Arquivos de Gastroenterologia最新文献

{"title":"SYSTEMATIC REVIEW AND BRAZILIAN EXPERT CONSENSUS ON THE USE OF BIOSIMILARS IN INFLAMMATORY BOWEL DISEASE: BRAZILIAN ORGANIZATION FOR CROHN'S AND COLITIS.","authors":"Cristina Flores, Francisco Guilherme Cancella Penna, Marcello Imbrizi, Adalberta Lima Martins, Renata de Sá Brito Fróes, Munique Kurtz de Mello, Stefania Burjack Gabriel, Licia Maria Rodrigues, Ligia Yukie Sassaki, Marjorie Costa Argollo, Fabio Vieira Teixeira, Jane Oba, Eduardo Garcia Vilela, Rogério Saad-Hossne, Matheus Freitas Cardoso de Azevedo, Júlio Maria Fonseca Chebli, José Miguel Luz Parente, Aderson Omar Mourão Cintra Damião, Eloá Marussi Morsoletto, Vera Lucia Sdepanian, Rogerio Serafim Parra, Paulo Gustavo Kotze","doi":"10.1590/S0004-2803.24612026-011","DOIUrl":"10.1590/S0004-2803.24612026-011","url":null,"abstract":"<p><strong>Background: </strong>Biologics improve outcomes in inflammatory bowel disease, but high costs restrict access and strain healthcare resources. Biosimilars lower costs, expand access, and support sustainable IBD care.</p><p><strong>Objective: </strong>Provide clear, evidence-based answers on biosimilar use in IBD across clinical, therapeutic, and economic domains to guide safe implementation and informed decision-making.</p><p><strong>Methods: </strong>GEDIIB conducted a PICO-structured systematic review across multiple databases and trial registries. We extracted clinically relevant outcomes and performed systematic review. We assessed risk of bias with RoB 2.0 and ROBINS-I and graded certainty using GRADE. A structured Delphi process with two voting rounds and external validation finalized recommendations, with consensus predefined at 85 percent or higher.</p><p><strong>Results: </strong>Anti-TNF biosimilars and originator biologics have similar efficacy, safety, immunogenicity, treatment persistence, and mucosal healing in biologic-naive patients and after switching, with no clinically meaningful differences in adverse events, loss of response, or discontinuation. Data on multiple switches do not indicate harm, though evidence remains limited. Pediatric studies suggest similar profiles, with lower precision. Economic evaluations show substantial cost savings and improved access, supporting the sustainability of the health system.</p><p><strong>Conclusion: </strong>Biosimilars represent a viable, safe, and cost-effective option for IBD management. We recommend structured switching strategies, clear communication with patients, and continuous clinical monitoring. Additional robust studies should strengthen evidence in specific populations and clinical scenarios.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26011"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ERRATUM: Vth Brazilian Consensus Conference on Helicobacter pylori infection.","authors":"","doi":"10.1590/S0004-2803.24612026-E43","DOIUrl":"10.1590/S0004-2803.24612026-E43","url":null,"abstract":"<p><p>[This corrects the article doi: 10.1590/s0004-2803.24612026-043].</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26E43"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ERRATUM: Role Of Statins In Cirrhotic Portal Hypertension: Meta-Analysis Of Randomized Studies.","authors":"","doi":"10.1590/S0004-2803.24612026-E36","DOIUrl":"10.1590/S0004-2803.24612026-E36","url":null,"abstract":"<p><p>[This corrects the article doi: 10.1590/S0004-2803.24612025-036].</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26E36"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DESIGN AND VALIDATION OF A BUNDLE FOR ASSESSING GONADAL FUNCTION IN INDIVIDUALS WITH LIVER CIRRHOSIS.","authors":"Nikaelle Ximenes Rios, Amarílis Cavalcante Monteiro, João Guilherme de Mello Batista, Elísio Victor Chaves Aguiar, Renan Martins Lopes, Cristina Micheletto Dallago","doi":"10.1590/S0004-2803.24612026-063","DOIUrl":"10.1590/S0004-2803.24612026-063","url":null,"abstract":"<p><strong>Background: </strong>Liver cirrhosis (LC) constitutes the final stage of various chronic liver diseases and represents a serious public health problem. Its pathophysiology involves an inflammatory and fibrotic process that culminates in liver dysfunction and several systemic repercussions, including gonadal dysfunction with consequent hormonal alterations. Despite the clinical importance of this condition, there is a lack of studies that systematically address the assessment of gonadal function in men with LC, justifying the development of specific instruments for this purpose.</p><p><strong>Objective: </strong>This study aimed to construct and validate a package for assessing gonadal function in men with LC.</p><p><strong>Methods: </strong>A methodological approach divided into stages of construction and validation of the proposed instrument was used. Initially, an integrative review was conducted using 21 included articles to identify the main clinical and laboratory parameters associated with gonadal dysfunction in men with cirrhosis. These parameters formed the basis for the development of the instrument package, which is structured around three axes: clinical manifestations, laboratory tests, and management of gonadal dysfunction. The instrument underwent content validation by 11 expert judges, selected according to standardized expertise criteria. The evaluation was carried out using a single questionnaire on the Google Forms platform, where judges, based on a Likert scale, assigned scores from 0 to 4 to assess the three domains of the package: i) Objectives; ii) Structure and Presentation; iii) Relevance. Data were analyzed using SPSS 23, employing the Index of Agreement (IA), the Exact Binomial Distribution test (P>0.05), and the Intraclass Correlation Coefficient (ICC) to determine reliability.</p><p><strong>Results: </strong>Validation of the package showed excellent agreement among those evaluated, with a total confidence interval of 98.8% and an ICC of 0.814, demonstrating high reliability of the instrument. All evaluated domains obtained agreement greater than 80%, and the binomial distribution test indicated that the observed agreement proportion was not significantly lower than the predetermined value of 80% (P>0.05). The main suggestions from the experts focused on improving the visual and functional aspects of the material, including flowcharts, detailing the procedures, and multidisciplinary integration.</p><p><strong>Conclusion: </strong>The results confirm the content validity and theoretical consistency of the instrument, establishing it as a useful environmental tool for standardizing the assessment of gonadal function in men with LC.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26063"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REFRACTORY BENIGN ESOPHAGEAL STRICTURES: A SYSTEMATIC REVIEW OF ENDOSCOPIC THERAPY.","authors":"Aléxia Bezerra de Mendonça Belarmino, José Jota Moura Neto, Helena Aben-Athar Ponte, Franklin Freire Cartaxo Rolim Júnior, Diego Bomfim Saboia, Marcellus Henrique Loiola Ponte de Souza","doi":"10.1590/S0004-2803.24612026-027","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612026-027","url":null,"abstract":"<p><strong>Background: </strong>Refractory benign esophageal strictures (RBES) represent a significant clinical challenge due to their diverse etiologies and the variety of available therapeutic approaches. They affect approximately 30-40% of patients with recurrent strictures.</p><p><strong>Objective: </strong>To evaluate the efficacy of endoscopic therapies stratified by stricture etiology (anastomotic vs nonanastomotic).</p><p><strong>Methods: </strong>We conducted a systematic review in accordance with the PRISMA guidelines, including studies published between 2005 and 2025. Literature searches were performed in PubMed, ScienceDirect, and the CAPES Portal. Outcomes assessed included technical success, complication rates, and long-term clinical success. Study screening and data extraction were performed independently by two reviewers using Rayyan software.</p><p><strong>Results: </strong>Eighteen studies were included, comprising 208 individuals with anastomotic strictures (72.2% of studies) and 265 with nonanastomotic strictures (77.8% of studies). Therapeutic modalities included bougie dilation (7 studies; 38.9%), balloon dilation (7; 38.9%), triamcinolone injection (2; 11.1%), mitomycin C (3; 16.7%), stricturotomy (6; 33.3%), stent placement (10; 55.6%), and self-dilation (1; 5.6%). The overall technical success rate was 84.1%, whereas clinical success was 58.1%. Anastomotic strictures were associated with a worse prognosis, exhibiting a technical success rate of 89.4%, a complication rate of 33.2%, and a clinical success rate of 53.8%. Nonanastomotic strictures showed a technical success rate of 80.0%, a complication rate of 11.3%, and a clinical success rate of 61.1%. Four definitions of refractoriness were identified; the most common was the failure to achieve a diameter of 14 mm to 15 mm or greater after multiple dilations (9 studies) and repeated dilations without quantified criteria (5 studies).</p><p><strong>Conclusion: </strong>RBES demonstrate high technical success rates across therapeutic modalities; however, long-term clinical success remains limited and varies according to etiology. Anastomotic strictures are associated with a worse prognosis than nonanastomotic strictures, likely reflecting the complexity of postsurgical fibrotic remodeling. The marked heterogeneity in definitions of refractoriness across studies represents a critical limitation in the current literature.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26027"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CLINICAL PREDICTORS OF CHOLEDOCHOLITHIASIS IN MILD ACUTE BILIARY PANCREATITIS: DEVELOPMENT OF AN EXPLORATORY RISK STRATIFICATION MODEL.","authors":"Bruno Losi Zacharias, Gustavo Correa Macedo, Pedro de Souza Lucarelli Antunes, Vinícius Alves de Andrade, Jacqueline Giannini Arantes Perlingeiro, José Cesar Assef","doi":"10.1590/S0004-2803.24612026-032","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612026-032","url":null,"abstract":"<p><strong>Background: </strong>Acute biliary pancreatitis is one of the most common forms of acute pancreatitis and is frequently associated with transient or persistent common bile duct stones. When not promptly recognized, choledocholithiasis may result in severe complications such as cholangitis and recurrent pancreatitis. Early identification of patients at higher risk for concomitant choledocholithiasis, based on clinical and laboratory findings, is essential to guide timely diagnostic and therapeutic interventions while avoiding unnecessary procedures and costs.</p><p><strong>Objective: </strong>To evaluate clinical and laboratory predictors associated with choledocholithiasis in patients with mild acute biliary pancreatitis and to develop an exploratory risk stratification model based on routinely available clinical variables.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted through review of medical records and imaging studies of patients admitted to the Central Emergency Department of Santa Casa de São Paulo between January 2017 and August 2024 with mild acute biliary pancreatitis according to the revised Atlanta classification.</p><p><strong>Results: </strong>A total of 630 medical records were screened, and 145 patients with mild acute biliary pancreatitis met inclusion criteria, with the mean age of 48 years. Among the patients, 65.5% were female. Patients with confirmed choledocholithiasis had significantly higher total bilirubin levels at admission and after 48 hours (P=0.001). Alkaline phosphatase levels were also significantly higher in the stone group (P=0.011), whereas gamma-glutamyl transferase showed no significant difference (P=0.115). Gallstone size did not differ between groups (P=0.936). A logistic regression model demonstrated approximately 80% accuracy (AUROC 0.80), based on age ≥65 years, day-2 total bilirubin ≥2.4 mg/dL, and alkaline phosphatase ≥183 U/L. Internal validation using bootstrap resamples demonstrated a AUROC of 0.793. The calibration slope was 1.33, with an intercept of 0.24 and Brier score of 0.126.</p><p><strong>Conclusion: </strong>A simple clinical prediction model based on older age, persistent bilirubin elevation, and elevated alkaline phosphatase demonstrated acceptable discrimination to associate choledocholithiasis in patients with mild acute biliary pancreatitis and reasonable internal calibration after bootstrap validation, with particular usefulness for identifying patients at low probability of choledocholithiasis.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26032"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SEVERE COMPLICATIONS OF BUTTON BATTERY INGESTION IN CHILDREN.","authors":"Vitoria P Maróstica, Karyne Sumico de Lima Uyeno Jordão, Elizete Aparecida Lomazi, Joaquim Murray Bustorff Silva, Andrea de Melo Alexandre Fraga, Maria Ângela Bellomo-Brandão","doi":"10.1590/S0004-2803.24612026-037","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612026-037","url":null,"abstract":"<p><strong>Background: </strong>Button battery (BB) ingestion has emerged as a global health concern, particularly among children.</p><p><strong>Objective: </strong>To investigate the clinical outcomes and complications related to BB ingestion among pediatric patients managed at a referral center.</p><p><strong>Methods: </strong>A case series study was conducted between March 2016 and December 2023, including patients under 14 years old diagnosed with BB ingestion. Clinical and radiological evaluations were performed, followed by endoscopic assessment and treatment when required. Data collected included clinical presentation, endoscopic findings, complications, and outcomes.</p><p><strong>Results: </strong>A total of 568 cases of foreign body ingestion were initially reviewed, from which only 16 pediatric patients with confirmed BB ingestion were identified between 2016 and 2023. No cases were documented between 2016 and 2018; however, a substantial increase was observed from 2019 through 2022, with a pronounced surge during 2020-2021 that coincided with the COVID-19 pandemic (P=0.011). Patient ages ranged from 3 months to 5 years, with a median of 3.22 years (1.62-4.55). Endoscopic retrieval was required in seven children (n=7, 43.7%), whereas nine did not undergo endoscopic intervention owing to the extraesophageal location of the BB. Complications were documented in seven patients, including ulceration (n=6; 37.5%), fistulas (n=3, 18.7%), and stenosis (n=3, 18.7%).</p><p><strong>Conclusion: </strong>This study highlights the significant risks of severe complications associated with BB ingestion, even in very young children. A significant increase in severe cases referred to our center during the COVID-19 pandemic underscores the importance of awareness, prevention, and timely medical intervention.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26037"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRIMARY INTRACRANIAL TUMORS: PROGNOSTIC FACTORS OF ORAL INTAKE SCALE OF PATIENTS PRE AND POST SURGICAL TREATMENT.","authors":"Luisa Vargas Braz, Ana Maria Furkim, Diego Fernando Dorneles Bilheri, Vinicius Alexandre Aliano, Fernanda Yasmin Odila Maestri Miguel Padilha","doi":"10.1590/S0004-2803.24612026-022","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612026-022","url":null,"abstract":"<p><strong>Background: </strong>Primary intracranial tumors are rare neoplasms associated with high morbidity and mortality, whose location, size, and impact on neurological and cognitive status influence treatment and survival.</p><p><strong>Objectives: </strong>To characterize prognostic factors using the Functional Oral Intake Scale in patients diagnosed with primary intracranial tumors undergoing surgical treatment and hospitalized in a reference hospital in the state of Santa Catarina, Brazil.</p><p><strong>Methods: </strong>This is a cross-sectional, retrospective, observational study with secondary data collection and analysis of electronic medical records. Medical records of patients admitted to Neurosurgery and undergoing surgical treatment between January 2021 and March 2023 were selected. Based on the information obtained, a correlation was established between the aforementioned scale and age, sex, tumor topography, and classification.</p><p><strong>Results: </strong>The 68 patients analyzed were a heterogeneous group, showing tumors in various brain locations (left hemisphere, right hemisphere, central regions, and posterior fossa). A higher prevalence was observed in women. The most prevalent tumor was meningioma, with the left cerebral hemisphere being the most affected. Regarding the Functional Oral Intake Scale, the group of patients with posterior fossa tumors showed greater variation when comparing the level at admission to the patient's immediate postoperative level. Two patients presented Level 1 with the use of an alternative feeding route in the immediate postoperative period; these patients were followed up by the speech therapy team, progressing to Levels 5 and 6 at hospital discharge.</p><p><strong>Conclusion: </strong>It was observed that the highest prevalence of decreased/restricted oral food intake occurred in patients with primary intracranial tumors of the posterior fossa. No other prognostic factors for decreased/restricted oral intake were found in the sample studied, besides tumor location.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26022"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACT OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY ON THE ESOPHAGEAL/GASTRIC MUCOSA AND HELICOBACTER PYLORI IN INDIVIDUALS WITH NEUROGENIC OROPHARYNGEAL DYSPHAGIA.","authors":"João Paulo Galletti Pilon, Rodolfo de Oliveira Medeiros, Paula Cristina Cola, Suely Mayumi Motonaga Onofri","doi":"10.1590/S0004-2803.24612026-034","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612026-034","url":null,"abstract":"<p><strong>Background: </strong>Oropharyngeal dysphagia is frequent among individuals with neurological disorders and may impair nutrition and quality of life. Long-term nasoenteric tube use is associated with esophagitis, gastritis, and increased Helicobacter pylori, highlighting the need for safer nutritional alternatives. Percutaneous endoscopic gastrostomy (PEG) is widely used for long-term enteral feeding.</p><p><strong>Objective: </strong>To evaluate esophageal and gastric inflammatory changes and the presence of H. pylori before and 6 months after PEG placement in patients with neurogenic oropharyngeal dysphagia.</p><p><strong>Materials and methods: </strong>In this prospective study, 42 patients (median age 76 years) underwent upper gastrointestinal endoscopy and rapid urease testing at baseline and six months after PEG placement. Esophagitis and gastritis were classified using the Los Angeles and Sydney systems. McNemar test was applied (P≤0.05).</p><p><strong>Results: </strong>Esophagitis decreased from 57% to 5% and gastritis from 52% to 10% (both P<0.001). H. pylori positivity declined from 24% to 12% (P=0.154).</p><p><strong>Conclusion: </strong>PEG was associated with significant improvement in esophageal and gastric mucosal integrity, supporting its role as a safe long-term nutritional strategy in patients with neurogenic oropharyngeal dysphagia.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26034"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REGIONAL AND MULTIFACTORIAL PATTERNS OF INFLAMMATORY BOWEL DISEASE IN BRAZIL: A SYSTEMATIC ANALYSIS OF HOT SPOTS IN WESTERN SÃO PAULO AND PARANÁ.","authors":"Abel Botelho Quaresma, Fabio V Teixeira, Douglas A Valverde, Adriano A F Hino, Aderson Omc Damião, Paulo Gustavo Kotze","doi":"10.1590/S0004-2803.24612026-007","DOIUrl":"10.1590/S0004-2803.24612026-007","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory Bowel Disease (IBD) is a complex condition influenced by interactions among genetic, environmental, immunological, and behavioral factors. The global rise in IBD, particularly in rapidly urbanizing countries like Brazil, reflects environmental transitions' impact on disease patterns. Regional disparities in diagnostic coverage and environmental factors highlight IBD \"hot spots\", particularly in Western São Paulo and Northwestern Paraná, which share similar socio-economic and environmental characteristics. This study systematically reviews these epidemiological patterns to address gaps and support public health policies.</p><p><strong>Methods: </strong>A systematic literature review adhering to PRISMA guidelines was conducted to assess Brazilian IBD epidemiology from 2006 to 2026. Data sources included PubMed, SciELO, and LILACS, with Boolean search strategies incorporating controlled vocabulary and free-text terms. Eligible studies provided primary epidemiological data on IBD incidence, prevalence, and associated risk factors. Hot spots were identified through geospatial analysis using Moran's I index, supported by integrative conceptual models like Directed Acyclic Graphs (DAGs).</p><p><strong>Results: </strong>The review identified prominent IBD hot spots in Western São Paulo and Northwestern Paraná, characterized by shared urbanization (85%+), agro-industrial activity, and dietary transitions. These regions exhibit increased prevalence due to multifactorial mechanisms, such as genetic predisposition, Westernized diets, reduced environmental microbial exposure, and pesticide-related dysbiosis. However, diagnostic infrastructure disparities highlight underreporting in less developed regions, complicating nationwide comparisons.</p><p><strong>Conclusion: </strong>Western São Paulo and Northwestern Paraná form a continuous IBD hot spot influenced by urbanization, agro-industrial practices, and environmental exposures. Addressing these challenges requires integrated public health policies focusing on environmental regulation, nutritional education, and improved diagnostic access. Future longitudinal studies should assess gene-environment interactions and further explore underrepresented regions to enhance IBD management and prevention strategies in Brazil.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26007"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}