Current Elective Surgical Treatment of Inflammatory Bowel Disease

The incidence of inflammatory bowel disease (IBD) is increasing world-wide and most patient will require some surgical treatment once in life. IBD surgical patients are a challenge to surgeons. Main goals of surgical treatment are (1) to preserve the small bowel integrity because many resections may lead the patient to a small bowel short syndrome and (2) restore normal function as they have absorption disturbances. IBD patients may present mal-nutrition status and/or immunosuppression at the time of surgery. Types of surgery range from a simple plasty in Crohn disease to a total proctocolectomy in Ulcerative Colitis. For Crohn disease most procedures avoid resection and use diseased segments to prevent disabsorption. Herein we describe the most currently used techniques to treat IBD patients, when to indicate surgery and how to prepare them to less outcomes. Patients with Crohn disease with high risk for short bowel syndrome and intestinal failure should be submitted to Strictureplasty otherwise, Bowel Resection is the favored surgical technique for the management of fibrostenotic. Bowel Resection is associated with lower recurrence rate and longer recurrence-free survival

Discriminating radiation injury from recurrent tumor with [18F]PARPi and amino acid PET in mouse models

Background Radiation injury can be indistinguishable from recurrent tumor on standard imaging. Current protocols for this differential diagnosis require one or more follow-up imaging studies, long dynamic acquisitions, or complex image post-processing; despite much research, the inability to confidently distinguish between these two entities continues to pose a significant dilemma for the treating clinician. Using mouse models of both glioblastoma and radiation necrosis, we tested the potential of poly(ADP-ribose) polymerase (PARP)-targeted PET imaging with [18F]PARPi to better discriminate radiation injury from tumor. Results In mice with experimental radiation necrosis, lesion uptake on [18F]PARPi-PET was similar to contralateral uptake (1.02 ± 0.26 lesion/contralateral %IA/ccmax ratio), while [18F]FET-PET clearly delineated the contrast-enhancing region on MR (2.12 ± 0.16 lesion/contralateral %IA/ccmax ratio). In mice with focal intracranial U251 xenografts, tumor visualization on PARPi-PET was superior to FET-PET, and lesion-to-contralateral activity ratios (max/max, p = 0.034) were higher on PARPi-PET than on FET-PET. Conclusions A murine model of radiation necrosis does not demonstrate [18F]PARPi avidity, and [18F]PARPi-PET is better than [18F]FET-PET in distinguishing radiation injury from brain tumor. [18F]PARPi-PET can be used for discrimination between recurrent tumor and radiation injury within a single, static imaging session, which may be of value to resolve a common dilemma in neuro-oncology

The DICA Endoscopic Classification for Diverticular Disease of the Colon Shows a Significant Interobserver Agreement among Community Endoscopists: an International Study

Background & Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (kappa) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal. was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD

International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease

The statements produced by the Chairmen and Speakers of the 3rd International Symposium on Diverticular Disease, held in Madrid on April 11th-13th 2019, are reported. Topics such as current and evolving concepts on the pathogenesis, the course of the disease, the news in diagnosing, hot topics in medical and surgical treatments, and finally, critical issues on the disease were reviewed by the Chairmen who proposed 39 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 124 physicians from 18 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas

Aspectos histologicos do figado de pacientes com cirrose alcoolica, em fase de consumo e apos abstinencia etilica

BV UNIFESP: Teses e dissertaçõe

Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test

CONTEXT: Functional dyspepsia is a condition in which symptoms are not related to organic underlying disease; its pathogenesis is not well known. The small intestinal bacterial overgrowth (SIBO) is characterized by the increase in the number and/or type of colonic bacteria in the upper gastrointestinal tract. The hypothesis of SIBO being associated to functional dyspepsia must be considered, since the impaired motility of the gastrointestinal tract is one of the main etiologic factors involved on both pathologies. OBJECTIVE: To determine if there is SIBO in patients with functional dyspepsia. METHODS: Case-control study, evaluating 34 patients: 23 functional dyspeptic and 11 non-dyspeptic (control group). Questionnaire applied based on Rome III criteria. The patients underwent H2-lactulose breath test, considered positive when: H2 peak exceeding 20 ppm, in relation to fasting, or two peaks exceeding 10 ppm sustained until 60 minutes. RESULTS: Of the 23 dyspeptic patients, 13 (56.5%) obtained positive results for SIBO trough the H2-lactulose breath test. On control group, SIBO was not observed. The association between the dyspeptic group and the control group regarding SIBO was statistically significant, with P = 0.0052. In the group of dyspeptic patients, 12 (52.2%) were using proton pump inhibitor; of these 9 (75%) were positive for SIBO. In the control group, none of the 11 patients used proton pump inhibitors and SIBO was not observed. The association of the dyspeptic group using proton pump inhibitor that were positive for SIBO and the control group was statistically significant, with P = 0.0011. CONCLUSION: It was found that, patients with functional dyspepsia presented SIBO, when they underwent to H2-lactulose breath test, compared to the non-dyspeptic. In addition, it was observed a higher prevalence of SIBO in dyspeptic patients that were using proton pump inhibitors, compared to control group

Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test Avaliação de supercrescimento bacteriano no intestino delgado em pacientes com dispepsia funcional, utilizando o teste de H2 no ar expirado

CONTEXT: Functional dyspepsia is a condition in which symptoms are not related to organic underlying disease; its pathogenesis is not well known. The small intestinal bacterial overgrowth (SIBO) is characterized by the increase in the number and/or type of colonic bacteria in the upper gastrointestinal tract. The hypothesis of SIBO being associated to functional dyspepsia must be considered, since the impaired motility of the gastrointestinal tract is one of the main etiologic factors involved on both pathologies. OBJECTIVE: To determine if there is SIBO in patients with functional dyspepsia. METHODS: Case-control study, evaluating 34 patients: 23 functional dyspeptic and 11 non-dyspeptic (control group). Questionnaire applied based on Rome III criteria. The patients underwent H2-lactulose breath test, considered positive when: H2 peak exceeding 20 ppm, in relation to fasting, or two peaks exceeding 10 ppm sustained until 60 minutes. RESULTS: Of the 23 dyspeptic patients, 13 (56.5%) obtained positive results for SIBO trough the H2-lactulose breath test. On control group, SIBO was not observed. The association between the dyspeptic group and the control group regarding SIBO was statistically significant, with P = 0.0052. In the group of dyspeptic patients, 12 (52.2%) were using proton pump inhibitor; of these 9 (75%) were positive for SIBO. In the control group, none of the 11 patients used proton pump inhibitors and SIBO was not observed. The association of the dyspeptic group using proton pump inhibitor that were positive for SIBO and the control group was statistically significant, with P = 0.0011. CONCLUSION: It was found that, patients with functional dyspepsia presented SIBO, when they underwent to H2-lactulose breath test, compared to the non-dyspeptic. In addition, it was observed a higher prevalence of SIBO in dyspeptic patients that were using proton pump inhibitors, compared to control group.<br>CONTEXTO: A dispepsia funcional é uma afecção cujos sintomas não estão relacionados à doença de base orgânica; sua etiopatogenia não é bem definida. O supercrescimento bacteriano no intestino delgado (SBID) é caracterizado pelo aumento do número e/ou tipo de bactérias colônicas no trato gastrointestinal superior. A hipótese de SBID associado à dispepsia funcional deve ser considerada, uma vez que o distúrbio de motilidade do trato gastrointestinal é um dos principais fatores etiológicos envolvidos nas duas patologias. OBJETIVO: Determinar se há presença de SBID em pacientes com dispepsia funcional. MÉTODO: Estudo caso-controle, avaliando 34 pacientes: 23 dispépticos funcionais e 11 não dispépticos (grupo controle). Questionário baseado nos critérios de Roma III foi aplicado. Os pacientes se submeteram ao teste de H2 no ar expirado com lactulose, considerado positivo: pico de H2 superior a 20 ppm, em relação ao jejum ou dois picos superiores a 10 ppm sustentados até 60 minutos. RESULTADOS: Dos 23 pacientes dispépticos, 13 (56.5%) obtiveram resultado positivo para SBID através do teste de H2 no ar expirado. No grupo controle, não foi evidenciado SBID. A associação entre o grupo dispéptico e o grupo controle em relação ao SBID, mostrou-se estatisticamente significante, com P = 0.0052. Do grupo dispéptico, 12 (52.2%) pacientes faziam uso de inibidor de bomba de prótons; destes, 9 (75%) apresentaram resultado positivo para SBID. No grupo controle, os 11 pacientes não usavam inibidor de bomba de prótons e não foi evidenciado SBID. Mostrou-se estatisticamente significante a associação do grupo de dispépticos em uso de inibidor de bomba de prótons que tiveram SBID e grupo controle, com P = 0.0011. CONCLUSÃO: Concluiu-se que, pacientes com dispepsia funcional apresentaram SBID, quando submetidos ao teste de H2 no ar expirado, em relação aos não-dispépticos. Além disso, observou-se maior prevalência de SBID em pacientes dispépticos que faziam uso de inibidor de bomba de prótons, em relação ao grupo controle

Tratamento da síndrome do intestino irritável tipo diarreia-predominante com mesalazina e/ou Saccharomyces boulardii

Submitted by Luciana Ferreira ([email protected]) on 2019-02-05T12:11:38Z No. of bitstreams: 2 Artigo - Mauro Bafutto - 2013.pdf: 449979 bytes, checksum: 4faed4ed3b048c7dbb39f8e15b848743 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Approved for entry into archive by Luciana Ferreira ([email protected]) on 2019-02-06T11:12:59Z (GMT) No. of bitstreams: 2 Artigo - Mauro Bafutto - 2013.pdf: 449979 bytes, checksum: 4faed4ed3b048c7dbb39f8e15b848743 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2019-02-06T11:12:59Z (GMT). No. of bitstreams: 2 Artigo - Mauro Bafutto - 2013.pdf: 449979 bytes, checksum: 4faed4ed3b048c7dbb39f8e15b848743 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2013-12A síndrome do intestino irritável (SII) é uma doença funcional do intestino, caracterizada por dor abdominal e alterações do hábito intestinal, cuja fisiopatologia permanece desconhecida. Estudos recentes sustentam a hipótese de que algumas formas de SII, especialmente a síndrome do intestino irritável tipo diarreia (SII-D), apresentam sinais de uma inflamação de baixo grau persistente da mucosa intestinal e alterações da microflora intestinal. A mesalazina é conhecida por suas propriedades anti-inflamatórias intestinais. O Saccharomyces boulardii é um probiótico largamente utilizado para o tratamento da diarreia relacionada à causa infecciosa. Objetivo – Avaliar os efeitos da mesalazina, da terapia com me- salazina combinada ao Saccharomyces boulardii e do Saccharomyces boulardii, em pacientes com SII-D. Método – Com base nos critérios de Roma III, 53 pacientes com SII-D (maiores de 18 anos) foram incluídos. Para excluir as doenças orgânicas, todos os pacientes realizaram colonoscopia, coprocultura, anticorpo anti-endomísio, teste de tolerância à lactose e exame parasitológico de fezes. Os pacientes foram divididos em três grupos: grupo mesalazina (GM) – 20 pacientes foram medicados com mesalazina via oral 800 mg t.i.d. por 30 dias; grupo mesalazina e Saccharomyces boulardii (GMSb) – 21 pacientes foram medicados com mesalazina 800mg t.i.d. e Saccharomyces boulardii 200 mg via oral t.i.d. por 30 dias; grupo Saccharomyces boulardii (GSb) – 12 pacientes foram medicados com Saccharomyces boulardii 200 mg t.i.d. por 30 dias. Não foram permitidas drogas concomitantes com algum efeito sobre secreção ou motilidade intestinal. Os sintomas foram avaliados no basal e após tratamento por meio da escala de Likert de 4 pontos que incluía: frequência de evacuações; forma e consistência das fezes (baseado na escala de Bristol); dor abdominal; e distensão abdominal. A analise estatística foi realizada por meio de teste t pareado e do teste de Kruskal-Wallis. Resultados - Comparados ao basal, observou-se uma redução estatisticamente significativa da pontuação de sintomas após 30 dias de tratamento no GM (P<0.0001); GMSb (P<0.0001); e GSb (P<0.003). Diferença estatisticamente significativa da pontuação de sintomas após 30 dias de tratamento entre GM, GMSb e GSb (P = 0.03). Não foi observada diferença estatisticamente significativa entre GM e GMSb após 30 dias de tratamento (P = 0,9). Conclusão – O uso da mesalazina isolada, do Saccharomyces boulardii isolado ou do tratamento combinado com ambos, mesalazina e Saccaromyces boulardii, melhoraram os sintomas da SII-D. A melhora dos sintomas foi maior naqueles que usaram mesalazina seja isolada ou em combinação com Saccharomyces boulardii quando comparada com o uso de Saccharomyces boulardii isoladamente. Estes resultados sugerem que a mesalazina pode ser útil no tratamento de pacientes com SII-D e justificam outros estudos com maior número de pacientes.Irritable bowel syndrome (IBS) is a functional bowel disease characterized by abdominal pain and altered in- testinal habits. The pathophysiology of IBS remains unclear. Recent studies have demonstrated that some IBS patients, especially in diarrhea-predominant IBS (IBS-D), display persistent signs of minor mucosal inflammation and a modified intestinal microflora. The mesalazine has known intestinal anti-inflammatory properties. Saccharomyces boulardii is a probiotic used for a long time in treatment of diarrhea, including infectious diarrhea. Objective - Evaluate the effects of mesalazine alone, combined therapy of me- salazine with liophylised Saccharomyces boulardii or alone on symptoms of IBS-D patients. Methods - Based on Rome III criteria, 53 IBS-D patients (18 year or more) were included. To exclude organic diseases all patients underwent colonoscopy, stool culture, serum anti-endomisium antibody, lactose tolerance test and ova and parasite exam. Patients were divided in three groups: mesalazine group (MG) - 20 patients received mesalazine 800 mg t.i.d. for 30 days; mesalazine and Saccharomyces boulardii group (MSbG) - 21 patients received mesalazine 800 mg t.i.d. and Saccharomyces boulardii 200 mg t.i.d. for 30 days and; Saccharomyces boulardii group (SbG) – 12 patients received Sb 200 mg t.i.d. for 30 days. Drugs that might have any effect on intestinal motility or secretion were not allowed. Symptom evaluations at baseline and after treatment were performed by means of a 4-point likert scale including: stool frequency, stool form and consistency (Bristol scale), abdominal pain and distension. Paired t test and Kruskal-Wallis test were used for statistical analyses. Results - Compared to baseline, there were statistically significant reduction of symptom score after 30 th day therapy in all three groups: MG (P<0.0001); MSbG (P<0.0001) and in SbG (P = 0.003). There were statistically significant differ- ences in the symptom score at 30 th day therapy of the MG, MSbG and SbG groups (P = 0.03). There were no statistical differences between MSbG and MG symptom score at 30th day therapy (P = 0.9). Conclusions - The use of mesalazine alone, Saccharomyces boulardii alone or combined treatment with mesalasine and Saccaromyces boulardii improved IBS-D symptoms. The improvement of the symptom score was greater with mesalazine alone or combined with Sb as compared with Sb treatment alone. These preliminary results suggest that mezalazine may be useful in treatment of IBS-d patients, and warrant further larger studies