Resumo Introdução: O fígado gordo associado a disfunção metabólica (FGADM) é uma causa crescente de doença hepática crónica. Em 2020, o score Fibroscan-AST (FAST) foi validado internacionalmente como uma nova ferramenta capaz de identificar pacientes com esteatohepatite que beneficiam de terapêuticas adicionais, baseado nos achados da elastografia hepática transitória (EHT) e níveis séricos de aspartato aminotransferase (AST). Os autores procuraram identificar, em pacientes com FGADM, que fatores metabólicos predizem um score-FAST maior. Métodos: Estudo retrospetivo de pacientes com FGADM submetidos a EHT durante 2 anos consecutivos. Pacientes sem uma amostra de AST colhida nos 6 meses prévios à EHT foram excluídos. O score-FAST foi calculado, estratificando o risco do paciente como baixo (<0,35), moderado (0,35-0,67) ou alto (>0,67). Resultados: A amostra incluiu 117 pacientes, 53% do sexo feminino, com uma idade média de 53 anos. Em análise multivariada, pacientes com Diabetes Mellitus tipo 2 (DMT2) (p < 0,001), dislipidemia (p = 0,046) e hábitos tabágicos (p = 0,037) apresentaram valores de score-FAST significativamente maiores. Além disso, os pacientes diabéticos apresentaram não só valores de score-FAST significativamente maiores, como também foram mais frequente classificados como pertencendo ao grupo de alto risco, de acordo com os critérios deste score (OR = 9,2; 95%IC = 1,8-45,5; p = 0,007). Conclusões: Calculando o score-FAST, pacientes com FGADM e DMT2 apresentaram um risco significativamente maior. Esta ferramenta validada poderá ser utilizada para selecionar os pacientes com DMT2 e FGADM que poderão beneficiar de seguimento especializado.

Abstract Background: Metabolic-associated fatty liver disease (MAFLD) is an increasingly prevalent cause of chronic liver disease. In 2020, the FibroScan-AST (FAST) score was internationally validated as a new tool able to identify patients with steatohepatitis who benefit the most from further therapies, based on liver transient elastography (LTE) findings and serum levels of aspartate aminotransferase (AST). We aimed to identify, in MAFLD patients, which metabolic features may predict a higher FAST score. Methods: Retrospective study of consecutive patients with MAFLD submitted to LTE for two consecutive years. Patients without an AST sample collected within 6 months of the LTE were excluded. FAST score was calculated, stratifying the patient’s risk as low (<0.35), medium (0.35-0.67), or high (>0.67). Results: The sample included 117 patients, 53.0% of the female gender, with a mean age of 53 years. On multivariate analysis, patients with type 2 diabetes (T2DM) (p < 0.001), dyslipidemia (p = 0.046), and smoking habits (p = 0.037) presented with significantly higher FAST score values. Furthermore, diabetic patients did not only present significantly higher FAST scores but were also more frequently assigned to the high-risk group according to FAST score criteria (OR = 9.2; 95% CI = 1.8-45.5; p = 0.007). Conclusions: Calculating the FAST score, patients with T2DM presented a significantly higher risk of having significant fibrosis and steatohepatitis. Physicians may rely on this validated instrument to more easily identify which patients with T2DM and MAFLD benefit the most from a specialized follow-up.

Introdução: Apesar dos vários scores propostos para prever os diferentes outcomes no contexto de hemorragia digestiva alta (HDA), poucos estudos se debruçaram sobre a comparação entre eles. Este estudo avaliou o desempenho dos scores de Rockall pré- (PreRS) e pós-endoscópico (PosRS), Glasgow-Blatchford (GBS) e a sua versão simplificada (sGBS), bem como o score AIMS65 na previsão de diferentes outcomes clínicos. Métodos: Neste estudo retrospetivo, foram calculados os scores PreRS, PosRS, GBS, sGBS e AIMS65 e posteriormente as respectivas áreas sob as curvas de ROC para avaliar a capacidade de cada score em predizer necessidade de suporte transfusional, terapêutica endoscópica, cirurgia, admissão em unidade de cuidados intensivos/intermédios, tempo de internamento, bem como recidiva hemorrágica ou morte aos 30 dias. Resultados: Em todos os 433 doentes incluídos foram calculados os scores PreRS, PosRS, GBS, sGBS, mas o cálculo do score AIMS65 apenas foi possível em 315 doentes. Apenas o PreRS e o PosRS foram capazes de prever de forma aceitável a mortalidade aos 30 dias. O GBS e o sGBS apresentaram uma boa capacidade de prever necessidade de transfusão e razoável capacidade para prever cirurgia. Nenhum dos cinco scores foi bom a predizer a necessidade de tratamento endoscópico, internamento em unidade de cuidados intensivos/intermédios, tempo de internamento ou recidiva hemorrágica aos 30 dias. Conclusões: Devido às limitações identificadas, nenhum dos scores pode ser usado isoladamente na previsão dos diferentes outcomes no contexto de HDA. O sGBS é tão preciso como o GBS na previsão da necessidade de transfusão ou cirurgia. Apenas os scores PreRS e PosRS são capazes de prever mortalidade aos 30 dias. É sugerido um algoritmo para a abordagem inicial de doentes com HDA usando os scores PreRS e sGBS.

Introduction: Although different scores have been suggested to predict outcomes in the setting of upper gastrointestinal bleeding (UGIB), few comparative studies between simplified versions of older scores and recent scores have been published. We aimed to evaluate the accuracy of pre- (PreRS) and postendoscopic Rockall scores (PostRS), the GlasgowBlatchford score (GBS) and its simplified version (sGBS), as well as the AIMS65 score in predicting different clinical outcomes. Methods: In this retrospective study, PreRS, PostRS, GBS, sGBS, and AIMS65 score were calculated, and then, areas under the receiver operating characteristic curve were used to evaluate the performance of each score to predict blood transfusion, endoscopic therapy, surgery, admission to intensive/intermediate care unit, length of hospital stay, as well as 30-day rebleeding or mortality. Results: PreRS, PostRS, GBS, and sGBS were calculated for all the 433 included patients, but AIMS65 calculation was only possible for 315 patients. Only the PreRS and PostRS were able to fairly predict 30-day mortality. The GBS and sGBS were good in predicting blood transfusion and reasonable in predicting surgery. None of the studied scores were good in predicting the need for endoscopic therapy, admission to intensive/intermediate care unit, length of hospital stay, and 30-day rebleeding. Conclusions: Owing to the identified limitations, none of the 5 studied scores could be singly used to predict all the clinically relevant outcomes in the setting of UGIB. The sGBS was as precise as the GBS in predicting blood transfusion and surgery. The PreRS and PostRS were the only scores that could predict 30-day mortality. An algorithm using the PreRS and the sGBS as an initial approach to patients with UGIB is presented and suggested.

Introdução: Os inibidores da bomba de protões estão entre dos fármacos mais utilizados a nível mundial e globalmente considerados seguros. Contudo, evidência recente tem levantado dúvidas sobre o seu perfil de segurança. Sumário: Efetuada uma revisão não-sistemática da literatura relativamente aos inibidores da bomba de protões e seus efeitos adversos. Os inibidores da bomba de protões parecem associar-se significativamente com o desenvolvimento de pólipos das glândulas fûndicas (sem significado clínico) e com a infeção por Clostridium difficile. Além disso, em doentes cirróticos a sua prescrição deve ser cuidadosamente revista. A sua associação com outras infeções entéricas, défice de micronutrientes, demência e doença renal crónica provêm de evidência de baixa qualidade e mais estudos são necessários. Mensagens chave: Tendo em conta a evidência atual, a maioria dos doentes com indicação para terapêutica com inibidores da bomba de protões podem beneficar da sua manutenção sem efeitos adversos significativos. Contudo, estudos de melhor qualidade são necessários para confirmar ou desmentir a maioria dos efeitos secundários propostos.

Background: Proton pump inhibitors are among the most frequently prescribed drugs in the world and are generally considered safe. However, there is growing concern regarding their safety. Summary: A nonsystematic review of the current literature was performed regarding proton pump inhibitors and their adverse effects. Proton pump inhibitors seem to be associated with fundic gland polyp development (without clinical relevance) and Clostridium difficile infection. Also, in cirrhotic patients, their prescription should be carefully reviewed. Regarding their association with other enteric infections, micronutrient deficiency, dementia, and chronic kidney disease, current evidence is still of low quality, and further studies are needed. Key Messages: Considering the current evidence, most patients with a clear clinical indication for proton pump inhibitor treatment should probably benefit from the maintenance of their treatment without significant adverse effects. However, higher-quality studies are needed to confirm or dismiss most of the proposed adverse effects.

RESUMO CONTEXTO: A anemia ferropénica constitui uma das principais indicações para realização de enteroscopia por cápsula. A literatura sugere que o rendimento diagnóstico é influenciado pela idade do doente, contudo, não é consensual o grupo etário para o qual o rendimento diagnóstico é maior. OBJETIVO: Clarificar as diferenças de rendimento diagnóstico e incidência de achados específicos de acordo com a idade. MÉTODOS: Estudo retrospetivo unicêntrico. Incluídos 118 doentes que realizaram sistematicamente enteroscopia por cápsula no estudo de anemia ferropénica. Todos os vídeos foram revistos e foram reportados os achados no intestino delgado que pudessem ser a causa da anemia ferropénica. Excluídas enteroscopia por cápsula incompletas. Comparados os achados entre doentes com ≤60 e >60 anos. RESULTADOS: Doentes com idade média de 58 anos (SD ±17,9), 69,5% do género feminino (n=82). O rendimento diagnóstico global foi de 49% (58/118), sendo superior em doentes >60 anos (36/60, rendimento diagnóstico 60%) do que em doentes ≤60 anos (20/58, 34%). As angiectasias foram mais frequentemente reportadas em doentes >60 anos (45% vs 9%, P<0,01). Nos doentes com ≤60 anos foi mais frequentemente reportada inflamação significativa (Score de Lewis >135 em 10,3% vs 1,7%, P<0,05) e lesões não vasculares (24% vs 10%, P=0,04). CONCLUSÃO: Na nossa amostra, a enteroscopia por cápsula revelou-se importante no estudo da anemia ferropénica detectando achados relevantes em cerca de metade dos doentes. O rendimento diagnóstico foi maior em doentes com mais de 60 anos (60%), sendo as lesões vasculares mais frequentes neste grupo. Apesar do menor rendimento diagnóstico em indivíduos até aos 60 anos, foi detectada patologia relevante neste grupo, em especial do tipo inflamatório.

ABSTRACT BACKGROUND: Iron deficiency anemia remains one of the main indications to perform small bowel capsule endoscopy. Literature suggests that diagnostic yield is influenced by patient’s age but with conflicting results regarding age cutoff. OBJECTIVE: We aimed to clarify the differences in diagnostic yield and incidence of specific findings according to age. METHODS: Retrospective single-center study including 118 patients performing small bowel capsule endoscopy in the study of iron deficiency anemia. Videos were reviewed and small bowel findings that may account for anemia were reported. Incomplete examinations were excluded. Findings were compared between patients ≤60 and >60 years. RESULTS: Patients had a mean age of 58 years old (SD ±17.9) with 69.5% females (n=82). The overall diagnostic yield was 49% (58/118), being higher among patients >60 years (36/60, diagnostic yield 60%) than those ≤60 years (20/58, diagnostic yield 34%), (P<0.01). Angioectasias were more frequent in patients >60 years (45% vs 9%, P<0.01). Patients ≤60 years presented more frequently significant inflammation (Lewis score >135 in 10.3% vs 1.7%, P<0.05) and other non-vascular lesions (24% vs 10%, P=0.04). CONCLUSION: In our cohort small bowel capsule endoscopy diagnosed clinically relevant findings in the setting of iron deficiency anemia in almost half the patients. Diagnostic yield was higher in patients older than 60 years (60%), with vascular lesions being more frequent in this age group. Despite the lower diagnostic yield in patients ≤60 years, significant pathology was also found in this age group, mainly of inflammatory type.

ABSTRACT Aim: To compare the findings and completion rate of PillCam(r) SB2 and SB3. Methods: This was a retrospective single-center study that included 357 consecutive small bowel capsule endoscopies (SBCE), 173 SB2 and 184 SB3. The data collected included age, gender, capsule type (PillCam(r) SB2 or SB3), quality of bowel preparation, completion of the examination, gastric and small bowel transit time, small bowel findings, findings in segments other than the small bowel and the detection of specific anatomical markers, such as the Z line and papilla. Results: The mean age of the patients was 48 years and 66.9% were female. The two main indications were suspicion/staging of inflammatory bowel disease (IBD) and obscure gastrointestinal bleeding (OGIB) (43.7% and 40.3%, respectively). Endoscopic findings were reported in 76.2% of examinations and 53.5% were relevant findings. No significant differences were found between SB2 and SB3 with regard to completion rate (93.6% vs 96.2%, p = 0.27), overall endoscopic findings (73.4% vs 78.8%, p = 0.23), relevant findings (54.3% vs 52.7%, p = 0.76), first tertile findings (43.9% vs 48.9%, p = 0.35), extra-SB findings (23.7% vs 17.3%, p = 0.14), Z line and papilla detection rate (35.9% vs 35.7%, p = 0.97 and 27.1% vs 32.6%, p = 0.32, respectively). With regard to the patient subgroups with suspicion/staging of IBD, significant differences were found in relation to the detection of villous edema and the 3rd tertile findings, thus favoring SB3 (26.3% vs 43.8%, p = 0.02 and 47.4% vs 66.3%, p = 0.02, respectively). Mucosal atrophy was significantly more frequently diagnosed with the PillCam(r) SB3 in patients with anemia/OGIB (0% vs 8%, p = 0.03). Conclusions: Overall, PillCam(r) SB3 did not improve the diagnostic yield compared to SB2, although it improved the detection of villous atrophy and segmental edema.