Arquivos de Gastroenterologia最新文献

Background: Extraintestinal manifestations (EIMs) significantly impact patients with inflammatory bowel disease (IBD). Janus kinase inhibitors (JAKi) are emerging as a potential treatment. This study describes real-world outcomes in Colombian patients with IBD and EIMs treated with upadacitinib or tofacitinib.

Methods: Multicenter study including moderate-to-severe IBD patients with EIMs. We analyzed the prevalence, resolution, and progression of EIMs with JAKi therapy.

Results: Among 77 patients (51 UC-tofacitinib, 16 UC-upadacitinib, 10 CD-upadacitinib), 28.6% (n=22) had EIMs, primarily articular (81.25%), followed by hepatobiliary (25%), cutaneous (18.75%), and ocular (6.25%). Most tofacitinib-UC patients (90%) had prior anti-TNF therapy. During induction, 66.6% had a clinical response, and 33.3% achieved EIM remission. In maintenance, 83.3% achieved remission. Among upadacitinib-UC patients, 66.6% had prior anti-TNF, 33.3% anti-integrin, and 33.3% were biologic-naïve. Corticosteroid use was reduced in 66.7%. Induction response was 66.7%, with 33.3% achieving remission. At six months, remission was 50%. No significant difference in remission rates was observed between upadacitinib and tofacitinib (OR 1.36, 95%CI 0.43-4.33, P=0.28). In CD-upadacitinib, all patients had prior anti-TNF therapy, with 66.6% achieving remission during induction. Adverse events included alopecia, acne, and herpes zoster.

Conclusion: JAKi therapy is a safe and effective alternative for IBD patients with EIMs. While upadacitinib may offer superior intestinal benefits, both treatments demonstrated efficacy in managing EIMs.

Background: The approval of new therapies has led to an increasing trend toward the use of various combinations of medications in Crohn's disease (CD) management. However, patients with ileocecal CD may still require surgery in up to 80% of cases.

Objectives: To analyze the literature and synthesize the data qualitatively to evaluate the outcomes of early surgery compared to drug therapy in patients with ileocecal CD, focusing on both adult and pediatric populations.

Methods: Studies were selected through an electronic search of the PUBMED database, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The MINORS (Methodological Index for Non-Randomized Studies) criteria were used to assess the methodological quality of non-randomized studies.

Results: A total of 665 articles were initially identified through the search strategy, and three additional relevant articles were added manually, leading to 22 studies eligible for qualitative evaluation. The evaluation of results was organized based on primary outcomes. Three studies assessed postoperative morbidity, with two showing higher morbidity in patients who underwent surgery for CD complications compared to those operated on for a purely inflammatory phenotype. Twelve observational studies evaluated CD recurrence, with ten showing evidence of higher surgical recurrence in patients who underwent surgery at a later stage. These studies demonstrated worse long-term clinical control of CD in this group, with a higher need for corticosteroids and advanced therapies. Only two pediatric studies met the inclusion criteria, limiting a more comprehensive analysis of this population.

Conclusion: Early surgery in adult patients is a solid therapeutic option in the treatment of uncomplicated isolated ileocecal CD.

Background: Despite the widespread adoption of single-operator cholangiopancreatoscopy for the management of biliary and pancreatic diseases, this method was recently introduced in Brazil. This study aimed to develop a Brazilian consensus for the diagnostic and therapeutic use of single-operator cholangiopancreatoscopy for the management of pancreatobiliary diseases.

Methods: A working group from the Brazilian Society of Digestive Endoscopy (SOBED) specialists, using a Delphi methodology, formulated statements across six topics: indeterminate biliary strictures, complex biliary stones, primary sclerosing cholangitis, peroral pancreatoscopy, post-liver transplantation, and antibiotic prophylaxis. Eighteen experts evaluated these statements using an anonymous electronic voting system. Consensus was defined as ≥80% agreement.

Results: Eighteen statements were formulated and voted on by a panel of experts to reach a consensus. The panel consisted of 18 endoscopy specialists from various regions of Brazil, with an average of 20.4 years of experience. Consensus was achieved on all statements in the first round.

Conclusion: These recommendations establish the role of cholangiopancreatoscopy in diagnostic and therapeutic for indeterminate biliary strictures, complex biliary stones, primary sclerosing cholangitis, peroral pancreatoscopy, post-liver transplantation, and antibiotic prophylaxis, providing a background for its standardized use in Brazil.

Background: In patients with Inflammatory Bowel Disease (IBD), fatigue is a debilitating problem and may be associated with sleep disturbance, anxiety, depression, anemia, use of systemic steroids and active phase of the disease. In addition, fatigue also affects the working conditions of these patients, as it is associated with absenteeism and is a reason for time off work, surpassing medical appointments and abdominal pain. Currently, there are no well-established pharmacological therapies for fatigue, making it a subject of growing research interest.

Objective: This study aimed to conduct an integrative review of pharmacological treatments for fatigue in patients with IBD.

Methods: Inclusion criteria included full articles published from January 1, 2017 to December 31, 2024. Eligible studies had to include fatigue assessment as a primary objective and discuss pharmacological treatments for fatigue in IBD patients.The databases used were PubMed, Lilacs, SciElo and Cochrane and the descriptors were (inflammatory bowel disease) AND (fatigue) AND (drug therapy).

Results: Total of 294 studies were identified, of which ten met the inclusion criteria, comprising 2,935 patients (1,664 with Crohn's disease, 1,215 with ulcerative colitis, and 56 with irritable bowel syndrome). Vitamin B12 has not demonstrated efficacy in alleviating fatigue in IBD patients. High doses of oral thiamine reduce fatigue, but studies using a dose of 300 mg/day of thiamine have not shown the same effect. Fatigue symptoms have been reduced with the use of vedolizumab, upadacitinib and modafinil. Studies assessing pharmacological treatments for fatigue in IBD remain limited, and available data are still insufficient. Establishing effective pharmacological therapies for fatigue in these patients may lead to better physical and emotional well-being, enhanced social interactions and employability, and reduced financial burdens associated with fatigue management. Further randomized clinical trials and systematic reviews are necessary to advance the understanding of pharmacological interventions for fatigue in IBD.

Background and objective: Selective IL-12/23p40 receptor antagonists (IL-12/23RA) show promise for treating moderate to severe ulcerative colitis (UC), but their efficacy and safety are not fully understood. Objective: This systematic review and meta-analysis assess the effectiveness and safety of IL-12/23RA in UC.

Methods: A systematic search of PubMed, Embase, Cochrane, and ClinicalTrials.gov was performed in December 2024. Randomized controlled trials (RCTs) comparing IL-12/23RA to placebo in moderate to severe UC were included. Outcomes included clinical and endoscopic remission, response rates, and adverse events (AEs). Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were pooled using a random-effects model.

Results: Nine RCTs (3,808 patients in the induction phase; 1,734 in the maintenance phase) were analyzed. IL-12/23RA enhanced clinical remission (induction: RR 2.63; 95%CI 2.05-3.36; maintenance: RR 1.99; 95%CI 1.63-2.44; all P<0.01) and endoscopic remission (induction: RR 2.36; 95%CI 1.70-2.20; maintenance: RR 1.96; 95%CI 1.63-2.37; all P<0.01). IL-12/23RA reduced serious AE in the induction phase (RR 0.40; 95%CI 0.27-0.69; P<0.01), while there was no difference during maintenance (RR 0.75; 95%CI 0.31-1.84; P=0.53). No differences were observed in overall AEs or specific AEs like headache or nasopharyngitis. Trial sequential analysis confirmed sufficient sample size for clinical endpoints.

Conclusions: IL-12/23RA showed superior effectiveness and similar safety when compared to placebo in moderate to severe UC.

Background: Inflammatory bowel disease (IBD) significantly affects patients' nutritional status and quality of life (QoL). Nutritional deficiencies are frequent and may worsen disease outcomes. The aim of this study is to assess the association between nutritional status and quality of life in patients with IBD.

Methods: A cross-sectional study was conducted in a specialised IBD centre. Nutritional status was evaluated using the MUST and MIRT tools in adults and the "Strong Kids" scale in paediatrics. An individualised nutritional support protocol was implemented. Quality of life was assessed with the EQ-5D and IBDQ-32 instruments.

Results: Among 90 patients, 26.6% required hospitalisation, predominantly adults and females. The mean age was 36.7 years. Crohn's disease (CD) was more prevalent (58.3%), and 83.3% received biological therapy. Malnutrition risk in hospitalised patients with ulcerative colitis (UC) and CD was significantly increased, with odds ratios of 8.33 (95%CI: 1.16-27) and 25 (95%CI: 11.6-45.2), respectively. All hospitalised patients with severe disease presented with malnutrition. In the paediatric group, 87.5% received enteral nutrition and 25% required parenteral nutrition. Nutritional support improved nutritional status in 75% of cases within three months. Malnutrition was significantly associated with poorer QoL, particularly affecting mobility, self-care, and daily activities (P<0.05).

Conclusion: Malnutrition has a substantial negative impact on quality of life in IBD patients. Early detection using tools such as MUST, MIRT, and strong kids is essential. Integrating systematic nutritional screening and tailored support into routine clinical practice is imperative to improve outcomes and promote recovery.

Background: Chemotherapy-induced diarrhea is a common and distressing side effect experienced by patients undergoing cancer treatment, particularly those with gastrointestinal cancer. It can lead to significant health complications, including dehydration, electrolyte imbalances, and treatment interruptions. Recent studies have shown that the gut microbiome plays an important role in the development and severity of chemotherapy-induced diarrhea. Modulating the gut microbiome with probiotics has emerged as a potential strategy for preventing and managing chemotherapy-induced diarrhea.

Objective: In this study we aimed to evaluate the efficacy of one probiotic containing a mixture of several strains of Lactobacillus and Bifidobacterium species in prevention of chemotherapy induced diarrhea among patients with gastrointestinal cancer.

Methods: Between April 2022 and June 2024, a total of 28 patients diagnosed with gastrointestinal cancer who were intended to receive chemotherapy based on fluoropyrimidine, oxaliplatin, and/or irinotecan were randomized in a ratio 1:1 to receive either a placebo or 20 billion colony-forming units (CFU) of a mixture containing five viable strains including 335 mg of Lactobacillus acidophilus NCFM®, Lactobacillus paracasei Lpc-37TM, Bifidobacterium lactis Bi-04TM, Bifidobacterium lactis Bi-07TM, and Bifidobacterium bifidum Bb-02TM. Patients were instructed to take the product orally once daily for 90 days and to record their bowel habits in a diary using the Bristol stool scale.

Results: The use of probiotics, compared to placebo, did not result in reduction of grade 2/3 diarrhea episodes (placebo arm 55.56% vs probiotic arm 44.44%; P=1). Likewise, no statistically significant difference was observed in the overall incidence of diarrhea between the two groups (71.43% vs 64.29%; P=1). The median number of diarrhea episodes during the 90-day follow-up tended to be lower in the probiotic group (eight episodes) compared to the placebo group (9 episodes) (P=0.639) Subgroup analyses failed to identify any specific patient characteristics that associated any benefit from the probiotic use, regardless of diarrhea grade. Also, no infections related to the probiotic strains administered in this study were detected.

Conclusion: Probiotic in comparison to a placebo did not result in a statistically significant effect, suggesting a lack of benefit of administered probiotic for prevention of chemotherapy induced diarrhea among patients with gastrointestinal cancer.

Background: Hepatitis C virus (HCV) infection remains a significant public health concern. Behavioral factors such as alcohol use and psychiatric comorbidities, particularly depression, may influence disease progression and eligibility for antiviral treatment.

Objective: To assess the prevalence and clinical impact of current alcohol consumption in patients with chronic HCV infection eligible for treatment with direct-acting antivirals (DAAs), and to explore its associations with depressive symptoms and clinical characteristics.

Methods: This was a cross-sectional study including 109 monoinfected HCV outpatients. Sociodemographic, clinical, and laboratory data were collected. Current alcohol use was assessed using the alcohol, smoking and substance involvement screening test (ASSIST), and depressive symptoms were measured by the Beck Depression Inventory (BDI).

Results: Among participants, 46 (43.4%) reported current alcohol consumption. No statistically significant difference in alcohol use was found between male and female participants (P=0.15). Women showed significantly higher depressive symptom scores compared to men (11.33 vs 7.67; P=0.024). However, no significant association was observed between levels of alcohol consumption (<12 g/day, ≥12 g/day, or abstinent) and the presence of moderate to severe depressive symptoms. Additionally, alcohol use was positively associated with tobacco use (P=0.01), but not with clinical comorbidities.

Conclusion: Moderate alcohol use in HCV-infected patients was not associated with increased depressive symptoms or worse clinical parameters prior to DAA therapy. These findings suggest that moderate alcohol consumption should not be an absolute contraindication for initiating HCV treatment, though further studies are needed.

Background/objective: Colonoscopy is a known tool for diagnosing precursor lesions of colorectal cancer. The use of AI has the potential to enhance the detection of these lesions. The aim of this study is to compare the adenoma detection rate (ADR) in colonoscopies performed with and without AI software.

Methods: An observational study was conducted in the endoscopy department with the contribution of the gastroenterology, coloproctology and pathology services, all from a tertiary hospital in the southern region of Brazil. A total of 305 patients undergoing screening colonoscopy were evaluated. Patients were scheduled for colonoscopy through random assignment to procedure rooms with high definition conventional colonoscopy (CC) or with "Cadeye" (CADe) system. The metrics associated with patients, the procedure and polyps' features were recorded.

Results: Of 305 colonoscopies, 112 were in the CADe system and 193 in the CC. 470 polyps were detected. The overall ADR was 53.8% and the overall polyp detection was 74.8%. There was no difference in the ADR between CC and CADe (57% vs 48.2%, respectively. P=0.138).

Conclusions: Although data argue for an increase in ADR with AI systems, our study did not show difference between conventional colonoscopy or AI. These findings suggest that, in settings with high ADR, the added benefit of AI may be limited.