Cardoso, M; Lourenço, L; Oliveira, AM; Boléo-Tomé, JP; Reis, J
Magro, F; Lopes, S; Coelho, R; Cotter, J; Castro, F; Sousa, H; Salgado, M; Andrade, P; Vieira, A; Figueiredo, P; Caldeira, P; Sousa, A; Duarte, M; Ávila, F; Silva, J; Moleiro, J; Mendes, S; Giestas, S; Ministro, P; Sousa, P; Gonçalves, R; Gonçalves, B; Oliveira, A; Chagas, C; Torres, J; Dias, C; Lopes, J; Borralho, P; Afonso, J; Geboes, K; Carneiro, F; Portuguese IBD Study Group [GEDII].
BACKGROUND AND AIMS:
Mucosal healing and histological remission are different targets for patients with ulcerative colitis, but both rely on an invasive endoscopic procedure. This study aimed to assess faecal calprotectin and neutrophil gelatinase B-associated lipocalin as biomarkers for disease activity in asymptomatic ulcerative colitis patients.
This was a multicentric cross-sectional study including 371 patients, who were classified according to their endoscopic and histological scores. These results were evaluated alongside the faecal levels of both biomarkers.
Macroscopic lesions [i.e. endoscopic Mayo score ≥1] were present in 28% of the patients, and 9% had active disease according to fht Ulcerative Colitis Endoscopic Index of...
Martins, I; Figueiredo, L
A obstipação crónica idiopática (OCI), uma doença frequente
no âmbito da gastrenterologia, tem sofrido grandes desenvolvimentos
nos últimos anos no que diz respeito à sua abordagem
terapêutica. Actualmente, antes da instituição de uma
terapêutica em “cascata”, preconiza-se a descontinuação, se
possível, de fármacos potencialmente causadores de obstipação.
Posteriormente está preconizado o início da utilização
de laxantes e, quando necessário, até mesmo associá-los. Na
tentativa de uma maior eficácia terapêutica, têm sido desenvolvidos
novos fármacos, dos quais destacamos o prucalopride
(procinético), a lubiprostona e a linaclotida (agentes secretores).
O prucalopride foi aprovado no tratamento da OCI, mas
ainda não se encontra disponível em Portugal. A lubiprostona
foi aprovada no tratamento da OCI e do...
Oliveira, AM; Carvalho, R; Martins, A; Reis, J
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a
severe, idiosyncratic reaction characterized by diffuse maculopapular rash, facial edema, lym-
phadenopathy, fever, eosinophilia and/or other leukocyte abnormalities, and involvement of
internal organs as liver, kidney, heart and lung.
Diagnosing this entity is speciﬁcally complicated due to the multiplicity of organs involved.
DRESS syndrome must be recognized promptly and the causative drug withdrawn in order to
improve patient outcomes. Indeed, it is a potentially life-threatening condition, with a reported
mortality between 5 and 20%.
We describe a case of a 22-year old woman admitted to our hospital with acute diffuse,
pruritic rash associated with crampy abdominal pain, vomiting,...
Oliveira, AM; Santiago, I; Carvalho, R; Martins, A; Reis, J
Visceral angioedema is a rare complication of therapy with angiotensin-converting
enzyme (ACE) inhibitors. Clinical presentation includes nausea, vomiting, abdominal pain and
diarrhea. Early detection of this entity can prevent recurrent episodes and unnecessary invasive
procedures, including surgery.
This article describes a 46-year-old-woman who presented to the emergency department with
abdominal pain, associated with nausea and vomiting. She had been taking ramipril for 15 days.
A computed tomography was performed which revealed thickening of a jejunal segment, with
ACE inhibitor-associated angioedema was suspected and the medication was discontinued, with
resolution of symptoms in 48 h.
After 7 months of follow-up, the patient is asymptomatic.
Despite of its rarity, ACE inhibitor-induced...
Oliveira, AM; Martins, M; Martins, A; Deus, JR
Cai, M; Zhou, P; Lourenço, L; Zhang, D
There has been booming interest in the endoscopic full-thickness resection (EFTR) technique since it was first described. With the advent of improved and more secure endoscopic closure techniques and devices, such as endoscopic suturing devices, endoscopists are empowered to perform more aggressive procedures than ever. This article focuses on the procedural technique and clinical outcomes of EFTR for gastrointestinal subepithelial tumors.
Portela, F; Dias, C; Caldeira, P; Cravo, M; Deus, JR; Gonçalves, R; Lago, P; Morna, H; Peixe, P; Ramos, J; Sousa, H; Tavares, L; Vasconcelos, H; Magro, F; Ministro, P
The use of complementary and alternative medicines is increasing among chronic patients, particularly those afflicted with inflammatory bowel diseases.
This study aimed to address the prevalence of complementary and alternative medicines use among Portuguese inflammatory bowel diseases' patients.
Patients were invited to fill an anonymous questionnaire concerning the use of complementary and alternative medicines.
Thirty-one per cent of the patients reported having used complementary and alternative medicines in the past, whereas 12% were using them by the time the questionnaire was administered. Fifty-nine per cent of the users did not share this information with their physician, whereas 14% and 8% discontinued their medication...
Lourenço, L; Horta, D; Rodrigues, C; Canena, J; Reis, J
Branco, J; Horta, D; Reis, J
Pancreaticopleural fistula is a rare complication of chronic pancreatitis. The diagnosis requires a high suspicion degree and its management frequently involves a multidisciplinary approach between gastroenterology and surgery.
Oliveira, AM; Branco, JC; Barosa, R; Rodrigues, JA; Ramos, L; Martins, A; Karvellas, C; Cardoso, F
Spontaneous bacterial peritonitis (SBP) is a prevalent and high mortality complication of cirrhosis. We aimed to describe these patients' clinical and microbiological characteristics and evaluate their impact on outcomes.
This was a retrospective cohort study including 139 consecutive patients with positive culture SBP from three Portuguese centers diagnosed between 2009 and 2014. Multivariate logistic regression was used to study associations with 30-day mortality.
The mean age of the patients was 62 years and 81% of patients were men. The mean model for end-stage liver disease score was 19. Hepatic encephalopathy, hepatorenal syndrome, and variceal bleeding developed in 47, 30, and 21% of...
Karvellas, C; Cardoso, F; Gottfried, M; Reddy, R; Hanje, A; Ganger, D; Lee, W
BACKGROUND & AIMS:
Acute liver failure (ALF) caused by hepatitis B virus (HBV) infection can occur after immunosuppressive treatment and be fatal, although it might be preventable. We aimed to characterize the causes, clinical course, and short-term outcomes of HBV-associated ALF after immune-suppressive therapy, compared with patients with HBV-associated ALF without immunosuppression (control subjects).
We performed a retrospective multicenter study of 156 consecutive patients diagnosed with HBV-associated ALF (22 with a solid or blood malignancy) enrolled in the Acute Liver Failure Study Group registry from January 1998 through April 2015. We collected data on results of serologic and hepatic biochemistry analyses, grade...
Rodrigues, C; Oliveira, A; Deus, JR
Canena, J; Coimbra, J; Carvalho, D; Rodrigues, C; Silva, M; Costa, M; Horta, D; Dias, A; Seves, I; Ramos, G; Ricardo, L; Coutinho, A; Romão, C; Veiga, P
Self-expandable metal stents (SEMSs) can be used for palliation of combined malignant biliary and duodenal obstructions. However, the results of the concomitant stent placement for the duration of the patients' lives, as well as the need for and efficacy of endoscopic revision, are unclear.
This study evaluated the clinical effectiveness of SEMS placement for combined biliary and duodenal obstructions throughout the patients' lives and the need for endoscopic revision.
This study is a retrospective multicenter study of 50 consecutive patients who underwent simultaneous or sequential SEMS placement for malignant biliary and duodenal obstructions. The data were collected to analyze the sustained relief...
Lourenço, L; Sousa, M; Oliveira, AM; Gomes, A; Rodrigues, C; Santos, I; Horta, D; Pignatelli, N; Nunes, V; Reis, J
Prémio Medtronic Investigação em Coloproctologia 2015, no XXV Congresso Nacional de Coloproctologia, que decorreu nos dias 26 e 27 de Novembro de 2015, no Porto.
Santos, S; Pires, E; Figueiredo, A; Silva, S; Deus, JR
A designação de polipo maligno significa a presença de um adenoma com um foco de carcinoma que invade a submucosa (carcinoma invasivo). Este tempo é habitualmente utilizado quando um polipo que foi ressecado por via endoscópica, se vem a comprovar, após exame histológico, conter carcinoma invasivo.
A incidência de polipos malignos, removidos endoscopicamente, é em média de 4,7% (0,2-9,4%).
O risco de malignidade está associado à dimensão, localização e configuração histológica.
A abordagem terapêutica dum polipo maligno varia entre uma atitude conservadora, considerando a polipectomia tratamento adequado e suficiente e uma atitude cirúrgica de ressecção complementar, no caso contrário.
A ressecção cirúrgica deverá tomar...
Pereira, A; Coelho, AP; Rodrigues, C; Costa, C; Carreteiro, M
O conceito de enfermeiro endoscopista ainda é recente, estando ligado em grande parte ao desenvolvimento das técnicas de diagnóstico e terapêutica em Gastroenterologia. A sua diversificação e complexidade tem vindo a reforçar o contributo do enfermeiro nesta área. Nesse sentido é da maior importância que se acompanhe esta evolução através da actualização de conhecimentos teóricos e práticos que se traduzam num desempenho eficaz e de qualidade.
Oliveira, AM; Cardoso, F; Rodrigues, C; Santos, L; Martins, A; Deus, JR; Reis, J
Introduction: Recently, it has been suggested an association between red cell distribution width
(RDW) and Crohn’s disease activity index (CDAI), but its use is not yet performed in daily clinical
Objectives: To determine whether RDW can be used as a marker of Crohn’s disease (CD) activity.
Methods: This was a cross-sectional study including patients with CD, observed consecutively
in an outpatient setting between January 1st and September 30th 2013. Blood cell indices,
erythrocyte sedimentation rate (ESR), and C-reactive protein were measured. CD activity was
determined by CDAI (active disease if CDAI ≥ 150). Associations were analyzed using logistic
regression (SPSS version 20).
Results: 119 patients (56% female) were...
Cardoso, F; Ricardo, L; Oliveira, AM; Horta, D; Papoila, A; Deus, JR; Canena, J
Introduction: C-reactive protein (CRP) and Bedside Index for Severity in Acute Pancreatitis
(BISAP) have been used in early risk assessment of patients with AP.
Objectives: We evaluated prognostic accuracy of CRP at 24 hours after hospital admission
(CRP24) for in-hospital mortality (IM) in AP individually and with BISAP.
Materials and Methods: This retrospective cohort study included 134 patients with AP
from a Portuguese hospital in 2009---2010. Prognostic accuracy assessment used area under
receiver---operating characteristic curve (AUC), continuous net reclassiﬁcation improvement
(NRI), and integrated discrimination improvement (IDI).
Results: Thirteen percent of patients had severe AP, 26% developed pancreatic necrosis, and 7%
died during index hospital stay. AUCs for CRP24 and...