Arquivos de Gastroenterologia最新文献

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.

Context: Due to the potential risk for chronic and severe progression, hepatitis B virus (HBV) infection requires antiviral medications, such as Tenofovir (TDF) and Entecavir (ETV), to reduce the HBV viral load and prevent the risk of liver cirrhosis and hepatocellular carcinoma (HCC). The PAGE-B score is a simple and reliable tool for assessing the risk of developing HCC, although it has not yet been validated in Brazil.

Objective: To validate the PAGE-B risk score for predicting HCC development in HBV carriers in Brazil. To analyze the association between the PAGE-B score and demographic, laboratory, and HBV treatment variables.

Methods: An observational cohort. retrospective study. Study sample - 659 individuals with chronic HBV mono-infection treated with antivirals for at least 3 years at two reference centers in Brazil's Northeast and Amazon regions. The PAGE-B score was used to analyze its association with sex, age, and platelet count, classifying each patient's HCC risk as low, moderate, or high.

Results: The mean PAGE-B score was 12.77±5.63. PAGE-B scores were classified as low, moderate, and high in 206 (31.2%), 287 (43.5%), and 166 (25.3%) individuals, respectively. Among the 659 patients, 31 (4.7%) developed HCC, a higher frequency than reported in PAGE-B score validation studies from other countries. Of these patients, 29 were male, with a mean age of 57.4±12.6 years and lower platelet levels (<200,000 10³/mL). Patients who developed HCC had fibrosis stages: F0-F1:6 (19.3%); F2:2 (6.4%); F3:2 (6.4%); and F4:21 (67.7%). High-risk patients were treated with ETV (n=129, 32%) versus TDF (n=37, 14,4%), P<0.00.

Conclusion: The PAGE-B score demonstrated, in the Brazilian population, a performance similar to that observed in studies with European and Asian populations in terms of sensitivity, specificity, and predictive values for HCC prediction. Based on these results, the PAGE-B score can be used in the Brazilian population to predict the risk of HCC.

Context: COVID-19, caused by SARS-CoV-2, is primarily characteri-zed by respiratory symptoms but also significantly affects the gastrointestinal (GI) tract and liver. Emerging evidence suggests that GI and hepatic manifestations may influence disease severity and outcomes. In Brazil, where disparities between public and private healthcare systems are pronounced, understanding these associations is crucial for optimizing patient management. This study aimed to evaluate the frequency and prognostic implications of digestive and hepatic injuries in hospitalized COVID-19 patients.

Objective: To analyze the frequency of hepatic and gastrointestinal injuries and their association with outcomes (discharge or death).

Methods: A retrospective cross-sectional study analyzed 3,555 patients from 50 private hospitals in Brazil (March-December 2020). Inclusion criteria were age ≥18 years, RT-PCR-confirmed COVID-19, and written consent. Demographic data, comorbidities, GI symptoms (diarrhea, nausea/vomiting, abdominal pain), liver enzymes (ALT, AST), and outcomes (discharge, mortality, ICU admission) were collected via REDCap. Statistical analyses included logistic regression to identify mortality predictors.

Results: Among 3,555 patients (59.9% male, mean age 55.8 years). A total of 42.2% of patients presented with at least one gastrointestinal (GI) symptom at admission. Diarrhea was reported in 15%, nausea or vomiting in 13.6%, and abdominal pain in 6.5%, with symptom overlap among patients. The deceased group exhibited significantly higher alanine aminotransferase (ALT) (p=0.019) and aspartate aminotransferase (AST) (p=0.026) levels, representing 4.2- and 8.4-fold increases, respectively, with a higher AST/ALT ratio in fatal cases (1.69 vs 0.84). COVID-19 patients in Brazilian private hospitals showed hepatic abnormalities (AST 354.1 IU/L vs 42.1 IU/L in deceased vs discharged patients, P=0.026), with diarrhea associated with lower mortality (OR 0.61; 95%CI 0.42-0.88), while chronic liver disease (OR 2.95; 95%CI 1.35-6.41) and hypoalbuminemia (OR 0.22; 95%CI 0.11-0.38) emerged as independent predictors of death.

Conclusion: Hepatic abnormalities and gastrointestinal symptoms are important markers of COVID-19 severity. Diarrhea, liver enzyme alterations, and serum albumin levels were significant predictors of mortality. Future strategies should prioritize hepatic monitoring, nutritional support, and healthcare equity through targeted interventions for high-risk groups, particularly in resource-limited settings.

Background: Hepatocellular carcinoma (HCC) is the leading cause of mortality among cirrhotic patients, often linked to advanced liver disease.

Objective: This cross-sectional study evaluated the nutritional factors, cytokine profiles, liver function parameters, and survival of patients with liver cirrhosis (LC) and HCC.

Methods: Forty-seven patients were grouped as LC (n=21) or LC with HCC (n=26). Nutritional status was assessed through anthropometry, bioelectrical impedance analysis, and dietary recall, while cytokine levels (IL-6, IL-10, TNF-α) and biochemical markers (AST, ALT, albumin, prealbumin) were analyzed. Survival data were evaluated using Kaplan-Meier curves and Cox regression.

Results: HCC patients exhibited higher IL-6 levels, correlating with advanced disease stages (P=0.035). IL-10 levels were elevated in early-stage HCC (BCLC A) compared to BCLC B (P=0.006). AST and ALT levels were significantly higher in HCC patients, reflecting greater hepatocyte damage. Survival analysis revealed a median of 756 days, with shorter survival in HCC patients (P=0.0172).

Conclusion: This study highlights the roles of IL-6 and IL-10 as potential biomarkers in HCC progression and provides critical insights into the biochemical and nutritional profiles associated with LC and HCC. These findings may inform future therapeutic interventions.

Background: Chronic liver diseases (CLDs), particularly metabolic-associated steatotic liver disease (MASLD), represent a significant global health burden, with potential progression to fibrosis, portal hypertension, and hepatocellular carcinoma (HCC). This review explores the role of vascular remodeling and angioarchitecture in MASLD pathogenesis, emphasizing the importance of microvascular changes, endothelial dysfunction, and angiogenesis in disease progression. Hepatic steatosis leads to hepatocyte enlargement and sinusoidal compression, disrupting microcirculation and oxygenation. Lipotoxicity, which is driven by excess fatty acids and oxidative stress, triggers inflammation and vascular permeability, fostering a proangiogenic environment. Capillarization of liver sinusoidal endothelial cells (LSECs) and activation of hepatic stellate cells (HSCs) contribute to fibrosis and neovascularization. Angiogenesis, especially via VEGF and other cytokines, is implicated in the transition from steatosis to steatohepatitis (MASH) and ultimately HCC, even in non-cirrhotic livers. Notably, portal hypertension may develop early in MASLD, independent of cirrhosis. Given the central role of vascular alterations in MASLD, future therapies may target endothelial and stromal cell interactions. Further research is needed to delineate disease-specific mechanisms and their implications for fibrosis and carcinogenesis.

Background: Gastroparesis is a delay in gastric emptying without mechanical obstruction, lacking a clear pathophysiological mechanism, but with multiple histological abnormalities, including loss of interstitial cells of Cajal, which may alter slow waves. Slow waves can be assessed by electrogastrography. Objective: This study aimed to determine the prevalence and range of abnormalities in gastric slow waves in children with gastroparesis.

Methods: We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO: CRD42023435301). Searches were performed in MEDLINE (PubMed), Embase, LILACS, Web of Science, and the Cochrane Register of Controlled Trials, from inception to September 2023, without language or publication restrictions. We included studies using surface electrogastrography in children (6-18 years) with gastroparesis. Outcomes included the percentage of recording time in normogastria (2-4 cycles per minute), tachygastria, and bradygastria; dominant frequency; power ratio; post-stimulus power change; and dominant frequency instability coefficient. Risk of bias was assessed using the Joanna Briggs Institute tool. Meta-analyses were conducted using random-effects models when appropriate, and heterogeneity was explored via the I² statistic and prediction intervals. When pooling was not feasible, a narrative synthesis was provided.

Results: A total of 3730 articles were reviewed, four articles were included, with a total of 70 patients and 15 controls. When compared to controls, gastroparetics had significantly less fasting normogastria (Standardized Mean Difference = -3.363 [95% confidence interval: -4.068 to -2.657]), significantly more fasting tachygastria (Standardized Mean Difference = 3.287 [95% confidence interval: 2.657 to 3.918]), and significantly less power ratio (Standardized Mean Difference = -4.067 [95% confidence interval: -4.791 to -3.343]).

Conclusion: Children with gastroparesis during fasting had a lower percentage of normogastria and higher percentage of tachygastria. Children with gastroparesis showed less change in post-stimulus power, reflecting possible alterations in gastric contraction and/or distension.