GE Portuguese Journal of Gastroenterology最新文献

{"title":"Modified Gastric Peroral Endoscopic Myotomy for the Treatment of Gastric Stenosis after Atypical Gastrectomy.","authors":"Pedro André Lima, Bruno Gomes Rodrigues, Raquel R Mendes, Rui Mendo, Cristina Chagas, Pedro Barreiro","doi":"10.1159/000551205","DOIUrl":"https://doi.org/10.1159/000551205","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"438-440"},"PeriodicalIF":0.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846050","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 Impact of Type 2 Diabetes Mellitus on Hepatic Fibrosis in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Cross-Sectional Study.","authors":"Paula Mesquita, Cristiane Macedo, Ana Matos, Carla Henriques, Armando Carvalho, Adélia Simão","doi":"10.1159/000551207","DOIUrl":"https://doi.org/10.1159/000551207","url":null,"abstract":"<p><strong>Aims: </strong>The aim of the study was to evaluate the impact of type 2 diabetes on hepatic fibrosis in patients with MASLD.</p><p><strong>Materials and methods: </strong>This cross-sectional study used retrospective data from patients with MASLD who underwent liver elastography between July 2022 and February 2024. Controlled attenuation parameter ≥248 dB/m was considered diagnostic for steatosis; elasticity (kPa) of 8.7-10.2 kPa for F3, and >10.2 kPa for F4. Clinical, demographic, and laboratory data were collected. Other etiologies of liver disease were excluded. Patients were divided into group 1 (with diabetes) and group 2 (without diabetes).</p><p><strong>Results: </strong>A total of 252 individuals were included, 96 in group 1 and 156 in group 2. The mean age was 56 years, and the median body mass index was 31.0 kg/m². There was a positive correlation between the degree of steatosis and the stage of fibrosis (<i>p</i> < 0.01). The prevalence of steatosis S3 was 83.3% in group 1 versus 70.5% in group 2 (<i>p</i> = 0.022). Fibrosis F3/F4 was present in 45.8% of group 1 compared to 12.2% of group 2 (<i>p</i> < 0.001), while presumed cirrhosis affected 33.3% of group 1 and 6.4% of group 2 (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Type 2 diabetes was associated with a higher degree of steatosis and more severe hepatic fibrosis in patients with MASLD, with presumed cirrhosis present in about one-third of patients with diabetes. Early diagnosis of MASLD in type 2 diabetes and screening for complications (cirrhosis and hepatocellular carcinoma) should be implemented.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"413-421"},"PeriodicalIF":0.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788390","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":"Colo-Ovarian Fistula: A Case Report.","authors":"Lalit Chandra Kummetha, Venkatesh Vaithiyam, Surbhi Goyal, Sanjeev Sachdeva","doi":"10.1159/000551272","DOIUrl":"https://doi.org/10.1159/000551272","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"410-412"},"PeriodicalIF":0.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787948","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":"Chronic Intestinal Failure: Portuguese Overview and Future Perspectives.","authors":"André Bargas, Luisa Glória, Jorge Fonseca, Anibal Marinho, Paula Gouveia, Simon Lal","doi":"10.1159/000551206","DOIUrl":"https://doi.org/10.1159/000551206","url":null,"abstract":"<p><strong>Background: </strong>Chronic intestinal failure (CIF) is a rare and complex condition in which patients require long-term intravenous supplementation to maintain health and quality of life. Across Europe, initiatives led by the European Society of Clinical Nutrition and Metabolism (ESPEN) and the European Nutrition Health Alliance have sought to harmonize definitions, care standards, and access to home parenteral support. However, international differences remain significant, particularly in countries where CIF care structures are still developing.</p><p><strong>Summary: </strong>This review outlines the current landscape of CIF care in Portugal, from its formal recognition to the ongoing establishment of national standards. This review revisits the traditional difficulties of CIF patients' management, the changes that come along with the publication of Health Directive 017/2020 marking a turning point, providing a legal and organizational framework for home management and multidisciplinary nutrition support teams. Recent Portuguese and European studies highlight both the progress achieved and the continuing gaps in coordination, registry data, and specialized services. Integrating the new ESPEN quality-of-care standards into clinical practice represents an opportunity to consolidate a structured national network, promote equity of access, and align Portuguese practice with broader European benchmarks.</p><p><strong>Key messages: </strong>CIF remains underrecognized and underreported in Portugal, highlighting the need for developing the current national registry and dedicated referral network. Legislative advances and professional initiatives represent critical first steps toward equitable, evidence-based CIF management and integration into European care models. Implementation of structured multidisciplinary teams and adherence to ESPEN quality-of-care standards are pivotal to improving safety, outcomes, and cost efficiency. Portuguese progress has been clear and significant, but there is still a long way to travel before reaching European standards of CIF patient care.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"422-430"},"PeriodicalIF":0.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789010","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":"High Prevalence of Patient Intolerance to Unsedated Esophagogastroduodenoscopy: A Cross-Sectional Study in a Portuguese Population.","authors":"Ana Beatriz Pires, Pedro Marcos","doi":"10.1159/000551187","DOIUrl":"https://doi.org/10.1159/000551187","url":null,"abstract":"<p><strong>Introduction: </strong>Esophagogastroduodenoscopy (EGD) is a diagnostic and therapeutic procedure increasingly performed worldwide that can be done with or without sedation.</p><p><strong>Aim: </strong>The aim of the study was to evaluate how common EGD intolerance without sedation is among a group of patients in a Western country.</p><p><strong>Methods: </strong>A cross-sectional study at a Portuguese hospital reviewed EGD procedures without sedation from January 2021 to March 2024. Reports indicated patient tolerance (well tolerated or intolerant). Only patients aged 18 or older were included. When patients had multiple EGDs without sedation within the analysis period, only the first procedure was analysed. Data collected from endoscopy reports included gender, age, EGD setting, and a history of previous upper gastrointestinal tract surgery.</p><p><strong>Results: </strong>This study involved 849 patients who underwent unsedated EGD, with 452 males and 397 females. Of these, 258 patients (30.4%) did not tolerate the procedure. Younger patients (under 50 years old) exhibited significantly higher intolerance than older patients, with adjusted odds ratio (AOR) of 3.14 (95% CI 2.06-4.79, <i>p</i> < 0.001). Additionally, females showed greater intolerance compared to males, with an AOR of 1.41 (95% CI 1.04-1.90, <i>p</i> = 0.025).</p><p><strong>Conclusion: </strong>Approximately one-third of patients are unable to tolerate EGD without sedation. Younger age (<50 years) and female gender were independent predictors of intolerance to unsedated EGD. This high prevalence highlights the importance of providing sedation during EGD to decrease patient discomfort, avoid the need for a repeat EGD due to an inconclusive unsedated first attempt, improve diagnostic accuracy by meeting performance standards, and reduce the risk of missing precancerous conditions or lesions.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"431-437"},"PeriodicalIF":0.6,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823583","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":"Systemic Absorption of Biliary Contrast: An Unexpected Finding - A Case Report.","authors":"José Damasceno, Bruno Gonçalves","doi":"10.1159/000551186","DOIUrl":"https://doi.org/10.1159/000551186","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"408-409"},"PeriodicalIF":0.6,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678463","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":"Hepatic Hydrothorax: A Comprehensive Approach to Diagnosis and Management.","authors":"Ivo Mendes, Ana Siopa Inácio, Martim Costa Urbano, Paulo Calvinho, Gonçalo Nunes","doi":"10.1159/000550982","DOIUrl":"https://doi.org/10.1159/000550982","url":null,"abstract":"<p><strong>Background: </strong>Hepatic hydrothorax (HH) is an uncommon but serious complication of advanced cirrhosis, characterized by transudative pleural effusion in the absence of cardiopulmonary or renal pathology. Despite its relatively low prevalence, HH carries significant morbidity and mortality, often presenting complex diagnostic and therapeutic challenges.</p><p><strong>Summary: </strong>The pathogenesis of HH is multifactorial, primarily involving the passage of ascitic fluid through diaphragmatic defects, exacerbated by altered hemodynamics, hypoalbuminemia, and neurohormonal dysregulation. Diagnosis relies on identifying transudative pleural effusion and excluding alternative etiologies. Management requires a stepwise multidisciplinary approach. Initial therapy includes sodium restriction, diuretics, and paracentesis to control ascites. Refractory cases may require serial thoracenteses, transjugular intrahepatic portosystemic shunt (TIPS), or surgical interventions in selected cases. Liver transplantation remains the definitive treatment leading to survival outcomes comparable to other transplant indications.</p><p><strong>Conclusion: </strong>HH develops in advanced cirrhosis and predicts a poor prognosis, with median survival often less than 1 year without transplantation. Optimal care requires early recognition, individualized treatment planning, and close multidisciplinary coordination between hepatology, pulmonology, interventional radiology, and surgical teams. Further research is needed to refine risk stratification and establish standardized management algorithms to improve patient outcomes.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"396-407"},"PeriodicalIF":0.6,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610631","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":"Inflammatory Bowel Disease Incidence following COVID-19: A Systematic Review and Meta-Analysis.","authors":"Aris P Agouridis, Alexandros Hadjivasilis, Georgios Vougiouklakis, Theognosia Ioannou, Stavria Charitonos, Marios Christoforou, Evangelos Ionas, Dimitrios Giannakakis, Nikolaos Spernovasilis","doi":"10.1159/000550703","DOIUrl":"10.1159/000550703","url":null,"abstract":"<p><strong>Background: </strong>A surge of cases of autoimmune and inflammatory diseases, such as inflammatory bowel disease (IBD), have been reported after coronavirus disease 2019 (COVID-19).</p><p><strong>Objective: </strong>The objective of this study was to assess whether COVID-19 has a role in IBD risk.</p><p><strong>Methods: </strong>We searched MEDLINE (PubMed), Cochrane Library and OpenGrey databases up to October 30, 2025, for studies evaluating the incidence of IBD following COVID-19 infection (PROSPERO ID: CRD42024534916).</p><p><strong>Results: </strong>After a full-text review of 84 manuscripts, a total of 8 studies were used in the qualitative analysis. The studies were conducted between 2023 and 2024 and included in total 28,659,801 people, 8,560,826 of which were previously infected with COVID-19 and 20,098,975 that served as healthy controls. The results from the pooled synthesis of 6 studies indicate a 39% higher incidence of IBD in people that were previously infected with COVID-19 (risk ratio [RR] 1.39, 95% CI: [1.12-1.74], <i>p</i> = 0.003, <i>I</i> ² = 97%). Furthermore, from the pooled analysis of 4 eligible studies, a higher incidence of new ulcerative colitis cases following COVID-19 was observed (RR 1.25, 95% CI: [1.17-1.33], <i>p</i> < 0.00001, <i>I</i> ² = 0%). On the contrary, no difference was observed in Crohn's disease incidence between COVID-19 and non-COVID-19 patients (RR 1.23 95% CI: [0.88, 1.72], <i>p</i> = 0.22, <i>I</i> ² = 91%).</p><p><strong>Conclusions: </strong>The findings of the present meta-analysis suggest an increased risk of IBD after COVID-19 infection. Although this is more evident regarding ulcerative colitis, we believe that the available outcomes arising from future studies will clarify the real incidence of Crohn's disease following COVID-19 infection.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"387-395"},"PeriodicalIF":0.6,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13021230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576177","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":"Malignant Small Bowel Neoplasms: A 20-Year Retrospective Analysis in a Tertiary Center.","authors":"Ana Teresa Ferreira, Joana Mesquita, Marta Rocha, Ricardo Marcos-Pinto, Isabel Pedroto, Marta Salgado","doi":"10.1159/000550586","DOIUrl":"10.1159/000550586","url":null,"abstract":"<p><strong>Introduction: </strong>Malignant small bowel neoplasms are rare entities, and knowledge about them remains limited due to their histological diversity and the challenges associated with their investigation. However, their rising incidence has generated increasing clinical and research interest. This study aimed to describe the demographic and clinical characteristics of patients with malignant neoplasms of small bowel and the evolution in their diagnosis over 20 years in a tertiary center.</p><p><strong>Methods: </strong>Single-center retrospective study of data of patients with malignant small bowel neoplasms diagnosed between 2001 and 2020 in a tertiary hospital was performed. Statistical analysis was performed with SPSS version 29.0 (significance level ≤0.05).</p><p><strong>Results: </strong>Out of 135 patients included, 57% were male. Eighty-nine neoplasms (65.9%) were found in the jejunum/ileum. Adenocarcinomas were the most frequently diagnosed neoplasms (31.1%), followed by neuroendocrine tumors (28.1%). At the time of diagnosis, the majority of patients (80.7%) were symptomatic, with severe complications - including obstruction, hemorrhage, or perforation - occurring in 55.4% of cases. Diagnosis typically involved CT scan (40.7%) or upper digestive endoscopy (22.2%); notably, 22.2% patients still required surgery for diagnosis. Diagnoses were mainly made between 2011 and 2020 (65.9%). Between 2001 and 2010, the most common diagnosed tumors were adenocarcinomas (37.0%), whereas between 2011 and 2020, the most frequently diagnosed malignant neoplasms were neuroendocrine tumors (37.1%). The distribution of histological types differed significantly over the years (<i>p</i> = 0.016). Adenocarcinoma had a higher mortality rate (54.8%) compared to neuroendocrine tumors (7.9%).</p><p><strong>Discussion/conclusion: </strong>Given the rarity of these tumors, the cohort of malignant small bowel neoplasms collected at this tertiary center over a 20-year period represents a substantial sample. More than half of patients were symptomatic at diagnosis, despite diagnostic advances over the years. In the last 10 years of the study, there has been an increase in incidence as well as in 5-year survival rates, possibly due to the higher incidence of neuroendocrine tumors and the lower incidence of adenocarcinomas. Notably, the diagnosis of each histological neoplasm type differed significantly statistically over the years, with neuroendocrine tumors being the most diagnosed in recent years.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"355-366"},"PeriodicalIF":0.6,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12981900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470226","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":"Managing Advanced Fibrolamellar Carcinoma at Stage IV: A Case Report.","authors":"Ivánia Furtado, Nuno Gião, Martim Urbano, João Boavida Ferreira","doi":"10.1159/000550704","DOIUrl":"10.1159/000550704","url":null,"abstract":"<p><strong>Introduction: </strong>Fibrolamellar carcinoma (FLC) is a rare primary liver malignancy that predominantly affects young individuals without underlying liver disease, distinguishing it from typical hepatocellular carcinoma. It is characterized by the <i>DNAJB1-PRKACA</i> fusion gene, which is believed to drive tumorigenesis. The diagnosis is often delayed due to nonspecific symptoms. Disease stage and resectability are the most significant prognostic factors. Surgery remains the only potentially curative option, but many patients present with unresectable or metastatic disease, for which there is no established standard treatment. For unresectable and metastatic disease, treatment decisions are largely empirical and based on case series.</p><p><strong>Case presentation: </strong>We report a case of a 29-year-old woman diagnosed with metastatic FLC who was treated with 6 cycles of gemcitabine + oxaliplatin, achieving stable disease for nearly 1 year. However, she subsequently experienced disease progression and rapidly declined, preventing the initiation of further systemic therapy.</p><p><strong>Discussion/conclusion: </strong>This case highlights the limitations of current systemic therapies and the urgent need for novel targeted treatments. Further research is essential to improve outcomes for patients with metastatic FLC.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"33 1","pages":"377-383"},"PeriodicalIF":0.6,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516748","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}