Introdução: No Brasil, o câncer gástrico é o quarto mais comum em homens e o sexto entre as mulheres, excetuando-se os tumores de pele não melanoma. Aspectos epidemiológicos evidenciam a etiologia multifatorial desta neoplasia, destacando como fatores de risco: a infecção pela bactéria Helicobacter pylori, idade avançada, tabagismo, etilismo crônico, hábitos alimentares e polimorfismos genéticos. No contexto dos polimorfismos genéticos, tem-se a ausência do gene GSTM1. A falta da função de GSTM1 em detoxificar xenobióticos e promover defesa contra o estresse oxidativo, leva ao maior dano do DNA, favorecendo a carcinogênese gástrica. Este processo é multifatorial e o desenvolvimento do câncer gástrico resulta de uma interação complexa dessas variáveis. Objetivos: O objetivo do presente estudo foi investigar a associação do polimorfismo nulo de GSTM1 na gênese do câncer gástrico. Metodologia: Foi conduzida uma metanálise a partir de 70 artigos colhidos dos bancos de dados: SciELO e PubMed, entre setembro de 2015 e julho de 2016. Para avaliar uma possível associação, utilizou-se o Odds Ratio (OR) e intervalo de confiança de 95% (IC95%). Para avaliar a heterogeneidade dos estudos utilizou-se o teste do qui-quadrado. A análise estatística foi realizada utilizando-se o BioEstat® 5.0. Resultados: A presente pesquisa contou com 70 estudos do tipo caso-controle que incluíram 28.549 indivíduos avaliados para o polimorfismo nulo do gene GSTM1, dos quais 11.208 (39,26%) eram casos e 17.341 (60,74%) eram controle. A análise final mostra que a presença do gene GSTM1 funciona como um fator de proteção contra o desenvolvimento de câncer gástrico (OR=0,788; IC95%=0,857, p<0,0001). Associação estatística positiva foi encontrada na Ásia (OR=0,736; IC95%=0,809 p<0,0001) e Eurásia OR=0,671; IC95%=0,988; p=0,05). No entanto, não temos dados com significância estatística da Europa (OR=1,033; IC95%=0,222; p=0,705) e América (OR=0,866; IC95%=0,549-1,364; p=0,534) para inferir proteção ao câncer gástrico no mundo. Conclusão: Estudos futuros são necessários para melhor compreender a associação entre GSTM1 nulo e câncer gástrico, especialmente nos continentes em que não foram encontrados tal associação, como Europa e Américas. ABCDExpress 2017;1(2):886Codigo: 61153 Acesso está disponível em www.revistaabcd.com.br e www.sbad2017.com.br Acesso pelo
BACKGROUND: Despite the numerous advances in medical treatment, it is estimated that a significant percentage of patients with Crohn's disease (CD) requires bowel resection at least once. The aim of this study was to evaluate patient characteristics and factors associated to surgical resection in patients with Crohn's disease in a tertiary IBD unit in Southeastern Brazil. METHODS: Retrospective analysis of data from 247 patients with Crohn's disease in follow-up at the University Hospital, Ribeirão Preto Medical School, from January 2000 up to December 2016. Medical records data comprised age, gender, disease location, disease behavior, disease duration and smoking. Patients were divided into two groups: presence or absence of surgical resection. RESULTS: Out of the 247 patients with CD, 111 underwent surgical resection (53.2% female, 82.9% Caucasians, mean age: 45.49 ± 13.30 years). More than one surgical procedure was performed in 15.3% of patients. Main indications for surgery were: stenosis (10.3%), clinical intractability (6.5%) and massive hemorrhage (2.7%). Smoking (P = 0.0109, OR = 2.244; 95% CI: 1.237 to 4.056), stenotic phenotype (P < 0.0001, OR = 5.294; 95% CI: 3.073 to 9.1212), ileo-colonic location (P < 0.0001, OR = 3.447; 95% CI: 2.061 to 5.698), longer disease duration (P < 0.0001) and more advanced age (P = 0.001) were significantly associated with operations for CD. No significant differences were observed in relation to gender, race, age at diagnosis and previous use of corticosteroids. CONCLUSION(S): Need for surgical treatment is still frequent in patients with CD. Smoking (current or past), longer disease time, stenotic phenotype and ileo-colonic localization in CD patients were associated with a higher risk of surgery in our IBD Unit. Awareness about factors associated with unfavorable outcome allows these patients to be treated more appropriately.
BACKGROUND: Ulcerative proctitis (UP) accounts for a significant proportion of cases of ulcerative colitis (UC) and implies limited involvement of the rectum. Some patients presenting initially with UP may progress to more extensive colitis (inflammation found distally to the rectum-sigmoid junction). Although several predictive factors for this progression have been described, none has been established as definitive. We aimed at determining risk factors predictive of proximal disease extension in UP. METHODS: Retrospective analysis of data from 97 patients (67% female) with UP (Montreal Classification: E1) with at least 12 months of follow-up at the local University Hospital from January 2001 up to December 2018. Proximal extension was evaluated endoscopically during follow-up and was defined as E1 progressing to E2/E3. Factors examined comprised age, gender, race, presence of extraintestinal manifestations, Mayo endoscopic score, disease relapse, use of corticosteroids, immunosuppressive and biological agents and colectomy. We used univariate analysis (Chi-square test) to assess the association of individual factors to proximal disease extension. RESULTS: A total of 29 (29.9%) patients experienced proximal disease extension during a mean follow-up of 137.36 ± 86.63 months. The following factors were significantly associated with proximal disease extension: higher initial Mayo score (P = 0.035) and higher initial disease severity (P = 0.0024). Use of corticosteroids initially (86.2% vs 41.2%, P < 0.0001), increased disease relapse rate (86.2% vs 20.6%, P < 0.0001) and the need for immunosuppressive agents (57.1% vs 13.6%, P < 0.0001) or biological agents (42.9% vs 10.3%, P < 0.0001) were all significantly higher among UP patients with disease proximal extension, when compared to non-extensors. Colectomy was also associated with proximal disease extension (P = 0.0002). No significant association was found between UP proximal extension and gender, race, age at diagnosis and extraintestinal manifestations. CONCLUSION(S): UP is a dynamic disease that may progress over time. UP patients with increased clinical and endoscopic severity at the diagnosis are likely to evolve with proximal extension and should be more carefully followed up.
Background Ulcerative proctitis (UP) accounts for a significant proportion of cases of ulcerative colitis (UC) and implies limited involvement of the rectum. Some patients presenting initially with UP may progress to more extensive colitis (inflammation found distally to the rectum-sigmoid junction). Although several predictive factors for this progression have been described, none has been established as definitive. We aimed at determining risk factors predictive of proximal disease extension in UP. Methods Retrospective analysis of data from 97 patients (67% female) with UP (Montreal Classification: E1) with at least 12 months of follow-up at the IBD tertiary centre from January 2001 up to December 2018. Proximal extension was evaluated endoscopically during follow-up and was defined as E1 progressing to E2/E3. Factors examined comprised age, gender, race, presence of extra-intestinal manifestations, Mayo endoscopic score, disease relapse, use of corticosteroids, immunosuppressive and biological agents and colectomy. We used univariate analysis (Chi-square test) to assess the association of individual factors to proximal disease extension. Results A total of 29 (29.9%) patients experienced proximal disease extension during a mean follow-up of 137.36 ± 86.63 months. The following factors were significantly associated with proximal disease extension: higher initial Mayo score (p = 0.035) and higher initial disease severity (p = 0.0024). Use of corticosteroids initially (86.2% vs. 41.2%, p <0.0001), increased disease relapse rate (86.2% vs. 20.6%, p < 0.0001)and the need for immunosuppressive agents (57.1% vs. 13.6%, p <0.0001) or biological agents (42.9% vs. 10.3%, p <0.0001) were all significantly higher among UP patients with disease proximal extension, when compared with non-extensors. Colectomy was also associated with proximal disease extension (p = 0.0002). No significant association was found between UP proximal extension and gender, race, age at diagnosis and extraintestinal manifestations. Conclusion UP is a dynamic disease that may progress over time. UP patients with increased clinical and endoscopic severity at the diagnosis are likely to evolve with proximal extension and should be more carefully followed up. Reference
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