Alfonso Elosua-González's research while affiliated with Complejo Hospitalario de Navarra and other places

Introduction: Gastric premalignant conditions (GPC) surveillance has been proposed to improve the prognosis of gastric cancer (GC), but the early GC detection rate remaining low, and missing GC during an esophago-gastro-duodenoscopy is still a problem. We aimed to explore the gastroenterologists' attitudes on the detection and management of GPC. Methods: A cross-sectional study was designed based on a survey among gastroenterologists from Asociación Española de Gastroenterología. Results: The participation rate was 12% (146/1243). Eighty-one percent worked at secondary or tertiary-care hospitals with the capability to perform mucosectomy (80%), but with a lesser availability of endoscopic submucosal dissection (35%). Most respondents had high-definition endoscopes (88%), and virtual chromoendoscopy (86%), but during performing an upper endoscopy, 34% never or rarely use chromoendoscopy, and 73% apply a biopsy protocol often/very often when atrophy or intestinal metaplasia (IM) is suspected. Half of the respondents self-reported their ability to recognize atrophy or IM ≤7 (on a scale from 0 to 10), whereas ≤6 for dysplasia or early GC. Helicobacter pylori infection is eradicated and verified by ≥90%. Endoscopic surveillance of atrophy/IM is performed by 62%. An immediate endoscopy for dysplasia is not always performed. For low-grade dysplasia, 97.6% consider endoscopic management, but for high-grade dysplasia, 23% regard gastric surgery. Conclusion: There is a wide variability in the detection and management of GPC among Spanish gastroenterologists, and compliance with guidelines and biopsy protocols could be improved. Performance of high-quality gastroscopies including use of virtual chromoendoscopy, that might allow an improvement in the GPC detection, needs also to be generalized.

Introduction About 20% patients with perianal Crohn’s (pCD) undergo proctectomy with a significant number developing unhealed wounds. The purpose of this study was to determine factors which may be associated with poor wound healing in patients with pCD who had undergone proctectomy in the biologics era. Methods Case record review was carried out of 79 patients with pCD who underwent proctectomy at St Mark’s Hospital between 2005 and 2017. Healing rates at 6 and 12 months post proctectomy were considered and univariate regression analysis was performed. Results Complete data regarding healing were available for 97.5% (77/79) at 6 months and 100% at 12 months. 45/77 (43.7%) patients had failure of wound healing at 6 months and 34/79 (33%) at 12 months. A younger age at diagnosis of Crohn’s disease was significantly associated with failure of healing at 12 months (median age 21± 9.7 unhealed; median age 27 ± 13.6 healed; p=0.03).76.7% (61/79) patients received biologic treatments prior to proctectomy, however exposure to biologics was not a significant factor in predicting failure of wound healing (Infliximab p=0.74; Adalimumab p=0.57; Vedolizumab p=0.21). Current smoking status was not associated with poor wound healing (p=0.18). Other parameters which were not associated with failure of wound healing in our cohort included gender, corticosteroid exposure in the previous one month, thiopurine exposure in previous 3 months, number of biologics exposed to, perianal sepsis on MRI within the last 12 months, Montreal Classification, duration of CD prior to proctectomy, albumin and CRP. Conclusion A third of patients have unhealed wounds after 1 year follow-up after protectomy. A younger age at diagnosis of Crohn’s disease was the only factor associated with an unhealed perineal wound; this may in part be due to more severe disease progression in patients diagnosed at a younger age. Larger scale studies are required to determine if other parameters such as exposure to biologics play a role in predicting rates of wound healing.