In clinical practice, ADA was effective in UC, especially in anti-TNF naïve patients. FC and CRP could be predictors of treatment effectiveness.

Whereas spontaneous bacterial peritonitis (SBP) isSpontaneous bacterial empyema (SBEM) is an infection of a preexisting hydrothorax in cirrhotic patients a well-known entity with a reported incidence between and has seldom been reported. To determine its inci-15% and 20% in hospitalized cirrhotic patients with dence and primary characteristics, all cirrhotic patients ascites, 1-3 spontaneous bacterial empyema (SBEM)-with pleural effusion underwent thoracentesis at our the infection of a preexisting hydrothorax-has seldom hospital either on admission or when an infection was been reported. 4 Because 5% to 10% of cirrhotic patients suspected. Pleural fluid (PF) study included biochemi-with ascites have an associated hydrothorax, 5,6 SBEM cal analysis, polymorphonuclear (PMN) leukocyte count, could be expected to appear in 1% to 2% of hospitalized and culture by two methods: conventional and modified cirrhotic patients with ascites. Apart from case reports, (inoculation of 10 mL of PF into a blood culture bottle at only two retrospective series including a total of 15 the bedside). SBEM was defined according to previously episodes have been published. 4,7 The aim of this study reported criteria: PF culture positive or PMN count was to investigate incidence, bacteriology, and clinical greater than 500 cells/mL, and exclusion of parapneumonic effusions. Sixteen of the 120 (13%) cirrhotic characteristics of SBEM and to confirm the data obpatients admitted with hydrothorax had 24 episodes of tained in our previous retrospective study. 4 SBEM. In 10 of the 24 episodes (43%), SBEM was not associated with spontaneous bacterial peritonitis (SBP). PATIENTS AND METHODS PF culture was positive by the conventional method inIn a university-based reference hospital, from September 8 episodes (33%) and by the modified method (blood cul-1988 to December 1992, a thoracentesis was performed on ture inoculation) in 18 (75%) (P Å .004, McNemar). The all cirrhotic patients with pleural effusion on admission (or microorganisms identified in PF were Escherichia coli when the effusion was detected for the first time during hosin 8 episodes, Streptococcus species in 4, Enterococcus pitalization) or when an infection was suspected during adspecies in 3, Klebsiella pneumoniae in 2, and Pseudomomission because of fever, abdominal or chest pain, hepatic nas stutzeri in 1. All episodes were treated with antibiotencephalopathy, or shock. If ascites was present, a paracenteics without inserting a chest tube in any case. Mortality sis also was performed at the same time. Pleural fluid (PF) during treatment was 20%. We conclude that SBEM is a study included bacteriologic study, cytology, polymorphonucommon complication of cirrhotic patients with hydroclear (PMN) leukocyte count, and glucose, protein, amylase, thorax. Almost half of the episodes were not associated lactic dehydrogenase, and adenosine deaminase determinawith SBP; thus, thoracentesis should be performed in tions. pH also was performed if an infection was suspected. patients with cirr...

Intestinal dysbiosis is key in the onset and development of Crohn’s disease (CD). We evaluated the microbiota changes in CD patients before and after a six-month anti-TNF treatment, comparing these changes with the microbiota of healthy subjects. This prospective multicenter observational study involved 27 CD patients initiating anti-TNF treatment and 16 healthy individuals. Inflammatory activity was determined at baseline, 3 and 6 months, classifying patients into responders and non-responders. Fecal microbiota was analyzed by massive genomic sequencing thought 16S rRNA amplicon sequencing before and after six months of anti-TNF treatment. The CD cohort showed a decrease in genera of the class Clostridia, short-chain fatty acid producers, and an increase in the phylum Proteobacteria (p < 0.01) versus the healthy cohort. After anti-TNF treatment, the phylum Proteobacteria also increased in non-responders versus responders (13/27) (p < 0.005), with the class Clostridia increasing. In addition, alpha diversity increased in responders versus non-responders (p < 0.01), tending towards eubiosis. An association was found (p < 0.001) in the F.prausnitzii/E.coli ratio between responders and non-responders. The F/E ratio was the most accurate biomarker of anti-TNF response (area under the curve 0.87). Thus, anti-TNF treatment allows partial restoration of intestinal microbiota in responders and the F.prausnitzii/E.coli ratio can provide a reliable indicator of response to anti-TNF in CD.

Background/AimsTo evaluate esophageal sensitivity to acid between morbidly obese (MO) patients and non-MO controls with abnormal esophageal acid exposure.MethodsWe conducted a cross-sectional study of 58 patients: 30 MO (cases) and 28 non-MO (controls). Esophageal symptoms and esophageal sensitivity to 0.1 M hydrochloric acid solution (Bernstein test) were compared between MO and non-MO patients with a prior diagnosis of abnormal esophageal acid exposure.ResultsMO patients were less symptomatic than non-MO controls (14% vs 96%; odds ratio [OR], 0.006; 95% confidence interval [CI], 0.001 to 0.075; p=0.000). MO patients were more likely to present with decreased esophageal sensitivity to the instillation of acid than non-MO controls (57% vs 14%; OR, 8; 95% CI, 1.79 to 35.74; p=0.009). Subgroup analysis revealed no differences in esophageal sensitivity in MO patients with and without abnormal esophageal acid exposure (43% vs 31%; p=0.707).ConclusionsSilent gastroesophageal reflux disease (GERD) is common among MO individuals, likely due to decreased esophageal sensitivity to acid. The absence of typical GERD symptoms in these patients may delay discovery of precancerous conditions, such as Barrett’s esophagus. We believe that these patients may require a more aggressive diagnostic work-up to rule out the presence of silent GERD.

BackgroundThe effect of thiopurine immunomodulators on health-related quality of life (HRQoL) in patients with inflammatory bowel disease (IBD) has been controversial. The aims were to evaluate the HRQoL in patients with IBD treated with thiopurines and assess the short- and long-term impacts of the treatment on HRQoL.MethodsNinety-two consecutive patients who started treatment with thiopurines were prospectively included. Evaluation of HRQoL was performed at months 0, 6, and 12 using two questionnaires, the Short-Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ).ResultsBaseline score of IBDQ was 4,6, range (2,31-6,84), with an impairment of the five dimensions of HRQoL compared with inactive patients. Results obtained in 8 dimensions of SF-36 showed worse HRQoL than Spanish general population. At 6 months patients had a significant improvement in overall IBDQ score -5,8 (1,58 -6,97)- and also in all IBDQ dimensions. All the 8 dimensions of SF-36 obtained a significant improvement. At twelve months score of IBDQ was 6,1, range (2,7-6,98), with improvement in all dimensions compared with baseline and 6 months. SF-36 showed a similar significant improvement in all subscales.ConclusionsThiopurine immunomodulators alone or with other treatments have a positive and long lasting impact on HRQoL of IBD patients.