Objective Our goal in this multicentric prospective study was 2-fold: first, to test the diagnostic accuracy of ultrasound, color Doppler imaging (CDI), and contrast-enhanced ultrasound (CEUS) in identifying disease activity in patients with Crohn’s disease (CD) compared with endoscopy as the reference standard; and, second, to construct a sonographic score that allows disease activity to be detected. Materials and methods Seventy-two patients with CD from 3 hospitals underwent within a 30-day period both colonoscopy and ultrasound (US), including mural thickness, CDI, and CEUS, prospectively as part of clinical care. A multivariate analysis was carried out to assess the influence of each of the ultrasound variables in predicting endoscopic activity. We then developed a predictive ultrasound score for disease activity, and a receiver operating characteristic (ROC) curve was constructed to determine the area under the ROC curve (AUC) and the best cut-off score value to discriminate between active and inactive disease. Results Sonographic findings that were independent predictors of the presence of active disease at endoscopy were wall thickness, color grade, and contrast parameters. A score based on those variables showed high accuracy in predicting active disease, with an area under the ROC curve of 0.972. A simpler index, without contrast parameters, also showed high accuracy in detecting disease activity (AUC, 0.923). Conclusion A score based on wall thickness, color Doppler grade, and contrast parameters showed high accuracy in predicting active disease. A score without including the use of contrast agent had practically similar results and is easier to use in monitoring response to treatment.

BACKGROUND Current guidelines do not address the post–sustained virological response management of patients with baseline hepatitis C virus (HCV) cirrhosis and oesophageal varices taking betablockers as primary or secondary prophylaxis of variceal bleeding. We hypothesized that in some of these patients portal hypertension drops below the bleeding threshold after sustained virological response, making definitive discontinuation of the betablockers a safe option. AIM To assess the evolution of portal hypertension, associated factors, non-invasive assessment, and risk of stopping betablockers in this population. METHODS Inclusion criteria were age > 18 years, HCV cirrhosis (diagnosed by liver biopsy or transient elastography > 14 kPa), sustained virological response after direct-acting antivirals, and baseline oesophageal varices under stable, long-term treatment with betablockers as primary or secondary bleeding prophylaxis. Main exclusion criteria were prehepatic portal hypertension, isolated gastric varices, and concomitant liver disease. Blood tests, transient elastography, and upper gastrointestinal endoscopy were performed. Hepatic venous pressure gradient (HVPG) was measured five days after stopping betablockers. Betablockers could be stopped permanently if gradient was < 12 mmHg, at the discretion of the attending physician. RESULTS Sample comprised 33 patients under treatment with propranolol or carvedilol: median age 64 years, men 54.5%, median Model for End-Stage Liver Disease (MELD) score 9, Child-Pugh score A 77%, median platelets 77.000 × 10 3 /µL, median albumin 3.9 g/dL, median baseline transient elastography 24.8 kPa, 88% of patients received primary prophylaxis. Median time from end of antivirals to gradient was 67 wk. Venous pressure gradient was < 12 mmHg in 13 patients (39.4%). In univariate analysis the only associated factor was a MELD score decrease from baseline. On endoscopy, variceal size regressed in 19/27 patients (70%), although gradient was ≥ 12 mmHg in 12/19 patients. The elastography area under receiver operating characteristic for HVPG ≥ 12 mmHg was 0.62. Betablockers were stopped permanently in 10/13 patients with gradient < 12 mmHg, with no bleeding episodes after a median follow-up of 68 wk. CONCLUSION Portal hypertension dropped below the bleeding threshold in 39% of patients more than one year after antiviral treatment. Endoscopy and transient elastography are inaccurate for reliable detection of this change. Stopping betablockers permanently seems uneventful in patients with a gradient < 12 mmHg.

Background Malnutrition is a frequent problem in inflammatory bowel disease (IBD) due to the increase in caloric consumption because of the pathology itself and due to the reduced intake. This low intake is mainly caused by the symptoms and the anorexia associated with the disease, but it is more and more common for patients to adopt elimination diets. Our aim was to investigate the general ideas about nutrition in patients with IBD, as well as to determine whether they consider that health professionals value the nutritional aspect. Methods Inclusion of patients with an established diagnosis of IBD followed-up in the unit of the Hospital Universitario La Paz, using an anonymised survey for the researcher and for the attending physician. Results A total of 118 patients were included, of which 56% (65 patients) were women. The mean age of the patients was 48.84 years (SD 14.2). All patients had a previous diagnosis of IBD: 51.7% (61 patients) ulcerative colitis (UC), 45% (53 patients) Crohn’s disease (CD) and 3.3% (4 patients) undetermined colitis. 55.6% (64 patients) believed that nutrition influenced the course of their IBD. The patients who answered yes were on average younger (44.5 vs. 53.9 years), these differences being statistically significant (p = 0.0003). Only 22 of the 64 patients (34.4%) believed that it was caused by a specific food or food group and the most frequent answer was food rich in fats, dairy products, alcohol or spices. 52.1% of the sample (61 patients) had eliminated some food from the diet since the diagnosis of IBD. The most noteworthy was the avoiding of dairy products (37%), fibre in 28% (most of them reducing the intake of fruits and vegetables), alcoholic drinks (17%) and carbonated drinks (11.5%). No statistically significant differences were found in the elimination of food from the diet according to age, sex or type of IBD. No differences were observed in the elimination of dairy products, carbonated drinks or alcoholic beverages depending on the type of IBD, being more frequent the elimination of fibre in patients with UC (7/10 patients) than in CD. Regarding the role of their attending physician, 77.5% (86 patients) thought that nutrition was important for their doctor and/or nurse dedicated to IBD, although only 52.6% (61 patients) believed they had received enough information for their pathology. Conclusion The health professionals dedicated to IBD should increase our efforts to properly inform patients about nutritional aspects, since in our experience more than a half of patients avoid one or more foods (without scientific evidence to support it). Furthermore, only 52.6% consider that they receive sufficient information regarding this matter.

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