P045 Prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD) in a Brazilian public healthcare clinic.

BACKGROUND: Inflammatory Bowel Disease (IBD) is an inflammatory and chronic disease, as well as non-alcoholic fatty liver disease (NAFLD). Current literature has shown that IBD patients are at high risk for NAFLD. In those patients, the pathogenesis of NAFLD may be more complex and related to multifactor causes, such as gut dysbiosis, unhealthy nutritional behavior, body composition and systemic inflammation. There is an increase in NAFLD's incidence in the general population, otherwise, there are few studies evaluating NAFLD prevalence in IBD patients. So, this study aimed to evaluate prevalence of NAFLD and identify the clinical factors associated with the presence of NAFLD in patients with IBD. METHODS: This cross-sectional, descriptive, observational study included 71 IBD patients from an IBD public outpatient in São Paulo State, Brazil. Laboratory evaluation and clinical data were collected. The presence of NAFLD was evaluated by ultrasonography. The exclusion criteria were as follows: pre-existing liver disease, history of alcohol intake >20g/day for women and >30g/day for men, and glucocorticoids treatment >20mg/day. Statistical analysis: descriptive statistics and association tests. RESULTS: 71 patients were included, of which 34 (47.89%) were Crohn´s disease (CD) and 37 (52.11%) ulcerative colitis (UC). Median age was 45.32±13.59 years, 63.38% were female, 69.1% Caucasian, 7.04% smokers. The time from diagnosis was 12.55 ± 8.01 years. Regarding the characteristics of the diseases, 42.42% of patients with CD have ileocolonic involvement, 50% penetrating disease and 39.4% perianal involvement. In relation to patients with UC, most patients have pancolitis (72.22%). Mostly, the patients were in clinical (63.89%) and endoscopic (52.86%) remission. Regarding medical treatment, the most used drugs were biological therapy (79.41%) and azathioprine (52.94%) in CD, and mesalazine (45.95%), azathioprine (40.54%) and biological therapy (40.54%) in UC. The NAFLD group consists of 32 (45.07%) patients: 40.63% had mild steatosis; 40.63% moderate and 18.65% intense NAFLD. Development of NAFLD vs no NAFLD was associated with body mass index (29.49 ± 3.93 vs 24.32 ± 3.85, p < 0.0001), and laboratory biomarkers, such as C-reactive protein (1.99 ± 4.39 vs 0.87 ± 0.52, p = 0.0061), AST (29.72 ± 16.64 vs 23.46 ± 5.31, p = 0.0226), ALT (24.92 ± 14.22 vs 17.92 ± 6.57, p = 0.0099), albumin (4.1 ± 0.37 vs 4.36 ± 0.32, p = 0.0415), fasting glucose (95.5 ± 14.01 vs 84.36 ± 13.01, p = 0.0251) and blood insulin (18.41 ± 11.88 vs 6.4 ± 4.26, p = 0.0054). Also, the NAFLD group had higher prevalence of systemic arterial hypertension (31.25% vs 10.26%, p = 0.0369). When comparing patients with the presence or absence of NAFLD, there was no difference between the groups regarding time since diagnosis (p = 0.9684), previous surgery (p = 0.5908), Montreal classification, clinical activity assessed by CDAI (p = 0.2258), clinical activity assessed by the Mayo score (p = 0.4935), endoscopic activity (p = 0.0599), histological activity (p = 1.0), or medical treatment. CONCLUSION: Development of NAFLD is a frequent occurrence in patients with IBD. NAFLD group had higher levels of body mass index, C-reactive protein, AST, ALT, fasting glucose and blood insulin, which are also associated with metabolic syndrome. Early diagnosis and appropriate nutritional orientation are necessary to prevent NAFLD related complications.

P049 Investigation of Liver Diseases by Ultrasound in Patients With Inflammatory Bowel Disease.

BACKGROUND: Inflammatory Bowel Disease (IBD), which can be divided into Crohn's Disease (CD) and Ulcerative Colitis (UC), is an immune mediated disease featured by gastrointestinal tract involvement. Hepatic disease, such as non-alcoholic fatty liver disease (NAFLD), cirrhosis, cholelithiasis, hepatic thromboembolic events and primary sclerosing cholangitis (PSC) are some hepatic complications presented by IBD patients. Since these hepatic disorders have a higher prevalence in IBD patients, ultrasonography is a noninvasive low-cost versatile tool, that allows to identify these manifestations at early stages. Therefore, this study aims to analyze the prevalence of hepatic diseases in patients with IBD. METHODS: A cross-sectional study was performed in a single IBD center, Brazil. This study considered clinical and sociodemographic data of these individuals, besides the evaluation of disease activity, biochemical tests, and liver ultrasound with doppler. Statistical analysis: descriptive, association tests. RESULTS: 71 patients were included, 34 had CD and 37 had UC, mean age 45.32 ± 13.59 years, 63.38% women. Among CD patients, 42.42% have ileocolonic involvement, 50% penetrating behavior and 39.4% perianal involvement. Among patients with UC, most patients have pancolitis (72.22%). Most patients were in clinical (CD: 93.55%, UC: 63.89%) and endoscopic (47.14%) remission. The main medications used were azathioprine (46.48%), infliximab (40.85%), salicylates (28.17%), corticosteroids (16.9%) and adalimumab (11.27%). According to ultrasound, NAFLD was found in 32 (45.07%) patients: 40.63% mild, 40.63% moderate and 18.75% severe. Furthermore, we found a correlation between liver steatosis and blunt liver edge (p < 0.0155). Only 2 patients presented with choledocholithiasis. One patient had features of chronic liver disease such as irregular surface, heterogeneity of a hepatic parenchymal echo and bluntness of the liver edge. No signs of thrombosis were found in portal, splenic or superior mesenteric veins. CONCLUSION: A higher prevalence of NAFLD was found in patients with IBD, and no signs of thrombosis were found in the splanchnic system.

Cirrhosis regression after SVR with indirect methods of fibrosis analysis: How far is it real?

Hepatitis C virus has infected over 71 million people worldwide, and it is the main cause of cirrhosis in the western world. Currently, the treatment involves direct-acting antiviral agents (DAAs) and its main goal is to achieve sustained virologic response (SVR). The aim of this study was to evaluate the impact of SVR using DAAs in the improvement of liver fibrosis using scores evaluation by indirect method, liver function, and inflammation indirect biomarkers. Patients with cirrhosis with SVR after treatment (n = 104) were evaluated using liver function scores, indirect fibrosis methods, alpha-fetoprotein, and ferritin at t-base and t-SVR. Statistically significant positive results in all parameters were observed: 54 patients were classified as 5 in the CP score in t-base, and 77 in t-SVR; a significant decrease was observed in MELD score, alpha-fetoprotein, ferritin, APRI, FIB-4 and liver stiffness in liver elastography. We did not observe difference in the liver function scores between regressors and non-regressors of liver stiffness, as well as in indirect inflammation biomarkers. The measurements of fibrosis using the indirect methods have significantly decreased in patients with cirrhosis treated who achieved SVR associated with decreased indirect inflammation biomarkers and improved liver function scores.

A prospective study of conventional and expanded coagulation indices in predicting ulcer bleeding after variceal band ligation.

BACKGROUND & AIMS: There is controversy over whether coagulation status predicts bleeding caused by ulceration after esophageal varices band ligation (EVL). METHODS: EVL was performed for primary (n = 45) or secondary (n = 105) prophylaxis in 150 patients with cirrhosis (Child A, n = 74, 49%; Child B, n = 42, 28%; Child C, n = 34, 23%). International normalized ratio (INR) and platelet counts were assessed in all. In 92 patients, levels of factor V, fibrinogen, D-dimer, protein C and protein S, von Willebrand factor, and thromboelastography (TEG) were assessed. Platelet count <50 x 10(3)/mm(3) and INR >1.5 were considered high-risk cutoff for bleeding. Conversely, platelet count >or=50 x 10(3)/mm(3) with INR

Prevalence of the hepatitis C virus among University employees in São Paulo, Southeastern Brazil: predictive factors and geoprocessing spatial analysis.

BACKGROUND: There are limited studies on the prevalence and risk factors associated with hepatitis C virus (HCV) infection. Objective Identify the prevalence and risk factors for HCV infection in university employees of the state of São Paulo, Brazil. METHODS: Digital serological tests for anti-HCV have been performed in 3153 volunteers. For the application of digital testing was necessary to withdraw a drop of blood through a needlestick. The positive cases were performed for genotyping and RNA. Chi-square and Fisher's exact test were used, with P-value <0.05 indicating statistical significance. Univariate and multivariate logistic regression were also used. RESULTS: Prevalence of anti-HCV was 0.7%. The risk factors associated with HCV infection were: age >40 years, blood transfusion, injectable drugs, inhalable drugs (InDU), injectable Gluconergam®, glass syringes, tattoos, hemodialysis and sexual promiscuity. Age (P=0.01, OR 5.6, CI 1.4 to 22.8), InDU (P<0.0001, OR=96.8, CI 24.1 to 388.2), Gluconergam® (P=0.0009, OR=44.4, CI 4.7 to 412.7) and hemodialysis (P=0.0004, OR=90.1, CI 7.5 - 407.1) were independent predictors. Spatial analysis of the prevalence with socioeconomic indices, Gross Domestic Product and Human Development Index by the geoprocessing technique showed no positive correlation. CONCLUSIONS: The prevalence of HCV infection was 0.7%. The independent risk factors for HCV infection were age, InDU, Gluconergan® and hemodialysis. There was no spatial correlation of HCV prevalence with local economic factors.

Low bone mineral density in noncholestatic liver cirrhosis: prevalence, severity and prediction.

BACKGROUND: Metabolic bone disease has long been associated with cholestatic disorders. However, data in noncholestatic cirrhosis are relatively scant. AIMS: To determine prevalence and severity of low bone mineral density in noncholestatic cirrhosis and to investigate whether age, gender, etiology, severity of underlying liver disease, and/or laboratory tests are predictive of the diagnosis. PATIENTS/METHODS: Between March and September/1998, 89 patients with noncholestatic cirrhosis and 20 healthy controls were enrolled in a cross-sectional study. All subjects underwent standard laboratory tests and bone densitometry at lumbar spine and femoral neck by dual X-ray absorptiometry. RESULTS: Bone mass was significantly reduced at both sites in patients compared to controls. The prevalence of low bone mineral density in noncholestatic cirrhosis, defined by the World Health Organization criteria, was 78% at lumbar spine and 71% at femoral neck. Bone density significantly decreased with age at both sites, especially in patients older than 50 years. Bone density was significantly lower in post-menopausal women patients compared to pre-menopausal and men at both sites. There was no significant difference in bone mineral density among noncholestatic etiologies. Lumbar spine bone density significantly decreased with the progression of liver dysfunction. No biochemical variable was significantly associated with low bone mineral density. CONCLUSIONS: Low bone mineral density is highly prevalent in patients with noncholestatic cirrhosis. Older patients, post-menopausal women and patients with severe hepatic dysfunction experienced more advanced bone disease. The laboratory tests routinely determined in patients with liver disease did not reliably predict low bone mineral density.

PREVALENCE OF THE HEPATITIS C VIRUS AMONG UNIVERSITY EMPLOYEES IN SÃO PAULO, SOUTHEASTERN BRAZIL: predictive factors and geoprocessing spatial analysis / Prevalência do vírus da hepatite C em funcionários universitários do Estado de São Paulo, Brasil: fatores preditivos e análise espacial por geoprocessamento

Background There are limited studies on the prevalence and risk factors associated with hepatitis C virus (HCV) infection. Objective Identify the prevalence and risk factors for HCV infection in university employees of the state of São Paulo, Brazil. Methods Digital serological tests for anti-HCV have been performed in 3153 volunteers. For the application of digital testing was necessary to withdraw a drop of blood through a needlestick. The positive cases were performed for genotyping and RNA. Chi-square and Fisher’s exact test were used, with P-value <0.05 indicating statistical significance. Univariate and multivariate logistic regression were also used. Results Prevalence of anti-HCV was 0.7%. The risk factors associated with HCV infection were: age >40 years, blood transfusion, injectable drugs, inhalable drugs (InDU), injectable Gluconergam®, glass syringes, tattoos, hemodialysis and sexual promiscuity. Age (P=0.01, OR 5.6, CI 1.4 to 22.8), InDU (P<0.0001, OR=96.8, CI 24.1 to 388.2), Gluconergam® (P=0.0009, OR=44.4, CI 4.7 to 412.7) and hemodialysis (P=0.0004, OR=90.1, CI 7.5 – 407.1) were independent predictors. Spatial analysis of the prevalence with socioeconomic indices, Gross Domestic Product and Human Development Index by the geoprocessing technique showed no positive correlation. Conclusions The prevalence of HCV infection was 0.7%. The independent risk factors for HCV infection were age, InDU, Gluconergan® and hemodialysis. There was no spatial correlation of HCV prevalence with local economic factors. .

Contexto Existem escassos estudos sobre a prevalência e fatores de risco associados à infecção pelo vírus da hepatite C. Objetivos Identificar a prevalência e os fatores de risco para a infecção pelo vírus da hepatite C em funcionários de uma Universidade do Estado de São Paulo, Brasil. Métodos Testes sorológicos digitais para anti vírus da hepatite C foram realizados em 3.153 voluntários. Para a aplicação do teste digital foi necessário retirar uma gota de sangue através de uma picada de agulha. Nos casos positivos foram realizados genotipagem e RNA. Os testes Qui-quadrado e exato de Fisher foram utilizados, com valor de P<0,05 sendo considerado como estatisticamente significante. Regressão logística univariada e multivariada também foram aplicadas. Resultados A prevalência de anti vírus da hepatite C foi de 0,7%. Os fatores de risco associados com a infecção pelo vírus da hepatite C foram idade >40 anos, transfusão de sangue, uso de drogas injetáveis, uso de drogas inalatórias, Gluconergam® injetável, uso de seringas de vidro, tatuagens, hemodiálise e promiscuidade sexual. Idade (P=0,01, OR 5,6, IC 1,4-22,8), uso de drogas inalatórias (P<0,0001, OR=96,8, IC 24,1-388,2), Gluconergam® injetável (P=0,0009, OR=44,4, IC 4,7-412,7) e hemodiálise (P=0,0004, OR=90,1, IC 7,5-407,1) foram preditores independentes. A análise espacial da prevalência com índices socioeconômicos, produto interno bruto e índice de desenvolvimento humano, por meio da técnica de geoprocessamento, não mostrou correlação positiva. Conclusões A prevalência da infecção pelo vírus da hepatite C foi de 0,7%. Os fatores de risco independentes para a infecção pelo vírus da hepatite C foram idade, uso de drogas inalatórias, Gluconergan® injetável e hemodiálise. Não houve correlação espacial da prevalência de vírus da hepatite C com fatores econômicos locais. .

Low bone mineral density in noncholestatic liver cirrhosis: prevalence, severity and prediction

RACIONAL: Existe associação entre doença óssea metabólica e doença hepática colestática. Contudo, a associação com cirrose não-colestática ainda é pouco conhecida. OBJETIVOS: Determinar a prevalência e a gravidade da perda de densidade mineral óssea na cirrose não-colestática e investigar fatores preditivos do seu diagnóstico. MÉTODOS: Oitenta e nove pacientes e 20 controles foram estudados de março a setembro de 1998. Todos foram submetidos a exames laboratoriais e densitometria óssea da coluna lombar e do colo do fêmur. RESULTADOS: A massa óssea estava significativamente reduzida em ambos os sítios nos pacientes quando comparado aos controles. A prevalência da perda de massa óssea na cirrose não-colestática, de acordo com os critérios da Organização Mundial da Saúde, foi de 78 por cento na coluna lombar e 71 por cento no colo do fêmur. A massa óssea diminuiu significativamente com a idade em ambos os sítios, especialmente em pacientes acima de 50 anos. Pacientes mulheres pós-menopausa tinham massa óssea significativamente menor do que pacientes mulheres pré-menopausa e homens em ambos os sítios. Não houve diferença significativa na massa óssea entre as etiologias não-colestáticas. A massa óssea da coluna lombar diminuiu significativamente com a progressão da disfunção hepática. Nenhuma variável bioquímica foi associada com a perda da massa óssea. CONCLUSÕES: A perda de massa óssea foi freqüente em pacientes com cirrose não-colestática. Pacientes idosos, do sexo feminino na pós-menopausa e com disfunção hepática grave apresentaram doença óssea mais avançada. Os exames laboratoriais rotineiramente dosados nos pacientes com doença hepática não puderam predizer com segurança a presença de redução na massa óssea.

Acometimento intestinal da paracoccidioidomicose: relato de caso / Intestinal involvement of paracoccidioidomycosis: case report

A paracoccidioidomicose é uma moléstia gra»nulomatosa crônica, causada pelo fungo Paracoc»cidioides brasiliensis. Predomina no sexo masculi»no, adultos jovens oriundos, principalmente, da zona rural. Entre as formas clínicas, pode-se enc! contrar comprometimento digestivo, com incit dência variável, de acordo com o órgão conside»rado. O presente estudo relata um caso de para»coccidioidomicose com envolvimento do intestino delgado diagnosticado pela colonoscopia e his»topatológico, que evoluiu para um quadro de suboclusão intestinal pela fibrose do processo inflamatório decorrente da patologia. Através de revisão da literatura, são feitos comentários so»bre a doença de base, forma intestinal e suas complicaçoes clínico-cirúrgicas, enfatizando a raridade dessa apresentação clínica.

Curso de gastrenterologia. Aula 6: síndrome de Budd-Chiari: estudo clínico e evolutivo de sete casos / Course of gastroenterology. Class 6: Budd-Chiari syndrome

Os autores estudaram sete casos de síndrome de Budd-Chiari (SBC) diagnosticados por métodos de imagem, exame histolôgico do fígado e estudo hemodinâmico. Relatam os aspectos clínicos, laboratoriais, radiológicos e evolutivos dos pacientes. Discutem as principais etiologias da SBC, com particular realce nas deficiências de anticoagulantes circulantes. Valorizam a importância do diagnóstico pela ultrasonografia com Doppler em substituiçäo a métodos radiológicos invasivos. Discutem, por fim, as diversas modalidades de tratamento clínico e cirúrgico.

Síndrome hepatopulmonar / Hepatopulmonary syndrome: prevalence and role of contrast transesophageal echocardiography in cirrhosis related pulmonary disease

A síndrome hepatopulmonar (SHP) é definida como uma tríade de doença hepática, evidência de dilatações vasculares intrapulmonares e aumento do gradiente alvéolo-arterial de oxigênio em ar ambiente. Por ser considerada atualmente uma indicação para o transplante hepático é importante conhecermos sua prevalência, além de tentarmos fazer seu diagnóstico mais precocemente, obtendo-se melhores resultados com esse método terapêutico. Através da utilização do ecocardiograma transesofágico com contraste (ETE), mais sensível do que o ecocardiograma transtorácico com contraste (ETT), talvez consigamos alcançar melhor esse objetivo. Os objetivos desse estudo foram avaliar a prevalência da síndrome hepatopulmonar e avaliar o papel do ecocardiograma transesofágico com contraste (ETE) no seu diagnóstico. Foram estudados 59 pacientes e 20 controles, encontrando-se 18 (30,5 por cento) pacientes com DVI através do ETT e 42 (71,1 por cento) pacientes através do ETE (p = 0,001). Com o ETE ainda foi possível subclassificar a dilatação vascular intrapulmonar, encontrando-se 31 (52,5 por cento) pacientes com DVI discreta e 11 (18,6 por cento) pacientes com DVI significativa, que se correlacionaram com a gravidade da doença hepática. Preencheram os critérios para o diagnóstico de SHP 6 (10 por cento) pacientes através do ETT e 8 (13,5 por cento) pacientes através do ETE (p < 0,001), sem haver relação com a gravidade da cirrose. Portanto o ETE mostrou ser mais sensível, fazendo mais freqüentemente o diagnóstico de DVI e de SHP, quando comparado ao ETT. A prevalência da SHP na população de cirróticos foi de 10 por cento. O ETE estaria indicado naqueles pacientes com doença hepática crônica, alteração do gradiente alvéolo-arterial de oxigênio ou hipoxemia, cujo ETT tivesse sido normal ou inconclusivo...