Inês Botto, Juliana Serrazina, Carlos Rodrigues Freitas, S. Carvalhana, Gonçalo Nogueira-Costa, Helena Cortez-Pinto
Introduction: Hepatocellular carcinoma (HCC) is a highly vascular malignancy with the potential for intravascular invasion. However, vascular extension into the cardiac chambers is extremely rare. Case Presentation: We present a 25-year-old male patient in whom the investigation of a cardiac murmur led to the discovery of an intracardiac mass that proved to be advanced-stage HCC with vascular invasion of the right heart. The patient had a previously unknown non-cirrhotic chronic hepatitis B virus (HBV) infection. Despite antiviral therapy and systemic treatment for HCC, he eventually died about 1 month later due to disease progression. Conclusion: This report highlights the importance of early HBV diagnosis and treatment for timely detection and management of HCC. Advanced-stage HCC, particularly with cardiac involvement, has an extremely poor prognosis.
{"title":"Hepatocellular Carcinoma with Vascular and Cardiac Involvement in a Young Patient with Non-Cirrhotic Hepatitis B: A Case Report","authors":"Inês Botto, Juliana Serrazina, Carlos Rodrigues Freitas, S. Carvalhana, Gonçalo Nogueira-Costa, Helena Cortez-Pinto","doi":"10.1159/000539093","DOIUrl":"https://doi.org/10.1159/000539093","url":null,"abstract":"Introduction: Hepatocellular carcinoma (HCC) is a highly vascular malignancy with the potential for intravascular invasion. However, vascular extension into the cardiac chambers is extremely rare. Case Presentation: We present a 25-year-old male patient in whom the investigation of a cardiac murmur led to the discovery of an intracardiac mass that proved to be advanced-stage HCC with vascular invasion of the right heart. The patient had a previously unknown non-cirrhotic chronic hepatitis B virus (HBV) infection. Despite antiviral therapy and systemic treatment for HCC, he eventually died about 1 month later due to disease progression. Conclusion: This report highlights the importance of early HBV diagnosis and treatment for timely detection and management of HCC. Advanced-stage HCC, particularly with cardiac involvement, has an extremely poor prognosis.","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"33 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141801616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristiana Monteiro, Jorge Lima, Tiago Ribeiro, Maria Helena Gonçalves, Natália Gonçalves, Carina Oliveira, Liliana Soares, Ana Carvalho, F. Vilas-Boas, Maria Manuela Ribeiro, Guilherme Macedo, Sónia Barros
Introduction: International societies recommend microbiological surveillance of endoscopes to reduce the incidence of endoscope-associated infections, particularly for duodenoscopes. However, surveillance protocols are not internationally standardized, both regarding sample collection, processing, and culture. This study aims to provide a framework protocol encompassing the experience of a tertiary large volume endoscopy center and the microbiology laboratory for collecting and culturing of endoscope samples for microbiological surveillance. Methods: A sample collection and processing protocol was designed as a result of a cooperation between the Endoscopy Center of the Gastroenterology Department and the Microbiology Laboratory of the Department of Clinical Pathology. This protocol reflects international recommendations in this topic and the human and technological resources of the involved departments. Results: The established protocol for collecting samples varies according to the type and model of endoscope. The specimens are collected as sterile saline liquid samples, as well as swabs (with and without transport media). Together with the collection of samples from the endoscope, samples from the final rinse water as well as the water bottle are also collected. For duodenoscopes and curvilinear echoendoscopes, we perform microbiological surveillance every 3 months; for gastroscopes and colonoscopes, at least, once a year; and for specific endoscopes, such as the pediatric or dual-channel therapeutic endoscopes, enteroscopes, or radial echoendoscopes, every 6 months. Conclusion: Endoscopy units should have detailed protocols for microbiological surveillance of endoscopes. These protocols should be drawn up by a multidisciplinary team that includes endoscopy nurses, gastroenterologists, microbiologists, and the antimicrobial stewardship team, following international recommendations, adapted to each institution resources.
{"title":"Implementation of a Microbiological Surveillance Protocol in a Portuguese Tertiary Care Academic Endoscopy Unit","authors":"Cristiana Monteiro, Jorge Lima, Tiago Ribeiro, Maria Helena Gonçalves, Natália Gonçalves, Carina Oliveira, Liliana Soares, Ana Carvalho, F. Vilas-Boas, Maria Manuela Ribeiro, Guilherme Macedo, Sónia Barros","doi":"10.1159/000539455","DOIUrl":"https://doi.org/10.1159/000539455","url":null,"abstract":"Introduction: International societies recommend microbiological surveillance of endoscopes to reduce the incidence of endoscope-associated infections, particularly for duodenoscopes. However, surveillance protocols are not internationally standardized, both regarding sample collection, processing, and culture. This study aims to provide a framework protocol encompassing the experience of a tertiary large volume endoscopy center and the microbiology laboratory for collecting and culturing of endoscope samples for microbiological surveillance. Methods: A sample collection and processing protocol was designed as a result of a cooperation between the Endoscopy Center of the Gastroenterology Department and the Microbiology Laboratory of the Department of Clinical Pathology. This protocol reflects international recommendations in this topic and the human and technological resources of the involved departments. Results: The established protocol for collecting samples varies according to the type and model of endoscope. The specimens are collected as sterile saline liquid samples, as well as swabs (with and without transport media). Together with the collection of samples from the endoscope, samples from the final rinse water as well as the water bottle are also collected. For duodenoscopes and curvilinear echoendoscopes, we perform microbiological surveillance every 3 months; for gastroscopes and colonoscopes, at least, once a year; and for specific endoscopes, such as the pediatric or dual-channel therapeutic endoscopes, enteroscopes, or radial echoendoscopes, every 6 months. Conclusion: Endoscopy units should have detailed protocols for microbiological surveillance of endoscopes. These protocols should be drawn up by a multidisciplinary team that includes endoscopy nurses, gastroenterologists, microbiologists, and the antimicrobial stewardship team, following international recommendations, adapted to each institution resources.","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141809352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Vara-Luiz, Luísa Glória, I. Mendes, S. Carlos, Paula Guerra, G. Nunes, Cátia Sofia Oliveira, Andreia Ferreira, Ana Paula Santos, J. Fonseca
Background: Short bowel syndrome is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). Patients need parenteral support for months or years. Ideally, it should be delivered at home, reducing limitations in everyday life activities. Summary: The Portuguese Health Directive 017/2020 was the first step in the regulation of home CIF management, and more patients are now being treated in an ambulatory setting. However, much work still needs to be performed in this area. Our country lacks a network of units capable of providing home parenteral nutrition (HPN), and only a few centers have expertise to take care of these complex patients: fluid support, oral, enteral, and parenteral nutrition; disease/HPN-related complications; pharmacologic treatment; and surgical prevention/treatment. Providing adequate transition from pediatric to adult care is a mandatory issue that should only be addressed by expert centers. Key Messages: Implementation of a national network, as well as the creation of an intestinal failure registry, with an initial focus on adult patients, will start a new era in the identification and management of these complex CIF patients.
{"title":"Chronic Intestinal Failure and Short Bowel Syndrome in Adults: Principles and Perspectives for the Portuguese Health System","authors":"F. Vara-Luiz, Luísa Glória, I. Mendes, S. Carlos, Paula Guerra, G. Nunes, Cátia Sofia Oliveira, Andreia Ferreira, Ana Paula Santos, J. Fonseca","doi":"10.1159/000540116","DOIUrl":"https://doi.org/10.1159/000540116","url":null,"abstract":"Background: Short bowel syndrome is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). Patients need parenteral support for months or years. Ideally, it should be delivered at home, reducing limitations in everyday life activities. Summary: The Portuguese Health Directive 017/2020 was the first step in the regulation of home CIF management, and more patients are now being treated in an ambulatory setting. However, much work still needs to be performed in this area. Our country lacks a network of units capable of providing home parenteral nutrition (HPN), and only a few centers have expertise to take care of these complex patients: fluid support, oral, enteral, and parenteral nutrition; disease/HPN-related complications; pharmacologic treatment; and surgical prevention/treatment. Providing adequate transition from pediatric to adult care is a mandatory issue that should only be addressed by expert centers. Key Messages: Implementation of a national network, as well as the creation of an intestinal failure registry, with an initial focus on adult patients, will start a new era in the identification and management of these complex CIF patients.","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"92 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tatiana Pacheco, P. Costa-Moreira, Sara Monteiro, Joana Pinto, Luísa Barros, Jorge Silva
Introduction: Aortoesophageal fistula (AEF) is a rare and potentially fatal cause of upper gastrointestinal bleeding. The classic Chiari’s triad of symptoms and typical endoscopic findings are not present in all patients, making diagnosis challenging. Case Presentation: An 86-year-old man was admitted to the emergency room for melena and hematemesis with hemodynamic instability. He had a previous hospitalization for cardioembolic stroke complicated by hematemesis of unknown etiology after initiation of anticoagulation (which was suspended), being discharged on aspirin. His medical history also included hypertension, diabetes, ischemic heart disease, and prostate cancer. On upper endoscopy, no lesions were found, despite the presence of a large non-mobilizable clot in the gastric fundus. He was admitted to the intensive care unit, and, on the next day, reassessment esophagogastroduodenoscopy was normal. On the eighth day of hospitalization, the patient presented with hemorrhagic shock due to new-onset hematemesis. Upper endoscopy revealed an esophageal 10-mm non-ulcerated mucosal depression with a visible vessel at 20 cm from the incisors, closed with 3 hemoclips. Thoracic CT angiography showed a brachiocephalic trunk aneurysm with aortoesophageal fistulization. He was deemed unsuitable for endovascular or surgical treatment. About 2 months later, the patient was admitted to the emergency room in cardiorespiratory arrest following an episode of hematemesis at home. Discussion: This report highlights the diagnostic and therapeutic complexity of AEF. Endoscopic treatment can be the main therapy in patients without indication for vascular intervention. The purpose was to palliate new bleeding episodes, maintaining a very poor prognosis.
{"title":"Aortoesophageal Fistula Mimicking Dieulafoy Disease: A Case Report","authors":"Tatiana Pacheco, P. Costa-Moreira, Sara Monteiro, Joana Pinto, Luísa Barros, Jorge Silva","doi":"10.1159/000539913","DOIUrl":"https://doi.org/10.1159/000539913","url":null,"abstract":"Introduction: Aortoesophageal fistula (AEF) is a rare and potentially fatal cause of upper gastrointestinal bleeding. The classic Chiari’s triad of symptoms and typical endoscopic findings are not present in all patients, making diagnosis challenging. Case Presentation: An 86-year-old man was admitted to the emergency room for melena and hematemesis with hemodynamic instability. He had a previous hospitalization for cardioembolic stroke complicated by hematemesis of unknown etiology after initiation of anticoagulation (which was suspended), being discharged on aspirin. His medical history also included hypertension, diabetes, ischemic heart disease, and prostate cancer. On upper endoscopy, no lesions were found, despite the presence of a large non-mobilizable clot in the gastric fundus. He was admitted to the intensive care unit, and, on the next day, reassessment esophagogastroduodenoscopy was normal. On the eighth day of hospitalization, the patient presented with hemorrhagic shock due to new-onset hematemesis. Upper endoscopy revealed an esophageal 10-mm non-ulcerated mucosal depression with a visible vessel at 20 cm from the incisors, closed with 3 hemoclips. Thoracic CT angiography showed a brachiocephalic trunk aneurysm with aortoesophageal fistulization. He was deemed unsuitable for endovascular or surgical treatment. About 2 months later, the patient was admitted to the emergency room in cardiorespiratory arrest following an episode of hematemesis at home. Discussion: This report highlights the diagnostic and therapeutic complexity of AEF. Endoscopic treatment can be the main therapy in patients without indication for vascular intervention. The purpose was to palliate new bleeding episodes, maintaining a very poor prognosis.","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"40 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141814907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inês Pestana, C. Noronha Ferreira, Rita Luís, Rui Sousa, Eduardo Abrantes Pereira, A. Banhudo
Introduction: Porto-sinusoidal vascular disease (PSVD) is an entity characterized by the absence of histologic liver cirrhosis and the detection of specific or non-specific histological findings, irrespective of the presence of portal hypertension (PHT). The pathogenesis remains poorly understood. Pulmonary arterial hypertension (PAH), independently of the presence of PHT, can be associated with an increase in central venous pressure, which can rarely lead to the development of downhill varices in the proximal esophagus. Case Presentation: A 53-year-old woman, with an unremarkable medical and pharmacological history, presented with a 3-day history of melena, epigastric pain and hematemesis. Physical examination revealed bilateral peripheral edema of the legs. Laboratory findings included severe anemia, normal hepatic enzymology, and NT-proBNP 1,748 pg/mL. Endoscopy showed large proximal esophageal varices and mild hypertensive gastropathy. A complete liver disease etiology panel was negative. Ultrasound showed an irregular liver surface, splenomegaly, and dilated supra-hepatic veins and inferior vena cava. Echocardiogram revealed significant cardiac valve and cavity abnormalities, especially on the right side, as well as moderate to severe PAH. Diuretics therapy was started with clinical improvement. Beta-blockers were suspended due to intolerance. There were no images suggestive of portosystemic collateralization on angiography. Re-evaluation endoscopy showed large but reduced esophageal varices, without red spots. Cardiopulmonary hemodynamic assessment revealed moderate PAH (40 mm Hg). Liver hemodynamic study revealed non-clinically significant sinusoidal PHT. Transjugular liver biopsy revealed nodular regenerative hyperplasia suggestive of PSVD. Discussion/Conclusion: The case was complex and presented diagnostic challenges, illustrating the uncommonly reported association between PSVD and porto-pulmonary hypertension and the importance of the transjugular liver biopsy and pressure measurements to confirm both diagnoses.
{"title":"Porto-Sinusoidal Vascular Disease and Downhill Varices: Separate Clinical Entities?","authors":"Inês Pestana, C. Noronha Ferreira, Rita Luís, Rui Sousa, Eduardo Abrantes Pereira, A. Banhudo","doi":"10.1159/000539092","DOIUrl":"https://doi.org/10.1159/000539092","url":null,"abstract":"Introduction: Porto-sinusoidal vascular disease (PSVD) is an entity characterized by the absence of histologic liver cirrhosis and the detection of specific or non-specific histological findings, irrespective of the presence of portal hypertension (PHT). The pathogenesis remains poorly understood. Pulmonary arterial hypertension (PAH), independently of the presence of PHT, can be associated with an increase in central venous pressure, which can rarely lead to the development of downhill varices in the proximal esophagus. Case Presentation: A 53-year-old woman, with an unremarkable medical and pharmacological history, presented with a 3-day history of melena, epigastric pain and hematemesis. Physical examination revealed bilateral peripheral edema of the legs. Laboratory findings included severe anemia, normal hepatic enzymology, and NT-proBNP 1,748 pg/mL. Endoscopy showed large proximal esophageal varices and mild hypertensive gastropathy. A complete liver disease etiology panel was negative. Ultrasound showed an irregular liver surface, splenomegaly, and dilated supra-hepatic veins and inferior vena cava. Echocardiogram revealed significant cardiac valve and cavity abnormalities, especially on the right side, as well as moderate to severe PAH. Diuretics therapy was started with clinical improvement. Beta-blockers were suspended due to intolerance. There were no images suggestive of portosystemic collateralization on angiography. Re-evaluation endoscopy showed large but reduced esophageal varices, without red spots. Cardiopulmonary hemodynamic assessment revealed moderate PAH (40 mm Hg). Liver hemodynamic study revealed non-clinically significant sinusoidal PHT. Transjugular liver biopsy revealed nodular regenerative hyperplasia suggestive of PSVD. Discussion/Conclusion: The case was complex and presented diagnostic challenges, illustrating the uncommonly reported association between PSVD and porto-pulmonary hypertension and the importance of the transjugular liver biopsy and pressure measurements to confirm both diagnoses.","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"63 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141338434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Teresa Ferreira, S. Archer, I. Pedroto, C. Caetano
{"title":"Beware the Hole: A Trick for Endoscopic Success while Closing an Esophageal Perforation","authors":"Ana Teresa Ferreira, S. Archer, I. Pedroto, C. Caetano","doi":"10.1159/000539021","DOIUrl":"https://doi.org/10.1159/000539021","url":null,"abstract":"","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"35 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141356984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raquel Oliveira, V. Martins, Laetitia Teixeira, H. Tavares de Sousa, J. Roseira
Introduction: Food-related quality of life (FR-QoL) has been shown to be an important patient-reported outcome in inflammatory bowel disease (IBD). We aimed to translate and validate a Portuguese version of the FR-QoL-29. Methods: This was a case-control cross-sectional study undertaken at a tertiary hospital. After obtaining the original authors’ authorization, both forward and backward translations of the original FR-QoL-29 were performed by bilingual researchers. After an IBD expert’s revision and the input of a small group of patients, a final version was obtained. Portuguese IBD patients were prospectively recruited from the outpatient clinic of a tertiary hospital and completed the questionnaire at two timepoints (0 and 4 weeks). Reliability (internal consistency, test-retest, and intraclass correlation [ICC]), validity (content and convergent validity, and hypothesis testing using Spearman’s correlations), and responsiveness (Student t tests) were analysed. Results: 239 patients (mean age 50.1 [SD = 15.3 years], 56.5% female) and 87 (36.4%) patients answered the questionnaire at the first and second timepoints, respectively; 126 controls answered the questionnaire. Overall, the FR-QoL-29-Portuguese showed excellent internal consistency (Cronbach’s α = 0.97) and good test-retest reliability (ICC = 0.78 [95% CI: 0.64–0.85]). FR-QoL moderately correlated with health-related quality of life, measured by the SIBDQ-PT (R = 0.49; p < 0.05). Lastly, the questionnaire revealed appropriate responsiveness when patients reported an overall improvement in general well-being (mean improvement 25.88 [SD = 32.50]; p < 0.05). Discussion/Conclusions: We present an adaptation and validation of the FR-QoL-29 tool for Portuguese IBD patients. The FR-QoL-29-Portuguese is a reliable and valid tool shown to be responsive to changes in general well-being.
{"title":"Food-Related Quality of Life in Inflammatory Bowel Disease: Translation and Validation of Food-Related Quality of Life to the Portuguese Language (FR-QoL-29-Portuguese)","authors":"Raquel Oliveira, V. Martins, Laetitia Teixeira, H. Tavares de Sousa, J. Roseira","doi":"10.1159/000539227","DOIUrl":"https://doi.org/10.1159/000539227","url":null,"abstract":"Introduction: Food-related quality of life (FR-QoL) has been shown to be an important patient-reported outcome in inflammatory bowel disease (IBD). We aimed to translate and validate a Portuguese version of the FR-QoL-29. Methods: This was a case-control cross-sectional study undertaken at a tertiary hospital. After obtaining the original authors’ authorization, both forward and backward translations of the original FR-QoL-29 were performed by bilingual researchers. After an IBD expert’s revision and the input of a small group of patients, a final version was obtained. Portuguese IBD patients were prospectively recruited from the outpatient clinic of a tertiary hospital and completed the questionnaire at two timepoints (0 and 4 weeks). Reliability (internal consistency, test-retest, and intraclass correlation [ICC]), validity (content and convergent validity, and hypothesis testing using Spearman’s correlations), and responsiveness (Student t tests) were analysed. Results: 239 patients (mean age 50.1 [SD = 15.3 years], 56.5% female) and 87 (36.4%) patients answered the questionnaire at the first and second timepoints, respectively; 126 controls answered the questionnaire. Overall, the FR-QoL-29-Portuguese showed excellent internal consistency (Cronbach’s α = 0.97) and good test-retest reliability (ICC = 0.78 [95% CI: 0.64–0.85]). FR-QoL moderately correlated with health-related quality of life, measured by the SIBDQ-PT (R = 0.49; p < 0.05). Lastly, the questionnaire revealed appropriate responsiveness when patients reported an overall improvement in general well-being (mean improvement 25.88 [SD = 32.50]; p < 0.05). Discussion/Conclusions: We present an adaptation and validation of the FR-QoL-29 tool for Portuguese IBD patients. The FR-QoL-29-Portuguese is a reliable and valid tool shown to be responsive to changes in general well-being.","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"12 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"All Neuroendocrine Tumors Seem to Look Alike but Some Look Alike More Than Others","authors":"Ana Paula Santos","doi":"10.1159/000539161","DOIUrl":"https://doi.org/10.1159/000539161","url":null,"abstract":"","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"45 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Vara-Luiz, Luísa Glória, I. Mendes, S. Carlos, Paula Guerra, G. Nunes, Cátia Sofia Oliveira, Andreia Ferreira, Ana Paula Santos, J. Fonseca
Background: Short bowel syndrome (SBS) is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). During the intestinal rehabilitation process, patients may need parenteral support for months or years, parenteral nutrition (PN), or hydration/electrolyte supplementation, as a bridge for the desired enteral autonomy. Summary: Several classification criteria have been highlighted to reflect different perspectives in CIF. The management of CIF-SBS in adults is a multidisciplinary process that aims to reduce gastrointestinal secretions, slow transit, correct/prevent malnutrition, dehydration, and specific nutrient deficiencies, and prevent refeeding syndrome. The nutritional support team should have the expertise to take care of these complex patients: fluid support; oral, enteral, and PN; disease/PN-related complications; pharmacologic treatment; and surgical prevention/treatment. Key Messages: CIF-SBS is a complex disease with undesired consequences, if not adequately identified and managed. A comprehensive approach performed by a multidisciplinary team is essential to reduce PN dependence, promote enteral independence, and improve quality of life.
{"title":"Chronic Intestinal Failure and Short Bowel Syndrome in Adults: The State of the Art","authors":"F. Vara-Luiz, Luísa Glória, I. Mendes, S. Carlos, Paula Guerra, G. Nunes, Cátia Sofia Oliveira, Andreia Ferreira, Ana Paula Santos, J. Fonseca","doi":"10.1159/000538938","DOIUrl":"https://doi.org/10.1159/000538938","url":null,"abstract":"Background: Short bowel syndrome (SBS) is a devastating malabsorptive condition and the most common cause of chronic intestinal failure (CIF). During the intestinal rehabilitation process, patients may need parenteral support for months or years, parenteral nutrition (PN), or hydration/electrolyte supplementation, as a bridge for the desired enteral autonomy. Summary: Several classification criteria have been highlighted to reflect different perspectives in CIF. The management of CIF-SBS in adults is a multidisciplinary process that aims to reduce gastrointestinal secretions, slow transit, correct/prevent malnutrition, dehydration, and specific nutrient deficiencies, and prevent refeeding syndrome. The nutritional support team should have the expertise to take care of these complex patients: fluid support; oral, enteral, and PN; disease/PN-related complications; pharmacologic treatment; and surgical prevention/treatment. Key Messages: CIF-SBS is a complex disease with undesired consequences, if not adequately identified and managed. A comprehensive approach performed by a multidisciplinary team is essential to reduce PN dependence, promote enteral independence, and improve quality of life.","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"49 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141102918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Revés, Ana Catarina Bravo, B. S. Abreu, Mariana Gamito, Ana Neves Figueiredo, Rui Loureiro
{"title":"Endoscopic Retrieval of Migrated Uterine Device: Case Report","authors":"J. Revés, Ana Catarina Bravo, B. S. Abreu, Mariana Gamito, Ana Neves Figueiredo, Rui Loureiro","doi":"10.1159/000538759","DOIUrl":"https://doi.org/10.1159/000538759","url":null,"abstract":"","PeriodicalId":508782,"journal":{"name":"GE - Portuguese Journal of Gastroenterology","volume":"107 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141017582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：