Biologics Drugs in Behçet’s Disease: A Single Centre Experience

Introduction: Behçet´s disease (BD) is a systemic vasculitis of unknown cause. Several cytokines, such as tumor necrosis factor-alpha (TNF-α), appear to play a substantial role. Therefore, biologics such as anti-TNF-α agents are rising to control severe or refractory BD´s manifestations. We aimed to describe the biological therapy´s outcomes in BD patients. Methods: A longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic. We collected data regarding BD´s manifestations, treatments, and outcomes during follow-up. Results: Our cohort includes 243 patients, of whom 31% were male. During follow-up, 20 patients (8%) were treated with biological drugs. Patients who received biological therapies were younger (p = 0.030), had less frequently genital aphthosis (p = 0.009), and more frequently erythema nodosum (p = 0.009), polyarthritis (p = 0.002), spondyloarthritis (p = 0.024), retinal vasculitis (p = 0.011) and gastrointestinal manifestations (p = 0.024), namely gastroduodenal ulcer (p = 0.035), digestive bleeding from ulcers (p = 0.002), and bowel perforation (p = 0.004). Anti-TNF-α agents were used in all of these patients, most frequently infliximab. Patients started biologicals after classical immunosuppressors failure, and most went into remission (93%). Three patients developed tuberculosis during treatment, regardless of regular screening tests. It was possible to stop biological therapy in five patients, so far, without recurrence, with 33 months of mean follow-up time after suspension. Discussion: Anti-TNF-α agents are highly effective for refractory BD´s manifestations, although they are not innocuous. Little is known about the optimal duration of these therapies, regarding when and how to stop these drugs. This issue is essential not only to avoid relapses but also to reduce therapy side-effects.

P-EGS13 Risk Factors of Bleeding Gastroduodenal Ulcer Among Patient Undergo Emergency Upper Endoscopy in Hospital Melaka

Background Bleeding gastroduodenal ulcer has been one of the leading causes of admission in surgical or gastroenterology departments all over the world, requiring immediate intervention with high associated mortality exceeding 10%. We analyzed few important risk factors that lead to this potentially ill condition. Methods Data from a number of 548 patients who underwent emergency upper endoscopy were collected retrospectively from June 2020 till June 2021 in Hospital Melaka. Results From our data collection of emergency upper endoscopy performed, 111 patients had findings of high-risk ulcer (Forrest Ia, Ib, 2a and 2b). From these 111 patients, the most common presentation was low hemoglobin value (<10g/dL), with 43.6%. Presentation of melena encountered the second most common symptom (26.3%), while fresh per rectal bleeding counts the less common symptom (1%). Forrest Ib ulcer showed the commonest diagnosis found during endoscopy (45.5%), followed by Forrest IIa ulcer (34.5%), Forrest IIb ulcer (16.4%), and Forrest Ia ulcer (3.6%). There were 27 participants who undergo repetitive endoscopy. For Helicobacter Pylori infection, there were 367 patients (66.7%) underwent the test during endoscopy, which showed 187 patients detected (51%) with H.Pylori positive. We identify other risk factors which lead to this fatal condition such as, patient’s comorbidities including liver disease, renal disease and their medications, blood investigations including hemoglobin level, platelet count, total white cell count, total bilirubin, Alanine Transaminase (ALT), serum urea and creatinine. Conclusions It is a must to identify important risk factors for bleeding gastroduodenal ulcers to prevent morbidity and mortality, and to initiate emergency intervention medically and surgically. From this study, it was a great move for us to make further research on how these risk factors affecting our management of patients.

GASTRODUODENAL PERFORATION, A FREQUENT SURGICAL EMERGENCY. REVIEW AND DESCRIPTIVE STUDY

INTRODUCTION Perforated gastroduodenal ulcer represents a common surgical emergency and is associated with a morbimortality close to 40-50%. HP infection, tobacco and alcohol and some socioeconomic aspects represent the most commonly described risk factors. MATERIAL AND METHODS A descriptive and retrospective study was performed between 2018-2020. A total of 40 patients with a history of gastroduodenal perforation were selected. Data corresponding to: sex, age, ulcer location, treatment, tobacco and alcohol consumption, HP infection (presence or not of eradicating treatment) and other potential risk factors were collected and analysed. The aim of the study is to assess how new lifestyle changes, the evolution and improvement in the management of PH infection and the general decrease in smoking have modified the classic profile of patients with gastroduodenal perforations. RESULTS Gastroduodenal perforations predominated in the fifth/sixth decade of life (mean age 59 years). Although a predominance in men is described in the literature, in our sample no significant sex differences were found (1:1 ratio). The most frequent location was duodenal and the reference surgical treatment was primary suture + epipoplasty. Only one third of the patients had a known history of peptic ulcer. CONCLUSIONS Gastroduodenal perforations are a major problem for the on-call surgeon. It is essential to know the current risk factors and their potential relationship with morbimortality and postoperative evolution in order to guarantee the optimal management of these patients.

The effect on the gastrointestinal tract of various forms of alendronate in comorbid patients taking NSAIDs

Introduction. The use of bisphosphonates is associated with some risk of side effects. Gastrointestinal tract complications are particularly important in clinical practice, as they constitute the main reason for refusing bisphosphonate therapy.Objective: To evaluate the effect of various forms of alendronate on the gastrointestinal tract in comorbid patients taking NSAIDs.Materials and methods. The study included 88 women aged 58–65 years (mean age 61.5 ± 3.5 years) with polyosteoarthrosis combined with postmenopausal osteoporosis, who received NSAIDs at medium therapeutic doses to manage a pain syndrome for a long time (3–5 years). The patients were divided into two groups: a group of patients receiving alendronate in the form of a buffered solution (n = 45), and a group of patients receiving alendronate in the form of non-dissolving tablets (n = 43). The first group used Binosto (adendronic acid) 70 mg as effervescent tablets once a week. The results were assessed before initiation of treatment and 6 months after treatment with bisphosphonates. Symptoms were evaluated using the GerdQ questionnaire. Esophageal mucosal injury and gastroduodenal ulceration were assessed by upper gastrointestinal endoscopy.Results and discussion. After 6-month treatment, comparison of the two groups showed that the percentage of patients with a total GerdQ score of ≥ 8 points was significantly higher in the group of patients taking alendronate in the form of non-dissolving tablets (p = 0.04). The endoscopic findings showed that the number of patients with grade A reflux esophagitis in group 1 increased by 3.3%. The number of grade A reflux esophagitis cases in group 2 increased by 2.2%, those of grade B, C and D cases by 2.4%. The number of gastroduodenal ulcer cases also increased by 2.2% and 4.7% in groups 1 and 2, respectively. The number of gastroduodenal erosions increased by 3.5% in group 1 and 7% in group 2.Сonclusion. Symptoms were less severe in patients receiving alendronate in the form of a solution, which points to the importance of choosing the optimal oral bisphosphonate for each patient.

The original scale prediction of recurrence risk of gastroduodenal ulcer bleeding

Research goal - to examine the effectiveness of active-individualized tactics in treatment of chronic gastric and duodenal ulcers. Material and methods. Analysis of treatment of 251 patients with chronic gastric and duodenal ulcer bleeding was conducted. Duodenal ulcer bleeding was present in 202 cases (80,5%), gastric ulcers were the reason of bleeding in 49 cases (19,5%). Treatment conducted according to principles of active-individualized tactics. Results. The provided characteristics and the acquired results were presented according to the fundamental components of active-individualized tactics in treatment of gastric and duodenal ulcers. Diagnostic and treatment abilities of endoscopy were determined, an unique scale of bleeding relapse risk was presented, the time limits and main indications for surgery were explained,, the role of bleeding relapse was emphasized as crucial in forming the main results of treatment of patients with bleeding gastric and duodenal ulcers. Conclusion. At present time, active-individualized tactics should be used for treatment of gastric and duodenal ulcer bleeding.