Eva Iglesias

Hospital Universitario Reina Sofía, Cordoue, Andalusia, Spain

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Publications (6)38.55 Total impact

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    ABSTRACT: BACKGROUND:: Whether current smoking worsens the clinical course of microscopic colitis (MC) is unknown. The aim was to evaluate the impact of smoking on the clinical course of MC. METHODS:: One hundred and eighty-four patients (72% women; age, 62.4 ± 1.1 years) with MC (118 collagenous colitis (CC) and 66 lymphocytic colitis (LC) were evaluated (39 of them were current smokers). In all the patients, smoking habits and clinical data at presentation, response to therapy, and clinical relapses during follow-up were prospectively recorded. Risk factors for clinical relapse were studied in 160 patients after a mean follow-up of 28 ± 1 months. Cox regression analysis was used to adjust for confounding variables. RESULTS:: Age at diarrhea onset was 63.0 ± 1.4 years in nonsmokers and 50.4 ± 2.1 years in current smokers (P < 0.001). There was no significant influence of smoking habit on either clinical symptoms at diagnosis or clinical remission rate. Clinical relapse rate was 25.5% for CC and 29.6% for LC, with the mean relapse-free time 28.8 months (95% confidence interval, 26.3-31.4) for CC and 26.9 months (95% confidence interval, 26-30.3) for LC (P = 0.5). Multivariate analysis showed that age at diagnosis (<50 years versus others; adjusted hazard ratio, 2.8; 95% confidence interval, 1.3-6; P = 0.01) was associated with risk of relapse of CC but not LC. Current smoking was not an independent risk factor for either CC or LC relapse. CONCLUSIONS:: Active smokers developed MC more than a decade before nonsmokers. Age at diagnosis, but not smoking, was an independent risk factor of relapse in patients with CC.
    Inflammatory Bowel Diseases 04/2013; · 5.12 Impact Factor
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    ABSTRACT: BACKGROUND:: The cause of collagenous colitis (CC) and lymphocytic colitis (LC) is unknown and epidemiological risk factors for CC and LC are not well studied. The aim was to evaluate in a case-control study epidemiological risk factors for CC and LC. METHODS:: In all, 120 patients with CC, 70 with CL, and 128 controls were included. For all cases and controls information was prospectively recorded. A binary logistic regression analysis was performed separately for CC and LC. RESULTS:: Independent associations observed with the diagnosis of CC were: current smoking (odds ratio [OR], 2.4), history of polyarthritis (OR, 20.8), and consumption of lansoprazole (OR, 6.4), low-dose aspirin (OR, 3.8), beta-blockers (OR, 3.6), and angiotensin II receptor antagonists (OR 0.20). In the case of LC they were: current smoking (OR, 3.8), associated autoimmune diseases (OR, 8), and consumption of sertraline (OR, 17.5), omeprazole (OR 2.7), low-dose aspirin (OR, 4.7), and oral antidiabetic drugs (OR, 0.14). CONCLUSIONS:: The consumption of drugs, current smoking, and associated autoimmune diseases were independently associated with the risk of microscopic colitis.
    Inflammatory Bowel Diseases 01/2013; · 5.12 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: Ciclosporin has proven to be effective in patients with corticosteroid-refractory ulcerative colitis (UC). When therapy with this drug fails, infliximab can be considered to avoid colectomy. The efficacy and safety of this sequential approach remain unknown. To assess the efficacy and safety profile of treatment with infliximab after failure of ciclosporin in patients with a corticosteroid-refractory flare of UC. Retrospective review of medical records of patients with a corticosteroid-refractory flare of UC who did not respond to ciclosporin and received salvage therapy with infliximab within a month of discontinuing ciclosporin. The severity of the flare and response to the treatment were graded using the Lichtiger index. Cumulative rates of colectomy were calculated using Kaplan-Meier analysis. Cox regression analysis was performed to identify predictors of colectomy. To evaluate the safety profile of this treatment strategy, any adverse event occurring after the first infusion of infliximab was considered. The study population comprised 47 patients with corticosteroid-refractory UC treated with infliximab after failure of ciclosporin. The median baseline Lichtiger index was 13. The mean time from the last ciclosporin dose to the first infliximab infusion was 6 days. After the first infliximab infusion, 13% of patients achieved remission, and 74% partial response. Of the 35 patients who received the third infliximab infusion, 60% achieved remission, and 37% partial response. Fourteen patients (30%) underwent colectomy. The rate of adverse events was 23%. One death occurred in a 40-year-old man who failed ciclosporin and infliximab and underwent surgery 10 days after the first infliximab infusion; he died of nosocomial pneumonia. Treatment with infliximab makes it possible to avoid colectomy in two-thirds of corticosteroid-refractory UC patients in whom ciclosporin fails. However, the rates of adverse events and mortality mean that the decision to administer sequential therapy (ciclosporin-infliximab) should be taken on an individual basis.
    Alimentary Pharmacology & Therapeutics 12/2011; 35(2):275-83. · 4.55 Impact Factor
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    ABSTRACT: Beclometasone dipropionate (BDP) is a relatively new topically acting oral steroid to treat mild to moderately active ulcerative colitis (UC). We estimate that 20,000 patients have received oral BDP in Spain in the last two years. Our aim was to evaluate the efficacy and safety of oral BDP in clinical practice. Retrospective and multicenter study that included 434 patients with active UC treated with BDP. The partial Mayo Clinic score (pMS, 0-9) was used to measure disease activity. Remission was defined as post-treatment pMS of 0 or 1; response as a decrease in pMS of 3 points or 2 points and >30%, and failure as lack of remission or response. BDP dose was 5 mg/day in 88% of patients and mean treatment duration was 6.2 weeks. BDP achieved remission in 44.4%, response in 22.3% and failed in 33.2% of patients. Mean pMS decreased from 4.9 ± 1.3 to 2.4 ± 2.3 (p<0.0001). Remission rate was higher in mild and moderate than in severe UC (p<0.043) and tended to be higher in left-sided and extensive UC than in proctitis (p<0.06). Failure was less frequent in patients treated for >4 weeks (p<0.02). Mild adverse events were reported in 7.6% of patients. BDP induces response or remission in two thirds of active UC patients, with a good safety profile. Patients with mild to moderate, left-sided or extensive UC, receiving BDP for more than 4 weeks are most likely to benefit from this treatment.
    Journal of Crohn s and Colitis 12/2010; 4(6):629-36. · 3.39 Impact Factor
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    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
    Gastroenterology 01/2009; 32(3):189-190. · 12.82 Impact Factor