RESUMO
Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepato-logy (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.
Assuntos
Doenças Biliares/cirurgia , Hepatopatias/cirurgia , Brasil , Gerenciamento Clínico , Guias como Assunto , Humanos , Sociedades MédicasRESUMO
BACKGROUND: Celiac disease is one of the most common dietary-mediated inflammatory enteropathies that occur in genetically predisposed individuals in response to gluten intolerance. This disorder has become more common than in the past, even if it frequently remains undetected for long periods of time. The screening of patients with dyspepsia, a symptom that can be a manifestation of celiac disease, may allow an early identification of affected individuals. Endoscopy and serological tests may have an important role in the management of these patients. AIMS: Determining the prevalence of celiac disease in dyspeptic patients submitted to routine diagnostic upper gastrointestinal endoscopy. PATIENTS/METHODS: Endoscopic findings, duodenal biopsy histological specimens and serological test results were assessed and compared in 142 patients consecutively admitted with dyspeptic symptoms between October 2001 and October 2003. RESULTS: An endoscopic pattern suggestive of celiac disease was observed in four patients. The IgG-AGA assay was positive in 24 patients. Two of the IgG-AGA positive patients also yielded positive results on the IgA-EMA test and concomitantly disclosed endoscopic pattern and histological features in duodenal biopsy compatible with celiac disease. Abnormal endoscopic findings were notably marked in biopsy proven celiac patients. Therefore, a 1.4% prevalence of celiac disease was observed in this study group. CONCLUSIONS: The high prevalence of celiac among dyspeptic symptomatic individuals indicates that they are a higher risk group for developing celiac disease. Undiagnosed celiac disease may be inferred by endoscopic markers of duodenal villous atrophy. Endoscopic findings, however, may be inadequate to suitably diagnose this disease and consequently the incorporation of diagnostic serologic assays of celiac disease in routine testing for dyspepsia is strongly recommended.
Assuntos
Doença Celíaca/complicações , Dispepsia/complicações , Adolescente , Adulto , Idoso , Doença Celíaca/diagnóstico , Duodenopatias/diagnóstico , Endoscopia Gastrointestinal , Feminino , Humanos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
RACIONAL: A doença celíaca, uma das mais comuns enteropatias inflamatórias mediadas por um componente da dieta, ocorre em resposta à intolerância ao glúten nos indivíduos geneticamente predispostos. Com a disponibilidade dos exames sorológicos, essa enfermidade tem se mostrado mais freqüente que no passado, contudo seu diagnóstico ainda é, habitualmente, tardio. A pesquisa de intolerância ao glúten em pacientes com sintomas dispépticos, possível manifestação clínica da doença celíaca, pode permitir uma detecção mais precoce dos indivíduos afetados. OBJETIVO: Determinar a prevalência de doença celíaca em pacientes dispépticos submetidos a endoscopia digestiva alta de rotina.PACIENTES/MÉTODOS: Achados endoscópicos, análise histológica da mucosa duodenal e resultado de testes sorológicos de 142 pacientes consecutivos com dispepsia foram obtidos entre outubro de 2001 e outubro de 2003, e comparados. RESULTADOS: O padrão endoscópico sugestivo de doença celíaca foi encontrado em quatro pacientes. O teste IgG-AGA foi positivo em 24 pacientes. Dois dos pacientes IgG-AGA positivos também apresentaram teste IgA-EMA positivo e padrão endoscópico e histológico duodenal compatíveis com doença celíaca. Alterações endoscópicas duodenais foram expressivamente mais evidentes nestes pacientes. A prevalência de doença celíaca observada neste estudo foi de 1,4%. CONCLUSÃO: Pacientes dispépticos, por sua elevada prevalência de doença celíaca, são um grupo de maior risco para essa patologia. Celíacos sem diagnóstico prévio podem ser identificados através de marcadores endoscópicos de atrofia vilositária duodenal. Entretanto, essas alterações endoscópicas podem ser insuficientes para que o diagnóstico seja estabelecido e, conseqüentemente, deve ser recomendada a inclusão de testes sorológicos para doença celíaca na investigação dos pacientes com dispepsia.
