GE Portuguese Journal of Gastroenterology最新文献

Background and aims: Endoscopy holds a pivotal role in colorectal (CRC) and gastric cancer screening, and adherence rates might be impacted by the patient's risk perception, encompassing concerns about complications during endoscopic screening procedures. This study aimed to evaluate how individuals perceive the risk of complications associated with undergoing a screening colonoscopy and upper gastrointestinal endoscopy (UGIE).

Methods: This is a cross-sectional study enrolling individuals eligible for CRC screening in northern Portugal, where a populational fecal occult blood test program is implemented. The validated PERCEPT-PREVENT tool was applied through telephonic interviews in 2 groups: (a) never-screened and (b) already submitted to endoscopic screening.

Results: Among the 217 included healthy participants, 61% (n = 133) and 83% (n = 181) were unaware of any possible complications from colonoscopy and UGIE, respectively. Never-screened individuals less frequently reported a high complication risk perception (colonoscopy: 19% vs. 45%, p < 0.001; UGIE: 14% vs. 41%, p < 0.001). A lower risk perception for UGIE complications was associated with a higher willingness to undergo UGIE combined with a screening colonoscopy (OR: 2.30, 95% confidence interval: 1.42-3.70). Participants who underwent combined screening reported less frequently a high complication risk perception (colonoscopy: 27% vs. 61%, p < 0.001; UGIE: 28% vs. 54%, p = 0.006) and scored higher for complication awareness (colonoscopy: 14 ± 5 vs. 11 ± 4, p < 0.001; UGIE: 11 ± 4 vs. 9 ± 3, p < 0.001) compared to those who had only undergone colonoscopy.

Discussion: Enhancing risk perception and knowledge of complications associated with endoscopic screening procedures offers an opportunity to increase adherence rates.

Objectives: The aim of this study was to assess disease burden and cost of illness of hepatocellular carcinoma (HCC) in Portugal, assuming full adherence to the treatment algorithm associated to the Barcelona Clinic Liver Cancer (BCLC) system.

Methods: An individual-level, continuous-time, state-transition model was used to simulate the progression of HCC patients through the BCLC disease stages. Health state transition rates were derived from the published literature. An expert panel provided further information on Portuguese epidemiology and clinical practice, including treatments and other healthcare resources utilization at each disease stage. Unit costs for health resources were collected from national public sources. HCC associated costs and outcomes were estimated over a 5-year time horizon.

Results: Over the 5-year horizon of this study, the projections of HCC annual prevalence (including patients in remission) show an increasing trend, rising from 4,151 in 2023 to 4,851 in 2027. Despite the slight reduction in the predicted annual mortality rate (from 29.8% to 28.7%), we estimated that HCC could still lead to a total of 120,314 years of life lost due to premature mortality in the Portuguese population. Costs attributed to HCC were predicted to rise from around EUR 70 million in 2023 up to around EUR 77 million in 2027. Around 44.3% of these costs are related to HCC systemic treatment and 29.0% related to liver transplantation costs.

Conclusion: HCC's increasing prevalence trend will continue to impose substantial disease burden in terms of premature mortality, with more than 20,000 years of life lost per year in the Portuguese population. Consequently, costs attributed to HCC are expected to rise despite the reduction on mortality by full adherence to the BCLC treatment algorithm. Continuing high disease burden and substantial cost of illness urge for a need of a comprehensive and effective healthcare interventions, as well as adequate resource allocation for HCC.

Introduction: Achalasia is a rare disorder, with few cases occurring during childhood. It is also part of the Allgrove syndrome phenotype and a clinical feature that has a major impact on children's development. Timely diagnosis and effective treatment of symptoms are essential. The novel peroral endoscopic myotomy (POEM) may represent an effective alternative in children.

Case presentation: We present the case of a female child born in 2013, without relevant family history or perinatal events. At 6 years old, she presented with seizures related to recurrent hypoglycemia episodes, and adrenal insufficiency was diagnosed. Two years later, the patient was referred to our institution due to regurgitation and vomiting, causing failure to thrive. After an upper endoscopy with no significant findings, high-resolution manometry revealed type II achalasia. Alacrima was also part of the clinical picture, and Allgrove syndrome was genetically confirmed. Due to significant symptoms, an endoscopic pneumatic dilation was performed, with transient relief of symptoms. After a second pneumatic dilation and several hospitalizations due to achalasia complications, a POEM was considered. She underwent POEM in March 2024, without adverse events and excellent short-term outcomes.

Discussion: Although there is limited literature on POEM in children, the results demonstrate an encouraging success rate, compared to pneumatic dilation and laparoscopic Heller's myotomy. We present the first reported case of POEM performed in a child in Portugal. The long-term efficacy of this promising minimally invasive procedure should be assessed in the pediatric population.

Background: The most appropriate strategy for completing a previous incomplete colonoscopy (IC) is not standardized. We aimed to compare the efficacy and safety of two strategies for completing a previous IC: colon capsule endoscopy (CCE) versus repeat conventional colonoscopy.

Methods: A retrospective cohort study that included consecutive adult patients referred to our center after IC under sedation due to irreducible loop formation or colonic fixed angulation was performed. Patients underwent CCE (PillCam COLON2 Medtronic^®) or repetition of conventional colonoscopy under sedation. In this setting, an appropriate CCE progression was defined as the capsule reaching the segment achieved during the previous IC. Repeated conventional colonoscopy was considered complete when cecal intubation was accomplished. We compared the rate of appropriate CCE colon progression with the cecal intubation rate from repeated conventional colonoscopy. Quality of colon preparation, diagnostic yield, and rate of adverse events for CCE and colonoscopy was also analyzed.

Results: A total of 192 CCE and 181 colonoscopies were performed for IC, primarily due to fixed angulation of the left colon (69.2%, n = 258). There were no significant differences between the two groups (CCE vs. colonoscopy) concerning age, sex, overweight/obesity status, previous abdominal surgery, and reasons for IC. The rate of appropriate colon progression with CCE was not significantly different from the cecal intubation rate of repeated colonoscopy (95.3% vs. 90.1%, p = 0.073, respectively), even after adjusting for the quality of colon preparation (p = 0.122), which differed significantly between the groups (76.0% vs. 92.8%, p < 0.001, respectively). There were no significant differences in overall colorectal findings identified between the CCE and colonoscopy groups (55.2% vs. 62.4%, p = 0.172, respectively), and no adverse events were reported in either group.

Conclusions: Our findings suggest that both CCE and repeat conventional colonoscopy are effective and safe options for completing a previous IC.

Cholangiocarcinoma (CCA) is a malignancy that originates from the epithelial cells of the biliary system. Despite advancements in medical diagnostic techniques, CCAs remain a challenge to detect due to their silent clinical progression, making it difficult to diagnose these diseases. There are several well-established risk factors for CCA, including biliary tract infection and inflammation. However, there is also growing evidence that community and occupational exposures play a significant role in the development of bile duct cancers. This review examines the geographical distribution of these risk factors and the importance of surveillance in individuals exposed to these toxins who are more prone to developing CCA.

Background: In 2018, the authors surveyed the clinical practices among Portuguese gastroenterologists (PGEs) regarding treatment targets in Crohn's disease (CD) and ulcerative colitis (UC). Since then, new evidence has emerged supporting additional targets, such as transmural remission and histological remission. This study provides an updated assessment of treatment practices among PGE with special emphasis on these new targets.

Methods: Using the Portuguese Inflammatory bowel disease Study Group (GEDII) physician database, we invited PGE to participate in an anonymous online survey.

Results: Fifty-six physicians agreed to participate in the study. Deep remission, steroid-free clinical remission, endoscopic remission, and biomarker remission were ranked among the most important treatment targets in CD (89%, 80%, 89%, and 84%, respectively) and UC (82%, 84%, 79%, and 84%, respectively). In CD, transmural remission was considered a target by 70% of participants, with 48% agreeing to intensify treatment to achieve it. In UC, histological remission was aimed by only 45% of PGE with most (88%) being unwilling to intensify treatment to achieve this goal. Physicians were more likely to seek endoscopic remission in CD and UC in younger and healthier patients, compared to older patients with comorbidities.

Conclusion: PGEs are increasingly pursuing tougher treatment targets such as transmural remission in CD and, to a lesser extent, histological remission in UC. Physicians are more willing to escalate treatment to achieve endoscopic remission in younger patients.

Wilson disease (WD) is a genetic disorder of copper metabolism caused by mutations in the ATP7B gene resulting in toxic copper accumulation in several organs. WD can manifest as liver disease, a progressive neurological disorder, a psychiatric illness, or a combination of these. Other clinical manifestations can also occur. Diagnosis is challenging and typically requires a range of biochemical tests, imaging, genetic testing for ATP7B, and/or liver biopsy. WD is treatable with chelating agents, such as d-penicillamine and trientine, and/or zinc salts alongside with dietary copper restriction. Liver transplantation may be indicated in WD patients with severe hepatic disease, and cautiously considered in patients with neurological WD. Treatment success highly depends on patient adherence and treatment persistence. Therefore, effective interventions for improving patient adherence and close monitoring are key for preventing WD progression. In Portugal, there are no reference centers for WD, and patients are dispersed across numerous medical specialists. This review aimed to summarize the most recent and relevant information for the diagnosis, treatment, and monitoring of WD in Portugal, as well as possible interventions for stimulating adherence to treatment.