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¿Están recibiendo los pacientes con enfermedad inflamatoria intestinal una adecuada inmunización?
Are patients with inflammatory bowel disease receiving adequate immunisation?
Rodrigo Queraa,b,
Autor para correspondencia
rquera@clc.cl

Autor para correspondencia.
, Daniela Simiana,c, Paulina Núñeza,d, Lilian Floresa,b, Carolina Figueroaa,b, Patricio Ibáñeza,b, Udo Kronberga,e, Jaime Lubaschera,b, Gonzalo Pizarroa,b
a Programa Enfermedad Inflamatoria Intestinal, Clínica Las Condes, Santiago, Chile
b Departamento de Gastroenterología, Clínica Las Condes, Santiago, Chile
c Dirección Académica, Clínica Las Condes, Santiago, Chile
d Departamento Gastroenterología, Hospital San Juan de Dios, Universidad de Chile, Santiago, Chile
e Unidad de Coloproctología, Departamento de Cirugía, Clínica Las Condes, Santiago, Chile
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Tasas de vacunaci&#243;n seg&#250;n el tipo de tratamiento para la enfermedad inflamatoria intestinal &#40;EII&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La enfermedad inflamatoria intestinal &#40;EII&#41;&#44; que abarca principalmente a la enfermedad de Crohn y la colitis ulcerosa &#40;CU&#41;&#44; son enfermedades gastrointestinales cr&#243;nicas caracterizadas por per&#237;odos alternos de reca&#237;da y remisi&#243;n&#46; Recientemente&#44; se ha demostrado el aumento en la incidencia y prevalencia de la EII en Latinoam&#233;rica y el Caribe<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a>&#44; similar a lo observado hace algunas d&#233;cadas en pa&#237;ses desarrollados<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a>&#46; Aunque en Chile no contamos con datos&#44; estudios realizados en centros terciarios confirman un aumento en el n&#250;mero de casos y hospitalizaciones durante los &#250;ltimos a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Por otra parte&#44; el tratamiento de la EII ha tenido en las &#250;ltimas d&#233;cadas un avance sustancial tras la incorporaci&#243;n de la terapia biol&#243;gica &#40;anti-TNF&#44; antiintegrinas&#44; anti p40 IL12&#47;23&#41; y mol&#233;culas peque&#241;as<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a>&#46; Si bien estos f&#225;rmacos son efectivos en controlar la actividad de la enfermedad logrando la remisi&#243;n cl&#237;nica y endosc&#243;pica en una proporci&#243;n de pacientes&#44; tambi&#233;n pueden incrementar el riesgo de infecciones o reactivaci&#243;n de enfermedades latentes<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7</span></a>&#44; dado que afectan el sistema inmune humoral y celular<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Se ha propuesto un cribado sistem&#225;tico de infecciones&#44; y un esquema de inmunizaciones en todo paciente con EII&#44; m&#225;s a&#250;n en aquellos que recibir&#225;n terapia inmunomoduladora &#40;tiopur&#237;nicos&#47;metotrexato&#41;&#44; biol&#243;gicos o mol&#233;culas peque&#241;as<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#44;8&#8211;10</span></a>&#46; El momento ideal para realizar la inmunizaci&#243;n es al diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;10</span></a>&#44; independientemente de la gravedad al inicio&#44; ya que la evoluci&#243;n de la enfermedad y su tratamiento pueden variar con el tiempo&#46; Es importante considerar que el estado de inmunosupresi&#243;n secundario a los f&#225;rmacos puede interferir en la eficacia de la inmunizaci&#243;n o contraindicar la administraci&#243;n de aquellas constituidas por agentes vivos&#46; Vacunas con virus vivo atenuado&#44; como es el caso de la vacuna herpes zoster virus&#44; triv&#237;rica&#44; varicela y fiebre amarilla&#44; est&#225;n contraindicadas en caso de inmunosupresi&#243;n severa<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;8&#8211;10</span></a>&#46; Este grupo incluye a aquellos pacientes con EII que se encuentren en tratamiento con prednisona<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a por m&#225;s de 2 semanas&#59; inmunomoduladores&#59; terapia biol&#243;gica y mol&#233;culas peque&#241;as&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Si bien existen diferentes esquemas de inmunizaci&#243;n publicados<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#44;8&#8211;10</span></a>&#44; la prescripci&#243;n de vacunas en pacientes con EII sigue siendo a&#250;n baja<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#8211;15</span></a>&#46; Un estudio realizado en Canad&#225; mostr&#243; que solo el 61&#37; de los pacientes con EII mencion&#243; haber recibido la vacuna de la influenza y un 10&#37; la vacuna antineumococo<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&#46; Por otra parte&#44; un estudio realizado recientemente en Francia&#44; que incluy&#243; 199 pacientes con EII&#44; muestra porcentajes de inmunizaci&#243;n a&#250;n menores contra influenza &#40;34&#37;&#41; y aunque el porcentaje de vacuna contra neumococo fue mayor &#40;38&#37;&#41;&#44; este a&#250;n es bajo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#46; Entre los factores que contribuyen a esta baja tasa de inmunizaci&#243;n destaca el escaso conocimiento de los gastroenter&#243;logos sobre inmunizaci&#243;n en EII&#44; la falta de educaci&#243;n que reciben los pacientes sobre las vacunas y su rol&#44; percepci&#243;n err&#243;nea de la seguridad de las vacunas en pacientes inmunocomprometidos y miedo a los eventos adversos secundarios<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#8211;18</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es describir las prescripciones y la adherencia a las inmunizaciones en pacientes con EII e identificar los posibles factores asociados a esta&#44; compar&#225;ndolo con las recomendaciones de la literatura&#44; con el fin de verificar si las pautas de vacunaci&#243;n se est&#225;n aplicando y cumpliendo correctamente en nuestra poblaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio observacional&#44; descriptivo&#44; transversal y anal&#237;tico&#44; realizado en pacientes con EII atendidos en el Programa de EII de Cl&#237;nica Las Condes durante el per&#237;odo abril-junio de 2019&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los pacientes con diagn&#243;stico confirmado de EC&#44; CU o EII no clasificable&#44; con seguimiento anual en el Programa de EII de Cl&#237;nica Las Condes&#44; fueron invitados a contestar un cuestionario breve donde se evaluaron los siguientes puntos&#58; prescripci&#243;n por equipo tratante de vacuna contra la influenza durante el &#250;ltimo a&#241;o&#44; sugerencia de otras vacunas del programa de inmunizaciones en EII&#44; administraci&#243;n de las mismas&#44; y en caso negativo&#44; razones de no adherencia&#46; La informaci&#243;n de las vacunas administradas se obtuvo del Registro Nacional de Inmunizaciones&#46; Se incluyeron en el an&#225;lisis las siguientes vacunas&#58; influenza&#44; neumoc&#243;cica 13-valente&#44; neumoc&#243;cica 23-polisac&#225;rida&#44; difteria-t&#233;tano-pertussi&#44; hepatitis A&#44; hepatitis B&#44; virus del papiloma humano&#44; meningoc&#243;cica&#44; varicela zoster&#44; herpes zoster vivo&#44; sarampi&#243;n y fiebre amarilla&#46; Para la vacuna contra la influenza&#44; con fines comparativos&#44; se evalu&#243; la informaci&#243;n de la inmunizaci&#243;n recibida los a&#241;os 2017&#44; 2018 y 2019&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables demogr&#225;ficas &#40;edad&#44; g&#233;nero y sistema de cobertura en salud&#41; y cl&#237;nicas &#40;diagn&#243;stico&#44; clasificaci&#243;n de Montreal&#44; a&#241;os de evoluci&#243;n de la enfermedad&#44; a&#241;os de ingreso al Programa de EII&#44; tratamiento actual y tratamiento al momento de recibir vacunas&#41; fueron obtenidas del Registro con fines de Investigaci&#243;n de pacientes con EII de Cl&#237;nica Las Condes&#44; el cual fue aprobado por el Comit&#233; de &#201;tica local en abril de 2012&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se defini&#243; como un esquema de inmunizaci&#243;n completa la administraci&#243;n de las vacunas contra la hepatitis A&#44; hepatitis B&#44; influenza &#40;dentro del &#250;ltimo a&#241;o&#41;&#44; neumoc&#243;cica 13-valente&#44; neumoc&#243;cica 23-polisac&#225;rida&#44; virus papiloma &#40;todo paciente entre 11-26 a&#241;os&#41; y herpes zoster &#40;todo paciente<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50 a&#241;os&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Este estudio fue aprobado por el Comit&#233; de &#201;tica de la instituci&#243;n y se realiz&#243; manteniendo los principios de la Declaraci&#243;n de Helsinki&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los resultados del estudio fueron analizados mediante el software R Commander&#46; Las variables categ&#243;ricas se analizaron a trav&#233;s de frecuencia absoluta y porcentual&#46; Las variables continuas se describieron con medidas de tendencia central y dispersi&#243;n seg&#250;n la distribuci&#243;n de los datos &#40;promedio y desviaci&#243;n est&#225;ndar si siguieron una distribuci&#243;n normal y rango intercuart&#237;lico si no siguieron una distribuci&#243;n normal&#41;&#46; Las variables continuas se compararon usando Mann-Whitney o t-test seg&#250;n fuese la distribuci&#243;n&#46; Para variables categ&#243;ricas se utiliz&#243; frecuencia relativa porcentual y para el an&#225;lisis estad&#237;stico comparativo chi-cuadrado&#46; Se determin&#243; como significaci&#243;n estad&#237;stica un valor de p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Un total de 243 pacientes con EII &#40;correspondientes al 53&#37; del total de pacientes evaluados en el Programa de EII durante el per&#237;odo abril-junio de 2019&#41; respondieron la encuesta de vacunas&#59; no hubo exclusiones por datos incompletos&#46; Los datos demogr&#225;ficos y cl&#237;nicos de los pacientes incluidos en el estudio se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Ciento cuarenta y ocho pacientes con diagn&#243;stico de CU&#44; 86 de EC y 9 con EII no clasificable fueron incluidos en el an&#225;lisis&#46; La mayor&#237;a eran mujeres &#40;68&#37;&#41;&#44; con una mediana de edad de 36 a&#241;os &#40;rango 18-78&#41;&#44; y una mediana de duraci&#243;n de la enfermedad de 5 a&#241;os &#40;rango 0-49&#41;&#46; La mayor&#237;a de los pacientes ten&#237;an un sistema de salud privado &#40;82&#37;&#41; y con estudios universitarios completos &#40;83&#37;&#41;&#46; De los encuestados&#44; un 22&#37; de los pacientes se encontraban en terapia inmunomoduladora &#40;tiopur&#237;nicos&#47;metotrexato&#41; y el 24&#37; con terapia biol&#243;gica &#40;43&#37; de los pacientes con EC y 12&#37; con CU&#41;&#46; Un 64&#37; del total de pacientes con terapia biol&#243;gica se encontraban en tratamiento combinado con alg&#250;n tiopur&#237;nico o metotrexato&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inmunizaci&#243;n&#58; aspectos generales</span><p id="par0060" class="elsevierStylePara elsevierViewall">Solo 6 pacientes &#40;2&#37;&#41; recibieron el esquema de inmunizaci&#243;n completo&#58; 3 de ellos se encontraban en tratamiento combinado de terapia biol&#243;gica y azatioprina&#44; los otros 3 solo en tratamiento con 5-ASA&#46; Las vacunas con los mayores porcentajes de administraci&#243;n fueron contra el virus hepatitis B en 98 pacientes &#40;40&#37;&#41;&#44; siendo m&#225;s frecuente en pacientes con EC vs&#46; CU &#40;50&#37; vs&#46; 34&#37;&#44; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;019&#41;&#44; neumoc&#243;cica 13-valente se administr&#243; en 83 pacientes &#40;34&#37;&#41;&#44; siendo m&#225;s frecuente en EC vs&#46; CU &#40;47&#37; vs&#46; 28&#37;&#44; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#59; neumoc&#243;cica 23-polisac&#225;rida en 39 pacientes &#40;16&#37;&#41;&#44; sin diferencias significativas entre EC y CU &#40;15&#37; vs&#46; 18&#37;&#44; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;627&#41;&#46; Solo 18 pacientes &#40;7&#44;4&#37;&#41; han recibido ambas vacunas contra el neumococo&#46; En relaci&#243;n con la vacuna virus papiloma y herpes zoster&#44; esta se administr&#243; en 10 y 7 pacientes&#44; respectivamente&#46; El porcentaje de administraci&#243;n de las diferentes vacunas y las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas por tipo de vacuna recibida se muestran en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> y <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#44; respectivamente&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Al analizar las tasas de inmunizaciones por grupo de f&#225;rmacos&#44; se observa que el porcentaje de vacunados contra la hepatitis B es significativamente mayor en el grupo que se encuentra en terapia biol&#243;gica&#46; Para la vacuna neumoc&#243;cica 13-valente&#44; solo se observ&#243; una tendencia a ser administrada con mayor frecuencia en pacientes en tratamiento con inmunosupresores o biol&#243;gicos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Al revisar el Registro Nacional de Inmunizaciones&#44; 40 pacientes recibieron una vacuna virus vivo atenuada&#44; incluso 3 de ellos recibieron m&#225;s de una vacuna&#46; La inmunizaci&#243;n recibida fue 17 contra la fiebre amarilla&#44; 17 contra sarampi&#243;n&#44; 7 contra herpes zoster y 2 contra varicela zoster&#46; Siete de ellos &#40;18&#37;&#41; se encontraban en tratamiento inmunosupresor al momento de su administraci&#243;n &#40;un paciente con esteroides&#44; 4 con tiopur&#237;nicos&#47;metotrexato y 2 con terapia combinada con anti-TNF e inmunomoduladores&#41;&#44; ninguno de ellos recibi&#243; m&#225;s de una vacuna virus atenuado&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Vacuna influenza</span><p id="par0075" class="elsevierStylePara elsevierViewall">En relaci&#243;n con la administraci&#243;n de la vacuna influenza durante el 2019&#44; los datos demogr&#225;ficos de los pacientes se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; El porcentaje de vacunaci&#243;n fue mayor en mujeres que en hombres &#40;66&#37; vs&#46; 53&#37;&#44; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;045&#41;&#44; pacientes no fumadores &#40;95&#37; vs&#46; 73&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y en tratamiento con terapia biol&#243;gica &#40;81&#37; vs&#46; 19&#37;&#44; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;011&#41;&#46; Al evaluar la de inmunizaci&#243;n contra la influenza realizada los a&#241;os 2017&#44; 2018 y 2019&#44; se aprecia que el porcentaje de pacientes vacunados ha aumentado significativamente tanto en EC como en CU &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Encuesta</span><p id="par0080" class="elsevierStylePara elsevierViewall">El 83&#37; &#40;202 pacientes&#41; se&#241;al&#243; que su m&#233;dico tratante le hab&#237;a prescrito la vacuna contra la influenza y un 79&#37; alguna otra vacuna&#46; Por otra parte&#44; el 23&#37; &#40;57 pacientes&#41; respondi&#243; no haber recibido ning&#250;n tipo inmunizaci&#243;n&#46; Las principales razones se&#241;aladas por los pacientes fueron la falta de tiempo &#40;25&#37;&#41;&#44; la falta de prescripci&#243;n m&#233;dica &#40;23&#37;&#41; y el alto costo econ&#243;mico de estas &#40;20&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">El uso de distintas terapias&#44; ya sea esteroides&#44; inmunomoduladores&#44; terapia biol&#243;gica y&#47;o mol&#233;culas peque&#241;as&#44; tiene un riesgo de desarrollar infecciones&#44; siendo este de grado variable seg&#250;n el f&#225;rmaco<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a>&#44; las cuales potencialmente pueden ser prevenidas con un adecuado esquema de inmunizaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#44;8&#8211;10</span></a>&#46; Se ha demostrado en varios estudios un mayor riesgo de infecciones fulminantes y mortalidad por hepatitis B&#44; varicela y neumococo en pacientes con EII inmunosuprimidos<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#8211;23</span></a>&#46; Se recomienda la vacunaci&#243;n de rutina de los pacientes con EII&#44; con la excepci&#243;n de las vacunas que contienen virus vivos atenuados&#44; las cuales deben evitarse en inmunocomprometidos<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#44;8&#8211;10</span></a>&#46; Se ha sugerido realizar una evaluaci&#243;n de las inmunizaciones al diagn&#243;stico con el fin de indicar todas aquellas vacunas que est&#233;n pendientes<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; Por otro lado&#44; se debe enfatizar que un adecuado esquema de inmunizaciones&#44; y la adherencia a este&#44; se considera un indicador de calidad de atenci&#243;n en pacientes con EII<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24&#44;25</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran un d&#233;ficit significativo en los esquemas de inmunizaci&#243;n en pacientes con EII&#44; con porcentajes de vacunaci&#243;n que van del 66&#37; para la vacuna influenza al 5&#37; para la vacuna meningoc&#243;cica&#44; esta &#250;ltima en poblaci&#243;n de riesgo<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#44;8&#8211;10</span></a>&#46; Estos hallazgos son similares a lo referido en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;26</span></a>&#46; Se ha sugerido que todos los pacientes con EII deben recibir ambas vacunas&#44; idealmente primero la vacuna neumoc&#243;cica 13-valente y 2 meses despu&#233;s la neumoc&#243;cica 23-polisac&#225;rida con un refuerzo de esta &#250;ltima a los 5 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; En nuestro estudio&#44; solo el 7&#44;4&#37; recibi&#243; ambas vacunas contra el neumococo&#46; Por otra parte&#44; frecuencias a&#250;n m&#225;s bajas de vacunaci&#243;n contra la influenza han sido mostradas en otros estudios&#44; como reportan Loubet et al&#46;&#44; donde solo el 34&#37; de los pacientes la recibieron<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#46; Finalmente&#44; otros han se&#241;alado que el 45&#37; de los pacientes con EII ten&#237;an completo el esquema de vacunaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&#46; En nuestro estudio solo 6 &#40;2&#37;&#41; pacientes recibieron un esquema de inmunizaci&#243;n con todas las vacunas recomendadas&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Se ha demostrado en varios estudios que el nivel de informaci&#243;n de los pacientes acerca de su enfermedad es deficiente<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">27&#44;28</span></a>&#44; e incluso un 58&#37; de los pacientes refirieron tener una informaci&#243;n inadecuada acerca de la necesidad de vacunarse contra la influenza y el neumococo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#46; Por otra parte&#44; hay d&#233;ficit en los conocimientos del equipo tratante acerca de las vacunas y hay incertidumbre en los pacientes sobre las indicaciones de estas<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#8211;18</span></a>&#46; Sin duda estas dos variables deben ser consideradas&#44; dado que son predictoras de una adecuada adherencia a los esquemas de inmunizaci&#243;n y otras intervenciones preventivas en pacientes con EII<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;29</span></a>&#46; En el estudio de Malhi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&#44; solo el 54&#37; de los pacientes en terapia biol&#243;gica recordaban haber discutido la necesidad de vacunaci&#243;n antes de iniciar esta estrategia terap&#233;utica y solo el 60&#37; recibi&#243; la indicaci&#243;n de vacunarse contra la influenza&#46; En nuestro estudio se observa que pacientes en terapia biol&#243;gica presentaron un mayor porcentaje de vacunaci&#243;n antiinfluenza versus los pacientes con otros f&#225;rmacos&#46; Esto podr&#237;a estar relacionado con el mayor n&#250;mero de atenciones y por lo tanto mayor exposici&#243;n con el equipo del Programa&#44; lo cual podr&#237;a determinar un mejor nivel de educaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> y el hecho de que haber recibido esta vacuna sea requisito para poder acceder a la Ley 20&#46;850 &#40;&#171;Ley Ricarte Soto&#187;&#41;&#44; beneficio estatal que permite a los pacientes con EII acceder a la terapia biol&#243;gica anti-TNF&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En relaci&#243;n con el porcentaje de vacunaci&#243;n de acuerdo al diagn&#243;stico&#44; nuestros resultados mostraron que la administraci&#243;n de la vacuna contra virus de la hepatitis B y la neumoc&#243;cica 13-valente fueron m&#225;s frecuentes en pacientes con EC vs CU&#44; similar a lo descrito en otros estudios<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&#46; El mayor porcentaje de administraci&#243;n de estas vacunas en la EC se podr&#237;a explicar por el mayor n&#250;mero de pacientes con esta patolog&#237;a en tratamiento con terapia biol&#243;gica y con ello un mayor n&#250;mero de atenciones por parte del equipo tratante&#46; Es importante considerar que&#44; en nuestro pa&#237;s&#44; la Ley 20&#46;850 entr&#243; en vigencia para los pacientes con EC en enero de 2017 y para CU en julio de 2019&#44; lo que pudo haber influido en el mayor porcentaje de pacientes con EC tratados con estos f&#225;rmacos&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">El porcentaje de vacunaci&#243;n contra la influenza aument&#243; de manera significativa del 2017 al 2019&#44; alcanzando un 66&#37; este &#250;ltimo a&#241;o&#46; Esta alza se podr&#237;a relacionar con la educaci&#243;n realizada a los pacientes y con el rol de las recientes campa&#241;as nacionales de vacunaci&#243;n contra la influenza&#46; Situaciones similares han sido se&#241;aladas en otros estudios<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Se ha demostrado que hay conceptos err&#243;neos sobre la seguridad de las vacunas y la necesidad de una mayor educaci&#243;n de los pacientes con EII<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&#46; En nuestro estudio&#44; 40 pacientes recibieron una vacuna virus vivo atenuado&#44; 7 de los cuales &#40;18&#37;&#41; se encontraban en tratamiento inmunomodulador&#46; En el estudio de Malhi et al&#46;&#44; el 70&#37; de los pacientes en tratamiento inmunomodulador nunca recibieron la instrucci&#243;n de que esta vacuna estaba contraindicada<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&#46; Esto pese a que las gu&#237;as y revisiones sobre inmunizaci&#243;n en pacientes con EII son claras en se&#241;alar que las vacunas con virus atenuado est&#225;n contraindicadas en pacientes en terapia con este tipo de f&#225;rmacos<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6&#44;8&#8211;15</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Finalmente&#44; se evidencia que el 23&#37; de los pacientes no han sido inmunizados con ninguna vacuna&#46; Las principales razones referidas por los pacientes fueron la falta de tiempo&#44; la falta de prescripci&#243;n m&#233;dica y el alto costo econ&#243;mico de estas&#46; Se ha se&#241;alado que la incertidumbre sobre la indicaci&#243;n&#44; efectividad de estas y eventos adversos secundarios son factores que pueden llevar a una mala adherencia al esquema de inmunizaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene ciertas fortalezas&#59; al ser un estudio transversal y mostrar la experiencia de un centro terciario con un Programa de EII establecido&#44; proporciona una visi&#243;n de la pr&#225;ctica cl&#237;nica diaria con una variedad de etapas de evoluci&#243;n tanto de la EC como de la CU y con estrategias terap&#233;uticas distintas&#46; Esta experiencia local se evalu&#243; en el 53&#37; de los pacientes en seguimiento en nuestro Programa de EII&#44; lo cual permite comparar nuestros resultados con otros estudios&#46; Finalmente&#44; para evitar el sesgo de memoria&#44; limitaci&#243;n al momento de realizar estudios retrospectivos que incluyan encuestas&#44; se revis&#243; el Registro Nacional de Inmunizaci&#243;n para obtener informaci&#243;n acerca de la vacunaci&#243;n de cada paciente&#46; Por otra parte&#44; sabemos que existen tambi&#233;n limitaciones&#59; es un estudio realizado en un centro terciario&#44; lo que implica probablemente pacientes con mayor gravedad&#44; mayor porcentaje de tratamiento inmunomodulador y&#47;o terapia biol&#243;gica&#46; Por lo tanto&#44; la percepci&#243;n de la inmunizaci&#243;n puede no reflejar lo que ocurre en la poblaci&#243;n general de EII atendida en otros centros a nivel nacional&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; nuestro estudio sugiere que los programas de inmunizaci&#243;n en pacientes con EII son a&#250;n deficitarios&#46; Dado que los tratamientos actuales y las futuras estrategias terap&#233;uticas ponen en riesgo a estos pacientes&#44; resulta fundamental la educaci&#243;n de ellos y del equipo tratante&#44; con el fin de mejorar la adherencia a los programas de vacunaci&#243;n&#46; El equipo tratante debe desempe&#241;ar un papel activo en la atenci&#243;n integral de los pacientes con EII&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Inmunizaci&#243;n&#58; aspectos generales"
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              "titulo" => "Vacuna influenza"
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    "fechaRecibido" => "2020-04-23"
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            1 => "Enfermedad de Crohn"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tratamiento de la enfermedad inflamatoria intestinal &#40;EII&#41; puede aumentar el riesgo de infecci&#243;n&#46; La inmunizaci&#243;n es parte del manejo integral de la atenci&#243;n de estos pacientes&#46; El objetivo de este estudio es describir la prescripci&#243;n y adherencia a la vacunaci&#243;n en pacientes con EII e identificar los posibles factores asociados a esta&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio anal&#237;tico&#44; descriptivo&#44; transversal en pacientes de un Programa de EII de Chile&#44; entre abril y junio de 2019&#46; A los pacientes se les solicit&#243; responder un cuestionario acerca de la adherencia a la vacunaci&#243;n&#46; La informaci&#243;n de las vacunas se obtuvo del Registro Nacional de Inmunizaciones&#46; Se realiz&#243; an&#225;lisis estad&#237;stico descriptivo y de asociaci&#243;n &#40;&#967;<span class="elsevierStyleSup">2</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 243 pacientes con EII &#40;148 colitis ulcerosa &#91;CU&#93;&#44; 86 enfermedad de Crohn &#91;EC&#93; y 9 EII no clasificable&#41;&#46; Solo 6 pacientes &#40;2&#37;&#41; recibieron el esquema de inmunizaci&#243;n completo&#46; Las vacunas con los mayores porcentajes fueron contra la influenza &#40;67&#37;&#41;&#44; virus hepatitis B &#40;40&#37;&#41;&#44; neumoc&#243;cica 13-valente &#40;34&#37;&#41; y neumoc&#243;cica 23-polisac&#225;rida &#40;16&#37;&#41;&#44; siendo las dos primeras m&#225;s frecuentes en EC vs&#46; CU &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La administraci&#243;n de la vacuna contra la influenza ha aumentado significativamente&#44; alcanzando un 67&#37; el 2019&#46; La encuesta mostr&#243; que el 23&#37; no ha sido inmunizado con ninguna vacuna&#44; principalmente por falta de tiempo&#44; falta de prescripci&#243;n m&#233;dica y el alto costo econ&#243;mico&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En esta cohorte&#44; aunque las tasas de vacunaci&#243;n son m&#225;s altas que las reportadas previamente&#44; la adherencia al programa de inmunizaci&#243;n debe mejorar&#44; siendo consideradas desde el diagn&#243;stico por el equipo multidisciplinario&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Inflammatory Bowel Disease &#40;IBD&#41; treatment may increase the risk of infections&#46; Vaccines are part of the comprehensive IBD patient care&#46; The aim of this study was to describe indications and adherence of immunizations in IBD and identify possible associated factors&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional&#44; analytic study was conducted in patients from an IBD Program of a tertiary center in Chile&#44; between April &#8211; June 2019&#46; Patients were asked to answer a vaccine survey and information also was obtained from the National Immunization Registry&#46; Descriptive and association statistic were used &#40;&#967;<span class="elsevierStyleSup">2</span>&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 243 patients were included &#40;148 ulcerative colitis &#40;UC&#41;&#44; 86 Crohn&#39;s disease &#40;CD&#41; and 9 non-classifiable IBD&#41;&#46; Only six patients &#40;2&#37;&#41; of IBD patients received a complete immunization schedule&#46; The highest vaccine rates were against influenza &#40;67&#37;&#41;&#44; hepatitis B virus &#40;40&#37;&#41;&#44; 13-valent pneumococcal &#40;34&#37;&#41; and 23-polysaccharide pneumococcal &#40;16&#37;&#41;&#46; The influenza vaccine rate has significantly increased&#44; reaching 67&#37; in 2019&#46; The survey showed that 23&#37; of patients have not been immunized with any vaccine&#44; mainly due to lack of time&#44; lack of medical prescription and high cost&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In this cohort&#44; although vaccination rates are higher than previously reported&#44; adherence to IBD immunization program would be improved&#44; being considered since diagnosis by the multidisciplinary team&#46;</p></span>"
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">G&#233;nero</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">151 &#40;62&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">92 &#40;37&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel educacional</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&#225;sico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;15&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Universitario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Posgrado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154 &#40;63&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Previsi&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Privada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">198 &#40;81&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estatal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;18&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin informaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tabaco</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Activo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Exfumador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;16&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hijos</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8804;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">6 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diagn&#243;stico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colitis ulcerosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad de Crohn&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EII no clasificable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">A&#241;os de enfermedad &#40;mediana&#59; rango&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;0-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clasificaci&#243;n de Montreal</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CU &#40;extensi&#243;n&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extensa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Izquierda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Proctitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin informaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">EC &#40;localizaci&#243;n&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ileon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ileocol&#243;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GI superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin informaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">EC &#40;fenotipo&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflamatorio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Previsi&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Privada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">133 &#40;81&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;673&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gubernamental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin informaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel educacional</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&#225;sico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;451&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Universitario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">107 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Posgrado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">No fumador</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">156 &#40;95&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">56 &#40;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hijos &#8804;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">6 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">32 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;554&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Diagn&#243;stico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colitis ulcerosa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">97 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">51 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad de Crohn&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">23 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">A&#241;os de enfermedad &#40;mediana&#59; rango&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;0-49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6 &#40;6-47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;603&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapia biol&#243;gica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">47 &#40;81&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;011&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inmunomoduladores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;879&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5-ASA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prednisona&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 02105705
Idioma original: Español
DOI:10.1016/j.gastrohep.2020.06.024
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2023 Diciembre 43 2 45
2023 Noviembre 40 3 43
2023 Octubre 60 4 64
2023 Septiembre 25 1 26
2023 Agosto 28 0 28
2023 Julio 24 3 27
2023 Junio 25 4 29
2023 Mayo 44 4 48
2023 Abril 42 1 43
2023 Marzo 20 1 21
2023 Febrero 2 0 2
2023 Enero 1 0 1
2022 Diciembre 1 0 1
2022 Noviembre 3 3 6
2022 Octubre 6 5 11
2022 Septiembre 5 6 11
2022 Agosto 6 7 13
2022 Julio 1 3 4
2022 Junio 1 4 5
2022 Marzo 1 0 1
2021 Noviembre 1 2 3
2021 Octubre 2 0 2
2021 Septiembre 7 4 11
2021 Julio 2 0 2
2021 Junio 1 0 1
2021 Mayo 3 2 5
2021 Abril 8 0 8
2021 Marzo 17 13 30
2021 Febrero 8 4 12
2020 Diciembre 0 2 2
2020 Octubre 0 1 1
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