Acta Gastroenterologica Latinoamericana最新文献

Introduction and objectives: Systemic fungal infections are an under-recognized cause of morbidity and mortality in patients with decompensated liver cirrhosis. Our goal was to describe the clinical features, microbiological findings, and outcomes of invasive fungal infections in this population in the context of a liver transplant center.

Materials and methods: We conducted a retrospective observational study of 16 adult patients with decompensated cirrhosis and culture-proven invasive fungal infections diagnosed between 2013 and 2024. Data were collected from electronic medical records and microbiology databases. Fungal pathogens were isolated from blood or ascitic fluid cultures. We analyzed demographics, cirrhosis etiology, antifungal treatment, and outcomes.

Results: The mean age was 41 years, and 50% of patients were female. All patients had decompensated cirrhosis and a mean model for end-stage liver disease-sodium score of 25.7. Half of them met criteria for acute-on-chronic liver failure at diagnosis. The most frequent isolates were Candida albicans (37.5%) and Cryptococcus neoformans (37.5%). Ascites was present in 87.5% of patients; and 68.8% had received antibiotics, while 31.2% had received corticosteroids, within 30 days prior to diagnosis. In-hospital mortality was 62.5%, with a median survival of 11 days.

Conclusions: Invasive fungal infections in decompensated cirrhosis are associated with high short-term mortality and often occur in patients who have been exposed to antibiotics or corticosteroids. Awareness of this complication and prompt initiation of antifungal treatment may improve outcomes. Multicenter studies are needed to define risk factors and optimize diagnostic and therapeutic strategies.

Introduction: Biliary atresia is a disease with high morbidity and mortality, characterized by a fibrosclerosis and obstruction of the biliary ducts. Treatment is surgical and includes hepatic portoenterostomy and liver transplant. Early diagnosis is essential to ensure access to hepatic portoenterostomy within the first 30 - 45 days of life. In our country, we do not have national data on this pathology, which motivated the Hepatology Committee of the Argentine Society of Pediatrics to create a registry for this purpose. This report presents the results of incorporating a first center into the registry. This study allowed us to characterize a population of patients diagnosed with biliary atresia and treated at a high-complexity center in Argentina.

Objective: The objective of this study was to describe the clinical, surgical, and evolutionary characteristics of the registered patients.

Material and methods: This observational, descriptive, and retrospective study included patients diagnosed with biliary atresia treated at the Dr. Juan P. Garrahan Pediatric Hospital, born between January 1, 2015, and January 1, 2020. The diagnosis was based on clinical, biochemical, radiological, histological, and surgical findings. Hepatic portoenterostomy was performed according to Kasai technique or one of its variants.

Results: Ninety-one patients from various regions of Argentina and abroad were included in the study. Of these, 55 children underwent surgical treatment (32 at the high-complexity institution and 23 at other centers). Sixty-three patients received liver transplants (31 as a first intervention and 32 after failure of hepatic portoenterostomy). There was a delay in the age of the patients at the time of diagnosis, and overall survival exceeded 80%, in coincidence with other case series.

Conclusions: This is the first study in our country on biliary atresia that includes demographic, clinical-surgical, diagnostic, treatment, and short-term outcome data.

Introduction: Chronic constipation and fecal incontinence are common functional pelvic floor disorders with a significant impact on quality of life. Although the London Classification standardizes anorectal manometric assessment, its application in Latin American populations is still limited.

Objectives: To characterize anorectal manometric profiles according to clinical indication (constipation, fecal incontinence, or coexisting symptoms), using the London Classification.

Materials and methods: A retrospective observational study was conducted on 413 adult patients who were evaluated using high-resolution anorectal manometry (Diversatek and ManoScan AR^®) at a tertiary care center. Clinical, manometric, and sensory variables were classified according to the four domains of the London Classification and analyzed. ANOVA and chi-square tests were used for group comparisons.

Results: Patients with constipation had higher resting and voluntary contraction pressures of the anal canal, a higher prevalence of hypertonia and dyssynergia, and higher sensory thresholds. Patients with fecal incontinence presented hypotonia, hypocontractility, and altered coordination but not dyssynergia. Patients with coexisting symptoms exhibited mixed patterns. There were no significant differences in the prevalence of the inhibitory anal rectal reflex or rectal sensory disorders.

Conclusion: The London Classification allowed the identification of specific pathophysiological patterns based on clinical phenotypes. These findings suggest its usefulness as a standardized diagnostic tool, with clinical implications for more accurate and personalized evaluation of defecation disorders.

Esophageal perforation is one of the most important lesions of the digestive system with serious complications and a high mortality rate, requiring an early diagnosis and timely management. The causes can be iatrogenic, traumatic, caustic or secondary due to foreign bodies. The present case reports deep esophageal laceration caused by a foreign body in an older infant treated with a fully covered biliary stent, with clinical and technical success.

Introduction: According to the Rome IV Criteria infantile dyschezia has a worldwide prevalence of 2.0%, and according to the Rome III Criteria it ranges from 3.2% to 35.0% in Latin America.

Objective: . To determine the prevalence of infant dyschezia and associated brain-gut axis disorders in Latin American infants under 9 months of age, according to the Rome IV Criteria.

Materials and methods: This was a descriptive, observational, non-experimental prevalence-type study conducted in seven Latin American countries. The study included infants under 9 months of age diagnosed with infantile dyschezia using the Pediatric Gastrointestinal Symptom Questionnaire Rome IV and who were registered in the database of the Functional International Digestive Epidemiological Research Survey. Sociodemographic, family, clinical, enviromental, and nutritional variables were analyzed.

Results: A total of 1,241 children (4.6 +/- 2.6 months; 53.3% male; 59.2% mixed-race) were included in the study. Infantile dyschezia was diagnosed in 2.9% of cases. The peak age of presentation was 4 months. The main gut-brain axes disorders found were colic (8.1%), regurgitation (7.6%), and constipation (7.1%). Overlapping disorders were found in 3.2% of cases. Infantile dyschezia was more common in the post-COVID-19 pandemic period, in public institutions, in patients treated by pediatric gastroenterologists, breastfed, and not bottle-fed (p < 0.05).

Conclusion: The prevalence of dyschezia in Latin American infants under 9 months of age is slightly lower than the global reported rate, was higher during the post-COVID-19 pandemic period, and is mainly diagnosed in public institutions by a pediatric gastroenterologist.

Lactose malabsorption and lactose intolerance are common yet clinically distinct conditions. Lactose malabsorption refers to the passage of undigested lactose into the colon due to lactase deficiency, whereas lactose intolerance involves the onset of gastrointestinal symptoms following lactose ingestion in the presence of malabsorption. Alactasia is a rare congenital disorder characterized by complete absence of lactase activity. Primary hypolactasia is a physiological and genetically determined decline in lactase activity occurring in adulthood. Globally, the prevalence of lactose malabsorption affects up to two-thirds of the population, with particularly high rates in Latin America and Mexico. Diagnosis can be established through non-invasive methods such as the hydrogen breath test, genetic testing, the gaxilose test, and lactose tolerance testing, or through invasive procedures like enzymatic activity measurement in duodenal biopsies. Management should aim to control symptoms without compromising nutritional status and may include low-lactose diets, oral lactase enzyme supplementation, and the use of probiotics or prebiotics. Avoiding unnecessary dietary restrictions is essential to prevent nutritional deficiencies or the development of avoidant/restrictive food intake disorder. An individualized diagnostic and therapeutic approach improves both clinical outcomes and quality of life in affected patients.

Irritable bowel syndrome is the most common functional gastrointestinal disorder significantly affecting quality of life. The nutritional intervention with the greatest scientific support and most recommended by international guidelines is the low-FODMAPs diet, however, a relevant proportion of patients (between 20% and 50%) do not adequately respond to this intervention. This has prompted the exploration of alternative nutritional interventions, such as the starch- and sucrose-reduced diet and the Mediterranean diet. The aim of this study is to review the scientific evidence on new nutritional strategies for the management of irritable bowel syndrome, focusing on the the starch-sucrose reduced diet and the Mediterranean diet.

Introduction: Data on morbidity and mortality after subtotal or total gastrectomy are scarce in developing countries, especially considering the epidemiological shift in gastric cancer (decrease in distal and increase in proximal tumors).

Objective: To identify factors associated with morbidity and mortality in patients with gastric cancer undergoing curative-intent surgery at a cancer center in Ecuador.

Materials and methods: Historical cohort study conducted at the National Oncology Institute "Dr. Juan Tanca Marengo" in Guayaquil (2019 - 2021). Only adenocarcinomas treated with curative intent were included. Outcomes were postoperative complications and mortality at 30, 90 days, and overall. Logistic regression was used to estimate factors associated with higher risk.

Results: A total of 111 patients were included (87 subtotal, 24 total gastrectomy). At least one complication occurred in 15.4% (subtotal) and 17.9% (total). Thirty-day, 90-day, and overall mortality after subtotal gastrectomy were 1.1%, 2.3%, and 34.5%; after total gastrectomy, 0%, 4.2%, and 54.2%, respectively. Postoperative complications were significantly associated with Bormann III/IV tumors (OR 9.6; 95% CI 1.8 - 79.7; p = 0.0175) and longer hospital stay (OR 2.3; 95% CI 1.4 - 5.1; p <0.001). Mortality was associated with Bormann III/IV tumors (p = 0.0038) and gastro-duodenal leak (p = 0.0383).

Conclusion: Ninety-day morbidity and mortality rates were lower than previously reported. Bormann III/IV tumors and postoperative gastro-duodenal leakage were associated with increased mortality.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies, with a five-year survival rate of less than 10%. Most patients are diagnosed at advanced stages, and both incidence and mortality are expected to rise over the next decade.

Objectives: To estimate overall survival in patients undergoing surgery for pancreatic ductal adenocarcinoma and to analyze associated clinicopathological factors.

Materials and methods: A multicenter, retrospective cohort study was condcuted. Patients who underwent surgery between January 2019 and December 2024 with histologically confirmed pancreatic ductal adenocarcinoma were included. Factors associated with overall survival were identified through multivariate analysis using Cox proportional hazards regression.

Results: A total of 122 patients were evaluated. The mean age was 66.6 years, and 53.3% were female. Postoperative chemotherapy was administered in 62.3% of cases. The median overall survival was 31.7 months. Tumor recurrence occurred in 28.7% of patients, and 31.1% experienced postoperative complications. Multivariate analysis revealed that adjuvant chemotherapy was significantly associated with reduced mortality risk (HR 0.09; 95% CI: 0.04-0.21; p < 0.001). Tumor recurrence (HR 2.5; 95% CI: 1.25-5.03; p = 0.01) and histological tumor differentiation (HR 2.2; 95% CI: 1.214.00; p = 0.01) were associated with increased mortality.

Conclusion: Surgery combined with adjuvant chemotherapy is significantly associated with improved survival in patients with pancreatic ductal adenocarcinoma. Conversely, tumor recurrence and histological tumor differentiation are linked to decreased survival.