Gastroenterologia y hepatologia最新文献

{"title":"Spontaneous cholecysto-cutaneous fistula in a patient with peritoneal carcinomatosis.","authors":"Miriam Bragado Pascual, Rosanna Villanueva Hernández, M Pilar Delgado Alvarez, Luis Ricardo Gotuzzo Altez, Juan Manuel Blanco Esteban","doi":"10.1016/j.gastrohep.2025.502447","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2025.502447","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502447"},"PeriodicalIF":2.2,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary clinical practice guideline on the management of metabolic hepatic steatosis.","authors":"Manuel Romero-Gómez, Javier Escalada, Mar Noguerol, Antonio Pérez, Juana Carretero, Javier Crespo, Juan J Mascort, Ignacio Aguilar, Francisco Tinahones, Pedro Cañones, Ricardo Gómez-Huelgas, Daniel de Luis, Idoia Genúa Trullos, Rocío Aller, Miguel A Rubio","doi":"10.1016/j.gastrohep.2025.502442","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2025.502442","url":null,"abstract":"<p><p>Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideline aims to respond to its main challenges, both in terms of disease burden and complexity. To this end, recommendations have been proposed to experts through the Delphi method. The consensus was optimal in recommendations regarding type 2 diabetes as a risk factor (1.5.1, 4.5.1), in which cases early detection of MetHS should be carried out (4.5.2). Its results also emphasize the importance of the use of non-invasive tests (FIB-4, NFS, HFS) for the exclusion of significant fibrosis in patients with suspected MetHS (2.3.1, 2.3.3). Diagnosis should be carried out through the sequential combination of non-invasive indices and transient elastography by FibroScan® for its risk stratification (2.3.3). A nearly unanimous consensus was reached regarding the role of early prevention in the impact on the quality of life and survival of patients (5.1.2), as well as on the effectiveness of the Mediterranean diet and physical exercise in relation to the improvement of steatosis, steatohepatitis and fibrosis in MetHS patients (5.2.2) and on the positive results offered by resmiterom and semaglutide in promoting fibrosis regression (5.4.1). Finally, a great consensus has been reached regarding the importance of multidisciplinary management in MetHS, for which it is essential to agree on multidisciplinary protocols for referral between levels in each health area (6.2.1), as well as ensuring that referrals to Hepatology/Digestive and Endocrinology or Internal Medicine services are effective and beneficial to prevent the risk of disease progression (6.2.3, 6.3.1).</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502442"},"PeriodicalIF":2.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric intussusception caused by submucosal eminence of gastric antrum.","authors":"Jianhong Xu, Kai Yang, Zhenguo Qiao, Ling Fan","doi":"10.1016/j.gastrohep.2025.502441","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2025.502441","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502441"},"PeriodicalIF":2.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in adherence to STRIDE-II: Perspectives from gastroenterologists and patients with inflammatory bowel disease.","authors":"Francisca Carvajal, Karin Herrera, Paulina Núñez, Lilian Flores, Andrea Córdova, Gonzalo Pizarro, Pamela San Martín, Rodrigo Quera","doi":"10.1016/j.gastrohep.2025.502440","DOIUrl":"10.1016/j.gastrohep.2025.502440","url":null,"abstract":"<p><strong>Introduction: </strong>The treatment aims to achieve symptomatic remission, normalization of biomarkers such a fecal calprotectin, and endoscopic remission. Therefore, early recognition of inflammatory activity and timely therapeutic intervention are essential to improve the morbidity and mortality.</p><p><strong>Objective: </strong>Evaluate the adherence among gastroenterologists and the patients compliance with medical recommendations in the Inflammatory Bowel Disease Program at Clínica Universidad de los Andes PATIENTS AND METHODS: A retrospective study that included patients presenting with a flare confirmed by colonoscopy. Three follow-up stages were defined: Short-Term Control: symptomatic remission at 3months, Medium-Term Control: remission of fecal calprotectin as a biomarker (<250μg/g) between 4 and 6months, and Long-Term Control: endoscopic remission between 6 and 9months.</p><p><strong>Results: </strong>A total of 104 patients were evaluated, 64% of the cohort were females and a median age of 41years. Among them, 81% had Crohn's disease, with an inflammatory phenotype in 87% and colonic localization in 39%. The remaining 19% had ulcerative colitis with left-sided involvement in 50%. Ninety percent of the patients attended short term control with a symptomatic remission in 72%. Eighty-two percent attended medium term control, resulting in biomarker remission for 83% of them. Seventy seven percent attended long term control, achieving endoscopic remission in 59% of the cases.</p><p><strong>Conclusion: </strong>The results indicate that our program achieves a physician adherence of over 90% to STRIDE-II, with patient's adherence to pharmacological therapy and follow up above 70%. Although these are high percentages, they are subject to improvement.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502440"},"PeriodicalIF":2.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A giant retrorectal obstructing cyst.","authors":"Ismael Mora-Guzmán, Julián de Pedro Conal","doi":"10.1016/j.gastrohep.2025.502438","DOIUrl":"https://doi.org/10.1016/j.gastrohep.2025.502438","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502438"},"PeriodicalIF":2.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of remission in ulcerative colitis: Relationship between clinical, endoscopic, and histological markers as predictors of relapse.","authors":"Francisca Carvajal, Karin Herrera, Paulina Núñez, Lilian Flores, Andrea Córdova, Gonzalo Pizarro, Pamela San Martín, Luis Contreras, Rodrigo Quera","doi":"10.1016/j.gastrohep.2025.502437","DOIUrl":"10.1016/j.gastrohep.2025.502437","url":null,"abstract":"<p><strong>Introduction: </strong>In ulcerative colitis (UC), STRIDE-II consensus has established the long-term goal of achieving endoscopic remission (ER), which helps reduce inflammatory burden, prevent permanent intestinal damage, and improve patient's quality of life. However, achieving histological remission (HR) is also associated with a lower risk of experiencing outbreaks of inflammatory activity, the need for corticosteroids, hospitalizations, and the development of colorectal cancer.</p><p><strong>Objective: </strong>Evaluate the role of ER and HR in the development of inflammatory activity flares in patients who have achieved these long-term goals and are being followed in the Inflammatory Bowel Disease (IBD) Program.</p><p><strong>Material and methods: </strong>A retrospective study was conducted on patients with UC treated in the IBD Program at the Universidad de los Andes, between January 2021 and April 2023. Patients with ER (Mayo Endoscopic Index [MEI] 0) or endoscopic response (MEI 1), with at least one year of follow-up, were included. HR was defined using the Nancy (<2), Geboes (<2), and Robarts (<3) indices. Inflammatory activity was assessed by a Partial Mayo Index (PMI) ≥2 and fecal calprotectin >250μg/g.</p><p><strong>Results: </strong>A total of 84 patients were included, 57.1% were women, with a median age of 37 years (IQR 31-45). During follow-up, 71 patients continued in the study, and 24 (31%) experienced inflammatory flares. In the MEI 0 group, the percentage of flares at 12 and 44 months was 15% and 53%, respectively, compared to 43% and 67% in the MEI 1 group (p=0.0302). PMI and fecal calprotectin levels were significantly lower in MEI 0 than in MEI 1 (p<0.001 and p<0.05, respectively). Although the Nancy, Geboes, and Robarts indices showed significant differences between MEI 0 and MEI 1, none were associated with a lower risk of flares in the MEI 0 group. No cases of colorectal neoplasia or need for surgery were reported during follow-up.</p><p><strong>Conclusion: </strong>In this cohort, ER is a significant predictor of the development of inflammatory flares in patients with UC, while HR did not show a clear impact in this regard. Further studies are needed to clarify the role of HR as a therapeutic target in UC.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502437"},"PeriodicalIF":2.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic management experince in patients undergoing motorized spiral enteroscopy.","authors":"María Leonor Moreno Vigil, Matilde Núñez Esteban, María Isabel Altamirano Jiménez, María Pérez Sánchez, Marc Salazar Bardía, Elisa Ruíz Blanco, Julia Martínez-Ocón, Begoña González-Suárez, Fernando Dana Muzzio, Eva Rivas","doi":"10.1016/j.gastrohep.2025.502436","DOIUrl":"10.1016/j.gastrohep.2025.502436","url":null,"abstract":"<p><strong>Introduction: </strong>The implementation of motorized spiral enteroscopy (MSE) in digestive endoscopy units required the upgrading of assistencial guidelines to perform general anesthesia with orotracheal intubation in a systematic and safe manner.</p><p><strong>Objective: </strong>To describe the anaesthetic management during MSE and to evaluate the incidence of complications during and within 24hours after the procedure. To assess whether there is a relationship between the difficulty of inserting and withdrawing the MSE and the patient's airway characteristics.</p><p><strong>Patients and methods: </strong>Observational, prospective study in patients undergoing anterograde MSE under GA in our endoscopy unit between 2021 and 2023. We recorded clinical and demographic, and airway characteristics. We registered the anesthesia and MSE procedure, as well as the peri-procedure complications within 24hours.</p><p><strong>Results: </strong>After excluding one patient due to a full stomach, 49 patients were included (mean age 63±14 years, 53% women, 41% ASA III-IV). All underwent total intravenous general anesthesia and orotracheal intubation, with a 12% incidence of difficult VA. The incidence of anaesthetic complications was 4%, with no serious events. 18% had difficulties in inserting and/or withdrawing the MSE and 33% had difficult airway. During recovery, 46% had sore throat and VAS>3 in 31%. At 24hours, VAS>3 persisted in 47% of cases.</p><p><strong>Conclusions: </strong>Motorized spiral enteroscopy under GA in the endoscopy unit is a safe procedure, with a low incidence of serious complications. Multidisciplinary collaboration and preanesthetic assessment are essential to minimize risk.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502436"},"PeriodicalIF":2.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic abscess secondary to gastrohepatic migration of a fishbone.","authors":"Alex Gil-Ordóñez, Gerard Rafart, Carlos Pérez-Serrano, Carolina González-Abós, Sergio Jiménez-Serrano","doi":"10.1016/j.gastrohep.2025.502435","DOIUrl":"10.1016/j.gastrohep.2025.502435","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502435"},"PeriodicalIF":2.2,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide trends in colectomy rates for ulcerative colitis in Brazil: An analysis of the unified public healthcare system.","authors":"Mariane Christina Savio, Julia Ceconello Coelho, Emilia Oliveira, Daniela Oliveira Magro, Douglas Andreas Valverde, Abel Botelho Quaresma, Rafaela de Araujo Molteni, Maria Paz Gimenez Villamil, Paulo Gustavo Kotze","doi":"10.1016/j.gastrohep.2025.502434","DOIUrl":"10.1016/j.gastrohep.2025.502434","url":null,"abstract":"<p><strong>Introduction: </strong>Ulcerative colitis (UC) is a chronic inflammatory bowel disease with significant global prevalence. Despite advancements in medical management, including the widespread use of biologic agents and small molecules, approximately 15-20% of patients eventually require surgery. This study aimed to analyze colectomy and hospitalization rates for UC in Brazil from 2012 to 2022 and assess their temporal trends.</p><p><strong>Methods: </strong>This was a retrospective, observational, population-based study using public database records from January 1, 2012, to December 31, 2022. The study included all patients with one or more diagnostic codes associated with UC (ICD-10) who underwent a UC-related surgical procedure during the study period.</p><p><strong>Results: </strong>A total of 178,552 unique UC patients were identified. UC prevalence increased significantly, from 17.31 per 100,000 in 2012 to 84.23 per 100,000 in 2022, with an annual average percentage change (AAPC) of 15% (95% CI 14.97-15.11, p<0.001). The Southeastern and Southern regions accounted for the highest number of cases. Among the 1374 surgical procedures identified, 69.4% were total colectomies, and 10.6% were pouch procedures. By the end of 2022, the proportion of surgeries relative to the total number of UC patients was 0.7%, with a declining trend (AAPC -11.8%; 95% CI -13.38 to -10.33, p<0.001). Hospitalization rates also showed a significant decline over time (AAPC -14.3%; 95% CI -14.75 to -14.03, p<0.001).</p><p><strong>Conclusions: </strong>UC prevalence in Brazil has increased substantially over the past decade. However, colectomy rates remain low and have shown a declining trend over the same period. Additionally, there has been a notable reduction in hospitalization rates, reflecting potential improvements in UC management and disease control.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502434"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and microbiological profile in obstructive biliary disease in a tertiary center: Observational study.","authors":"Marusia González-Villarreal, Joel Omar Jáquez-Quintana, Paola Bocanegra-Ibarias, Juan Manuel Millán-Alanís, Ariadnee Irma Reyna-Aréchiga, Víctor Andrés Cab-Morales, Valeria Hernández-Rodarte, Adrián Camacho-Ortiz, Héctor Jesús Maldonado-Garza","doi":"10.1016/j.gastrohep.2025.502431","DOIUrl":"10.1016/j.gastrohep.2025.502431","url":null,"abstract":"<p><strong>Aims: </strong>There is limited information on bacterial isolation, antibiotic susceptibility, and microbiological profile in obstructive biliary disease (OBD). Providing information on this could help offer more effective empirical antibiotic therapy in clinical cholangitis. This study aims to evaluate the clinical and microbiological profile in obstructive biliary disease.</p><p><strong>Patients and methods: </strong>The study was conducted at a tertiary academic center between August 2021 and January 2023. Hospitalized patients with OBD, with indication for biliary drainage by endoscopic retrograde cholangiopancreatography, were recruited. Biliary samples were obtained following a standardized protocol, and were processed in laboratory for Gram staining, culture, subculture. Microorganisms were identified and subjected to antibiotic susceptibility testing.</p><p><strong>Results: </strong>A total of 61 patients were included, 73.8% were women, average age was 44.8 years. Overweight/obesity was the most common comorbidity (62.3%); clinical cholangitis was present in 75.4%. Biliary lithiasis was the most common etiology of OBD (86.9%). Positive cultures were obtained in 44.3% of participants, predominating the group of Gram-positive bacteria; individually, Escherichia coli was the most isolated microorganism. A 68.2% of bacteria showed resistance to at least one antibiotic. We found significant associations between bile appearance and cholangitis, bile appearance and OBD etiology, OBD etiology and cholangitis severity. Male sex, increased age, tobacco use were associated with positive cultures. We found a spectrum of microorganisms and antibiotic susceptibilities partially different from those of Tokyo Guidelines 2018 and other publications.</p><p><strong>Conclusions: </strong>Our findings highlight the need to characterize microbiological profile in OBD according to each region.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502431"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}