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[PMID]:28501581
[Au] Autor:Park JM; Huo SM; Lee HH; Lee BI; Song HJ; Choi MG
[Ad] Endereço:Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. Electronic address: parkjerry@catholic.ac.kr.
[Ti] Título:Longer Observation Time Increases Proportion of Neoplasms Detected by Esophagogastroduodenoscopy.
[So] Source:Gastroenterology;153(2):460-469.e1, 2017 Aug.
[Is] ISSN:1528-0012
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND & AIMS: Esophagogastroduodenoscopy (EGD) is commonly used to detect upper gastrointestinal (GI) neoplasms. However, there is little evidence that longer examination time increases rate of detection of upper GI neoplasia. We investigated the association between length of time spent performing a normal screening EGD and rate of neoplasm detection. METHODS: We performed a retrospective analysis of data from 111,962 subjects who underwent EGD as part of a comprehensive health-screening program from January 2009 to December 2015 in Korea. Endoscopy findings were extracted from reports prepared by 14 board-certified endoscopists. Endoscopists were classified as fast or slow based on their mean examination time for a normal EGD without biopsy during their first year of the study. All endoscopists used the same endoscopy unit. We obtained findings from histologic analyses of GI biopsies from patient records; positive findings were defined as the detection of neoplasms (esophageal, gastric, or duodenal lesions). We examined the association between examination time and proportions of neoplasms detected. The primary outcome measure was the rate of neoplasm detection for each endoscopist (total number of neoplastic lesions detected divided by the number of subjects screened) and as the proportion of subjects with at least 1 neoplastic lesion. RESULTS: The mean examination time was 2 minutes 53 seconds. Using 3 minutes as a cutoff, we classified 8 endoscopists as fast (mean duration, 2:38 ± 0:21 minutes) and 6 endoscopists as slow (mean duration, 3:25 ± 0:19 minutes). Each endoscopist's mean examination time correlated with their rate of neoplasm detection (R = 0.54; P = .046). Fast endoscopists identified neoplasms in the upper GI tract in 0.20% of patients, whereas slow endoscopists identified these in 0.28% of patients (P = .0054). The frequency of endoscopic biopsy varied among endoscopists (range, 6.9%-27.8%) and correlated with rate of neoplasm detection (R = 0.76; P = .0015). On multivariable analysis, slow endoscopists were more likely to detect gastric adenomas or carcinomas than fast endoscopists (odds ratio, 1.52; 95% CI, 1.17-1.97). CONCLUSIONS: In a retrospective analysis of data from more than 100,000 subjects who underwent EGD in a screening program, we found slow endoscopists detected a higher proportion of neoplasms than fast endoscopists. Examination time is therefore a useful indicator of quality for EGD.
[Mh] Termos MeSH primário: Erros de Diagnóstico/estatística & dados numéricos
Endoscopia do Sistema Digestório/estatística & dados numéricos
Neoplasias Gastrointestinais/diagnóstico
Fatores de Tempo
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Endoscopia do Sistema Digestório/métodos
Endoscopia do Sistema Digestório/normas
Feminino
Seres Humanos
Masculino
Meia-Idade
Duração da Cirurgia
República da Coreia
Estudos Retrospectivos
Trato Gastrointestinal Superior/cirurgia
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170515
[St] Status:MEDLINE


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[PMID]:28494001
[Au] Autor:Buechter M; Kahraman A; Manka P; Gerken G; Dechêne A; Canbay A; Wetter A; Umutlu L; Theysohn JM
[Ad] Endereço:Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.
[Ti] Título:Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation.
[So] Source:PLoS One;12(5):e0177401, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is a severe and life-threatening complication among patients with portal hypertension (PH). Covered transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice for patients with refractory or recurrent UGIB despite pharmacological and endoscopic therapy. In some patients, TIPS implantation is not possible due to co-morbidity or vascular disorders. Spleen embolization (SE) may be a promising alternative in this setting. MATERIALS AND METHODS: We retrospectively analyzed 9 patients with PH-induced UGIB who underwent partial SE between 2012 and 2016. All patients met the following criteria: (i) upper gastrointestinal hemorrhage with primary or secondary failure of endoscopic interventions and (ii) TIPS implantation not possible. Each patient was followed for at least 6 months after embolization. RESULTS: Five patients (56%) suffered from cirrhotic PH, 4 patients (44%) from non-cirrhotic PH. UGIB occured in terms of refractory hemorrhage from gastric varices (3/9; 33%), hemorrhage from esophageal varices (3/9; 33%), and finally, hemorrhage from portal-hypertensive gastropathy (3/9; 33%). None of the patients treated with partial SE experienced re-bleeding episodes or required blood transfusions during a total follow-up time of 159 months, including both patients with cirrhotic- and non-cirrhotic PH. DISCUSSION: Partial SE, as a minimally invasive intervention with low procedure-associated complications, may be a valuable alternative for patients with recurrent PH-induced UGIB refractory to standard therapy.
[Mh] Termos MeSH primário: Embolização Terapêutica
Hemorragia Gastrointestinal/etiologia
Hemorragia Gastrointestinal/cirurgia
Hipertensão Portal/complicações
Derivação Portossistêmica Transjugular Intra-Hepática
Baço/cirurgia
Trato Gastrointestinal Superior/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Endoscopia Gastrointestinal
Feminino
Hemorragia Gastrointestinal/fisiopatologia
Seres Humanos
Hipertensão Portal/fisiopatologia
Hipertensão Portal/cirurgia
Masculino
Meia-Idade
Estudos Retrospectivos
Baço/patologia
Baço/fisiopatologia
Trato Gastrointestinal Superior/patologia
Trato Gastrointestinal Superior/fisiopatologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170512
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0177401


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[PMID]:28420890
[Au] Autor:Iwamuro M; Kondo E; Tanaka T; Hagiya H; Kawano S; Kawahara Y; Otsuka F; Okada H
[Ad] Endereço:Departments of General Medicine, and Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.iwamuromasaya@yahoo.co.jp.
[Ti] Título:Endoscopic Manifestations and Clinical Characteristics of Cytomegalovirus Infection in the Upper Gastrointestinal Tract.
[So] Source:Acta Med Okayama;71(2):97-104, 2017 Apr.
[Is] ISSN:0386-300X
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:We retrospectively analyzed the cases of 14 patients (9 women, 5 men, mean age: 51.6 years) with cytomegalovirus (CMV) involvement in the esophagus, stomach, and/or duodenum diagnosed at a single center, to determine their endoscopic features and clinical backgrounds. Thirteen patients (92.9%) had hematologic disease; the other had rheumatoid arthritis. Of the former, 12 patients underwent allogeneic hematopoietic stem cell transplantation, and 9 of these patients had graft-versus-host disease (GVHD) before undergoing esophagogastroduodenoscopy (EGD). All 14 patients had been taking one or more immunosuppressive agents including cyclosporine (n=10), corticosteroids (n=9), mycophenolic acid (n=6), tacrolimus (n=3), and methotrexate (n=1). Tests for CMV antigenemia were positive in 11 patients (78.6%). EGD examinations revealed esophageal (n=3), gastric (n=9), and duodenal involvement (n=6). Macroscopically, esophageal lesions by CMV infection presented as redness (n=1), erosions (n=1), and ulcers (n=1). Gastric lesions manifested as redness (n=7), erosions (n=3), exfoliated mucosa (n=2), and verrucous erosions (n=1). Mucosal appearances in the duodenum varied: redness (n=2), ulcers (n=2), multiple erosions (n=2), single erosion (n=1), edema (n=1). CMV was detected even in the intact duodenal mucosa (n=1). In conclusion, physicians must recall the relevance of CMV infection when any mucosal alterations exist in the upper gastrointestinal tract of immunosuppressed patients.
[Mh] Termos MeSH primário: Infecções por Citomegalovirus/diagnóstico
Duodenopatias/diagnóstico
Doenças do Esôfago/diagnóstico
Imunossupressores/efeitos adversos
Gastropatias/diagnóstico
Trato Gastrointestinal Superior/patologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Infecções por Citomegalovirus/complicações
Duodenopatias/etiologia
Duodenopatias/fisiopatologia
Endoscopia do Sistema Digestório
Doenças do Esôfago/etiologia
Doenças do Esôfago/fisiopatologia
Feminino
Doença Enxerto-Hospedeiro/complicações
Transplante de Células-Tronco Hematopoéticas/efeitos adversos
Seres Humanos
Hospedeiro Imunocomprometido
Masculino
Meia-Idade
Estudos Retrospectivos
Sensibilidade e Especificidade
Gastropatias/etiologia
Gastropatias/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunosuppressive Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170420
[St] Status:MEDLINE
[do] DOI:10.18926/AMO/54977


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[PMID]:28375474
[Au] Autor:Banerjee JK; Saranga Bharathi R
[Ti] Título:Minimally invasive substernal colonic transposition for corrosive strictures of the upper aerodigestive tract.
[So] Source:Dis Esophagus;30(4):1-11, 2017 Apr 01.
[Is] ISSN:1442-2050
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Corrosive upper aerodigestive tract strictures are conventionally treated by open surgery. Surgical advancements permit these strictures to be addressed with minimal invasion. Corrosive strictures treated minimally invasively over a 2-year period (2014-2015) were audited. Colonic mobilization and retrosternal tunneling were performed laparoscopically. The left colic vessel-based isoperistaltic colonic/ileocolonic segment was transposed substernally into the neck, aided by miniceliotomy. Proximal anastomosis was side-to-side esophagocolic in all patients except those who underwent pharyngolaryngectomy or partial laryngectomy, where pharyngocolic/pyriform fossa-ileal anastomosis was employed. Distal anastomoses were colo-jejunal and colocolic/ileocolic in all the patients. Enteral nutrition and ambulation were commenced on the first postoperative day. Oral nutrition was commenced following a normal contrast swallow on the seventh postoperative day. Patients were followed up on an outpatient basis. Ten adults, aged between 19 and 40 years, were treated for acid-induced strictures. Esophagus and stomach were multiply strictured in all patients. Additionally, duodenum was involved in two patients while pharynx and larynx were strictured in three patients. Two patients underwent pharyngolaryngectomy. One patient underwent partial laryngectomy. The average operative time was 240 minutes (range: 210-300 minutes). The mean blood loss was 150 mL (range: 100-200 mL). One patient (10%) had cervical anastomotic leak on the ninth postoperative day, which was resolved spontaneously. One patient (10%) had proximal anastomotic stricture, requiring dilatation thrice. One patient (10%) had the transient left recurrent laryngeal nerve paresis, which was resolved spontaneously. All the patients are on oral solid diet. The followup ranged from 5 months to 2 years. Minimal access substernal colonic transposition is feasible and efficacious in restoring alimentary continuity in corrosive strictures.
[Mh] Termos MeSH primário: Queimaduras Químicas/cirurgia
Colo/cirurgia
Estenose Esofágica/cirurgia
Faringe/cirurgia
Trato Gastrointestinal Superior/cirurgia
[Mh] Termos MeSH secundário: Adulto
Anastomose Cirúrgica/métodos
Queimaduras Químicas/complicações
Cáusticos/toxicidade
Colo/lesões
Colo/patologia
Constrição Patológica
Estenose Esofágica/induzido quimicamente
Feminino
Seres Humanos
Laparoscopia/métodos
Laringectomia
Laringe/lesões
Laringe/patologia
Laringe/cirurgia
Masculino
Auditoria Médica
Duração da Cirurgia
Faringectomia
Faringe/lesões
Faringe/patologia
Resultado do Tratamento
Trato Gastrointestinal Superior/lesões
Trato Gastrointestinal Superior/patologia
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Caustics)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.1093/dote/dow030


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[PMID]:28365919
[Au] Autor:Suzuki H
[Ad] Endereço:Medical Education Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. hsuzuki.a6@keio.jp.
[Ti] Título:Helicobacter pylori-Associated Upper Gastrointestinal Symptoms: FD or HpD?
[So] Source:Dig Dis Sci;62(6):1391-1393, 2017 06.
[Is] ISSN:1573-2568
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Infecções por Helicobacter
Helicobacter pylori
[Mh] Termos MeSH secundário: Dispepsia
Seres Humanos
Trato Gastrointestinal Superior
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170403
[St] Status:MEDLINE
[do] DOI:10.1007/s10620-017-4556-4


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[PMID]:28361278
[Au] Autor:Chau SH; Sluiter RL; Kievit W; Wensing M; Teichert M; Hugtenburg JG
[Ad] Endereço:Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. s.chau@vumc.nl.
[Ti] Título:Cost Effectiveness of Gastroprotection with Proton Pump Inhibitors in Older Low-Dose Acetylsalicylic Acid Users in the Netherlands.
[So] Source:Drugs Aging;34(5):375-386, 2017 May.
[Is] ISSN:1179-1969
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The present study aimed to assess the cost effectiveness of concomitant proton pump inhibitor (PPI) treatment in low-dose acetylsalicylic acid (LDASA) users at risk of upper gastrointestinal (UGI) adverse effects as compared with no PPI co-medication with attention to the age-dependent influence of PPI-induced adverse effects. METHODS: We used a Markov model to compare the strategy of PPI co-medication with no PPI co-medication in older LDASA users at risk of UGI adverse effects. As PPIs reduce the risk of UGI bleeding and dyspepsia, these risk factors were modelled together with PPI adverse effects for LDASA users 60-69, 70-79 (base case) and 80 years and older. Incremental cost-utility ratios (ICURs) were calculated as cost per quality-adjusted life-year (QALY) gained per age category. Furthermore, a budget impact analysis assessed the expected changes in expenditure of the Dutch healthcare system following the adoption of PPI co-treatment in all LDASA users potentially at risk of UGI adverse effects. RESULTS: PPI co-treatment of 70- to 79-year-old LDASA users, as compared with no PPI, resulted in incremental costs of €100.51 at incremental effects of 0.007 QALYs with an ICUR of €14,671/QALY. ICURs for 60- to 69-year-old LDASA users were €13,264/QALY and €64,121/QALY for patients 80 years and older. Initiation of PPI co-treatment for all Dutch LDASA users of 60 years and older at risk of UGI adverse effects but not prescribed a PPI (19%) would have cost €1,280,478 in the first year (year 2013 values). CONCLUSIONS: PPI co-medication in LDASA users at risk of UGI adverse effects is generally cost effective. However, this strategy becomes less cost effective with higher age, particularly in patients aged 80 years and older, mainly due to the increased risks of PPI-induced adverse effects.
[Mh] Termos MeSH primário: Aspirina/efeitos adversos
Hemorragia Gastrointestinal/prevenção & controle
Inibidores da Bomba de Prótons/economia
[Mh] Termos MeSH secundário: Idoso
Envelhecimento/efeitos dos fármacos
Aspirina/administração & dosagem
Análise Custo-Benefício
Relação Dose-Resposta a Droga
Hemorragia Gastrointestinal/induzido quimicamente
Hemorragia Gastrointestinal/economia
Seres Humanos
Masculino
Cadeias de Markov
Meia-Idade
Países Baixos
Inibidores da Bomba de Prótons/administração & dosagem
Inibidores da Bomba de Prótons/efeitos adversos
Inibidores da Bomba de Prótons/uso terapêutico
Anos de Vida Ajustados por Qualidade de Vida
Fatores de Risco
Trato Gastrointestinal Superior
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Proton Pump Inhibitors); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170401
[St] Status:MEDLINE
[do] DOI:10.1007/s40266-017-0447-9


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[PMID]:28355953
[Au] Autor:Jovani M; Abidi WM; Lee LS
[Ad] Endereço:a Clinical and Translational Epidemiology Unit, Division of Gastroenterology , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA.
[Ti] Título:Novel fork-tip needles versus standard needles for EUS-guided tissue acquisition from solid masses of the upper GI tract: a matched cohort study.
[So] Source:Scand J Gastroenterol;52(6-7):784-787, 2017 Jun - Jul.
[Is] ISSN:1502-7708
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There are very few available data on the novel SharkCore™ needles for EUS-FNB. AIM: Comparison of the performance of the SharkCore™ needles with the standard EUS-FNA needles for the diagnosis of solid upper GI masses. PATIENTS AND METHODS: Single-center, retrospective cohort study in an academic tertiary referral hospital. Patients were matched 1:1 for the site of the lesion and the presence or absence of rapid on-site evaluation (ROSE). RESULTS: A total of 102 patients were included. There was no statistically significant difference in the mean number of passes (3.3 ± 1.3 versus 3.4 ± 1.5; p = .89). Similar results were observed at the subgroup with ROSE (4.3 ± 1.3 versus 3.7 ± 1.5; p = .26). More histological specimens were obtained with the SharkCore™ needles compared to standard needles (59 versus 5%; p < .001). Diagnostic test characteristics were not significantly different (sensitivity: 91.5 versus 85.7; specificity: 100 versus 100%; accuracy: 92.2 versus 85.4% for SharkCore™ versus standard needles, p > .05 in all cases). At multivariable analysis, there was no statistically significant difference in the mean number of passes in all patients (p = .23) and in the ROSE subgroup (p = .66). However, the SharkCore™ needle obtained significantly more histological material than the standard needle (odds ratio 66; 95% confidence interval: 11.8, 375.8, p < .001). There was no significant difference in complication rates (p = .5). LIMITATIONS: Retrospective study, single-center. CONCLUSION: The SharkCore needles were similar to standard FNA needles in terms of the number of passes to reach diagnosis, but obtained significantly more histological specimen.
[Mh] Termos MeSH primário: Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação
Agulhas/classificação
Neoplasias/patologia
Trato Gastrointestinal Superior/patologia
[Mh] Termos MeSH secundário: Idoso
Diagnóstico Diferencial
Desenho de Equipamento
Feminino
Seres Humanos
Masculino
Meia-Idade
Análise Multivariada
Neoplasias/diagnóstico
Análise de Regressão
Estudos Retrospectivos
Sensibilidade e Especificidade
Centros de Atenção Terciária
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170331
[St] Status:MEDLINE
[do] DOI:10.1080/00365521.2017.1306879


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[PMID]:28346037
[Au] Autor:Rothschild B; Rinawi F; Herman Y; Nir O; Shamir R; Assa A
[Ad] Endereço:a Institute of Gastroenterology, Nutrition and Liver Disease , Schneider Children's Hospital , Petach-Tikva , Israel.
[Ti] Título:Prognostic significance of granulomas in children with Crohn's disease.
[So] Source:Scand J Gastroenterol;52(6-7):716-721, 2017 Jun - Jul.
[Is] ISSN:1502-7708
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Granulomas have long been considered the histological hallmark of Crohn's disease (CD). Currently, there is considerable dispute with regards to their prognostic implications. We aimed to determine the effect of granulomas on phenotypic features and disease's long-term outcomes in a large cohort of pediatric CD patients. MATERIALS AND METHODS: Medical records of pediatric CD patients diagnosed at the Schneider Children's Medical Center were reviewed retrospectively. Patients were categorized into two groups based on the presence or absence of granulomas at diagnosis. Baseline characteristics included anthropometric, clinical, laboratory, radiological and endoscopic data. Outcome measures included flares, hospitalizations, biological therapy and surgery. RESULTS: Of 289 CD patients diagnosed between 2001 and 2015, 99 patients (34%) had granulomas. Median age of the entire cohort at diagnosis was 14.2 years (females, 42.6%), with a median follow-up of 8.5 years. Patients with granulomas had a significantly higher percentage (47.5% vs. 23.7%, p = .001) of upper gastrointestinal involvement and ileo-colonic disease (64.9% vs. 49.5%, p = .01). Extraintestinal manifestations were twice as common in patients without granulomas (16.3% vs. 8.1%, p = .05). Patients with granulomas were more likely to be hospitalized (HR =1.43, 95% CI: 1.0-2.0) and to receive biologic therapy (HR = 1.52, 95% CI: 1.1-2.11). Additionally, both of these disease outcomes occurred significantly earlier (p = .013 and p = .027, respectively). In contrast, patients with granulomas did not exhibit increased risk of flares or bowel resection. CONCLUSION: Patients with granulomas exhibited a distinct phenotype at diagnosis and demonstrated a more severe disease course.
[Mh] Termos MeSH primário: Doença de Crohn/complicações
Doença de Crohn/diagnóstico
Granuloma/epidemiologia
Granuloma/patologia
[Mh] Termos MeSH secundário: Adalimumab/uso terapêutico
Adolescente
Criança
Doença de Crohn/tratamento farmacológico
Endoscopia
Feminino
Seres Humanos
Infliximab/uso terapêutico
Israel
Estimativa de Kaplan-Meier
Masculino
Prognóstico
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Trato Gastrointestinal Superior/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
B72HH48FLU (Infliximab); FYS6T7F842 (Adalimumab)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170328
[St] Status:MEDLINE
[do] DOI:10.1080/00365521.2017.1304571


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[PMID]:28072728
[Au] Autor:Carabotti M; Lahner E; Esposito G; Sacchi MC; Severi C; Annibale B
[Ad] Endereço:aDepartment of Internal Medicine and Medical Specialties, University Sapienza, viale del Policlinico 155, 00161, Rome, Italy bDepartment of Medical and Surgical Sciences and Traslational Medicine, University Sapienza, Via di Grottarossa 1035, 00189, Rome, Italy.
[Ti] Título:Upper gastrointestinal symptoms in autoimmune gastritis: A cross-sectional study.
[So] Source:Medicine (Baltimore);96(1):e5784, 2017 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Autoimmune gastritis is often suspected for its hematologic findings, and rarely the diagnosis is made for the presence of gastrointestinal symptoms. Aims of this cross-sectional study were to assess in a large cohort of patients affected by autoimmune gastritis the occurrence and the pattern of gastrointestinal symptoms and to evaluate whether symptomatic patients are characterized by specific clinical features.Gastrointestinal symptoms of 379 consecutive autoimmune gastritis patients were systematically assessed and classified following Rome III Criteria. Association between symptoms and anemia pattern, positivity to gastric autoantibodies, Helicobacter pylori infection, and concomitant autoimmune disease were evaluated.In total, 70.2% of patients were female, median age 55 years (range 17-83). Pernicious anemia (53.6%), iron deficiency anemia (34.8%), gastric autoantibodies (68.8%), and autoimmune disorders (41.7%) were present. However, 56.7% of patients complained of gastrointestinal symptoms, 69.8% of them had exclusively upper symptoms, 15.8% only lower and 14.4% concomitant upper and lower symptoms. Dyspepsia, subtype postprandial distress syndrome was the most represented, being present in 60.2% of symptomatic patients. Univariate and multivariate analyses showed that age <55 years (OR 1.6 [CI:1-2.5]), absence of smoking habit (OR 2.2 [CI:1.2-4]), and absence of anemia (OR 3.1 [CI:1.5-6.4]) were independent factors associated to dyspepsia.Autoimmune gastritis is associated in almost 60% of cases with gastrointestinal symptoms, in particular dyspepsia. Dyspepsia is strictly related to younger age, no smoking, and absence of anemia.
[Mh] Termos MeSH primário: Doenças Autoimunes
Dispepsia/diagnóstico
Gastrite
Hemoglobinas/análise
Trato Gastrointestinal Superior/fisiopatologia
[Mh] Termos MeSH secundário: Autoanticorpos/análise
Doenças Autoimunes/diagnóstico
Doenças Autoimunes/epidemiologia
Doenças Autoimunes/imunologia
Doenças Autoimunes/fisiopatologia
Estudos Transversais
Feminino
Gastrite/diagnóstico
Gastrite/epidemiologia
Gastrite/imunologia
Gastrite/fisiopatologia
Helicobacter pylori/isolamento & purificação
Seres Humanos
Itália/epidemiologia
Masculino
Meia-Idade
Fatores de Risco
Estatística como Assunto
Avaliação de Sintomas/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Autoantibodies); 0 (Hemoglobins)
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170224
[Lr] Data última revisão:
170224
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170111
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000005784


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[PMID]:28053181
[Au] Autor:Stanley AJ; Laine L; Dalton HR; Ngu JH; Schultz M; Abazi R; Zakko L; Thornton S; Wilkinson K; Khor CJ; Murray IA; Laursen SB; International Gastrointestinal Bleeding Consortium
[Ad] Endereço:Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 OSF, UK adrian.stanley@ggc.scot.nhs.uk.
[Ti] Título:Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study.
[So] Source:BMJ;356:i6432, 2017 Jan 04.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE:  To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding. DESIGN:  International multicentre prospective study. SETTING:  Six large hospitals in Europe, North America, Asia, and Oceania. PARTICIPANTS:  3012 consecutive patients presenting over 12 months with upper gastrointestinal bleeding. MAIN OUTCOME MEASURES:  Comparison of pre-endoscopy scores (admission Rockall, AIMS65, and Glasgow Blatchford) and post-endoscopy scores (full Rockall and PNED) for their ability to predict predefined clinical endpoints: a composite endpoint (transfusion, endoscopic treatment, interventional radiology, surgery, or 30 day mortality), endoscopic treatment, 30 day mortality, rebleeding, and length of hospital stay. Optimum score thresholds to identify low risk and high risk patients were determined. RESULTS:  The Glasgow Blatchford score was best (area under the receiver operating characteristic curve (AUROC) 0.86) at predicting intervention or death compared with the full Rockall score (0.70), PNED score (0.69), admission Rockall score (0.66, and AIMS65 score (0.68) (all P<0.001). A Glasgow Blatchford score of ≤1 was the optimum threshold to predict survival without intervention (sensitivity 98.6%, specificity 34.6%). The Glasgow Blatchford score was better at predicting endoscopic treatment (AUROC 0.75) than the AIMS65 (0.62) and admission Rockall scores (0.61) (both P<0.001). A Glasgow Blatchford score of ≥7 was the optimum threshold to predict endoscopic treatment (sensitivity 80%, specificity 57%). The PNED (AUROC 0.77) and AIMS65 scores (0.77) were best at predicting mortality, with both superior to admission Rockall score (0.72) and Glasgow Blatchford score (0.64; P<0.001). Score thresholds of ≥4 for PNED, ≥2 for AIMS65, ≥4 for admission Rockall, and ≥5 for full Rockall were optimal at predicting death, with sensitivities of 65.8-78.6% and specificities of 65.0-65.3%. No score was helpful at predicting rebleeding or length of stay. CONCLUSIONS:  The Glasgow Blatchford score has high accuracy at predicting need for hospital based intervention or death. Scores of ≤1 appear the optimum threshold for directing patients to outpatient management. AUROCs of scores for the other endpoints are less than 0.80, therefore their clinical utility for these outcomes seems to be limited.Trial registration Current Controlled Trials ISRCTN16235737.
[Mh] Termos MeSH primário: Hemorragia Gastrointestinal/etiologia
Medição de Risco/métodos
Trato Gastrointestinal Superior
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Área Sob a Curva
Feminino
Hemorragia Gastrointestinal/mortalidade
Hemorragia Gastrointestinal/terapia
Seres Humanos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Prognóstico
Estudos Prospectivos
Curva ROC
Medição de Risco/estatística & dados numéricos
Sensibilidade e Especificidade
Índice de Gravidade de Doença
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1703
[Cu] Atualização por classe:171111
[Lr] Data última revisão:
171111
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170106
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.i6432



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