Papers by Guilherme Macedo
Gastroenterology, 2017
respectively. Patients were started on anti-tubercular therapy for nine months. Four patients und... more respectively. Patients were started on anti-tubercular therapy for nine months. Four patients underwent surgery for intestinal obstruction while on antitubercular therapy. Twenty eight completed full therapy and improved. Conclusion: NBI-M guided biopsy improved the yield of histology for diagnosis of GITB. Endoscopic and computed tomography abdomen findings of 32 patients with GITB High definition white light endoscopic image and corresponding narrow band imaging image of a patient with colonic tuberculosis Sa2042
Journal of Crohn's and Colitis, 2017
Annals of hepatology, 2016
Hepatocellular adenomas (HCAs) are benign liver tumors recently characterized into 4 different ty... more Hepatocellular adenomas (HCAs) are benign liver tumors recently characterized into 4 different types according to genetic, pathological and clinical features. The prognosis is not well established yet and malignant transformation has been recently associated with β-catenin activation. We aimed to describe a case of a pigmented HCA with β-catenin nuclear expression and inflammatory features and to review the cases of pigmented HCAs in the literature. We report a case of a young female patient without contraceptive use, with a liver tumor diagnosis. Liver biopsy revealed diffuse expression of β-catenin and a partial hepatic resection was performed. The histologic analysis revealed a hepatocellular tumor composed of uniform trabeculae of hepatocytes and solid areas, the later with a significant amount of black pigment highlighted by Masson-Fontana stain. Immunohistochemistry showed co-expression of C-reactive protein and serum amyloid A in the tumor. Literature review revealed that pig...
Endoscopy International Open, 2017
Background and study aims Clinical impact of single-balloon enteroscopy (SBE) is fairly known, as... more Background and study aims Clinical impact of single-balloon enteroscopy (SBE) is fairly known, as well as its diagnostic yield comparing with other small bowel gastrointestinal investigations. This study represents a contribution to better understand it and is designed to evaluate SBE efficacy and degree of concordance with previous evaluation of small bowel. Patients and methods This is a single-center retrospective study of patients that underwent SBE with suspected small bowel disease based on non-invasive imaging. Demographic, clinical, procedural and outcome data were collected for analysis. Agreement beyond positive findings was evaluated using κ-coefficient. Results A total of 197 SBEs were performed in 168 patients; mainly men (64.3 %) with mean age 53.3±17.6 years. Most SBEs (86.3 %) performed were preceded by a noninvasive evaluation: in 61.4 % (n = 119) of cases, capsule enteroscopy (CE) was performed, in 18.8 % (n = 37), computed tomography was performed, and in 6.1 % (n...
Journal of Translational Internal Medicine, 2016
The eradication of Helicobacter pylori is essential for prevention and treatment of various condi... more The eradication of Helicobacter pylori is essential for prevention and treatment of various conditions associated with this infection. However, its effectiveness is limited and influenced by factors linked to the bacteria and the host. In particular, influence of the biotype, smoking, diabetes mellitus, and previous treatment failure in eradication is understudied. Our center proposed to evaluate these aspects in a real life cohort by applying a questionnaire with demographic and lifestyle variables in patients who consecutively underwent urease breath test after the eradication therapy.
PloS one, 2017
Inflammation is the driving force in inflammatory bowel disease (IBD) and its link to oxidative s... more Inflammation is the driving force in inflammatory bowel disease (IBD) and its link to oxidative stress and carcinogenesis has long been accepted. The antioxidant system of the intestinal mucosa in IBD is compromised resulting in increased oxidative injury. This defective antioxidant system may be the result of genetic variants in antioxidant genes, which can represent susceptibility factors for IBD, namely Crohn's disease (CD) and ulcerative colitis (UC). Single nucleotide polymorphisms (SNPs) in the antioxidant genes SOD2 (rs4880) and GPX1 (rs1050450) were genotyped in a Portuguese population comprising 436 Crohn's disease and 367 ulcerative colitis patients, and 434 healthy controls. We found that the AA genotype in GPX1 is associated with ulcerative colitis (OR = 1.93, adjusted P-value = 0.037). Moreover, we found nominal significant associations between SOD2 and Crohn's disease susceptibility and disease subphenotypes but these did not withstand the correction for mu...
Clinical Gastroenterology and Hepatology, 2017
A 43-year-old man with type 1 human immunodeficiency virus (HIV) infection diagnosed in 1999, rec... more A 43-year-old man with type 1 human immunodeficiency virus (HIV) infection diagnosed in 1999, receiving treatment with highly active antiretroviral therapy since April 2015, was referred in November 2015 for a 2-month history of mucous diarrhea. He denied any other symptoms, namely abdominal pain, rectal bleeding, fever, asthenia, or weight loss. Physical examination was unremarkable. His HIV-1 RNA viral load was 92 copies/mL and his CD4 cell count was 264/mm. There were no other laboratory abnormalities. A lower gastrointestinal endoscopy was performed and showed a 7-mm sessile polyp in the sigmoid colon (Figure A) with no other lesions. The colonic polyp was removed with a diathermic snare for histologic examination (Figure B). Histologic examination of the polyp showed large atypical lymphoid cells with irregular nuclei and prominent nucleoli with the appearance of plasmablasts/immunoblasts (Figure C). The cellular proliferation index, measured by Mib1/Ki67 staining, was Most current article
Revista española de enfermedades digestivas : organo oficial de la Sociedad Española de Patología Digestiva, 2016
A 35-year-old female patient, with Batten's disease, submitted to a surgical gastrostomy in 2... more A 35-year-old female patient, with Batten's disease, submitted to a surgical gastrostomy in 2005, and had it replaced in 2007, 2011 and 2014 with one with a filled balloon as its internal retention mechanism. In 2015, she presented to the emergency room due to stomal enlargement, leakage and chemical dermatitis and cellulitis. A 12 mm over-the-scope clip was placed, after anchoring the fistula edges with the twin grasper and suction of the defect into the applicator cap. Endoscopic resolution of the fistula was achieved.
Journal of Hepatology, 2016
Acta Médica Portuguesa, 2015
Purpose: Despite being rare entities, the incidence of malignant small bowel tumors seems to be r... more Purpose: Despite being rare entities, the incidence of malignant small bowel tumors seems to be rising. The development of capsule endoscopy and balloon assisted enteroscopy provided an advance in the assessment of small bowel lesions. We aim to describe the clinical and pathological characteristics of patients with small bowel cancer and ascertain what roles these endoscopic techniques currently have.Material and Methods: A retrospective study of patients diagnosed with small bowel cancer, from January 2010 to October 2014, was performed. The data was submitted to statistical analysis.Results: Of the 28 diagnosed patients, 54% were female. The mean age at diagnosis was 61 years. Adenocarcinoma was the most frequent tumor (n = 11), followed by sarcoma (n = 6), lymphoma (n = 6) and neuroendocrine tumors (n = 3). The main form of presentation was related to blood loss or intestinal obstruction. By the time of diagnosis, 46% of patients had distant metastasis/ unresectable cancer. Most...
Journal of gastrointestinal and liver diseases : JGLD, 2015
Nodular regenerative hyperplasia is a histopathological diagnosis characterized by the diffuse tr... more Nodular regenerative hyperplasia is a histopathological diagnosis characterized by the diffuse transformation of the liver parenchyma into regenerative nodules associated with rheumatologic and hematologic disorders, azathioprine immunosuppression or vascular injuries. The authors report the case of a 60-year-old female patient with a diagnosis of familial systemic paramyloidosis submitted to liver transplantation complicated by a hepatic artery thrombosis. A second liver transplant was performed and after 6 months she developed ascites and peripheral edema. The abdominal computed tomography (CT) showed an inferior vena cava stenosis. She underwent balloon angioplasty and an endovascular prosthesis was placed. The patient remained asymptomatic under immunosuppression with tacrolymus for 4 years, when she complained of peripheral edema and ascites. Laboratory work-up showed anemia and hypoalbuminemia with liver chemistry within the normal range. The ascites fluid analysis revealed a ...
World journal of gastroenterology : WJG, Jan 28, 2015
This article describes cases of anti-tumor necrosis factor (TNF)-α-induced autoimmune hepatitis a... more This article describes cases of anti-tumor necrosis factor (TNF)-α-induced autoimmune hepatitis and evaluates the outcome of these patients in relation to their immunosuppressive strategy. A retrospective analysis of medical records was performed in our center, in order to detect cases of autoimmune hepatitis (AIH) associated with anti-TNF biologic agents. We describe and analyze eight cases of AIH following anti-TNF therapy, 7 with infliximab and 1 with adalimumab. A distinction should be made between induction of autoimmunity and clinically evident autoimmune disease. Liver biopsy is useful in detecting the role of the TNF-α antagonist in the development of AIH. The lack of relapse after discontinuing immunosuppressive therapy favors, as in this case series, an immune-mediated drug reaction as most patients with AIH have a relapse after treatment is suspended. Although AIH related to anti-TNF therapy is rare, a baseline immunological panel along with liver function tests should be...
Revista Española de Enfermedades Digestivas, 2015
Background: Malignant colorectal obstruction (MCRO) by advanced colonic cancer occurs in 8-13% of... more Background: Malignant colorectal obstruction (MCRO) by advanced colonic cancer occurs in 8-13% of colonic cancer patients. Emergent surgery carries a high mortality and morbidity risk. Endoscopic self-expanding metal stents (SEMS) may be used in acute MCRO. Aim: Evaluate clinical outcome of SEMS in acute MCRO and efficacy of SEMS placement considering fluoroscopy guidance. Methods: Retrospective study of patients with acute MCRO that placed SEMS in a 3 years period. Results: SEMS were placed in 47 patients, followed-up for a median time of 150 days. The intent of stenting was bridge to definitive surgery in 40% of the patients (n = 19) and palliation in the remaining 60% (n = 28). The location of the tumor did not influence the presence of lymph node involvement (p = 0.764) nor metastasis (p = 0.885). Mortality rate at year 1 was 61%. Survival was significantly higher in patients submitted later to combination therapy compared to chemotherapy, surgery or symptomatic treatment (p < 0.001). Fluoroscopy was used in 57% of the procedures. Clinical success was 79%. A second SEMS was needed during the procedure in 6% of the patients. Rate of early and late complications was 11% and 5%, respectively. Fluoroscopy guidance did not influence the occurrence of immediate (p = 0.385), early (p = 0.950) or late complications (p = 0.057). Thirty-three percent of patients underwent surgery at a later stage, with neo-adjuvant therapy in 18%. Conclusions: SEMS provide a relative safe and successful treatment in a palliative or bridge-to-surgery indication. No significant differences were found in SEMS placement success, early complications or late complications considering fluoroscopy guidance.
Endoscopy, 2015
An 11-year-old boy was admitted to the emergency department with severe abdominal pain and vomiti... more An 11-year-old boy was admitted to the emergency department with severe abdominal pain and vomiting after falling off his bicycle. A round hematoma was noted in the left hypochondrium consistent with bicycle handlebar trauma. Blood analysis showed mild leucocytosis and marked elevation of lipase (2507 U/L) and amylase (1331 U/L). Abdominal ultrasound excluded spleen injury, and thoracic X-ray was unremarkable. Abdominal computed tomography (CT) scan showed a total transection of the pancreas, including the pancreatic duct, in the distal body, without liver, splenic, or vascular lesions (• " Fig. 1 and• " Fig. 2). Endoscopic retrograde cholangiopancreatography (ERCP) was performed. Pancreatography revealed contrast extravasation from the main pancreatic duct in the distal body (• " Fig. 3,• " Video 1). Cannulation of the caudal portion of the duct was not possible; therefore, a 5-Fr, 12-cm length, plastic monopigtail stent was placed with the distal extremity in the fistula. The patient recovered well and was discharged after 20 days without pain, and Cases and Techniques Library (CTL) E112
GE Jornal Português de Gastrenterologia, 2014
Foreign body-induced perforation is responsible for 16.7% of esophageal perforations and may be a... more Foreign body-induced perforation is responsible for 16.7% of esophageal perforations and may be associated with respiratory failure, sepsis or hemorrhage if delayed diagnosis and treatment. The mortality rate of esophageal perforations hovers close to 20%, especially if treatment is delayed more than 24 h. Esophageal perforation management remains controversial and treatment decisions should be individualized depending on the etiology of perforation, degree of mediastinopleural contamination, underlying esophageal disease, and overall health status of the patient. We report a case of successful endoscopic management in a delayed diagnosis of an esophageal perforation presenting with an associated peri-esophageal abscess.
Revista Española de Enfermedades Digestivas, 2013
Journal of Crohn's and Colitis, 2012
Thiopurines are widely used for remission maintenance and post-operative recurrence prevention in... more Thiopurines are widely used for remission maintenance and post-operative recurrence prevention in Crohn's disease. The increased risk of cancer in transplant recipients on azathioprine is well recognized and there are concerns that this may also be true for inflammatory bowel disease patients. We report a case of a 33-year-old Caucasian woman with Crohn's disease treated with azathioprine for 9 years who developed an ulcerated lesion at the right superior retromolar trigone. Biopsy specimen revealed a squamous cell carcinoma.
Journal of Crohn's and Colitis, 2013
Background and aims: An increased incidence of tuberculosis (TB) in patients under anti-TNF-α the... more Background and aims: An increased incidence of tuberculosis (TB) in patients under anti-TNF-α therapy has been reported, but outcome compared with TB in the general population are unknown. Methods: Patients who had active tuberculosis while taking anti-TNF-α drugs were studied and compared with a control group of community-acquired TB matched for sex, age and data of TB. Results: Twenty-five cases of TB were reported from a cohort of 765 patients under anti-TNF-α from 2001 to 2012. The incidence of TB per 100,000 patient-years was estimated to be 1337, 792 and 405 respectively for those on infliximab, adalimumab and etanercept. Twelve patients had inflammatory bowel disease, ten had rheumatologic diseases and three had psoriasis. From the 17 patients screened for latent TB before anti-TNF-α, three were treated with isoniazid. TB was diagnosed 1-108 months after starting anti-TNF-α, being the median time six, seven and 89 months respectively for those on infliximab, adalimumab and etanercept. Sixty per
Inflammatory Bowel Diseases, 2013
Background: Inflammatory bowel disease (IBD) is associated with a higher prevalence of opportunis... more Background: Inflammatory bowel disease (IBD) is associated with a higher prevalence of opportunistic infections. Epstein-Barr virus (EBV) is a ubiquitous virus related to several malignancies, namely lymphoma; its prevalence in patients with IBD and its relation with different therapeutic regimens are not well studied. Methods: Patients followed in our IBD outpatient clinic were consecutively enrolled for participation in a prospective study, and healthy volunteers were recruited as controls. EBV DNA was measured at least 1 time in each patient. Results: Three hundred and seventy-nine individuals were enrolled in the study (93 treated with 5-aminosalicylates, 91 with azathioprine, 70 with infliximab, 43 with combined treatment with infliximab and azathioprine, and 82 controls). More than 90% of the patients had previous EBV exposure. EBV DNA was found in 132 samples (35%); its prevalence was significantly higher in every group of patients with IBD, comparing to controls. Among patients with IBD, infliximab with or without azathioprine was related to higher prevalence of EBV comparing to azathioprine alone or 5-aminosalicylates (P , 0.05). Age above 60 years was related to EBV DNA positivity with a specificity of 92%. Concerning treated groups, ulcerative colitis was the only risk factor identified for high levels of EBV DNA (.1000 and 2500 copies per milliliter). No relationship was found between EBV and C-reactive protein. Conclusions: IBD is a risk factor for the presence of EBV DNA in blood, particularly in older patients and in those taking infliximab. C-reactive protein was not related to EBV DNA prevalence.
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Papers by Guilherme Macedo