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Mucosa Intestinal/cirurgia , Laparoscopia/métodos , Doenças Retais/cirurgia , Cirurgia Endoscópica Transanal/métodos , Úlcera/cirurgia , Adulto , Constrição Patológica , Humanos , Masculino , Doenças Retais/etiologia , Doenças Retais/patologia , Reto/patologia , Reto/cirurgia , Úlcera/complicaçõesRESUMO
BACKGROUND: The current literature suggests that there has been a decrease in opportunistic diseases among HIV-infected patients since the widespread introduction of highly active antiretroviral therapy (HAART) in 1995. OBJECTIVES: The aim of the study was to investigate the impact of HAART and CD4 lymphocyte count on diseases of the upper gastrointestinal (UGI) tract, digestive symptoms, and endoscopic and histological observations. METHODS: A review of 706 HIV-infected patients who underwent GI endoscopy was undertaken. The cohort was divided into three groups: group 1 (G1), pre-HAART, consisting of 239 patients who underwent endoscopy between January 1991 and December 1994; group 2 (G2), early HAART, consisting of 238 patients who underwent endoscopy between January 1999 and December 2002; and group 3 (G3), recent HAART, consisting of 229 patients who underwent endoscopy between January 2005 and December 2008. Parameters studied included age, gender, opportunistic chemoprophylaxis, antiretroviral therapies, CD4 cell counts, symptoms, observations at the first UGI endoscopy and histology. RESULTS: When G1, G2 and G3 were compared, significant increases were seen over time in the following parameters: the percentage of women, the mean CD4 cell count, and the frequencies of reflux symptoms, gastroesophageal reflux disease (GERD), inflammatory gastropathy, gastric ulcer and Helicobacter pylori (HP) infection. Significant decreases were seen in the frequencies of the administration of anti-opportunistic infection prophylaxis, odynophagia/dysphagia, acute/chronic diarrhoea, candida oesophagitis, nonspecific oesophageal ulcer and Kaposi sarcoma. No significant change was observed in the other parameters, i.e. digestive bleeding, duodenal ulcer and inflammatory duodenopathy. CONCLUSION: These results suggest a correlation between the improvement of immunity as a result of more efficient antiviral therapy and the decrease in the frequency of digestive diseases in AIDS, mainly opportunistic pathologies. However, HP infection, reflux symptoms and GERD have increased in the HAART era.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Gastroenteropatias/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/imunologia , Adolescente , Adulto , Idoso , Contagem de Linfócito CD4 , Estudos de Coortes , Endoscopia Gastrointestinal , Feminino , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/patologia , Gastroenteropatias/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Úlcera Gástrica/epidemiologia , Úlcera Gástrica/patologia , Carga Viral , Adulto JovemRESUMO
BACKGROUND AND STUDY AIMS: Vedolizumab (VDZ) is a gutselective integrin inhibitor used to treat Crohn's disease (CD) and ulcerative colitis (UC). This retrospective study assessed effectiveness and treatment persistence of VDZ in a Belgian reallife cohort of CD and UC patients. PATIENTS AND METHODS: CD and UC patients from 15 Belgian centers, who started VDZ between 01/09/2015 and 31/06/2016 and attended ≥1 visit after the first VDZ infusion, were included. Data were collected before first infusion, at week (W)10, W14 (CD patients only), month (M)6 and last follow-up. Treatment response and remission rates (changes in disease activity scores) and treatment persistence (Kaplan-Meier analysis) were assessed. RESULTS: Of the 348 patients receiving at least one dose of VDZ, 325 (202 CD, 45 biologic-naïve; and 123 UC, 42 biologic-naïve) patients were included in data analyses. At M6, 87.6% (176/201) of CD and 86.1% (105/122) of UC patients were still on VDZ treatment, 75.6% (34/45) and 83.9% (26/31) achieved clinical response, and 66.7% (44/66) and 42.9% (15/35) were in remission. At M6 remission rates was significantly higher while response rates tended to be higher among biologic-naïve versus biologic-failure CD patients. CONCLUSIONS: VDZ offers an effective treatment option in real-life settings and treatment effectiveness appears higher in biologic-naïve versus biologic-failure CD patients. (Acta gastroenterol. belg., 2020, 83, 15-23).
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Doenças Inflamatórias Intestinais , Anticorpos Monoclonais Humanizados , Bélgica , Fármacos Gastrointestinais , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Indução de Remissão , Estudos RetrospectivosRESUMO
METHODS: In a 4-yr survival study, the prognostic value of the inferior mesenteric shunt, as evaluated by 201Tl per rectum scintigraphy, was assessed in 170 alcoholic cirrhotic patients. The global severity of the hepatic disease was assessed by the Child score, and specific hepatocellular function was evaluated by the aminopyrine breath test. Using 201Tl scintigraphy, three groups were considered: group I, heart-liver activities ratio (H/L ratio) < or = 0.5, n = 55; group II, H/L between 0.5 and 0.85, n = 50; and group III, H/L > 0.85, n = 65. RESULTS: The 4-yr survival rates in the three groups were 76%, 36% and 18%, respectively. The log-rank test showed that the differences between the groups were statistically significant. Regression analysis using Cox's proportional-hazards model showed that the three parameters, Child score, aminopyrine breath test results and H/L ratio were significantly related to survival. CONCLUSION: The inferior mesenteric shunt per se has a prognostic value in alcoholic cirrhosis. Moreover, the H/L ratio provides additional information on survival after the Child score and the aminopyrine breath test results have been taken into account.
Assuntos
Cirrose Hepática Alcoólica/diagnóstico por imagem , Radioisótopos de Tálio , Administração Retal , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Cintilografia , Radioisótopos de Tálio/administração & dosagemRESUMO
To define the physiopathological significance of 201Tl per rectum scintigraphy, we compared results obtained using this method with direct measurement of inferior mesenteric shunting, portal pressure, liver cellular function as evaluated by the Aminopyrine Breath Test and the size of esophagogastric varices and spleen, constituting, respectively, indirect representation of azygos and splenic shunts. Results indicated that a high correlation exists between the measures of portal systemic shunt estimated by the per rectal method and those obtained by direct administration of the tracer in the inferior mesenteric artery. No correlation was observed between 201Tl per rectal results and portal pressure or with azygos and splenic shunting. Fair correlation was observed with the Aminopyrine Breath Test. This could be explained by the fact that both methods are altered in advanced liver disease. These results suggest that the 201Tl per rectal scintigraphy explores the portal systemic shunt, which depends almost exclusively on the inferior mesenteric territory. While the limited territory explored by the method constitutes, undoubtedly, a limiting factor in detection and quantitation of total portal-systemic shunt, the specific information provided by the test could be useful in defining clinical and biological profiles of cirrhotic patients with inferior mesenteric shunting.
Assuntos
Cirrose Hepática Alcoólica/diagnóstico por imagem , Radioisótopos de Tálio , Adulto , Idoso , Feminino , Coração/diagnóstico por imagem , Veias Hepáticas/fisiopatologia , Humanos , Fígado/diagnóstico por imagem , Cirrose Hepática Alcoólica/fisiopatologia , Masculino , Artéria Mesentérica Inferior/fisiopatologia , Pessoa de Meia-Idade , Sistema Porta/fisiopatologia , Cintilografia , Fluxo Sanguíneo Regional , Baço/diagnóstico por imagem , Radioisótopos de Tálio/administração & dosagem , Pressão VenosaRESUMO
A superior mesenteric artery syndrome (SMAS) was diagnosed in two young women with, respectively, a 2- and 1-year history of postprandial vomiting and epigastric pain. The patients underwent a laparoscopic duodenojejunal bypass, and resumed a normal diet on the fifth postoperative day. The patients are still symptom-free with patent anastomosis on gastrointestinal radiographic control at 24 and 6 months, respectively, following their operation. Herein we also describe the varying clinical presentation of this rare syndrome, as well as treatment options. We conclude that laparoscopic duodenojejunostomy offers a new therapeutic approach to SMAS. It is reliable and safe; the operating time is acceptable; and diet recovery and hospital stay are both short. However, these preliminary results still need to be confirmed by further observations.
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Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodeno/cirurgia , Jejuno/cirurgia , Laparoscopia , Síndrome da Artéria Mesentérica Superior/cirurgia , Adolescente , Adulto , Feminino , Humanos , Síndrome da Artéria Mesentérica Superior/diagnósticoRESUMO
The aims of this research were to study some methodological aspects of radionuclide methods for assessing regional gastric motility and to determine the parameters that can be extracted along with their normal values or patterns. During the lag phase, the antral contraction curve showed three different patterns. At the beginning, the antral activity was too low to be analysed. Irregular variation of the count rate was then observed, followed by a more regular contraction. The application of Fourier transformation to the well-defined cyclical count rate variations revealed two areas with high amplitude values but with phase opposition. No peristaltic wave could be identified. After the lag phase, the antral curve showed cyclical variations of count rates with a frequency of about three cycles per minute. Slightly displaced curves but with a much lower amplitude were observed at different parts of the stomach. Several factors were found to influence the antral contraction curve, including the choice of region of interest and time since the last meal. Irregularities in the antral curve, both in terms of frequency and of amplitude, were not unusual in healthy subjects. These should be taken into account when interpreting antral contraction curves. The phase image showed a well-defined peristaltic contraction pattern. Three 360 degrees cycles were usually observed throughout the stomach, suggesting that the time necessary for a peristaltic wave to sweep through from the upper part of the stomach to the antrum is about 1 min. Similar phase images were obtained in all subjects regardless of the amount of time since the meal containing the radioactive tracer, suggesting that gastric peristalsis can easily be assessed and interpreted. The amplitude image showed high amplitude in the antral area and in the greater curvature of the stomach. In the lesser curvature, the amplitude was much lower. Unlike the phase image, however, there was marked variability in the regional amplitude distribution. The value of the regional amplitude distribution for evaluating regional gastric motility is therefore limited.
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Motilidade Gastrointestinal , Antro Pilórico/diagnóstico por imagem , Adulto , Ingestão de Alimentos , Feminino , Esvaziamento Gástrico , Humanos , Masculino , Pessoa de Meia-Idade , Peristaltismo , Antro Pilórico/fisiologia , Cintilografia , Coloide de Enxofre Marcado com Tecnécio Tc 99mRESUMO
BACKGROUND/AIMS: Proton Pump inhibitors and laparoscopic techniques have had a dramatic impact on the therapy of gastroesophageal reflux disease. These techniques have introduced new complications associated with the treatment. This study compares the results of a laparoscopic Nissen fundoplication with life-long proton pump inhibitor treatment. MATERIALS AND METHODS: Between May 1991 and February 1996, 274 patients were treated by laparoscopic Nissen fundoplication (LNF). Two hundred twenty-four patients were included in this prospective study. Thirteen patients presented stage V esophagitis (Barrett); 4 had esophagitis stage IV; 16 had stage III, 181 had stage II and 11 had stage I. Five trocars were needed for the operation. After mobilization of the greater curvature, a fundic wrap of 5 cm was created and fixed on the esophagus. RESULTS: Median operating time was 60 min (39-300). There were 5 perioperative complications (a gastric perforation, three pleural perforations, and one liver laceration treated by coagulation). Three conversions to laparotomy were necessary. There were 4 early complications: two pulmonary infections and two re-operations; one case of wrap necrosis with peritonitis, and one case of small bowel perforation. Gastroscopy was performed in 133 cases. The esophagus was normal in 121 cases, an esophagitis stage I was present in 9, esophagitis stage II in 2, esophagitis stage III in one. Median lower esophageal sphincter pressure was 10 mmHg (2.9-30) preoperatively and 19 mmHg (9-40) post-operatively. Median reflux time was 10% (0-65) preoperatively and 1% (0-38) post-operatively. One hundred fifty-four patients were interviewed with a median follow up of 30 months (1-58). One hundred thirty patients were Visick I, 11 Visick II, 8 Visick III and 5 patients needed re-operation; three reoperations because of dysphagia, 1 because of epigastric pain and 1 for heartburn recurrence. CONCLUSIONS: From these results, we conclude that LNF seems to be an attractive alternative to long term medical treatment.
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Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastroscopia , Humanos , Laparoscopia/métodos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
AIM: A Belgian registry for pediatric Crohn's disease, BELCRO, was created. This first report aims at describing disease presentation and phenotype and determining associations between variables at diagnosis and registration in the database. METHODS: Through a collaborative network, children with previously established Crohn's disease and newly diagnosed children and adolescents (under 18 y of age) were recruited over a 2 year period. Data were collected by 23 centers and entered in a database. Statistical association tests analyzed relationships between variables of interest at diagnosis. RESULTS: Two hundred fifty-five patients were included. Median age at diagnosis was 12.5 y (range: 1.6-18 y); median duration of symptoms prior to diagnosis was 3 m (range: 1-12 m). Neonatal history and previous medical history did not influence disease onset nor disease behavior. Fifty three % of these patients presented with a BMI z-score < -1. CRP was an independent predictor of disease severity. Steroids were widely used as initial treatment in moderate to severe and extensive disease. Over time, immunomodulators and biological were prescribed more frequently, reflecting a lower prescription rate for steroids and 5-ASA. A positive family history was the sole significant determinant for earlier use of immunosuppression. CONCLUSION: In Belgium, the median age of children presenting with Crohn's disease is 12.5 y. Faltering growth, extensive disease and upper GI involvement are frequent. CRP is an independent predictive factor of disease activity. A positive family history appears to be the main determinant for initial treatment choice.
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Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Sistema de Registros , Adolescente , Distribuição por Idade , Idade de Início , Anti-Inflamatórios/uso terapêutico , Bélgica/epidemiologia , Criança , Pré-Escolar , Doença de Crohn/tratamento farmacológico , Progressão da Doença , Quimioterapia Combinada , Humanos , Imunossupressores , Lactente , Modelos Logísticos , Monitorização Fisiológica/métodos , Análise Multivariada , Prevalência , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Estatísticas não ParamétricasRESUMO
BACKGROUND AND AIMS: TPMT deficiency is associated with azathioprine (AZA)-induced myelosuppression (MS). However, in one previous study, only about » of MS episodes in Crohn's Disease patients under AZA can be attributed to TPMT deficiency. Recently, new TPMT mutations have been described and our aim is to investigate their clinical relevance before and after a first MS episode on thiopurine therapy. METHODS: Clinical data from 61 IBD patients having developed MS during AZA therapy were collected. Sequencing analysis was carried out on TPMT cDNA for the presence of all currently known mutations. RESULTS: Only TPMT *2, *3A and *3C mutations were found in this cohort. TPMT mutations were observed in 15 out of 61 patients (25%). Four out of 15 were homozygous for a TPMT mutation (low methylator, LM genotype) and 11 were heterozygous (intermediate methylator, IM genotype). Median delays of MS onset were 2, 2.75 and 6months in the LM, IM and HM (high methylator, wild type TPMT) groups, respectively. After the first MS episode, 36 patients resumed thiopurine treatment of which 13 experienced a second MS episode. This second episode was also rarely associated with TPMT mutations. CONCLUSIONS: One quarter of MS episodes during AZA were associated with TPMT deficient genotype. After a first leucopenia episode, thiopurine therapy may be resumed in a majority of patients independently of their TPMT genotype.
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Azatioprina/efeitos adversos , Hipersensibilidade a Drogas/complicações , Doenças Inflamatórias Intestinais/complicações , Metiltransferases/genética , Erros Inatos do Metabolismo da Purina-Pirimidina/complicações , Adolescente , Adulto , Idoso , Azatioprina/uso terapêutico , Análise Mutacional de DNA , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/genética , Feminino , Genótipo , Humanos , Imunossupressores , Doenças Inflamatórias Intestinais/tratamento farmacológico , Leucopenia , Masculino , Pessoa de Meia-Idade , Mutação , Pancitopenia/induzido quimicamente , Pancitopenia/genética , Erros Inatos do Metabolismo da Purina-Pirimidina/etiologia , Erros Inatos do Metabolismo da Purina-Pirimidina/genética , Estudos Retrospectivos , Adulto JovemRESUMO
Both dyspeptic and gastro-oesophageal reflux-like symptoms are frequent in the general population, but their degree of overlap is unknown. In severe functional dyspepsia (FD), symptoms are organized in factors associated with pathophysiological mechanisms. The aims of this study were: (i) to assess the prevalence of dyspeptic symptoms with and without overlapping reflux symptoms in the general population and their impact on daily life and on healthcare utilization; and (ii) to compare symptom groupings in the general population to FD patients. A total of 2025 subjects, representative of the Belgian general population, were used in this study. The subjects were submitted to a questionnaire with validated questions on their dyspeptic and reflux symptoms and with evaluators of impact on daily life and use of healthcare resources. Significant dyspeptic symptoms were found in 417 (20.6%). Overlapping reflux symptoms were present in 141 (33.8%). In this group, symptoms were more frequent and more severe. Dyspeptic symptoms induced weight loss (12.7%) and absenteeism (12.4%), affected daily life (61.2%) and generated use of healthcare resources, such as medical consultations (61.4%) and medication (70.9%). Factor analysis revealed a three-component structure with factor 1 including fullness, bloating and early satiety, factor 2 including nausea and vomiting and factor 3 including discomfort, pain, belching and reflux. If forced in a four-factor model, the analysis separates belching as independent factor. Dyspeptic symptoms are frequent in the general population, with overlapping reflux symptoms and increased symptom burden in about a third.
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Dispepsia/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Análise por Conglomerados , Dispepsia/complicações , Dispepsia/fisiopatologia , Análise Fatorial , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
In a 4-year survival study, we evaluated the prognostic value of the aminopyrine breath test and the Child-Turcotte-Pugh score in 190 alcoholic patients. Using aminopyrine breath test results, the patients were stratified into group 1 (aminopyrine breath test > 2%), group 2 (1% < or = aminopyrine breath test < 2%) and group 3 (aminopyrine breath test < 1%). Survival rates at 4 years were 68% in group 1, 35% in group 2 and 17% in group 3. Using the Child-Turcotte-Pugh score, survival rates at 4 years were 67% in Child-Turcotte-Pugh class A, 40% in class B and 7% in class C. To assess the value of aminopyrine breath test as an adjunct to Child-Turcotte-Pugh score in prognostic evaluation of patients with cirrhosis, two approaches have been used: a regression analysis using Cox's proportional hazard model by including the Child-Turcotte-Pugh score and aminopyrine breath test value, and the log-rank test to assess the prognostic value of aminopyrine breath test in each Child-Turcotte-Pugh class separately. The regression analysis showed that both parameters, the Child-Turcotte-Pugh score and the aminopyrine breath test results, were accepted in the model, suggesting that the aminopyrine breath test was still significantly related to survival once the Child-Turcotte-Pugh score had been entered into the model. Analysis of the prognostic value of the aminopyrine breath test in each Child-Turcotte-Pugh class separately indicated, however, that the contribution was negligible in the Child-Turcotte-Pugh class C.(ABSTRACT TRUNCATED AT 250 WORDS)
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Aminopirina , Testes Respiratórios , Cirrose Hepática Alcoólica/diagnóstico , Humanos , Cirrose Hepática Alcoólica/mortalidade , Cirrose Hepática Alcoólica/fisiopatologia , Prognóstico , Índice de Gravidade de Doença , Análise de Sobrevida , Fatores de TempoRESUMO
Cholestasis in patients with acquired immune deficiency syndrome was systematically investigated by ultrasonography and endoscopic retrograde cholangiopancreatography. The two procedures were found to be complementary, and showed similar results in 56.2% of the cases. Ultrasonography was superior in detecting common bile duct wall thickening, whereas endoscopic retrograde cholangiography was superior in demonstrating intrahepatic narrowing of the biliary tract.
Assuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico por imagem , Colestase/diagnóstico por imagem , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/patologia , Adulto , Sistema Biliar/diagnóstico por imagem , Sistema Biliar/patologia , Colangiopancreatografia Retrógrada Endoscópica , Colestase/complicações , Colestase/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , UltrassonografiaRESUMO
OBJECTIVES: The aim of this work was to assess the contribution of thallium-201 chloride (Tl-201) per rectal scintigraphy in long term prognostic evaluation of alcoholic, cirrhotic patients. METHODS: The data obtained from 170 biopsy-proven cirrhotic patients have been used in this 4-yr survival study. The severity of the liver disease was assessed by using the classic Child-Turcotte score as modified by Pugh (CTP score). RESULTS: In patients belonging to CTP class A and CTP class B, the Tl-201 test allowed the identification of subgroups with different survival rates. In these two classes of patients, the Tl-201 per rectal scintigraphy could be used for improving prognostic evaluation. In patients of class C on the other hand, 4-yr survival rates were very low, and the Tl-201 test did not bring significant additional prognostic information. CONCLUSIONS: Therefore, we suggest performing the Tl-201 test in cirrhotic patients of classes A and B as defined by the CTP score.
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Coração/diagnóstico por imagem , Cirrose Hepática Alcoólica/diagnóstico por imagem , Fígado/diagnóstico por imagem , Sistema Porta/diagnóstico por imagem , Radioisótopos de Tálio , Estudos de Casos e Controles , Humanos , Tábuas de Vida , Cirrose Hepática Alcoólica/mortalidade , Pessoa de Meia-Idade , Sistema Porta/fisiopatologia , Prognóstico , Cintilografia , Índice de Gravidade de Doença , Análise de Sobrevida , Taxa de SobrevidaRESUMO
In a long-term survival study, we compared the prognostic significance of the hepatic venous pressure gradient and of the aminopyrine breath test (ABT) in 99 alcoholic cirrhotic patients. Thirty patients survived and had a complete follow-up for at least 4 yr. Mean hepatic venous pressure gradient was 19.1 +/- 5.8 mm Hg (range 8-35 mm Hg). Variceal rupture occurred only when the gradient was > or = 12 mm Hg. Variceal bleeding was observed exclusively in patients with large varices. Survival was not influenced by the level of gradient. We used the ABT to classify patients into three groups (group I, ABT > or = 2%; group II, 1% < or = ABT < 2%; and group III, ABT < 1%). Survival was significantly higher in group I than in group II (p < 0.05) or III (p < 0.01), indicating a better prognosis at a residual functional hepatic cellular mass of about 50% of the lower limit of normal value.