Arquivos de Gastroenterologia最新文献

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.

Background: Pancreaticoduodenectomy is the procedure of choice for the treatment of resectable pancreaticoduodenal tumours. It has been proposed that jaundice is associated with worse outcomes, but the usefulness of preoperative biliary drainage in these patients is still controversial.

Methods: Retrospective cohort study of patients undergoing Whipple procedure at the Hospital Universitario San Ignacio, Bogotá (Colombia), between January 2010 and June 2023. The cohort of patients who underwent preoperative biliary drainage was compared with those who went directly operated on. Comorbidities, functional status and procedural characteristics were recorded. The outcomes, including mortality and intraoperative and 30-day postoperative complications, were compared between groups.

Results: A total of 98 patients were included, 49 of whom underwent preoperative biliary drainage. In this group, there was a higher proportion of patients with pathological stage II and III disease (77.5 vs 49.0, P=0.04) and higher preoperative bilirubin levels (median 6.4 vs 4.9 mg/dL; P=0.02). There were no differences in intraoperative (10.2% vs 14.3%; P=0.34) or postoperative (61.2% vs 51%; P=0.15) complications, but 30-day mortality was higher in patients with biliary drainage (8.2 vs 20.4%; P=0.03).

Conclusion: Our data suggest that there are no differences in postoperative complications. The higher mortality rate in patients with preoperative biliary drainage may be related to differences in baseline patient characteristics and/or delays between biliary drainage and Whipple procedure.

Background: • The usefulness of preoperative biliary drainage in patients undergoing Whipple procedure is still controversial.

Background: • Our data suggest that there are no differences in postoperative complications.

Background: • 30-day mortality is higher in patients with biliary drainage maybe related to differences in baseline characteristics and/or delays between biliary drainage and Whipple procedure.

Background: Acute pancreatitis (AP) is a common gastrointestinal disorder, with organ failure being the primary cause of mortality. This study evaluates the combined score of C-reactive protein level and neutrophil-to-lymphocyte ratio (C-NLR score), as a predictor of organ failure.

Methods: A retrospective analysis was conducted on AP patients admitted to the Hospital Clínico Universitario de Valladolid between March 2014 and January 2022. The C-NLR score was calculated from admission data: patients with both elevated neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were assigned a score of 2, those with one elevated marker received a score of 1, and a score of 0 was given to those with neither.

Results: A total of 778 patients were included: 611 with mild AP (MAP), 123 with moderately severe AP (MSAP), and 44 with severe AP (SAP). A C-NLR score of 2 was most frequently observed in patients with MSAP (56.1%) and SAP (56.85%), while a score of 1 was more common in patients with MAP (46.9%). Multivariable logistic regression analysis revealed that a C-NLR score of 2 significantly increased the likelihood of organ failure by threefold (OR 3.176; 95% CI 1.297-7.775).

Conclusion: The C-NLR score could be a useful supplementary tool for predicting organ failure in AP, complementing traditional scoring systems.

Background: Malnutrition, sarcopenia, and obesity can negatively impact the course of gastrointestinal surgery, increasing the risk of postoperative complications such as anastomotic dehiscence, reoperations, increased mortality and morbidity, and prolonged hospitalizations, leading to higher healthcare costs. Weight loss greater than 10% in the previous six months is a prognostic indicator of mortality in gastrointestinal surgeries and one of the few modifiable variables. Preoperative malnutrition prevalence ranges from 17% to 20%, increasing the risk of infectious complications, especially in malignant diseases. Obesity, i.e., body mass index (BMI) ≥30.0 kg/m2, also impairs the clinical course, contributing to postoperative complications and hospital mortality. Enhanced recovery protocols, like ERAS, are becoming standard practice, with preoperative nutritional interventions crucial for improving surgical outcomes. However, there is no consensus on the ideal preoperative dietary intervention, but regardless of nutritional status, all individuals are eligible for preoperative screening. The American Gastroenterological Association (AGA) proposes to assess malnutrition using signs and symptoms, including unintentional weight loss, edema, loss of fat and body muscle mass, and fluid retention, in addition to BMI ≤18.5 kg/m2. In the case of malnutrition, the use of oral supplementation, enteral nutrition (EN), or parenteral nutrition (PN) is recommended, even if there is a need to postpone surgery. This article discusses the importance of nutritional status screening and perioperative nutritional support, emphasizing the need for a comprehensive approach to improve patients' quality of life and reduce postoperative complications.

Background: Patients diagnosed with Crohn's disease (CD) are at high risk of nutritional impairment due to the symptoms and the intense inflammatory response of the disease. The use of indirect calorimetry (IC) to assess resting energy expenditure (REE) proves to be a valuable alternative for more accurately determining the energy requirements of these patients.

Objective: The primary objective of this study was to compare the REE, increased by 20% (to account for diet-induced thermogenesis and daily energy expenditure), as measured by IC in patients at different stages of CD, with the total energy expenditure (TEE) calculated using the Simple Weight-Based Equation (30 kcal/kg and 35 kcal/kg).

Methods: Sessions for measuring REE were conducted using IC, along with the collection of clinical, biochemical, and anthropometric data. The clinical activity of CD was classified using the Harvey-Bradshaw Index (HBI), while endoscopic classification was assessed through the Simple Endoscopic Score in CD (SES-CD).

Results: A total of 60 adult patients diagnosed with CD in different disease phases were randomly evaluated, with 56.7% being male and 43.3% female, and a mean age of 39 years. The majority (76.7%) were of caucasian ethnicity, and 48.3% had completed high school. According to body mass index (BMI), 21.7% were classified as undernourished, 48.3% as eutrophic, 16.7% as overweight, and 13.3% as obese. Regarding disease activity classification based on the HBI, 50% were in the active phase and 50% in remission. Endoscopic classification revealed that 60% had findings indicative of active disease. The patients evaluated were diagnosed with Crohn's disease (CD) at an average age of 28.2 years, with the majority presen-ting ileocolonic involvement (61.8%) and a stenosing behavior (45.5%). Regarding biochemical serum analysis, the average values found were 12.5 g/dL for hemoglobin, 38.7% for hematocrit, and 15.7 mg/L for C-reactive protein. 58.3% of patients did not have fistulas. No agreement was found between the energy expenditure results measured by the weight-based formulas (30 kcal/kg and 35 kcal/kg) and IC (ICC <0.4), with the values obtained by simple weight-based equations being higher than those from IC. The result obtained using 30 kcal/kg showed slightly greater concordance with IC, but still with low agreement. In isolation, energy expenditure in male patients was statistically higher than in female patients. There was a statistically significant direct correlation between energy expenditure and hemoglobin levels, as well as statistically significant indirect correlations with age and age at diagnosis. The difference in energy expenditure between the methods was indirectly correlated with age, BMI, and age at diagnosis. No statistically significant correlations were found between energy expenditure and the behavior, location, or activity of Crohn's disea