Bowel symptoms associated with coronavirus disease 19 in hospitalized patients with moderate to severe illness

Bowel symptoms, such as diarrhea, have higher prevalence during coronavirus disease 2019 (COVID-19). The correlation between the severity of these symptoms and their prognosis has not been defined yet. Furthermore, higher prevalence of gastrointestinal symptoms after recovery from COVID-19 has been reported. This study aimed to analyze the correlation of potential factors with the severity of diarrhea during COVID-19 and to assess the progression of post-COVID-19 bowel symptoms. This prospective longitudinal cohort included 109 patients with moderate to severe COVID-19 symptoms who were hospitalized from May to July 2021. Patients were interviewed to assess the presence and intensity of bowel symptoms during COVID-19 and 3–6 months after hospital discharge using the Gastrointestinal Symptom Rating Scale questionnaire. Demographic and clinical data were obtained and their correlations with the intensity of bowel symptoms were examined. The presence of severe diarrhea was correlated with the need for ventilatory support and the use of anticoagulants but not with the use of antibiotics. In addition, bowel symptoms, such as loose stools and incomplete evacuation but not diarrhea, constipation, or abdominal pain, persisted for at least 3–6 months after hospital discharge. These results suggest that the severity of diarrhea during COVID-19 may be associated with worsening of the disease and that only loose stools and incomplete evacuation are present after COVID-19. The chronicity of these bowel symptoms should be evaluated to improve the treatment of patients with COVID-19

Dyspeptic symptoms and delayed gastric emptying of solids in patients with inactive Crohn's disease

Background: Patients with Crohn's disease (CD) have been shown to present dyspeptic symptoms more frequently than the general population. Some of these symptoms could be related to motility disorders to some degree. Then, we propose to investigate whether gastric emptying of solids in patients with inactive CD is delayed and to determine the relationships between gastric emptying and dyspeptic symptoms in inactive CD. Methods: Twenty-six patients with inactive Crohn's disease, as defined by a Crohn's Disease Activity Index (CDAI) < 150, underwent a gastric emptying test by breath test using C-13 octanoic acid coupled to a solid meal and answered a validated questionnaire (The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms. Patients with scores >= 6 were considered to have dyspepsia. The control group was composed by 19 age-and sex-matched healthy volunteers. Results: Patients with CD had a significantly longer t 1/2 and t lag (p<0.05) than the controls. CD patients with dyspepsia had significantly (p<0.05) prolonged gastric emptying when compared to patients without dyspeptic symptoms. When the individual symptom patterns were analyzed, only vomiting was significantly associated with delayed gastric emptying (p<0.05). There was no difference between the subgroups of patients with respect to gender, CDAI scores, disease location, clinical behavior (obstructive/obstructive) or previous gastrointestinal surgery. Conclusion: Delayed gastric emptying in inactive Crohn's disease patients seems to be associated with dyspeptic symptoms, particularly vomiting, even without any evidence of gastrointestinal obstruction.Brazilian National Research Council (CNPq)Brazilian National Research Council (CNPq

Sulfated-Polysaccharide Fraction from Red Algae Gracilaria caudata Protects Mice Gut Against Ethanol-Induced Damage

The aim of the present study was to investigate the gastroprotective activity of a sulfated-polysaccharide (PLS) fraction extracted from the marine red algae Gracilaria caudata and the mechanism underlying the gastroprotective activity. Male Swiss mice were treated with PLS (3, 10, 30 and 90 mg·kg−1, p.o.), and after 30 min, they were administered 50% ethanol (0.5 mL/25 g−1, p.o.). One hour later, gastric damage was measured using a planimeter. Samples of the stomach tissue were also obtained for histopathological assessment and for assays of glutathione (GSH) and malondialdehyde (MDA). Other groups were pretreated with l-NAME (10 mg·kg−1, i.p.), dl-propargylglycine (PAG, 50 mg·kg−1, p.o.) or glibenclamide (5 mg·kg−1, i.p.). After 1 h, PLS (30 mg·kg−1, p.o.) was administered. After 30 min, ethanol 50% was administered (0.5 mL/25g−1, p.o.), followed by sacrifice after 60 min. PLS prevented-ethanol-induced macroscopic and microscopic gastric injury in a dose-dependent manner. However, treatment with l-NAME or glibenclamide reversed this gastroprotective effect. Administration of propargylglycine did not influence the effect of PLS. Our results suggest that PLS has a protective effect against ethanol-induced gastric damage in mice via activation of the NO/KATP pathway

IMMUNOHISTOCHEMICAL APPROACH REVEALS LOCALIZATION OF CYSTATHIONINE-?-LYASE AND CYSTATHIONINE-ß-SYNTHETASE IN ETHANOL-INDUCED GASTRIC MUCOSA DAMAGE IN MICE

Context Hydrogen sulphide (H2S) has been proved to be a neuromodulator and contributes to the maintenance of gastric mucosal integrity in damage caused by anti-inflammatory nonsteroidal drugs. Previously, we demonstrated that H2S synthesis is essential to gastric protection against ethanol. Objective To better understanding the role of H2S and the detailed localization of its production in both normal and injured stomach due to ethanol injection, we studied the expression of cystathionine-γ-lyase (CSE) and cystathionine-β-synthetase (CBS) isoforms in gastric mucosa of mice treated with saline or 50% ethanol. Methods Mice were treated by gavage with saline or 50% ethanol (0.5 mL/25 g). After 1 hour, mice were sacrificed, and gastric tissue was evaluated by histological and immunohistochemical analysis specific for CSE and CBS. Results We have demonstrated a non-specific expression of CBS in the normal gastric mucosa and expression of CSE occurring mainly in the parietal cells of the animals treated with ethanol. Conclusion Thus, we demonstrated that the expression of CBS appears to be constitutive and diffuse across the gastric epithelium, while the expression of CSE appears to be induced in parietal cells by damage agents such as ethanol

AGREEMENT BETWEEN DIFFERENT PATHOLOGISTS IN HISTOPATHOLOGIC DIAGNOSIS OF 128 GASTRIC POLYPS

ABSTRACT BACKGROUND - Gastric polyps are elevated mucosal lesions. Most of them are less than 1 cm and when larger than 2 cm, has a high malignancy probability. The histopathological types are mainly fundic gland polyps, hyperplastic polyps and adenomatous polyps. OBJECTIVE - To evaluate the agreement between three different pathologists in the histopathological diagnosis of 128 biopsied gastric polyps in Digestive Endoscopy Unit from Walter Cantídeo University Hospital, between May 2010 to May 2012. METHODS - To describe the intensity of agreement between observers, we use kappa index that is based on the number of concordant measures between them. RESULTS - There was substantial agreement in the diagnosis of adenoma (kappa=0.799, CI: 0.899-0.698) and fundic glands (kappa=0.655, CI: 0.755-0.555). Regarding to hyperplastic polyps (kappa=0.415, CI: 0.515-0.315) and inflammatory (kappa=0.401, CI: 0.501-0.301), we obtained a moderate agreement. Regarding the presence of Helicobacter pylori in biopsy of the polyp, there was a low agreement (kappa=0.219, CI: 0.319-0.119). CONCLUSION - It is clear that the agreement between pathologists depends on the histological type of the biopsied polyp and this agreement is more substantial in adenoma, or fundic gland polyps

Fatores relacionados à detecção de displasia em pacientes com esôfago de Barrett longo do Hospital Universitário Walter Cantídio

Introdução: pacientes com doença do refluxo gastroesofágico (DRGE) têm de 10 a 15% de chance de desenvolver esôfago de Barrett. Este pode evoluir para displasia e adenocarcinoma esofágico. Objetivo: avaliar fatores relacionados à detecção de displasia em pacientes com esôfago de Barrett longo. Metodologia: estudo retrospectivo com análise de informações de 18 pacientes com diagnóstico de esôfago de Barrett longo, colhidas de bancos de dados dos serviços de Endoscopia e Patologia e prontuários do Hospital Universitário Walter Cantídio (HUWC-UFC), no período de 2010 a 2015. Os pacientes foram divididos em dois grupos para comparação, grupo sem displasia (N=11) e grupo com displasia/adenocarcinoma (N=7). Resultados: do total de 18 pacientes com esôfago de Barrett longo no HUWC, 72% eram do sexo masculino, 47% tinham mais de 50 anos, 64% apresentavam sintomas típicos de DRGE, 23% eram tabagistas, 77% tinha hérnia hiatal, 50% realizaram fundoplicatura. Não houve diferenças estatísticas destas características entre o grupo com e sem displasia. Entretanto, o grupo com displasia teve uma média de 5 endoscopias/paciente, enquanto o grupo sem displasia teve apenas 2 endoscopias/paciente(p<0,05). Conclusão: O maior número de endoscopias realizadas foi um fator relacionado à maior detecção de displasia/adenocarcinoma em pacientes com esôfago de Barrett no HUWC-UFC

A MEDICAL AND NEUROPSYCHIATRIC MANAGEMENT SURVEY IN A BRAZILIAN COHORT OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD)

ABSTRACT Inflammatory bowel disease (IBD) can be accompanied by several neurological disorders. Since 2004, we started a Brazilian cohort to assess neuropsychiatric complications in IBD patients. Changes in therapeutic strategy and differences in the prevalence and relevance of neuropsychiatric disorders have been reported in the literature. We conducted a short patient-reported survey about the medical management of IBD (with a special focus on neuropsychiatric management) and its complications. During the enrollment period (9/1/2021 to 8/31/2022), 279 patients with IBD answered the survey (128 patients with ulcerative colitis and 151 with Crohn’s disease). This is the first medical management survey aimed to verify the level of perception of IBD patients about their neuropsychiatric conditions. We found a high prevalence of neurologic (59%), psychiatric (32%), and neuropsychiatric co-morbidities (69%). There is a marked discrepancy between the findings of neurological disorders reported in our studies over the first 10 years of the cohort in comparison with the current perception/knowledge among the patients registered in the present management survey. Patients tend to have a better understanding of central rather than peripheral nerve conditions