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Conscience imperative of providing information and knowledge in hepatology:The Portuguese approach

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World Journal of Clinical Cases 2017年第1期5卷 24-26页

作者： guilherme macedo Marco Silva Department of Gastroenterology the Centro Hospitalar São JoãoWGO Training CenterFaculty of MedicineUniversity of Porto4200-319 PortoPortugal

The last 25 years have been a thrilling time for the Portuguese hepatologists. Our national meetings have been providing the forum for the exchange of scientific ideas and the presentation of clinical research in clinical Hepatology, a growing world of knowledge in medical care. Bridging the gaps between technology and clinical daily practice, the latest development and the almost humble bedside care, has been a challenge for the increasing numbers of doctors devoted to the diagnostic and treatment of liver disease. We have been trying to be very persuasive among the Portuguese medical community in demonstrating that cultural vectors may influence the origin and pattern of liver disease among us. Viral hepatitis and alcoholic liver disease are paradigms of this assumption. Chronic liver disease is responsible for 3% of the deaths in Portugal, which accounts for the top ten causes of death in our country. The recognition by public health authorities of this fact along with the national net of hepatology outpatient consultation in public hospitals, has brought liver diseases under the lights of doctors concerns and an increased public awareness of its dimension.

关键词： Alcohol Cirrhosis Hepatology Liver Public health

Diagnosis and treatment of iron-deficiency anemia in gastrointestinal bleeding:A systematic review

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World Journal of Gastroenterology 2020年第45期26卷 7242-7257页

作者： Jose Cotter Cilenia Baldaia Manuela Ferreira guilherme macedo Isabel Pedroto Department of Gastroenterology Hospital da Senhora da Oliveira-GuimarãesGuimarães 4835-044Portugal Department of Life and Health Sciences Research Institute(ICVS) School of MedicineUniversity of MinhoBraga 4710-057Portugal Department of Life and Health Sciences Research Institute(ICVS)/3B’s PT Government Associate LaboratoryBraga 4710-057Portugal Department of Gastroenterology Hospital de Santa MariaCentro Hospitalar Lisboa NorteLisbon 1649-035Portugal Department of University Clinic of Medicine II Faculty of MedicineUniversity of LisbonLisbon 1649-028Portugal Department of Gastroenterology Centro Hospitalar e Universitário de CoimbraCoimbra 3000-075Portugal Department of Faculty of Medicine University of CoimbraCoimbra 3004-504Portugal Department of Gastroenterology Centro Hospitalar de São JoãoPorto 4200-319Portugal Department of Gastroenterology Faculty of MedicineUniversity of PortoPorto 4200-319Portugal Department of Gastroenterology and Hepatology Training Center World Gastroenterology OrganizationPorto 4200-319Portugal Department of Gastroenterology Centro Hospitalar do PortoPorto 4099-001Portugal Department of Institute of Biomedical Sciences Abel Salazar University of PortoPorto 4050-313Portugal

BACKGROUND Anemia is considered a public health issue and is often caused by iron ***-deficiency anemia(IDA)often originates from blood loss from lesions in the gastrointestinal tract in men and postmenopausal women,and its prevalence among patients with gastrointestinal bleeding has been estimated to be 61%.However,few guidelines regarding the appropriate investigation of patients with IDA due to gastrointestinal bleeding have been *** To review current evidence and guidelines concerning IDA management in gastrointestinal bleeding patients to develop recommendations for its diagnosis and *** Five gastroenterology experts formed the Digestive Bleeding and Anemia Workgroup and conducted a systematic literature search in PubMed and professional association ***(via PubMed)searches combined medical subject headings(MeSH)terms and the keywords“gastrointestinal bleeding”with“iron-deficiency anemia”and“diagnosis”or“treatment”or“management”or“prognosis”or“prevalence”or“safety”or“iron”or“transfusion”or“quality of life”,or other terms to identify relevant articles reporting the management of IDA in patients over the age of 18 years with gastrointestinal bleeding;retrieved studies were published in English between January 2003 and April *** professional association websites were searched for clinical practice *** lists from guidelines were reviewed to identify additional relevant *** recommendations were developed by consensus during two meetings and were supported by the published literature identified during the systematic *** From 494 Literature citations found during the initial literature search,17 original articles,one meta-analysis,and 13 clinical practice guidelines were *** on the published evidence and clinical experience,the workgroup developed the following ten recommendations for the management of IDA in patients with gastrointestinal bleeding:(1)Evaluation of

关键词： Anemia iron-deficiency Erythrocyte transfusion Ferric carboxymaltose Gastrointestinal hemorrhage Iron Practice guidelines as topic

Liver and COVID-19:From care of patients with liver diseases to liver injury

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World Journal of Hepatology 2021年第10期13卷 1367-1377页

作者： Rui Gaspar Catarina Castelo Branco guilherme macedo Department of Gastroenterology and Hepatology Centro Hospitalar de Sao JoaoPorto 4200Portugal Department of Internal Medicine Centro Hospitalar e Universitario do PortoPorto 4100Portugal

The global pandemic of coronavirus disease 2019(COVID-19)changed dramatically all priorities on medical society and created several challenges for clinicians caring for patients with liver *** performed a comprehensive review about how COVID-19 can affect the liver,the influence of liver diseases on the risk of developing severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and COVID-19 severity and also some strategies to overcome all the challenges clinicians have to face in the management of patients with liver diseases in a period of time when all the focus turned on *** analyze the relationship between COVID-19 and non-alcoholic fatty liver disease,alcoholic liver disease,viral hepatitis,autoimmune liver disease,cirrhosis,hepatocellular carcinoma and liver transplantation,as well as the approach to SARS-CoV-2 vaccination.

关键词： COVID-19 Liver diseases Vaccination SARS-CoV-2

Liver manifestations and complications in inflammatory bowel disease:A review

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World Journal of Hepatology 2021年第12期13卷 1956-1967页

作者： Rui Gaspar Catarina Castelo Branco guilherme macedo Department of Gastroenterology and Hepatology Centro Hospitalar de São JoãoPorto 4200Portugal Internal Medicine Department Centro Hospitalar e Universitário do PortoPorto 4200Portugal

Hepatobiliary manifestations are common in inflammatory bowel disease(IBD),with 30%of patients presenting abnormal liver tests and 5%developing chronic liver *** range from asymptomatic elevated liver tests to lifethreatening disease and usually follow an independent course from *** pathogenesis of liver manifestations or complications and IBD can be closely related by sharing a common auto-immune background(in primary sclerosing cholangitis,IgG4-related cholangitis,and autoimmune hepatitis),intestinal inflammation(in portal vein thrombosis and granulomatous hepatitis),metabolic impairment(in non-alcoholic fatty liver disease or cholelithiasis),or drug toxicity(in drug induced liver injury or hepatitis B virus infection reactivation).Their evaluation should prompt a full diagnostic workup to identify and readily treat all complications,improving management and outcome.

关键词： Hepatobiliary manifestations Inflammatory bowel disease Drug induced liver injury Primary sclerosing cholangitis Viral hepatitis Crohn's disease Ulcerative colitis

Fecal marker levels as predictors of need for endoscopic balloon dilation in Crohn's disease patients with anastomotic strictures

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World Journal of Gastroenterology 2017年第35期23卷 6482-6490页

作者： Susana Lopes Patrícia Andrade Eduardo Rodrigues-Pinto Joana Afonso guilherme macedo Fernando Magro Gastroenterology Department Faculty of MedicineHospital de Sao Joao Department of Pharmacology and Therapeutics University of Porto

AIM To evaluate the accuracy and best cut-off value of fecal calprotectin(FC) and fecal lactoferrin(FL) to predict disease recurrence in asymptomatic patients presenting with anastomotic strictures. METHODS This was a longitudinal single tertiary center study based on prospectively collected data(recorded in a clinical database created for this purpose) performed between March 2010 and November 2014. Crohn's disease(CD) patients with anastomotic stricture who submitted to postoperative endoscopic evaluation were included. Stools were collected on the day before bowel cleaning for FC and FL. Endoscopic balloon dilation(EBD) was performed if the patient presented an anastomotic stricture not traversed by the colonoscope, regardless of patients' symptoms. Successful dilation was defined as passage of the colonoscope through the dilated stricture into the neotermimal *** recurrence was defined as a modified Rutgeerts score of ≥ i2 b. RESULTS In a total of 178 patients who underwent colonoscopy, 58 presented an anastomotic stricture, 86% were asymptomatic, and 48(54% male; median age of 46.5 years) were successfully dilated. Immediate success rate was 92% and no complications were recorded. FC and FL levels correlated significantly with endoscopic recurrence(P < 0.001) with an optimal cut-off value of 90.85 μg/g(sensitivity of 95.5%, specificity of 69.2%, positive predictive value(PPV) of 72.4%, negative predictive value(NPV) of 94.7% and accuracy of 81%] for FC and of 5.6 μg/g(sensitivity of 77.3%, specificity of 69.2%, PPV of 68%, NPV of 78.4% and accuracy of 72.9%) for *** Fecal markers are good predictors of CD endoscopic recurrence in patients with asymptomatic anastomotic stricture. FC and FL may guide the need for EBD in this context.

关键词： Crohn's disease Anastomotic strictures Endoscopic balloon dilation Fecal markers Po stoperative recurrence

HIPPOCRATES®project:A proof of concept of a collaborative program for hepatitis C virus micro-elimination in a prison setting

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World Journal of Hepatology 2020年第12期12卷 1314-1325页

作者： Rui Gaspar Rodrigo Liberal Jorge Tavares Rui Morgado guilherme macedo Department of Gastroenterology Centro Hospitalar de São JoãoPorto 4200Portugal Department of Gastroenterology and Hepatology Centro Hospitalar de São JoãoPorto 4200Portugal Estabelecimento Prisional do Porto Porto 4200Portugal

BACKGROUND In the last few years we have witnessed a revolution in the treatment of hepatitis C virus(HCV)*** the introduction of direct-acting antiviral agents(DAAs),sustained virological response(SVR)is achieved in more than 95%of the *** focus is now being turned to the global targets set by the World Health Organization,with the aim of achieving HCV elimination by *** inmates constitute one of the high-risk groups,and receive treatment less frequently due to several barriers in access to health *** To describe the management and follow-up of a cohort of HCV monoinfected patients treated with DAA in the prison setting,where tertial referral liver center specialists locally provide,on-site assessment and treatment for the *** A prospective observational study was conducted from April 2017 to March 2020,which included all HCV monoinfected prison inmates in the largest Northern Portugal ***,clinical,and laboratory data,as well as transient elastography measurements,were collected onsite by the medical team and prospectively *** were treated with DAA according to international *** primary endpoint was SVR at post-treatment week *** There were 98 monoinfected HCV male inmates(mean age,42.7±8.6 years)included in the *** drugs or tattooing were reported in 74.5%,with 38.8%of the latter being done in *** consumption of more than 30 g/d was referred in 69.4%.The most prevalent genotype was 1a(54.1%),followed by 3(27.6%),4(9.2%)and 1b(6.1%).Pretreatment fibrosis degree was mild-tomoderate(F0-F2)in 77.6%and severe in 22.4%(F3-F4).Treatment regimens chosen were:45.9%elbasvir/grazoprevir,29.6%sofosbuvir/velpatasvir,and 12.2%sofosbuvir/ledispavir and glecaprevir/*** major adverse events were *** at post-treatment week 12 was 99%.CONCLUSION In a population considered to be both hard-to-access and a cornerstone for HCV elimination,the onsit

关键词： Hepatitis C infection Treatment Prison setting Direct-acting antiviral agents Micro-elimination

Autoimmune hepatitis and eosinophilia:A rare case report

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World Journal of Hepatology 2023年第2期15卷 311-317页

作者： Isabel Garrido Susana Lopes Elsa Fonseca Fátima Carneiro guilherme macedo Department of Gastroenterology and Hepatology Centro Hospitalar Universitário de São JoãoWorld Gastroenterology Organization Porto Training CenterFaculty of Medicine of the University of PortoPortoPortugal Department of Pathology Centro Hospitalar Universitário de São JoãoInstituto de Investigação e Inovação em Saúde(i3S)and Institute of Molecular Pathology and ImmunologyUniversity of Porto(Ipatimup)Faculty of Medicine of the University of PortoPortoPortugal

BACKGROUND Autoimmune hepatitis consists of a chronic liver disease whose etiology is *** is comprised of relevant immunological aspects and of immunemediated liver *** may be a considerable feature,particularly happening in male *** SUMMARY We report here a Crohn´s disease patient presenting with de novo hypergammaglobulinemia,circulating autoantibodies and elevated transaminase *** also had significant peripheral eosinophilia and elevated immunoglobulin E levels at *** pathology findings from liver biopsy were compatible with autoimmune hepatitis with eosinophilic *** This is the first report of autoimmune hepatitis with exuberant eosinophilic infiltration in the liver and bone marrow,described in a patient with Crohn’s disease.

关键词： Autoimmune hepatitis Eosinophilia Bone marrow Crohn’s disease Case report

Not all liver tumors are alike—an accidentally discovered primary hepatic leiomyosarcoma:A case report

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World Journal of Hepatology 2022年第4期14卷 860-865页

作者： Isabel Garrido Patrícia Andrade João Pacheco Elisabete Rios guilherme macedo Gastroenterology and Hepatology Department Centro Hospitalar Universitário de São JoãoPorto 4200-319Portugal World Gastroenterology Organization Porto Training Center Porto 4200-319Portugal Pathology Department Centro Hospitalar Universitário de São JoãoPorto 4200-319Portugal

BACKGROUND Primary hepatic leiomyosarcoma is a very rare entity that originates from smooth *** diagnosis requires a high degree of suspicion due to atypical clinical presentation and non-specific imaging *** SUMMARY We report the case of a 42-year-old man,with no relevant past medical history,accidentally diagnosed with a nodular liver lesion on a routine abdominal *** function tests and hematology parameters as well as tumor markers were normal.A contrast-enhanced abdominal computed tomography scan revealed a heterogenous hepatic lesion measuring 40 mm 30 mm,adjacent to the left branch of the portal vein and the round *** to the unclear diagnosis,the patient underwent surgical *** and immunohistochemical examinations confirmed complete(R0)resection of a hepatic *** patient remains without any signs of tumor recurrence for more than 2 *** We report a rare case of accidentally diagnosed primary hepatic leiomyosarcoma originating from the portal vein or the round *** this tumor has aggressive metastatic potential,a tumor-free resection margin is essential to improve survival.

关键词： Primary hepatic leiomyosarcoma Portal vein Round ligament Surgical resection Case report

Endoscopic balloon dilation of crohn's disease stricturessafety,efficacy and clinical impact

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World Journal of Gastroenterology 2017年第41期23卷 7397-7406页

作者： Susana Lopes Eduardo Rodrigues-Pinto Patrícia Andrade Joana Afonso Todd H Baron Fernando Magro guilherme macedo Gastroenterology Department Faculty of MedicineHospital de Sao Joao Department of Pharmacology and Therapeutics University of Porto Division of Gastroenterology and Hepatology University of North Carolina

AIM To evaluate the incidence of anastomotic strictures after intestinal resection in Crohn's disease(CD), demonstrate long-term efficacy and safety of endoscopic balloon dilation(EBD) in CD strictures and its impact on the diagnosis of subclinical postoperative endoscopic recurrence. METHODS Retrospective single tertiary center study based on prospectively collected data between 2010 and 2015including anastomotic and non-anastomotic strictures. RESULTS29% of 162 CD patients included developed an anastomotic stricture. 43 patients with anastomotic strictures and 37 with non-anastomotic strictures underwent EBD; technical success was 97.7% and 100%, respectively, however, 63% and 41% needed repeat dilation during the 4.4-year follow-up. Longer periods between surgery and index colonoscopy and higher lactoferrin levels were associated with the presence of stricture after surgery. Calprotectin levels > 83.35 μg/g and current or past history of smoking were associated with a shorter time until need for dilation(HR = 3.877, 95%CI: 1.480-10.152 and HR = 3.041, 95%CI: 1.213-7.627). Anastomotic strictures had a greater need for repeat dilation(63% vs 41%, P = 0.047). No differences were found between asymptomatic and symptomatic cohorts. Disease recurrence diagnosis was only possible after EBD in a third of patients. CONCLUSION EBD is an effective and safe alternative to surgery, with a good short and long-term outcome, postponing or even avoiding further surgery. EBD may allow to diagnose disease recurrence in patients with no clinical signs/biomarkers of disease activity.

关键词： Crohn’s disease Endoscopic recurrence Anastomotic strictures Non-anastomotic strictures Endoscopic balloon dilation