Arquivos de Gastroenterologia最新文献

Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus that affects both children and adults.

Objective: The purpose of this article is to establish guidance and updates for the diagnosis and treatment of EoE.

Methods: The Brazilian Federation of Gastroenterology, FBG, gathered a group of gastroenterology experts in the field of esophagus and conducted a Delphi process to develop updated guideline for the management of patients with EoE in the light of recent evidence. Grading of the strength and quality of evidence of the recommendations was performed using GRADE criteria. The database searched included MEDLINE, EMBASE, SciELO, LILACS, ClinicalTrials.gov, and CINAHL, using their respective search mechanisms with studies retrieved up to January 2025. The resulting document is presented in the form of 15 questions and answers on diagnosis and treatment, with practical approaches and particularities of EoE, based on the current best evidence-based medicine, indicating the quality of data and specialists' opinion on the subject.

Results: From the standpoint of diagnosis, the present clinical guideline focused on the most prevalent aspects of EoE as well aiming to promote the benefits of the early diagnosis in clinical practice. The treatment is herein focused on the major advances in pharmacologic approach and therapeutic options available, as well as in the consistent corpus of evidence on dietary therapy.

Conclusion: This FBG guideline is established to support clinical practice and suggest preferable approaches to a typical patient with EoE based on the currently available published literature. In this context, physicians must take into account patient´s medical comorbidities, adherence to treatment and preferences.

Background: The late diagnosis of gastric cancer, which is usually diagnosed via upper digestive endoscopy, may be attributed to the failure to detect precursor lesions. This study aimed to determine the prevalence of gastric cancer and its precursor lesions in individuals undergoing routine upper gastrointestinal endoscopies at a tertiary hospital in Brazil.

Methods: Patients aged >40 years who had undergone diagnostic endoscopic examinations in 2017 at our institution were included in this retrospective cross-sectional study. We exclude patients with more than one examination in the time-period, without gastric biopsies, and those with autoimmune atrophic gastritis and history of gastric surgery. The histopathological findings were reviewed by two gastrointestinal pathologists. The Operative Link on Gastritis Assessment (OLGA) classification was used in cases wherein gastric mapping was performed. Descriptive statistical analysis for the diagnostic findings of the malignant precursor lesions and gastric cancer was performed using Chi-square test. Statistical significance was set at P<0.05.

Results: Among the 1,071 patients (64.6% females; age 60±10.4 years old) who underwent endoscopic examinations, 277 (25.9%) were diagnosed with malignant precursor lesions or cancer, three (0.3%) dysplastic lesions, and 12 (1.1%) neoplasms. A total of 888 patients underwent gastric mapping; OLGA III and IV stages were observed in 46 (5.2%) patients. Chi-square test revealed significant correlations between dysplastic and neoplastic lesions and male sex, age >80 years and the prevalence of chronic atrophic gastritis and intestinal metaplasia, and age 40-49 years and the prevalence of Helicobacter pylori infection.

Conclusion: Precursor lesions for gastric cancer were observed in up to 25% of the patients, with a predominance of low-risk lesions. Further prospective studies must be conducted to evaluate the risk of gastric cancer in individuals with precursor lesions and formulate prevention strategies.

Introduction: Helicobacter pylori infection has a high prevalence in Brazil, and eradication therapy is recommended for all diagnosed cases. While smoking has been identified as a factor associated with therapeutic failure, its impact on treatment efficacy has not yet been conclusively demonstrated in studies conducted within the Brazilian population.

Objective: To determine the factors associated with Helicobacter pylori eradication failure in patients submitted to empirical 14-day antimicrobial therapy with omeprazole 20 mg BID, amoxicillin 1 g BID, and clarithromycin 500 mg BID at a Brazilian university center.

Methods: An observational and retrospective study was conducted in the Hospital de Clinicas, University of Campinas, Brazil, between April 2022 and September 2023. The study included treatment-naive patients with Helicobacter pylori infection. These patients received PPI-clarithromycin triple therapy and underwent the 13C-urea breath test (13C-UBT) to evaluate eradication. Clinical and demographic variables were analyzed as potential factors associated with therapeutic failure, including age, gender, obesity, diabetes mellitus, anxiety and depression disorders, irritable bowel syndrome, fibromyalgia, smoking, alcoholism and cirrhosis.

Results: A total of 97 patients were included, with a mean age of 55±14 years, 67 (69.1%) female. The antimicrobial treatment achieved 90.7% effectiveness (n=88). Smoking (P=0.0068) was the only factor associated with eradication failure after multiple regression analysis.

Conclusion: Smoking was the only factor associated with Helicobacter pylori eradication failure, as determined by the 13C-urea breath test.

Background: Acute upper gastrointestinal bleeding (AUGIB) is a critical medical emergency and is a common cause of illness and death in individuals with liver cirrhosis.

Objective: The point of this study was to check how well the albumin-to-bilirubin ratio (ALBI) and model for end-stage liver disease (MELD) scores could predict how these patients would do in the future.

Methods: The Imam Khomeini Hospital gastroenterology department conducted a retrospective examination. We admitted 102 patients with AUGIB and liver cirrhosis from April 2021 to September 2023. The study included a full medical history and clinical evaluation upon admission, as well as all laboratory test results throughout the hospital stay. We diagnosed liver cirrhosis using clinical, laboratory, and radiologic data. We diagnosed AUGIB as having hematemesis, melena, or hematochezia. We then tested the ALBI, MELD, and liver and kidney function. Some criteria allow continuous variable comparison, whereas others allow discrete variable comparison. Death during hospitalization and rebleeding were the key outcomes, with one-month mortality assessed. We compared ALBI and MELD before establishing their relationship to mortality and rebleeding.

Results: Of the 102 patients, 68.5% survived. Upon arrival, we noted a markedly elevated prevalence of edema, ascites, and chilly extremities among patients who did not survive. The MELD and ALBI scoring systems effectively forecast in-hospital mortality. The threshold for MELD is 21 (CI: 0.759-0.930, P=0.00), whereas for ALBI it is -2.3 (CI: 0.865-0.950, P=0.01). Neither party could foresee hospitalization or premature rebleeding. The probability of death may be forecasted using the MELD during the first discharge phase (P<0.05).

Conclusion: The MELD and ALBI scores show a suitable ability to predict short-term outcomes and both of them can predict death and rebleeding, as well as 1-month mortality. Nevertheless, we recommend that in individuals with advanced liver cirrhosis, the MELD score is a more accurate prognostic indicator compared to the ALBI score.

Background: Crohn's disease (CD) is a chronic inflammatory disease, with a heterogeneous clinical course, which can affect any segment of the gastrointestinal tract. Data on the natural history of CD in developing countries are rare.

Objective: to delineate the clinical, epidemiological, and longitudinal characteristics of CD patients at a Brazilian referral center.

Methods: this is an observational, cohort, retrospective study, carried out from the collection of data obtained from the medical records of individuals diagnosed with CD followed up in the period between 1991 and 2021.

Results: A total of 328 participants were included, 54.3% female. The median age at diagnosis was 31 years [interquartile range (IQR)=14-45]. At diagnosis, there was a predominance of the stricturing form (38.7%) and ileocolonic location (53.7%). Among the patients with the inflammatory form, 10.8% evolved to the stricturing or penetrating forms, and the time they remained with uncomplicated disease had a median of 6 years (IQR=0-13). Aminosalicylates were used in 70.7% of the patients, but there has been a reduction in their use in the last 15 years (P=0.04). Corticosteroids were used in 90.2% of the participants, with a median time of use of 12 months (IQR=0-36). Immunosuppressants were used in 93.9% of participants. Two hundred and ten patients (64%) received treatment with immunobiological. The median interval between diagnosis and initiation of biological therapy was 24 months (IQR=12-60). One hundred and eighty-nine patients (57.6%) were hospitalized during follow-up, and the median hospital stay was 20 days (IQR=11-36). In the last 15 years, there was a decrease in the hospitalization rate (P<0.001), but there was no change in the number of hospitalizations per patient (P=0.62). One hundred and fifty-two patients (46.3%) underwent surgical treatment during the period evaluated and the most frequently performed surgeries were enterectomies (26.8%) and perianal procedures (25%). In the last 15 years, there has been a decrease in the rate of surgeries (P=0.04) and in the number of surgeries per patient (P<0.001).

Conclusion: The data presented indicate a high prevalence of complicated CD at the onset of follow-up, alongside a significant percentage of corticosteroid use and hospitalization. However, over the past 15 years, there has been a notable reduction in hospitalization rates, surgical rates, and the number of surgeries per patient.

Objective: To verify the effect of physical exercise on the quality of life of patients with liver cirrhosis (LC).

Methods: the sample included controlled and randomized experimental studies of individuals with LC, at any stage of the disease, over 18 years of age, of both sexes, who performed any type of physical exercise compared to any other intervention or no intervention, with quality of life as the outcome assessed by the Chronic Liver Disease Questionnaire (CLDQ). The search for articles was conducted in 11 databases. The descriptors considered for the search were physical exercise, quality of life, liver cirrhosis, and their synonyms. The methodological quality and study bias were assessed using the Jadad scale and the RoB 2 scale, respectively. Review Manager 5.4 was used for the meta-analysis of the data. Quality of life was considered a continuous variable. The mean difference was considered as the effect measure. The analysis model was fixed-effect. The confidence level adopted was .05. The level of evidence for the meta-analysis results was assessed using the GRADE tool.

Results: A meta-analysis of five studies, in which 153 participants with LC, of which 83 belonged to the physical exercise group and 70 to the control group, showed that the experimental group that performed physical exercise significantly increased quality of life by 0.46 [0.09 to 0.84]; P=.02. The level of evidence of the meta-analysis was considered high.

Conclusion: Physical exercise led to an improvement in the health-related quality of life of patients with LC.

Objectives: This study aimed to translate the Neurogenic Bowel Dysfunction Score into Brazilian Portuguese, adapting it culturally and validating it semantically.

Methods: The process followed international guidelines for translation, back-translation, cultural adaptation, and semantic validation, involving a committee of specialists and a pre-test with 10 Brazilian pediatric patients with neurogenic bowel dysfunction (mean age: 11 years). Participants were divided into two groups, depending on whether they used transanal irrigation for intestinal management. The translated version was evaluated considering its clarity, equivalence (Likert scale), Kendall's Coefficient of Concordance, and applicability.

Results: The Brazilian version of the pediatric Neurogenic Bowel Dysfunction Score, presented here, showed high levels of linguistic and cultural equivalence (Kendall greater than 0.8) according to the specialists, after the second round of evaluations. Furthermore, participants understood the questionnaire very well (mean clarity on a Likert scale: 4.7±0.1). The groups were homogeneous for most variables analyzed. The score of Group 1, which used transanal irrigation, was found to be less severe than that of Group 2 (P=0.004). Group 1 showed more satisfaction with their bowel function control than Group 2 (P=0.008).

Conclusion: The initial validation of the pediatric Neurogenic Bowel Dysfunction Score is a step forward in its integration into the national clinical context. The instrument was found to be reliable and viable for use in clinical practice and research, enabling standardized assessments and global comparisons. Its implementation will help ensure efficient neurogenic bowel dysfunction management and improve the health and quality of life of these children and adolescents.

Background: Gastroesophageal reflux disease has a prevalence of 12% in the Brazilian population. Its treatment includes hygienic-dietary changes, use of medications and, in selected cases, surgery with laparos-copic hiatoplasty and Nissen total fundoplication. However, this last treatment modality presents risks of postoperative dysphagia. High Resolution Esophageal Manometry (HREM) has been considered the test of choice for identifying patients who are candidates for surgical treatment at an increased risk of developing dysphagia.

Objective: The objective of this study is to carry out a systematic review to evaluate the clinical and manometric factors that predict post-hiatoplasty and Nissen fundoplication dysphagia using HREM.

Methods and results: Having defined the search engine, we used the databases MEDLINE, PUBMED, EBSCOHOST, SCOPUS and EMBASE. 2147 articles were identified. After selection, 11 studies remained.

Conclusion: We concluded that the data from the selected articles are heterogeneous, but there is agreement regarding a higher risk of dysphagia among female patients, patients with dysphagia present in the preoperative period and, about manometric parameters, for patients with dysphagia in the preoperative period, there is a higher incidence of dysphagia resolution for patients with DCI >1000 mmHg.s.cm. In patients with ineffective esophageal motility, it is recommended to perform the Rapid Multiple Swallowing Test to assess the contractile reserve of the eso-phageal body. If there is an increase in contractile strength with this test, it is considered safe to perform a total fundoplication because the incidence of late dysphagia is low in these cases.

Background: Most Helicobacter pylori (H. pylori) infections are acquired in childhood. It remains uncertain whether gastroenterologists involved in endoscopic procedures face an increased occupational risk of H. pylori.

Objective: To determine H. pylori prevalence among gastroenterologists and gastroendoscopists in Brazil.

Methods: A prospective, observational, non-interventional study was conducted during the 2022 Brazilian Digestive Disease Week meeting. Attendees were invited to undergo a 13C-urea breath test (UBT) to investigate their H. pylori status. The attendees completed a questionnaire regarding their demographic data and information about medical specialties and activities (gastroenterology or gastroendoscopy). This study included 286 participants (160 women, 126 men; mean age, 42 years; SD, 13, range 25-83 years) agreed to participate. 13C-urea breath test: Before the study, all participants abstained from proton pump inhibitors (PPIs) and H2 blockers for 1 week, and antibiotics for four weeks. The test was performed after at least one-hour of fasting using the BreathID HP Lab System® (Exalenz Bioscience, Israel, now Meridian Bioscience, USA), with a delta over baseline (DOB) ≥5‰ indicated H. pylori infection.

Results: Among the 286 study participants, 218 tested negative and 68 tested positive with an overall prevalence of 23.8%. If we excluded all 67 participants who reported prior treatment for HP infection (54 HP-ve and 13 HP+ve) from the analysis of our sample, our sample of 219 participants presented a current prevalence of 25.1% (55 HP+ve and 164 HP-ve). The HP prevalence among participants who did or did not perform endoscopic procedures in their daily activities was 28.4% and 23.2%, respectively, with no statistically significant difference (P=0.39).

Conclusion: The prevalence of H. pylori infection among Brazilian gastroenterologists is moderate, with one in four professionals still infected. H. pylori infection prevalence increases with age and is higher among overweight and obese individuals. Performing endoscopic procedures does not appear to increase the risk of infections among gastroenterologists in Brazil.