Acta Gastroenterologica Latinoamericana最新文献

{"title":"[The Great Imposter: Three Cases of Inflammatory Bowel Disease Associated with Innate Immune Defects].","authors":"Diana Paola Sánchez Hernández, Sara Vallejo Tamayo","doi":"10.52787/agl.v56i3.597","DOIUrl":"https://doi.org/10.52787/agl.v56i3.597","url":null,"abstract":"<p><p>Pediatric inflammatory bowel disease associated with inborn errors of immunity represents a diagnostic and therapeutic challenge, particularly in cases of early-onset, severe disease, extraintestinal manifestations, or refractoriness to treatment. We present three pediatric cases with an aggressive clinical course, multisystemic involvement, and an inadequate response to multiple therapeutic lines of therapy, in whom the persistent presence of warning signs prompted genetic testing. In one of these patients, exome sequencing identified a pathogenic variant in FOXP3, confirming the diagnosis of IPEX syndrome. In the other two patients, who were siblings, an alteration in XIAP was identified, consistent with a diagnosis of X-linked lymphoproliferative syndrome type 2. In the index patient with XIAP deficiency, the initial exome sequencing did not identify any causative variants. Subsequently, genome sequencing established the molecular diagnosis, which subsequently led to the cascade diagnosis of his sibling. These cases highlight the importance of early recognition of phenotypes suggestive of monogenic disease, maintaining diagnostic suspicion despite initially negative genetic test results, and conducting a timely multidisciplinary evaluation. Identification of an underlying inborn error of immunity can substantially modify the therapeutic approach, allow for the consideration of potentially curative options such as hematopoietic stem cell transplantation, and facilitate family genetic counseling.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"357-364"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184953","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":"[Adherence to Hepatocellular Carcinoma Surveillance and Its Association with Tumor Stage at Diagnosis: Experience at a University Hospital].","authors":"Gabriel Adrián Mariño Camacho, Jonathan David Salmon Pico, Lorena Bortot, Andrea Curia, Cielo Gutiérrez, Gabriela Quintero, José María Sanguinetti, Esteban González Ballerga","doi":"10.52787/agl.v56i3.661","DOIUrl":"https://doi.org/10.52787/agl.v56i3.661","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatocellular carcinoma is the most common primary liver cancer. Surveillance using abdominal ultrasound and alpha-fetoprotein testing allows for its detection in early stages. The objective of this study was to evaluate adherence to hepatocellular carcinoma surveillance in patients with cirrhosis and to analyze its association with tumor stage, liver function, and alpha-fetoprotein levels at the time of diagnosis.</p><p><strong>Methods: </strong>This retrospective study included patients with cirrhosis and a diagnosis of hepatocellular carcinoma between 2000 and 2024. A patient was considered adherent if they had undergone at least one surveillance examination via abdominal ultrasound and alpha-fetoprotein testing within the six months prior to diagnosis. Demographic variables, etiology, liver function, tumor stage according to the Barcelona Clinic Liver Cancer (BCLC) classification, and alpha-fetoprotein levels were analyzed.</p><p><strong>Results: </strong>A total of 121 patients were included; the mean age was 64.3 ± 10.6 years, and 73.6% were male. Thirty-three percent (40/121) met the adherence criteria. Adherent patients had a higher proportion of Child-Pugh A (60% vs. 24.7%; p < 0.001), were more frequently diagnosed with BCLC stage A (37.5% vs. 17.3%; p = 0.023), and showed a lower median AFP level in the descriptive analysis (7 vs. 21 ng/mL). However, in the multivariable analysis adjusted for age, sex, liver function, etiology, and year of diagnosis, the association between adherence and BCLC stage A diagnosis did not reach statistical significance.</p><p><strong>Conclusions: </strong>Adherence to hepatocellular carcinoma surveillance was low. In the unadjusted analysis, adherent patients were more frequently diagnosed at BCLC stage A and, descriptively, had a lower median alpha-fetoprotein level. The association between adherence and diagnosis at BCLC stage A did not remain statistically significant after adjustment for relevant clinical variables.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"324-331"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184955","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":"[Modified Endoscopic Biliary Stent as a Bridging Strategy in Complex Biliary Strictures].","authors":"María Cristina du Plessis, Gustavo A Ibarra, Jorge F Alonso Quintas, Hugo I Zandalazini","doi":"10.52787/agl.v56i3.640","DOIUrl":"https://doi.org/10.52787/agl.v56i3.640","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic therapy represents the first-line strategy for the management of biliary strictures. However, strictures associated with altered biliary anatomy (particularly those located near the hepatic hilum or with angulated courses) may hamper the placement of conventional stents, especially when dedicated devices are unavailable.</p><p><strong>Objective: </strong>To evaluate the technical feasibility and early clinical outcomes of using a modified endoscopic biliary stent as a temporary drainage strategy for the management of complex biliary strictures.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted on a consecutive series of patients who underwent endoscopic retrograde cholangiopancreatography between 2020 and 2025. A hydrophilic percutaneous biliary drainage catheter, modified intraoperatively, was used when placement of a conventional plastic stent was not feasible or when such a device was unavailable. Technical and clinical success, bilirubin reduction, complications, stent migration, and device removal were analyzed.</p><p><strong>Results: </strong>Fourteen patients were included (mean age, 52 ± 11 years; 35.7% female). Nine strictures were benign and five were malignant. Six cases (42.9%) were located ≤ 2 cm from the hepatic hilum. Both technical and clinical success rates were 100%, with a bilirubin decrease ≥ 1 mg/dL within 48 hours in all patients. No complications or stent migrations were observed. All devices were successfully removed endoscopically without difficulty.</p><p><strong>Conclusion: </strong>The modified endoscopic biliary stent was technically feasible as a temporary drainage strategy for complex biliary strictures associated with altered anatomy and showed favorable preliminary clinical outcomes, particularly in settings with limited availability of dedicated devices.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"316-323"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185015","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":"Glucagon-Like Peptide-1 Receptor Agonist and Gastrointestinal Adverse Effects: A Comprehensive Review.","authors":"Julio Zúñiga Cisneros, Michael Camilleri, Madhusudan Grover","doi":"10.52787/agl.v56i3.690","DOIUrl":"https://doi.org/10.52787/agl.v56i3.690","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonist (GLP-1 RA) has transformed the management of type 2 diabetes and obesity, with expanding indications now spanning cardiovascular, renal, and hepatic disease. As exposure broadens across increasingly diverse populations, gastrointestinal adverse events (GIAEs) have emerged as the dominant tolerability limitation and a leading drug-related reason for discontinuation of treatment. This review synthesizes the mechanisms, clinical spectrum, and management of GLP-1 RA-associated GIAEs. These effects arise from a dual peripheral-central mechanism: peripheral receptor activation slows gastric motility, whereas activation in the area postrema and nucleus tractus solitarius (NTS) drives nausea and emesis. This dual mechanism explains why symptom severity may correlate poorly with the measured degree of gastric-emptying delay and why centrally acting antiemetics are most widely used to relieve nausea and emesis. Across clinical trials, nausea, emesis, diarrhea, constipation, and abdominal pain follow a consistent dose- and indication-dependent gradient, with the highest incidence observed with higher-dose obesity and MASH regimens and multi-agonist molecules. Most symptoms are mild, emerge during dose escalation, and attenuate over time, though a clinically important minority of patients experience persistent symptoms, and a subset develops gastroparesis. Management should rest on anticipation and screening of gastrointestinal symptoms at baseline, pretreatment counseling, gradual up-titration, and dietary measures before pharmacotherapy. Future priorities include standardized motility measurements and endpoints, predictive biomarkers, and evidence-based management algorithms.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"269-288"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184960","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":"[Gastric Intestinal Metaplasia: an Update on Epidemiology, Diagnosis, Risk Stratification, and Clinical Management].","authors":"Luis Capella-Vernia, Irina Luzko, Leticia Moreira","doi":"10.52787/agl.v56i3.683","DOIUrl":"https://doi.org/10.52787/agl.v56i3.683","url":null,"abstract":"<p><p>GIM is one of the main premalignant lesions in the intestinal-type gastric adenocarcinoma carcinogenesis sequence described by Correa. Its identification represents one of the cornerstones of secondary gastric cancer prevention, as it allows the selection of patients at higher risk of progression and the establishment of individualized surveillance programs. In recent years, significant advances have been made in the pathophysiological understanding of intestinal metaplasia and in endoscopic diagnostic techniques. Among the most relevant advances are virtual chromoendoscopy, the EGGIM classification, the OLGA and OLGIM histological systems, and the progressive incorporation of artificial intelligence. Current clinical guidelines have reinforced the role of high-quality endoscopy, individualized risk stratification, and systematic Helicobacter pylori eradication. This review summarizes the most recent evidence on the epidemiology, pathophysiology, classification, diagnosis, risk stratification, and clinical management of GIM, comparing the main international guidelines and incorporating perspectives on the application of artificial intelligence to gastrointestinal endoscopy.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"289-303"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185010","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":"[Diagnostic Agreement Between Capsule Endoscopy and Double-Balloon Enteroscopy in Mid-Gut Gastrointestinal Bleeding at a Referral Hospital in Peru].","authors":"Ofelia Castillo-Contreras, Jairo Asencios-Cusihuallpa, Elizabeth Ayala-Quintanilla","doi":"10.52787/agl.v56i3.655","DOIUrl":"https://doi.org/10.52787/agl.v56i3.655","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnostic approach to mid-gut gastrointestinal bleeding requires several examinations, primarily video capsule endoscopy followed by double-balloon enteroscopy) at tertiary care centers.</p><p><strong>Objective: </strong>To evaluate the level of diagnostic agreement between video capsule endoscopy and double-balloon enteroscopy in patients treated with mid-gut gastrointestinal bleeding at a referral hospital in Lima, Peru, during the 2020-2025 period.</p><p><strong>Methods: </strong>This was an observational, retrospective, and comparative study. Diagnostic agreement between the two procedures was calculated using the Kappa coefficient. Statistical analysis was performed using IBM SPSS Statistics v.20.0 and R software version 4.1.2, with a significant p-value < 0.05.</p><p><strong>Results: </strong>In fifty-one patients with mid-gut gastrointestinal bleeding (28 women; median age: 65 years [IQR: 55-71]), video capsule endoscopy and subsequent double-balloon enteroscopy (39 antegrade and 12 retrograde) were performed. Most patients (34/51; 66.7%) presented with overt mid-gut gastrointestinal bleeding, while the rest had occult bleeding, with a mean hemoglobin level of 7.3 ± 2.24 g/dL. The median time interval between the two procedures was 13 days (IQR 5-29). In 10 (19.6%) patients where video capsule endoscopy showed positive findings, no lesions were identified during double-balloon enteroscopy , whereas in one case (2%) with a negative video capsule endoscopy , double-balloon enteroscopy was positive. Overall diagnostic agreement was low (κ = 0.37; [95% CI: 0.10-0.64]; p = 0.002). Moderate agreement was observed regarding lesion type (κ = 0.58; [95% CI: 0.42-0.74]; p < 0.001) and lesion location (κ = 0.50; [95% CI: 0.31-0.69]; p < 0.001), with moderate agreement for vascular (κ = 0.60) and tumoral (κ = 0.60) lesions.</p><p><strong>Conclusion: </strong>Video capsule endoscopy and double-balloon enteroscopy showed low overall diagnostic agreement in patients with mid-gut gastrointestinal bleeding, and moderate agreement regarding the type and location of the lesion.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"305-315"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184944","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":"[Gastric Plexiform Fibromyxoma as a Diagnostic Challenge in the Differential Diagnosis of GIST].","authors":"Sara Martino, Federico Suldrup, Catalina Poggi, Florencia Sánchez, Fernando Gabriel Wright, Axel Federico Beskow","doi":"10.52787/agl.v56i3.614","DOIUrl":"https://doi.org/10.52787/agl.v56i3.614","url":null,"abstract":"<p><p>Gastric plexiform fibromyxoma is an extremely rare, benign mesenchymal neoplasm predominantly located in the gastric antrum. We report the case of a 30-year-old female with anemia caused by a gastric subepithelial lesion. Endosonography and nuclear magnetic resonance confirmed a tumor originated in the muscularis propria, showing hyperintensity on T2. Management involved laparoscopic wedge resection with adequate margins. Histopathological examination and microscopy revealed the characteristic plexiform growth pattern of the fibromyxoid stroma. Immunohistochemistry -critical for excluding gastrointestinal stromal tumors (DOG-1/KIT negative, focally positivity for smooth muscle actin)-confirmed the diagnosis. Gastric plexiform fibromyxoma carries an excellent prognosis, with no recurrences or metastases reported in the literature.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"352-356"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184990","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":"[Introduction to Cluster Randomized Trials].","authors":"Emiliano Rossi","doi":"10.52787/agl.v56i3.668","DOIUrl":"https://doi.org/10.52787/agl.v56i3.668","url":null,"abstract":"","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"261-264"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184998","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":"An Unusual Distal Esophageal Finding: An Endoscopic Challenge.","authors":"Jonatan Merino-Soriano, José Luis Gálvez Romero, Andrea Báez Núñez, Sayuri Chong Hernández, Francisco de Jesús García-Mendoza","doi":"10.52787/agl.v56i3.667","DOIUrl":"https://doi.org/10.52787/agl.v56i3.667","url":null,"abstract":"","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"304"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184988","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":"[Cystic Fibrosis in Latin America: Clinical Practices, Diagnosis, and Therapeutic Access: a Multicenter Cross-sectional Study].","authors":"Michelle Higuera Carrillo, María Cristina Arregui, María Soledad Arcucci, Magali Reyes-Apodaca, Elizabeth Navarro Díaz, Violeta Sereno, Gabriela Oropeza Gianfelici, Magaly Rodríguez Guerrero, María Clara Jijón Andrade, Mario Alomía, Gustavo Boldrini, Natali González Rozó, Pierangela Previte Nastasi, Lourdes Ortiz Paranza","doi":"10.52787/agl.v56i3.583","DOIUrl":"https://doi.org/10.52787/agl.v56i3.583","url":null,"abstract":"<p><strong>Introduction: </strong>Cystic fibrosis is a condition that requires early diagnosis, multidisciplinary follow-up, and access to specialized therapies. The diversity of healthcare systems in Latin America could affect the quality of care.</p><p><strong>Objetive: </strong>The objective was to describe clinical practices, diagnostic resources, and access to therapies at centers that care for patients with cystic fibrosis in the region.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted using an online survey administered in 2024 to 101 healthcare professionals in Latin America. The study examined institutional characteristics, care burden, availability of neonatal screening, multidisciplinary organization, diagnostic methods, and access to CFTR modulators.</p><p><strong>Results: </strong>A total of 101 responses from healthcare professionals were analized; 52 respondents (51.5%) worked in centers specializing in cystic fibrosis and 49 (48.5%) in non-specialized centers, a distribution that accounts for 100% of the sample. Respondents working in specialized centers had a higher patient burden and more comprehensive multidisciplinary teams. Neonatal screening and the sweat test were reported as available by 58 (57.4%) and 50 (49.5%) of the respondents, respectively. Genetic testing and CFTR modulators showed limited and variable availability across countries.</p><p><strong>Conclusions: </strong>Cystic fibrosis care in Latin America is heterogeneous. Standardizing protocols, strengthening specialized centers, and improving access to molecular diagnosis and advanced therapies are regional priorities that would enhance timely diagnosis and treatment, as well as patient survival.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"56 3","pages":"342-351"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184933","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}