Arquivos de Gastroenterologia最新文献

{"title":"DYSBIOSIS IN ACUTE-ON-CHRONIC LIVER FAILURE - FROM A PATHOPHYSIOLOGICAL COMPONENT TO A THERAPEUTIC TARGET.","authors":"Angelo A Mattos, Cristiane A Alves, Johana Acuña, Angelo Z Mattos","doi":"10.1590/S0004-2803.24612025-141","DOIUrl":"10.1590/S0004-2803.24612025-141","url":null,"abstract":"<p><strong>Background: </strong>Acute-on-chronic liver failure (ACLF) affects approximately one-third of patients hospitalized for acute decompensation of cirrhosis. These patients exhibit an extremely high degree of systemic inflammation, and infections as well as severe alcohol-related hepatitis are the most common precipitating factors of ACLF.</p><p><strong>Objective: </strong>This paper aims to discuss the most relevant aspects of ACLF emphasizing the role of gut dysbiosis.</p><p><strong>Methods: </strong>This review includes clinical and epidemiological studies, meta-analyses, and other articles published in English and indexed in the following databases: PubMed, Scopus, and Embase. Only full-text articles were selected.</p><p><strong>Results: </strong>ACLF is the most severe complication in patients with cirrhosis and is associated with high mortality rates. Bacterial translocation is considered responsible for the systemic inflammation leading to acute decompensation of cirrhosis when other precipitating events are not identified. Different microbiome profiles may influence the incidence of decompensation and thus the clinical course of the disease. Dysbiosis causes intestinal inflammation, which contributes to gut barrier dysfunction and pathological bacterial translocation, the main triggering factor of the cascade leading to acute decompensation of cirrhosis and multiple organ failure. Since dysbiosis plays a central role in the pathophysiology of acute decompensation of cirrhosis and ACLF, it is expected that treatments targeting the microbiome could modify the course of the disease. Despite current limitations, the role of probiotics, prebiotics, postbiotics, rifaximin, bacteriophages, and fecal microbiota transplantation is discussed in the present review.</p><p><strong>Conclusion: </strong>ACLF is a highly significant complication of liver disease. Dysbiosis and the gut-liver axis play key roles in its pathophysiology. This knowledge supports the idea that manipulation of the microbiome may be a potential therapeutic strategy.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25141"},"PeriodicalIF":0.0,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621699","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":"MULTICHANNEL INTRALUMINAL IMPEDANCE MAY BE USEFUL TO IDENTIFY CLINICALLY RELEVANT ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION.","authors":"Felipe Nelson Mendonça, Ricardo Brandt de Oliveira","doi":"10.1590/S0004-2803.24612025-101","DOIUrl":"10.1590/S0004-2803.24612025-101","url":null,"abstract":"<p><strong>Background: </strong>A clinically relevant conclusive diagnosis of esophagogastric junction outflow obstruction (EGJOO) requires a manometric diagnosis, relevant symptoms and adjunct exams supporting outflow obstruction. Multichannel intraluminal impedance measurement provides an evaluation of esophageal clearance.</p><p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of multichannel intraluminal impedance in providing supportive evidence of outflow obstruction and differentiating between severe and mild cases in patients suspected of having esophagogastric junction outflow obstruction.</p><p><strong>Methods: </strong>A cohort of fifty-nine patients presenting with Abnormal Esophagogastric Junction Relaxation (AEJR), as classified by Chicago Classification version 4.0, was selected from a retrospective, single-center study. Their data from high-resolution impedance manometry were reviewed and compared with clinical and radiologic data. Patients were classified as highly symptomatic (AEJR-HS) or moderately/mildly symptomatic (AEJR-MS) using the Eckardt score.</p><p><strong>Results: </strong>AEJR-HS was identified in 28 patients and AEJR-MS in 24. Incomplete liquid clearance by multichannel intraluminal impedance demonstrated a strong association with radiological incomplete esophageal clearance (OR: 14.08, 95%CI 2.93 - 87.60, P<0.001) and high diagnostic accuracy (93.2%) for EGJOO CC v4.0. Forty percent or more incomplete liquid clearance by multichannel intraluminal impedance during supine swallows showed good accuracy in separating AEJR-HS from AEJR-MS with 75% sensitivity and 83% specificity (AUC=0.825; 95%CI 0.708-0.941, P<0.001).</p><p><strong>Conclusion: </strong>Multichannel intraluminal impedance closely matches esophageal radiography in identifying severe obstructive symptoms and incomplete clearance in AERJ patients and may serve as an alternative to radiography in confirming EGJOO v4.0 in patients with manometric EGJOO.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25101"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550542","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":"HELICOBACTER PYLORI BEYOND THE STOMACH: WHEN THE STORY CHANGES.","authors":"Bruno Squárcio Fernandes Sanches, Sandro Rodrigues Chaves, Frederico Passos Marinho, Guilherme Grossi Lopes Cançado, Daniel Antônio Albuquerque Terra, Maria Clara Freitas Coelho, Luiz Gonzaga Vaz Coelho","doi":"10.1590/S0004-2803.24612026-031","DOIUrl":"10.1590/S0004-2803.24612026-031","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori (H. pylori) is well known as an etiological agent in several gastric diseases, including chronic gastritis, gastric and duodenal ulcers, gastric carcinoma, and lymphoma. Over the past decades, the understanding of its pathogenic role has evolved substantially, overcoming initial skepticism and establishing the bacterium as a major factor in gastroduodenal disease. However, epidemiological and experimental studies suggest that this chronic infection may also be associated with a variety of extragastric conditions.</p><p><strong>Objective: </strong>This review aims to evaluate the relationship between H. pylori infection and anemia, immune thrombocytopenic purpura, colorectal cancer, cardiovascular diseases, and neurological disorders.</p><p><strong>Methods: </strong>For each association, the most recent evidence and current recommendations regarding the diagnosis and treatment of H. pylori infection during the clinical course of these conditions were assessed.</p><p><strong>Conclusion: </strong>Further prospective studies are needed to clarify whether these associations represent causal relationships with clinical relevance or merely statistical correlations, and to better determine the impact of H. pylori infection on extragastric diseases.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e26031"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550444","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":"DIAGNOSIS AND MANAGEMENT OF INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS: A NARRATIVE REVIEW BASED ON INTERNATIONAL GUIDELINES.","authors":"Claudia Teresa Carvente, Henrique Carvente Toledo, Carlos Fischer de Toledo","doi":"10.1590/S0004-2803.24612025-099","DOIUrl":"10.1590/S0004-2803.24612025-099","url":null,"abstract":"<p><strong>Background: </strong>Intraductal papillary mucinous neoplasms (IPMNs) are the leading cause of incidentally detected pancreatic cysts and exhibit a wide biological spectrum with variable malignant potential. Recent advances in imaging, endoscopic assessment, molecular testing, and artificial intelligence have improved risk stratification and influenced contemporary international guidelines.</p><p><strong>Objective: </strong>To synthesize the most recent evidence on the diagnosis, risk stratification, and management of IPMNs, with emphasis on comparing the Fukuoka (2017), European (2018), and Kyoto (2024) guidelines, and on the integration of emerging technologies.</p><p><strong>Methods: </strong>A structured narrative review was conducted based on major international clinical guidelines and systematic reviews identified through PubMed/MEDLINE and Embase. Eligible publications in English from 2020 to 2025 addressing clinical, radiologic, molecular, and management-related aspects of IPMNs were included.</p><p><strong>Results: </strong>Diagnosis primarily relies on magnetic resonance imaging and endoscopic ultrasound, supplemented by fine-needle aspiration, molecular analysis of cyst fluid, and emerging tools such as radiomics and artificial intelligence models. International guidelines differ in risk criteria, anatomic thresholds, and recommended surveillance intervals, directly influencing decisions between follow-up and surgical resection. Minimally invasive techniques, including EUS-guided radiofrequency ablation and intralesional chemoablation, are under investigation as alternative options for patients who are not surgical candidates.</p><p><strong>Conclusion: </strong>The management of IPMNs should be individualized and multidimensional, integrating clinical, radiologic, and molecular information within the framework of updated guidelines. Active surveillance is safe for low-risk lesions, whereas surgery remains indicated for patients with high-risk stigmata. Emerging technologies including radiomics, artificial intelligence, and next-generation sequencing, are expected to enhance diagnostic precision and support personalized therapeutic decision-making.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25099"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550451","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":"TEMPORAL TRENDS IN PANCREATIC CANCER MORTALITY IN BRAZIL BETWEEN 1980 AND 2023: ARE WE ALIGNED WITH THE GLOBAL PROJECTIONS?","authors":"Lucas Casagrande Passoni Lopes, Isabela Ussifati Negrine, Carlos Antonio Negrato","doi":"10.1590/S0004-2803.24612025-070","DOIUrl":"10.1590/S0004-2803.24612025-070","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer (PC) is a highly lethal malignancy with rising incidence and mortality rates, although its burden remains poorly investigated in Brazil. Understanding its regional and sex-specific trends is critical for tailoring public health interventions and mitigating the disease's impact in the Brazilian population.</p><p><strong>Objective: </strong>This study aimed to evaluate the temporal trends in PC mortality among Brazilian individuals between 1980 and 2023 and its alignment with the global projections.</p><p><strong>Methods: </strong>This retrospective, population-based ecological study analyzed PC mortality data using the Sistema de Informação de Mortalidade (SIM) and demographic data from the Instituto Brasileiro de Geografia e Estatística (IBGE). Annual Percent Change (APC) calculations were performed to assess temporal trends by Brazilian geographic regions and sex, accounting for demographic shifts over time.</p><p><strong>Results: </strong>A total of 257,671 PC-related deaths occurred during the study period, averaging 5,856 deaths per year. The overall mortality trend for PC in Brazil showed a continuous increase of (APC: 1.23; 95%CI: 1.16-1.32; P-value <0.01). Regional analyses revealed significant increases in the North (APC: 2.32), South (APC: 0.59), and Midwest (APC: 1.45) regions. Sex-specific trends indicated a steady increase for women throughout the period, while men experienced alternating phases of rising and stationary trends.</p><p><strong>Conclusion: </strong>PC mortality in Brazil has risen significantly over the past four decades, with marked regional and sex-specific disparities, aligning with global perspectives. These findings highlight the need for targeted PC prevention, early detection, and equitable access to high-quality cancer care, particularly in vulnerable regions and populations.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25070"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550588","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":"LIMITED DIAGNOSTIC ACCURACY OF FIB-4 FOR DETECTING SIGNIFICANT LIVER FIBROSIS IN CHRONIC HEPATITIS B: A CROSS-SECTIONAL STUDY.","authors":"Elyas Abdullah Alsalamy, Heba Mahmoud Taha Elweshahi, Heba Hany Omar, Ahmed Kamal","doi":"10.1590/S0004-2803.24612025-085","DOIUrl":"10.1590/S0004-2803.24612025-085","url":null,"abstract":"<p><strong>Background: </strong>Liver disease linked to the hepatitis B virus (HBV) is a serious public threat worldwide and in Egypt. The incidence of HBV infection in Egypt is about 1.4%. Accurate liver fibrosis assessments are crucial in the evaluation and follow-up of HBV patients, but traditional biopsies have limitations, prompting the use of non-invasive methods like the vibration controlled transient elastography (VCTE), which may not be available in limited-resource treatment centers.</p><p><strong>Objective: </strong>This study aimed to assess the diagnostic accuracy of Fibrosis-4 (FIB-4) and Aminotransferase to Platelet Ratio Index (APRI) compared to VCTE in detecting significant liver fibrosis in adult chronic HBV patients, potentially offering a more accessible and less costly approach to disease management. Methods - In this cross-sectional study, 247 subjects with chronic HBV from Alexandria University Viral Hepatitis Treatment Unit were included. Data collected included demographic details, HBV viral load, liver function tests, Complete Blood Count (CBC), international normalized ratio (INR), prothrombin time, albumin, total and direct bilirubin, APRI score, FIB-4 score, imaging, and VCTE data. IBM SPSS software was used for statistical analysis, with qualitative and quantitative data described appropriately. Logistic regression and receiver operating characteristic curve (ROC) curves were used to identify significant predictors of advanced fibrosis and assess diagnostic performance.</p><p><strong>Results: </strong>Based on VCTE results, 247 chronic hepatitis B patients were classified into two groups: 140 with no or mild fibrosis (F0/1) and 107 with significant fibrosis (F2-F4). Significant differences were found in hemoglobin, albumin, and INR levels between the groups. The FIB-4 and APRI scores were significantly higher in the significant fibrosis group, with median FIB-4 scores of 1.26 vs 0.79 and median APRI scores of 0.40 vs 0.27. The FIB-4 index remained a significant predictor of significant fibrosis in multivariate analysis, with an odds ratio of 1.558. At a cut-off value of >0.88, the FIB-4 score achieved a sensitivity of 65.42% and a specificity of 60.0% in differentiating patients with and without significant fibrosis.</p><p><strong>Conclusion: </strong>Although the use of FIB-4 score is potentially useful in resource-limited settings, a significant number of misclassifications can occur due to its moderate sensitivity and specificity which necessitate further incorporation of additional diagnostic methods to ensure the accurate staging of liver fibrosis.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25085"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550575","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":"THE IL-6/IL-10 INFLAMMATORY AXIS AND PROGNOSIS OF CIRRHOSIS-ASSOCIATED HEPATOCELLULAR CARCINOMA: A NARRATIVE REVIEW.","authors":"Rubens Barbosa Rezende","doi":"10.1590/S0004-2803.24612025-163","DOIUrl":"10.1590/S0004-2803.24612025-163","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) arises predominantly in cirrhotic livers and remains one of the leading causes of mortality related to chronic liver disease. Chronic inflammation, immune dysfunction, and tissue remodeling sustain hepatocarcinogenesis, making circulating cytokines promising candidates for clinical biomarkers.</p><p><strong>Objective: </strong>To critically synthesize evidence on the role of interleukin-6 (IL-6) and interleukin-10 (IL-10) as biomarkers associated with HCC occurrence, staging, therapeutic response, and prognosis in individuals with cirrhosis.</p><p><strong>Methods: </strong>A narrative review was performed based on a structured literature search in PubMed/MEDLINE, SciELO, Europe PMC, and publishers' databases (2010-2025), using descriptors related to hepatocellular carcinoma, cirrhosis, IL-6, IL-10, prognosis, and biomarkers. Clinical studies assessing serum or plasma cytokine levels, meta-analyses, mechanistic reviews, and contemporary clinical guidelines were prioritized.</p><p><strong>Results: </strong>The majority of clinical studies indicate a consistent association between elevated IL-6 levels and poor prognosis, increased tumor burden, systemic inflammation, and inferior outcomes following both systemic and locoregional therapies. For IL-10, the evidence supports elevated levels in a substantial proportion of patients with HCC, with signals of association with tumor-related immunosuppression and worse outcomes in advanced disease, although some studies suggest a context- and disease-stage-dependent role.</p><p><strong>Conclusion: </strong>IL-6 demonstrates greater consistency as a biomarker of progression and prognosis in cirrhosis-associated HCC, whereas IL-10 emerges as an immune regulatory marker with heterogeneous behavior depending on disease etiology, tumor stage, and the tumor microenvironment. Standardization of assay methodologies, cutoff values, and multivariable prognostic models is essential for clinical implementation.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25163"},"PeriodicalIF":0.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212700","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":"TRENDS AND RESEARCH FRONTIERS ON GUT MICROBIOTA AND STUNTING: A BIBLIOMETRIC INSIGHT FROM 2009 TO 2025.","authors":"Rafli Z Kamil, Nurul Hasniah, Heni Rizqiati, Linda Windiarti, Tyas Utami, Endang S Rahayu","doi":"10.1590/S0004-2803.24612025-142","DOIUrl":"10.1590/S0004-2803.24612025-142","url":null,"abstract":"<p><strong>Background: </strong>Stunting, a chronic consequence of undernutrition, continues to affect millions of children under five years of age worldwide, particularly in developing countries, with long-term impacts on physical growth, cognitive development, and economic productivity.</p><p><strong>Methods: </strong>This study provides a bibliometric analysis of 172 publications indexed in Scopus from 2009 to 2025, aiming to identify trends, key contributors, core sources, thematic evolution, and future research directions in this emerging field.</p><p><strong>Results: </strong>Results indicate a steady annual growth rate of 11.85%, with peak publication output in 2021, reflecting global attention. Influential contributions were led by Gordon JI, Barratt MJ, and Ahmed T, with the United States, France, Bangladesh, China, and Indonesia identified as the most active countries, and institutions such as Washington University and the International Centre for Diarrhoeal Disease Research (Bangladesh) playing pivotal roles. The most productive journals included PLOS ONE, Frontiers in Microbiology, Nutrients, and Gut Microbes, with Subramanian S serving as the foundational reference. Keyword analysis revealed a thematic shift from \"malnutrition\" and \"stunting\" toward mechanistic terms such as \"dysbiosis,\" \"environmental enteric dysfunction,\" and interventions including \"probiotics\" and \"prebiotics.\" Emerging themes highlight moderate acute malnutrition and microbiota-directed interventions as promising frontiers.</p><p><strong>Conclusion: </strong>This bibliometric analysis provides valuable insights into research trends, influential contributors, and emerging areas, offering a foundation for guiding future studies and supporting global strategies to address stunting as a critical public health challenge.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25142"},"PeriodicalIF":0.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212684","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":"GLP-1 AND CIRRHOSIS: EFFECTS ON MORTALITY AND LIVER-RELATED COMPLICATIONS.","authors":"Chidera N Onwuzo, Odusanya Kikunlore Elijah, Fnu Alvina, Rashid Abdel Razeq, Kojo-Frimpong B Awuah, Somtochukwu Onwuzo","doi":"10.1590/S0004-2803.24612025-130","DOIUrl":"10.1590/S0004-2803.24612025-130","url":null,"abstract":"<p><strong>Background: </strong>Cirrhosis is characterized by complications, including hepatic encephalopathy (HE), hepatorenal syndrome (HRS), and acute variceal bleeding, Glucagon-like peptide-1 (GLP-1) analogs, have shown potential benefits in reducing liver inflammation and lowering cirrhosis-related complications. This study aims to provide insights into the effect of GLP-1 therapy on mortality and clinical outcomes in patients with cirrhosis.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using TriNetX research network. The cohort comprised patients ≥18 years old with a diagnosis of cirrhosis. Patients who were started on GLP-1 analogs after the diagnosis of cirrhosis were identified. Primary outcomes included all-cause mortality, HE, HRS, and portal hypertensive bleeding. Variables such as age, sex, race, comorbidities (e.g., diabetes, obesity, chronic kidney disease, hypertension), and lifestyle factors underwent 1:1 propensity matching to reduce confounding. Cox proportional hazards regression analysis was utilized to analyze the matched cohorts, and hazard ratios (HR) with 95% confidence intervals.</p><p><strong>Results: </strong>GLP-1 analog use was significantly associated with a reduced risk of several cirrhosis-related complications. Patients treated with GLP-1 analogs exhibited a significantly lower risk of all-cause mortality (HR 0.374, 95%CI 0.359-0.392), HE (HR 0.900, 95%CI 0.843-0.959), and HRS (HR 0.554, 95%CI 0.496-0.619). Additionally, there was reduced rates of portal hypertensive bleeding among GLP-1 users (HR 0.487, 95%CI 0.444-0.533).</p><p><strong>Conclusion: </strong>This study demonstrates that GLP-1 analog use is associated with a significantly lower risk of all-cause mortality and cirrhosis-related complications. Furthermore, the reduced rate of portal hypertensive bleeding might correlate with subsequent decrease in hospitalizations.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25130"},"PeriodicalIF":0.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212752","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":"EVALUATION OF CLINICAL ASPECTS OF PATIENTS UNDERGOING SACRAL NEUROMODULATION FOR FECAL INCONTINENCE: A RETROSPECTIVE MULTICENTER STUDY.","authors":"Hugo Parra de Camargo, Vanessa Foresto Machado, Rogério Serafim Parra, Omar Féres, José Joaquim Ribeiro da Rocha, Sthela Maria Murad Regadas, Luiz Henrique Cury Saad, Gilmara Pandolfo Zabot, Luciana Amaral de Retamal Marzán, Marcos Antonio Dal Ponte, Aline Landim Mano, Carina Quaquio Mesquita, Paulo José Pereira de Campos Carvalho, Marley Ribeiro Feitosa","doi":"10.1590/S0004-2803.24612025-154","DOIUrl":"10.1590/S0004-2803.24612025-154","url":null,"abstract":"<p><strong>Background: </strong>Fecal incontinence affects approximately 5%-10% of non-institutionalized individuals and is associated with socioeconomic burden. A meaningful proportion of patients fail conservative management and may require interventional therapies. Sacral neuromodulation has emerged as a less invasive option with favorable outcomes in clinical practice.</p><p><strong>Objective: </strong>To describe clinical and demographic characteristics and to assess fecal incontinence severity and fecal urgency before and after sacral neuromodulation implantation in Brazilian centers.</p><p><strong>Methods: </strong>Observational study including patients who underwent sacral neuromodulation implantation for fecal incontinence refractory to conservative treatment. Clinical-demographic variables, previous treatments, surgical implantation aspects, and the Wexner fecal incontinence score before and after the procedure were collected. All patients underwent anorectal manometry. Additional examinations were performed according to clinical indication. The study was approved by the local Ethics Committee.</p><p><strong>Results: </strong>A total of 87 patients were included; 72 (82.8%) were female, with a mean age of 61.22±16.32 years. Most patients were economically active (56.3%), had completed secondary education (44.8%), and were married (60.9%). The most frequent etiology was neurogenic (42; 48.3%), with a mean disease duration of 73.9±61.33 months. Among women, 17 were nulliparous. Previous surgeries included perineal procedures in 22 (25.3%), colorectal surgery in 16 (18.4%), and pelvic surgery in 12 (13.8%). Only 12 (13.8%) patients had undergone prior surgery specifically for fecal incontinence. Additional tests included endoanal ultrasound (52.9%), colonoscopy (26.4%), electromyography (31%), and pelvic magnetic resonance imaging (2.3%). The median Wexner score decreased after implantation (16; interquartile range: 12-17 vs 2; interquartile range: 0-4), and fecal urgency frequency decreased (51.7% vs 26.4%).</p><p><strong>Conclusion: </strong>In Brazilian centers, sacral neuromodulation was associated with clinically meaningful reductions in fecal incontinence severity and fecal urgency among patients refractory to conservative treatment, with a safety profile consistent with the literature.</p>","PeriodicalId":35671,"journal":{"name":"Arquivos de Gastroenterologia","volume":"63 ","pages":"e25154"},"PeriodicalIF":0.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212750","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}