Arquivos de Gastroenterologia最新文献

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.

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.