Arquivos de Gastroenterologia最新文献

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.

Background: Worldwide, acute appendicitis (AA) is the most frequent cause of acute surgical abdomen. Although typically associated with pain migrating to the right iliac fossa, AA can also manifest with pain in the left lower quadrant, often linked to anatomical anomalies. Latin America and the Caribbean (LAC) have the highest incidence of AA compared to other regions of the world.

Objective: To explore the sociodemographic characteristics; clinical characteristics, and postoperative outcomes in patients with left-sided AA in LAC.

Methods: We performed a systematic review including PubMed, Scopus, Web of Science, Embase, LILACS, Dialnet, Redalyc, Scielo, and Google Scholar databases. We considered as inclusion criteria case reports of left-sided appendicitis involving specific anatomical anomalies, and studies conducted in LAC. Morevoer, we assessed methodologic quality using Joanna Briggs Institute tool for case reports.

Results: A total of 23 patients were included in 23 case reports. Colombia accounted for the majority of left-sided AA cases. The median age was 37 years (8-65). Initial pain location was diffuse abdominal pain (39.1%), pain was refered (n=5; 55.6%) and migrated (n=11; 78.6%) mainly to left iliac fossa. Situs inversus totalis (SIT) was the most prevalent anatomical anomaly (69.6%), while laparotomy emerged as the predominant surgical approach (65.2%).

Conclusion: Considering left-sided AA in the diagnosis of adults with diffuse abdominal pain towards the left lower quadrant is crucial. SIT is the primary associated anatomical variation. These emphasize the significance of understanding atypical presentations for effective management in the LAC population.