Arquivos de Gastroenterologia最新文献

Background: Since Ludwig proposed the term "nonalcoholic steatohepatitis" (NASH) for this liver disease in 1980, there have been many advances in understanding it, including its epidemiology, pathogenesis, diagnostic methods, and treatment.

Objective: This literature review aims to discuss the most relevant aspects of metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: The review included clinical studies from the following databases: Embase, PubMed, Scopus, Web of Science, Lilacs, Ovid, and Scopus.

Results: MASLD is the most frequent liver disease worldwide, with increasing prevalence and incidence, and can evolve with liver cirrhosis and hepatocellular carcinoma. The diagnosis involves specific diagnostic criteria involving the presence of hepatic steatosis and other metabolic factors. Drug treatment, still in its incipient, involves pioglitazone, glucagon-like peptide-1 (GLP1) agonists, and sodium glucose cotransporter-2 (SGLT2) inhibitors, especially in diabetic patients. More recently, the Food and Drug Administration (FDA) approved Resmetiron for selected cases.

Conclusion: MASLD is extremely common, presents complex pathophysiology, and requires an intensive multidisciplinary approach. It is hoped that future studies will provide effective and accessible pharmacological therapeutic options for the disease. It is necessary to bring the population's attention to this condition, which can be associated with significant morbidity and mortality.

Objective: Identify psychosocial risk factors for non-adherence to medication following liver transplantation.

Methods: We used the Medication Level Variability Index (MLVI) for the assessment of adherence in 52 subjects selected for a pre-transplant liver procedure and monitored them for 6 months following transplantation. Patients were divided into exposed and non-exposed groups according to adherence, and each group was analyzed using psychosocial variables: demographic characteristics, quality of life, impulsivity, resilience, anxiety and depression.

Results: Patients with non-adherence had lower scores in the SF-36v2 domains and in the components of physical and mental health, with significant differences in the physical functioning (P=0.03) and physical health component (P=0.03) domains. In addition, non-adherent patients showed higher levels of impulsiveness (P=0.04) and 44.2% of the non-adherent patients being men (P=0.04).

Conclusion: Physical functioning and summary of the physical components of quality of life, impulsivity and male gender were associated with low adherence to medication.

Background: Pancreaticoduodenectomy (PD) is a complex procedure with significant postoperative morbidity. Associated sarcopenia could be a potential risk for increased post-operative complications.

Methods: Patients who had undergone pancreaticoduodenectomy bet-ween July 2019 to December 2020 were included in the study. Preope-rative comprehensive sarcopenia assessment was done by hand grip strength test, Dual energy X-ray absorptiometry (DEXA) scan and gait speed test. Only myopenia was also assessed by DEXA scan in all the patients. Post-operative outcomes were recorded and the association of preoperative sarcopenia with postoperative complications were analyzed.

Results: Of 47 patients assessed, 36 patients were finally included (Median age -58 years (IQR-51,68) years, 26 male). The five (13.8%) had sarcopenia confirmed on comprehensive assessment. Thirteen (36.5%) patients had myopenia on DEXA assessment. The major Clavien-Dindo complications were significantly higher in sarcopenia (40% vs 6.6%, P=0.04) and similarly, grade C DGE (40% vs 0, P=0.04) was also more frequent in patients with sarcopenia. The patients with myopenia only did not have a significant correlation with post-operative complications. (15.4% vs 8.7% P=0.66).

Conclusion: Comprehensive assessment using muscle strength and muscle quantity is essential for sarcopenia diagnosis. Preoperative sarcopenia is a significant risk factor for post-operative complications.

Background: Accurate evaluation of the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) is crucial for optimal treatment. While magnifying endoscopy (ME) using the Japanese Esophageal Society (JES) classification is reported as the most accurate method to predict invasion depth, its efficacy has not been tested in the Western world. This study aims to evaluate the interobserver agreement of the JES classification for SESCC and its accuracy in estimating invasion depth in a Brazilian tertiary hospital.

Methods: We retrospectively selected ME with Narrow Band Imaging (ME-NBI) images of 30 suspected SESCC cases. The best images of each case were included in online forms, which were evaluated by ten endoscopists (five experts and five novices). The evaluators classified the lesions according to the JES-IPCL classification and estimated the depth of invasion. Interobserver agreement was assessed using kappa values. Histological comparison was possible for 17 lesions.

Results: The overall interobserver agreement for the JES-IPCL classification was moderate (K=0.455, P<0.001). Agreement among experts (K=0.437) and novices (K=0.483) was also moderate. Sensitivity, specificity, and accuracy for IPCL types were: B1 (41.3%, 78.9%, 59.9%), B2 (75%, 66.7%, 68.7%), and B3 (46%, 91.7%, 78.6%). Overall accuracy of the JES classification for estimating depth of invasion was 47.5%.

Conclusion: The moderate interobserver agreement suggests the JES-IPCL classification may be useful in the Western world, but extensive training is needed. The findings indicate a longer learning curve for accurate ME-NBI image evaluation using the JES classification.

Background: Pancreatic collections are a common complication of acute pancreatitis. In Latin America, information on the types of pancreatic collections and their management is limited and may vary between regions depending on the availability of highly specialised and minimally invasive treatment resources.

Methods: Retrospective cohort of patients with acute pancreatic collections secondary to acute pancreatitis treated at the Hospital Universitario San Ignacio, Bogotá (Colombia) between 2012-2023. Clinical characteristics, laboratory profiles and treatment received were described, comparing those who had a fatal outcome with those who did not.

Results: Of 689 patients with acute pancreatitis, 113 presented with pancreatic collection (55.1% women, mean age 55 years). Of these, 47.8% presented with acute necrotic collection, 36.3% with acute fluid collection, 9.7% with walled-off necrosis and 6.2% with pancreatic pseudocyst. C-reactive protein, BUN, creatinine levels (at admission and at 48 hours), PaO2/FiO2 (at admission and at 48 hours) and antibiotic use were significantly associated with mortality (P<0.05). The majority of acute necrotic collections, walled-off necrosis and pseudocysts received interventional management, with minimally invasive and combined management being more common than surgical management. Antibiotic management was used in 48.6% of collections, although microbiological isolation was performed in only 24.7% of cases.

Conclusion: Acute collections are a common and heterogeneous complication of pancreatitis, requiring intervention more often in complicated collections. Certain laboratory parameters seem to be more associated with mortality.

Background: • Pancreatic collections are a common complication of acute pancreatitis.

Background: • Their management depends on the availability of specialized and minimally invasive resources.

Background: • A study conducted on 689 patients with acute pancreatitis showed that 113 developed pancreatic collections.

Background: • Acute pancreatic collections are frequent and heterogeneous complications of pancreatitis.

Background: • Some altered laboratory parameters (creatinine, urea, C-reactive protein, and FiO2) seem to be more associated with mortality.

Background: Celiac disease is a chronic autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals, leading to intestinal damage. Probiotics have been studied for their potential benefits in modulating gut microbiota and alleviating gastrointestinal symptoms, which may be beneficial in managing celiac disease (CD).

Objective: In this way, this study evaluated the effects of probiotics compared to placebo in individuals with CD over the course of treatment.

Methods: A total of 85 participants, with an average age of 40 years, were randomized into two groups using a computer-generated list: 39 receiving placebo and 46 receiving a probiotic blend of Bifidobacterium lactis CCT 7858 and Lactobacillus rhamnosus CCT 7863 (1 x 109 CFU/day) over 90 days. Participants received either a daily probiotic capsule or an identical placebo made from maltodextrin, provided by Gabbia Biotecnologia Ltda. The randomization process and group assignments were concealed from both participants and investigators.

Results: Both groups exhibited similar demographic and clinical characteristics, with most participants symptomatic for CD and adhering to a gluten-free diet. The Bristol Stool Form Scale (BSFS) showed a predominance of normal stool forms in both groups, with a higher prevalence of type 4 in the probiotic group. Gastrointestinal Symptom Rating Scale (GSRS) scores improved significantly in the probiotic group compared to placebo. Additionally, the probiotic group showed significant improvements in emotional well-being and gastrointestinal symptoms, leading to a better quality of life, as measured by the CD-specific quality of life (CD-QOL) scores.

Conclusion: These results suggest that probiotics contribute to symptom improvement and enhanced quality of life in CD patients.

Background: • Probiotics improve celiac disease symptoms.

Background: • This study involved 85 participants with celiac disease.

Background: • The probiotic group significantly modulated gastrointestinal symptoms and quality of life.

Background: • The probiotics are beneficial adjunct therapy for individuals with celiac disease.

Objectives: to determine the prevalence and identify the factors associated with bacterial infection in cirrhotic patients in Togo.

Methods: This was a descriptive and analytical cross-sectional study, with retrospective data collection, conducted in the hepato-gastroenterology department of the Campus University Hospital during three years. All patients hospitalized in the department during this period and diagnosed with cirrhosis were included in the study.

Results: During the study period, 270 patients were hospitalized for cirrhosis including 63 cases of bacterial infection, a prevalence of 23.3%. Bacterial infections were represented by spontaneous infection of ascites fluid (15.9%) followed by urinary tract infection (4%). The median length of hospital stay was 10 days Thirty-six of the patients with infection died in hospital, corresponding to a mortality rate of 57.1%. Factors associated with bacterial infection were ascites (P=0.017; OR=4.56), hepatic encephalopathy (P=0.02; OR=4.32), a prothrombin level below 25% (P=0.002; OR=9.67) and a high MELD score (P=0.03; OR=0.93).

Conclusion: Bacterial infection occurs in advanced cirrhosis and is associated with a poor prognosis.

Background: • Bacterial infections are a frequent complication of cirrhosis and were associated with ascites, hepatic encephalopathy and a high MELD score.

Background: • The most frequent type of infection in this study was spontaneous bacterial peritonitis followed by urinary tract infection.

Background: Restorative proctocolectomy (RPC) is a common surgical indication to manage familial adenomatous polyposis (FAP) patients.

Objective: We compared outcomes after ileostomy closure in patients undergoing laparoscopic (LAP) or conventional (OPEN) RPC at one single institution.

Methods: Charts from FAP patients (1997-2013) were reviewed. Demographic data (age, sex, previous surgery) and surgical outcomes (original surgical approach, early and late morbidity, complications and reoperations after ileostomy closure) were compared.

Results: A total of 84 patients (53 women and 31 men) submitted to ileostomy closure at a mean age of 30.6 years (11-64) were analyzed. Twenty-one (25%) and 63 patients (75%) formed the OPEN and LAP groups, respectively. Demographic features were similar. After pouch construction, 27 early (32.1%) and 8 late (9.5%) complications occurred, with no mortality. Although overall morbidity rates were similar between both approaches, late complications rate were less common in LAP patients (7.9% x 14.2%). After ileostomy closure, complications were registered in 6 (7.1%) patients, and patients previously operated with the LAP approach also presented less complications (4.7% x 14.2%) and reoperations (3.1% x 9.5%). Additionally, the need for surgical management of complications was greater in the OPEN (9.5%) than the LAP group (3.1%). Besides these numbers, analysis didn't reveal statistical differences among both groups.

Conclusion: In the conditions of the present manuscript, the abdominal approach used for restorative proctocolectomy doesn't seem to decisively influence outcomes after loop ileostomy reversal. In the future, analysis of a greater number of patients may probably demonstrate an expected greater complication and reoperation rates in those previously treated through OPEN procedures.

Background: • Ileostomy closure is an important part of the surgical treatment of FAP patients undergoing restorative proctocolectomy by any approach.

Background: • Complication rates after loop ileostomy reversal occurred in 7% of a group of 84 FAP patients.

Background: • Among those operated with the laparoscopic approach, complications (4.7% x 14.2%) an reoperations (3.15% X .5%) were less common when compared to the group treated with conventional approach.

Background: • In the future, annalysis of a greater number of patients may probably reveal an statistical difference between these numbers, thus clearly demonstrating this great advantage of minimally invasive procedures in this group of patients.

Background: Gluten - related diseases, such as celiac disease (CD) and dermatitis herpetiformis (DH) are autoimmune conditions triggered by gluten intolerance. CD manifests with a broad spectrum of clinical symptoms, both intestinal and extraintestinal, while DH is a cutaneous manifestation associated with CD. The clinical manifestations of both CD and DH can vary between men and women.

Objective: This study aimed to describe the clinical profiles and histological findings at the time of diagnosis in men with CD and DH, comparing the differences and similarities between the findings.

Methods: This retrospective study included male patients diagnosed with CD or DH from a specialized private clinic in Curitiba, Brazil. The study involved a review of patients' clinical charts and was carried out over a ten-year period, from January 2014 to January 2024. CD diagnosis was based on positive serological tests and duodenal biopsies graded by Marsh classification. All patients had DH diagnosis was confirmed through clinical assessment and direct immunofluorescence on skin biopsies before CD diagnosis. All patients were ingesting gluten.

Results: The study analyzed 75 male patients, 57 with CD and 18 with DH. Diarrhea was significantly more prevalent in CD patients, while osteoporosis was exclusively observed in the CD group. Mild enteropathy (Marsh I or Marsh II), accounting for 34.7%, was more commonly associated with DH. In both groups, Marsh III predominated, representing 65.3% of cases. Men with CD and DH displayed similar symptoms.

Conclusion: There were no significant differences in clinical and histological findings between male patients with CD and DH, apart from a higher incidence of diarrhea in CD patients. Duodenal biopsies are recommended for all DH patients.

Background: • Celiac disease and dermatitis herpetiformis shared genetic background and are frequently underdiagnosed.

Background: • Diagnoses of mild enteropathy in both conditions have increased in recent years due to better awareness and improved serological testing.

Background: • Women are more affected and studied. There are few studies in men.

Background: • Overall, clinical presentations were similar between the two diseases.

Context: The rising antibiotic resistance in Helicobacter pylori (H. pylori) infection have made treatment more challenging. A low-nickel diet may improve eradication rates based on the bacteria's mechanisms.

Objective: This study aimed to evaluate the effect of a low-nickel diet during standard triple therapy on the rate of H. pylori eradication.

Methods: This randomized clinical trial included patients with H. pylori infection who were classified into the following two groups: low-nickel diet and regular diet. Both groups received the standard triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor. After at least 8 weeks of treatment, a control test for H. pylori was performed.

Results: Per-protocol analysis showed a higher rate of H. pylori eradication in the low-nickel diet group than in the regular diet group (91.7% vs 75.8%; P=0.026). In addition, obesity was associated with poorer eradication rates (73.2% vs 88.9%, P=0.038). Patients on a low-nickel diet were 3.41 times (1.21-11.40) more likely to have H. pylori eradication than those on a normal diet.

Conclusion: This study showed that low-nickel diet, which is a low-cost and low-risk intervention, may be an appropriate strategy for increasing H. pylori eradication rates.

Background: • Evaluate the effect of low-nickel diet during standard triple therapy on the rate of Helicobacter pylori eradication.

Background: • This randomized clinical trial included patients infected with Helicobacter pylori in groups with a low-nickel nickel or regular diet, who underwent standard triple therapy and the efficacy of bacterial eradication was compared between both groups.

Background: • Per-protocol analysis showed a higher rate of Helicobacter pylori eradication in the low-nickel diet group than in the regular diet group (91.7% vs 75.8%; P=0.026).

Background: • The low-nickel diet is an appropriate strategy for increasing Helicobacter pylori eradication rates.