Arquivos de Gastroenterologia最新文献

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.

Background: Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass. When associated with cancer, it correlates with poorer clinical outcomes. Cancers of the gastrointestinal tract, prevalent globally and in Brazil, are associated with a greater nutritional risk. Early detection and intervention for nutritional risks are critical in this population. Recent studies on turmeric/curcumin have demonstrated beneficial effects in cancer patients. Specifically, curcumin have shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia. This review aims to elucidate sarcopenia and sarcopenia secondary to cancer, emphasizing nutritional management and the role of curcumin supplementation. Effective cancer management, whether with or without sarcopenia, demands comprehensive public health strategies and multimodal interventions within healthcare institutions. Nutrition is pivotal across the cancer care journey, encompassing screening, guidance, and provision of nutrients that support maintaining or recovering body composition. Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management. Nevertheless, further clinical studies are warranted to substantiate these findings.

Background: • Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass.

Background: • Sarcopenia when associated with cancer, it correlates with poorer clinical outcomes.

Background: • Curcumin has shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia.

Background: • Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management.

Background: The natural history of cirrhosis is characterized by an asymptomatic phase (compensated cirrhosis) followed by a rapidly progressive phase (decompensated cirrhosis). The ability to predict the survival of patients with cirrhosis is crucial for decision-making, some as complex as the indication for a liver transplant. Several models have been developed and validated.

Objective: To analyze and compare the performance of models in predicting 90-day mortality among patients hospitalized with decompensated cirrhosis.

Methods: A sample of 481 hospitalized patients, with a mean age of 59.04 years 73% male, diagnosed with decompensated cirrhosis and a mean Child-Pugh score of 9. The prognostic models were calculated based on tests performed on admission: MELD-Na, MELD-Plus, MELD 3.0, ReMELD, Refit MELD, and Refit MELD-Na. The accuracy of the models was assessed by calculating the area under the receiver operating characteristic (AUROC) curve, and their respective 95% confidence intervals. Comparisons between the areas were conducted using the DeLong test. A comparison was conducted among all scores, with a primary focus on MELD 3.0 and MELD-Plus. These specific scores were the focal points of interest.

Results: The scores presented AUROC curve values of 0.703-0.758, indicating a moderate capacity to discriminate between survivors and deceased patients during the considered period. The comparison between the models did not unequivocally establish the superiority of one model over the other.

Conclusion: The scores have a limited predictive ability for death within 90 days in patients with decompensated cirrhosis. Our study is unable to establish the prognostic superiority of a specific scoring system.

Background: • This retrospective, multicenter study evaluated the accuracy of six predictive models of death within 90 days in 461 patients hospitalized for decompensated cirrhosis.

Background: • The scores presented an area under the receiver operating characteristic curve of 0.703-0.758, indicating a good ability to discriminate between survivors and deceased patients during the considered period.

Background: • The comparison between the models did not unequivocally establish the superiority of one model over the other.