Examinando por Autor "Carrascosa, Juan"

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    Ítem
    Subclinical bowel inflammation increases healthcare resources utilization and steroid use before diagnosis of inflammatory bowel disease
    (John Wiley and Sons Inc, 2023-02) Rodríguez Lago, Iago; Aguirre Larracoechea, Urko ; Ramírez de la Piscina, Patricia; Muñagorri, Ana I.; Zapata, Eva ; Higuera, Rebeca; Montalvo, Isabel; Iriarte, Ainara; Fernández Calderón, María; Arreba González, Paz; Carrascosa, Juan; Cabriada, José Luis ; Barreiro de Acosta, Manuel
    Background: Previous data support that the inflammatory process underlying ulcerative colitis (UC) and Crohn's disease (CD) can start years before the diagnosis. The aim of this study was to determine if patients with an incidental diagnosis of UC or CD demonstrate an increase in healthcare utilization in the years preceding the symptomatic onset of the disease. Methods: We performed a multicenter, retrospective, hospital-based, case-control study. Patients with an incidental diagnosis of UC or CD during the colorectal cancer screening program at 9 hospitals were included. Cases were matched 1:3 and compared separately with two control populations: one including healthy non-IBD subjects adjusted by gender, age, and date, excluding those with visits to Gastroenterology; and a second control cohort of UC/CD patients with symptomatic onset. Results: A total of 124 patients with preclinical inflammatory bowel disease (IBD) were included (87 UC, 30 CD, 7 IBD unclassified; median age 56 years). Patients with preclinical IBD showed an increase in the number of visits to Primary Care up to 3 and 5 years before diagnosis (aIRR 1.59, 95% CI [1.37–1.86], p = 0.001; aIRR 1.43, 95% CI [1.24–1.67], p = 0.01) and more frequent use of steroids (aOR 2.84, 95% CI [1.21–6.69], p = 0.03; aOR 2.25, 95% CI [1.06–4.79], p = 0.04) compared to matched non-IBD healthy controls, respectively. In contrast, patients with a symptomatic onset visited Primary Care less frequently, but they had an increase in the number of visits to Emergency Department, specialist care, sick-leaves, CT/ultrasound examinations, and use of antibiotics or systemic steroids. Conclusions: There is an increased need for medical assistance and use of systemic steroids during the presymptomatic phase of IBD. These results will help in establishing new tools for early identification of IBD in the future.
  • Miniatura
    Ítem
    Transmural cross-sectional findings and bowel damage assessment in preclinical Crohn’s disease: a case-control study
    (Springer Nature, 2024-06-14) Rodríguez Lago, Iago; Aduna, Marta; Ramírez de la Piscina, Patricia; Merino, Olga; Carrascosa, Juan; Higuera, Rebeca; Maíz, Ainara; Zapata, Eva; Cabriada, José Luis; Barreiro de Acosta, Manuel
    Purpose: Crohn’s disease (CD) is a progressive disorder leading to cumulative bowel damage. The Lémann index is a validated tool that can help in monitoring the progression of the disease and evaluating the effectiveness of different therapies. Our aim was to describe the main radiological findings in incidentally diagnosed CD and to evaluate bowel damage in this subgroup compared to patients diagnosed at later stages. Methods: Patients with an incidental diagnosis of CD during the colorectal cancer screening program were compared to controls with a CD cohort diagnosed after symptomatic onset and matched 1:1 by disease extent. All cross-sectional examinations were centrally read, performing a descriptive analysis of the main findings and calculation of Lémann index. Results: Thirty-eight patients were included: 19 with preclinical CD (median age 55 years (IQR, 54–62), 53% male, 74% non-smokers; 74% B1 and 26% B2) and 19 matched-controls with symptomatic CD. In those with preclinical CD, the most frequent transmural findings on MRE were contrast enhancement (79%), wall thickening (79%), followed by lymphadenopathy (68%), edema (42%), and increased vascularity (42%). Among those with strictures, controls showed a higher rate of preestenotic dilation (100% vs. 0%, p = 0.01). Bowel damage assessment revealed no statistically significant differences in the Lémann index between preclinical CD and controls (p = 0.95). A statistically significant higher score in the colonic/rectum score was observed (p = 0.014). Conclusion: Patients with preclinical CD demonstrate similar radiological findings and degree of bowel damage as new-onset symptomatic CD.