fast track pathways for diagnosis of cancer intend to decrease delays in diagnosis and treatment of cancer. It is recommended to initiate treatment in a period no longer than 30 days since admission ...in these circuits.
to know the characteristics and fluency of our Fast Track Diagnostic Pathway (FTDP) for Colorectal Cancer (CRC), with special attention to those patients selected for surgical treatment as a first choice.
all patients who entered the FTDP for CRC during a period of 2 years (2008-2009) were analyzed as well as the rest of patients also diagnosed with CRC but never seen in the FTDP.
of the 316 patients referred to the FTDP only 78 (24.7%) were diagnosed as having some kind of cancer derived from the digestive system. At the end 61 patients (19.3%) were diagnosed with CCR. The time interval from entry into the FTDP to the first hospital visit was 3 days (range 1-8), and the interval until colonoscopy was performed was 11.5 days (range 1-41). Fourteen (41.1%) of those patients chosen for surgery were operated on in a period lesser than 30 days while 28 patients (82.3%) underwent surgery before day 45 since admission into the circuit.
though the functioning of the FTDP is acceptable, any increase in number of patients can generate delays. For this reason it is advisable to have a team to assure a good functioning of the FTDP. A proper follow-up of the whole process will possibly avoid unnecessary delays and it will improve coordination of the different phases of the fast track pathway and treatment. As the diagnostic outcome is poor it is mandatory to implement alternatives programs like screening of asymptomatic population, allowing an early detection of this condition.
The efficacy of ustekinumab and vedolizumab for treating complex perianal fistula in Crohn's disease has been barely studied. We aimed to assess treatment persistence, clinical remission, and safety ...of these drugs in this context.
Crohn's disease patients who had received ustekinumab or vedolizumab for the indication of active complex perianal fistula, were included. Clinical remission was defined according to Fistula Drainage Assessment Index (no drainage through the fistula upon gentle pressure) based on physicians’ assessment.
Of 155 patients, 136 received ustekinumab, and 35 vedolizumab (16 received both). Median follow-up for ustekinumab was 27 months. Among those on ustekinumab, 54 % achieved remission, and within this group, 27 % relapsed during follow-up. The incidence rate of relapse was 11 % per patient-year. Multivariate analysis found no variables associated with treatment discontinuation or relapse. Median follow-up time for patients receiving vedolizumab was 19 months. Remission was achieved in 46 % of the patients receiving vedolizumab, and among them, 20 % relapsed during follow-up. The incidence rate of relapse was 7 % per patient-year. Adverse events were mild in 6 % on ustekinumab and 8 % on vedolizumab.
Ustekinumab and vedolizumab appear effective, achieving remission in around half of complex perianal fistula patients, with favorable safety profiles.
(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to ...explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients,
< 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.
Background
Instruments that enable to select individuals that will benefit most from bariatric surgery (BS) are necessary to increase its cost-efficiency. Our goal was to assess if intake capacity, ...measured with a standardized test, predicts response to BS.
Methods
Patients with criteria for BS were randomly allocated to laparoscopic gastric bypass (LRYGB) or sleeve gastrectomy (LSG). We measured caloric intake capacity before and 1 year after surgery using a standardized nutrient drink test. We evaluated if pre-surgery satiation could predict satiation and weight loss (%) 1 year after surgery using multiple regression modeling. Descriptive statistics are given as mean ± SD.
Results
Fourteen women (48 ± 9 years old, BMI 41 ± 3 kg/m
2
) were evaluated before and 11 ± 2.6 months after surgery (seven LRYGB, seven LSG). Caloric intake capacity diminished after surgery (−950 ± 85 kcal on average 70 ± 8 % decrease over basal intake capacity;
p
= 0.002) and similarly in both LRYGB (72 ± 7 % decrease) and LSG groups (68 ± 8 % decrease);
p
= 0.5. There was a significant weight reduction after surgery (-32 ± 10 kg 30 ± 8 % of total basal weight) with a mean post-surgery BMI of 29 ± 2 kg/m
2
. The best predictive model of weight loss (%) after surgery (
R
2
= 89 %,
p
= 0.0009) included: BMI (
p
= 0.0004), surgery type (
p
= 0.01) and pre-surgery intake capacity (
p
= 0.006). Weight loss was higher in heavier patients and those undergoing LRYGB. Patients with higher intake capacity had a poorer outcome independently of basal BMI and surgery type.
Conclusions
Caloric intake capacity, as measured by a standard nutrient drink test, helps to predict weight loss after bariatric surgery. This test might be useful in algorithms of obesity treatment decision.
La capacitat d’ingesta o sacietat i el seu control neuroendocrí són variables d'interès en la recerca en obesitat. No obstant això, el patró or actual per avaluar la sacietat mesura l'energia ...ingerida durant un bufet lliure. Això és car i difícil d'estandarditzar entre diferents laboratoris. Recentment, s'ha proposat mesurar la ingesta ad libitum amb una beguda nutritiva com a mètode més barat i senzill. Ambdos mètodes no han estat mai comparats. Així, el primer estudi d’aquesta tesi té com a objectiu comparar la capacitat d’ingesta i la resposta neuroendocrina postprandial, durant un bufet de menjar i amb una beguda nutritiva. Per provar això, es va demanar a voluntaris sans que fessin ambdues proves en dos dies diferents. Els resultats mostren una bona correlació de totes les variables mesurades per les dues proves i similars respostes neurohormonals postprandials. Per tant, les nostres dades donen suport a la utilització de la prova beguda en l’estudi de la fisiologia de la sacietat en humans.
La sacietat és induïda quan els nutrients arriben l'intestí prim estimulant la secreció de diverses citoquines i pèptids que regulen la ingesta d'aliments, coneguts com factors de sacietat, a través de mecanismes neurohormonals. Dades prèvies del nostre grup
suggerien que una arribada precoç de nutrients a l'intestí prim podia adelantar l’estat de sacietat a través de l’avançada secreció de factors de sacietat entèrics. Així, el segon estudi d’aquesta tesi tenia com a objectiu provar aquesta hipòtesi mitjançant l’acceleració farmacològica del buidament gàstric de nutrients a l'intestí prim. Usant la prova prèviament validada de la beguda nutritiva, hem demostrat que un augment en la velocitat de buidament gàstric indueix sacietat de forma precoç i, d'altra banda, una disminució significativa en la quantitat de calories ingerides. Això obre un nou i interessant camp d'estudi sobre la regulació de la ingesta i teràpies contra l'obesitat
Acute energy intake/satiation is an outcome of interest in obesity trials as it is its neuro-endocrine control. However, the gold standard to assess satiation measures energy intake during an ad libitum buffet-meal, which is expensive and difficult to standardize across laboratories. Recently, a nutrient drink test has been proposed as a more standardized, cheaper and easier method for measuring ad libitum energy intake. However, the latter has never been compared with the gold standard. Thus, in the first study of this thesis we aimed to compare energy intake and the neuro-endocrine postprandial response, during a free-buffet meal and the new nutrient-drink test. To test this we asked healthy volunteers to undergo both test on two different days. The results show a good correlation of all variables measured by the two tests and similar postprandial neuro-hormonal satiation responses. Hence, our data support the potential of the use of a simple nutrient drink test to study satiation/obesity physiology in humans.
Satiation is induced when nutrients arrive to the small intestine stimulating secretion of several cytokines and peptides that regulate food intake, known as satiation factors, through neuro-hormonal mechanisms. Previous data from our group suggested us that a precocious arrival of nutrients to the small intestine might induce an earlier satiation state through precocious secretion of enteric satiation factors. Thus, in the second study of this thesis we aimed to prove this by pharmacologically accelerating gastric dumping of nutrients to the small bowel. Using the previously validated nutrient drink test we have demonstrated that an increase in gastric emptying rate induced satiation earlier and, moreover, a significant decrease in the amount of calories ingested. This opens up a new and interesting field of study on food intake regulation and obesity therapies.
Introduction: fast track pathways for diagnosis of cancer intend to decrease delays in diagnosis and treatment of cancer. It is recommended to initiate treatment in a period no longer than 30 days ...since admission in these circuits. Aims: to know the characteristics and fluency of our Fast Track Diagnostic Pathway (FTDP) for Colorectal Cancer (CRC), with special attention to those patients selected for surgical treatment as a first choice. Material and method: all patients who entered the FTDP for CRC during a period of 2 years (2008-2009) were analyzed as well as the rest of patients also diagnosed with CRC but never seen in the FTDP. Results: of the 316 patients referred to the FTDP only 78 (24.7%) were diagnosed as having some kind of cancer derived from the digestive system. At the end 61 patients (19.3%) were diagnosed with CCR. The time interval from entry into the FTDP to the first hospital visit was 3 days (range 1-8), and the interval until colonoscopy was performed was 11.5 days (range 1-41). 14 (41.1%) of those patients chosen for surgery were operated on in a period lesser than 30 days while 28 patients (82.3%) underwent surgery before day 45 since admission into the circuit. Conclusions: though the functioning of the FTDP is acceptable, any increase in number of patients can generate delays. For this reason it is advisable to have a team to assure a good functioning of the FTDP. A proper follow-up of the whole process will possibly avoid unnecessary delays and it will improve coordination of the different phases of the fast track pathway and treatment. As the diagnostic outcome is poor it is mandatory to implement alternatives programs like screening of asymptomatic population, allowing an early detection of this condition.Introducción: los circuitos de diagnóstico rápido de cáncer (CDRC) pretenden disminuir las demoras en el diagnóstico y tratamiento del cáncer colorrectal (CCR). Se recomienda el inicio del primer tratamiento en un plazo de 30 días desde la entrada en el circuito de diagnóstico rápido. Objetivos: conocer las características y fluidez de nuestro circuito de diagnóstico rápido del cáncer colorrectal (CDRC). Centrando el interés en los pacientes cuyo primer tratamiento va a ser el quirúrgico. Material y método: se analizan los pacientes que ingresan el circuito de diagnóstico rápido durante un periodo de 2 años (2008-2009) y también los pacientes diagnosticados durante el tiempo del estudio por otras vías. Resultados: acceden al circuito de diagnóstico rápido 316 pacientes, 78 pacientes (24,7%) presentan cáncer digestivo, siendo finalmente diagnosticados de CCR 61 pacientes (19,3%). El intervalo de tiempo desde la entrada al CDRC hasta la primera visita en el hospital fue de 3 días (rango 1-8), y el intervalo hasta la realización de la colonoscopia fue de 11,5 días (rango 1-41). Los pacientes candidatos a cirugía que fueron intervenidos en un intervalo inferior a 30 días fueron 14 (41,1%), 28 pacientes (82,3%) fueron intervenidos antes de los 45 días. Conclusiones: la rapidez del circuito es aceptable pero cualquier aumento de la demanda puede generar retrasos, con lo que un responsable de seguimiento del proceso posiblemente evitará demoras y mejorará la coordinación en las diferentes fases del circuito y tratamiento. El rendimiento diagnóstico es bajo por lo que hay que pensar en la aplicación de alternativas ya existentes, como el cribado poblacional, que permitan el diagnóstico precoz en pacientes que aún no presentan sintomatología.
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