Interpretation of the American College of Gastroenterology clinical guidelines for acute-on-chronic liver failure / 中华肝脏病杂志

In January 2022, the American College of Gastroenterology released its first clinical guidelines, integrating the latest research, summarizing the three current definitions characteristics, and proposing recommendations and core viewpoints with important clinical practice value to guide diagnosis, treatment, and management of acute-on-chronic liver failure. This article interprets and summarizes the highlights of the guideline, raises controversial issues, and suggests directions for future research.

Adherence to colonoscopy recommendations for first-degree relatives of young patients diagnosed with colorectal cancer

OBJECTIVES:Colorectal cancer is the third leading cause of cancer death in the United States. The American College of Gastroenterology recommends screening for first-degree relatives of patients diagnosed with colorectal cancer before the age of 50. A colonoscopy is one of the most commonly recommended exams due to its specificity and the possibility to resect pre-malignant lesions. Nevertheless, the rate of physician adherence to this recommendation is unknown.METHODS:This transversal study was performed at a major cancer center in Brazil with 62 patients, aged 18 to 50, who completed a questionnaire on information received from their physicians regarding screening their first-degree relatives. We used the answers from patients who provided explicit consent.RESULTS:Two hundred and three patients were eligible to participate and 93 (45.8%) agreed to complete the questionnaire. Twenty-three questionnaires (24.73%) were returned and 39 were completed by telephone. Of the patients who answered the questionnaire, 39 (62.9%) had received a colonoscopy recommendation for their first-degree relatives and 23 (37.1%) were not informed of the recommendation. Among the patients who received the recommendations, 20.51% affirmed that all relatives completed the exam and 51.28% stated that no relatives completed the exam.DISCUSSION:The adherence rate of our physicians to the ACG guideline recommendations was 62.9%. Considering that our study was performed at a leading center for cancer treatment in Latin America, we had expected better adherence. The results show that adherence to the colorectal cancer screening recommendations for high-risk patients must be improved.

Pancreatitis aguda: revisión de las nuevas guías del 2013 / Acute pancreatitis: a review of the new guidelines of 2013

La pancreatitis aguda es una patología que se produce por una inflamación del tejido pancreático y la consecuente liberación de las enzimas producidas por este órgano. Afecta, además del tejido pancreático, tejidos cercanos, produciendo complicaciones locales, y sistemas más alejados, produciendo falla orgánica. Según la evidencia de falla orgánica persistente se define la severidad de la enfermedad. En el 2013 se publicaron las guías actualizadas sobre el diagnóstico y manejo de esta patología por el “American College of Gastroenterology”, donde se analizó más de 150 artículos y se buscó dar recomendaciones según evidencia o criterio de expertos, tomando en cuenta lo avanzado en los últimos años. El objetivo de este artículo es realizar una revisión bibliográfica de estas guías y de otras referencias de relevancia.

Acute pancreatitis is a pathology that is produced by inflammation of pancreatic tissue and the subsequent release of pancreatic enzymes. It affects, besides of the pancreatic tissue, nearby tissues, producing local complications, and more distant systems, producing organ failure. Depending on the presence of this organ failure and its persistence, is that the severity of the disease is defined. In 2013 the “American College of Gastroenterology” published current guidelines about the diagnostic and management of this pathology, in which more than 150 articles where revised and recommendations where given according to expert criteria and evidence, taken into consideration what has come to light in the past years. This article has the objective of realizing a review of this guidelines and other articles of relevance.