Arquivos de Gastroenterologia最新文献

Background: To investigate the association between metabolic dysfunction-associated steatotic pancreas disease (MASPD) and insulin resistance (IR).

Methods: This cross-sectional study involved 157 participants diagnosed with MASPD based on ultrasonography criteria. Baseline demographic data were collected, including age, gender, and body mass index. Serum levels of fasting glucose, insulin, lipid profile (including total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol), glycated hemoglobin and insulin were measured using standardized laboratory techniques. Abdominal ultrasonography was performed on all participants using convex transducer (frequency range, 3,5 MHz) by experienced radiologist blinded to the clinical data. The association between MASPD and IR was assessed using logistic regression analysis, adjusting for potential confounders. Statistical significance was set at a P-value <0.05.

Results: The logistic regression analysis was performed to verify whether MASPD was a risk factor for IR. After adjusting for gender and age, the results demonstrate a significant correlation between MASPD and markers of IR. TyG index: OR (95%IC) 5.72 (1.90-16.00), P 0.021, and HOMA -IR: OR (95%IC) 6.20 (2.1-22.00) P 0.037.

Conclusion: This study presents a description of MASPD and its association with IR indices. Our findings demonstrate a significant correlation between MASPD and markers of IR. These results suggest that MASPD may contribute to the development of insulin resistance and further highlight the importance of pancreatic health in metabolic disorders.

Background: Several preoperative pulmonary assessment protocols have been established over the years, but assessments of this magnitude are lacking in the bariatric population. Therefore, the assessment of lung capacity, maximum inspiratory and expiratory pressures, the peak expiratory flow and mobility can be predictors of operative safety and determine the time of hospital discharge.

Objective: To evaluate lung capacity, respiratory muscle strength and level of mobility in the pre, immediate post-operative and hospital discharge of patients undergoing bariatric surgery.

Methods: Cross-sectional study, with 38 bariatric patients undergoing surgical intervention. Anthropometric data, lung function, respiratory muscle strength and mobility level were evaluated pre-, post-operatively and at hospital discharge. Statistical Analysis: GEE; P<0.05.

Results: In relation to the preoperative period, in the POi there was a significant reduction in mobility, respiratory muscle strength, FVC, FEV1, PEF and a significant increase in these variables at hospital discharge, however, not reaching the same conditions as the preoperative period, except the Tiffeneau index (P<0.644).

Conclusion: Bariatric surgery impacts the mobility, respiratory muscle strength and lung function of patients with grade II and III obesity, leading to longer hospital stays and possible major complications. The role of physiotherapy in the prevention and rehabilitation of these patients must be strongly considered.

Background: This study aims to analyze the structural dynamics of research collaboration in hepatology over a 30-year period (1994-2023), focusing on co-authorship networks. By examining data from the Web of Science Core Collection, the study explores key metrics such as network density, clustering coefficient, and centrality measures, providing insights into how collaborative efforts have shaped the field of hepatology.

Methods: Using Python (Version 3.10.5) in the PyCharm environment, I conducted a network analysis of 9,278 hepatology-related publications. Macro-level indicators, including network density, clustering coefficient, number of components, and average path length, were used to evaluate overall network structure. Micro-level metrics, such as degree centrality, closeness centrality, and betweenness centrality, were employed to assess the influence of individual researchers within the network.

Results: The analysis showed an increase in network fragmentation, with components rising from 338 in 1994-2003 to 1,302 by 2014-2023. Despite the growing number of publications, network density remained consistently low, indicating limited direct collaboration. However, high clustering coefficients across all periods suggest that collaborations form in tightly connected groups. This study identified key researchers such as LAMBERTINI A. (1994-2003), Manns, Michael P. (2004-2013), and Berg, Thomas (2014-2023), who played central roles, linking different research clusters and facilitating collaboration across groups.

Conclusion: Hepatology research has experienced significant growth in publications over the past 30 years, yet collaborative efforts remain localized, with increasing network fragmentation. Identifying central researchers who bridge gaps between otherwise disconnected groups is essential to fostering broader collaboration. This analysis underscores the importance of strengthening international cooperation and collaborative research to address the increasingly complex and region-specific liver diseases worldwide.

Background: The inflammatory bowel disease (IBD) disk is a simple and quick method to assess the level of disability experienced by patients with IBD. It has been already translated and validated in European countries, however it was not yet translated and validated to use in Brazil.

Objective: This study was performed to translate and validate a Brazilian version of the IBD-Disk. Methods: The original version of the IBD-Disk was translated into Portuguese (Brazilian) and administered to patients with IBD in a referral center in Brazil. This step included direct translation by two native-language expert translators, followed by back translation by two expert translators, with synthesis of the two versions after each step analyzed by a committee of experts and tested in a pilot group. After obtaining the cross-cultural adaptation of the instrument, a validation process was conducted.

Results: A total of 198 patients were included (Crohn's disease, n=149, 75.2%). The model presented satisfactory parameters regarding precision (ORION=0.93), representativeness of the construct (FDI=0.97), sensitivity (SR=3.77), expected percentage of the factor (EPTD=94.3%) and replicability by the latent G-H index (0.93) and observed (0.89), revealing how well the factor can be identified by the continuous attentive response variables and observed items. The item-total correlation coefficients ranged from 0.518 to 0.750, considered ideal. The total instrument presented α=0.921 and ω=0.922, values above the cut-off point and are therefore considered satisfactory.

Conclusion: The translation and cross-cultural adaptation of the IBD-Disk into Brazi-lian-Portuguese (BR-IBD Disk) proved to be a reliable and valid tool in detecting and assessing IBD-related disability in a Brazilian cohort.

Background: Liver biopsy (LB) is still the gold standard method for assessing hepatic fibrosis (HF), associated diseases, and liver inflammation. Nowadays, noninvasive techniques such as Acoustic radiation force impulse (ARFI) elastography have been introduced instead of liver biopsy. However, there are controversies about the time it should be performed after treatment for hepatitis C virus (HCV).

Objective: To evaluate hepatic fibrosis using ARFI technology before and after successive treatments for chronic HCV.

Methods: We prospectively included 50 adult patients with chronic HCV (genotype 1). Patients were first submitted to triple therapy with first-generation protease inhibitors (boceprevir and telaprevir) at the hepatitis division of the Gastroenterology Department of the Federal University of São Paulo. The non-responders underwent re-treatment with interferon-free direct-acting antiviral agents (DDAs - sofosbuvir associated with daclatasvir or simeprevir). Assessment of hepatic stiffness by ARFI was performed before and after the first treatment and before and after the re-treatment with DDAs.

Results: ARFI values decreased significantly after treatments. In patients on first-generation protease inhibitor therapy and achieving sustained virological response (SVR), ARFI decreased from 2.41±0.58 pre-treatment to 2.02+/-0.58 (P<0.042) post-treatment. In patients who did not reach SVR, that is, non-responders, a significant reduction was similarly observed (2.39±0.63 to 2.03±0.54; P<0.001 before and after treatment, respectively). Before starting the re-treatment, non-responders had elevated ARFI values again, dropping after SVR following re-treatment (from 2.46±0.57 to 1.45±0.68, P<0.004). Laboratory parameters such as AST and ALT were directly correlated to ARFI elastography.

Conclusion: The evaluation of hepatic elastography by the ARFI method before and after (6 - 9 months) successive treatment of hepatitis C in responders and non-responders led to the conclusion that the reduction of elastography parameters seems to be related to a decrease in hepatic inflammation rather than a reduction in fibrosis per se.

Chondroitin sulfate (CS) and glucosamine (GlcN) are indicated for the treatment of some inflammatory diseases, such as osteoarthritis, mainly because of the anti-inflammatory effects in reducing metalloproteinases activities (MMP), and other inflammatory mediators. Herein, we reported the structure of the CS, the anti-inflammatory and protective effects of the CS, and GlcN administration in ulcerative colitis model induced by dextran sulfate sodium (DSS) in rats. Experimental data indicated that CS disaccharide composition is very similar to the C4S standard, with modal molecular weight at 30.4 kDa. Orally administration of the CS/GlcN improved the severity of acute colitis with reduction the histological score and goblet cells destruction. We also observed a decreasing in NO production, myeloperoxidase and MMP, especially MMP-9, activities. Moreover, CS/GlcN not cytotoxic in the intestinal epithelial cells. These results indicate that combination CS/GlcN showed improvements in intestinal inflammation and protection intestinal barrier, suggesting CS/GlcN might have beneficial effects in treatment of IBD.

Background: Hepcidin's main function is to control iron availability to hematopoiesis. However, it has been shown that hepcidin may have an additional role in intestinal inflammation, as intestinal cells and leukocytes increase the production in experimental colitis and Crohn's disease.

Objective: Using an HT-29 cell as a model, we investigated the role of hepcidin in intestinal inflammation.

Methods: The ability of HT-29 cells to produce hepcidin was evaluated after stimulus with IL-6, TNF-α, and lipopolysaccharide (LPS) for 24 h. Experiments were performed in the presence of stat-3 or IκBα phosphorylation inhibitor. The release of IL-8 by HT-29 cells was evaluated after hepcidin stimulus in the presence or absence of ferroportin (FPN) antibody. Nuclear factor (NF) κB translocation and reactive oxidative species (ROS) production in response to hepcidin were also studied.

Results: HT-29 cells can produce hepcidin under IL-6, TNF-α, and LPS stimulation. The Stat-3 inhibitor reduces hepcidin production induced by IL-6, and the IκBα inhibitor reduces hepcidin production by all stimuli tested. IL-8 is produced by HT-29 cells in response to hepcidin, and the FPN antibody did not modify IL-8 release. Il-8 production induced by hepcidin was NFκB dependent, but when cells were co-stimulated with LPS, IL-8 release, and NFκB translocation were inhibited, and HPN antibody reduced it. Hepcidin increases ROS production by HT-29 cells.

Conclusion: We used HT-29 cells to demonstrate that hepcidin is produced at low levels in response to inflammatory stimuli. The hepcidin action is dual in HT-29 cells, performing a proinflammatory action by producing ROS and IL-8 under physiological conditions but an anti-inflammatory action by reducing IL-8 release and NFκ-B activation when LPS is present, suggesting that hepcidin has a modulatory role in intestinal inflammation.

Objective: To investigate the ability of the estimated plasma gene-expression levels of microRNA (miR)-21 and 126 to define patients suspected to have hepatocellular carcinoma (HCC) among patients with complicated hepatitis-C virus (HCV) infection.

Methods: Patients with uncomplicated (U-HCV) or complicated HCV underwent clinical and ultrasonographic (US) evaluations and assessment for the computerized hepatorenal index, hepatic steatosis index and fibrosis indices. Blood samples were obtained for estimation of serum levels of alpha-fetoprotein (AFP) and tumor necrosis factor-α (TNF-α), and plasma expression levels of miR-21 and miR-126 using the quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR).

Results: Serum levels of AFP and TNF-α were significantly higher in samples of HCV-HCC patients than controls and other HCV patients. Plasma levels of miR-21 were the highest, while miR-126 levels were the lowest in samples of HCV-HCC patients with significant differences in comparison to samples of controls and other HCV patients. The ROC curve analysis defined high plasma miR-21 levels as specific predictor for HCV infection, and could identify samples of complicated HCV, and samples of HCV-HCC patients, while estimated plasma levels of miR-126 could be applied to screen for HCV and its related complications.

Conclusion: Deregulated plasma expression levels of miR-21 and miR-126 might distinguish cases of HCV complicated by HCC and define cases of HCV-LC, even those that showed low Fib-4 scores.

Background: Cirrhosis is a prevalent disease and ranks among the leading causes of death worldwide. Sarcopenia is believed to be associated with a poorer prognosis in patients with cirrhosis.

Objective: To evaluate the impact of sarcopenia on the prognosis of patients hospitalized for acute decompensation of cirrhosis, with or without acute-on-chronic liver failure.

Methods: This prospective cohort study evaluated patients hospitalized for acute decompensation of cirrhosis, with or without acute-on-chronic liver failure. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People, using skeletal muscle mass analysis by bioelectrical impedance and handgrip strength testing. The data was collected between March-2019 and April-2020. Qualitative variables were presented as frequencies and percentages, and quantitative variables as means and standard deviations when symmetrical, or medians and 25th and 75th percentiles when asymmetrical. The association of sarcopenia and mortality with quantitative variables was tested using Student's t-test or the Mann-Whitney test, while associations with qualitative variables were tested using the Chi-square test or Fisher's Exact test. For significant associations, crude and adjusted (multivariate analysis) relative risk estimates with a 95% confidence interval were calculated using Poisson regression analysis. Results with P<0.05 were considered significant.

Results: Fifty patients were included, with a mean age of 60.5 years (±10.4) and a slight predominance of men (56%). The main causes of cirrhosis were alcohol use disorder (28%) and hepatitis C (24%). The median Child-Pugh score was 8 points (7-10), and the median Model for End-stage Liver Disease score was 15 points (12.5-21). Ten patients were diagnosed with acute-on-chronic liver failure. Sarcopenia was present in 50% of the sample. Sarcopenia was present in 70.0% of patients with acute-on-chronic liver failure and in 43.2% of those without acute-on-chronic liver failure (P=0.168). Overall mortality was 48% in patients with sarcopenia and 44% in those without sarcopenia (P=1.000). In multivariate analysis, overall mortality was associated only with leukocyte count (relative risk=1.01, 95% confidence interval=1.01-1.01) and Model for End-stage Liver Disease score (relative risk=1.07, 95% confidence interval =1.03-1.10).

Conclusion: In this study, sarcopenia was not associated with mortality in patients hospitalized for acute decompensation of cirrhosis, with or without acute-on-chronic liver failure. There was a non-significant trend towards a higher prevalence of sarcopenia among individuals with acute-on-chronic liver failure.

Background: There is no consensus on which nutritional diagnosis methods are most relevant in the hospital clinical practice.

Objective: This study investigated the agreement between the global leadership initiative on malnutrition (GLIM) criterion and the nutritional risk screening (NRS) instrument for the nutritional diagnosis of in-patients.

Methods: Cross-sectional study with 95 hospitalized surgical patients. Clinical data, nutritional risk using the NRS and malnutrition using the GLIM criteria were evaluated. The data were analyzed using the chi-square, Mann-Whitney, McNemar and Kappa coefficient tests.

Results: There was good agreement between the two methods (Kappa=0.6067). Patients who were malnourished according to the GLIM or at nutritional risk by NRS were older (P=0.0461 by GLIM and P=0.0200 by NRS) and had a higher diagnosis rate of neoplasms (38.5%, P=0.0006 by GLIM and 32.7%, P=0.0030 by NRS). The GLIM criterion identified a lower percentage of patients with malnutrition (41.05%) in relation to the NRS regarding patients with nutritional risk (54.7%).

Conclusion: The GLIM criteria and the NRS instrument are concordant methods for diagnosing malnutrition and nutritional risk in hospitalized surgical patients respectively.