Estrategias actuales en el diagnóstico y seguimiento de las enfermedades inflamatorias intestinales
DOI:
https://doi.org/10.52787/agl.v52i3.242Palabras clave:
Enfermedad Inflamatoria Intestinal, enfermedad de Crohn, colitis ulcerosa, biomarcadores, estudios por imágenes, colonoscopía, diagnóstico diferencial, curación mucosaResumen
Las enfermedades inflamatorias intestinales son entidades crónicas con manifestaciones y evolución heterogéneas, por lo que constituyen un desafío diagnóstico y terapéutico. En los últimos años se han producido cambios trascendentales en el manejo de las enfermedades inflamatorias intestinales, de la mano del mayor conocimiento de su inmunofisiopatología y evolución a largo plazo. A diferencia de otras enfermedades, la clínica no es soberana y debemos respaldarnos en parámetros más certeros de inflamación para la toma de decisiones. Con el advenimiento de nuevas herramientas bioquímicas, de imágenes y endoscópicas, el enfoque actual está dirigido a lograr un menor retraso en el diagnóstico y un monitoreo estrecho de la curación mucosa como una de las metas fundamentales asociada a una evolución favorable. El objetivo de esta revisión es actualizar los nuevos conceptos respecto a estrategias diagnósticas y de monitoreo en las enfermedades inflamatorias intestinales.
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-1. Baumgart DC, Carding SR. Inflammatory bowel disease: cause and immunobiology [Internet]. Vol. 369, The Lancet. 2007. p. 1627-40. Available from: http://dx.doi.org/10.1016/s0140-6736(07)60750-8
-2. Sawczenko A, Sandhu BK. Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child. 2003 Nov;88(11):995-1000.
-3. Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. Extraintestinal Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis. 2015 Aug;21(8):1982-92.
-4. Bouguen G, Levesque BG, Feagan BG, Kavanaugh A, Peyrin-Biroulet L, Colombel J, et al. Treat to Target: A Proposed New Paradigm for the Management of Crohn’s Disease [Internet]. Vol. 13, Clinical Gastroenterology and Hepatology. 2015. p. 1042–50.e2. Available from: http://dx.doi.org/10.1016/j.cgh.2013.09.006
-5. Plevris N, Lees CW. Disease Monitoring in Inflammatory Bowel Disease: Evolving Principles and Possibilities. Gastroenterology. 2022 Apr;162(5):1456-75.e1.
-6. Sairenji T, Collins KL, Evans DV. An Update on Inflammatory Bowel Disease. Prim Care. 2017 Dec;44(4):673-92.
-7. Pellino G, Sciaudone G, Riegler G, Canonico S, Selvaggi F. Surgical Treatment of Ulcerative Colitis [Internet]. Ulcerative Colitis- Treatments, Special Populations and the Future. 2011. Available from: http://dx.doi.org/10.5772/26268
-8. Aniwan S, Park SH, Loftus EV Jr. Epidemiology, Natural History, and Risk Stratification of Crohn’s Disease. Gastroenterol Clin North Am. 2017 Sep;46(3):463-80.
-9. Vavricka SR, Spigaglia SM, Rogler G, Pittet V, Michetti P, Felley C, et al. Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease. Inflamm Bowel Dis. 2012 Mar;18(3):496-505.
-10. Balestrieri P, Ribolsi M, Guarino MPL, Emerenziani S, Altomare A, Cicala M. Nutritional Aspects in Inflammatory Bowel Diseases. Nutrients [Internet]. 2020 Jan;31;12(2). Available from: http://dx.doi.org/10.3390/nu12020372
-11. Schwartz DA, Loftus EV, Tremaine WJ, Panaccione R, Scott Harmsen W, Zinsmeister AR, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota [Internet]. Vol. 122, Gastroenterology. 2002. p. 875-80. Available from: http://dx.doi.org/10.1053/gast.2002.32362
-12. Louis E, Collard A, Oger A, Groote E, Belaiche J. Location and behavior of Crohn’s disease according to Vienna classification evolution over the course of the disease [Internet]. Vol. 120, Gastroenterology. 2001. p. A141-A141. Available from: http://dx.doi.org/10.1136/gut.49.6.777
-13. Tozer PJ, Whelan K, Phillips RKS, Hart AL. Etiology of perianal Crohn’s disease: role of genetic, microbiological, and immunological factors. Inflamm Bowel Dis. 2009 Oct;15(10):1591-8.
-14. Safar B, Sands D. Perianal Crohn’s disease. Clin Colon Rectal Surg. 2007 Nov;20(4):282-93.
-15. Satsangi J. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications [Internet]. Vol. 55, Gut. 2006. p. 749-53. Available from: http://dx.doi.org/10.1136/gut.2005.082909
-16. Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management. Gastroenterology. 2021 Oct;161(4):1118-32.
-17. Jharap B, Sandborn WJ, Reinisch W, D’Haens G, Robinson AM, Wang W, et al. Randomised clinical study: discrepancies between patient-reported outcomes and endoscopic appearance in moderate to severe ulcerative colitis. Aliment Pharmacol Ther. 2015 Nov;42(9):1082-92.
-18. Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010 Apr 15;362(15):1383-95.
-19. Sands BE. Biomarkers of Inflammation in Inflammatory Bowel Disease [Internet]. Vol. 149, Gastroenterology. 2015. p. 1275-85.e2. Available from: http://dx.doi.org/10.1053/j.gastro.2015.07.003
-20. Alghoul Z, Yang C, Merlin D. The Current Status of Molecular Biomarkers for Inflammatory Bowel Disease. Biomedicines [Internet]. 2022 Jun 24;10(7). Available from: http://dx.doi.org/10.3390/biomedicines10071492
-21. Henriksen M, Jahnsen J, Lygren I, Stray N, Sauar J, Vatn MH, et al. C-reactive protein: a predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study [Internet]. Vol. 57, Gut. 2008. p. 1518-
-23. Available from: http://dx.doi.org/10.1136/gut.2007.146357
-22. Solem CA, Loftus EV Jr, Tremaine WJ, Harmsen WS, Zinsmeister AR, Sandborn WJ. Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis. 2005 Aug;11(8):707-12.
-23. Travis SP, Farrant JM, Ricketts C, Nolan DJ, Mortensen NM, Kettlewell MG, et al. Predicting outcome in severe ulcerative colitis [Internet]. Vol. 38, Gut. 1996. p. 905-10. Available from: http://dx.doi.org/10.1136/gut.38.6.905
-24. Lindgren SC, Flood LM, Kilander AF, Löfberg R, Persson TB, Sjödahl RI. Early predictors of glucocorticosteroid treatment failure in severe and moderately severe attacks of ulcerative colitis. Eur J Gastroenterol Hepatol. 1998 Oct;10(10):831-5.
-25. Ho GT, Mowat C, Goddard CJR, Fennell JM, Shah NB, Prescott RJ, et al. Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery [Internet]. Vol. 19, Alimentary Pharmacology & Therapeutics. 2004. p. 1079-87. Available from: http://dx.doi.org/10.1111/j.1365-2036.2004.01945.x
-26. D’Amico F, Rubin DT, Kotze PG, Magro F, Siegmund B, Kobayashi T, et al. International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases. United European Gastroenterol J. 2021 May;9(4):451-60.
-27. Mari A, Baker FA, Mahamid M, Yacoob A, Sbeit W, Khoury T. Clinical utility of fecal calprotectin: potential applications beyond inflammatory bowel disease for the primary care physician. Ann Gastroenterol Hepatol. 2019 Sep;32(5):425-30.
-28. van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010 Jul 15;341:c3369.
-29. Jukic A, Bakiri L, Wagner EF, Tilg H, Adolph TE. Calprotectin: from biomarker to biological function. Gut. 2021 Oct;70(10):1978-88.
-30. Sipponen T, Kärkkäinen P, Savilahti E, Kolho KL, Nuutinen H, Turunen U, et al. Correlation of faecal calprotectin and lactoferrin with an endoscopic score for Crohn’s disease and histological findings. Aliment Pharmacol Ther. 2008 Nov 15;28(10):1221-9.
-31. Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjarnason I. Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease [Internet]. Vol. 119, Gastroenterology. 2000. p. 15-22. Available from: http://dx.doi.org/10.1053/gast.2000.8523
-32. Hart L, Chavannes M, Kherad O, Maedler C, Mourad N, Marcus V, et al. Faecal Calprotectin Predicts Endoscopic and Histological Activity in Clinically Quiescent Ulcerative Colitis. J Crohns Colitis. 2020 Jan 1;14(1):46-52.
-33. Zhou G, Song Y, Yang W, Guo Y, Fang L, Chen Y, et al. ASCA, ANCA, ALCA and Many More: Are They Useful in the Diagnosis of Inflammatory Bowel Disease? Dig Dis. 2016 Mar 16;34(1-2):90-7.
-34. Prideaux L, De Cruz P, Ng SC, Kamm MA. Serological antibodies in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2012 Jul;18(7):1340-55.
-35. Solberg IC, Lygren I, Cvancarova M, Jahnsen J, Stray N, Sauar J, et al. Predictive value of serologic markers in a population-based Norwegian cohort with inflammatory bowel disease. Inflamm Bowel Dis. 2009 Mar;15(3):406-14.
-36. Cioffi M, Rosa AD, Serao R, Picone I, Vietri MT. Laboratory markers in ulcerative colitis: Current insights and future advances. World J Gastrointest Pathophysiol. 2015 Feb 15;6(1):13-22.
-37. Dubinsky MC, Lin YC, Dutridge D, Picornell Y, Landers CJ, Farrior S, et al. Serum immune responses predict rapid disease progression among children with Crohn’s disease: immune responses predict disease progression. Am J Gastroenterol. 2006 Feb;101(2):360-7.
-38. Fleshner PR, Vasiliauskas EA, Kam LY, Fleshner NE, Gaiennie J, Abreu-Martin MT, et al. High level perinuclear antineutrophil cytoplasmic antibody (pANCA) in ulcerative colitis patients before colectomy predicts the development of chronic pouchitis after ileal pouch-anal anastomosis. Gut. 2001 Nov;49(5):671-7.
-39. Samuel S, Bruining DH, Loftus EV Jr, Becker B, Fletcher JG, Mandrekar JN, et al. Endoscopic skipping of the distal terminal ileum in Crohn’s disease can lead to negative results from ileocolonoscopy. Clin Gastroenterol Hepatol. 2012 Nov;10(11):1253-9.
-40. Liu W, Liu J, Xiao W, Luo G. A Diagnostic Accuracy Meta-analysis of CT and MRI for the Evaluation of Small Bowel Crohn Disease. Acad Radiol. 2017 Oct;24(10):1216-25.
-41. Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med. 2007 Nov 29;357(22):2277-84.
-42. Sahni VA, Ahmad R, Burling D. Which method is best for imaging of perianal fistula? Abdom Imaging. 2008 Jan;33(1):26-30.
-43. Rimola J, Ordás I, Rodriguez S, García-Bosch O, Aceituno M, Llach J, et al. Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis. 2011 Aug;17(8):1759-68.
-44. Rimola J, Torres J, Kumar S, Taylor SA, Kucharzik T. Recent advances in clinical practice: advances in cross-sectional imaging in inflammatory bowel disease [Internet]. Gut. 2022. p. gutjnl - 2021. Available from: http://dx.doi.org/10.1136/gutjnl-2021-326562
-45. Ordás I, Rimola J, Alfaro I, Rodríguez S, Castro-Poceiro J, Ramírez-Morros A, et al. Development and Validation of a Simplified Magnetic Resonance Index of Activity for Crohn’s Disease. Gastroenterology. 2019 Aug;157(2):432-9.e1.
-46. Karoui S, Nouira K, Serghini M, Ben Mustapha N, Boubaker J, Menif E, et al. Assessment of activity of Crohn’s disease by Doppler sonography of superior mesenteric artery flow. J Crohns Colitis. 2010 Sep;4(3):334-40.
-47. Christian M, Giovanni M, Torsten K, Mariangela A. Ultrasonography in inflammatory bowel disease - So far we are? United European Gastroenterol J. 2022 Mar;10(2):225-32.
-48. Allocca M, Craviotto V, Bonovas S, Furfaro F, Zilli A, Peyrin-Biroulet L, et al. Predictive Value of Bowel Ultrasound in Crohn’s Disease: A 12-Month Prospective Study. Clin Gastroenterol Hepatol. 2022 Apr;20(4):e723-40.
-49. Chan G, Fefferman DS, Farrell RJ. Endoscopic assessment of inflammatory bowel disease: colonoscopy/esophagogastroduodenoscopy. Gastroenterol Clin North Am. 2012 Jun;41(2):271-90.
-50. Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis. 2017 Jun 1;11(6):649-70.
-51. Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management. J Crohns Colitis. 2017 Jan;11(1):3-25.
-52. Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol. 2019 Mar;114(3):384-413.
-53. Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019 Feb 1;13(2):144-64.
-54. Geboes K, Ectors N, D’Haens G, Rutgeerts P. Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease? Am J Gastroenterol. 1998 Feb;93(2):201-6.
-55. Gecse KB, Vermeire S. Differential diagnosis of inflammatory bowel disease: imitations and complications. Lancet Gastroenterol Hepatol. 2018 Sep;3(9):644-53.
-56. Tontini GE, Vecchi M, Pastorelli L, Neurath MF, Neumann H. Differential diagnosis in inflammatory bowel disease colitis: state of the art and future perspectives. World J Gastroenterol. 2015 Jan 7;21(1):21-46.
-57. Kedia S, Das P, Madhusudhan KS, Dattagupta S, Sharma R, Sahni P, et al. Differentiating Crohn’s disease from intestinal tuberculosis. World J Gastroenterol. 2019 Jan 28;25(4):418-32.
-58. Lee Y, Yang SK, Byeon JS, Myung SJ, Chang HS, Hong SS, et al. Analysis of Colonoscopic Findings in the Differential Diagnosis Between Intestinal Tuberculosis and Crohn’s Disease [Internet]. Vol. 38, Endoscopy. 2006. p. 592-7. Available from: http://dx.doi.org/10.1055/s-2006-924996
-59. Kantor M, Abrantes A, Estevez A, Schiller A, Torrent J, Gascon J, et al. Entamoeba Histolytica: Updates in Clinical Manifestation, Pathogenesis, and Vaccine Development. Can J Gastroenterol Hepatol. 2018 Dec 2;2018:4601420.
-60. Kurahara K, Matsumoto T, Iida M, Honda K, Yao T, Fujishima M. Clinical and endoscopic features of nonsteroidal anti-inflammatory drug-induced colonic ulcerations. Am J Gastroenterol. 2001 Feb;96(2):473-80.
-61. Calmet FH, Yarur AJ, Pukazhendhi G, Ahmad J, Bhamidimarri KR. Endoscopic and histological features of mycophenolate mofetil colitis in patients after solid organ transplantation. Ann Gastroenterol Hepatol. 2015 Jul;28(3):366-73.
-62. Barquín-García A, Molina-Cerrillo J, Garrido P, Garcia-Palos D, Carrato A, Alonso-Gordoa T. New oncologic emergencies: What is there to know about inmunotherapy and its potential side effects? Eur J Intern Med. 2019 Aug;66:1-8.
-63. Soularue E, Lepage P, Colombel JF, Coutzac C, Faleck D, Marthey L, et al. Enterocolitis due to immune checkpoint inhibitors: a systematic review. Gut. 2018 Nov;67(11):2056-67.
-64. Haanen JBAG, Carbonnel F, Robert C, Kerr KM, Peters S, Larkin J, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29(Suppl 4):iv264-6.
-65. Doulberis M, Panagopoulos P, Scherz S, Dellaporta E, Kouklakis G. Update on ischemic colitis: from etiopathology to treatment including patients of intensive care unit [Internet]. Vol. 51, Scandinavian Journal of Gastroenterology. 2016. p. 893-902. Available from: http://dx.doi.org/10.3109/00365521.2016.1162325
-66. Vodusek Z, Feuerstadt P, Brandt LJ. Review article: the pharmacological causes of colon ischaemia. Aliment Pharmacol Ther. 2019 Jan;49(1):51-63.
-67. Lee JS, Kim ES, Moon W. Chronological Review of Endoscopic Indices in Inflammatory Bowel Disease. Clin Endosc. 2019 Mar;52(2):129-36.
-68. Carbonnel F, Lavergne A, Lémann M, Bitoun A, Valleur P, Hautefeuille P, et al. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci. 1994 Jul;39(7):1550-7.
-69. Qiu Y, Chen B, Li Y, Xiong S, Zhang S, He Y, et al. Risk factors and long-term outcome of disease extent progression in Asian patients with ulcerative colitis: a retrospective cohort study. BMC Gastroenterol. 2019 Jan 10;19(1):7.
-70. Turner D, Ricciuto A, Lewis A, D’Amico F, Dhaliwal J, Griffiths AM, et al. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570-83.
-71. Itzkowitz SH, Harpaz N. Diagnosis and management of dysplasia in patients with inflammatory bowel diseases [Internet]. Vol.126, Gastroenterology. 2004. p. 1634-48. Available from: http://dx.doi.org/10.1053/j.gastro.2004.03.025
-72. Gupta RB, Harpaz N, Itzkowitz S, Hossain S, Matula S, Kornbluth A, et al. Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study. Gastroenterology. 2007 Oct;133(4):1099-105; quiz 1340-1.
-73. Ullman TA, Itzkowitz SH. Intestinal Inflammation and Cancer [Internet]. Vol. 140, Gastroenterology. 2011. p. 1807-16.e1. Available from: http://dx.doi.org/10.1053/j.gastro.2011.01.057
-74. Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001 Apr;48(4):526-35.
-75. Jess T, Rungoe C, Peyrin-Biroulet L. Risk of colorectal cancer in patients with ulcerative colitis: a meta-analysis of population-based cohort studies. Clin Gastroenterol Hepatol. 2012 Jun;10(6):639-45.
-76. Terg R, Sambuelli A, Coronel E, Mazzuco J, Cartier M, Negreira S, et al. Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis and the risk of developing malignancies. A large prospective study. Acta Gastroenterol Latinoam. 2008 Mar;38(1):26-33.
-77. Farraye FA, Odze RD, Eaden J, Itzkowitz SH. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010 Feb;138(2):746-74, 774.e1-4; quiz e12-3.
-78. Van Assche G, Dignass A, Bokemeyer B, Danese S, Gionchetti P, Moser G, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations. J Crohns Colitis. 2013 Feb;7(1):1-33.
-79. Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R, et al. SCENIC International Consensus Statement on Surveillance and Management of Dysplasia in Inflammatory Bowel Disease [Internet]. Vol. 148, Gastroenterology. 2015. p. 639-51.e28. Available from: http://dx.doi.org/10.1053/j.gastro.2015.01.031
-80. Murthy SK, Feuerstein JD, Nguyen GC, Velayos FS. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology. 2021 Sep;161(3):1043-51.e4.
-81. Shen B. Interventional IBD: The Role of Endoscopist in the Multidisciplinary Team Management of IBD [Internet]. Vol. 24, Inflammatory Bowel Diseases. 2018. p. 298-309. Available from: http://dx.doi.org/10.1093/ibd/izx058
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