Arquivos de Gastroenterologia最新文献

Background: Cholelithiasis, characterized by hardened deposits in the gallbladder, presents symptoms such as abdominal pain, jaundice, nausea, and potential complications like cholecystitis and choledocholithiasis. Despite increasing diagnoses, literature on pediatric cholelithiasis is limited, with undefined protocols.

Objective: This study aims to evaluate the clinical, laboratory characteristics, and outcomes of pediatric cholelithiasis cases, identifying factors associated with cholecystectomy.

Methods: A retrospective case series study was conducted on patients treated at a tertiary service, diagnosed with cholelithiasis via ultrasound from 2007 to 2021. Clinical profiles, comorbidities, examinations, procedures, and patient evolution were assessed. Patients were categorized into two groups: Group NC (no cholecystectomy) and Group C (cholecystectomy).

Results: Thirty-five patients were included, with 51% females and 60% having comorbidities with abdominal pain was the predominant symptom. Thirty-three patients were managed outpatient while two patients continued follow-up at another facility. Twelve opted for expectant management (Group NC), while 21 underwent cholecystectomy (Group C). Elective laparoscopic cholecystectomy was performed in Group C, with a median age of 11 years and 3 months. Group C showed a higher frequency of abdominal pain compared to Group NC, and this difference was significant (P=0.04). No differences were observed in gender, comorbidities, jaundice, fever, laboratory findings, symptom duration, follow-up time, or age at diagnosis. The median follow-up duration in Group NC was 1 year and 7 months.

Conclusion: Abdominal pain was the predominant symptom in patients undergoing cholecystectomy, while comorbidities and laboratory abnormalities showed no significant associations. Although surgical intervention is typically recommended, expectant management proved viable in select cases without ensuing complications during the evaluation period.

Background: Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in bacterial population in the small intestine, leading to symptoms such as bloating, abdominal pain, distension, diarrhea, and eventually malabsorption. The diagnosis and management of SIBO remain challenging due to overlapping symptoms with other gastrointestinal disorders such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and coeliac disease.

Objective: This article aims to review current evidence on the diagnosis and treatment of SIBO, with a focus on strategies suitable for the Brazilian healthcare system.

Methods: A comprehensive literature review was performed, focusing on clinical guidelines, randomized controlled trials, and cohort studies concerning SIBO. Diagnostic methods, including breath tests and direct aspiration techniques, were critically analyzed. Treatment approaches, including antibiotics, dietary modifications, and probiotics, were reviewed. The recommendations were formulated based on a panel of gastroenterologists, members of the Brazilian Federation of Gastroenterology (FBG), with approval from the majority of the members.

Results: Breath tests using glucose and lactulose remain the most commonly used non-invasive diagnostic tools, though they are subject to limitations such as false positives and false negatives. Treatment with rifaximin is effective in most cases of SIBO, while systemic antibiotics like metronidazole and ciprofloxacin are alternatives. Probiotics and dietary interventions, particularly low FODMAP diets, can complement antibiotic therapy. Long-term follow-up is essential due to the recurrence rate, which is common in SIBO patients.

Conclusion: Standardizing SIBO diagnosis and treatment in Brazil is essential to reduce diagnostic delays and optimize care, especially given the disparities and heterogeneity in clinical practice across the country. This article provides evidence-based recommendations to guide clinical practice. Further research is needed to refine diagnostic methods, explore novel treatment strategies, and better understand the specific characteristics of the Brazilian population.

Background: This study aims to analyze the co-authorship network in Gastroenterology research, focusing on publications from 2000 to 2023, to understand the collaborative relationships among researchers and identify key contributors in the field.

Methods: Using data from the Web of Science (WoS), I examined 18,855 Gastroenterology-related articles published between 2000 and 2023. The analysis was conducted using Python within the PyCharm environment. I assessed the network at both macro and micro levels. Macro-level indicators included network density, clustering coefficient, components, and average path length. Micro-level indicators included degree centrality, closeness centrality, and betweenness centrality, which helped identify influential researchers and research groups.

Results: The analysis revealed an evolution from a fragmented and sparsely connected network in the early 2000s to a more interconnected structure in recent years. Despite the overall increase in network density and clustering, full integration was not achieved, with many researchers remaining in isolated clusters. Key researchers such as Gasbarrini G., Vandenplas Y., and Hassan C. were identified as central figures within the network, playing crucial roles in fostering collaboration.

Conclusion: The study highlights the ongoing development of collaborative networks in Gastroenterology research, identifying influential researchers and groups that drive advancements in the field. The findings provide valuable insights for enhancing future research collaborations, particularly in areas where Japan excels, such as endoscopic technology.

Background: Conventional white light endoscopic (WLE) findings of H. pylori-associated gastritis are often non-specific and may not correlate with histology. Narrow band imaging (NBI), an optical digital technique employed for the visualization of vessels and patterns of gastric mucosa may improve identification. We evaluated the role of NBI in detecting H. pylori-associated gastritis and classifying its severity.

Methods: Institution-based prospective observational study conducted between May 2021-October 2022. Children presenting with chronic abdominal pain (>1-month duration) were evaluated. Eligible children underwent gastroscopy with NBI and gastric biopsies for rapid urease test and histopathology. NBI gastroscopic findings were classified into five grades as per the classification by Alboudy et al. The association of NBI grade with the presence and severity of H. pylori gastritis on histopathology was analysed.

Results: Ninety children (mean age 12.65±3.91 years), 52 (57.7%) males with median duration of symptoms of 4.5 (3-12) months underwent gastroscopy. H. pylori was detected on histopathology in 29 (32%) patients. NBI findings suggested a mucosal abnormality in 27/29 (93.1%) children with H. pylori on histopathology. H. pylori positive gastritis was significantly more common among those with higher (≥3) NBI grades as compared to those with lower NBI grades (61% vs10%, P<0.001). No significant association was found between NBI grade and the severity of H. pylori gastritis (P=0.75). NBI exhibited better sensitivity (0.82) compared to WLE (0.55) in identifying H. pylori-associated gastritis. On receiver operating characteristic curve analysis, NBI had higher area under curve (0.79 vs 0.65) as compared to WLE.

Conclusion: NBI morphological pattern is a useful tool in identifying patients with H. pylori-associated gastritis.

Background: Microscopic colitis (MC) is a chronic inflammatory condition of the colon, primarily characterized by watery diarrhea, with normal or near-normal endoscopic findings. It encompasses two main subtypes: lymphocytic colitis and collagenous colitis.

Objective: This position paper from the Brazilian Federation of Gastroenterology aims to review current evidence on the diagnosis and management of MC in Brazil, emphasizing the need for standardization across the country's healthcare systems.

Methods: A comprehensive review of the latest scientific literature, clinical guidelines, and consensus statements was performed, focusing on randomized clinical trials, meta-analyses, and cohort studies. The evidence was analyzed by a panel of gastroenterologists and pathologists specializing in MC. The recommendations were based on the consensus of the group, approved by the majority of the panel members.

Results: Histological examination with biopsies from multiple segments of the colon remains essential for the accurate diagnosis of MC, as endoscopic findings are often non-specific. Budesonide is the first-line treatment for inducing remission in most patients. However, alternatives such as immunosuppressants and biologics are available for those who are refractory to or intolerant of budesonide. Non-pharmacological interventions, including dietary and lifestyle modifications, can complement medical treatment. The need for long-term follow-up is highlighted due to the high recurrence rates and the impact of MC on the quality of life.

Conclusion: Standardizing the diagnosis and treatment of MC in Brazil is crucial, given the significant regional disparities in healthcare access. This position paper provides evidence-based recommendations to optimize care and improve patient outcomes across diverse clinical settings in Brazil. Further research is needed to address the gaps in understanding the epidemiology and management of MC in underserved regions.

Background: To investigate the association between metabolic dysfunction-associated steatotic pancreas disease (MASPD) and insulin resistance (IR).

Methods: This cross-sectional study involved 157 participants diagnosed with MASPD based on ultrasonography criteria. Baseline demographic data were collected, including age, gender, and body mass index. Serum levels of fasting glucose, insulin, lipid profile (including total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol), glycated hemoglobin and insulin were measured using standardized laboratory techniques. Abdominal ultrasonography was performed on all participants using convex transducer (frequency range, 3,5 MHz) by experienced radiologist blinded to the clinical data. The association between MASPD and IR was assessed using logistic regression analysis, adjusting for potential confounders. Statistical significance was set at a P-value <0.05.

Results: The logistic regression analysis was performed to verify whether MASPD was a risk factor for IR. After adjusting for gender and age, the results demonstrate a significant correlation between MASPD and markers of IR. TyG index: OR (95%IC) 5.72 (1.90-16.00), P 0.021, and HOMA -IR: OR (95%IC) 6.20 (2.1-22.00) P 0.037.

Conclusion: This study presents a description of MASPD and its association with IR indices. Our findings demonstrate a significant correlation between MASPD and markers of IR. These results suggest that MASPD may contribute to the development of insulin resistance and further highlight the importance of pancreatic health in metabolic disorders.

Background: Several preoperative pulmonary assessment protocols have been established over the years, but assessments of this magnitude are lacking in the bariatric population. Therefore, the assessment of lung capacity, maximum inspiratory and expiratory pressures, the peak expiratory flow and mobility can be predictors of operative safety and determine the time of hospital discharge.

Objective: To evaluate lung capacity, respiratory muscle strength and level of mobility in the pre, immediate post-operative and hospital discharge of patients undergoing bariatric surgery.

Methods: Cross-sectional study, with 38 bariatric patients undergoing surgical intervention. Anthropometric data, lung function, respiratory muscle strength and mobility level were evaluated pre-, post-operatively and at hospital discharge. Statistical Analysis: GEE; P<0.05.

Results: In relation to the preoperative period, in the POi there was a significant reduction in mobility, respiratory muscle strength, FVC, FEV1, PEF and a significant increase in these variables at hospital discharge, however, not reaching the same conditions as the preoperative period, except the Tiffeneau index (P<0.644).

Conclusion: Bariatric surgery impacts the mobility, respiratory muscle strength and lung function of patients with grade II and III obesity, leading to longer hospital stays and possible major complications. The role of physiotherapy in the prevention and rehabilitation of these patients must be strongly considered.

Background: This study aims to analyze the structural dynamics of research collaboration in hepatology over a 30-year period (1994-2023), focusing on co-authorship networks. By examining data from the Web of Science Core Collection, the study explores key metrics such as network density, clustering coefficient, and centrality measures, providing insights into how collaborative efforts have shaped the field of hepatology.

Methods: Using Python (Version 3.10.5) in the PyCharm environment, I conducted a network analysis of 9,278 hepatology-related publications. Macro-level indicators, including network density, clustering coefficient, number of components, and average path length, were used to evaluate overall network structure. Micro-level metrics, such as degree centrality, closeness centrality, and betweenness centrality, were employed to assess the influence of individual researchers within the network.

Results: The analysis showed an increase in network fragmentation, with components rising from 338 in 1994-2003 to 1,302 by 2014-2023. Despite the growing number of publications, network density remained consistently low, indicating limited direct collaboration. However, high clustering coefficients across all periods suggest that collaborations form in tightly connected groups. This study identified key researchers such as LAMBERTINI A. (1994-2003), Manns, Michael P. (2004-2013), and Berg, Thomas (2014-2023), who played central roles, linking different research clusters and facilitating collaboration across groups.

Conclusion: Hepatology research has experienced significant growth in publications over the past 30 years, yet collaborative efforts remain localized, with increasing network fragmentation. Identifying central researchers who bridge gaps between otherwise disconnected groups is essential to fostering broader collaboration. This analysis underscores the importance of strengthening international cooperation and collaborative research to address the increasingly complex and region-specific liver diseases worldwide.

Background: The inflammatory bowel disease (IBD) disk is a simple and quick method to assess the level of disability experienced by patients with IBD. It has been already translated and validated in European countries, however it was not yet translated and validated to use in Brazil.

Objective: This study was performed to translate and validate a Brazilian version of the IBD-Disk. Methods: The original version of the IBD-Disk was translated into Portuguese (Brazilian) and administered to patients with IBD in a referral center in Brazil. This step included direct translation by two native-language expert translators, followed by back translation by two expert translators, with synthesis of the two versions after each step analyzed by a committee of experts and tested in a pilot group. After obtaining the cross-cultural adaptation of the instrument, a validation process was conducted.

Results: A total of 198 patients were included (Crohn's disease, n=149, 75.2%). The model presented satisfactory parameters regarding precision (ORION=0.93), representativeness of the construct (FDI=0.97), sensitivity (SR=3.77), expected percentage of the factor (EPTD=94.3%) and replicability by the latent G-H index (0.93) and observed (0.89), revealing how well the factor can be identified by the continuous attentive response variables and observed items. The item-total correlation coefficients ranged from 0.518 to 0.750, considered ideal. The total instrument presented α=0.921 and ω=0.922, values above the cut-off point and are therefore considered satisfactory.

Conclusion: The translation and cross-cultural adaptation of the IBD-Disk into Brazi-lian-Portuguese (BR-IBD Disk) proved to be a reliable and valid tool in detecting and assessing IBD-related disability in a Brazilian cohort.

Background: Liver biopsy (LB) is still the gold standard method for assessing hepatic fibrosis (HF), associated diseases, and liver inflammation. Nowadays, noninvasive techniques such as Acoustic radiation force impulse (ARFI) elastography have been introduced instead of liver biopsy. However, there are controversies about the time it should be performed after treatment for hepatitis C virus (HCV).

Objective: To evaluate hepatic fibrosis using ARFI technology before and after successive treatments for chronic HCV.

Methods: We prospectively included 50 adult patients with chronic HCV (genotype 1). Patients were first submitted to triple therapy with first-generation protease inhibitors (boceprevir and telaprevir) at the hepatitis division of the Gastroenterology Department of the Federal University of São Paulo. The non-responders underwent re-treatment with interferon-free direct-acting antiviral agents (DDAs - sofosbuvir associated with daclatasvir or simeprevir). Assessment of hepatic stiffness by ARFI was performed before and after the first treatment and before and after the re-treatment with DDAs.

Results: ARFI values decreased significantly after treatments. In patients on first-generation protease inhibitor therapy and achieving sustained virological response (SVR), ARFI decreased from 2.41±0.58 pre-treatment to 2.02+/-0.58 (P<0.042) post-treatment. In patients who did not reach SVR, that is, non-responders, a significant reduction was similarly observed (2.39±0.63 to 2.03±0.54; P<0.001 before and after treatment, respectively). Before starting the re-treatment, non-responders had elevated ARFI values again, dropping after SVR following re-treatment (from 2.46±0.57 to 1.45±0.68, P<0.004). Laboratory parameters such as AST and ALT were directly correlated to ARFI elastography.

Conclusion: The evaluation of hepatic elastography by the ARFI method before and after (6 - 9 months) successive treatment of hepatitis C in responders and non-responders led to the conclusion that the reduction of elastography parameters seems to be related to a decrease in hepatic inflammation rather than a reduction in fibrosis per se.