Publications by authors named "Víctor Amo Trillo"

11 Publications

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Sunlight exposure in inflammatory bowel disease outpatients: Predictive factors and correlation with serum vitaminD.

Gastroenterol Hepatol 2019 Dec 28;42(10):604-613. Epub 2019 Aug 28.

Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional de Málaga, Málaga, España; Facultad de Medicina, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.

Introduction: Sunlight exposure is the main source of vitaminD. Our aim was to describe both sun exposure and sun protection behaviour in a series of patients with inflammatory bowel disease (IBD), and to study their potential association with vitaminD concentration.

Patients And Methods: A cross sectional, observational study. The clinical-demographic variables were obtained via clinical interviews and medical history review. The sunlight exposure assessment was carried out using the Sun Exposure Questionnaire and the concentration of 25-hydroxy vitaminD (25OHD) was measured by an electro-chemiluminescence immunoassay. Questionnaires were conducted on quality of life, physical activity, weekly vitaminD intake and sun protection behaviour.

Results: 149 patients were included. In 69% of patients, deficient or insufficient 25OHD values were recorded. 67% showed low sun exposure. A modest significant correlation was observed between the total score of the solar exposure questionnaire and the 25OHD concentration in the complete series (r=0.226, P=.006) and in the summer (r=0.274, P=.01). The sun protection behaviour questionnaire score did not influence the 25OHD concentration. In the multivariate analysis, only the presence of clinical activity was associated with low sun exposure (OR=3.23).

Discussion: Sun exposure according to the questionnaire used was low, was associated with the presence of clinical activity and was weakly correlated with serum 25OHD concentration. More studies are needed to explore the use of individual questionnaires for sun exposure and its relationship with vitaminD in patients with IBD.
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http://dx.doi.org/10.1016/j.gastrohep.2019.07.002DOI Listing
December 2019

Vitamin D in Inflammatory Bowel Disease: Biological, Clinical and Therapeutic Aspects.

Curr Drug Metab 2019 ;20(5):390-398

Clinical Management Unit of Digestive Diseases, Regional University Hospital of Malaga, Malaga, Spain; Faculty of Medicine, University of Malaga, Malaga, Spain.

Background: Vitamin D has an immunoregulatory action in Inflammatory Bowel Disease (IBD) as well as other immune-mediated disorders. Its influence on intestinal permeability, innate and adaptive immunity, and the composition and diversity of the microbiota contribute to the maintenance of intestinal homeostasis. Patients with IBD have a greater prevalence of vitamin D deficiency than the general population, and a possible association between this deficit and a worse course of the disease. However, intervention studies in patients with IBD have proved inconclusive.

Objective: To review all the evidence concerning the role of vitamin D as an important factor in the pathophysiology of IBD, review the associations found between its deficiency and the prognosis of the disease, and draw conclusions for the practical application from the main intervention studies undertaken.

Methods: Structured search and review of basic, epidemiological, clinical and intervention studies evaluating the influence of vitamin D in IBD, following the basic principles of scientific data.

Results: Vitamin D deficiency is associated with disease activity, quality of life, the consumption of social and healthcare resources, and the durability of anti-TNFα biological treatment. Determination of new metabolites of vitamin D, measurement of its absorption capacity and questionnaires about sun exposure could help identify groups of IBD patients with a special risk of vitamin D deficiency.

Conclusion: Well-designed intervention studies are needed in IBD, with probably higher objective plasma doses of vitamin D to establish its efficacy as a therapeutic agent with immunomodulatory properties. Meanwhile, vitamin D deficiency should be screened for and corrected in affected patients in order to achieve adequate bone and phosphocalcic metabolism.
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http://dx.doi.org/10.2174/1389200220666190520112003DOI Listing
December 2019

Vitamin D deficiency in outpatients with inflammatory bowel disease: prevalence and association with clinical-biological activity.

Rev Esp Enferm Dig 2019 Jan;111(1):46-54

UGC Aparato Digestivo, Hospital Regional Universitario de Málaga, España.

Introduction: there are few data on the prevalence of vitamin D deficiency in patients with inflammatory bowel disease (IBD) in Spain. A deficiency could be associated with a worse course of the disease.

Aim: to determine the prevalence of 25-hydroxyvitamin D (25OHD) deficiency in a cohort of outpatients with IBD and assess its association with clinical and biological activity, quality of life and psychological symptoms.

Methods: a cross-sectional, single-center observational study was performed. The study variables were obtained via clinical interviews, medical chart review and validated questionnaires (Hospital Anxiety and Depression Scale and Short Quality of Life in Inflammatory Bowel Disease Questionnaire). 25OHD was measured in the same laboratory by an electro-chemiluminescence immunoassay.

Results: the study included 224 patients. The prevalence of vitamin D deficiency in Crohn's disease and ulcerative colitis was 33.3% and 20.3%, respectively. In Crohn's disease, vitamin D deficiency was associated with a higher clinical activity (p < 0.001) and a higher concentration of fecal calprotectin (p = 0.01). In ulcerative colitis, it was associated with clinical activity (p < 0.001), the use of steroids during the last six months (p = 0.001) and hospital admission during the previous year (p = 0.003). A sub-analysis of 149 patients failed to detect an association between vitamin D and quality of life or the scores of the Hospital Anxiety and Depression Scale.

Conclusions: vitamin D deficiency is common in patients with inflammatory bowel disease. An association was found between vitamin D concentration and clinical activity indexes, as well as fecal calprotectin levels in Crohn's disease.
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http://dx.doi.org/10.17235/reed.2018.5714/2018DOI Listing
January 2019

Efficacy and safety of vedolizumab as a treatment option for moderate to severe refractory ulcerative colitis in two patients after liver transplant due to primary sclerosing cholangitis.

Rev Esp Enferm Dig 2017 Sep;109(9):659-662

UGC Aparato Digestivo, Hospital Regional Universitario de Málaga, España.

Vedolizumab is a humanized IgG1 monoclonal antibody that selectively blocks the lymphocyte integrin α4β7 and prevents its interaction with endothelial adhesion molecules and subsequent transmigration to the gastrointestinal tract. The drug was approved in 2014 for the induction and maintenance treatment of ulcerative colitis and moderate to severe Crohn's disease that is refractory or intolerant to conventional treatment with corticoids and immunosuppressants and/or anti-TNFα drugs. However, inflammatory bowel disease has a variable behavior following liver transplant. One third of patients with ulcerative colitis associated with primary sclerosing cholangitis are expected to deteriorate despite receiving immunosuppression to prevent rejection. There is limited experience with anti-TNFα agents in patients with inflammatory bowel disease in the setting of liver transplantation and the studies to date involve a limited number of cases. The efficacy and safety data of vedolizumab in this situation are unreliable and very preliminary. We present two cases with the aim to present the efficacy and safety of vedolizumab after one year of treatment in two patients who underwent a transplant due to primary sclerosing cholangitis. One case had de novo post-transplant ulcerative colitis refractory to two anti-TNFα drugs (golimumab and infliximab). The other patient had a colostomy due to fulminant colitis and developed severe ulcerative proctitis refractory to infliximab after reconstruction with an ileorectal anastomosis.
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http://dx.doi.org/10.17235/reed.2017.5024/2017DOI Listing
September 2017

Medium to long-term efficacy and safety of oral tacrolimus in moderate to severe steroid refractory ulcerative colitis.

Rev Esp Enferm Dig 2017 Aug;109(8):559-565

UGC Aparato Digestivo, Hospital Regional Universitario de Málaga.

Background And Objective: Oral tacrolimus is an effective drug that induces clinical remission in patients with moderate to severe ulcerative colitis refractory to steroids. However, there is little data with regard to its medium to long-term efficacy and safety. The aim of this study was to assess the medium to long-term efficacy and safety of oral tacrolimus in this challenging clinical situation.

Methods: This was a retrospective observational review of the clinical charts of 34 patients with moderate to severe ulcerative colitis refractory to steroids treated with oral tacrolimus at our hospital (July 2001-July 2016). Remission was defined as a Lichtiger index score < 3 and response was defined as a score < 10 with a reduction of at least three points compared to the baseline score.

Results And Conclusions: Seven patients (20.58%) required colectomy during the follow-up period (mean 65 months). Nine patients required rescue with infliximab (four patients during the first six months of follow-up and the other five after the first six months). The short to medium clinical efficacy combining both remission and clinical response was 82% at six months. Kaplan-Meier analysis showed that the percentage of patients free from colectomy and additional sequential rescue therapy was 75% at 54 months (median follow-up). The early introduction of thiopurines (< 2 months from start of tacrolimus) showed no significant improvement in prognosis (p = 0.72). Fifty-three per cent of patients experienced adverse effects, none of whom required treatment withdrawal. No severe infections were noted during the follow-up.
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http://dx.doi.org/10.17235/reed.2017.4899/2017DOI Listing
August 2017

Inflammatory Bowel Disease: New Therapeutic Options in the Post Anti-TNFα Era.

Curr Drug Metab 2017 ;18(7):666-679

UGC de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga. Spain.

Background: Inflammatory bowel diseases are chronic bowel disorders the causes of which have not been fully elucidated, though they all sharean immunological basis. They have an important impact on both quality of life of the patient and on healthcare services.

Method: The incorporation of biological agents against tumour necrosis factor (TNF) alpha some 15 years ago represented a revolution in the management of patients with disease that did not respond to conventional treatment, enabling an overall improvement in the quality of life of many of these patients.

Results: Nonetheless, these agents are not effective in an appreciable percentage of patients (primary lack of response), can lose their efficacy over time even though they were initially effective (loss of secondary response), and can also be burdened by varied and sometimes severe adverse effects (e.g., infusion reactions, infections, neoplasms). Consequently, basic research over recent years has provided us with promising new pharmacological agents aimed at targets other than TNF alpha (IL12/23, anti-adhesion molecules, Janus kinase inhibitors, anti- Smad7, blockade of sphingosine-1-phosphate receptors).

Conclusion: This paper reviews some of the key aspects of these new drugs, including their mechanism of action, some incipient pharmacokinetic and metabolic data, their efficacy and their safety. These new agents will take on an important role in the coming years in the management of patients with moderate-to-severe forms of inflammatory bowel disease.
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http://dx.doi.org/10.2174/1389200218666170406120203DOI Listing
September 2018

Metabolic complications in liver transplant recipients.

World J Gastroenterol 2016 Jul;22(28):6416-23

Miguel Jiménez-Pérez, Rocío González-Grande, Edith Omonte Guzmán, Víctor Amo Trillo, Juan Miguel Rodrigo López, UGC de Aparato Digestivo, Unidad de Hepatología-Trasplante Hepático, Hospital Universitario Regional de Málaga, 29010 Málaga, Spain.

The metabolic syndrome (MS), which includes obesity, dyslipidaemia, hypertension and hyperglycaemia according to the most widely accepted definitions now used, is one of the most common post-transplant complications, with a prevalence of 44%-58%. The MS, together with the immunosuppression, is considered the main risk factor for the development of cardiovascular disease (CVD) in transplant recipients, which in turn accounts for 19%-42% of all deaths unrelated to the graft. The presence of MS represents a relative risk for the development of CVD and death of 1.78. On the other hand, non-alcoholic fatty liver disease (NAFLD), considered as the manifestation of the MS in the liver, is now the second leading reason for liver transplantation in the United States after hepatitis C and alcohol. NAFLD has a high rate of recurrence in the liver graft and a direct relation with the worsening of other metabolic disorders, such as insulin resistance or diabetes mellitus. Consequently, it is vitally important to identify and treat as soon as possible such modifiable factors as hypertension, overweight, hyperlipidaemia or diabetes in transplanted patients to thus minimise the impact on patient survival. Additionally, steroid-free regimens are favoured, with minimal immunosuppression to limit the possible effects on the development of the MS.
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http://dx.doi.org/10.3748/wjg.v22.i28.6416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968123PMC
July 2016

[Peristomal pyoderma gangrenosum after rectal adenocarcinoma in the context of colonic and complex perianal Crohn's disease].

Gastroenterol Hepatol 2016 May 18;39(5):338-41. Epub 2015 Jun 18.

Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, España.

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http://dx.doi.org/10.1016/j.gastrohep.2015.05.001DOI Listing
May 2016

[Postpolypectomy syndrome. A report of our experience].

Gastroenterol Hepatol 2014 Dec 8;37(10):570-2. Epub 2014 Aug 8.

Hospital Regional Universitario Carlos Haya, Málaga, España.

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http://dx.doi.org/10.1016/j.gastrohep.2014.02.004DOI Listing
December 2014

[Extramedullary plasmacytoma of the colon].

Gastroenterol Hepatol 2007 May;30(5):277-9

Servicio Aparato Digestivo, Hospital Universitario Carlos Haya, Avenida Pepa Guerra Valdenebro 12, F.29631 Arroyo de la Miel, Málaga, España.

We report the case of a 68 year-old man in whom a tumour of the colon was identified by colonoscopy, during diagnostic studies for lower gastrointestinal bleeding as an outpatient. Histological examination showed clonal proliferation of plasma cells IgG-K. No other location was affected (including bone marrow). Diagnosis of plasmacytoma of the colon was made. We have carried out a review of the literature in relation to this unusual disorder.
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http://dx.doi.org/10.1157/13101978DOI Listing
May 2007

[Tacrolimus in the treatment of refractory moderate-to-severe inflammatory bowel disease].

Gastroenterol Hepatol 2006 Jun-Jul;29(6):327-33

Servicio de Aparato Digestivo, Hospital Regional Universitario Carlos Haya, Málaga, Spain.

Introduction: The primary endpoint of this study was to evaluate the efficacy of oral tacrolimus in patients with active moderate-to-severe luminal IBD, mainly those refractory to steroids. Secondary endpoints were surgery requirements during follow-up, the percentage of patients achieving steroid withdrawal, and treatment safety.

Patients And Method: Nineteen patients were included. The main indication for tacrolimus therapy was steroid resistance. The mean duration of treatment was 11 (range 3- 13) and 15 (range 4-44) months in patients with UC and CD, respectively. Remission was evaluated at weeks 4, 8 and 24 from the start of treatment, using the Harvey-Bradshaw index and the Truelove-Witts criteria for CD and UC patients, respectively, and acute- phase reactants (Serum erythrocyte sedimentation rate and C-reactive protein). Steroid withdrawal, need for surgery, and previous and concomitant medication were also evaluated.

Results: Overall, 47%, 66% and 41% of the patients were in complete remission at weeks 4, 8 and 24, respectively. Steroid withdrawal was achieved in 50% of the patients. Among patients who could not undergo complete steroid withdrawal, steroid therapy was reduced to a mean prednisone dose of 12.5 mg /day (range 10-15 mg). Surgery was required in 16% (mean follow-up of 38 months). Adverse effects occurred in 63% patients, who improved with dose reduction; none of the patients required tacrolimus withdrawal.

Conclusions: Oral tacrolimus could be a safe, effective and useful option in patients with refractory IBD.
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http://dx.doi.org/10.1157/13089714DOI Listing
September 2006