Arquivos de Gastroenterologia最新文献

Background: Obesity is considered a global epidemic and has shown a progressive increase in recent decades. Bariatric surgery, such as Roux-en-Y gastric bypass (RYGB), is the most effective sustainable weight loss option. However, weight regain is one of the challenges facing patients and is attributed to several factors, including dilatation of the gastrojejunal anastomosis (GJA).

Objectives: The central objective of this study is to correlate the influence of time on GJA widening in patients undergoing RYGB over a 7-year period.

Methods: Prospective and longitudinal study conducted over 7 years in patients undergoing RYGB. Surgical and endoscopic procedures were performed in a medium hospital in the same city. Weight, body mass index (BMI) and GJA size were assessed at intervals of 2, 6, 12, 24, 30, 48, 60, and 72 months after the surgical procedure.

Results: The highest mean value in the distribution of anastomosis diameter was 20±2.27 mm at 72 months after surgery. The lowest mean value was 10.2±1.70 mm at 2 months after surgery. The analysis showed that there is a significant effect of time on anastomosis diameter, with statistically significant differences in the mean value between 2, 6, 12, 24, 60, and 72 months after surgery (F(1,724,5,172)=9.555, P<0.05).

Conclusion: Multiple comparative analysis showed that there are statistically significant differences between the mean lengths of anastomosis across the times studied, with a greater influence of the time factor 24 months after surgery.

Background: Biliary atresia (BA) is the leading cause of cholestatic jaundice in the first months of life. Liver stiffness measurement by shear wave elastography (2D-SWE) could help discriminate BA from other causes of cholestasis.

Objectives: To assess the use of abdominal ultrasound with bidimensional shear wave elastography and liver histology to diagnose Biliary Atresia in cholestatic infants. To compare the use of elastography to estimate the stage of liver fibrosis with the histologic classification.

Methods: Cholestatic infants younger than three months were divided into BA and non-BA groups (other than neonatal cholestasis). 2D-SWE measured liver stiffness, and fibrosis was measured by Metavir score. Receiver operator characteristic (ROC) curves were developed to assess whether the variables of liver stiffness could be used to identify patients with BA and the best cutoff values.

Results: 21 infants with BA and 26 non-BA were included, of which 53,2% were males. The triangular cord was seen in 15/21 (71.4%) of BA and 2/26 (7.7%) non-BA, P<0.0001. The median value of liver stiffness in the first group was 2.7 m/s (IQ 2.1/3.6) and 1.6m/s (IQ 1.2/2) in the second group, P<0.0001. The area under the ROC curve to predict BA was 0.85 (95%CI, 0.74-0.96; P<0.0001). The best cutoff value was 1.99 m/s with sensitivity 81% and specificity 73.1%. Patients with BA classified as F0-2 had mean liver stiffness values by the 2D-SWE of 1.8±0.2m/s, and F3-4, mean values of 3±0.8m/s, P=0.008.

Conclusion: Ultrasound and histology contribute to distinguishing BA from other diagnoses. Liver elastography is a promising tool in the differential diagnosis between BA and other causes of cholestasis, allowing the degree of fibrosis to be estimated at diagnosis.

Background: The main clinical impact of superficial neoplasms associated with Barrett's esophagus lies in their increasing oncogenic potential in the medium and long term. For this reason, the main international guidelines agree on the importance of their early eradication. However, controversy persists as to the most appropriate endoscopic resection technique either endoscopic mucosal resection or endoscopic submucosal dissection (ESD) that guarantees the best resective quality standards.

Objective: This study aims to present the results of the clinical application of endoscopic submucosal dissection to manage superficial esophageal neoplasms in Barrett's esophagus.

Methods: A retrospective analysis was performed on a prospectively collected database on consecutive patients treated with ESD for superficial neoplasms associated with Barrett's esophagus, between 2009 and 2022. The following clinical outcomes were assessed: en-bloc, complete and curative resection rates, local recurrence, adverse events and procedure-related mortality.

Results: Esophageal ESD was carried out in 27 patients with a final histological diagnosis of adenocarcinoma in 55.6% and high-grade intraepithelial neoplasia in 44.4%. En bloc and complete resection rates were 96.2% and 85.1%, respectively. The curative resection rate was 77.7%. Adverse events occurred in two cases (7.4%). The mean post ESD endoscopic follow up was 22.1 months. Disease free survival rate at 2 years was 88.9%.

Conclusion: ESD performed by trained endoscopists is feasible, safe and clinically effective for managing early Barrett's esophagus neoplasm.

Background: Inflammatory bowel disease (IBD) requires a multidisciplinary approach due to its complexity. Nurses play a key role in disease management, patient education, and care coordination. This study describes the role of nurses in an IBD Center of Excellence in Colombia, focusing on five pillars: clinical care, research, quality of life (including fatigue and mental health assessment), empowerment, and multidisciplinary support.

Methods: Descriptive observational study conducted between 2023 and 2024, using semi-structured interviews, direct observations, and surveys with the nursing team. Data were analyzed using descriptive statistics and thematic analysis. Measures were taken to minimize observer and interviewer bias.

Results: A total of 90 IBD patients were evaluated (56.6% female; mean age 40.8 years). Nurses played a central role in patient education, phenotyping, follow-up, and performing intestinal ultrasound. The IBDQ-32 questionnaire revealed moderate impact on quality of life, and the IBD-F scale identified fatigue in a subset of patients despite clinical remission. Patient satisfaction remained above 98% in both years. Nurses also coordinated pediatric-to-adult transitions, organized multidisciplinary meetings, and contributed to 41 research posters, some of which received international recognition.

Conclusion: Nurses are essential in IBD management, contributing to clinical care, education, quality of life assessment, research, and patient empowerment. Their involvement enhances outcomes, satisfaction, and the efficiency of multidisciplinary teams. Expanding standardized nurse training in Latin America is vital to strengthen IBD care.

Background: Gastrointestinal bleeding (GIB) is one of the leading causes of hospitalization attributed to digestive disorders. Little is known about etiology and outcomes of GIB and temporal trends in the incidence of upper GIB (UGIB) and lower GIB (LGIB) in Brazil.

Objective: To investigate the main causes and mortality of patients admitted to a tertiary care hospital in Brazil with UGIB and LGIB, as well as to assess trends in epidemiology and outcomes of GIB over time.

Methods: All patients admitted to the Gastrointestinal (GI) Unit of the Portuguese Hospital of Salvador, Bahia, Brazil with the diagnosis of GIB between January 2012 and December 2023 were retrospectively investigated. All patients with GIB were classified as non-variceal (NUGIB), variceal (VUGIB) UGIB and LGIB according to standard criteria and managed according to an institutional protocol. Demographics, type and etiology of GIB and in-hospital mortality were evaluated in two different periods, between 2012-2017 (period 1) and 2018-2023 (period 2).

Results: 2.145 patients (1.214 males, mean age 70+16 years) were admitted, 1.185 in period 1 and 960 in period 2. Most of the patients had hematochezia and melena. NUGIB, VUGIB, LGIB and mid-GIB were observed in 37.5%, 14.4%, 40.3% and 5.6% of the patients, respectively. The remaining 47 subjects were not investigated due to advanced age or comorbidity. The most common etiologies for UGIB and LGIB were, respectively, esophagogastric varices (EV), duodenal (DU) and gastric ulcer (GU), and colonic diverticular disease (CDD), actinic proctocolitis (APC) and hemorrhoids (HE). Changes in the frequency of LGIB (42.1% vs 38.0% in period 2, P<0.0001) and mid-GIB (3.8% vs 7.9% in period 2, P<0.0001) were recorded over time. Age (68.7+15.6 vs 71+15.7 years in period 2, P=0.001) and gender (54,1% vs 59.1% of males in period 2, P=0.01) were also shown to vary as well as a significant decrease in mortality in recent years (14,2% vs 10.1% of deaths in period 2, P=0.005).

Conclusions: EV, DU, GU and CDD, APC and HE were the most frequent causes of UGB and LGIB, respectively. Shifts in demographics, frequency of LGIB and mid-GIB and mortality were demonstrated in recent years.

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.