Arquivos de Gastroenterologia最新文献

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.

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.