ABSTRACT Background: Hepatic encephalopathy (HE) is a major complication of cirrhosis; however, its characterization in alcohol-related cirrhosis (ARC) remains limited because most available evidence derives from mixed-etiology cohorts. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, EMBASE, and LILACS were searched through April 2026. Randomized controlled trials and cohort studies involving adults with ARC or documented alcohol consumption reporting HE-related outcomes were included. Risk of bias was assessed using the Cochrane RoB 2.0 tool and the Newcastle-Ottawa Scale, while certainty of evidence was evaluated using the GRADE framework. Due to substantial heterogeneity, a narrative synthesis was performed. Results: Fourteen studies involving 6,185 participants were included. HE was associated with a hospital prevalence of 18.5% and a 90-day mortality of 12.1%. Observational evidence suggested that HE was associated with increased mortality (HR 3.1 at 90 days; HR 2.9 at 1 year), while active alcohol consumption was identified as a potential adverse prognostic factor (HR 2.5). For secondary prophylaxis, rifaximin was associated with reduced recurrence (HR 0.42), predominantly as add-on therapy to lactulose. Lactulose also reduced recurrence compared with placebo. In acute HE, polyethylene glycol demonstrated faster clinical improvement than lactulose, although evidence was limited. Conclusion: Available evidence suggests that HE in alcohol-related cirrhosis may represent a clinically relevant subgroup with potentially distinct prognostic characteristics. However, current evidence remains indirect, heterogeneous, and largely derived from mixed-etiology populations, precluding definitive conclusions regarding a specific alcohol-related HE phenotype. Dedicated prospective studies are needed.
ABSTRACT Background: The role and optimal timing of surgery following preoperative biliary drainage (PBD) in patients undergoing pancreatoduodenectomy remain controversial. Early surgery may be influenced by procedure-related inflammation, whereas delayed intervention may increase infectious complications due to biliary colonization. Objective: To evaluate the impact of the interval between biliary drainage and pancreatoduodenectomy on postoperative outcomes and its association with biliary contamination. Methods: This retrospective cohort study included 239 patients undergoing pancreatoduodenectomy between 2013 and 2025. Of these, 174 (73%) underwent PBD via endoscopic retrograde cholangiopancreatography. Patients were stratified by interval between drainage and surgery: ≤2 weeks, 3-6 weeks, and >6 weeks. The primary outcome was 90-day mortality; secondary outcomes included major complications (Clavien-Dindo ≥III). Multivariable logistic regression adjusted for confounders. Results: Surgery at 3-6 weeks was associated with the lowest rates of major complications (31.7%) and 90-day mortality (9.7%), compared with ≤2 weeks (57.1%; 28.6%) and >6 weeks (40.6%; 23.2%). Surgery outside this interval increased 90-day mortality risk (OR 2.9, 95%CI 1.07-7.83). Biliary colonization rose with longer intervals, exceeding 90% after three weeks. Conclusion: A 3-6 week interval between biliary drainage and pancreatoduodenectomy is associated with improved outcomes, suggesting an optimal window balancing inflammation and bacterial colonization.
ABSTRACT Background: Lynch Syndrome (LS) is a genetic condition associated with a high risk of colorectal cancer, often linked to microsatellite instability (MSI), which is caused by defects in DNA mismatch repair (MMR) genes such as MLH1 and MSH2. Although MMR deficiency and MSI are well-documented in the literature, the role of these genes in adenomas remains unclear. Objectives: To evaluate, through meta-analysis, the correlation between loss of expression of the MLH1 and MSH2 genes and MSI in adenomas from patients with LS. Methods: A systematic search was conducted in the MEDLINE, SCOPUS, and Web of Science databases up to 06/09/2025, using a strategy with descriptors related to MSI, LS, and precursor lesions. Data were analyzed using the Inverse Variance method, with 95% confidence intervals. Heterogeneity was assessed using the I-squared ( I²) statistic. Outliers were identified through statistical influence diagnostics applied to each study. Publication bias was assessed using funnel plots and Egger’s regression test. Statistical analyses were performed using RStudio, version 4.4.0. Results: 5 studies were included, totaling 145 adenomas from individuals with LS. A highly significant correlation was found between MSI and MSH2 expression loss (OR=13,91 [3,97-48,72]; P=0,000038; I²=0%). No significant correlation was found between MSI and loss of MLH1 expression (OR=2,19 [0,93-5,16]; P=0,073; I²=0%). Funnel plot analysis and Egger’s regression test showed no significant evidence of publication bias for MLH1 (t=0.25, df=3, P-value=0.8155) or MSH2 (t=-0.79, df=3, P-value=0.4860). Conclusion: This meta-analysis found a strong, significant and consistent correlation between MSI and MSH2 expression loss in adenomas, but a non-significant association for MLH1 expression loss. The lack of statistical significance in Egger’s test for both genes should be interpreted with caution due to the small number of included studies (k=5). The limited literature available highlights the need for further, larger-scale research.
ABSTRACT Background: Primary biliary cholangitis (PBC) is a rare autoimmune liver disease with limited epidemiological data from Latin America. Objectives: To analyzed nationwide trends in PBC-related hospitalizations and in-hospital mortality within Brazil’s Unified Health System (SUS) from 2015 to 2024. Methods: National hospital admission data for ICD-10 code K74.3 were analyzed. Hospitalization rates per 100,000 inhabitants, in-hospital mortality, costs, and mean length of stay were estimated. Temporal changes were assessed using interrupted time-series segmented regression, and descriptive analyses were stratified into pre-pandemic, pandemic (COVID-19), and post-pandemic periods. Results: Between 2015 and 2024, 2,913 hospitalizations were recorded. The annual hospitalization rate ranged from 0.11 per 100,000 in 2022 to 0.19 per 100,000 in 2020, with a mean of 0.15 per 100,000 over the study period. Mean admission-level in-hospital mortality was 15.4%, ranging from 11.7%-18.5%. Mean length of stay was 7.9 days, with little variation over time. A transient increase in hospitalizations was observed in 2020 (β2 = +0.046, P=0.03), followed by a negative slope change in the post-2020 period (β2 = −0.009, P=0.04), suggesting temporary disruption related to the COVID-19 pandemic. The Southeast had the highest hospitalization burden. Inflation-adjusted expenditures totaled R$ 11.38 million (USD 2,112,227.43), with a mean cost of R$ 3,908 (USD 725.10) per admission. Conclusion: PBC-coded hospitalizations in Brazil are infrequent but associated with substantial in-hospital mortality. Strengthening outpatient management and regional equity in hepatology care remains a public health priority.
ABSTRACT Background: Metabolic and bariatric surgery is an effective obesity treatment. One anastomosis gastric bypass (OAGB) has emerged as an alternative to Roux-en-Y gastric bypass (RYGB); however, evidence regarding its postoperative nutritional outcomes remains limited. Objective: To compare food tolerance, gastrointestinal symptoms, and nutritional status between OAGB and RYGB one year after surgery. Methods: This retrospective, observational, comparative study included 46 patients (16 OAGB and 30 RYGB). Weight loss, laboratory parameters, dietary intake, food tolerance, and gastrointestinal symptoms were evaluated one year postoperatively. Linear regression models were adjusted for relevant confounding variables, including age, sex, and baseline values when appropriate. Results: The percentage of total weight loss (29.55% vs 26.32%) and excess weight loss (63.36% vs 58.29%) were similar between RYGB and OAGB groups (P>0.05). A high prevalence of vitamin D deficiency was observed in both groups (RYGB: 82% vs. OAGB: 92%). Elevated parathyroid hormone levels were more frequent in the OAGB group (75% vs 50%), although the difference was not statistically significant. OAGB patients showed numerically lower serum iron and reduced transferrin saturation; however, none of the patients developed anemia. Mean protein intake met the recommended levels in both groups, whereas fiber intake was below the minimum recommended level. OAGB patients presented significantly lower gastrointestinal symptom scores for diarrhea, indigestion, and total score (P<0.05). Food tolerance was satisfactory and similar between groups. Conclusion: Under structured multidisciplinary follow-up, OAGB and RYGB demonstrated comparable nutritional outcomes. OAGB appears to be a nutritionally safe alternative at one year of follow-up, with the need for ongoing monitoring of iron and vitamin D status.
