Arquivos de Gastroenterologia最新文献

{"title":"SEROLOGICAL CLEARANCE OF HBSAG IN CHRONIC HEPATITIS B: EXPERIENCE IN A UNIVERSITY HOSPITAL.","authors":"Ana Gabriella Gonçalves Amorim, Alessandra Porto de Macedo Costa","doi":"10.1590/S0004-2803.24612026-020","DOIUrl":"10.1590/S0004-2803.24612026-020","url":null,"abstract":"<p><strong>Background: </strong>Chronic hepatitis B virus (HBV) infection represents a major public health problem due to its high morbidity and mortality associated with liver cirrhosis and hepatocellular carcinoma. Functional cure, characterized by serological clearance of the HBV surface antigen (HBsAg), is the main therapeutic goal, since sterilizing viral eradication is not yet feasible. HBsAg clearance rates vary widely in the literature, and understanding the factors associated with this event is crucial for optimizing patient management.</p><p><strong>Objective: </strong>To investigate the HBsAg clearance rate and identify the demographic, clinical, and virological factors associated with this event in a cohort of patients with chronic hepatitis B virus infection followed up at a reference center in Northeast Brazil.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted through a review of the medical records of patients with chronic hepatitis B virus infection treated at a Hepatology Service in Northeast Brazil between January 2015 and October 2025. Clinical, demographic and laboratory variables were analyzed. Statistical analysis used tests such as Mann-Whitney for quantitative variables and Fisher's exact test for categorical variables, in addition to the construction of Kaplan-Meier curves with the Log-Rank test to evaluate HBsAg clearance. The significance level was set at P<0.05.</p><p><strong>Results: </strong>Of the 600 medical records screened, 299 patients were included in the analysis, 63.2% of whom were women, with a median age of 45 years. During a mean follow-up period of 5.14 years, totaling 1,538 person-years, 12 patients (4%) achieved serological clearance of HBsAg, resulting in an annual rate of 0.78%. Statistical analysis revealed significant associations between HBsAg clearance and advanced age (P=0.008) and lower HBV-DNA levels (P=0.0156).</p><p><strong>Conclusion: </strong>The annual rate of HBsAg serological clearance in this cohort was 0.78%. Advanced age and low viral load levels were significantly associated with functional cure. These findings enrich the knowledge about the natural history of chronic hepatitis B in the region and reaffirm the importance of viral suppression in disease control.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26020"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040835","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":"ASSOCIATION OF TUMOR DEPOSITS WITH TUMOR PATHOLOGY AND SURVIVAL IN GASTRIC CANCER: A CROSS-SECTIONAL STUDY.","authors":"Nasrin Sarkhani, Bahareh Mehramuz, Ali Akbar Shekarchi, Sajad Sarkhani, Maryam Jafarzadeh, Elham Sarkhani","doi":"10.1590/S0004-2803.24612026-008","DOIUrl":"10.1590/S0004-2803.24612026-008","url":null,"abstract":"<p><strong>Background: </strong>Tumor deposits (TDs) are recognized as adverse prognostic factors in colorectal cancer and are incorporated as N1c in the TNM staging system. Their significance in gastric cancer (GC), however, remains less clear.</p><p><strong>Objective: </strong>This study aimed to investigate the association of TDs with pathological features and survival outcomes in GC.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of patients with pathologically confirmed GC treated at two tertiary hospitals in Tabriz, Iran, between January 2020 and December 2024. Clinical and pathological data, including tumor characteristics and survival status, were collected for the participants. TDs and their characteristics were also evaluated. Associations between the presence of TDs and clinicopathological features were analyzed using logistic regression models, while overall survival was assessed using Kaplan-Meier analysis and Cox proportional hazards regression.</p><p><strong>Results: </strong>The study included 256 patients (mean age 60.7±12.3 years; 61.3% male). TDs were present in 111 patients (43.4%). In multivariable analysis, pT category (OR=7.44, 95%CI: 2.22-24.89), pN category (OR=4.63, 95%CI: 1.97-10.86), and perineural invasion (OR=5.65, 95%CI: 2.40-13.29) were significant correlates of TDs. Kaplan-Meier analysis showed 1-, 3-, and 5-year overall survival rates of 93.7%, 75.7%, and 64.9%, respectively. Patients without TDs had significantly better survival compared to those with TDs (log-rank P<0.001). In multivariable Cox regression analysis, histological subtype (HR=2.07, 95%CI: 1.21-3.52), pT category (HR=4.68, 95%CI: 1.37-16.00), pN category (HR=2.79, 95%CI: 1.21-6.46), and the presence of TDs (HR=2.00, 95%CI: 1.06-3.75) were identified as independent predictors of poorer overall survival.</p><p><strong>Conclusion: </strong>TDs were observed in a considerable proportion of GC cases and were associated with more aggressive pathological features and poorer survival. They may improve prognostic stratification, but further validation in larger multicenter studies is required.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26008"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041219","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":"COVID-19 AND IBD: LOOK BEYOND THE VIRUS. A SYSTEMATIC REVIEW AND META-ANALYSIS FOCUSED ON BIOLOGIC THERAPY CONTINUITY.","authors":"Mariana Rolim, Andrea Benevides Leite, Lauro Vieira Perdigão Neto, Anna Sara Levin","doi":"10.1590/S0004-2803.24612025-147","DOIUrl":"10.1590/S0004-2803.24612025-147","url":null,"abstract":"<p><strong>Background/objective: </strong>Whether COVID-19 worsens the longterm course of inflammatory bowel disease (IBD) remains uncertain. We synthesized comparative cohorts to assess IBD outcomes after SARS-CoV-2 infection versus noninfected IBD controls and to evaluate the impact of biologic discontinuation.</p><p><strong>Methods: </strong>Systematic review (PRISMA 2020). Adult IBD cohorts with vs without prior SARS-CoV-2. Databases: MEDLINE (PubMed), Web of Science, and Scopus; reference lists screened. Time window: Jan 2020 to Dec 2024. Risk of bias: Newcastle-Ottawa. Randomeffects Mantel-Haenszel with REML variance and Hartung-Knapp adjustment; heterogeneity by I2/τ2/Q. Zero events handled via 0.5 continuity correction; sensitivity analyses reported risk differences (percentage points) and studylevel effects for sparse outcomes. Certainty graded with GRADE.</p><p><strong>Results: </strong>Four matched cohorts (n≈1.3k; Italy/USA). Prior SARS-CoV-2 did not worsen IBD clinical course (OR: 1.06; 95%CI: 0.76-1.49), nor alter UC extent (OR: 1.26; 95%CI: 0.33-4.83) or CD location/behavior (OR: 1.00; 95%CI: 0.06-16.15 / OR: 1.00; 95%CI: 0.46-2.18). Conversely, COVID-19 associated with biologic delay/discontinuation (OR: 10.44; 95%CI: 3.56-30.62). Across studies, flares were more frequent when biologics were delayed/stopped (~52% vs ~18%; RD ≈ +34 p.p.).</p><p><strong>Conclusion: </strong>COVID-19 per se does not appear to aggravate IBD outcomes; the clinically actionable signal is treatment continuity. In IBD patients without highrisk features for severe COVID-19, maintaining biologics should be considered to prevent flares.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25147"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041221","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":"CROSS-CULTURAL ADAPTATION OF THE LIVER DISEASE UNDERNUTRITION SCREENING TOOL TO BRAZILIAN PORTUGUESE.","authors":"Marina da Silva Guedes, Mariana Segaspini Golombieski, Nairane Pinto Boaventura, Priccila Zuchinali, Samanta Catherine Ferreira, Valesca Dall Alba","doi":"10.1590/S0004-2803.24612026-012","DOIUrl":"10.1590/S0004-2803.24612026-012","url":null,"abstract":"<p><strong>Background: </strong>Chronic liver diseases represent a relevant public health problem, and undernutrition is one of their most frequent complications, being associated with higher morbidity and mortality in patients with cirrhosis. Early identification of undernutrition risk in outpatients with liver disease is fundamental; however, there is no nutritional screening tool culturally adapted for this population in Brazil. The Liver Disease Undernutrition Screening Tool (LDUST) is a simple and validated instrument for this purpose.</p><p><strong>Objective: </strong>The objective of this study was to perform the cross-cultural adaptation of the LDUST instrument into Brazilian Portuguese.</p><p><strong>Methods: </strong>The cross-cultural adaptation process followed the methodology of Beaton et al. (2000). The original tool in English was translated into Brazilian Portuguese by two independent translators, synthesized, and back-translated by two native English translators. The multidisciplinary committee evaluated semantic, idiomatic, experiential, and conceptual equivalences, consolidating the pre-final version named Triagem de Desnutrição em Pacientes com Doença Hepática (TriDH). This version was then electronically administered to healthcare professionals from different regions of Brazil. Internal reliability was analyzed using Cronbach's alpha, adopting a minimum acceptable value of 0.8. The study was approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre, and all participants signed the Informed Consent Form.</p><p><strong>Results: </strong>In the pretest, the TriDH was administered to 38 healthcare professionals. It was considered easy to understand. The questionnaire presented excellent internal consistency (Cronbach's alpha = 0.88), with all eight items exhibiting values greater than 0.8.</p><p><strong>Conclusion: </strong>The LDUST was adapted into Portuguese, originating the TriDH. This Brazilian version demonstrated high internal consistency and adequate understanding among healthcare professionals.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26012"},"PeriodicalIF":0.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040664","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 LEUKOCYTE INFLAMMATORY MARKERS ON OUTCOMES OF CRITICALLY ILL PATIENTS WITH GASTROINTESTINAL DISEASES.","authors":"Anna Clara Rios Rocha, Liana Codes, Fernanda Sales, Cláudio Celestino Zollinger, Paulo Lisboa Bittencourt","doi":"10.1590/S0004-2803.24612026-051","DOIUrl":"10.1590/S0004-2803.24612026-051","url":null,"abstract":"<p><strong>Background: </strong>Leukocyte markers, such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune inflammation index (SII), are related to systemic inflammation and may predict organ failure (OF) and mortality in critically ill patients. This study aims to evaluate the association of NLR, MLR, and SII with OF and mortality in medical and surgical patients admitted to a specialty ICU dedicated to the treatment of gastrointestinal (GI) disorders.</p><p><strong>Methods: </strong>All patients admitted to a specialty GI ICU in Brazil, from January 2016 to December 2023, were retrospectively evaluated. Baseline white blood cell counts, NLR, MLR, and SII were calculated in all subjects and compared to different outcomes, including OF and in-hospital mortality.</p><p><strong>Results: </strong>6,703 patients (3,593 women, mean age 67.4 ± 18.3 years) were included in the study. NLR, MLR, and SII were significantly higher in subjects with sepsis and circulatory failure (CF). Likewise, higher NLR and SII were also observed in patients with kidney (KF) and respiratory (RF) failure. NLR, MLR and SII were associated with in-hospital mortality, but only NLR was independently associated with CF (OR: 1.017; 95%CI: 1.013-1.021; P<0.0001), RF (OR: 1.007; 95%CI: 1.001-1.012; P<0.0001) and with an increased risk of death (OR: 1.016; 95%CI: 1.012-1.019; P<0.0001) in multivariate analysis.</p><p><strong>Conclusion: </strong>Leukocyte markers, particularly NLR and MLR, were associated with OF and mortality in critically ill patients with gastrointestinal disorders, but only NLR was independently associated with CF, RF, and mortality.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26051"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888736","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":"VACCINATION STATUS OF PATIENTS WITH CHRONIC LIVER DISEASE FOLLOWED UP AT A REFERENCE CENTER IN BRAZIL.","authors":"Maria Elizabete Calore Neiva, Maria Lucia Gomes Ferraz, Raimundo Araújo Gama, Antônio Eduardo Benedito Silva","doi":"10.1590/S0004-2803.24612026-023","DOIUrl":"10.1590/S0004-2803.24612026-023","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic liver disease (CLD) often experience varying degrees of immune dysfunction, making them vulnerable to multiple preventable infectious diseases through appropriate vaccination.</p><p><strong>Objective: </strong>To evaluate vaccination status and vaccine coverage among patients with chronic liver disease (CLD) receiving care at a tertiary referral center.</p><p><strong>Methods: </strong>This cross-sectional observational study was conducted at the Hepatology Outpatient Clinic of Hospital São Paulo, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil. A convenience sample of adult patients with different etiologies of CLD was prospectively included. Participants underwent a standardized interview, review of vaccination records, and serological testing for hepatitis A and hepatitis B.</p><p><strong>Results: </strong>Among 104 patients (61.5% women, median age 51 years), chronic hepatitis C (63.5%) and hepatitis B (10.6%) were the most common causes of CLD. Advanced liver fibrosis was identified in 46.1% of the patients. Vaccination records were available for 82.7% of participants, but only 45.1% showed serological evidence of hepatitis B immunization (anti-HBs positive). Positive anti-HAV IgG serology was detected in 75% of patients, whereas only 14.4% had documented hepatitis A vaccination. Vaccination coverage for other vaccines was as follows: meningococcal conjugate vaccine (8.7%), pneumococcal vaccine PPSV23 (25%), influenza vaccine (53.8%), tetanus-diphtheria vaccine (60.6%), measles-mumps-rubella vaccine (23%), yellow fever vaccine (28.8%), and COVID-19 vaccination coverage was 92.3%.</p><p><strong>Conclusion: </strong>Vaccination coverage among patients with chronic liver disease remained lower than expected for several recommended vaccines, even in a specialized referral center. These findings highlight the importance of systematic assessment of immunization status and reinforcement of vaccination strategies in patients with chronic liver disease.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26023"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888730","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":"HEALTH-RELATED QUALITY OF LIFE IN CHRONIC LIVER DISEASE: CLINICAL BURDEN, DETERMINANTS, AND IMPLICATIONS FOR PATIENT-CENTERED CARE.","authors":"Maria Gabriela Fernandes Dezan, Caio Pedro Gomes da Hora, Catharina Ribeiro Lyra, Lourianne Nascimento Cavalcante, Helma Pinchemel Cotrim, André Castro Lyra","doi":"10.1590/S0004-2803.24612026-064","DOIUrl":"10.1590/S0004-2803.24612026-064","url":null,"abstract":"<p><strong>Background: </strong>Chronic liver disease significantly distresses patients' health-related quality of life (HRQoL). Factors such as ascites, hepatic encephalopathy, medication side effects, malnutrition, sarcopenia, frailty, the prospect of liver transplantation, caregiver reliance, financial burdens, and future uncertainty can all negatively influence HRQoL. Evaluating HRQoL in liver disease is critical. Recognizing factors that impair HRQoL in these patients enables the multidisciplinary team to promote health in a comprehensive biopsychosocial approach to well-being.</p><p><strong>Methods: </strong>We searched the PubMed database using these descriptors: health-related quality of life, cirrhosis, liver disease, alcohol-related liver disease, metabolic dysfunction-associated steatotic liver disease, viral hepatitis, autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, hepatocellular carcinoma, liver transplantation, sarcopenia, frailty, and malnutrition.</p><p><strong>Results: </strong>HRQoL is negatively affected by the severity of liver disease and its complications. Moreover, nutritional and psychological aspects such as sarcopenia, frailty, malnutrition, fear of disease progression and need for transplantation, feeling of dependence on caregivers, and financial impacts of the disease also culminate in reduced quality of life.</p><p><strong>Conclusion: </strong>People with chronic liver disease experience a significant impairment in their quality of life due to various clinical, nutritional, and social factors. For this reason, a multidisciplinary, global assessment with systematic appreciation of HRQoL at each consultation is essential when following these patients.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26064"},"PeriodicalIF":0.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798878","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":"COMPARING THE EFFECTS OF BIOFEEDBACK AND TRANSCUTANEOUS TIBIAL NERVE STIMULATION, ALONE OR IN COMBINATION, IN WOMEN WITH COEXISTING COMPLAINTS OF DYSSYNERGIC DEFECATION AND STRESS URINARY INCONTINENCE: A RANDOMIZED CONTROLLED TRIAL.","authors":"Neda Orakifar, Fatemeh Oraki Koohshoori, Nahid Pirayeh, Eskandar Hajiani, Shahla Zahednejad","doi":"10.1590/S0004-2803.24612025-123","DOIUrl":"10.1590/S0004-2803.24612025-123","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of electromyography biofeedback (EMG-BF), transcutaneous tibial nerve stimulation (TTNS), and combination of EMG-BF with TTNS in women with stress urinary incontinence (SUI) and dyssynergic defecation (DD) disorders.</p><p><strong>Methods: </strong>In this single-blinded, three-arm, randomized controlled trial, eighty-seven women (18-60 years) with concurrent SUI and DD disorders randomly allocated into three groups (29 per group) including TTNS, EMG-BF and combined treatment group. Participants in each group received fifteen treatment sessions (3 day per week with at least 48-hour break between sessions). Wexner constipation scoring system questionnaire, 3-day bladder diary and EMG activity level of the pelvic floor muscle (PFM) during maximal voluntary contraction (MVC), straining, and coughing were assessed as treatment outcomes measures at baseline and immediately after sessions 5,10 and 15.</p><p><strong>Results: </strong>A two-way repeated measure analysis of variance showed that group interaction by time was significant for all measured variables. Further analysis by the Tukey post hoc test showed significant difference of Wexner questionnaire, 3-day bladder diary and EMG activity level values in the EMG-BF group compared with TTNS group (P<0.001) and in combined treatment group compared with TTNS group (P<0.001) in sessions 10 and 15.</p><p><strong>Conclusion: </strong>EMG-BF and combined treatment significantly improved defecatory and urinary related symptoms and PFM performance in women with SUI and DD disorders.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25123"},"PeriodicalIF":0.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798902","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":"CIRRHOSIS-ASSOCIATED SARCOPENIA: INTEGRATING IMAGING, FUNCTION, AND METABOLISM FOR CLINICAL DECISION-MAKING.","authors":"Aloma Conceição Magno Campeche-Leão, Monalisa Reis Arruda, Ana Clara Vital Batista, Lais Spindola Garcez, Rosangela Passos de Jesus, Helma Pinchemel Cotrim, Lourianne Nascimento Cavalcante","doi":"10.1590/S0004-2803.24612026-017","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612026-017","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is a highly prevalent and clinically impactful complication of cirrhosis, affecting 30-70% of patients depending on diagnostic criteria and disease stage. It is strongly associated with increased mortality, hepatic decompensation, infections, waitlist dropout, and inferior posttransplant outcomes. Despite growing recognition, the field remains limited by heterogeneous definitions, lack of standardized cutoffs, and inconsistent integration of functional and structural assessments.</p><p><strong>Objective and methods: </strong>This narrative review synthesizes mechanistic pathways linking cirrhosis to muscle wasting, including hyperammonemia, anabolic resistance, systemic inflammation, hormonal dysregulation, and mitochondrial dysfunction, and critically evaluates current diagnostic tools such as CT morphometry, DEXA, BIA, and functional performance tests. Emerging biomarkers (myostatin, irisin, metabolomic signatures) and artificial intelligence-based imaging approaches are discussed as promising but still immature tools requiring validation.</p><p><strong>Conclusion: </strong>Therapeutic strategies remain constrained by low-quality evidence, with nutritional optimization, resistance training, and management of hepatic complications forming the cornerstone of care. Novel anabolic and anticatabolic therapies show potential but lack robust clinical trial data. Standardization of diagnostic criteria, integration of multimodal assessments, and development of targeted interventions represent urgent priorities to improve outcomes in cirrhosis-associated sarcopenia.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26017"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798850","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":"REAL-WORLD EFFECTIVENESS OF HIGH-DOSE DUAL THERAPY VS OPTIMIZED CLARITHROMYCIN TRIPLE THERAPY FOR HELICOBACTER PYLORI: A PROSPECTIVE COHORT STUDY WITH TEST-OF-CURE SENSITIVITY ANALYSES.","authors":"Alejandro Ugarte Lastra, David E Advincula Solis, Harold Ramos Mamani, Hugo Guillermo Cedrón Cheng, Álvaro Bellido-Caparo, Dora Montezuma Calvo, Eduardo Vesco Monteagudo, Günther Poppele Molina, Juan Antonio Chirinos Vega, Jorge Espinoza-Ríos, Juan Sebastián Frías-Ordoñez, Víctor Aguilar Sánchez, José Luis Pinto Valdivia, Jorge Huerta Mercado Tenorio","doi":"10.1590/S0004-2803.24612026-014","DOIUrl":"10.1590/S0004-2803.24612026-014","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori eradication rates have declined globally due to rising antibiotic resistance, challenging the effectiveness of standard triple therapy. High-dose dual therapy has emerged as a simplified alternative supported by pharmacodynamic rationale. We aimed to compare the real-world effectiveness, adherence, and safety of high-dose dual therapy versus optimized clarithromycin-based triple therapy in routine gastroenterology practice.</p><p><strong>Methods: </strong>We conducted a prospective, multicenter observational cohort study in adult patients with confirmed H. pylori infection treated with either high-dose dual therapy (amoxicillin 1 g three times daily plus esomeprazole 40 mg three times daily for 14 days) or optimized clarithromycin-based triple therapy (amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, and esomeprazole 40 mg twice daily for 14 days) according to physician decision. Eradication was assessed by carbon-14 urea breath test ≥4 weeks after therapy. Comparative effectiveness was estimated with effect measures, 95% confidence intervals (CI), and predefined sensitivity analyses for incomplete test-of-cure follow-up.</p><p><strong>Results: </strong>Among 218 treated patients, 104 completed post-treatment breath testing. Eradication rates were 80.4% with high-dose dual therapy and 81.3% with triple therapy (absolute difference -0.9%; 95%CI -16.3 to 14.5; P=0.91). Moderate-to-high adherence was observed in 51.5% vs 67.6%, respectively (P=0.19). Adverse events were more frequent with high-dose dual therapy (70.8% vs 58.9%), although the difference was not statistically significant. Mainly gastrointestinal intolerance and taste disturbance. Sensitivity analyses across plausible missing-outcome scenarios showed stable comparative results.</p><p><strong>Conclusion: </strong>In prospective real-world practice, high-dose dual therapy achieved eradication effectiveness comparable to optimized triple therapy, with favorable tolerability. These findings support high-dose dual therapy as a pragmatic and clinically attractive alternative in settings with evolving resistance and adherence constraints.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26014"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798856","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}