Arquivos de Gastroenterologia最新文献

{"title":"COLORECTAL CANCER: IS THERE A T OR B CELL SIGNATURE RELATED TO THE PATIENT OUTCOME?","authors":"Valquiria Bueno, Juliana do Carmo Barros Santos, Daniela Frasca, Nora Manoukian Forones","doi":"10.1590/S0004-2803.24612025-146","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612025-146","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is the third more common cancer with around 1.9 million people diagnosed in 2020. Age is an important risk factor for CRC development and older patients have the lowest survival rates which has been associated with age-related comorbidities and less aggressive treatment. Older individuals present a systemic low-level of chronic inflammation (inflammageing) and, at the same time, they develop a less efficient adaptive immune response, in addition to the changes in innate immunity with an overall negative impact in the immune response (immunosenescence). These processes contribute for tumor cell evasion of the immune surveillance and development of a tumor microenvironment (TME) favorable for metastatic spread.</p><p><strong>Objective: </strong>T or B cell signature related to the patient outcome after therapy could be a very useful tool to anticipate the treatment of disease relapse or metastasis.</p><p><strong>Methods: </strong>We evaluated 24 patients with CRC in a follow-up of at least 24 months and correlated with T and B cells subsets.</p><p><strong>Results: </strong>We found that patients with disease relapse (n=2) presented the highest levels of double negative B cells (B DN). Other patients with high levels of B DN were classified as CRC 2 group and presented also lower IgM memory and higher switched memory B cells.</p><p><strong>Conclusion: </strong>Our findings suggest a possible exploratory association between alterations in B-cell subsets and clinical outcomes. A higher number of patients and further characterization of DN B cells are fundamental to use these cells as prognostic biomarker in CRC.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25146"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798932","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":"EVIDENCE OF THE INFLUENCE OF GLUCAGON-LIKE PEPTIDE ANALOGS IN INFLAMMATORY BOWEL DISEASE: A SCOPING REVIEW.","authors":"Lucas Dalvi Armond Rezende, Camila Adour, Gabriel Confalonieri Bertoldi, Marco Antônio Oliveira Brito, Flávia Lúcia Conceição, Mariana Poltronieri Pacheco","doi":"10.1590/S0004-2803.24612026-028","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612026-028","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease is a chronic, immune-mediated condition characterized by relapsing intestinal inflammation and progressive tissue damage. Despite advances in biological and small-molecule therapies, a considerable proportion of patients experience suboptimal response, treatment intolerance, or persistent disease activity. In parallel, the growing prevalence of obesity and type 2 diabetes among individuals with inflammatory bowel disease has raised interest in therapeutic agents capable of modulating both metabolic dysfunction and intestinal inflammation. Glucagon-like peptide-1 and glucagon-like peptide-2 receptor agonists have demonstrated anti-inflammatory and intestinotrophic properties in experimental and clinical settings, suggesting a potential role in this population.</p><p><strong>Objective: </strong>To systematically map and synthesize current scientific evidence regarding the effects of glucagon-like peptide-1 and glucagon-like peptide-2 receptor agonists in patients with inflammatory bowel disease.</p><p><strong>Methods: </strong>A scoping review was conducted following established methodological frameworks for evidence synthesis. A comprehensive search of electronic databases was performed to identify pre-clinical, observational, and interventional studies evaluating the effects of glucagon-like peptide-1 and glucagon-like peptide-2 receptor agonists in inflammatory bowel disease. Studies were screened according to predefined eligibility criteria. Data extraction focused on mechanisms of action, inflammatory markers, clinical outcomes, safety profile, and therapeutic implications.</p><p><strong>Results: </strong>Pre-clinical studies consistently demonstrated that glucagon-like peptide-1 receptor agonists reduce intestinal inflammation through modulation of immune signaling pathways, suppression of pro-inflammatory cytokines, and enhancement of epithelial barrier integrity. Observational human studies suggest potential clinical benefits, including reduction in disease activity and decreased need for corticosteroid escalation in selected patients. Glucagon-like peptide-2 analogs showed pronounced effects on mucosal regeneration, epithelial proliferation, and improved nutrient absorption, particularly in patients with Crohn's disease and intestinal failure. Overall, the available evidence indicates promising metabolic and intestinal benefits; however, most studies were limited by small sample sizes and heterogeneous designs.</p><p><strong>Conclusion: </strong>Glucagon-like peptide-based therapies represent a promising adjunctive strategy in inflammatory bowel disease due to their anti-inflammatory and regenerative properties. Nevertheless, high-quality randomized controlled trials focusing on diseasespecific clinical, endoscopic, and safety outcomes are necessary to establish their efficacy and therapeutic positioning in routine care.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26028"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798841","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":"GUT MICROBIOTA IN INFANTS WITH COW MILK ALLERGY: A SYSTEMATIC REVIEW OF CONTROLLED STUDIES.","authors":"Marcela Duarte de Sillos, Juliana Satomi de Souza Matsuo, Mauro Batista de Morais","doi":"10.1590/S0004-2803.24612025-133","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612025-133","url":null,"abstract":"<p><strong>Background: </strong>Alterations in the gut microbiota may be involved in the pathophysiology of cow milk allergy (CMA). However, whether gut microbiota abnormalities contribute to the diagnostic confirmation of CMA through specific microbiome signatures is still unknown.</p><p><strong>Objective: </strong>To conduct a systematic review of the literature on the gut microbiota of infants with CMA.</p><p><strong>Methods: </strong>This systematic review included studies on the gut microbiota of infants aged <2 years with CMA at diagnosis and at follow-up after different interventions to control clinical manifestations and compared them with that of healthy controls. The PubMed database was used for literature search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was applied. This review was registered on the PROSPERO platform (CRD42024574354).</p><p><strong>Results: </strong>A total of 1,096 articles were identified. After applying inclusion and exclusion criteria, 18 studies were selected for the systematic review. Clinical manifestations included infants with immunoglobulin E (IgE)-mediated CMA (n=7), those with non-IgE-mediated CMA (n=10), or both (n=1). An oral challenge test for CMA diagnosis was mentioned in 11 studies, and in seven of them, a double-blind placebo-controlled challenge test was used. Most studies (n=13) used 16S rRNA gene sequencing to investigate the intestinal microbiota, and only three studies used shotgun metagenomic analysis. There was significant heterogeneity in the expression of results on microbiota characteristics. Alpha diversity was similar in the control group in most studies. A low abundance of Bifidobacteria was observed in some studies (n=5).</p><p><strong>Conclusion: </strong>The results of this systematic review did not identify a typical microbiota pattern in infants with CMA. Studies including infants before elimination diet and with a diagnosis confirmed by an oral challenge test, and studies including one group of infants of the same age on exclusive breastfeeding and another group of infants of the same age on formula feeding as a control group are needed. Therefore, currently available data do not allow CMA diagnosis through a microbiota signature.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25133"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798861","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":"STAYIN' ALIVE: CAN VIRTUAL COLONOSCOPY SURVIVE AS A SCREENING METHOD?","authors":"Pedro Averbach, Marcelo Averbach","doi":"10.1590/S0004-2803.24612026-E01","DOIUrl":"https://doi.org/10.1590/S0004-2803.24612026-E01","url":null,"abstract":"","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26E01"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798894","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":"VTH BRAZILIAN CONSENSUS CONFERENCE ON HELICOBACTER PYLORI INFECTION.","authors":"Luiz Gonzaga Vaz Coelho, Bruno Squárcio Fernandes Sanches, Ismael Maguilnik, James Ramalho Marinho, Sandro Rodrigues Chaves, Ana Flávia P Ramos, Heinrich Seidler, Ricardo C Barbuti, Renato S Laboissière, Laércio Tenório Ribeiro, Maria do Carmo F Passos, Julio César de Soares Veloso, Lucia Libanês C Braga, Frederico Passos Marinho, Helenice P Breyer, Hoiti Okamoto, Jardel Soares Caetano, Paulo Pimentel D'Assumpção, Leonardo Soares da Silva, Gerson Domingues, Raul Carlos Wahle, Eliza Maria de Brito, Marcela Tavares da Rocha Loures, Joaquim Prado Moraes-Filho, Décio Chinzon, Áureo Almeida Delgado","doi":"10.1590/S0004-2803.24612026-043","DOIUrl":"10.1590/S0004-2803.24612026-043","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori infection remains highly prevalent, affecting approximately 40% of the global population. Individuals with infection continue to be at risk for its various clinical consequences, including chronic gastritis, peptic ulcer disease, and gastric cancer.</p><p><strong>Objective: </strong>The Brazilian Helicobacter pylori and Microbiota Study Group and the Brazilian Federation of Gastroenterology present the Fifth Brazilian Consensus on this topic, following the inaugural edition in 1995. Significant advances across various areas have emerged since the publication of the last consensus in 2018. These advances are particularly relevant to bacterial eradication, as treatment encounters mounting challenges due to rising antimicrobial resistance.</p><p><strong>Methods: </strong>For this update, five working groups were established to address: 1) epidemiology; 2) associated diseases and treatment indications; 3) diagnosis; 4) gastric cancer; and 5) treatment and microbiota.</p><p><strong>Conclusion: </strong>The groups developed 34 evidence-based recommendations to guide clinicians in managing this infection within the Brazilian population.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26043"},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725976","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":"NUTRITION MANAGEMENT OF INFLAMMATORY BOWEL DISEASES: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN'S AND COLITIS (GEDIIB).","authors":"Daniéla Oliveira Magro, Carina Rossoni, Raquel Rocha, Ligia Yukie Sassaki, Marcello Imbrizi, Isadora Sayuri Macedo Tuma, Carina Andriatta Blume, Cristina Henschel Matos, Ryan Nunes Yoshio Yoshihara, Maria Izabel Lamounier de Vasconcelos, Patricia Hanako Ribeiro Sato, Maria Paula Carlin Cambi, Claiza Barretta LA Bella, Matheus Freitas Cardoso de Azevedo, Julio Maria Fonseca Chebli, Cristiane Kibune Nagasako, Júlio Pinheiro Baima, Claudio Saddy Rodrigues Coy, Paulo Gustavo Kotze, Cristina Flores, Rogério Saad-Hossne, Eduardo Garcia Vilela","doi":"10.1590/S0004-2803.24612026-042","DOIUrl":"10.1590/S0004-2803.24612026-042","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel diseases (IBD), specifically Crohn's disease and ulcerative colitis, are multifactorial conditions. Genetic and behavioral factors are associated with disease development and influence its progression. It is known that diet plays a role in this pathogenic process.</p><p><strong>Objective: </strong>to position nutritional and dietary factors in the management of IBD.</p><p><strong>Methods: </strong>This consensus was developed by nutritionists, gastroenterologists, and colorectal surgeons, members of GEDIIB (Brazilian Organization for Crohn's disease and colitis). A systematic review of the most recent evidence was conducted to support the recommendations/statements. All recommendations and statements were endorsed by stakeholders and IBD experts in a modified Delphi panel, achieving a consensus rate of at least 80%.</p><p><strong>Results and conclusion: </strong>the recommendations were directed according to disease activity and severity. Nutritional screening and diagnosis, nutritional therapy in the active and remission phases of the disease, dietary management and exclusion diets, and supplementation were addressed. The consensus is targeted at nutritionists, general practitioners, gastroenterologists, and surgeons interested in managing adults with IBD. It supports decision-making by health insurance companies, regulatory agencies, and health institutional managers.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26042"},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724127","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":"USE OF THE FIBROSIS-4 INDEX FOR SCREENING LIVER FIBROSIS IN PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS AND GLUCOSE METABOLISM DISORDERS.","authors":"Arthur Cavalcante Lopes, Amanda Aymoré Santos, Ivo da Cunha Nunes, Jeremias Estevam Lopes, Rosana Maria Feio Libonati","doi":"10.1590/S0004-2803.24612026-003","DOIUrl":"10.1590/S0004-2803.24612026-003","url":null,"abstract":"<p><strong>Background and objective: </strong>To evaluate the performance of the Fibrosis-4 (FIB-4) index for liver fibrosis screening in people living with HIV (PLWH) with glucose metabolism disorders (diabetes and prediabetes).</p><p><strong>Methods: </strong>Cross-sectional study including 100 PLWH on continuous antiretroviral therapy at a reference center in Brazil (March-November 2025). Clinical, laboratory, and ultrasonographic data were collected for FIB-4 calculation. Participants with diabetes were compared to non-diabetic individuals.</p><p><strong>Results: </strong>Altered FIB-4 values were observed in 32 participants, with no sex differences. Mild steatosis (S≥1) was present in 47.0%, and clinically significant steatosis (S≥2) in 11.0%. S≥1 was associated with higher BMI, waist circumference, visceral fat, total cholesterol, LDL, triglycerides, and ALT levels. FIB-4 showed limited ability to classify S≥2.</p><p><strong>Conclusion: </strong>FIB-4 is useful for fibrosis screening, particularly to exclude advanced disease, but does not adequately identify clinically significant steatosis (S≥2). Its use should be combined with metabolic assessment and elastography when values are ≥1.3.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26003"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621749","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":"GUT MICROBIOTA ALTERATIONS IN RODENT MODELS OF CHOLESTASIS INDUCED BY BILE DUCT LIGATION: A SYSTEMATIC REVIEW.","authors":"Stephane Lima Calixto, Ana Caroline Lopes de Paula Macedo, Jair Adriano Kopke Aguiar","doi":"10.1590/S0004-2803.24612025-159","DOIUrl":"10.1590/S0004-2803.24612025-159","url":null,"abstract":"<p><strong>Background and objective: </strong>Cholestatic liver diseases are a major public health issue, marked by impaired bile flow and significant disruptions in liver and systemic physiology. Growing evidence points to the gut microbiota as a key player in cholestasis pathogenesis through gut-liver axis interactions. This systematic review aimed to synthesize and evaluate current findings on intestinal microbiota changes in rodents (rats and mice) subjected to bile duct ligation (BDL)-induced cholestasis, focusing on microbial diversity, taxonomic shifts, and potential pathophysiological implications.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Scopus, and Embase for studies published from January 2020 to February 2025, following PRISMA guidelines. Eligible studies included original research using BDL in rodents without therapeutic intervention and reporting gut microbiota profiles. Data were qualitatively analyzed, emphasizing experimental conditions and microbiome outcomes.</p><p><strong>Results: </strong>Twenty-two studies met inclusion criteria. Most used 16S rRNA sequencing; two used shotgun metagenomics. BDL consistently induced gut dysbiosis, with reductions in alpha diversity (in most studies), altered beta diversity, and shifts in dominant phyla such as Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, and Verrucomicrobiota. At finer taxonomic levels, increases in Prevotella, Enterococcus, Escherichia coli, and Alistipes were common, while Lactobacillus and Ruminococcus often decreased. Elevated levels of Akkermansia muciniphila and Bifidobacterium pseudolongum may represent compensatory microbial responses.</p><p><strong>Conclusion: </strong>Bile duct ligation (BDL)-induced cholestasis leads to complex changes in the microbiota that can worsen intestinal barrier integrity, increase bacterial translocation, and intensify liver inflammation. These findings reinforce the central role of the gut-liver axis and corroborate the potential of microbiota-targeted therapies in the management of cholestatic liver diseases. However, as most of the available evidence derives from experimental models, further well-designed clinical studies are needed to validate the safety, efficacy, and translational applicability of these strategies in human diseases.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25159"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621711","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":"MANAGEMENT OF CLOSTRIDIOIDES DIFFICILE INFECTION IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF ANTIBIOTIC EFFICACY.","authors":"Isadora Brandão Pelucio, Carla Malaguti, Túlio Medina Dutra de Oliveira, Karoline Maria de Souza Marques Chitarra, Maria Cristina Vasconcellos Furtado, Júlio Maria Fonseca Chebli","doi":"10.1590/S0004-2803.24612025-145","DOIUrl":"10.1590/S0004-2803.24612025-145","url":null,"abstract":"<p><strong>Background: </strong>Clostridioides difficile infection (CDI) is a significant complication in patients with inflammatory bowel disease (IBD), often associated with higher recurrence rates, increased morbidity, and complex therapeutic decision-making. The optimal antibiotic regimen for CDI in IBD remains uncertain.</p><p><strong>Objective: </strong>To evaluate the efficacy of different antibiotic therapies for CDI in patients with IBD.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Searches were performed in MEDLINE, EMBASE, PubMed, Epistemonikos, and the Cochrane Library through October 2024. Observational studies and clinical trials comparing antibiotic regimens in adult IBD patients with CDI were included. Data on recurrence, clinical outcomes, colectomy, and mortality were extracted. Random-effects meta-analysis was performed when appropriate.</p><p><strong>Results: </strong>Nine studies involving 643 patients met inclusion criteria. Recurrence occurred in 17.4% of patients treated with metronidazole and 8.2% of those treated with vancomycin. In the meta-analysis of four studies (n=214), vancomycin showed a trend toward lower recurrence, although not statistically significant (OR 0.55; 95%CI 0.15-1.99; P=0.36; I2=66%). Mortality was low and similar between groups, and colectomy occurred exclusively in patients with ulcerative colitis. Data on clinical success and adverse events were heterogeneously reported and summarized narratively.</p><p><strong>Conclusion: </strong>Vancomycin may be associated with lower recurrence in higher-risk IBD patients; however, available evidence remains limited and heterogeneous. Treatment decisions should be individualized, and further prospective, IBD-specific studies are needed to clarify optimal management strategies.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25145"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621663","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":"BILIARY SLUDGE-ASSOCIATED ACUTE PANCREATITIS: CLINICAL SPECTRUM, DIAGNOSIS, AND MANAGEMENT.","authors":"Mingqi Su, Yayun Xie, Ji Chen","doi":"10.1590/S0004-2803.24612025-155","DOIUrl":"10.1590/S0004-2803.24612025-155","url":null,"abstract":"<p><strong>Background: </strong>Biliary disease is the leading identifiable cause of acute pancreatitis, yet many attacks remain \"idiopathic\" after routine tests. Wider use of endoscopic ultrasonography (EUS) has revealed biliary sludge and microlithiasis as frequent, previously occult causes of pancreatitis.</p><p><strong>Objective: </strong>To summarise current evidence on the pathophysiology, diagnosis and management of biliary sludge-associated acute pancreatitis (BSAP) and propose a simple clinical framework.</p><p><strong>Methods: </strong>Narrative review of experimental and clinical studies, practice guidelines and consensus statements identified through targeted searches of PubMed, Embase and the Cochrane Library, complemented by citation tracking of key articles.</p><p><strong>Results: </strong>Available data support a microcrystal-driven model in which lithogenic bile, impaired gallbladder emptying and mucin-rich aggregates promote sludge formation, while transient obstruction and bile acid-mediated epithelial injury in the distal bile duct-papillary outflow segment trigger pancreatitis. First-line ultrasonography and computed tomography have low sensitivity for sludge, whereas EUS is more sensitive than magnetic resonance cholangiopancreatography for detecting microlithiasis in suspected idiopathic acute pancreatitis. Grading diagnostic confidence (definite, probable or presumptive BSAP) and integrating disease severity can rationalise use of MRCP/EUS, selective ERCP, cholecystectomy and adjunctive medical or metabolic strategies.</p><p><strong>Conclusion: </strong>BSAP is a clinically relevant entity within the biliary pancreatitis spectrum. Applying a structured, confidence- and severity-based approach may help standardise investigations, optimise timing of ERCP and cholecystectomy and reduce preventable recurrences.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25155"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621684","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}