GE Portuguese Journal of Gastroenterology最新文献

{"title":"Building Clinical and Research Delivery Networks: A Blue Print for Multidisciplinary Management and Consensus in Wilson Disease.","authors":"Aftab Ala, James Liu Yin, Michael L Schilsky","doi":"10.1159/000542402","DOIUrl":"10.1159/000542402","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"75-77"},"PeriodicalIF":1.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765742","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":"Practical and Multidisciplinary Review on Wilson Disease: The Portuguese Perspective.","authors":"Filipe Calinas, Hélder Cardoso, Sofia Carvalhana, José Ferreira, Cristina Gonçalves, Marina Magalhães, Helena Pessegueiro Miranda, José Presa, Carla Rolanda, Arsénio Santos, Rui M Santos","doi":"10.1159/000541208","DOIUrl":"10.1159/000541208","url":null,"abstract":"<p><p>Wilson disease (WD) is a genetic disorder of copper metabolism caused by mutations in the ATP7B gene resulting in toxic copper accumulation in several organs. WD can manifest as liver disease, a progressive neurological disorder, a psychiatric illness, or a combination of these. Other clinical manifestations can also occur. Diagnosis is challenging and typically requires a range of biochemical tests, imaging, genetic testing for ATP7B, and/or liver biopsy. WD is treatable with chelating agents, such as d-penicillamine and trientine, and/or zinc salts alongside with dietary copper restriction. Liver transplantation may be indicated in WD patients with severe hepatic disease, and cautiously considered in patients with neurological WD. Treatment success highly depends on patient adherence and treatment persistence. Therefore, effective interventions for improving patient adherence and close monitoring are key for preventing WD progression. In Portugal, there are no reference centers for WD, and patients are dispersed across numerous medical specialists. This review aimed to summarize the most recent and relevant information for the diagnosis, treatment, and monitoring of WD in Portugal, as well as possible interventions for stimulating adherence to treatment.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"78-94"},"PeriodicalIF":1.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722536","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":"X-Tackling the Path to Closure: Post-Endoscopic Submucosal Dissection Defect Resolution Strategies.","authors":"João A Cunha Neves, Jéssica Chaves, Mário Dinis-Ribeiro, Diogo Libânio","doi":"10.1159/000541865","DOIUrl":"10.1159/000541865","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"127-130"},"PeriodicalIF":1.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765722","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":"Under the Hood: An Easy Method for Lesions Retrieval.","authors":"João Pedro Pereira, Leonor Guedes-Novais, Pedro Antunes, Masami Omae, Henrik Maltzman, Francisco Baldaque-Silva","doi":"10.1159/000541246","DOIUrl":"10.1159/000541246","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"124-126"},"PeriodicalIF":1.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765718","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":"Hypertrichosis Lanuginosa Acquisita: When Hair Unravels the Unseen.","authors":"Joana Revés, Catarina Bexiga, Alexandra Chaveiro, Catarina Ferreira Gouveia","doi":"10.1159/000541214","DOIUrl":"10.1159/000541214","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"131-133"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765747","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":"Positive <i>Yersinia</i> Serology and Colonic Cobblestone Pattern: A Diversion or Main Culprit?","authors":"Joana Revés, Catarina Frias-Gomes, Lídia Roque Ramos, Luísa Glória","doi":"10.1159/000541220","DOIUrl":"10.1159/000541220","url":null,"abstract":"<p><p><i>Yersinia enterocolitica</i> infection, the third most prevalent gastrointestinal infection in Europe, poses a diagnostic challenge due to its resemblance to other common conditions such as acute appendicitis, Crohn's disease, and malignancy. We report the case of a 48-year-old female patient who sought medical attention for abdominal pain and diarrhoea. Her endoscopic examination revealed a cobblestone pattern affecting the entire colon, more pronounced in the right colon, but with normal mucosa in the terminal ileum. This unique presentation created a challenge in distinguishing Yersiniosis from Crohn's disease. This case report aimed to highlight this atypical endoscopic manifestation of <i>Y. enterocolitica</i> infection. We underline the subacute nature of the symptoms, which can last up to 4-6 weeks. This reinforces the importance of considering <i>Y. enterocolitica</i> infection as a diagnostic possibility, even when the endoscopic appearance closely resembles other chronic intestinal diseases.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"143-150"},"PeriodicalIF":1.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765667","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-Time Gastric Juice Analysis in Cirrhotic Patients: Can We Avoid Unrewarding Gastric Biopsies?","authors":"Sergio Peralta, Vincenza Calvaruso, Francesca Di Giorgio, Marco Peralta, Vincenzo Di Martino, Ada Maria Florena, Angelo Zullo","doi":"10.1159/000540698","DOIUrl":"10.1159/000540698","url":null,"abstract":"<p><strong>Background: </strong>To search for <i>H. pylori</i> infection and gastric precancerous lesions in cirrhotic patients is worthwhile when considering the high incidence of peptic ulcers and gastric cancer in these patients. We tested if gastric juice analysis allows to avoid unrewarding gastric biopsies.</p><p><strong>Methods: </strong>This prospective study enrolled consecutive patients with liver cirrhosis who underwent upper endoscopy with standard gastric biopsies. Real-time gastric juice analysis was performed with a specific device (EndoFaster^®) that test ammonium concentration for <i>H. pylori</i> diagnosis, and pH values to suspect extensive atrophy/metaplasia involving gastric body mucosa. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), the overall accuracy, and the likelihood ratio were calculated for both <i>H. pylori</i> infection and extensive precancerous lesions on gastric mucosa.</p><p><strong>Results: </strong>A total of 78 cirrhotic patients (males: 55; mean age: 66 ± 12 years) were enrolled. When considering as positive EndoFaster^® results when at least one of two (ammonium and pH levels) tests were positive, the NPVs were as high as 89% and 86%, respectively, to rule out <i>H. pylori</i> and extensive precancerous lesions on gastric mucosa, with an overall accuracy of 83% and 74%.</p><p><strong>Conclusions: </strong>This study supports the evidence that real-time gastric juice analysis allows to avoid clinically unrewarding and potentially unsafe gastric biopsies in a definite portion of cirrhotic patients, but more data are needed.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"118-123"},"PeriodicalIF":1.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765689","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":"Treatment of Hemorrhoidal Disease in Patients with Liver Cirrhosis: A Systematic Review.","authors":"Sofia Bizarro Ponte, Joana Oliveira, Andreia Rei, Paulo Salgueiro","doi":"10.1159/000540702","DOIUrl":"10.1159/000540702","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The incidence of hemorrhoidal disease (HD) in cirrhotic patients is similar to that of general population, varying between 21% and 79%. Managing this clinical condition in these patients is challenging, due to the need to differentiate between bleeding originating from hemorrhoids or anorectal varices, and the unique hemostatic balance of each patient, which can lead to a decompensation of liver function and subsequently increase the anesthetic risk. To date, there are no systematic reviews specifically addressing this topic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from three electronic databases. Efficacy (symptomatic improvement, patient satisfaction, quality of life improvement, disease recurrence/need for surgery and/or hemorrhoidal prolapse reduction in anoscopy) and safety (reported adverse events) outcomes were evaluated. Data from each study were initially described individually, followed by a comparative analysis for procedures applied in multiple studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six studies were included - 1 randomized clinical trial (RCT), 2 prospective cohort studies, 1 retrospective cohort study, and 2 case series. The considered techniques encompassed rubber band ligation (RBL), injection sclerotherapy (IS) using 3 agents - aluminum potassium sulfate and tannic acid (ALTA), ethanolamine oleate 5% (EAO), or N-butyl-cyanoacrylate, hemorrhoidopexy, and emborrhoid technique. RBL showed great symptomatic improvement and patient satisfaction in 63% and 73% of patients, respectively, and in 90% was associated with one-grade prolapse reduction after only one session. The most frequently reported adverse events included pain (16%) and ulceration/fissure (1-17%). Concerning IS, symptomatic improvement was observed in all patients. Recurrence rates varied with the agent used (EAO: 13% at 12 months; N-butyl-cyanoacrylate: 40% at 12 months; ALTA: 18% at 5 years), and 86.7% of patients exhibited more than one-grade reduction after the initial session. The most frequent adverse event was pain (EAO: 63%; N-butyl-cyanoacrylate: 60%). Stapled hemorrhoidopexy resulted in symptomatic improvement in all patients, although associated with a recurrence rate of 25% within 4 months. With an emborrhoid technique, 80% of the patients showed clinical improvement at a 3-month follow-up, without significant adverse events, at the cost of a 40% recurrence rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;All the treatment methods assessed in the included studies appear to be effective and safe in cirrhotic patients. This assumption challenges previous concerns regarding significant bleeding after office-based procedures like RBL in this population. Future research should prioritize RCT to thoroughly assess the management of HD in these patients, particularly addressing polidocanol foam ","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"95-108"},"PeriodicalIF":1.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765697","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":"Deep Learning and Minimally Invasive Endoscopy: Panendoscopic Detection of Pleomorphic Lesions.","authors":"Miguel Mascarenhas, Francisco Mendes, Tiago Ribeiro, João Afonso, Pedro Marílio Cardoso, Miguel Martins, Hélder Cardoso, Patrícia Andrade, João Ferreira, Miguel Mascarenhas Saraiva, Guilherme Macedo","doi":"10.1159/000539837","DOIUrl":"10.1159/000539837","url":null,"abstract":"<p><strong>Introduction: </strong>Capsule endoscopy (CE) is a minimally invasive exam suitable of panendoscopic evaluation of the gastrointestinal (GI) tract. Nevertheless, CE is time-consuming with suboptimal diagnostic yield in the upper GI tract. Convolutional neural networks (CNN) are human brain architecture-based models suitable for image analysis. However, there is no study about their role in capsule panendoscopy.</p><p><strong>Methods: </strong>Our group developed an artificial intelligence (AI) model for panendoscopic automatic detection of pleomorphic lesions (namely vascular lesions, protuberant lesions, hematic residues, ulcers, and erosions). 355,110 images (6,977 esophageal, 12,918 gastric, 258,443 small bowel, 76,772 colonic) from eight different CE and colon CE (CCE) devices were divided into a training and validation dataset in a patient split design. The model classification was compared to three CE experts' classification. The model's performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the precision-recall curve.</p><p><strong>Results: </strong>The binary esophagus CNN had a diagnostic accuracy for pleomorphic lesions of 83.6%. The binary gastric CNN identified pleomorphic lesions with a 96.6% accuracy. The undenary small bowel CNN distinguished pleomorphic lesions with different hemorrhagic potentials with 97.6% accuracy. The trinary colonic CNN (detection and differentiation of normal mucosa, pleomorphic lesions, and hematic residues) had 94.9% global accuracy.</p><p><strong>Discussion/conclusion: </strong>We developed the first AI model for panendoscopic automatic detection of pleomorphic lesions in both CE and CCE from multiple brands, solving a critical interoperability technological challenge. Deep learning-based tools may change the landscape of minimally invasive capsule panendoscopy.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"31 6","pages":"408-418"},"PeriodicalIF":1.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781800","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":"Early-Stage Colon Cancer Surveillance: Pattern and Timing of Recurrence and the Role of 5-Year Surveillance.","authors":"Paula Ferreira Pinto, Mariana Peyroteo, Catarina Baía, Mariana Marques, Maria João Cardoso, José Flávio Videira, Joaquim Abreu de Sousa","doi":"10.1159/000540338","DOIUrl":"10.1159/000540338","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer is the third most prevalent cancer among both men and women with 80% of patients having localized disease enabling curative treatments. Given the low recurrence rate in early-stage disease, there is a growing interest in reviewing follow-up protocols. The aim of this study was to assess the frequency and timing of recurrence in early-stage colon cancer, as well as recurrence patterns.</p><p><strong>Methods: </strong>The data from all patients with colon adenocarcinoma consecutively treated with surgery at the Instituto Português de Oncologia do Porto, EPE, between January 2013 and December 2016, were retrospectively reviewed.</p><p><strong>Results: </strong>A total of 1,372 patients with colon cancer were submitted to surgery during the study period. From this group, 51.4% (<i>n</i> = 705) were early-stage colon cancers. Regarding the pathological stage, 3.5% were stage 0, 37.4% were stage I and 59.1% were stage II. The overall recurrence rate was 6.7%. When considering the group of patients without risk factors, the recurrence rate was 5.6%. The majority of recurrences occurred in the first 3 years of follow-up. The recurrence was diagnosed in the majority of patients through carcinoembryonic antigen elevation, followed by imaging exams. The presence of one or more risk factors (high nuclear grade, vascular invasion, extramural venous invasion, and perineural invasion) showed a statistically significant association with recurrence rate.</p><p><strong>Conclusion: </strong>The recurrence rate was low in early-stage colon cancer, with the majority of recurrences occurring in the first 3 years. Our study results show that surveillance should be tailored according to individual risk factors.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"109-117"},"PeriodicalIF":1.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765746","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}