase the risk of infections. Vaccines are part of the comprehensive IBD patient care. The aim of this study was to describe indications and adherence of immunizations in IBD and identify possible associated factors. Methods A cross-sectional, analytic study was conducted in patients from an IBD Program of a tertiary center in Chile, between April – June 2019. Patients were asked to answer a vaccine survey and information also was obtained from the National Immunization Registry. Descriptive and association statistic were used (χ2; p Results A total of 243 patients were included (148 ulcerative colitis (UC), 86 Crohn´s disease (CD) and 9 non-classifiable IBD). Only six patients (2%) of IBD patients received a complete immunization schedule. The highest vaccine rates were against influenza (67%), hepatitis B virus (40%), 13-valent pneumococcal (34%) and 23-polysaccharide pneumococcal (16%). The influenza vaccine rate has significantly increased, reaching 67% in 2019. The survey showed that 23% of patients have not been immunized with any vaccine, mainly due to lack of time, lack of medical prescription and high cost. Conclusion In this cohort, although vaccination rates are higher than previously reported, adherence to IBD immunization program would be improved, being considered since diagnosis by the multidisciplinary team.

Revista médica de Chile, 2014

Contribution of Chilean research to the formulation of national clinical guidelines Background: I... more Contribution of Chilean research to the formulation of national clinical guidelines Background: In Chile, 80 diseases were included in a health care system called Health Care Guarantees (GES) and clinical guidelines were elaborated for their management. Aim: To assess the scientific background of guidelines and if they were based on research financed by the Chilean National Commission for Science and Technology. Material and Methods: The references of the 82 guidelines developed for 80 diseases were reviewed, registering their number, authors, country of origin and funding source. Results: The guidelines had a total of 6,604 references. Of these, only 185 were Chilean (2.8%) and five (0.08%) originated from research financed by the National Commission for Science and Technology. Conclusions: The contribution of research funded by national agencies to the formulation of clinical guidelines is minimal.

Current Treatment Options in Gastroenterology, 2003

Purpose of review Roughly half of the nearly 1.6 million people with inflammatory bowel disease (... more Purpose of review Roughly half of the nearly 1.6 million people with inflammatory bowel disease (IBD) are women of reproductive age. Caring for women with IBD who are also pregnant can be challenging, particularly if with a disease flare or in remission, as there are special considerations needed. Recent findings Despite older studies concluding potential risks associated with IBD medical therapies, more recent literature reports healthier maternal and birth outcomes associated with disease control and reduction in the inflammatory burden. Most IBD therapies should generally be continued throughout all three trimesters without interruption as this is associated with better outcomes. Summary Active IBD increases risk of pregnancy complications and adverse pregnancy outcomes. Most medications have a favorable safety profile for use during pregnancy, regardless if in disease flare or remission. Short course corticosteroids for induction and management of flare is permitted. Thiopurines should not be started during pregnancy for a disease flare, but may be continued during pregnancy if previously on monotherapy. Biologics should be continued throughout pregnancy without interruption and timing of third trimester dosing made based on drug levels and estimated date of delivery. Risks/benefit assessment of therapies and disease control is important and should be individualized.

The American Journal of Case Reports, 2021

Patient: Male, 26-year-old Final Diagnosis: Herpetic esophagitis • eosinophilic esophagitis Sympt... more Patient: Male, 26-year-old Final Diagnosis: Herpetic esophagitis • eosinophilic esophagitis Symptoms: Fever • adynamia • retrosternal pain • dysphagia Medication: — Clinical Procedure: Endoscopy • pathological examination Specialty: Gastroenterology • Pathology Objective: Rare coexistence of disease or pathology Background: Gastroesophageal reflux disease, infectious esophagitis, and eosinophilic esophagitis are the most frequent causes of esophagitis, the latter 2 etiologies being generally considered independently. However, the association between both entities has been suggested through case reports in immunocompetent patients. Case Report: We present the case of an immunocompetent 26-year-old man presenting with fever, adynamia, retrosternal pain, and dysphagia. Endoscopy was performed, showing whitish lesions in circular plates with erosions, and in some depressed areas in the middle and distal esophagus. Biopsies showed the presence of ulcerated foci covered by fibrinoleukocyt...