F Bermejo

Hospital Universitario de La Princesa, Madrid, Madrid, Spain

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Publications (204)570.57 Total impact

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    ABSTRACT: Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin fails in >20 % of cases. A rescue therapy with PPI-amoxicillin-levofloxacin still fails in >20 % of patients. To evaluate the efficacy and tolerability of a bismuth-containing quadruple regimen in patients with two consecutive eradication failures. Prospective multicenter study of patients in whom 1st treatment with PPI-clarithromycin-amoxicillin and 2nd with PPI-amoxicillin-levofloxacin had failed. A 3rd eradication regimen with a 7- to 14-day PPI (standard dose b.i.d.), bismuth subcitrate (120 mg q.i.d. or 240 mg b.i.d.), tetracycline (from 250 mg t.i.d. to 500 mg q.i.d.) and metronidazole (from 250 mg t.i.d. to 500 mg q.i.d.). Eradication was confirmed by (13)C-urea-breath-test 4-8 weeks after therapy. Compliance was determined through questioning and recovery of empty medication envelopes. Adverse effects were evaluated by means of a questionnaire. Two hundred patients (mean age 50 years, 55 % females, 20 % peptic ulcer/80 % uninvestigated-functional dyspepsia) were initially included, and two were lost to follow-up. In all, 97 % of patients complied with the protocol. Per-protocol and intention-to-treat eradication rates were 67 % (95 % CI 60-74 %) and 65 % (58-72 %). Adverse effects were reported in 22 % of patients, the most common being nausea (12 %), abdominal pain (11 %), metallic taste (8.5 %), and diarrhea (8 %), none of them severe. A bismuth-containing quadruple regimen is an acceptable third-line strategy and a safe alternative after two previous H. pylori eradication failures with standard clarithromycin- and levofloxacin-containing triple therapies.
    Digestive Diseases and Sciences 10/2013; · 2.26 Impact Factor
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    ABSTRACT: Infliximab (IFX) is a valid treatment for Crohńs disease (CD), but a relevant percentage of patients do not benefit from this therapy. In the Japanese population, the response to IFX was associated with markers in the TNF receptor superfamily 1A (TNFRSF1A) and 1B (TNFRSF1B) genes. We aimed to replicate the association previously described in the Japanese population and to ascertain the role of TNF receptors as modulators of the response to IFX. We studied 297 white Spanish CD patients with a known response to IFX: 238 responders and 59 primary nonresponders. Four single nucleotide polymorphisms (SNPs) were analysed: rs767455 in TNFRSF1A and rs1061622, rs1061624 and rs3397 in TNFRSF1B. Comparisons between groups were performed with chi-square tests or the Fisheŕs exact test. Different features (sex, age, disease duration, smoking) were evaluated as possible confounding factors. No significant association was found between the studied TNFRSF1A polymorphisms and response to IFX. In the TNFRSF1B gene, the haplotype rs1061624_A-rs3397_T was significantly increased in nonresponders: p=0.015, OR=1.78, 95% CI 1.09-2.90; and an increased frequency of rs1061622_G carriers was observed in patients with remission: p=0.033 vs nonresponders and p=0.023 vs patients with a partial response. Our results support a role of TNFRSF1B gene variants in the response to IFX in CD patients.
    Human immunology 10/2013; · 2.55 Impact Factor
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    ABSTRACT: To evaluate the use of health care resources and the associated costs of complex perianal Crohn's disease (CD) from the National Health System perspective. We conducted a multicenter, retrospective, observational study in which gastroenterologists from 11 hospitals in the Community of Madrid took part. Data was collected on the direct healthcare resources (pharmacological treatments, surgical procedures, laboratory/diagnostic tests, visits to specialists and emergency departments, and hospitalizations) consumed by 97 adult patients with complex perianal CD which was active at some point between January 1, 2005, and case history review. We recorded 527 treatments: 73.1 % pharmacological (32.3 % antibiotic, 20.5 % immunomodulator, 20.3 % biological) and 26.9 % surgical. Mean annual global cost was 8,289/patient, 75.3 % ( 6,242) of which was accounted for by pharmacological treatments ( 13.44 antibiotics; 1,136 immunomodulators; 5,093 biological agents), 12.4 % ( 1,027) by hospitalizations and surgery, 7.7 % ( 640) by medical visits, 4.2 % ( 350) by laboratory/diagnostic tests, and 0.4 % ( 30) by emergency department visits. Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.
    Digestive Diseases and Sciences 09/2013; · 2.26 Impact Factor
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    ABSTRACT: OBJECTIVES:The safety of thiopurines and anti-tumor necrosis factor-α (TNF-α) drugs during pregnancy remains controversial, as the experience with these drugs in this situation is limited. Our aim is to assess the safety of thiopurines and anti-TNF-α drugs for the treatment of inflammatory bowel disease (IBD) during pregnancy.METHODS:Retrospective, multicenter study in IBD patients. Pregnancies were classified according to the therapeutic regimens during pregnancy or during the 3 months before the conception: non-exposed group, pregnancies exposed to thiopurines alone (group A), and pregnancies exposed to anti-TNF-α drugs (group B). An unfavorable Global Pregnancy Outcome (GPO) was considered if pregnancy developed with obstetric complications in the mother and in the newborn.RESULTS:A total of 187 pregnancies in the group A, 66 pregnancies in the group B, and 318 pregnancies in the non-exposed group were included. The rate of unfavorable GPO was different among the three groups (31.8% in non-exposed group, 21.9% in group A, and 34.8% in group B), being lower in pregnancies under thiopurines than among non-exposed (P=0.01). The rate of pregnancy complications was similar among the three groups (27.7% in non-exposed, 20.9% in group A, and 30.3% in group B). The rate of neonatal complications was different among the three groups (23.3% in non-exposed group, 13.9% in group A, and 21.2% in group B), being lower in pregnancies under thiopurines than among non-exposed (P=0.01). In the multivariate analysis, the treatment with thiopurines (odds ratio=0.6; 95% confidence interval=0.4-0.9, P=0.02) was the only predictor of favorable GPO, whereas maternal age >35 years at conception was the only predictor of unfavorable GPO. The treatment with anti-TNF-α drugs was not associated with an unfavorable GPO.CONCLUSION:The treatment with thiopurines and anti-TNF-α drugs does not seem to increase the risk of complications during pregnancy and does seem to be safe for the newborn.Am J Gastroenterol advance online publication, 15 January 2013; doi:10.1038/ajg.2012.430.
    The American Journal of Gastroenterology 01/2013; · 7.55 Impact Factor
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    ABSTRACT: Ulcerative colitis (UC) is one of the main clinical forms of inflammatory bowel diseases. Main symptoms are diarrhea and rectal bleeding. Systemic manifestations are less marked than in Crohn's disease. Abdominal pain, may signal a serious condition. Physical examination may reveal only a thin patient with blood presence on rectal examination. In its course alternate periods of remission and activity (flares), although in a minority disease may be fulminant, and other few have ongoing activity. The intensity of flares may be variable, and treatment depends on it. Subsequent maintenance treatment reduces frequency and severity of flares. The extension may affect the rectum, the left colon or even more (subtotal/pancolitis), and in some patients increases over time. Local complications are toxic megacolon, hemorrhage, perforation, and cancer. Extra-intestinal manifestations may appear. Main diagnostic tools are cell blood count, blood biochemistry and microbiological and parasitological analysis of faeces. Colonoscopy with multiples biopsies is always necessary, to determine the extension and severity of the disease.
    Medicine - Programa de Formación Médica Continuada Acreditado 03/2012; 11(5):266–274.
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    ABSTRACT: Spontaneous intraabdominal abscess is a potentially serious complication that occurs in a significant percentage of patients with Crohn's disease. Different therapeutic options exist. Percutaneous drainage is useful in larger abdominal abscesses. Conservative treatment with antibiotics is an excellent option in small abdominal abscesses and can also be used if percutaneous drainage is impossible and the patient is in good overall condition. Surgery should be considered as initial therapy in large percutaneous undrainable abscesses, in cases with clinical worsening or lack of response to other treatment options, and in those patients in whom the abscess relapse. The diagnosis of an abscess requires modifications in the medical treatment of Crohn's disease, necessitating an increase in the therapeutic step to immunomodulators or biological therapy depending on previous maintenance.
    Medicine - Programa de Formación Médica Continuada Acreditado 03/2012; 11(5):306–308.
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    ABSTRACT: The response of Crohn's disease (CD) to infliximab is initially good, although a loss of efficacy is observed over time. Dose escalation has been recommended in such cases. To study the response to an intensified infliximab regimen in patients with CD; and to evaluate the adverse effects associated with intensification of therapy and identify predictors of loss of response. We performed a retrospective multicenter survey of all patients with CD who had been treated with at least the 3 induction doses of standard infliximab therapy, and for whom treatment had to be intensified due to loss of response. We analyzed the efficacy of the intensified regimen. Thirty-three patients were included. After the first intensification dose, 79% of patients had a clinical response (33.5% complete response, 45.5% partial response). In the long term, 83%, 69%, 47%, and 29% of patients who had an initial response to the intensification maintained the response at 6, 12, 18, and 36 months, respectively. The loss of efficacy after escalation was 43% per patient-year of follow-up. One patient had an infusion reaction after 36 doses. One patient developed a herpes zoster infection. A high proportion of patients whose dose of infliximab is increased due to loss of efficacy respond initially. However, nearly half lose the response after one year. The safety profile of an intensified infliximab regimen is good.
    Journal of Crohn s and Colitis 02/2012; 6(1):62-7. · 3.39 Impact Factor
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    ABSTRACT: Methotrexate is an effective treatment for inflammatory bowel disease (IBD). However, long-term treatments have been associated with the development of liver fibrosis. FibroScan® is a noninvasive, safe, and effective technique to evaluate liver fibrosis. To evaluate the presence of significant liver fibrosis by transient elastography (FibroScan®) in IBD patients treated with methotrexate. Cross-sectional study including IBD patients treated with methotrexate from different hospitals. Clinical and analytical data, duration of treatment, and cumulative dose of methotrexate were obtained. Liver stiffness was assessed by FibroScan®. The cutoff value for significant liver fibrosis (according to METAVIR) was F ≥ 2: 7.1 kPa. Results. In the study, 46 patients were included, 30 women (65%), with a mean age of 43 ± 10 years. 31 patients had Crohn's disease (67.4%), 13 ulcerative colitis (28.3%), and 2 indeterminate colitis (4.3%). The mean cumulative dose of methotrexate was 1242 ± 1349 mg, with a mean treatment duration of 21 ± 24 months. The mean value of liver stiffness was 4.7 ± 6.9 kPa. There were 35 patients (76.1%) with F01, 8 patients (17.4%) with F = 2, and 3 patients with F ≥ 3 (6.5%). There were no differences in liver stiffness depending on sex, age, type of IBD, or cumulative dose of methotrexate. (1) Development of advanced liver fibrosis in IBD patients treated with methotrexate is exceptional. (2) There were no differences in liver stiffness depending on the type of IBD or the cumulative dose of methotrexate. (3) FibroScan® may be potentially useful for evaluation and follow-up of liver fibrosis in methotrexate-treated patients.
    Scandinavian journal of gastroenterology 01/2012; 47(5):575-9. · 2.08 Impact Factor
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    ABSTRACT: Surgeons have traditionally tried to avoid any complex surgical procedures in Crohn's patients with complex perianal diseases because of the fear of complications, worsening the patient's condition and risking an eventual proctectomy. The introduction of biological therapy has changed the management of Crohn's disease. This study assesses the long-term success of addressing defects in anal sphincter and complex fistula when patients receive anti-TNF-α antibodies. Ten consecutive patients were prospectively scheduled for induction therapy with 5mg/kg Infliximab at week 0, 2 and 6 and maintenance every 8 weeks associated with azathioprine. Elective surgery was performed conducting a simultaneous approach to the sphincter defect and fistula tracts. Outcomes were long-term continence, complications which were assessed by a Wexner's score along with a complementary questionnaire. Statistical analysis was performed using general linear model of repeated measures. Three patients had complications related to surgery: two abscesses and low intersphincteric fistula and one case of rectal stenosis causing fecal urgency. There was no suture dehiscence. Wexner's score improved at 12 months (10.0±2.4 vs. 18.0±2.6; p=0.003) and over time (48 month 9.5±2.8; p=0.001). These scores were significantly worse when patients had urgency before treatment (12.8±1.2 vs. 9.5±2.8; p=0.03) but not when the urgency appeared later. No patient remained incontinent to solid stools. Three patients had occasional incontinence to liquid stools associated to disease reactivation. Surgical repair and immunomodulator therapy with infliximab could be an option in incontinent patients with Crohn's disease involving both a sphincter defect and severe or refractory fistulas.
    Journal of Crohn s and Colitis 12/2011; 5(6):598-607. · 3.39 Impact Factor
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    ABSTRACT: Low thiopurine-methyl-transferase (TPMT) activity and high 6-thioguanine-nucleotide (6TGN) concentrations have been linked to therapeutic success in inflammatory bowel disease patients treated with thiopurines; however, this has not been implemented in clinical practice. To identify a therapeutic threshold value for TPMT or 6TGN concentrations, and their capability to predict treatment safety and efficacy. Prospective multicentre study including steroid-resistant/dependent patients starting thiopurines. The TPMT activity was determined at inclusion (>5 U/mL required). Azathioprine metabolites [6TGN, 6-methyl-mercaptopurine ribonucleotides (6MMP), and 6TGN/6MMP and 6TGN/TPMT ratios] were periodically monitored during steroid tapering and after withdrawal for 6 months or until a new flare occurred. A total of 113 patients were analysed (62% clinical response). Areas under the receiver operating characteristic (ROC) curve (AUC) relating clinical response and metabolite levels at 2, 4 and 6 months after steroid withdrawal were less than 0.7. The AUCs relating final response and initial TPMT activity or metabolite concentrations at 2, 4, 8 and 16 weeks after starting thiopurines were less than 0.7. No cut-off point with worthwhile sensitivity/specificity was found. Eight (7%) patients developed thiopurine-related toxicity that could not be linked to TPMT activity or 6TGN levels. Our results do not support determination of TPMT activity or 6TGN concentrations to predict treatment outcome, and no useful serum metabolites threshold value to adjust the drug's dose was identified.
    Alimentary Pharmacology & Therapeutics 07/2011; 34(5):544-54. · 4.55 Impact Factor
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    ABSTRACT: Few data are available on the prevalence of erosive and severe esophagitis in Western countries. To retrospectively determine the prevalence and the factors predicting erosive esophagitis and severe esophagitis in a large series of endoscopies in Spain. Retrospective observational study. A multivariate analysis was performed to determine variables predicting severe esophagitis. Databases of 29 Spanish endoscopy units. Patients submitted to a diagnostic endoscopy during the year 2005. Retrospective review of the databases. Esophagitis severity (graded according to the Los Angeles classification) and associated endoscopic findings. Esophagitis was observed in 8.7% of the 93,699 endoscopies reviewed. Severe esophagitis (LA grade C or D) accounted for 22.5% of cases of the disease and was found in 1.9% of all endoscopies. Incidences of esophagitis and those of severe esophagitis were 86.2 and 18.7 cases per 100,000 inhabitants per year respectively. Male sex (OR 1.89) and advanced age (OR 4.2 for patients in the fourth age quartile) were the only variables associated with severe esophagitis. Associated peptic ulcer was present in 8.8% of cases. Retrospective study, no data on individual proton pump inhibitors use. Severe esophagitis is an infrequent finding in Spain. It occurs predominantly in males and in older individuals. Peptic ulcer disease is frequently associated with erosive esophagitis.
    PLoS ONE 01/2011; 6(10):e25051. · 3.73 Impact Factor
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    ABSTRACT: Azathioprine (AZA) liver toxicity arises in approximately 3% of inflammatory bowel disease patients and may result in treatment discontinuation. To describe the tolerance to mercaptopurine (MP) in patients with previous AZA-related liver injury. Retrospective description of 31 patients (14 Crohn's, 17 ulcerative colitis), in which AZA therapy was interrupted because of liver injury, with MP started as alternative therapy. Mean AZA dose was 2.2 +/- 0.4 mg x kg/day. Median (interquartile range) of AZA exposure when liver injury was detected was 2 months (1-5.2). The type of AZA-related injury was cytolitic in 32%, cholestatic in 39% and mixed in 29%. After a median of 2.5 months (0.7-5.2), the therapy was switched to MP at a mean dose of 1.3 +/- 0.2 mg x kg/day. Median of follow-up of MP therapy was 32 months (8-54). In 87.1% of patients (95%CI: 70-96%), MP was tolerated without further liver injury; of these, 77.4% tolerated full MP doses and 9.7% tolerated lower doses. In a further cohort of 12.9% of patients, (95%CI: 3-29%), liver injury reappeared (two cholestasis, two mixed), 1-3 months after the onset of MP exposure. The administration of MP is a good alternative in patients with AZA-related liver injury, before thiopurines are definitely discarded.
    Alimentary Pharmacology & Therapeutics 09/2009; 31(1):120-4. · 4.55 Impact Factor
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    ABSTRACT: Introducción La elevación de los niveles séricos de los nucleótidos de la 6-tioguanina (6TGN) en los pacientes tratados con tiopurinas se ha relacionado con una mayor probabilidad de alcanzar la remisión, pero la traducción clínica de este hallazgo es dudosa. Objetivos y métodos Estudio prospectivo y multicéntrico para establecer la utilidad de la determinación sistemática de 6TGN como predictor o marcador de la eficacia de la azatioprina (AZA) o mercaptopurina (MP) en los pacientes con EII. Se determinaron los niveles séricos de 6TGN y 6-metilmercaptopurina-ribonucleótidos (6MMPR) en pacientes que comenzaban tratamiento con AZA/MP por corticoresistencia o corticodependencia. Esta determinación se realizó periódicamente durante el descenso de los esteroides y, una vez suspendidos éstos, hasta la aparición de un nuevo brote (persistencia de la corticoresistencia o dependencia) o durante 6 meses en los casos en los que se mantenía la respuesta clínica. Sólo se incluyeron pacientes cuya actividad de la tiopurina-metil-transferasa (TPMT) era mayor de 5 U/ml. Resultados Se incluyeron inicialmente 153 pacientes y 140 finalizaron el estudio (edad media 36 años, 50% varones, 72% con enfermedad de Crohn. No se encontraron diferencias significativas en los niveles medios de 6TGN (o en las razones 6TGN/6MMPR o 6TGN/TPMT) a las 2, 4, 6 semanas y 2, 4 o 6 meses tras abandonar los esteroides, entre aquellos pacientes que en cada momento estaban o no en remisión clínica. El área bajo la curva ROC que evalúa la fiabilidad de los niveles de 6TGN en el diagnóstico de respuesta clínica en cada punto fue menor de 0,7 en todos los casos. Entre los niveles de 6TGN, no se encontró ningún punto de corte con una sensibilidad y especificidad útil, incluidos los valores de 230 o 250 pmol/8×108 (que son los habitualmente propuestos en la literatura). El área bajo la curva ROC que evalúa la fiabilidad de la determinación de 6TGN a las 2 semanas, 1, 2 o 4 meses tras iniciar AZA/MP para predecir la respuesta al final del seguimiento fue también menor de 0,7 en todos los casos. Una vez más, no se encontró ningún punto de corte útil. Se describió toxicidad relacionada con AZA/MP en 9 casos (6,4%), incluyendo sólo 3 casos de mielotoxicidad y ninguno de hepatotoxicidad. No se encontraron diferencias significativas en los niveles de 6TGN de aquellos pacientes que sufrieron toxicidad relacionada con tiopurínicos. Específicamente, los niveles de 6TGN no se correlacionaron con el riesgo de sufrir mielotoxicidad. Conclusión La determinación sistemática de los metabolitos de la AZA en los pacientes con EII que reciben tratamiento con tiopurinas, con el objetivo de predecir o valorar la respuesta al tratamiento o su seguridad, no puede ser recomendada.
    Gastroenterology 03/2009; 32(3):220. · 12.82 Impact Factor
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    ABSTRACT: Antecedentes La respuesta al tratamiento con IFX es inicialmente elevada, aunque con el paso del tiempo se ha observado, con cierta frecuencia, una pérdida de eficacia. En estos pacientes con pérdida de respuesta se ha recomendado “intensificar” el tratamiento con IFX. No obstante, se desconoce si el efecto beneficioso de esta estrategia se mantiene en el tiempo o es sólo transitorio. Objetivos 1) Estudiar la respuesta (tanto a corto como a largo plazo) de los pacientes que precisan intensificar el tratamiento con IFX (aumentando la dosis o disminuyendo el intervalo). 2) Evaluar los efectos adversos asociados a la intensificación del tratamiento. Métodos Estudio multicéntrico retrospectivo. Se incluyeron pacientes con enfermedad de Crohn que hubieran recibido al menos las 3 dosis de inducción del tratamiento estándar con IFX (5 mg/kg) y que después precisaran intensificación del tratamiento (10 mg/kg cada 8 semanas o 5 mg/kg cada 4 semanas) por pérdida de respuesta. Se analizó la eficacia del tratamiento intensificado en el momento inicial (tras la 1a infusión de la dosis intensificada) y final (en la última revisión). Se utilizó el índice de Harvey-Bradshaw en el caso de enfermedad de Crohn no fistulizante. En la enfermedad fistulizante, la respuesta completa se definió como el cese del drenaje de todas las fístulas y la respuesta parcial como la reducción en al menos un 50% del número o del débito fistuloso. Se valoró la seguridad del tratamiento con la dosis intensificada. Resultados Se incluyeron 34 pacientes (edad media, 43 años; 50% varones; 31% fumadores; 64% con afectación ileocólica; 47% con patrón fistulizante; 60% con enfermedad perianal). La mayoría (72%) recibía tratamiento concomitante con inmunomoduladores. El tiempo medio de seguimiento con el tratamiento intensificado fue de 56 semanas (rango: 4–169 semanas). El tiempo medio de tratamiento con IFX antes de la intensificación de la dosis fue de 15 meses (rango: 3–43 meses). Con la primera dosis de tratamiento intensificado respondió el 78% de los pacientes (32% respuesta completa y 46% parcial). Mientras que con la última dosis de tratamiento intensificado sólo un 61% de los pacientes presentaban respuesta (22% respuesta completa y 39% respuesta parcial). Un paciente sufrió una reacción infusional tras 36 dosis de tratamiento intensificado, que se solucionó con el enlentecimiento de la infusión. Otro paciente presentó infección por virus del herpes zoster, no precisando suspensión del tratamiento. Conclusiones En ocasiones se requiere la intensificación del tratamiento con IFX, una media de 15 meses después del inicio del tratamiento con este fármaco. Un alto porcentaje de pacientes responden inicialmente al tratamiento intensificado, aunque éste pierde de nuevo su eficacia en más de un 10% de los casos. La intensificación del tratamiento presenta un buen perfil de seguridad, sin observarse reacciones adversas graves.
    Gastroenterología y Hepatología. 03/2009; 32(3):218.
  • Gastroenterology 01/2009; 32(3):214-214. · 12.82 Impact Factor
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    ABSTRACT: Objetivos La enfermedad inflamatoria intestinal (EII) constituye una entidad clínica en la que existe un riesgo elevado de baja adhesión al tratamiento. Nuestros objetivos fueron conocer el grado de adhesión al tratamiento en una consulta monográfica para pacientes con EII, y estudiar qué factores influyen la misma. Métodos Se incluyeron 107 pacientes consecutivos durante 3 meses. Previo consentimiento verbal, los pacientes rellenaron en otra sala una encuesta anónima con datos demográficos (edad, sexo, nivel de estudios, situación laboral, situación personal), datos referidos a la enfermedad (tipo de EII, año del diagnóstico, numero de ingresos hospitalarios y de intervenciones quirúrgicas por su EII), datos referidos al tratamiento (medicación, dosis e intervalo de administración), declaración autoaplicada de adhesión (Sewitch MJ et al. Am J Gastroenterol 2003) y automedicación. El médico recogió en hoja aparte tratamiento prescrito e índice de actividad (Harvey-Bradshaw/Truelove). Resultados Edad media 41,3±11 años, 60% mujeres, años de evolución con EII 7,9±7. Padecían enfermedad de Crohn 64% (71% inactiva), colitis ulcerosa 36% (70% inactiva). El 66% tomaba aminosalicilatos, 51% inmunosupresores, 8% esteroides. El 66% de enfermos había precisado por su EII algún ingreso hospitalario y el 17% alguna cirugía. Globalmente el 69% (IC95%: 60–77%) mostraba algún tipo de no-adhesión al tratamiento. El 66% (IC95%: 57–75%) reconocía algún grado de no-adhesión involuntaria: olvidaron alguna vez tomar la medicación (63%) y/o se descuidaron en cuanto a si debían tomarla (27%). El 16% (IC95%: 9–22%) reconocía algún grado de no-adhesión voluntaria: la habían dejado alguna vez por sentirse mejor (13%) y/o peor (6%) al tomarla. El 25% (IC95%: 17–33%) olvidaban al menos una toma a la semana (media 1,6 tomas olvidadas/semana, causa más frecuente: estar fuera de casa), más frecuentemente con mesalazina (30%) que con azatioprina (17%) (p=n.s.). En el analisis multivariante, los factores de riesgo de una peor adhesión fueron la dosificación de la medicación en 3 o más tomas al día (OR 3; IC95% 1,1–8,4; p=0,03) y los pacientes poco informados sobre su EII (OR 4,9; IC95% 1,1–23,8; p=0,04); por el contrario, la terapia con inmunomoduladores fue un factor predictivo de mejor adhesión (OR 0,29; IC95% 0,11–0,74; p=0,01). La concordancia medico–paciente en la medicación administrada fue completa en 86%, en 10,3% hubo diferencias en la dosis y en 3,7% diferencias en la medicación. Un 9% de enfermos reconoció haberse automedicado en alguna ocasión debido a presentar brote. Conclusiones En nuestro medio, la adhesión al tratamiento en enfermos con EII es insuficiente. Los pacientes en tratamiento con inmunosupresores presentan una mejor adhesión al tratamiento. Debemos intentar optimizar la información que proporcionamos al paciente sobre su EII y administrar la medicación en una o dos tomas al día para conseguir mejorar el cumplimiento terapéutico.
    Gastroenterology 01/2009; 32(3):224-224. · 12.82 Impact Factor
  • Gastroenterology 01/2009; 32(3):213-213. · 12.82 Impact Factor
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    ABSTRACT: Objetivo Evaluar la eficacia (sobre parámetros analíticos y calidad de vida) y la tolerancia del tratamiento con Fe oral e iv en los pacientes con EII. Métodos Estudio prospectivo, multicéntrico, en pacientes con colitis ulcerosa o enfermedad de Crohn con anemia (hemoglobina (Hgb)<13 g/dL en varones y<12 en mujeres) ferropénica. Criterios de exclusión: a) enfermedad grave asociada; b) vitamina B12 o ácido fólico bajos; c) administración en los últimos 3 meses de Fe, eritropoyetina o hemoderivados; d) inicio de azatioprina en los últimos tres meses; e) ingreso hospitalario reciente (tres meses). En los pacientes con Hgb >10 g/dL se prescribió sulfato ferroso vía oral (Ferogradumet® 1 comp/día). Si la Hgb era<10 g/dL se administraba Fe sacarosa intravenoso (Venofer®, 200 mg 2 días/semana). En los pacientes intolerantes al Fe oral se cambiaba a la vía iv. En el momento basal, a los 3 y a los 6 meses tras el comienzo del tratamiento con Fe se realizó una analítica, se evaluaron los efectos adversos y se cumplimentó el cuestionario de calidad de vida reducido CCVEII-9 (puntuación de 0 a 100). Se consideró como respuesta al tratamiento la consecución de cifras normales de Hgb. Resultados Se incluyeron 100 pacientes con EII (59 con enfermedad de Crohn y 41 con colitis ulcerosa). Las cifras medias de Hgb basal fueron de 10,8±1,3 g/dL (rango, 6,6–12,9). Sesenta y ocho pacientes recibieron tratamiento con Fe oral, mientras que 22 fueron tratados con Fe iv. Se comprobó una respuesta (normalización de Hgb) al tratamiento con Fe en el 86% de los pacientes (89% con Fe oral y 77% con Fe iv). No se demostró un incremento de la actividad de la EII en ningún paciente. Cuatro pacientes (5,1%) presentaron intolerancia al Fe oral, lo que obligó a suspender el tratamiento. No se describieron efectos adversos al Fe iv. Se demostró una correlación significativa entre las cifras de Hgb y la puntuación del CCVEII-9 (p<0,001). En los respondedores a los 3 meses, la puntuación del CCVEII-9 ascendió de 58 a 73 puntos (p<0,001), mientras que el incremento en los que precisaron 6 meses de tratamiento fue más lento (54, 68 y 74 puntos a los 0, 3 y 6 meses; p<0,001). Por su parte, el CCVEII-9 no se modificó en los no respondedores. Conclusión En los pacientes con EII el tratamiento de la anemia con Fe oral es eficaz y bien tolerado, no exacerbando los síntomas de la enfermedad intestinal subyacente. La formulación iv de Fe (“sacarosa”) es también una alternativa eficaz y segura para el tratamiento de los casos más graves o con intolerancia al Fe oral. La corrección de la anemia con ambos tratamientos, oral e iv, se asocia con una mejoría en la calidad de vida.
    Gastroenterology 01/2009; 32(3):226-226. · 12.82 Impact Factor
  • Journal of Crohns & Colitis - J CROHNS COLITIS. 01/2009; 3(1).
  • Journal of Crohns & Colitis - J CROHNS COLITIS. 01/2009; 3(1).

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  • 2012–2013
    • Hospital Universitario de La Princesa
      • Servicio de Aparato Digestivo
      Madrid, Madrid, Spain
    • Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
      Barcino, Catalonia, Spain
  • 2006–2013
    • Hospital Universitario de Fuenlabrada
      Madrid, Madrid, Spain
  • 2011
    • Instituto de Investigación Sanitaria
      Madrid, Madrid, Spain
  • 2008
    • Universidade Federal do Rio Grande do Sul
      Pôrto de São Francisco dos Casaes, Rio Grande do Sul, Brazil
  • 1995–2006
    • Hospital Universitario Ramón y Cajal
      • Departamento de Medicina Interna
      Madrid, Madrid, Spain
  • 1996–2005
    • Hospital Universitario 12 de Octubre
      Madrid, Madrid, Spain
    • Hospital Universitario Severo Ochoa
      Madrid, Madrid, Spain
  • 2000–2003
    • University of Alcalá
      Cómpluto, Madrid, Spain
  • 1990–2003
    • Hospital 12 de Octubre
      • Servicio de Neurología-Neurofisiología
      Madrid, Madrid, Spain
  • 1998
    • Hospital Universitario de Móstoles
      Madrid, Madrid, Spain
  • 1997
    • Hospital Carmen Y Severo Ochoa
      Cangas, Asturias, Spain
  • 1994
    • Hospital Universitario de Getafe
      Madrid, Madrid, Spain
  • 1989
    • Hospital Universitario Madrid Montepríncipe
      Madrid, Madrid, Spain