Andrea Vieira

Inflammatory bowel disease activity assessed by fecal calprotectin and lactoferrin: correlation with laboratory parameters, clinical, endoscopic and histological indexes.

BackgroundResearch has shown that fecal biomarkers are useful to assess the activity of inflammatory bowel disease (IBD). The aim of the study is: to evaluate the efficacy of the fecal lactoferrin and calprotectin as indicators of inflammatory activity.FindingsA total of 78 patients presenting inflammatory bowel disease were evaluated. Blood tests, the Crohns Disease Activity Index (CDAI), Mayo Disease Activity Index (MDAI), and Crohns Disease Endoscopic Index of Severity (CDEIS) were used for the clinical and endoscopic evaluation. Two tests were performed on the fecal samples, to check the levels of calprotectin and lactoferrin. The performance of these fecal markers for detection of inflammation with reference to endoscopic and histological inflammatory activity was assessed and calculated sensitivity, specificity, accuracy.A total of 52 patients samples whose histological evaluations showed inflammation, 49 were lactoferrin-positive, and 40 were calprotectin-positive (p = 0.000). Lactoferrin and calprotectin findings correlated with C-reactive protein in both the CD and UC groups (p = 0.006; p = 0.000), with CDAI values (p = 0.043; 0.010), CDEIS values in DC cases (p = 0,000; 0.000), and with MDAI values in UC cases (p = 0.000).ConclusionFecal lactoferrin and calprotectin are highly sensitive and specific markers for detecting intestinal inflammation. Levels of fecal calprotectin have a proportional correlation to the degree of inflammation of the intestinal mucosa.

Acoustic radiation force impulse elastography and serum fibrosis markers in chronic hepatitis C.

Abstract Objective. Liver biopsy (LB) remains the gold standard for the assessment of liver fibrosis, although it is invasive and can have complications. The present study compares several noninvasive methods of fibrosis assessment in chronic hepatitis C (CHC), including acoustic radiation force impulse (ARFI) elastography, aspartate aminotransferase:platelet ratio index (APRI), Forns, FIB-4, and King scores versus percutaneous LB. Material and methods. This prospective study enrolled 51 untreated CHC patients. Biological tests necessary for the calculation of the scores (according to the classic formulas) were performed within a week of LB. The time interval between LB and tissue stiffness, assessed according to the Metavir score, was <6 months. Cutoff values were determined using area under receiver-operating characteristic curves (AUROC). Results. The best test for predicting significant fibrosis (F ≥2 Metavir) was ARFI elastography with an AUROC of 0.90, followed by FIB-4 (AUROC = 0.86), King (AUROC = 0.85), Forns (AUROC = 0.84), and APRI (AUROC = 0.82). For a cutoff of 1.31 m/s, ARFI had 89.3% sensitivity (Se) and 87% specificity (Sp). The best test for predicting cirrhosis was ARFI elastography with an AUROC of 0.98, followed by FIB-4 (AUROC = 0.94), King (AUROC = 0.90), APRI (AUROC = 0.82), and Forns (AUROC = 0.81). For a cutoff of 1.95 m/s, ARFI had 100% Se and 95.2% Sp. Conclusion. ARFI elastography had very good accuracy for the assessment of liver fibrosis. It was more effective than APRI, Forns, King, and FIB-4 scores for the prediction of significant fibrosis and cirrhosis in CHC patients.

Association of nonalcoholic fatty liver disease and liver cancer

AIM To investigate the association between nonalcoholic fatty liver disease (NAFLD) and liver cancer, and NAFLD prevalence in different liver tumors. METHODS This is a retrospective study of the clinical, laboratory and histological data of 120 patients diagnosed with primary or secondary hepatic neoplasms and treated at a tertiary center where they underwent hepatic resection and/or liver transplantation, with subsequent evaluation of the explant or liver biopsy. The following criteria were used to exclude patients from the study: a history of alcohol abuse, hepatitis B or C infection, no tumor detected in the liver tissue examined by histological analysis, and the presence of chronic autoimmune hepatitis, hemochromatosis, Wilsons disease, or hepatoblastoma. The occurrence of NAFLD and the association with its known risk factors were studied. The risk factors considered were diabetes mellitus, impaired glucose tolerance, impaired fasting glucose, body mass index, dyslipidemia, and arterial hypertension. Presence of reticulin fibers in the hepatic neoplasms was assessed by histological analysis using slide-mounted specimens stained with either hematoxylin and eosin or Massons trichrome and silver impregnation. Analysis of tumor-free liver parenchyma was carried out to determine the association between NAFLD and its histological grade. RESULTS No difference was found in the association of NAFLD with the general population (34.2% and 30.0% respectively, 95%CI: 25.8-43.4). Evaluation by cancer type showed that NAFLD was more prevalent in patients with liver metastasis of colorectal cancer than in patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma (OR = 3.99, 95%CI: 1.78-8.94, P < 0.001 vs OR = 0.60, 95%CI: 0.18-2.01, P = 0.406 and OR = 0.70, 95%CI: 0.18-2.80, P = 0.613, respectively). There was a higher prevalence of liver fibrosis in patients with hepatocellular carcinoma (OR = 3.50, 95%CI: 1.06-11.57, P = 0.032). Evaluation of the relationship between the presence of NAFLD, nonalcoholic steatohepatitis, and liver fibrosis, and their risk factors, showed no significant statistical association for any of the tumors studied. CONCLUSION NAFLD is more common in patients with liver metastases caused by colorectal cancer.

Recidiva da ingesta alcoólica em pacientes candidatos a transplante hepático: análise de fatores de risco

RACIONAL: A recidiva do consumo do alcool apos transplante representa grande preocupacao nos centros transplantadores e e objeto de debate e controversia. OBJETIVO: Avaliar a recidiva da ingesta alcoolica e eventuais fatores a ela relacionados, em pacientes cirroticos, referidos para transplante hepatico. METODOS: Estudo retrospectivo de julho de 1995 a setembro de 2005 incluindo 90 pacientes adultos com cirrose hepatica, listados para transplante. Os criterios de exclusao eram: ausencia de 6 meses de abstinencia, nao liberacao da equipe de psicologia. O diagnostico da recidiva (ingesta de qualquer quantidade de bebida alcoolica) era feito com base nas informacoes contidas nos prontuarios e fornecidas por contato telefonico. RESULTADOS: A recidiva encontrada foi de 18,9%, que correspondeu a 14,6% do numero total de homens e 62,5% do numero total das mulheres. A raca, media das idades, classificacao de disfuncao hepatica, tempo de etilismo, quantidade da ingesta alcoolica e realizacao ou nao de transplante, nao mostraram correlacao significativa com a recidiva da ingesta alcoolica. A comparacao tempo de abstinencia e recidiva guardou relacao inversamente proporcional. CONCLUSAO: A recidiva da ingesta alcoolica e baixa. Sexo feminino e tempo de abstinencia inferior a 1 ano tem influencia sobre a recidiva da ingesta alcoolica.

ANÁLISE DOS PACIENTES COM DOENÇA DE CROHN ABDOMINAL COMPLICADA: PORQUE MUITOS PERMANECEM COM ESTOMAS?

assintomáticos e sem elevações de calprotectina, o médico poderá abrir mão do uso de exames mais invasivos. Esse marcador fecal ainda pode ser usado para monitorar a terapêutica. Estudos atuais já demonstram a importância da calprotectina na avaliação do efeito e ajuste de dose de biológicos. Hoje existem estudos que permitem a alteração de doses terepêutica apenas com o uso de calprotectina, apesar de esses ainda serem pequenos e com nível de evidência baixo para serem aplicados em nível clínico. Os dados apresentados nessa pesquisa corroboram os achados da literatura, uma vez que a dosagem de calprotectina conseguiu economizar na feitura de exames, ajudar no ajuste de dose terapêutica e a definir o melhor momento para a extensão da propedêutica.