Browsing by Author "Candia, Roberto"

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    Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile
    (2024) Silva, Felipe; Bustamante, Miguel; Latorre, Gonzalo; Flandez, Jorge; Montero, Isabella; Dukes, Eitan; Gandara, Vicente; Robles, Camila; Uribe, Javier; Iglesias, Andres; Bellolio, Felipe; Molina, Maria Elena; Migueles, Rodrigo; Urrejola, Gonzalo; Larach, Tomas; Besser, Nicolas; Sharp, Allan; Aguero, Carlos; Riquelme, Arnoldo; Vargas, Jose Ignacio; Candia, Roberto; Monrroy, Hugo; De Simone, Federico; Espino, Alberto
    Background: Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. Aim: To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. Methods: Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. Results: A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n = 38), gastrointestinal stromal tumors (GIST) (21.8%, n = 19), lymphoma (17.2%, n = 15) and adenocarcinoma (AC) (11.5%, n = 10). GIST was more frequent in duodenum (50%; n = 12) and NET in the ileum (65.8%; n = 25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC ( p = 0.035), as well as gastrointestinal bleeding in GIST ( p = 0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5 -year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1 - 99.2), 82.2% (95%CI: 57.6 - 93.3), 40.0% (95%CI: 16.5 - 82.8) and 25.9% (95%CI: 4.5 - 55.7%), respectively. NET (HR 6.1; 95%CI: 2.1 - 17.2) and GIST (HR 24.4; 95%CI: 3.0 - 19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. Conclusions: Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes. (c) 2024 Elsevier Espana, S.L.U. All rights reserved.
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    Colorectal adenomas and MAFLD: a cross-sectional study in a Hispanic screening cohort
    (2022) Villalon, Alejandro; Diaz, Luis Antonio; Fuentes-Lopez, Eduardo; Villalon, Javier; Villalon, Fernando; Ayares, Gustavo; Yanez, Barbara; Candia, Roberto; Arab, Juan Pablo; Arrese, Marco
    Aims: Prior evidence demonstrates an association between non-alcoholic fatty liver disease (NAFLD) and colorectal adenomas (CRA) risk. However, information using the new definition of the disease [i.e., metabolic dysfunction-associated fatty liver disease (MAFLD)] is scarce. We aimed to assess the relationship between MAFLD and CRA risk. Methods: We conducted a cross-sectional study including patients from three university centers in Chile who underwent a colonoscopy for colorectal cancer screening and abdominal imaging study. We obtained sociodemographic and clinical data, and we performed univariate and multivariable regression analyses. Results: In total, 895 patients were included; 42% were male, the mean age was 59.9 +/- 9.3 years, and 37.8% (338) had CRA. Patients harboring polyps were predominantly males (48.2% vs . 38.2%, P = 0.002), older (61.6 +/- 8.7 years vs . 58.9 +/- 9.5 years, P < 0.001), and exhibited a higher body weight than controls [75 (66-88) kg vs . 72 (63-82.3) kg, P = 0.002]. Fifty-six percent of patients showed hepatic steatosis in imaging studies and 54.4% met MAFLD diagnostic criteria. The adenoma detection rate was higher in the MAFLD group compared to controls (46.4% vs . 27.5%, P < 0.001). In the multivariable analysis, MAFLD was significantly associated with the presence of CRA (odds ratio = 2.32; 95%CI: 1.68-3.19, P < 0.0001). There were no statistically significant differences of histopathological characteristics of the adenomas according to the presence of MAFLD. Conclusion: The present study shows that, in Chilean Hispanic subjects, MAFLD is associated with an increased risk of CRA. This information may be useful to design specific screening colonoscopy recommendations in MAFLD patients.
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    De-escalating therapy in inflammatory bowel disease: Results from an observational study in clinical practice
    (2024) Arenas, Alex; Moreta, Maria Jose; Ordas, Ingrid; Fernandez-Clotet, Agnes; Caballol, Berta; Gallego, Marta; Vara, Alejandro; Barastegui, Rebeca; Giner, Angel; Prieto, Cristina; Masamunt, Maria Carme; Candia, Roberto; Ricart, Elena
    Background and objectives: Combination therapy with an immunomodulator (IMM) and an antiTNF is commonly recommended in Crohn's disease (CD) and ulcerative colitis (UC) patients. However, little is known about relapse rates after therapeutic de-escalation. This study aimed to evaluate the risk of relapse in a cohort of UC and CD patients with long-standing clinical remission after discontinuation of IMM or anti-TNF and to identify predictive factors for relapse. Methods: This retrospective study included patients with UC or CD on combination therapy and clinical remission for at least 6 months. IMM or anti-TNF was stopped upon physician decision. Primary objective was to evaluate the relapse rates after discontinuation of IMM or anti-TNF and to analyze predictors of relapse. Results: The study included 88 patients, 48 patients (54.5%) discontinued IMM and 40 (45.5%) anti-TNF. During follow-up, relapse rates were 16.7% and 52.5% in the IMM discontinuation group and anti-TNF discontinuation group, respectively (p < 0.001). Multivariate analysis showed that anti-TNF discontinuation (HR = 3.01; 95% CI = 1.22-7.43) and ileal CD location (HR = 2.36; 95% CI = 1.02-5.47) were predictive factors for relapse while inflammatory CD phenotype was a protective factor (HR = 0.32; 95% CI = 0.11-0.90). Reintroduction of anti-TNF upon relapse was effective and safe. Conclusion: Anti TNF discontinuation led to significantly higher relapse rates compared to IMM discontinuation in UC and CD patients on combination therapy. Anti-TNF discontinuation and ileal CD location were identified as predictive factors for relapse while inflammatory CD phenotype was a protective factor. Retreatment after anti-TNF discontinuation was effective and safe. (c) 2023ElsevierEspa na,S.L.U.Allrightsreserved.
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    Diagnóstico y manejo de colitis ulcerosa grave. Una mirada actualizada
    (2017) Hernandez Rocha, Cristian; Ibanez, Patricio; Elena Molina, Maria; Klaassen, Julieta; Valenzuela, Andrea; Candia, Roberto; Bellolio, Felipe; Zuniga, Alvaro; Miguieles, Rodrigo; Francisco Miquel, Juan; Chianale, Jose; Alvarez Lobos, Manuel
    Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.
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    ¿Es efectiva la pentoxifilina en hepatitis alcohólica?
    (2014) Rada G., Gabriel; Arteaga, Matías; Candia, Roberto
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    High prevalence of autoimmune gastropathy, clinical characteristics and association with hypothyroidism: prospective analisys of 921 patients with gastric biopsies by sydney protocol
    (2018) Vargas Domínguez, José Ignacio; Maquilon, Sara; Torres, Javiera; Revelo, Santiago; Vargas, Camila; Garcia-Huidobro, Antonia; Castro, Josefina; Candia, Roberto; Gonzalez, Robinson G.; Baudrand, Rene; Espino, Alberto
    BACKGROUND: The prevalence of autoimmune gastropathy is increasing, and is considered underdiagnosed. The application of the Sydney protocol for gastric biopsies will probably allow to detect more cases at an early stage. AIM: To determine the prevalence of autoimmune gastropathy in gastric biopsies according to Sydney-OLGA protocol, and define its clinical and laboratory characteristics. Explore the association of autoimmune gastropathy with other autoimmune diseases. METHODS: Single center prospective observational study. Evaluation of gastric biopsies according to Sydney protocol between July 2016 and July 2017 to determine prevalence of autoimmune gastropathy. Autoimmune gastropathy was defined by histologic criteria as gastric corporal exclusive or predominant atrophy. Identification of histologic, clinical and laboratory findings of patients with autoimmune gastropathy. Descriptive statistics and inferential analysis comparing histological findings of autoimmune gastropathy and H. pylori-associated gastropathy. RESULTS: 921 gastric biopsies were evaluated. Mean age was 58 years (range 27-87), 58% female gender. The prevalence of autoimmune gastropathy was 8.8% (81/921). Presence of OLGA stages 3-4 was higher in autoimmune gastropathy than in HP-associated gastropathy (33.3 vs 15.8%, p = 0.004). Age was no different between the two groups (p=0.82). In the characterization of patients with autoimmune gastropathy, the prevalence of gastric polyps in autoimmune gastropathy was 11% (9/81), 4 of then were NETs. In patients with autoimmune gastropathy, only 3.3% had a previous diagnosis of pernicious anemia, and in 11% the reasons for endoscopy was the study of anemia. 18.5% had family history of gastric cancer. The prevalence of hypothyroidism was 30% (24/81). Other autoimmune disease was less frequent (13.5%). CONCLUSION: Our study shows a high prevalence of autoimmune gastropathy detected by gastric biopsies with Sydney protocol. In most cases, clinical characteristics of pernicious anemia was absent and the suspicion for this disease prior to endoscopy was low. Presence of advanced stages of gastric atrophy were frequent. The prevalence of thyrogastric syndrome, autoimmune gastropathy associated to hypothyroidism, was also frequent. The use of Sydney protocol for gastric biopsies allows to detect a higher proportion of patients with autoimmune gastropathy at early stages of the disease.
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    Implementation of the updated Sydney system biopsy protocol improves the diagnostic yield of gastric preneoplastic conditions: Results from a real-world study
    (2024) Latorre, Gonzalo; Vargas, Jose Ignacio; Shah, Shailja C.; Ivanovic-Zuvic, Danisa; Achurra, Pablo; Fritzsche, Martin; Leung, Jai-Sen; Ramos, Bernardita; Jensen, Elisa; Uribe, Javier; Montero, Isabella; Gandara, Vicente; Robles, Camila; Bustamante, Miguel; Silva, Felipe; Dukes, Eitan; Corsi, Oscar; Martinez, Francisca; Binder, Victoria; Candia, Roberto; Espino, Alberto; Agueero, Carlos; Sharp, Allan; Torres, Javiera; Roa, Juan Carlos; Pizarro, Margarita; Corvalan, Alejandro H.; Rabkin, Charles S.; Camargo, M. Constanza; Riquelme, Arnoldo
    Background: The updated Sydney system biopsy protocol (USSBP) standardizes the sampling of gastric biopsies for the detection of preneoplastic conditions ( e.g. , gastric intestinal metaplasia [GIM]), but the real-world diagnostic yield is not well-described. Aim: To determine whether regular application of USSBP is associated with higher detection of chronic atrophic gastritis (CAG), GIM and autoimmune gastritis (AIG). Methods: We performed a real-world retrospective study at an academic urban tertiary hospital in Chile. We manually reviewed medical records from consecutive patients undergoing esophagogastroduodenoscopy (EGD) from January to December 2017. Seven endoscopists who performed EGDs were categorized into two groups (USSBP 'regular' and USSBP 'infrequent') based on USSBP adherence, using minimum 20% adherence as the prespecified threshold. Multivariable logistic regression models were used to estimate the odds ratios (aOR) and 95% confidence intervals (CI) for the association between endoscopist groups and the likelihood of diagnosing CAG, GIM or AIG. Results: 1206 patients were included in the study (mean age: 58.5; 65.3% female). The USSBP regular group demonstrated a higher likelihood of detecting CAG (20% vs . 5.3%; aOR 4.03, 95%CI: 2.69-6.03), GIM (12.2% vs. 3.4%; aOR 3.91, 95%CI: 2.39-6.42) and AIG (2.9% vs. 0.8%; aOR 6.52, 95%CI: 1.87-22.74) compared to infrequent group. Detection of advanced-stage CAG (Operative Link for Gastritis Assessment stage III/IV) was significantly higher in the USSBP regular vs. infrequent group (aOR 5.84, 95%CI: 2.23-15.31). Conclusions: Routine adherence to USSBP increases the detection rates of preneoplastic conditions, including CAG, GIM and AIG. Standardized implementation of USSBP should be considered in high gastric cancer risk populations. (c) 2023 Elsevier Espana, S.L.U. All rights reserved.
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    Overexpression of 11 beta-hydroxysteroid dehydrogenase type 1 in visceral adipose tissue and portal hypercortisolism in non-alcoholic fatty liver disease
    (WILEY, 2012) Candia, Roberto; Riquelme, Arnoldo; Baudrand, Rene; Carvajal, Cristian A.; Morales, Mauricio; Solis, Nancy; Pizarro, Margarita; Escalona, Alex; Carrasco, Gonzalo; Boza, Camilo; Perez, Gustavo; Padilla, Oslando; Cerda, Jaime; Fardella, Carlos E.; Arrese, Marco
    Background: The enzyme 11 beta-hydroxysteroid-dehydrogenase type 1 (11 beta HSD1) catalyses the reactivation of intracellular cortisol. We explored the potential role of 11 beta-HSD1 overexpression in visceral adipose tissue (VAT) in non-alcoholic fatty liver disease (NAFLD) assessing sequential changes of enzyme expression, in hepatic and adipose tissue, and the occurrence of portal hypercortisolism in obese mice. 11 beta-HSD1 expression was also assessed in tissues from obese patients undergoing bariatric surgery. Methods: Peripheral and portal corticosterone levels and liver histology were assessed in ob/ob mice at two time points (8-12 weeks of age). 11 beta-HSD1 tissue expression was assessed in by RT-pcr in ob/ob mice and in 49 morbidly obese patients. Results: Portal corticosterone serum levels were higher in obese mice with a 26% decrease between 8 and 12 weeks of age (controls: 78.3 +/- 19.7 ng/ml, 8-week-old ob/ob: 167.5 +/- 14.5 ng/ml and 12-week-old ob/ob: 124.3 +/- 28 ng/ml, P < 0.05). No significant differences were found in peripheral corticosterone serum levels. Expression of 11b-HSD1 was lower in the liver [-45% at 8 weeks and -35% at 12-weeks (P = 0.0001)] and highly overexpressed in VAT in obese mice, compared to controls (128-fold higher in 8-week-old ob/ob and 41-fold higher in 12-week-old ob/ob, P < 0.01). No significant differences were seen in the expression of 11 beta-HSD1 in subcutaneous adipose tissue. In multivariate analysis, human 11 beta-HSD1 expression in VAT (OR: 1.385 +/- 1.010-1.910) was associated with NAFLD. Conclusion: Murine NAFLD is associated with portal hypercortisolism and 11 beta-HSD1 overexpression in VAT. In humans, 11 beta-HSD1 VAT expression was associated with the presence of NAFLD. Thus, local corticosteroid production in VAT may contribute to NAFLD pathogenesis.
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    Prospective follow-up of chronic atrophic gastritis in a high-risk population for gastric cancer in latin america
    (2022) Latorre, Gonzalo; Silva, Felipe; Montero, Isabella; Bustamante, Miguel; Dukes, Eitan; Gandara, Vicente; Robles, Camila; Uribe, Javier; Corsi, Oscar; Crispi, Francisca; Espinoza Sepúlveda, Manuel Antonio; Cuadrado, Cristobal; Fuentes-Lopez, Eduardo; Shah, Shailja; Camargo, M. Constanza; Torres, Javiera; Roa, Juan Carlos; Corvalan, Alejandro H.; Candia, Roberto; Aguero, Carlos; Gonzalez, Robinson G.; Vargas Domínguez, José Ignacio; Espino, Alberto; Riquelme, Arnoldo
    Background. Gastric adenocarcinoma (GA) is preceded by premalignant conditions such as chronic atrophic gastritis (CAG) with or without gastric intestinal metaplasia (GIM). Endoscopic follow-up of these conditions has been proposed as a strategy for the detection of early-stage GA. Aim. To describe the risk of progression to gastric dysplasia (GD) and early-stage GA of patients who underwent esophagogastroduodenoscopy (EGD) with gastric biopsies obtained following the updated Sydney System biopsy protocol (USSBP). Methods. We conducted a real-world, multicenter, prospective cohort study. Patients undergoing EGD surveillance with USSBP were enrolled between 2015 and 2021 from three endoscopy units at Santiago, Chile. Patients with prior history of GA or gastric resection were excluded. Follow-up surveillance schedule was determined by gastroenterologist in accordance with the Chilean Digestive Endoscopy Association Guidelines. CAG was confirmed by two expert GI pathologists and categorized by the Operative Link on Gastritis Assessment as stage 0 (normal) through stage IV (advanced stage). The primary endpoint was a composite of GD (low-grade, LGD or high-grade, HGD) or GA, while secondary endpoints were progression in OLGA and separate outcomes of LGD, HGD or GA. Multivariable Cox regression analysis was used to estimate the association between CAG +/- GIM and the outcomes, adjusted for age, sex and Helicobacter pylori (Hp) infection. Results. 600 patients were included in the cohort (64% female; mean age 58 years). At baseline 32.3% (n=194) had active Hp infection. OLGA stage was: 31% (n=184) OLGA 0, 48% (n=291) OLGA I-II and 21% (125) OLGA III-IV. GIM was identified in 52% (n=312) and autoimmune gastritis in 6.2% (n=37). Median follow-up was 28 months (IQR 17-42). During follow-up, 6 early-stage GA, 3 HGD and 6 LGD were observed. No advanced-stage GA was diagnosed. Only 19% (n=35) of baseline OLGA 0 patients progressed to OLGA I-IV, with <2% progressing to OLGA III/IV (Figure 1). Persistence of Hp infection (aOR 2.1; 95%CI 1.1-4.0) was independently associated with increase of at least 1 point in the OLGA scale during follow-up. GA/GD free survival at 3- years for OLGA 0, I-II and III-IV was 99.4%, 97.1% and 91.7%, respectively (p=0.0015) (Figure 2). Based on multivariable Cox regression, OLGA III-IV (vs. OLGA 0) was associated with a 12.1-fold (95%CI 1.5-97.4) higher risk of GA, while GIM was associated with a 13.0-fold (95%CI 1.7-101.2) higher risk, although the CI was wide; this was particularly between 2 and 3 years of follow-up. Discussion: These findings, including the observation that all GAs were early-stage, support endoscopic/histologic surveillance for patients with advanced OLGA stages or GIM, which is a common finding in patients with advanced CAG. Further studies are needed to determine the optimal time interval for surveillance.
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    Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease
    (2017) Rumman, Amir; Candia, Roberto; Sam, Justina J.; Croitoru, Kenneth; Silverberg, Mark S.; Steinhart, A. Hillary; Nguyen, Geoffrey C.
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    Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy Response
    (2018) Parra-Blanco, Adolfo; Monrroy Bravo, Hugo Alfonso; Ignacio Vargas, Jose; Candia, Roberto; González Donoso, Robinson
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    Use of N-acetylcysteine plus simethicone to improve mucosal visibility during upper GI endoscopy: a double-blind, randomized controlled trial
    (2018) Monrroy Bravo, Hugo Alfonso; Vargas Domínguez, José Ignacio; Glasinovic, Esteban; Candia, Roberto; Azua, Emilio; Galvez, Camila; Rojas, Camila; Cabrera, Natalia; Vidaurre, Josefa; Alvarez, Natalia; Gonzalez, Jessica; Espino Espino, Alberto Antonio; González Donoso, Robinson; Parra-Blanco