Introduction and Objectives Some studies had described the relation between dietetic fats and carbohydrates with fatty liver disease although any specific amount has not been stablished. This study aimed to analyze the amount and type of dietetic fat and carbohydrates related with hepatic steatosis in a group of Mexican adults in a typical diet. Materials and Methods In a group of Mexican adults without hepatic steatosis, a registered cross- sectional study INCMNSZ- 3794- 21/22 consuming a typical diet, were applied food frequency questionnaires, anthropometry and transient elastography. If they had any chronic disease, uncontrolled diabetes, hypertension or thyroid disease, bariatric surgery or pacemaker, were not included. Dietary fat and carbohydrates were identified and quantified with The Food Processor software v11.11.32 (ESHA Co.); manually, the proportion of fats was classified according to WHO recommendations. Differences among steatosis group (CAP> 268 dB/m) were calculated with t- Student and a logistic regression to determine odds ratio with type and amount of nutrients related to hepatic steatosis. Results Of 321 participants, 200 were women; 162 had steatosis and were older, with higher BMI, waist circumference, fat mass and visceral fat (p=0.000); they also consumed more carbohydrates, total sugar and added sugars (113.8 g, 98.1 g and 52.6 g, respectively) compared to non- steatosis group (p=0.000). There were no statistical differences in total either type of fats. For carbohydrates were obtained OR= 2.44 (IC95% 1.4- 4.62, p=0.002), total sugar OR= 2.67 (IC95% 1.48- 4.63, p=0.001) and added sugars OR= 2.68 (IC95% 1.49- 4.83, p=0.001). Conclusions Unlike fats, type and amounts of dietary sugars are relevant risk factors for hepatic steatosis in a typical Mexican diet. In this study, we identified the amount that could be related to damage for non- alcoholic fatty liver disease.

Introduction an Objectives An increase in body fat is a risk factor to develop fatty liver disease. Until now, few studies have related different methods to estimate body fat related to liver fat. We aimed to determinate the correlation among different methods to estimate body and liver fat in healthy adults. Materials and Methods In a cross- sectional study registered in ethics and research committees GAS3794 evaluating healthy adults; chronic illness, uncontrolled diabetes, hypertension or thyroid, bariatric surgery or pacemaker, were not included. The estimation of body fat (BF) was by 3 methods, two with bioelectric impedance of 19 frequencies (19F), 4 frequencies (4F) and the third by the Durnin- Womersley (DW) skinfold thickness formulae; also, were measured body mass index (BMI), waist circumference (WC) and visceral fat (VF). The liver fat was estimated by controlled attenuation parameter (CAP) using transitory elastography. Correlations were calculated with Pearson coefficient among body composition methods and CAP; each anthropometric isolated parameter was associated with hepatic steatosis grades by a logistic regression analysis using SPSS v21.0. Results In 231 participants, mean age was 41.8 years (SD 11.3), WC 91 cm (SD 12), BMI 27.8 kg/m2 (SD 4.6). 112 had some grade of steatosis (S3 n=72, S2 n=18). The correlation among 3 methods was on average r= 0.853 (p=0.000), and between CAP and BF was 0.290 (p= 0.000). BMI, WC, VF and suprailiac skinfold thickness showed correlations of r=0.570 (p=0.000), r=0.477 (p=0.000), r=0.393 (p= 0.000) y r= 0.471 (p=0.000) respectively. Regression analysis demonstrated that BMI (OR=1.32, p=0.000), WC > 80 women and > 90 cm men (OR=14.7, p=0.010), VF (OR=1.8, p=0.008) and suprailiac skinfold thickness (OR=1.14, p=0.000) showed association with steatosis. Conclusions Three methods were like to estimate body fat although they were not able to represent the liver fat; waist circumference was the best indicator related with steatosis

Background:Malignant etiologies are found in 70-80% of symptomatic retroperitoneal masses. Histology is required for diagnosis and treatment. Information about endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-GTA) is scant for retroperitoneal masses. This study aimed to assess the pathology results of EUS-GTA for diagnosing retroperitoneal masses.Methods:This retrospective, multicenter study involved patients from 5 care centers. All patients with retroperitoneal masses who underwent EUS evaluation were enrolled. We recorded demographic and clinical characteristics, location and size of the mass, type of needle (FNA/FNB), and complications related to the procedure.Results:A total of 43 patients were included. The median age was 50.5 (range: 23-83) years, and 22 (51.2%) were female. The initial symptom was abdominal pain in 23 (52.3%) cases and weight loss in 11 (25%). Initial imaging was by computed tomography in 33 (75%) patients. Diagnosis with EUS-GTA was reached in 67.5% (29/43) cases. The most frequent histological diagnosis was carcinoma, in 25.5% (11/43). A malignant etiology was found in 31 (72%): 20 were primary tumors from the retroperitoneum, and 11 were metastases. In patients with metastasis, surgery was avoided and medical treatment was indicated. No adverse events were reported.Conclusion:EUS and EUS-GTA can frequently provide accurate tissue diagnosis and significantly impact the subsequent management.

Abstract Background Patients with celiac disease (CeD) reported increased COVID-19 vaccine hesitancy due to a fear of adverse events (AEs). However, the risk of AEs post-COVID-19 vaccination in patients with CeD is unknown. Purpose To assess whether the rate of common side effects (SEs) and AEs due to COVID vaccines are higher in patients with CeD compared to a non-CeD population. Method We conducted a collaborative international cross-sectional study in 16 countries between April 2022 and July 2022. An online survey was distributed to patients with CeD through patients’ local societies, and to non-CeD from the general population in each country through social media posts, word-of-mouth, and through academic institutions. We collected data on participant demographics, medical conditions, CeD diagnosis, GFD adherence, history of COVID-19 vaccinations (type and doses) and self-reported SEs and AEs post-COVID-19 vaccine. SEs included pain/swelling at the site, fatigue, fever, chills, nausea and/or headaches. AEs included thrombosis, myocarditis, anaphylactic reaction, and hospitalization related to the vaccine. Logistic regression models were used to assess predictors such as CeD diagnosis, age, gender, vaccine type and comorbidities on the likelihood of reporting SEs and AEs post-vaccine. Result(s) : A total of 17,795 participants completed the survey, 13,638 with CeD (median age of 45[27]) and 4,157 non-CeD controls (median age of 43[20]). There were no significant differences in sex between CeD and controls. Overall, CeD patients had similar odds of SEs compared with non-CeD individuals (aOR=1.02;95% CI=0.92-1.14). SEs were slightly increased only in the second dose of the vaccine in the CeD population compared to non-CeD individuals (aOR= 1.35; 95% CI=1.19-1.53). The most common reported SEs in CeD and controls were pain/swelling at the injection site (29% vs 23 %, p< 0.0001) and fatigue (29% vs 24%, p<0.0001). The odds of SEs were higher with Moderna Spikevax, AstraZeneca/Oxford and Johnson and Johnson vaccines than after the Pfizer vaccine (p< 0.0001). The overall rate of AEs post-vaccine was similar between patients with CeD and non-CeD individuals (aOR= 1.29; 95% CI= 0.89-1.87). Overall, female gender, older age, GFD adherence, respiratory conditions, obesity and receiving immunosuppressive medications increased the odds of SEs, while only age and a history of allergies increased the odds of AEs. Conclusion(s) In this large international study, patients with CeD reported similar rates of SEs and AEs post-COVID vaccine compared to non-CeD individuals. This information is highly relevant as it addresses the main concern leading to COVID-19 vaccine hesitancy in CeD patients. Disclosure of Interest None Declared

Introduction.Solid organ transplant recipients were excluded from the pivotal clinical trials of COVID-19 vaccines.Therefore, the safety and efficacy data of the different types of available vaccines in this susceptible population is scarce.The goal of the present analysis was to evaluate the humoral response to the COVID-19 vaccines in orthotopic liver transplant (OLT) recipients.Methods.Participants were included from February to September 2021.No prioritized vaccination was performed for OLT patients, and they were included in the regular schedule according to age and place of residency.Controls were otherwise healthy people, mainly family members of patients.All subjects completed the full vaccination schemes, and blood samples were taken after at least 15 days of the complete vaccine doses.The samples were analyzed according to the manufacturer instructions using Liaison XL platform from DiaSorin, LIAISON ® SARS-CoV-2 S1/S2 IgG (DiaSorin S.p.A., Italy), and SARS-COV-2 IgG II Quant (COV-2 IgG II) (Abbott Diagnostics, IL, USA).Results.In all, 187 participants (133 OLT, 54 controls, median age: 60 years, 58.8% women) were included for the analysis; 74.3% had at least one comorbidity (31.6% had hypertension, 32.6% diabetes, 7% neoplasia, and 23% obesity).By vaccine brands, 50.3% received Pfizer-BioN-Tech, 13.9% received Oxford-AstraZeneca, 10.7% received Sinovac, 7.0% Cansino; 16% Sputnik-V and 2.1% received Moderna.The serologic response in OLT patients was lower than in controls (median 549 AU/mL vs. 3450 AU/mL, respectively; p 0.001).A positive humoral response was found in 133 OLT individuals: 89.2% with Pfizer-BioNTech, 60% Oxford-AstraZeneca, 76.9% Sinovac, 55.6% Cansino, 68.2% Sputnik-V, and 100% with Moderna.In controls, only Cansino had a 75% humoral response; all other vaccines had a 100% response.In a multivariable model adjusted for relevant confounders, the antecedent of COVID-19 and Pfizer-BioNTech inoculation were associated positively with the serologic response, while the use of prednisone (compared with other immunosuppressants) interfere with this response.Conclusion.The serologic response to COVID-19 vaccines in OLT patients is lower than otherwise healthy controls.In these patients, the Pfizer-BioNTech vaccine was associated with a higher serologic response.Other variables significantly associated with the humoral response were the COVID-19 antecedent (positively) and prednisone exposure (negatively).At the moment, further analysis is necessary to determine whether this serological response is associated with SARS-COV2 infection or reinfection.

Idiopathic acute recurrent pancreatitis (IARP) is defined as at least two episodes of acute pancreatitis with the complete or near-complete resolution of symptoms and signs of pancreatitis between episodes, without an identified cause. There is a paucity of information about the usefulness of endoscopic ultrasound (EUS) in IARP.ObjectivesTo determine the diagnostic yield of EUS in IARP.DesignA retrospective study was performed in patients with IARP evaluated by EUS between January 2009 and December 2016. Follow-up assessments of acute pancreatitis recurrence were carried out.ResultsSeventy-three patients with 102 EUS procedures were included. EUS was able to identify the cause of IARP in 55 patients (75.3%). The most common findings were chronic pancreatitis in 27 patients (49.1%), followed by lithiasic pathology in 24 patients (43.6%), and intraductal papillary mucinous neoplasm in four patients (7.3%). A directed treatment against EUS findings had a protective tendency associated with the final resolution of recurrence. There were no complications reported.ConclusionEUS performed in patients with IARP helped to identify a possible cause in 2/3 of the cases. The majority of patients have a treatable disease.

Background and study aims Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a complication associated with important morbidity, occasional mortality and high costs. Preventive strategies are suboptimal as PEP continues to affect 4% to 9% of patients. Spraying epinephrine on the papilla may decrease oedema and prevent PEP. This study aimed to compare rectal indomethacin plus epinephrine (EI) versus rectal indomethacin plus sterile water (WI) for the prevention of PEP.Patients and methods This multicentre randomised controlled trial included patients aged >18 years with an indication for ERCP and naive major papilla. All patients received 100 mg of rectal indomethacin and 10 mL of sterile water or a 1:10 000 epinephrine dilution. Patients were asked about PEP symptoms via telephone 24 hours and 7 days after the procedure. The trial was stopped half way through after a new publication reported an increased incidence of PEP among patients receiving epinephrine.Results Of the 3602 patients deemed eligible, 3054 were excluded after screening. The remaining 548 patients were randomised to EI group (n=275) or WI group (n=273). The EI and WI groups had similar baseline characteristics. Patients in the EI group had a similar incidence of PEP to those in the WI group (3.6% (10/275) vs 5.12% (14/273), p=0.41). Pancreatic duct guidewire insertion was identified as a risk factor for PEP (OR 4.38, 95% CI (1.44 to 13.29), p=0.009).Conclusion Spraying epinephrine on the papilla was no more effective than rectal indomethacin alone for the prevention of PEP.Trial registration number This study was registered with ClinicalTrials.gov (NCT02959112).

INTRODUCTION: After the World Health Organization declared the COVID-19 outbreak a pandemic, the number of patients with confirmed SARS-CoV-2 infection (COVID-19) has increased exponentially, and gastroenterologists and other specialists most likely will be involved in the care of those patients. AIM: To evaluate the knowledge Latin American gastroenterologists and endoscopists (staff physicians and residents) have about the characteristics of COVID-19, as well as the prevention measures to be taken during endoscopic procedures. MATERIALS AND METHODS: We conducted a cross-sectional study that included gastroenterologists and endoscopists from 9 Latin American countries. An electronic questionnaire was applied that was designed to evaluate the knowledge of symptoms, risk groups for severe disease, prevention measures, and the reprocessing of endoscopes utilized in patients with COVID-19. RESULTS: Information was obtained from 133 physicians. Ninety-five percent of them correctly identified the most frequent symptoms of the virus, and 60% identified the 3 risk groups for severe disease. Sixty-six percent of those surveyed did not consider it necessary to use standard precautions during endoscopic procedures, and 30% did not consider contact precautions necessary. Forty-eight percent of the participants surveyed were not familiar with the protocol for reprocessing the endoscopes utilized in patients with COVID-19. CONCLUSION: The majority of the gastroenterologists and endoscopists surveyed were familiar with the signs and symptoms of COVID-19 and the populations at risk for complications. There was a lack of knowledge about prevention measures (during clinical care and endoscopic procedures) and the reprocessing of endoscopic equipment by 70% and 48%, respectively, of those surveyed. Dissemination and teaching strategies that increase the knowledge of specific biosafety measures must be carried out.

8.54-8.93)followed by HTN (OR 3.01, 95% CI: 2.95-3.07);and smoking (OR 2.78, 95% CI: 2.75-2.82).Conclusion In this large US-based cohort study, CP was associated with significantly increased prevalence of MI which was comparable to the traditional cardiovascular risk factors.Further studies are needed to evaluate this association and determine whether there is a need to develop strategies to reduce this risk of cardiovascular disease.

Background In contrast to the well-characterized Celiac Disease (CD), the clinical scenarios encompassed by the non-celiac self-reported wheat sensitivity (NCSRWS) might be related to different antigens that trigger distinct immune-inflammatory reactions. Although an increased number of intestinal intraepithelial lymphocytes is observed at the inception of both diseases, the subsequent immunopathogenic pathways seem to be different. We aimed to describe the cytokine profile observed in the duodenal mucosa of patients with NCSRWS. Methods In a blind, cross-sectional study, we included duodenal biopsies from 15 consecutive untreated patients with active CD, 9 individuals with NCSRWS and 10 subjects with dyspepsia without CD and food intolerances. Immunohistochemistry and flow-cytometry were used to determine the presence of pro-inflammatory cytokine expressing monocytes and monocyte-derived dendritic cells involved in innate immune activation, cytokine-driven polarization and maintenance of Th1 and Th17/Th 22, and anti-inflammatory/profibrogenic cytokines. Results The percentage of cells expressing all tested cytokines in the lamina propria and the epithelium was higher in CD patients than in the control group. Cytokines that induce and maintain Th1 and Th17 polarization were higher in CD than in NCSRWS and controls, also were higher in NCSRWS compared to controls. Similar differences were detected in the expression of IL-4 and TGF-1, while IL-10-expressing cells were lower in NCSRWS patients than in controls and CD subjects. Conclusions NCSRWS patients exhibit components of both, innate and adaptive immune mechanisms but to a lesser extent compared to CD.