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Introduction: Eosinophilic gastroenteritis (EoG) is a rare condition with a yet poorly understood pathophysiology. Case Presentation: We report on a case of a 36-year-old woman with a history of atopy presenting with nausea, abdominal discomfort, weight loss, and ascites. Laboratorial analysis revealed peripheral eosinophilia and a slight elevation of inflammatory markers. The patient pursued medical assistance several times with a delay in the diagnosis. The pathway to the diagnosis of EoG with serosal infiltration and further management is presented. Discussion: Despite being diagnosed by exclusion, it is important to suspect EoG with subserosa involvement in patients presenting with the uncommon association of peripheral eosinophilia and ascites, particularly if there is a history of atopy.

Introdução: A gastroenterite eosinofílica é uma condição rara, com uma etiologia ainda pouco compreendida. Caso Clínico: Uma mulher de 36 anos, com antecedentes de atopia, que se apresenta com náuseas, desconforto abdominal difuso, perda ponderal e ascite de novo. As análises laboratoriais revelaram eosinofilia periférica e ligeira elevação dos parâmetros inflamatórios. A doente recorreu a cuidados de saúde repetidamente sem um diagnóstico. É apresentado o percurso até ao diagnóstico de gastroenterite eosinofílica com infiltração serosa e tratamento subsequente. Discussão: Apesar de ser um diagnóstico de exclusão, é importante suspeitar de gastroenterite eosinofílica com envolvimento subseroso perante a associação de ascite a sintomas gastrointestinais inespecíficos particularmente em doentes com história de atopia.

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BACKGROUND: Despite the potential advantages of patients' self-recordings of bowel habits in lower digestive disorders, few studies evaluate the relevance of clinical information obtained through bowel diaries in clinical practice. OBJECTIVE: The main objective of this study was to evaluate the role of bowel diaries as an auxiliary diagnostic tool in lower gastrointestinal disorders consultations. METHODS: In this cross-sectional study, at the end of their gastroenterology consultation, patients were questioned about their bowel habits and gastrointestinal symptoms. The bowel diary was then filled by the patients at home for 2 weeks. The data collected from the clinical interview and from the bowel diaries were analyzed. RESULTS: Fifty-three patients participated in the study. Patients underestimated the number of their bowel movements (BM) in the interviews compared with the bowel diaries (P=0.007). There was a poor agreement between stool consistencies described in the interviews and recorded in the diaries (k=0.281). Patients overestimated their straining during evacuation in the interviews compared with the diaries (P=0.012). Regarding the subgroups' analysis, patients with proctological disorders described less BM in their interviews (P=0.033). Straining during evacuation was higher in the interviews of patients without proctological disorders (P=0.028) and in the interviews of more educated patients (P=0.028). CONCLUSION: Overall, there were discrepancies between the clinical interview and the bowel diary regarding the number of BM, the stool consistency and straining. Bowel diaries are therefore a relevant instrument as a complement to the clinical interview to objectify patients' complaints and treat functional gastrointestinal disorders more adequately.

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ABSTRACT Background Despite the potential advantages of patients' self-recordings of bowel habits in lower digestive disorders, few studies evaluate the relevance of clinical information obtained through bowel diaries in clinical practice. Objective The main objective of this study was to evaluate the role of bowel diaries as an auxiliary diagnostic tool in lower gastrointestinal disorders consultations. Methods In this cross-sectional study, at the end of their gastroenterology consultation, patients were questioned about their bowel habits and gastrointestinal symptoms. The bowel diary was then filled by the patients at home for 2 weeks. The data collected from the clinical interview and from the bowel diaries were analyzed. Results Fifty-three patients participated in the study. Patients underestimated the number of their bowel movements (BM) in the interviews compared with the bowel diaries (P=0.007). There was a poor agreement between stool consistencies described in the interviews and recorded in the diaries (k=0.281). Patients overestimated their straining during evacuation in the interviews compared with the diaries (P=0.012). Regarding the subgroups' analysis, patients with proctological disorders described less BM in their interviews (P=0.033). Straining during evacuation was higher in the interviews of patients without proctological disorders (P=0.028) and in the interviews of more educated patients (P=0.028). Conclusion Overall, there were discrepancies between the clinical interview and the bowel diary regarding the number of BM, the stool consistency and straining. Bowel diaries are therefore a relevant instrument as a complement to the clinical interview to objectify patients' complaints and treat functional gastrointestinal disorders more adequately.

RESUMO Contexto: Apesar das potenciais vantagens do diário intestinal como complemento à entrevista clínica, raros estudos avaliam a relevância da informação clínica obtida a partir de diários intestinais na prática clínica. Objetivo Os principais objetivos deste estudo foram avaliar o papel do diário intestinal como ferramenta diagnóstica numa consulta dedicada a patologia digestiva baixa. Métodos Foi realizado um estudo transversal, num período de 3 meses, em que no final das consultas os pacientes foram entrevistados relativamente a dados demográficos, antecedentes clínicos e hábitos e sintomas intestinais. Em seguida, foi solicitado o auto-preenchimento de um diário intestinal durante 2 semanas. Foram comparadas as respostas obtidas na entrevista clínica com os registos dos diários intestinais. Resultados: Cinquenta e três pacientes participaram no estudo. A frequência de evacuações reportada nas entrevistas clínicas e nos diários intestinais dos pacientes foi significativamente diferente (P=0,007). Verificou-se apenas uma concordância mínima entre a consistência das fezes descrita nas entrevistas e registada nos diários (κ=0,281). Em relação ao esforço evacuatório os pacientes sobrestimaram o seu esforço ao evacuar nas entrevistas (P=0,012). Adicionalmente, verificou-se que pacientes com doenças proctológicas descreveram menos evacuações nas suas entrevistas (P=0,033). A descrição do esforço durante a evacuação foi superestimada nas entrevistas de pacientes sem distúrbios proctológicos (P=0,028) e de pacientes com um nível mais elevado de educação (P=0,028). Conclusão: Globalmente verificaram-se discrepâncias entre a entrevista clínica e o diário intestinal dos pacientes em relação ao número de dejeções, à consistência das fezes e ao esforço evacuatório. Assim, esta ferramenta revelou-se uma potencial mais-valia na prática clínica diária, permitindo objetivar as queixas e consequentemente tratar os pacientes de forma mais adequada.

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Introduction: health literacy has an increasing relevance as the disseminated access to online contents may impact on community health. This study aimed to evaluate the suitability of the online content of benign proctological disorders.Methods: the platforms Google© and YouTube™ were searched using the keywords hemorrhoidal disease, anal fistula, anal fissure, anal pruritus and fecal incontinence. Each page was analyzed for: interactivity, credibility, readability and content adequacy. For each video, the content, reactions and comments of the users were analyzed. Three validated scales were applied: Simple Measure of Gobbledygook (SMOG); Suitability Assessment of Materials (SAM), and quality criteria for consumer health information on treatment choices (DISCERN).Results: a total of 127 webpages and 113 videos were evaluated. Forty webpages (31.50 %) included images and ten (37.04 %) had informative videos. The SMOG scale had an average value of 9.91 ± 0.94, which estimates the need for ten years of schooling for comprehension and 64 webpages (52.07 %) presented a reading level higher than the recommended B1. The mean SAM score was 39.46 ± 11.2 % and the DISCERN scale averaged 40.33 ± 5.69, corresponding to a reasonable content. Only 20 pages (15.75 %) included interactivity tools and 44 (34.64 %) contained bibliographic references. The videos posted by patients (n = 67, 59.2 %) had the highest number of views and positive comments whereas videos from health professionals (n = 21; 18.75 %) had the highest proportion of requests for additional information.Discussion: online content regarding benign proctological disorders is globally inappropriate for the health literacy level of the Portuguese population, both at the written and reading levels. (AU)

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BACKGROUND: Chronic constipation (CC) is a major public health condition and CC management remains challenging. OBJECTIVE: We aimed to evaluate the CC (and subtypes) prevalence in a Southern Europe Mediterranean country using Rome IV criteria, and to assess related factors, toilet and healthcare seeking behaviours. METHODS: Cross-sectional epidemiological survey, conducted in general community and representing the Portuguese population according to sex and age. The questionnaire covered bowel habits, factors potentially associated with CC (demographic, health/lifestyle, toilet behaviours) and data regarding healthcare seeking. RESULTS: From the study data of 1950 individuals were analyzed. The answer rate was 68% and 1335 questionnaires were available for calculation. The CC prevalence was 17.8%, with respectively 9.3% of Functional Constipation (FC) and 8.5% of Irritable Bowel Syndrome - subtype constipation (IBS-C). The likelihood of constipation was significantly higher in younger (OR 1.01; 95% confidence interval [CI], 1.007-1.031), solo (OR 2.48; 95% CI, 1.7-3.47) and low-income (OR 2.40; 95% CI, 1.77-3.47) individuals. Constipated individuals spent more time at defecation, longer than 5 min (p = 0.001), and had particular toilet behaviours (absence of a morning pattern [p = 0.008], the use of triggers [p = 0.001] and reading/technological material [p = 0.006]) to facilitate the evacuation. Only 39% of affected individuals sought medical advice, mainly IBS-C patients (p = 0.018). CONCLUSION: Chronic constipation seems to impact 1 in each 5 Portuguese. Constipated patients are younger, solo, less active and with low income. They develop a clear toilet behaviour profile. FC and IBS-C patients assume particular behaviours.

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A 76-year-old female with a medical history of diabetes, arterial hypertension and dyslipidemia sought medical assistance due to left flank abdominal pain, fatigue and anorexia over the previous month. Laboratory analyses were normal and the computed tomography (CT) scan showed colonic diverticulosis and mesenteric panniculitis.

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INTRODUCTION: health literacy has an increasing relevance as the disseminated access to online contents may impact on community health. This study aimed to evaluate the suitability of the online content of benign proctological disorders. METHODS: the platforms Google© and YouTube™ were searched using the keywords hemorrhoidal disease, anal fistula, anal fissure, anal pruritus and fecal incontinence. Each page was analyzed for: interactivity, credibility, readability and content adequacy. For each video, the content, reactions and comments of the users were analyzed. Three validated scales were applied: Simple Measure of Gobbledygook (SMOG); Suitability Assessment of Materials (SAM), and quality criteria for consumer health information on treatment choices (DISCERN). RESULTS: a total of 127 webpages and 113 videos were evaluated. Forty webpages (31.50 %) included images and ten (37.04 %) had informative videos. The SMOG scale had an average value of 9.91 ± 0.94, which estimates the need for ten years of schooling for comprehension and 64 webpages (52.07 %) presented a reading level higher than the recommended B1. The mean SAM score was 39.46 ± 11.2 % and the DISCERN scale averaged 40.33 ± 5.69, corresponding to a reasonable content. Only 20 pages (15.75 %) included interactivity tools and 44 (34.64 %) contained bibliographic references. The videos posted by patients (n = 67, 59.2 %) had the highest number of views and positive comments whereas videos from health professionals (n = 21; 18.75 %) had the highest proportion of requests for additional information. DISCUSSION: online content regarding benign proctological disorders is globally inappropriate for the health literacy level of the Portuguese population, both at the written and reading levels.

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Hemorrhoidal disease (HD) is a frequent health problem with considerable repercussions on patients' quality of life. However, much of the clinical practice related to HD is based on knowledge without scientific evidence and supported largely by empirical experience of the physician who deals with this pathology. As in other countries, the goal of this consensus is to establish statements supported by solid scientific evidence and whose purpose will be to standardize and guide the diagnosis and management of HD both in the general population and in some particular groups of patients.

A doença hemorroidária é uma patologia prevalente com repercussões consideráveis na qualidade de vida dos doentes. No entanto, muita da prática clínica relacionada com a doença hemorroidária é baseada em conhecimentos sem evidência científica e apoiada largamente por uma experiência empírica por parte do médico que lida com esta patologia. À semelhança do que tem sido feito noutros países, o objetivo deste consenso foi estabelecer statements suportados por evidência científica sólida e cuja finalidade será o de uniformizar e orientar o diagnóstico e tratamento da doença hemorroidária quer na população em geral quer em grupos particulares de doentes.

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Introduction: Some patients undergoing transanal total mesorectal excision (TaTME) may experience post-surgical complications, such as impaired bowel function and urogenital and sexual dysfunction. The present work aims to evaluate the one-year impact of TaTME surgery on bowel function, quality of life, and outcomes.Material and methods: Twenty patients undergoing TaTME with cancer in the mid and lower rectum were assessed prospectively by endoscopic transanal ultrasound (EUS) and three physiological function degrees, along with different clinical outcome questionnaires.Results: EUS sphincter evaluation revealed no structural impact in follow-up. For evacuatory evaluation, differences in the scores of the first postoperative month of Wexner questionnaires were shown when compared to a 12-month period. At least 10% of patients remain with major low anterior resection syndrome (LARS) after one year. The (Fecal incontinence Quality of Life) FiQoL questionnaire revealed that the cases in which values were worse in the first month posteriorly recovered to baseline preoperative values.Conclusions: TaTME does not seem to impact sphincter structure and evacuatory function, with a good recovery rate one year post-surgery, but does not seem to interfere with patients' evacuatory function quality of life.

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PURPOSE: Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting. METHODS: Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies. RESULTS: Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse). CONCLUSION: A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first week.

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BACKGROUND: Recently, the Obstructed Defecation Syndrome score (ODS score) was developed and validated by Renzi to assess clinical staging and to allow evaluation and comparison of the efficacy of treatment of this disorder. OBJECTIVE: Our goal is to validate the Portuguese version of Renzi ODS score, according to the Consensus based Standards for the selection of the Health Measurement Instruments (COSMIN) checklist. METHODS: Following guidelines for cross-cultural validity, Renzi ODS score was translated into the Portuguese language. Then, a group of patients and healthy controls were invited to fill in the Renzi ODS score at baseline, after 2 weeks and 3 months, respectively. We assessed internal consistency, reliability and measurement error, content and construct validity, responsiveness and interpretability. RESULTS: A total of 113 individuals (77 patients; 36 healthy controls) completed the questionnaire. Seventy and 30 patients repeated the Renzi ODS score after 2 weeks and 3 months respectively. Factor analysis confirmed the unidimensionality of the scale. Cronbach's α coefficient of 0.77 supported item's homogeneity. Weighted quadratic kappa of 0.89 established test-retest reliability. The smallest detectable change at the individual level was 2.66 and at the group level was 0.30. Renzi ODS score and the total (-0.32) and physical (-0.43) SF-36 scores correlated negatively. Patient and control's groups significantly differed (11 points). The change score of Renzi ODS score between baseline and 3 months correlated negatively with the clinical evolution (-0.86). ROC analysis showed minimal important change of 2.00 with AUC 0.97. Neither floor nor ceiling effects were observed. CONCLUSION: This work validated the Portuguese version of Renzi ODS score. We can now use this reliable, responsive, and interpretable (at the group level) tool to evaluate Portuguese ODS patients.

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ABSTRACT BACKGROUND: Recently, the Obstructed Defecation Syndrome score (ODS score) was developed and validated by Renzi to assess clinical staging and to allow evaluation and comparison of the efficacy of treatment of this disorder. OBJECTIVE: Our goal is to validate the Portuguese version of Renzi ODS score, according to the Consensus based Standards for the selection of the Health Measurement Instruments (COSMIN) checklist. METHODS: Following guidelines for cross-cultural validity, Renzi ODS score was translated into the Portuguese language. Then, a group of patients and healthy controls were invited to fill in the Renzi ODS score at baseline, after 2 weeks and 3 months, respectively. We assessed internal consistency, reliability and measurement error, content and construct validity, responsiveness and interpretability. RESULTS: A total of 113 individuals (77 patients; 36 healthy controls) completed the questionnaire. Seventy and 30 patients repeated the Renzi ODS score after 2 weeks and 3 months respectively. Factor analysis confirmed the unidimensionality of the scale. Cronbach's α coefficient of 0.77 supported item's homogeneity. Weighted quadratic kappa of 0.89 established test-retest reliability. The smallest detectable change at the individual level was 2.66 and at the group level was 0.30. Renzi ODS score and the total (-0.32) and physical (-0.43) SF-36 scores correlated negatively. Patient and control's groups significantly differed (11 points). The change score of Renzi ODS score between baseline and 3 months correlated negatively with the clinical evolution (-0.86). ROC analysis showed minimal important change of 2.00 with AUC 0.97. Neither floor nor ceiling effects were observed. CONCLUSION: This work validated the Portuguese version of Renzi ODS score. We can now use this reliable, responsive, and interpretable (at the group level) tool to evaluate Portuguese ODS patients.

RESUMO CONTEXTO: Recentemente, o Score de Distúrbios Evacuatórios (SDE) foi desenvolvido e validado por Renzi para avaliação e comparação da eficácia do tratamento dos doentes com esta patologia. Objetivo - O nosso objetivo é validar uma versão portuguesa do SDE de acordo com as orientações da checklist de COSMIN. MÉTODOS: O SDE foi traduzido para o português, cumprindo as orientações para validação cultural. Indivíduos com distúrbio evacuatório e controlos saudáveis foram convidados a responder ao SDE numa fase inicial, 2 semanas e 3 meses depois, respetivamente. Foi avaliada a consistência interna, confiabilidade, erro de medição, validade de conteúdo e constructo, responsividade e interpretabilidade. RESULTADOS: Foram entrevistados 113 indivíduos (77 doentes; 36 controlos saudáveis) na fase inicial. O SDE foi aplicado novamente aos 77 doentes, 2 semanas depois, e a 30 doentes, 3 meses depois. Relativamente à consistência interna, a análise fatorial confirmou a unidimensionalidade e o coeficiente α de Cronbach foi 0,77, suportando homogeneidade dos itens. O kappa quadrático ponderado de 0,89 estabeleceu a reprodutibilidade teste-reteste. Considerando o erro de medição, a mudança mínima detectável a nível individual foi 2,66 e a nível de grupo foi 0,30. A validade do constructo foi avaliada através do coeficiente de correlação de Spearman entre o SDE e o score total (-0,32) e físico (-0,43) do SF-36. Em termos de validação clínica, verificou-se uma diferença significativa de 11 pontos entre as médias dos doentes e controlos. A responsividade foi confirmada pelo coeficiente de correlação de -0,86 entre a mudança do score e a evolução clínica, avaliados após 3 meses. Através da curva ROC, a mudança mínima importante foi 2,00 e a AUC foi 0,97. Não foram observados efeito-chão efeito-tecto. CONCLUSÃO: Este projeto permitiu validar a versão portuguesa do SDE de Renzi. É possível agora utilizar esta ferramenta na avaliação de distúrbios evacuatórios em doentes falantes de língua portuguesa.

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BACKGROUND: Psychological assessment is not commonly performed nor easily accepted by coloproctological patients. Our aim was to evaluate the psychological component of coloproctological disorders using uncommon tools. METHODS: The 21-Item Depression Anxiety and Stress Scale and the Pescatori projective test were applied to coloproctological outpatients of the Gastroenterology Department of our hospital as well as to healthy volunteers. RESULTS: Seventy patients (median age 47 years, 22 male) divided in 4 groups (functional constipation, constipated irritable bowel syndrome, benign anorectal disease and perianal Crohn's disease) and 52 healthy volunteers (age 45 years, 18 male) completed the tests. Proctological patients showed higher scores of depression (P<0.001), anxiety (P<0.001), and stress (P<0.001) compared to healthy participants. Compared to the control group, patients with functional constipation, irritable bowel syndrome and perianal Crohn's disease maintained the highest scores in all subscales (P<0.05), while patients with benign anorectal disease only had higher anxiety and stress (P<0.001) scores. The patients' also showed lower scores in the Pescatori projective test (P=0.012). A weak association between the projective test and the depression subscale was found (P=0.05). CONCLUSION: Proctological patients had higher scores of depression, anxiety and stress and lower scores in the Pescatori projective test compared to healthy controls.

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BACKGROUND AND STUDY AIMS: Previous reports assessing the reproducibility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in the evaluation of solid pancreatic lesions (SPLs) involved mainly experienced endosonographers. We aimed to assess the interobserver agreement (IOA) of CH-EUS in the evaluation of SPLs by endoscopists with different levels of experience in EUS and CH-EUS. PARTICIPANTS AND METHODS: A cross-sectional observational multicenter study was designed and included 11 endoscopists who were divided into four groups according to their experience in EUS and CH-EUS: group A (long experience in EUS and CH-EUS); group B (short experience in EUS and CH-EUS); group C (long experience in EUS and no experience in CH-EUS); and group D (no experience in EUS or CH-EUS). The observers independently classified the patterns of 60 CH-EUS video sequences of 60 SPLs after a 20-minute training session. For each group, we calculated the IOA (kappa statistic, κ) of CH-EUS and the accuracy of CH-EUS for the diagnosis of pancreatic adenocarcinoma by comparing the pattern of CH-EUS indicative of pancreatic adenocarcinoma (hypo-enhanced contrast pattern) with the final diagnosis. RESULTS: The overall IOA for CH-EUS was fair (κ = 0.32; 95 %CI 0.22 - 0.41). Group A (κ = 0.63; 95 %CI 0.45 - 0.85) had the highest IOA, followed by group C (κ = 0.54; 95 %CI 0.39 - 0.71), group B (κ = 0.38; 95 %CI 0.22 - 0.55), and group D (κ = 0.21; 95 %CI 0.07 - 0.36). The IOA of groups A and C was significantly higher than that of group D. No significant difference was seen between groups A, B, and C or between groups B and D in terms of IOA. Group A (area under the curve under summary receiver operating characteristic [AUROC] = 0.67; 95 %CI 0.58 - 0.75) had the highest accuracy for the diagnosis of pancreatic adenocarcinoma, followed by group C (AUROC = 0.58; 95 %CI 0.50 - 0.65), group B (AUROC = 0.55; 95 %CI 0.48 - 0.63), and group D (AUROC = 0.51; 95 %CI 0.43 - 0.58). The diagnostic accuracy of group A was not significantly different from that of group C, but it was significantly higher than that of groups B and D. No significant difference was seen between groups B, C, and D in terms of diagnostic accuracy. CONCLUSIONS: CH-EUS is reproducible in the evaluation of SPLs, even between endoscopists with no or limited experience in EUS and/or CH-EUS. Long experience in EUS is a major contributor to the IOA and diagnostic accuracy of CH-EUS.

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OBJECTIVE: malignant colorectal polyp, defined by submucosally invasive adenocarcinoma, is the earliest form of clinically relevant colorectal cancer (CRC). After endoscopic resection additional surgery may be necessary, although decision criteria remain debatable. The objective of this study was to assess oncologic outcomes in terms of locoregional disease and to identify areas of improvement that may facilitate patients' management. METHODS: retrospective study of 40 patients with T1 CRC endoscopically resected between 2007 and 2012. Clinicopathological features were assessed and correlated with residual disease (RD), defined as presence of adenocarcinoma in intestinal wall and/ or lymph nodes. RESULTS: thirty-one patients underwent surgery while 9 were followed-up. After surgery, RD was confirmed in 15 (48.4%) patients: 8 (53.3%) wall disease, 5 (33%) nodal metastasis, and 2 (13.3%) with both. No recurrence was detected in the follow-up group. The characteristics of the lesions that were associated with DR were sessile configuration (p = 0.03), the degree of differentiation G3 (p = 0.01) and intercepted/indeterminate margins (p = 0.01). Twenty-two patients were operated because of inadequate evaluation, mainly due to piecemeal resection, and half of them were disease free. Postoperative complications were found in 9 (30%) patients, mainly anastomotic leakage that was associated with rectum anterior resection (p = 0.03). CONCLUSIONS: surgery should be considered in the presence of any risk factor for residual disease, while follow-up can be offered in low risk settings. Was also demonstrated a clear need for technical improvement in endoscopic resection and pathology evaluation in order to prevent unnecessary surgeries.

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BACKGROUND. Hyperplastic polyposis syndrome (HPS) is a rare condition characterized by numerous hyperplastic polyps (HP) with a pancolonic distribution. Genetic and environmental factors, including smoking, may be responsible for phenotypic differences. OBJECTIVE. To characterize HPS patients' phenotype and to determine HPS risk and colorectal cancer (CRC) risk in the first-degree relatives (FDRs). PATIENTS AND METHODS. Eight HPS patients were followed at our Gastroenterology Department (2008-2012). The data included (1) macroscopic and histological analysis of polyps, (2) demographic information about patients and their families and (3) colonoscopy results of FDR that accepted a screening exam. RESULTS. Six of the eight index cases (ICs) had family history of CRC. Of the 24 FDRs screened, 5 were diagnosed with HPS. In our study, HPS and CRC prevalence in FDR was 625 and 9 times higher than the risk of the general population. Polyps over 10 mm were preferentially located in proximal colon (p < 0.001). Advanced polyps were larger (p < 0.001) than HP and more frequent in older patients (p = 0.0054). Nonsmokers had smaller polyps (p = 0.037) preferentially in the proximal colon (p = 0.04) and a lower age at HPS diagnosis. Patients with CRC family history manifest HPS at an earlier age and patients whose relatives had CRC before 50 years had larger polyps (p = 0.0475). Smokers with CRC family history had larger polyps than nonsmokers (p = 0.048). CONCLUSION. Despite the small sample, the results reflect the phenotypic heterogeneity of HPS as well as the increased family risk of HPS and CRC. This study points out that CRC family history and smoking influence HPS expression.

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