Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru最新文献

Background: One of the pathways involved in liver regeneration processes is TWEAK/Fn14 (tumor necrosis factor-related weak inducer of apoptosis/fibroblast growth factor-inducible 14), which has been proposed to act directly and selectively on hepatic progenitor cells; however, its role in the regeneration of steatotic liver metabolic dysfunction associated fatty liver disease has not been fully elucidated.

Objective: To evaluate the behavior of Fn14 and its ligand TWEAK, as well as cellular stress signals as biochemical cues for possible liver regeneration in MAFLD.

Materials and methods: A prospective study was carried out where the behavior of Fn14 and its ligand TWEAK, as well as cellular stress signals were observed as biochemical indications of a possible liver regeneration in a condition of tissue damage caused by excessive lipid accumulation. The expression of TWEAK, Fn14 and heat shock proteins in hepatic steatosis of non-alcoholic origin was assessed using immunohistochemistry and western blotting.

Results: The histological classification of the tissues under study corresponded to microvesicular steatosis. We report a high level of expression of heat shock proteins in the cytoplasm. The expression of TWEAK and Fn14 in liver tissue affected by lipid accumulation was localized in the cytoplasm of hepatocytes, showing a higher intensity of reactivity for Fn14 compared to its ligand TWEAK.

Conclusion: The expression of TWEAK/Fn14 axis was positive suggesting reactivity of the signaling pathway in metabolic dysfunction associated fatty liver disease.

Typhoid fever (enteric fever), caused by Salmonella enterica subsp. enterica serovar Typhi (S. Typhi), is a public health problem especially in South Asia and sub-Saharan African countries, while incidence remains low in most other parts of the world, where the disease is primary related to recent travel to endemic countries or contact with chronic carriers. The diagnosis of typhoid fever is challenging in endemic countries, often also low- and middle- income countries (LMIC), due to the poor sensitivity/specificity of available serologic tests and lack of adequate infrastructure for blood cultures. We report the case of an 18-year-old male patient with a 21-day history of right-sided abdominal pain, malaise, headache, intermittent fever and watery diarrhea. Contrast-enhanced abdominal computed tomography (CT) exhibits thickening of the terminal ileum, cecum and ascending colon with mesenteric lymphadenopathy. Laboratory findings indicate elevated transaminases, positive blood culture to S. Typhi and a positive Widal test to S. Paratyphi A, B and S. Typhi H (flagellar) antigens. A diagnosis of complicated typhoid fever was made. Following a 13-day regimen of ceftriaxone, all symptoms resolved. Few reports have been made about CT manifestations in patients with typhoid fever. While CT can aid in diagnosis, it is particularly important for identifying complications of typhoid fever such as perforation, bleeding and abscess formation.

Introduction: Conventional management of small intestinal bacterial overgrowth (SIBO) involves intraluminal-action antibiotics. Controversially, probiotics are used to optimize outcomes, but this therapeutic intervention is understudied.

Objective: To evaluate the efficacy of probiotics in the treatment of small intestinal bacterial overgrowth. Materials and methos: A search was conducted using relevant terms guided by a documentalist in CENTRAL, MEDLINE, and EMBASE, LILACS, conference proceedings, the International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov, in English or Spanish, up to January 2023. The search aimed to identify studies evaluating the effectiveness of probiotics in small intestinal bacterial overgrowth. Controlled trials of probiotics compared to placebo or other interventions (antibiotics) for symptom control and normalization of hydrogen breath test in adult patients with small intestinal bacterial overgrowth were included. Two authors independently assessed and extracted data. Information on methods, participants, interventions, and outcomes (resolution of SIBO by hydrogen breath test, symptom control) was collected. When appropriate, risk ratios (OR) with 95% confidence intervals (CI) were calculated. Study quality was evaluated using the Cochrane Risk of Bias Assessment Tool.

Results: A total of 18 clinical trials were found, including one case-control study, two crossover trials, and one single-arm clinical trial. Out of these, 14 clinical trials had a control group, of which 9 were randomized, collecting information from 496 patients treated with probiotics and 480 controls. Among them, 6 clinical trials compared probiotics (n=122) against placebo (n=104). Due to lack of uniformity in outcome reporting, only 3 of these studies were included in the meta-analysis, revealing a favorable effect of probiotics in resolving SIBO by hydrogen breath test (OR=0.3, 95% CI, 0.3-1.0). The studies showed high heterogeneity and a high risk of bias.

Conclusions: Using the GRADE methodology, we found low-quality clinical evidence in favor of using probiotics compared to placebo for the resolution of SIBO.

Background: Management of anastomotic dehiscences following colorectal surgery is a topic of debate. In this context, endoluminal vacuum therapy offers promising results.

Objective: To analyze the efficacy and feasibility of endoluminal vacuum therapy in distal anastomotic dehiscences after colorectal surgery.

Materials and methods: This study is a descriptive case series that evaluates patients with anastomotic dehiscences over a period of 18 months. All patients were treated with Endo-sponge® (Braun Medical, Hessen, Germany).

Results: Fourteen patients were included in the final analysis. The indications for endoluminal vacuum therapy were Hartmann's stump insufficiency (n=6), anastomotic leakage after laparoscopic total mesorectal excision (n=4), and anastomotic dehiscence after transanal total mesorectal excision (n=4). A total of 204 sponges were placed per patient (median 12.5, range 1-33). Complete resolution was achieved in 9 patients (57.1%) in a mean time of 108 days (range 15-160 days). In the sub-analysis, patients with acute dehiscence (<3 months) achieved complete resolution in 80% (8/10), whereas no patient with chronic defects reached resolution (0/4). A low complication rate (7%) was recorded.

Conclusion: Endoluminal vacuum therapy appears to be a feasible and safe treatment with a high success rate in patients with large acute colorectal anastomotic defects.

Introduction: Colonoscopy is the standard method for colorectal cancer diagnosis. Despite the use of multiple devices, polyp and adenoma detection results have been inconsistent.

Objectives: The main aim of this research is to determine if there have been differences between conventional colonoscopy (CC) and cap-assisted colonoscopy (CAC) in the diagnosis performance to detect adenomas.

Materials and methods: This is a prospective randomized clinical trial that compares the diagnostic performance of CC and CAC in detecting adenomas in a public reference hospital.

Results: We randomly assigned 131 patients to either CC (n=64) or CAC (n=67). Cap-assisted colonoscopy was associated with shorter cecal intubation times (6 min vs. 7,5 min, p=0.005) and a higher chance of intubating the ileum (RR = 1.62; 1.21-2.17). There was no statistical difference in the adenoma detection rates (RR: 1.62; 1.21-2.17) or polyp detection rates (RR: 1.07; 0.602-1.919) between CC and CAC.

Conclusion: Cap-assisted colonoscopy was associated with a shorter duration of cecal intubation and a higher probability of ileum intubation. We did not find statistical differences in the adenoma detection rates. In the CAC arm, there was a trend to detect more adenoma in the right colon, although this difference was not statistically significant.

The capsule endoscopy (CE) is a minimally invasive diagnostic imaging technique, consisting of a disposable capsule that travels through the digestive system, transmitting images to a data recorder. CE has emerged as a tool for exploring the small intestine, however, the lack of standardization in interpretation and terminology has been a challenge in the medical community. This article proposes guidelines for the performance, reading, and interpretation of CE, highlighting its utility in various indications.

Percutaneous endoscopic gastrostomy (PEG) is an important procedure for nutrition delivery, and one that is often associated with complications. The formation of granulation tissue or periostomal granuloma is a chronic minor complication associated with gastrostomy, being more frequent in geriatric patients, but the therapeutic experience in pediatric patients is better known. We present the case of a 94-year-old female patient, diagnosed with Alzheimer's dementia with severe motor and cognitive impairment, who presents significant malnutrition and severe dysphagia. In treatment with rivastigmine, sertraline, and trazodone, in addition to muscle relaxant. She has been a gastrostomy user for 2 years due to severe motor and swallowing compromise. In the past 1 year ago with presence of ring granuloma, without bleeding. It was decided to treat with common salt as the first line of treatment since there was no bleeding. The primary caregiver was instructed on the details of how to apply common salt on the granuloma at home. The patient showed complete resolution of the granuloma within three days of application with no recurrence at follow-up 12 months after the initial evaluation, and without requiring a tube change. PEG-associated granuloma is a frequent minor chronic complication in adult gastrostomy users. The use of common salt is an effective, rapid and safe therapeutic alternative to consider in these patients.

We report the case of a patient with chronic hepatitis B and C managed with direct-acting antivirals in an outpatient setting. Chronic hepatitis B was first treated with entecavir before initiating treatment for chronic hepatitis C. The patient achieved viral suppression for hepatitis B and sustained virological response for hepatitis C. As direct-acting antivirals become more available, healthcare practitioners should be familiar with managing patients with chronic coinfection.

Portal hypertension (PHT) is defined as an increase in pressure at the level of the portal vein above 5 mmHg, the most common cause being liver cirrhosis. Among the presinusoidal intrahepatic causes of PHT with portal venular involvement, what was traditionally known as idiopathic non-cirrhotic portal hypertension (NCIH) is described, with the requirements of excluding those patients who did not present PHT, as well as those with the presence of liver cirrhosis and thrombosis. portal venous vein (PVT). Currently, the diagnostic criteria for this entity have been reconsidered, and its name, being known as porto-sinusoidal vascular disease (PSVD), also does not exclude patients with PHT or the presence of underlying liver disease. Liver biopsy continues to be the gold standard for diagnosis. The clinical manifestations are derived from PHT and the management is similar to the complications that occur in patients with liver cirrhosis. The case of a male patient is presented who presents with symptoms of digestive bleeding, with findings of esophageal varices in upper endoscopy in addition to a study of viral, autoimmune liver disease and negative deposits, with a conclusive liver biopsy of porto-sinusoidal vascular disease.

Introduction: Endoscopy plays a fundamental role in inflammatory bowel disease (IBD), and becomes essential in diagnosis, treatment monitoring, and detection and management of complications.

Materials and methods: The Pan American Crohn's and Colitis Organization (PANCCO) and the Inter-American Society of Endoscopy (SIED) appointed 22 Latin American experts in IBD to develop a consensus study using the modified Delphi method, based on the best available evidence. A working group of 22 members from 9 countries identified 15 topics and formulated 98 statements, who participated in 2 rounds of voting. It was defined as agreement of ≥80% of experts for each statement.

Results: After the voting of all the statements, 8 statements were obtained that did not reach 80% consensus among the participants, so the questions were reconsidered in the Coordinating Committee of the consensus with the participation of the expert reviewers of these questions and 7 final statements were voted again by all the experts in a second round and 1 was eliminated with consensus. After two rounds of voting, the experts reached consensus with literature review with the best available evidence, the most important issues were developed with scientific evidence supporting each of the statements around the topic of endoscopy in IBD.

Conclusions: Consensus statements were developed and based on the best available evidence about endoscopy in inflammatory bowel disease.