Arquivos de Gastroenterologia最新文献

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.

Background: In the past decades, endoscopic ultrasound has developed from a diagnostic tool to a platform for many therapeutic interventions. Various technological advancements have emerged since the last Brazilian Consensus, demanding a review and update of the recommendations based on the best scientific evidence.

Methods: A group of 32 renowned echoendoscopists selected eight relevant topics to be discussed to generate clinical questions. After that, a literature review was conducted to answer these questions based on the most updated evidence.

Results: Thirty-three statements were formulated and voted on by the experts to reach a consensus. The Oxford System was used to grade the level of evidence.

Conclusion: There is mo-derate evidence to support that the needle shape, gauge, or aspiration technique does not influence the yield of endoscopic ultrasound (EUS)-guided tissue sampling of pancreatic solid lesions. There is moderate evidence to support using EUS-TTNB of the cyst wall to differentiate between mucinous and non-mucinous cystic neoplasms. There is little evidence to support the EUS-guided treatment of gastric varices. There is a high level of evidence to support that EUS-guided biliary drainage and ERCP present similar outcomes in patients with distal malignant biliary obstruction. There is a high level of evidence for using EUS to diagnose neoplastic pancreatic cysts and detect necrosis before indicating drainage. There is moderate evidence to support EUS-GE over duodenal stent for malignant gastric outlet obstruction in patients with a life expectancy higher than 2 months. There is a high level of evidence to support the use of RFA in treating both functioning and non-functioning types of NET.

Background: Colorectal cancer (CRC) is globally the third most common malignant neoplasm and the second leading cause of cancer-related death worldwide. The COVID-19 pandemic led to the suspension of routine screening tests by health services. A 35.5% drop in total cancer diagnoses in 2020 is estimated when compared to 2019.

Objective: To evaluate the impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps (AP) and CRC in a population undergoing colonoscopy (COL) in a clinic in Goiânia, Brazil.

Methods: A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, was approved by the Research Ethics Committee (CAAE-45631421.0.0000.0037). We analyzed data related to identification, referral for medical examination, colonoscopic and histopathological findings.

Results: We evaluated 10,232 (93.4%) COL, divided into two groups according to the year of performance. In 2019, 6,777 (66.2%) COL were performed and in 2020, 3,455 (33.8%), demonstrating a reduction of 51.0%. A total of 3,267 (31.9%) colonoscopies found polyps, 72.1% of which were AP (68.8% in 2019 and 78.3% in 2020, P<0.001). High-grade dysplasia was found in 5.0% of the AP (4.9% in 2019 and 5.8% in 2020, P<0.34). CRC was diagnosed in 121 (1.2%) (0.9% in 2019 and 1.6% in 2020, P<0.001).

Conclusion: The COVID-19 pandemic significantly reduced COL in 2020, mainly due to infection fears and restrictions. However, the detection rate of cancer and polyps per procedure increased, indicating more symptomatic patients sought medical attention. Despite this, the absolute number of tumors and adenomas found decreased, potentially causing diagnostic losses and fewer prevented colorectal cancer cases. Thus, adaptive strategies are vital for maintaining essential healthcare services during similar crises.

Background: There is limited evidence focusing on the use of non-invasive markers to assess liver fibrosis in pediatric chronic liver diseases.

Objective: The aim of the study was to evaluate the correlation between liver stiffness measurement (LSM) using transient liver elastography (TLE) and serum non-invasive markers in pediatric autoimmune hepatitis (AIH).

Methods: Cross-sectional study between May 2016 and February 2020. Twenty-eight children with AIH (age range between 3 and 20 years old) who had undergone TLE and had routine serum tests were enrolled. Patients were divided into 2 groups: (1) Liver fibrosis degree ≥F2 (TLE ≥6.45 kPa) and (2)

Results: Twenty-eight AIH pediatric patients were enrolled, 21 were female and 22 had AIH type 1. Following the cut-off of 6.45 kPa in TLE, 20 patients (71%) were included in group 1, and 8 in group 2. A statistically significant difference was found between the two groups on APRI and FIB-4 results (P=0.0306 and P=0.0055, respectively). There was a significant correlation between TLE with APRI and FIB-4 (Rs=0.67 and 0.78, respectively; P<0.01) as well as with platelet count (Rs=-0.68; P<0.01).

Conclusion: APRI, FIB-4 and Platelet Count showed a good and positive correlation with transient liver elastography in pediatric patients with AIH.

Background: Hepatopulmonary syndrome (HPS) is characterized by the triad of abnormal arterial oxygenation caused by intrapulmonary vascular dilatations (IPVD) in the setting of advanced liver disease or portal hypertension, impacting the patient's quality of life and survival. There are still many gaps in the literature on this topic, especially in pediatrics, with practices frequently based on extrapolation of data obtained from adults.

Objective: Provide a synthesis of the current knowledge about HPS in children.

Methods: The research was carried out through narrative review. The databases used for the search include Medline, Embase, Elsevier, Lilacs and Scielo. The keywords used were "hepatopulmonary syndrome" AND child, children, infant, preschool, pediatric.

Results: In cirrhotic children, the prevalence of HPS can reach up to 42.5%, and it is even more common in those whose underlying condition is biliary atresia, reaching up to 63%. Screening with pulse oximetry (O2 saturation <96%), unlike in adults, has low sensitivity in the pediatric age group. Management involves supportive care with oxygen therapy; liver transplantation is the only definitive treatment to reverse the condition and HPS is considered an exceptional criterion for waitlist. The waitlist mortality is similar among children listed by HPS as a special criterion when compared to those listed for other reasons. The reported rates of complete resolution of hypo-xemia after liver transplantation are close to 100% in children. The post-liver transplantation survival is similar or slightly lower in children with HPS when compared to those without HPS. Contrary to findings from adults, no differences were found in post- liver transplantation mortality between children of different hypoxemia ranges, although longer mechanical ventilation time and hospital stay were observed in children with PaO2 <50 mmHg.

Conclusion: HPS is not an uncommon complication of cirrhosis in children and adolescents, particularly when biliary atresia is the underlying condition. There are still many gaps to be filled regarding the condition, and this article demonstrates that not all data obtained in studies with adults reflects the disease's behavior in pediatrics, especially concerning prognosis.

Background: A staggering 99% of infant undernutrition mortality comes from Sub-Saharan Africa and South Asia. Despite multiple interventions focusing on nutrition adequacy, 2.7 million children worldwide remain associated with undernutrition-related mortality. The lack of impact from multiple interventions toward undernutrition reflects a strong reason to believe that EED is the missing link that sustains undernutrition in low-to-middle-income countries (LMICs). EED is a sub-clinical condition caused by repeated oral enteropathogenic and non-pathogenic fecal microbes exposure that causes intestinal villous malformation, multi-omics changes, chronic intestinal and systemic inflammation, and gut dysbiosis. EED impacts the absorptive capacity and the integrity of the gut, causing a cycle of undernutrition in children. There is currently no protocol for the diagnosis and treatment of EED, hence EED is widely believed to be highly prevalent and underdiagnosed in LMICs.

Objective: To our knowledge, this is the first systematic review to study the impact of nutritional interventions on EED. Previous studies yielded inconsistent results, hence the synthesis of this information is essential in attaining a deeper understanding of EED to formulate new targets of intervention against child undernutrition.

Methods: This systematic review is registered to PROSPERO (CRD42022363157) in accordance to PRISMA, using keywords referring to nutrient supplementation, EED, and child growth failure.

Results: Eleven articles were eligible for review, comprising randomized controlled trials performed mainly in the African continent, with a total of 5689 healthy children eligible for analysis.

Conclusion: The systematic review illustrates that nutritional interventions have a minimal impact on EED biomarkers and linear growth and reflects the importance of understanding better the mechanisms causing EED and its consequences. It appears that the anabolic contribution of nutrition intervention to child growth is negated by EED.