Arquivos de Gastroenterologia最新文献

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

Background: Increasing population size and the presence of bottlenecks in access to specialized health care demonstrate the importance of developing measures for better clinical management. The implementation of teleregulation is expected to bring greater resolution in the system.

Objective: The objective of the present study was to evaluate the results of teleregulation in gastroenterology for the resolution of referrals in a large Brazilian city.

Methods: We carried out a retrospective cross-sectional study of primary health care teleregulation requests for gastroenterology in a Brazilian city. Data were collected from October 2022 to June 2023 in patients aged >18 years. Patient demographic data, the reason for requesting screening, and screening outcomes were collected. Requests for reassessment were excluded.

Results: Of the 3,000 teleregulation sessions screened in the study period, 71.1% were included, of which 68.17% were for women with a mean age of 54.32±16.19 years. Among the reasons for referral, 1,368 (64.13%) were to request examinations, 568 (26.63%) to discuss conduct and 197 (9.24%) to request a referral to a specialist. Ten percent of cases required referral to a specialist, 6.61% were incorrect requests and 14.95% were prioritized.

Conclusion: The present study highlights that teleregulation represents an important tool in health management, being able to bring resolution in 89.9% of cases.

Background: Steatotic liver disease (SLD) affects about 1 billion people globally, making its proper management essential to prevent progression to more severe stages.

Objective: The aim of this study was to evaluate medical management concerning hepatic steatosis incidentally identified by ultrasound in patients undergoing elective cholecystectomy.

Methods: This observational, cross-sectional, and retrospective study included patients aged 18 years or older who underwent elective cholecystectomy at Hospital do Trabalhador, in Curitiba/PR, between 2018 and 2022. Patients with external ultrasound reports or incomplete data in their medical records were excluded. Medical records, laboratory tests, and ultrasound reports were analyzed to evaluate the prevalence of steatosis in these patients.

Results: The study sample consisted of 355 patients, and 103 (29.01%) of them presented steatosis on ultrasound. Older age (P=0.0022), male sex (P=0.03009), higher body mass index (P<0.001), obesity (P<0.001), hypertension (P<0.001), dyslipidemia (P=0.0072), and elevated levels of oxaloacetic and pyruvic aminotransferases (P=0.02112) were associated with the presence of this finding. No action was taken regarding the presence of steatosis in 60.19% of patients. Approximately 39.81% had the finding recorded in their medical records, 6.80% received lifestyle change counseling, and 4.85% were investigated for the stage of steatosis.

Conclusion: A significant prevalence of hepatic steatosis was incidentally identified in the ultrasound of patients undergoing cholecystectomy. However, the approach to this finding was insufficient, highlighting the need for substantial improvements on its management and investigation.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the most prevalent cause of chronic hepatic disease worldwide. Recently, the association between MASLD and renal injury has emerged as an additional factor impacting the clinical course of MASLD.

Objective: The present study evaluated the clinical association in patients with obesity.

Methods: This study enrolled patients classified as having obesity class II and III (BMI >35 kg/m2) and MASLD from an obesity surgical treatment center. The diagnosis criteria for MASLD included the presence of hepatic steatosis as indicated by histology or imaging assessments. We use Fibrosis-4 (FIB-4) and NAFLD fibrosis score (NSF) to assess and determine the presence of liver fibrosis. The glomerular filtration rate (GRF) was determined using CKD-EPI (chronic kidney disease epidemiology collaboration) equation, with GFR levels ≥90 and <120 mL/min/1,73 m2 considered within the normal range.

Results: The study comprised a total of 560 individuals with obesity grade II and III, 325 individuals with MASLD. Among these, 422 (75.4%) patients were female, and the mean age was 36±10 years. Systemic arterial hypertension (SAH) was present in 162 (41.1%) patients, and 218 (42.8 %) were diagnosed with type 2 Diabetes Mellitus (T2DM). A total of 286 individuals (51.1%) had a GFR below 114 mL/min, with 183 (64%) of them exhibiting a higher degree of liver fibrosis, as indicated by FIB-4 >0.54.

Conclusion: In patients with obesity classified as grades II and III, age emerged as the primary determinant leading to decline in GFR. Furthermore, glomerular hyperfiltration could be an early sign of progression to chronic kidney disease. Nonetheless, the progression of hepatic fibrosis could also be a significant factor contributing to impaired renal function.

Background: The incidence of nephrolithiasis has increased significantly, diet, obesity, and high animal protein intake having been reported to be risk factors. Nephrolithiasis has a great economic impact on society related to work absenteeism, recurrent attacks of renal colic, and urological interventions. Nephrolithiasis can also progress to renal failure. It is therefore important to identify the risk factors for nephrolithiasis. Inflammatory bowel diseases, which include Crohn's disease, represent a risk factor for the formation of renal calculi, due to the disease itself and to the use of drugs that can influence the metabolism of substances related to nephrolithiasis. In the past, Crohn's disease patients were often submitted to surgery, which is known to contribute to nephrolithiasis. New drugs have changed the clinical course of Crohn's disease, whose incidence has increased worldwide. Specialists should be on the alert not only for the complications of Crohn's disease but also for its extraintestinal manifestations, which can dramatically affect the quality of life of these patients and lead to renal failure. It is therefore important to screen this population for nephrolithiasis.

Objective: To determine the prevalence of nephrolithiasis in a population of patients with Crohn's disease; to determine whether drugs, previous surgery, location of the disease, and clinical activity are risk factors for nephrolithiasis; and to alert specialists to the importance of screening for nephrolithiasis (through simple methods) in order to prevent chronic kidney disease.

Methods: Were analyzed the electronic medical records of 93 Crohn's disease patients treated between 2009 and 2010 at the Inflammatory Bowel Disease Center of the Scope Clinic, located in the city of Campo Grande. All of the patients underwent ultrasound at the first medical appointment.

Results: Of the 93 patients, 37 developed nephrolithiasis at some point during the study period. Risk factors for nephrolithiasis were disease location (P=0.023) and the use of ciprofloxacin (P=0.0001), corticosteroids (P=0.005), immunomodulators (P=0.001), or metronidazole (P=0.0005). Surgical status, age, and gender were not found to predispose to the formation of renal calculi.

Conclusion: This study demonstrates the importance of using imaging methods to screen Crohn's disease patients for nephrolithiasis, regardless of their surgical status.