RESUMEN
Introducción. El dolor abdominal es uno de los principales motivos de admisión a urgencias y una de las causas más frecuentes es la enfermedad diverticular, que aumenta su prevalencia en el adulto mayor. Sin embargo, la diverticulitis del intestino delgado es una enfermedad infrecuente y en la mayoría de casos es asintomática. No obstante, la perforación de un divertículo intestinal es una complicación común de esta patología, por lo que debe ser considerado como un diagnóstico diferencial de abdomen agudo en este grupo poblacional. Caso clínico. Paciente masculino de 71 años, quien consultó por dolor abdominal de inicio súbito, con signos de irritación peritoneal al examen físico. Dado su deterioro hemodinámico fue llevado a cirugía y en la laparotomía exploratoria se halló una diverticulitis aguda perforada de yeyuno e íleon distal. Resultados. El paciente cursó con una adecuada evolución postoperatoria, sin reingresos. Conclusión. La diverticulitis aguda yeyuno-ileal es una causa importante, pero no frecuente de perforación intestinal. Hay muy pocos casos reportados en la literatura, lo que la convierte en un reto diagnóstico para el médico de urgencias y el cirujano general. No obstante, debe ser considerado como un diagnóstico diferencial en adultos mayores con abdomen agudo.
Introduction. Abdominal pain is one of the main reasons for admission to the emergency room and one of the most frequent causes is diverticular disease, which increases its prevalence in the elderly. However, diverticulitis of the small bowel is rare and in most cases asymptomatic. However, perforation of an intestinal diverticulum is a common complication of this pathology and should be considered as a differential diagnosis of acute abdomen in this population group. Clinical case. A71-year-old male patient presented with abdominal pain of sudden onset, with signs of peritoneal irritation. Given his hemodynamic deterioration, he was taken to surgery and in the exploratory laparotomy an acute perforated diverticulitis of the jejunum and distal ileum was found. Results. The patient had an adequate postoperative evolution, without readmissions. Conclusion. Acute jejuno-ileal diverticulitis is an important but uncommon cause of intestinal perforation. There are very few cases reported in the literature, which makes it a diagnostic challenge for the emergency physician and general surgeon. However, it should be considered as a differential diagnosis in older adults with acute abdomen.
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Humanos , Dolor Abdominal , Diverticulitis , Abdomen Agudo , Íleon , Intestino Delgado , YeyunoRESUMEN
Background: Small bowel bleeding (SB) comprises 5%-10% of gastrointestinal (GI) bleeding cases. This article describes the staged retrograde intraoperative enteroscopy (SRIE) surgical technique for the etiological diagnosis and treatment of small bowel bleeding. Methods: SRIE was performed on patients with persistent SB at a quaternary university hospital in Brazil from 2020 to 2023. The technique is described in 5 steps, alongside visual aids, including images and a depicting a portion of the procedure. Patients presenting with confirmed coagulopathies, pregnancy, or unwillingness for surgery were excluded. Surgical procedures were performed after informed consent. Case Series: Four participants were submitted to SRIE, including 2 females (64 and 83 years old), and 2 males (46 and 57 years old). Three out of four (75%) of the patients received a confirmed diagnosis of GI bleeding, attributed to angioectasia, acquired von Willebrand disease, and vitamin K deficiency. SRIE was conducted via enterotomy, involving a subsequent insufflation-inspection-deflation of 10 to 10 cm segments of the small bowel (Steps 1 to 5). The procedure was successfully executed in all four patients without complications, allowing confirmation of the etiological diagnosis of SB or exclusion of anatomical causes of hemorrhage. Conclusions: SRIE is a valuable but invasive tool for assessing SB hemorrhage when conventional imaging falls short. When performed systematically and standardized, it allows accurate visualization of SB using a standard endoscope.
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Hemorragia Gastrointestinal , Intestino Delgado , Humanos , Masculino , Femenino , Persona de Mediana Edad , Hemorragia Gastrointestinal/cirugía , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Intestino Delgado/cirugía , Anciano de 80 o más Años , Endoscopía Gastrointestinal/métodosRESUMEN
OBJECTIVE: This study evaluated anthropometric, biochemical, and inflammatory biomarkers, as well as dietary intake in Brazilian children diagnosed with small intestinal bacterial overgrowth (SIBO) and compared them with their counterparts without SIBO. METHODS: This was a cross-sectional study with 106 children aged 7 to 10 years. A glucose-hydrogen breath test was performed to diagnose small intestinal bacterial overgrowth (SIBO). Anthropometric and dietary characteristics were assessed. Blood samples were collected and serum biochemical parameters and cytokines were measured. RESULTS: The occurrence of SIBO was 13.2%. Age, BMI, BMI/age WC, BFP, sex and biochemical markers were similar between SIBO-positive and SIBO-negative children (p > 0.05). High consumption of ultra-processed foods tended to be higher in SIBO-positive compared to SIBO-negative children (47.8 ± 8.2 vs. 42.6 ± 9.5, p = 0.06). Serum levels of IL-17 were higher in SIBO-positive than in SIBO-negative children [69.5 (5.4-125.7) vs. 53.4 (2.3-157.7), p = 0.03], while serum levels of IL-10 were lower in SIBO-positive than in SIBO-negative children [2.3 (0.6-7.2) vs. 5.7 (0.5-30.8), p = 0.04]. Finally, in a logistic regression adjusted for sex, BMI and age, consumption of ultra-processed foods (p = 0.03) and IL-6 levels (p = 0.003) were found to contribute to the occurrence of SIBO. CONCLUSION: this study identified for the first time an occurrence of 13% of SIBO in children living in the northeastern region of Brazil and showed that consumption of ultra-processed foods and serum levels of IL-6 may influence the occurrence of the SIBO in the pediatrics population.
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Biomarcadores , Alimentos Procesados , Intestino Delgado , Niño , Femenino , Humanos , Masculino , Biomarcadores/sangre , Síndrome del Asa Ciega/sangre , Síndrome del Asa Ciega/diagnóstico , Brasil/epidemiología , Pruebas Respiratorias , Estudios Transversales , Citocinas/sangre , Dieta , Inflamación/sangre , Intestino Delgado/microbiologíaRESUMEN
A T-cell-independent (TI) pathway activated by microbiota results in the generation of low-affinity homeostatic IgA with a critical role in intestinal homeostasis. Moderate aerobic exercise (MAE) provides a beneficial impact on intestinal immunity, but the action of MAE on TI-IgA generation under senescence conditions is unknown. This study aimed to determine the effects of long-term MAE on TI-IgA production in young (3 month old) BALB/c mice exercised until adulthood (6 months) or aging (24 months). Lamina propria (LP) from the small intestine was obtained to determine B cell and plasma cell sub-populations by flow cytometry and molecular factors related to class switch recombination [Thymic Stromal Lymphopoietin (TSLP), A Proliferation-Inducing Ligand (APRIL), B Cell Activating Factor (BAFF), inducible nitric oxide synthase (iNOS), and retinal dehydrogenase (RDH)] and the synthesis of IgA [α-chain, interleukin (IL)-6, IL-21, and Growth Factor-ß (TGF-ß)]; and epithelial cells evaluated IgA transitosis [polymeric immunoglobulin receptor (pIgR), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), IL-4] by the RT-qPCR technique. The results were compared with data obtained from sedentary age-matched mice. Statistical analysis was computed with ANOVA, and p < 0.05 was considered to be a statistically significant difference. Under senescence conditions, MAE promoted the B cell and IgA+ B cells and APRIL, which may improve the intestinal response and ameliorate the inflammatory environment associated presumably with the downmodulation of pro-inflammatory mediators involved in the upmodulation of pIgR expression. Data suggested that MAE improved IgA and downmodulate the cytokine pro-inflammatory expression favoring homeostatic conditions in aging.
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Envejecimiento , Homeostasis , Inmunoglobulina A , Ratones Endogámicos BALB C , Condicionamiento Físico Animal , Animales , Inmunoglobulina A/metabolismo , Inmunoglobulina A/inmunología , Ratones , Envejecimiento/inmunología , Citocinas/metabolismo , Linfocitos B/inmunología , Linfocitos B/metabolismo , Factor Activador de Células B/metabolismo , Factor Activador de Células B/genética , Mucosa Intestinal/metabolismo , Mucosa Intestinal/inmunología , Intestino Delgado/inmunología , Intestino Delgado/metabolismo , Masculino , Células Plasmáticas/inmunología , Células Plasmáticas/metabolismo , Miembro 13 de la Superfamilia de Ligandos de Factores de Necrosis Tumoral/metabolismo , Miembro 13 de la Superfamilia de Ligandos de Factores de Necrosis Tumoral/genéticaRESUMEN
OBJECTIVE: Small bowel obstruction (SBO) is a common and important surgical emergency. Our aim in this study is to describe the clinical, laboratory, and computed tomography (CT) findings to facilitate the objective identification of SBO patients in need of operative treatment in this patient population. METHODS: This retrospective study included 340 patients hospitalized due to a preliminary diagnosis of ileus. Retrieved data of patients included age, gender, comorbidities, previous hospitalization due to ileus, surgical history, physical examination findings, complete blood count and biochemistry test results, and CT findings at admission. RESULTS: The study included 180 (52.9%) male and 160 (47.1%) female patients. Treatment was conservative in 216 patients and surgery in 124 patients. Of the patients included in the study, 36.4% needed surgery. Of the female patients, 38.90% received conservative treatment and 61.30% underwent surgery. Adhesions were the most common cause of obstruction in operated patients (43.50%). CONCLUSION: We have found that female gender, vomiting, guarding, rebound, C-reactive protein levels above 75 mg/L, increased bowel diameter, and a transition zone on CT images indicate a strong need for surgery, but a history of previous hospitalization for ileus may show that surgery may not be the best option.
OBJETIVO: Describir los hallazgos clínicos, de laboratorio y de tomografía computarizada (TC) para facilitar la identificación objetiva de los pacientes con obstrucción del intestino delgado que necesitan tratamiento quirúrgico. MÉTODO: Este estudio incluyó 340 pacientes. Los datos obtenidos fueron edad, sexo, comorbilidad, hospitalización previa debida a íleo, historia quirúrgica, hallazgos de la exploración física, hemograma completo y resultados de las pruebas bioquímicas, y hallazgos de la TC al ingreso. RESULTADOS: El estudio incluyó 180 (52.9%) varones y 160 (47.1%) mujeres. El tratamiento fue conservador en 216 pacientes y quirúrgico en 124 pacientes. De los pacientes incluidos en el estudio, el 36.4% necesitaron cirugía. De las mujeres, el 38.90% recibieron tratamiento conservador y el 61.30% se sometieron a cirugía. CONCLUSIONES: Encontramos que el sexo femenino, los vómitos, la guardia, el rebote, los niveles de proteína C reactiva superiores a 75 mg/l, el aumento del diámetro intestinal y una zona de transición en las imágenes de TC indican una fuerte necesidad de cirugía.
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Obstrucción Intestinal , Intestino Delgado , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/cirugía , Adulto , Anciano de 80 o más Años , Ileus/etiología , Ileus/diagnóstico por imagen , Proteína C-Reactiva/análisis , Tratamiento Conservador , Adherencias Tisulares/diagnóstico por imagen , Adherencias Tisulares/complicaciones , Adherencias Tisulares/cirugía , Adulto JovenRESUMEN
Introducción. La neumatosis quística intestinal se describe como la presencia de gas dentro de la pared intestinal. Es una entidad poco frecuente, con una incidencia del 0,03 % en la población global. Aparece con predilección en el género masculino después de los 45 años yse localiza principalmente en el intestino delgado (42 %) y el colon. Se puede asociar a varias condiciones que en ocasiones requieren manejo quirúrgico. Caso clínico. Se presenta el caso de un hombre 75 años, con antecedente de hipertensión arterial, quien consultó por un cuadro de 15 días de evolución consistente en distensión abdominal, dolor y estreñimiento. En urgencias se solicitó una radiografía de tórax que mostró neumoperitoneo y varios niveles hidroaéreos, por lo que el cirujano de turno consideró una posible ruptura de víscera hueca. Resultados. Fue llevado a laparotomía exploratoria, donde se identificó neumatosis quística intestinal y estómago muy aumentado de tamaño, compatible con gastroparesia. Como resultado del tratamiento brindado, el paciente tuvo un desenlace satisfactorio logrando alta médica, apoyado con cuidados básicos de enfermería. Conclusiones. Si bien los casos de neumatosis quística intestinal son de presentación inusual, se puede encontrar en pacientes con hallazgos imagenológicos de neumoperitoneo. Por eso, se debe realizar un análisis concienzudo de cada paciente e individualizar el caso para el correcto diagnóstico.
Introduction. Cystic pneumatosis intestinalis is described as the presence of gas within the intestinal wall. It is a rare entity, with an incidence of 0.03% in the global population. It appears with a predilection in the male gender after 45 years of age and is located mainly in the small intestine (42%) and the colon. It can be associated with several conditions that sometimes require surgical management. Clinical case. The case of a 75-year-old man with a history of high blood pressure is presented, who consulted for a 15-day history consisting of abdominal distention, pain and constipation. In the emergency room, a chest x-ray was requested, which showed pneumoperitoneum and several air-fluid levels. The surgeon on call considered a possible rupture of the hollow viscus. Results. The patient was taken to exploratory laparotomy, where intestinal cystic pneumatosis and a greatly enlarged stomach were identified, compatible with gastroparesis. As a result of the treatment provided, the patient had a satisfactory outcome, achieving medical discharge, supported with basic nursing care. Conclusions. Although cases of intestinal cystic pneumatosis have an unusual presentation, it can be found in patients with imaging findings of pneumoperitoneum. Therefore, a thorough analysis of each patient must be carried out and the case individualized for the correct diagnosis.
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Humanos , Neumatosis Cistoide Intestinal , Neumoperitoneo , Gastroparesia , Enfermedades Gastrointestinales , Intestino Delgado , LaparotomíaRESUMEN
OBJECTIVE: Estimating which patients might require surgical intervention is crucial. Patients with complete bowel obstructions exhibit disrupted enterohepatic cycles of bile and bacteremia due to bacterial translocation. The goal of this study was to develop a prediction index using laboratory inflammatory data to identify patients who may need surgery. MATERIALS AND METHODS: The patients were divided into two groups based on their management strategy: Non-operative management (Group 1) and surgical management (Group 2). RESULTS: The indirect bilirubin, direct bilirubin, and total bilirubin were significantly higher in Group 2 than in Group 1 (p = 0.001, p < 0.001, and p < 0.001, respectively). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-NLR (PNLR), and direct bilirubin-to-lymphocyte ratio (DBR) were significantly higher in Group 2 compared to Group 1 (p = 0.041, p = 0.020, and p < 0.001, respectively). In group 2, 78% have viable bowels. Resection was performed in 40% of cases, with 12% mortality and a 10-day average hospital stay. DLR performs the best overall accuracy (72%), demonstrating a well-balanced sensitivity (62%) and specificity (81%). CONCLUSIONS: This study suggested that DBR is a more accurate predictive index for surgical intervention in pediatric adhesive small bowel obstruction patients compared to NLR and PNLR, providing valuable guidance for treatment strategies.
OBJETIVO: Desarrollar un índice de predicción utilizando datos inflamatorios de laboratorio para identificar qué pacientes podrían necesitar cirugía. MÉTODO: Los pacientes se dividieron en dos grupos según su estrategia de manejo: no quirúrgico (grupo 1) o quirúrgico (grupo 2). RESULTADOS: Las bilirrubinas indirecta, directa y total fueron significativamente más altas en el grupo 2 que en el grupo 1 (p = 0.001, p < 0.001 y p < 0.001, respectivamente). Las relaciones neutrófilos-linfocitos, plaquetas-neutrófilos-linfocitos y bilirrubina directa-linfocitos fueron significativamente más altas en el grupo 2 que en el grupo 1 (p = 0.041, p = 0.020 y p < 0.001, respectivamente). En el grupo 2, el 78% tenían intestino viable. Se realizó resección en el 40% de los casos, con un 12% de mortalidad y una estancia hospitalaria promedio de 10 días. La relación bilirrubina directa-linfocitos tuvo la mejor precisión general (72%), demostrando una sensibilidad bien equilibrada (62%) y una buena especificidad (81%). CONCLUSIONES: Este estudio sugiere que la relación bilirrubina directa-linfocitos es un índice predictivo más preciso para la intervención quirúrgica en pacientes pediátricos con obstrucción adhesiva de intestino delgado en comparación con la de neutrófilos-linfocitos y la de plaquetas-neutrófilos-linfocitos, proporcionando una valiosa orientación para las estrategias de tratamiento.
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Bilirrubina , Obstrucción Intestinal , Intestino Delgado , Humanos , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/sangre , Obstrucción Intestinal/etiología , Bilirrubina/sangre , Masculino , Femenino , Adherencias Tisulares/sangre , Intestino Delgado/cirugía , Lactante , Recuento de Linfocitos , Neutrófilos , Linfocitos , Preescolar , Estudios Retrospectivos , Sensibilidad y Especificidad , Niño , Tiempo de Internación/estadística & datos numéricos , Valor Predictivo de las PruebasRESUMEN
A rare condition, sclerosing encapsulating peritonitis, is characterized by a fibrotic membrane forming over the bowels, leading to intestinal obstruction. In this case of a 56-year-old male patient with a history of laparoscopic gastric bypass, a computed tomography scan showed findings indicative of the condition. Extensive adhesiolysis was performed, and biopsies confirmed the presence of fusiform cells (D2-40 positive on immunochemistry) resembling fibroblasts, within dense collagenous peritoneal tissue sheets, typical of sclerosing encapsulating peritonitis. The prevalence of this condition is uncertain, and diagnosis typically requires a peritoneal biopsy due to the nonspecific clinical presentation.
La peritonitis esclerosante encapsulada es una condición rara caracterizada por una membrana fibrótica que se genera sobre las asas intestinales causando cuadros de oclusión intestinal. Se presenta el caso de un paciente varón de 56 años con antecedente de derivación gastroyeyunal por laparoscopia que presenta oclusión intestinal. Se realizó tomografía computada que evidenció sitio de transición previo al sitio de anastomosis. Se realizó de anastomosis extensa y toma de biopsias. Histológicamente se observó engrosamiento de la membrana peritoneal, células fusiformes (D2-40 positivo en inmunohistoquímica) similares a fibroblastos con láminas de colágeno peritoneal denso. La peritonitis esclerosante encapsulada es una patología de prevalencia desconocida. El cuadro clínico es inespecífico y el diagnóstico definitivo es por patología con biopsia peritoneal.
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Derivación Gástrica , Obstrucción Intestinal , Fibrosis Peritoneal , Complicaciones Posoperatorias , Humanos , Masculino , Persona de Mediana Edad , Derivación Gástrica/efectos adversos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Complicaciones Posoperatorias/etiología , Fibrosis Peritoneal/etiología , Fibrosis Peritoneal/cirugía , Fibrosis Peritoneal/complicaciones , Fibrosis Peritoneal/diagnóstico por imagen , Peritonitis/etiología , Síndrome , Adherencias Tisulares/complicaciones , Tomografía Computarizada por Rayos X , Intestino DelgadoRESUMEN
BACKGROUND: Small bowel obstruction (SBO) is a major problem in emergencies. Comorbidities increase morbimortality, which is reflected in higher costs. There is a lack of Latin American evidence comparing the differences in postoperative results and costs associated with SBO management. AIMS: To compare the risk of surgical morbimortality and costs of SBO surgery treatment in patients older and younger than 80 years. METHODS: Retrospective analysis of patients diagnosed with SBO at the University of Chile Clinic Hospital from January 2014 to December 2017. Patients with any medical treatment were excluded. Parametric statistics were used (a 5% error was considered statistically significant, with a 95% confidence interval). RESULTS: A total of 218 patients were included, of which 18.8% aged 80 years and older. There were no differences in comorbidities between octogenarians and non-octogenarians. The most frequent etiologies were adhesions, hernias, and tumors. In octogenarian patients, there were significantly more complications (46.3 vs. 24.3%, p=0.007, p<0.050). There were no statistically significant differences in terms of surgical complications: 9.6% in <80 years and 14.6% in octogenarians (p=0.390, p>0.050). In medical complications, a statistically significant difference was evidenced with 22.5% in <80 years vs 39.0% in octogenarians (p=0.040, p<0.050). There were 20 reoperated patients: 30% octogenarians and 70% non-octogenarians without statistically significant differences (p=0.220, p>0.050). Regarding hospital stay, the average was significantly higher in octogenarians (17.4 vs. 11.0 days; p=0.005, p<0.050), and so were the costs, being USD 9,555 vs. USD 4,214 (p=0.013, p<0.050). CONCLUSIONS: Patients aged 80 years and older with surgical SBO treatment have a higher risk of medical complications, length of hospital stay, and associated costs compared to those younger.
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Obstrucción Intestinal , Intestino Delgado , Complicaciones Posoperatorias , Humanos , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/etiología , Estudios Retrospectivos , Anciano de 80 o más Años , Masculino , Femenino , Intestino Delgado/cirugía , Anciano , Complicaciones Posoperatorias/epidemiología , Factores de Edad , Persona de Mediana Edad , Tiempo de Internación/estadística & datos numéricos , AdultoRESUMEN
BACKGROUND: The general assumption that prebiotics reach the colon without any alterations has been challenged. Some in vitro and in vivo studies have demonstrated that 'non-digestible' oligosaccharides are digested to different degrees depending on their structural composition. In the present study, we compared different methods aiming to assess the digestibility of oligosaccharides synthesized by ß-galactosidase (ß-gal) of Lactobacillus delbruecki subsp. bulgaricus CRL450 (CRL450-ß-gal) from lactose, lactulose and lactitol. RESULTS: In the simulated gastrointestinal fluid method, no changes were observed. However, the oligosaccharides synthesized by CRL450-ß-gal were partially hydrolyzed in vitro, depending on their structure and composition, with rat small intestinal extract (RSIE) and small intestinal brush-border membrane vesicles (BBMV) from pig. Digestion of some oligosaccharides increased when mixtures were fed to C57BL/6 mice used as in vivo model; however, lactulose-oligosaccharides were the most resistant to the physiological conditions of mice. In general ß (1â6) linked products showed higher resistance compared to ß (1â3) oligosaccharides. CONCLUSION: In vitro digestion methods, without disaccharidases, may underestimate the importance of carbohydrates hydrolysis in the small intestine. Although BVMM and RSIE digestion assays are appropriate in vitro methods for these studies, in vivo studies remain the most reliable for understanding what actually happens in the digestion of oligosaccharides. © 2024 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
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Digestión , Ratones Endogámicos C57BL , Oligosacáridos , Prebióticos , beta-Galactosidasa , Prebióticos/análisis , Animales , beta-Galactosidasa/metabolismo , beta-Galactosidasa/química , Oligosacáridos/metabolismo , Oligosacáridos/química , Ratones , Ratas , Porcinos , Masculino , Lactulosa/metabolismo , Lactulosa/química , Proteínas Bacterianas/metabolismo , Proteínas Bacterianas/química , Intestino Delgado/metabolismo , Intestino Delgado/enzimología , Lactobacillus/metabolismo , Lactobacillus/enzimología , Hidrólisis , Lactosa/metabolismo , Lactosa/químicaRESUMEN
BACKGROUND: The most efficient way to prevent complications from inflammatory bowel disease (IBD) is to provide patients with optimized care. Nonetheless, in Brazil, there is no validated methodology for evaluating health services recognized as comprehensive care units (CCU), making it difficult to assess the quality of care provided. OBJECTIVE: To understand the current scenario, map the distribution of centers and identify strengths and weaknesses, considering local and regional characteristics. METHODS: The study was carried out in three phases. Initially, the Brazilian Organization for Crohn's disease and colitis (GEDIIB) developed 22 questions to characterize CCU in Brazil. In the second phase, all GEDIIB members were invited to respond to the survey with the 11 questions considered most relevant. In the last phase, an interim analysis of the results was performed, using the IBM SPSS Statistics v 29.0.1.0 software. Descriptive statistics were used to characterize the center's profile. The chi-square test was used to compare categorical variables. RESULTS: There were 53 responses from public centers (11 excluded). Most centers were concentrated in the Southeastern (n=22/52.4%) and only 1 (2.4%) in the Northern region of Brazil. Thirty-nine centers (92.9%) perform endoscopic procedures, but only 9 (21.4%) have access to enteroscopy and/or small bowel capsule endoscopy. Thirty-three centers (78.6%) offer infusion therapy locally, 26 (61.9%) maintain IBD patient records, 13 (31.0%) reported having an IBD nurse, 34 (81.0%) have specific evidence-based protocols and only 7 (16.7%) have a patient satisfaction methodology. In the private scenario there were 56 responses (10 excluded). There is also a concentration in the Southeastern and Southern regions. Thirty-nine centers (84.8%) have access to endoscopic procedures and 19 perform enteroscopy and/or small bowel capsule endoscopy, more than what is observed in the public environment. Infusion therapy is available in 24 centers (52.2%). Thirty-nine centers (84.8%) maintain a specific IBD patient database, 17 (37%) have an IBD nurse, 36 (78.3%) have specific evidence-based protocols, and 22 (47. 8%) apply a patient satisfaction methodology. CONCLUSION: IBD CCU in Brazil were mainly located in the Southeastern and Southern regions of the country. Most centers have dedicated multidisciplinary teams and IBD specialists. There is still a current need to improve the proportion of IBD nurses in IBD care in Brazil. BACKGROUND: â¢In Brazil, there is no validated methodology for evaluating health services recognized as comprehensive care units (CCU), making it difficult to assess the quality of care provided. BACKGROUND: â¢Most CCU were concentrated in the Southeast region and only one (2.4%) in the Northeast region of Brazil. This pattern follows the epidemiological trends of IBD in the country. BACKGROUND: â¢There is still difficulty in accessing enteroscopy and/or small bowel capsule endoscopy in the public health system. BACKGROUND: â¢Most centers have dedicated multidisciplinary teams and IBD specialist doctors. BACKGROUND: â¢There is still a current need to improve the proportion of nurses treating IBD in Brazil.
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Endoscopía Capsular , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Humanos , Brasil/epidemiología , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/terapia , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/terapia , Enfermedad de Crohn/complicaciones , Intestino DelgadoRESUMEN
Introducción: Dentro de las causas poco frecuentes de oclusión intestinal se encuentra el vólvulo de intestino delgado, el cual consiste en una torsión anormal del intestino alrededor del su propio eje de mesenterio, que provoca una obstrucción mecánica del intestino. Objetivo: Describir la semiografía del vólvulo de intestino delgado en un paciente de edad avanzada. Caso clínico: Paciente masculino de 62 años de edad, que ingresa en el cuerpo de guardia de cirugía, por dolor abdominal, tipo cólico intermitente, con una evolución de 72 horas; además, presenta distensión abdominal, náuseas y vómitos. Con el cuadro clínico, más los exámenes complementarios, se constata oclusión intestinal mecánica, causada por un vólvulo del intestino delgado. A los 5 días de ser intervenido quirúrgicamente se complicó por una perforación intestinal debido a necrosis del asa. Conclusiones: Debido a su presentación atípica y sus graves complicaciones, se precisa un diagnóstico certero y tratamiento urgente al paciente con vólvulo del intestino delgado, ya que pone en riesgo la vida(AU)
Introduction: Among the rare causes of intestinal obstruction is small intestine volvulus, which consists of an abnormal twisting of the intestine around its own mesentery axis, which causes a mechanical obstruction of the intestine. Objective: To describe the semiography of small intestine volvulus in an elderly patient. Clinical case: 62-year-old male patient, admitted to the surgery ward, due to abdominal pain, intermittent colic type, with an evolution of 72 hours; In addition, he presents abdominal distention, nausea and vomiting. With the clinical picture, plus complementary examinations, mechanical intestinal occlusion is confirmed, caused by a volvulus of the small intestine. Five days after undergoing surgery, it was complicated by intestinal perforation due to necrosis of the loop. Conclusions: Due to its atypical presentation and serious complications, an accurate diagnosis and urgent treatment are required for patients with small intestine volvulus, since it puts life at risk(AU)
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Humanos , Masculino , Persona de Mediana Edad , Vólvulo Intestinal/cirugía , Obstrucción Intestinal/cirugía , Perforación Intestinal/complicaciones , Intestino Delgado/cirugía , Necrosis/etiología , Vómitos , Dolor Abdominal/complicaciones , Cólico/diagnóstico , NáuseaRESUMEN
PURPOSE: Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract, and its unique location within the small intestine presents difficulties in obtaining tissue samples from the lesions. This limitation hinders the research and development of effective clinical treatment methods. Circulating tumor DNA (ctDNA) analysis holds promise as an alternative approach for investigating SBA and guiding treatment decisions, thereby improving the prognosis of SBA. METHODS: Between January 2017 and August 2021, a total of 336 tissue or plasma samples were obtained and the corresponding mutation status in tissue or blood was evaluated with NGS. RESULTS AND CONCLUSIONS: The study found that in SBA tissues, the most commonly alternated genes were TP53, KRAS, and APC, and the most frequently affected pathways were RTK-RAS-MAPK, TP53, and WNT. Notably, the RTK-RAS-MAPK pathway was identified as a potential biomarker that could be targeted for treatment. Then, we validated the gene mutation profiling of ctDNA extracted from SBA patients exhibited the same characteristics as tissue samples for the first time. Subsequently, we applied ctDNA analysis on a terminal-stage patient who had shown no response to previous chemotherapy. After detecting alterations in the RTK-RAS-MAPK pathway in the ctDNA, the patient was treated with MEK + EGFR inhibitors and achieved a tumor shrinkage rate of 76.33%. Our study utilized the largest Chinese SBA cohort to uncover the molecular characteristics of this disease, which might facilitate clinical decision making for SBA patients.
Asunto(s)
Adenocarcinoma , ADN Tumoral Circulante , Neoplasias Intestinales , Mutación , Humanos , Adenocarcinoma/genética , Adenocarcinoma/patología , Adenocarcinoma/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Anciano , Neoplasias Intestinales/genética , Neoplasias Intestinales/patología , ADN Tumoral Circulante/genética , ADN Tumoral Circulante/sangre , Biomarcadores de Tumor/genética , Intestino Delgado/patología , Adulto , Proteínas Proto-Oncogénicas p21(ras)/genética , Proteína p53 Supresora de Tumor/genética , Proteína de la Poliposis Adenomatosa del Colon/genética , China , Pronóstico , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. AIM: To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. METHODS: Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. RESULTS: A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1-99.2), 82.2% (95%CI: 57.6-93.3), 40.0% (95%CI: 16.5-82.8) and 25.9% (95%CI: 4.5-55.7%), respectively. NET (HR 6.1; 95%CI: 2.1-17.2) and GIST (HR 24.4; 95%CI: 3.0-19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. CONCLUSIONS: Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.
Asunto(s)
Hospitales Universitarios , Neoplasias Intestinales , Intestino Delgado , Humanos , Persona de Mediana Edad , Masculino , Femenino , Estudios Retrospectivos , Chile/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Pronóstico , Anciano , Neoplasias Intestinales/epidemiología , Neoplasias Intestinales/patología , Neoplasias Intestinales/diagnóstico , Intestino Delgado/patología , Adulto , Tumores del Estroma Gastrointestinal/epidemiología , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/diagnóstico , Anciano de 80 o más Años , Tasa de Supervivencia , Tumores Neuroendocrinos/epidemiología , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Adenocarcinoma/epidemiología , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Adulto Joven , Linfoma/epidemiología , Linfoma/diagnóstico , Linfoma/patologíaRESUMEN
Celiac disease (CD) is the chronic immune-mediated enteropathy of the small bowel, manifesting when exposure to gluten occurs in genetically predisposed individuals. Nowadays, the only treatment considered safe for CD is a gluten-free diet (GFD). However, one of the problems faced by celiac patients is the cross-contamination of gluten-free food when preparing meals, in addition to utensils, surfaces and equipment. This study aimed to evaluate cross-contamination in gluten-free products and strategies for removing gluten from cross-contamination in cooking environments. The selection of papers for this integrative review was carried out by searching different databases. Gluten cross-contamination is a global concern for celiac patients in food environments. Although some practices are positive, such as gluten labeling on processed food in several countries, it is crucial to promote good practices in food services around the world. Only a few studies showed effective results in removing gluten from surfaces and utensils; furthermore, sampling was limited, making it difficult to identify appropriate procedures to reduce cross-contamination. The variation in contamination in different kitchen environments also highlighted that celiac patients must continue paying attention to the methods used to prepare gluten-free food. More research is needed, especially into methods of removing gluten from surfaces and utensils, to ensure food safety for celiac patients in many food environments.
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Enfermedad Celíaca , Glútenes , Humanos , Alimentos , Dieta Sin Gluten , Intestino DelgadoRESUMEN
Euphractus sexcinctus has a diverse diet, so it needs anatomical and habitual features to help it get its meals. Therefore, the objective is to study the morphology of the small and large intestines of the six-banded armadillo (E. sexcinctus). The research was authorized and approved under number 136/16. Six animals, obtained from victims of predatory hunting, were dissected for the research. For the anatomical analysis, the specimens were dissected and photographed. The fragments of each organ were submitted to histological routine to obtain slides stained with hematoxylin-eosin, toluidine blue and Masson's trichrome for further analysis. The small intestine has three parts: duodenum, jejunum, and ileum. Histologically, it has the typical four layers of tubular organs. The mucosa is covered by simple cylindrical epithelium with the presence of specializations in the form of microvilli and variation in the number of goblet cells, depending on the portion observed. In the duodenal portion, the presence of the serous layer was not observed. In the jejunal portion, it is possible to observe lymphoid tissue aggregates in the submucosa, which become more evident in the ileum. The large intestine is divided into cecum, colon, and rectum and has the same histological subdivisions as the small intestine, but with some specializations. The presence of simple cylindrical intestinal crypts is clearly observed and the presence of a large number of goblet cells, which increase as it approaches the rectum. In the submucosa of the large intestine, the presence of organized lymphoid plaques is detected. RESEARCH HIGHLIGHTS: The presence of large numbers of goblet cells, which increase as one approaches the rectum. The presence of organized lymphoid plaques is detected. The duodenal portion was not observed presence of the serous layer.
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Armadillos , Mucosa Intestinal , Animales , Mucosa Intestinal/patología , Sistema Digestivo , Intestino Delgado , RectoRESUMEN
INTRODUCTION: Proton pump inhibitors (PPIs) are commonly prescribed drugs. Chronic PPI use has recently been associated with the risk for developing small intestinal bacterial overgrowth (SIBO). It is not known whether the short-term prescription of a PPI can trigger SIBO. Therefore, the aim of the present study was to evaluate the incidence of SIBO and gastrointestinal symptoms after 7 days of PPI use. MATERIALS AND METHODS: A prospective, pilot, open-label study was conducted on asymptomatic healthy volunteers. The incidence of SIBO was evaluated at the baseline and after administration of 40 mg of pantoprazole once a day for 7 days, through a glucose breath test. In addition, the presence of gastrointestinal symptoms, the number of bowel movements, and the consistency of stools, according to the Bristol scale, were assessed. RESULTS: Thirty-eight healthy subjects (71.1% women, mean age 25.18 ± 6.5 years) were analyzed. The incidence of SIBO after 7 days of PPI administration was 7.8% (95% CI 1.6-21.3%). The patients that developed SIBO had a greater prevalence of bloating (p = 0.0002) and flatulence (p = 0.004) after 7 days of treatment. CONCLUSIONS: Our study showed that a short-term 7-day PPI course produced SIBO in 7.8% of healthy subjects. Although, inappropriate use of PPIs should be discouraged, but since more than 90% of subjects who received PPIs for one week did not develop SIBO, the advantages of PPI administration seem to outweigh the disadvantages.