Arquivos de Gastroenterologia最新文献

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.

Background: Cholelithiasis, characterized by hardened deposits in the gallbladder, presents symptoms such as abdominal pain, jaundice, nausea, and potential complications like cholecystitis and choledocholithiasis. Despite increasing diagnoses, literature on pediatric cholelithiasis is limited, with undefined protocols.

Objective: This study aims to evaluate the clinical, laboratory characteristics, and outcomes of pediatric cholelithiasis cases, identifying factors associated with cholecystectomy.

Methods: A retrospective case series study was conducted on patients treated at a tertiary service, diagnosed with cholelithiasis via ultrasound from 2007 to 2021. Clinical profiles, comorbidities, examinations, procedures, and patient evolution were assessed. Patients were categorized into two groups: Group NC (no cholecystectomy) and Group C (cholecystectomy).

Results: Thirty-five patients were included, with 51% females and 60% having comorbidities with abdominal pain was the predominant symptom. Thirty-three patients were managed outpatient while two patients continued follow-up at another facility. Twelve opted for expectant management (Group NC), while 21 underwent cholecystectomy (Group C). Elective laparoscopic cholecystectomy was performed in Group C, with a median age of 11 years and 3 months. Group C showed a higher frequency of abdominal pain compared to Group NC, and this difference was significant (P=0.04). No differences were observed in gender, comorbidities, jaundice, fever, laboratory findings, symptom duration, follow-up time, or age at diagnosis. The median follow-up duration in Group NC was 1 year and 7 months.

Conclusion: Abdominal pain was the predominant symptom in patients undergoing cholecystectomy, while comorbidities and laboratory abnormalities showed no significant associations. Although surgical intervention is typically recommended, expectant management proved viable in select cases without ensuing complications during the evaluation period.

Background: Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in bacterial population in the small intestine, leading to symptoms such as bloating, abdominal pain, distension, diarrhea, and eventually malabsorption. The diagnosis and management of SIBO remain challenging due to overlapping symptoms with other gastrointestinal disorders such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and coeliac disease.

Objective: This article aims to review current evidence on the diagnosis and treatment of SIBO, with a focus on strategies suitable for the Brazilian healthcare system.

Methods: A comprehensive literature review was performed, focusing on clinical guidelines, randomized controlled trials, and cohort studies concerning SIBO. Diagnostic methods, including breath tests and direct aspiration techniques, were critically analyzed. Treatment approaches, including antibiotics, dietary modifications, and probiotics, were reviewed. The recommendations were formulated based on a panel of gastroenterologists, members of the Brazilian Federation of Gastroenterology (FBG), with approval from the majority of the members.

Results: Breath tests using glucose and lactulose remain the most commonly used non-invasive diagnostic tools, though they are subject to limitations such as false positives and false negatives. Treatment with rifaximin is effective in most cases of SIBO, while systemic antibiotics like metronidazole and ciprofloxacin are alternatives. Probiotics and dietary interventions, particularly low FODMAP diets, can complement antibiotic therapy. Long-term follow-up is essential due to the recurrence rate, which is common in SIBO patients.

Conclusion: Standardizing SIBO diagnosis and treatment in Brazil is essential to reduce diagnostic delays and optimize care, especially given the disparities and heterogeneity in clinical practice across the country. This article provides evidence-based recommendations to guide clinical practice. Further research is needed to refine diagnostic methods, explore novel treatment strategies, and better understand the specific characteristics of the Brazilian population.

Background: This study aims to analyze the co-authorship network in Gastroenterology research, focusing on publications from 2000 to 2023, to understand the collaborative relationships among researchers and identify key contributors in the field.

Methods: Using data from the Web of Science (WoS), I examined 18,855 Gastroenterology-related articles published between 2000 and 2023. The analysis was conducted using Python within the PyCharm environment. I assessed the network at both macro and micro levels. Macro-level indicators included network density, clustering coefficient, components, and average path length. Micro-level indicators included degree centrality, closeness centrality, and betweenness centrality, which helped identify influential researchers and research groups.

Results: The analysis revealed an evolution from a fragmented and sparsely connected network in the early 2000s to a more interconnected structure in recent years. Despite the overall increase in network density and clustering, full integration was not achieved, with many researchers remaining in isolated clusters. Key researchers such as Gasbarrini G., Vandenplas Y., and Hassan C. were identified as central figures within the network, playing crucial roles in fostering collaboration.

Conclusion: The study highlights the ongoing development of collaborative networks in Gastroenterology research, identifying influential researchers and groups that drive advancements in the field. The findings provide valuable insights for enhancing future research collaborations, particularly in areas where Japan excels, such as endoscopic technology.

Background: Conventional white light endoscopic (WLE) findings of H. pylori-associated gastritis are often non-specific and may not correlate with histology. Narrow band imaging (NBI), an optical digital technique employed for the visualization of vessels and patterns of gastric mucosa may improve identification. We evaluated the role of NBI in detecting H. pylori-associated gastritis and classifying its severity.

Methods: Institution-based prospective observational study conducted between May 2021-October 2022. Children presenting with chronic abdominal pain (>1-month duration) were evaluated. Eligible children underwent gastroscopy with NBI and gastric biopsies for rapid urease test and histopathology. NBI gastroscopic findings were classified into five grades as per the classification by Alboudy et al. The association of NBI grade with the presence and severity of H. pylori gastritis on histopathology was analysed.

Results: Ninety children (mean age 12.65±3.91 years), 52 (57.7%) males with median duration of symptoms of 4.5 (3-12) months underwent gastroscopy. H. pylori was detected on histopathology in 29 (32%) patients. NBI findings suggested a mucosal abnormality in 27/29 (93.1%) children with H. pylori on histopathology. H. pylori positive gastritis was significantly more common among those with higher (≥3) NBI grades as compared to those with lower NBI grades (61% vs10%, P<0.001). No significant association was found between NBI grade and the severity of H. pylori gastritis (P=0.75). NBI exhibited better sensitivity (0.82) compared to WLE (0.55) in identifying H. pylori-associated gastritis. On receiver operating characteristic curve analysis, NBI had higher area under curve (0.79 vs 0.65) as compared to WLE.

Conclusion: NBI morphological pattern is a useful tool in identifying patients with H. pylori-associated gastritis.

Background: Microscopic colitis (MC) is a chronic inflammatory condition of the colon, primarily characterized by watery diarrhea, with normal or near-normal endoscopic findings. It encompasses two main subtypes: lymphocytic colitis and collagenous colitis.

Objective: This position paper from the Brazilian Federation of Gastroenterology aims to review current evidence on the diagnosis and management of MC in Brazil, emphasizing the need for standardization across the country's healthcare systems.

Methods: A comprehensive review of the latest scientific literature, clinical guidelines, and consensus statements was performed, focusing on randomized clinical trials, meta-analyses, and cohort studies. The evidence was analyzed by a panel of gastroenterologists and pathologists specializing in MC. The recommendations were based on the consensus of the group, approved by the majority of the panel members.

Results: Histological examination with biopsies from multiple segments of the colon remains essential for the accurate diagnosis of MC, as endoscopic findings are often non-specific. Budesonide is the first-line treatment for inducing remission in most patients. However, alternatives such as immunosuppressants and biologics are available for those who are refractory to or intolerant of budesonide. Non-pharmacological interventions, including dietary and lifestyle modifications, can complement medical treatment. The need for long-term follow-up is highlighted due to the high recurrence rates and the impact of MC on the quality of life.

Conclusion: Standardizing the diagnosis and treatment of MC in Brazil is crucial, given the significant regional disparities in healthcare access. This position paper provides evidence-based recommendations to optimize care and improve patient outcomes across diverse clinical settings in Brazil. Further research is needed to address the gaps in understanding the epidemiology and management of MC in underserved regions.