Eosinophilic Gastroenteritis: Still a Diagnostic Challenge.

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.

The Impact of a Structured Virtual Reality Simulation Training Curriculum for Novice Endoscopists.

Background: Current evidence supports the use of virtual reality (VR) simulation-based training for novice endoscopists. However, there is still a need for a standardized induction programme which ensures sufficient preparation, with knowledge and basic skills, before their approach to patient-based training. We designed a structured progressive programme in upper endoscopy and colonoscopy and aimed to determine its impact on cognitive and technical performance. Methods: Prospective, multicentre study, focused on "Endoscopy I, 2018," a course with a theoretical and a hands-on module (20 h) in the GI Mentor II®. Gastroenterology residents of the 1st year were enrolled. A pre-test and test were applied to evaluate the cognitive component, and a pre-training and post-training esophagogastroduodenoscopy (EGD) and colonoscopy VR cases were used to evaluate the technical component. The hands-on training included psychomotor exercises (Navigation I, Endobubble I), 4 EGD, and 4 colonoscopy VR cases. The metrics applied for technical skills evaluation were time to reach the second portion of duodenum (D2)/cecum (seconds), efficiency of screening (%), and time the patient was in pain (%). Results: Twenty-three participants were included, majority female (67%), 26 ± 0.7 years old. Comparing the pre-test versus test, the cognitive score significantly improved (11/15 vs. 14/15; p < 0.001). Considering the technical assessment after training: in EGD, the time to D2 was significantly lower (193 vs. 63 s; p < 0.001), and the efficiency of screening significantly better (64 vs. 91%; p < 0.001); in colonoscopy, the time to reach the cecum was significantly lower (599 vs. 294 s; p = 0.001), the time the patient was in pain was significantly lower (27 vs. 10%; p = 0.005), and the efficiency of screening had a tendency towards improvement (50 vs. 68%; p = 0.062). Conclusion: The proposed training curriculum in basic endoscopy for novices is aligned with international recommendations and demonstrated a significant impact on cognitive and technical skills learning achievements.

Introdução: A evidência científica suporta o uso de simuladores de realidade virtual na fase inicial da formação. Contudo, persiste a necessidade de um programa padronizado, que garanta uma preparação adequada dos formandos, com conhecimento e competências básicas, antes de transitarem para o treino em pacientes. Desenhámos um programa de treino estruturado e progressivo em endoscopia digestiva alta (EDA) e colonoscopia, pretendendo este estudo avaliar o seu impacto no desempenho cognitivo e técnico. Métodos: Estudo prospetivo e multicêntrico, focado no programa de treino "Endoscopia I, 2018." Este curso incluiu um módulo teórico e um módulo prático (20 h) no simulador GI Mentor II®. Foram recrutados internos de Gastrenterologia do 1° ano. Realizou-se um pré-teste e um teste para avaliar o componente cognitivo e foram usados casos virtuais selecionados, de EDA e colonoscopia, para avaliar o componente técnico pré e pós-treino. A prática incluiu exercícios psicomotores (Navigation I, Endobubble I), 4 casos virtuais de EDA e 4 de colonoscopia. As métricas aplicadas na avaliação foram o tempo até à segunda porção duodenal (D2)/cego (segundos), a eficiência da inspeção (%) e o tempo que o paciente teve dor (%). Resultados: Vinte e três participantes incluídos, a maioria do género feminino (67%), com idade média de 26 ± 0.7 anos. Comparando o pré-teste versus (vs.) teste, o resultado da avaliação cognitiva melhorou (11/15 vs. 14/15; p < 0.001). Relativamente à avaliação técnica após o treino: na EDA, o tempo para alcançar D2 foi significativamente menor (193 vs. 63 s; p < 0.001) e a eficiência da inspeção foi significativamente melhor (64 vs. 91%; p < 0.001); na colonoscopia, o tempo até ao cego foi significativamente menor (599 vs. 294 s; p = 0.001), o tempo em que o paciente teve dor foi significativamente menor (27 vs. 10%; p = 0.005) e a eficiência da inspeção revelou uma tendência de melhoria (50 vs. 68%; p = 0.062). Conclusão: O presente programa de treino em endoscopia básica para iniciados está alinhado com as recomendações internacionais e demonstrou um impacto significativo na aquisição de capacidades cognitivas e técnicas.

Constipation: Prevalence in the Portuguese community using Rome IV-Associated factors, toilet behaviours and healthcare seeking.

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.

Cecal MALT lymphoma: a challenging diagnosis.

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.

Evaluation of online content of proctological disorders in the Portuguese language.

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.

Validation of the IBD-Disk in a Portuguese cohort.

OBJECTIVE: The aim of this study was to validate the IBD-Disk in a Portuguese cohort according to the COnsensus-based Standards for the selection of the health Measurement INstruments (COSMIN) recommendations. METHODS: After translation of the original IBD-Disk to Portuguese, a group of IBD patients was invited to complete the IBD-Disk at baseline (T0), after 1-4 weeks (T1) and after more than 3 months (T2), from July 2020 to February 2021. At T0 and T2, the patients also completed the IBD Disability Index. We evaluated reliability (internal consistency, test-retest, interrater reliability and measurement error), construct validity, responsiveness, interpretability of IBD-Disk, sociodemographic and clinical factors associated with IBD-Disk. RESULTS: At T0, 154 patients (107 - Crohn's disease; 46 - ulcerative colitis) completed the IBD-Disk; 1 - IBD-unclassified). At T1 and T2, 64 and 114 patients repeated the questionnaire, respectively. Factor analysis confirmed the unidimensionality of the scale and reduced the final version to 10 items. Internal consistency was excellent with a Cronbach's α of 0.916. The intraclass correlation coefficient was 0.95 for test-retest (T0 and T1). To evaluate construct validity, the IBD-Disk was compared with the IBD Disability Index and Manitoba IBD Index with a significative positive correlation (r = 0.850 and r = 0.459, respectively; P < 0.001 for both). IBD-Disk scores ranged from 0 to 93 with a mean of 38.18 ± 25.39. Female sex, professional inactivity, longer IBD duration and clinical activity were associated with significantly higher IBD-Disk scores. CONCLUSION: The Portuguese version of IBD-Disk is a reliable and valid tool to assess disability in Portuguese IBD patients.