GE Portuguese Journal of Gastroenterology最新文献

{"title":"Lactose Intolerance and Malabsorption Revisited: Exploring the Impact and Solutions.","authors":"Ana Isabel Borralho, Pedro Marcos","doi":"10.1159/000545923","DOIUrl":"10.1159/000545923","url":null,"abstract":"<p><strong>Background: </strong>Lactose intolerance (LI) is a condition in which the consumption of lactose-containing products leads to gastrointestinal symptoms. Despite being a common digestive disorder worldwide, LI is often overlooked, and there are few established recommendations for its diagnosis and management. This review aims to provide a comprehensive overview of LI, focusing on its clinical features, diagnostic evaluation, and management strategies.</p><p><strong>Summary: </strong>A review of literature published from 2013 to 2023 on PubMed was conducted. Systematic reviews, meta-analyses, randomized controlled trials, case-control studies, cohort studies, and expert reviews were prioritized for analysis. LI is a common condition that shares symptoms with several other diseases. Various diagnostic tests are available to identify LI, including hydrogen breath test (HBT), lactose tolerance test, urinary galactose test, gaxilose test, rapid lactase test, and genetic testing. Managing LI may involve adopting a lactose-free or low-lactose diet, taking oral enzyme supplements, using probiotics and prebiotics, or consuming plant-based alternative beverages.</p><p><strong>Key messages: </strong>LI affects many people worldwide and can significantly impact their quality of life. The HBT is the most widely used and effective method for diagnosing LI, along with a thorough assessment of symptoms. Instead of following a completely dairy-free diet, adopting a low-lactose diet - allowing up to 12-15 g of lactose per day - has been shown to be well tolerated and beneficial for most individuals with LI. While probiotics, prebiotics, and plant-based beverages may be helpful, their effectiveness in managing LI has not yet been proven.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163246","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":"Hypereosinophilic Syndrome Presenting with Digestive Symptoms in Pediatric Patients: A Portuguese Tertiary Hospital Case Series.","authors":"Maria Sousa, Sara Catarino, Céu Espinheira, Mariana Rodrigues, Fátima Ferreira, Eunice Trindade","doi":"10.1159/000545921","DOIUrl":"10.1159/000545921","url":null,"abstract":"<p><strong>Introduction: </strong>Hypereosinophilic syndrome (HES) is an uncommon disorder characterized by persistent peripheral eosinophilia and involvement of different organs. It is rare in pediatric ages.</p><p><strong>Cases presentation: </strong>We present 3 pediatric patients diagnosed with HES exhibiting digestive symptoms. Clinical records, laboratory results, imaging studies, and treatment plans were systematically collected and analyzed. All patients underwent an extensive etiological investigation to exclude infectious, autoimmune, and tumoral causes. Treatment with corticosteroids resulted in symptomatic and analytical improvement in all patients.</p><p><strong>Conclusion: </strong>This case series highlights the complexity of pediatric HES presenting with digestive manifestations. The diverse clinical presentation underscores the importance of considering HES in the differential diagnosis of unexplained gastrointestinal symptoms in children. Diagnostic and treatment challenges demand a multidisciplinary approach. These insights enhance our knowledge of this rare condition, enlarging the limited literature on this subject in the pediatric population.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":"1-7"},"PeriodicalIF":1.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12113416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175807","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":"Recommendations for the Clinical Practice concerning the Use of Cholangiopancreatoscopy: Proceedings from a Consensus Meeting.","authors":"Jorge Canena, Pedro Pereira, Tiago Bana E Costa, David Horta, Luís Carvalho Lourenço, Eduardo Rodrigues-Pinto, Isabel Tarrio, Ana Rita Franco, Tarcísio Araújo, Luís Lopes","doi":"10.1159/000545718","DOIUrl":"10.1159/000545718","url":null,"abstract":"<p><p>After a consensus meeting including experts from all over the country (more than 6 years of experience, at least 50 procedures and their center perform more than 30 procedures/year), several recommendations were issued. Main recommendations: (1) Single-operator digital cholangioscopy is indicated in cases of undetermined biliary strictures (UBSs) in which visual inspection, with or without histology, may change the patient's approach. (Strong recommendation, moderate quality of evidence). (2) In a cholangioscopy for a stricture of unclear etiology, the optical assessment aspects should be recorded in a standardized report and, according to the endoscopist's visual impression, suggest a malignant or benign etiology. (Strong recommendation, high quality of evidence). (3) When using cholangioscopy regardless of the visual impression, biopsies of the stenosis should be taken (ideally in a number equal to or greater than 6 fragments). (Strong recommendation, moderate quality of evidence). (4) Cholangioscopy with biopsies has a high diagnostic accuracy in the evaluation of UBSs, with a technical success >98% and visual diagnosis with sensitivity/specificity >95%. However, it must be considered that the sensitivity of histological diagnosis is lower (around 70%). (Strong recommendation, high quality of evidence). (5) The single-operator cholangioscopy (SOC)-assisted lithotripsy is a safe procedure associated with high rates of success. (Strong recommendation, high quality of evidence). (6) SOC-assisted lithotripsy should be reserved for selected cases in which conventional techniques for the treatment of difficult biliary stones have failed. However, SOC-assisted lithotripsy should be used early in the treatment algorithm to avoid repeated procedures. (Strong recommendation, moderate quality of evidence). (7) Pancreatoscopy can allow the diagnosis of lesions suggestive of malignancy in the pancreatic duct of patients with intraductal papillary mucinous neoplasm of the main duct with high sensitivity and specificity. The groups of patients who benefit most from its use are those with a diffusely dilated duct with a diameter greater than 10 mm, and in whom sectional imaging methods and endoscopic ultrasound do not reveal focal lesions. (Weak recommendation, low quality of evidence). (8) The use of intraductal lithotripsy guided by pancreatoscopy in patients with lithiasis in the main pancreatic duct should be reserved for patients with pain and lithiasis greater than 5 mm that cannot be removed using conventional techniques. Patients with an excessively distal location in the tail or head may cause increased technical difficulty. (Low recommendation, low quality of evidence).</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":"1-21"},"PeriodicalIF":1.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163284","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":"Referral to Liver Transplant: A National Survey from Portugal.","authors":"Filipe S Cardoso, Mónica Sousa, Luís Bagulho, Milena Mendes, Élia Mateus, Helena Glória, Jorge Lamelas, Luís Bicho, Raquel Mega, João S Coelho, Rui Perdigoto, Hugo P Marques","doi":"10.1159/000545593","DOIUrl":"10.1159/000545593","url":null,"abstract":"<p><strong>Introduction: </strong>The referral of patients with cirrhosis to liver transplant (LT) is a multi-stage, complex process. There is a lack of data on potential challenges to this process. We aimed to characterize challenges faced by Portuguese referring clinicians.</p><p><strong>Methods: </strong>This was a cross-sectional survey from Curry Cabral Hospital, Lisbon, Portugal. The survey was open for 90 days, from August to November 2024. The survey included 13 questions: characterization of participants with 5 questions and characterization of the process of referral to LT with 8 questions.</p><p><strong>Results: </strong>Overall, 56 clinicians responded to the survey (response rate of 46.7%). Their median (IQR) age was 38.1 (33.2-42.1) years. Their level of training was specialist grade for 47 (83.9%) and fellow or intern grade for 9 (16.1%) individuals. The responders were from 21 different hospitals in Portugal; 8 (38.1%) provided tertiary care and 2 (9.5%) were LT centers. Among responders, there was heterogeneity regarding the following topics: referring criteria to LT, liver-related prognostic scores, contact channels with the LT center, tests and visits part of the LT workup. Many of them suggested the following improvements to develop national or regional referral criteria, to expedite communication with the LT team, to accelerate access to the tests or visits part of the LT workup, and to shorten the time to the first appointment with the LT team.</p><p><strong>Conclusion: </strong>Portuguese clinicians identified several challenges and improvements to the referral of patients with cirrhosis to LT. These findings may inform future strategies to streamline the referral to LT.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998933","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":"Dual Portal Hypertension in Hepatic Tuberculosis: A Case Report.","authors":"Amal Joseph, Prajob Geevarghese Prasad, Jeby Jacob, Harikumar Nair","doi":"10.1159/000545522","DOIUrl":"10.1159/000545522","url":null,"abstract":"<p><strong>Background: </strong>Hepatic tuberculosis in itself is a rare condition, and that causing portal hypertension is even rarer. We present a unique clinical scenario of portal hypertension in a 64-year-old woman, with tuberculosis causing both sinusoidal and prehepatic portal hypertension.</p><p><strong>Case presentation: </strong>A 64-year-old woman presented with esophageal variceal bleeding. Evaluation revealed a rare combination of sinusoidal portal hypertension from hepatic tuberculosis and a prehepatic component of portal hypertension due to tubercular periportal lymphadenopathy compressing the portal vein at the hilum. Hepatic venous pressure gradient was 7 mm Hg, indicative of sinusoidal portal hypertension. Liver biopsy demonstrated bridging fibrosis and hepatic granulomas accounting for the sinusoidal component of portal hypertension. Since clinically significant portal hypertension is more than 10 mm Hg, variceal bleeding resulted from the additional element of prehepatic portal hypertension contributed by compression of extrahepatic portal vein by periportal lymph nodes. Positive tuberculosis polymerase chain reaction from lymph nodes confirmed the diagnosis and initiation of antitubercular therapy (ATT) led to significant clinical and biochemical improvement. This case represents a novel occurrence; hepatic tuberculosis causing both intrahepatic and prehepatic components of portal hypertension has not been reported in the literature.</p><p><strong>Conclusion: </strong>This case sheds light on the rarity of hepatic tuberculosis causing portal hypertension and also the importance of considering this diagnosis in patients with atypical presentations of tuberculosis. Recognizing and treating this unique complication promptly with ATT can lead to favorable clinical outcomes.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":"1-4"},"PeriodicalIF":1.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032197","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":"Rare Rectal Tumour: How to Approach It?","authors":"Margarida Rajão Saraiva, Daniel Conceição, Ricardo Fonseca, Isadora Rosa","doi":"10.1159/000545592","DOIUrl":"https://doi.org/10.1159/000545592","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":"1-3"},"PeriodicalIF":1.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995426","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":"Celiac Crisis in the Postpartum: A Life-Threatening Cause of Diarrhea and Malnutrition.","authors":"Madalena Pestana, Nélia Abreu, Vitor Magno Pereira, Paulo Câmara, Henrique Morna","doi":"10.1159/000545520","DOIUrl":"https://doi.org/10.1159/000545520","url":null,"abstract":"<p><strong>Introduction: </strong>Celiac crisis is a rare, severe manifestation of celiac disease, characterized by acute gastrointestinal symptoms, malnutrition, metabolic disturbances, and potential life-threatening complications. Postpartum celiac crisis is particularly rare but can be triggered by the physiological and hormonal changes of the puerperal period.</p><p><strong>Case presentation: </strong>We report the case of a 42-year-old woman with a 3-month history of watery diarrhea, significant weight loss, extremity paresthesias, muscle spasms, and lower limb edema following childbirth. Initial evaluation revealed severe malnutrition, electrolyte imbalances, and hypoalbuminemia. Endoscopic studies showed significant villous atrophy and mucosal damage, suggestive of celiac disease, which was confirmed by serological and histological findings. The patient was diagnosed with celiac crisis and initiated on a strict gluten-free diet with supportive care, resulting in full clinical and biochemical recovery.</p><p><strong>Discussion: </strong>This case highlights the importance of considering CD in the differential diagnosis of postpartum malnutrition and chronic diarrhea. Postpartum period may trigger the disease, underscoring the need for awareness in clinical settings. Celiac hepatitis is a prevalent occurrence within the spectrum of CD, with transient transaminase elevation with resolution following the initiation of a gluten-free diet. Celiac crisis, though rare, requires prompt diagnosis and intervention to avoid further complications.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":" ","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025255","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":"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}