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BACKGROUND: The most efficient way to prevent complications from inflammatory bowel disease (IBD) is to provide patients with optimized care. Nonetheless, in Brazil, there is no validated methodology for evaluating health services recognized as comprehensive care units (CCU), making it difficult to assess the quality of care provided. OBJECTIVE: To understand the current scenario, map the distribution of centers and identify strengths and weaknesses, considering local and regional characteristics. METHODS: The study was carried out in three phases. Initially, the Brazilian Organization for Crohn's disease and colitis (GEDIIB) developed 22 questions to characterize CCU in Brazil. In the second phase, all GEDIIB members were invited to respond to the survey with the 11 questions considered most relevant. In the last phase, an interim analysis of the results was performed, using the IBM SPSS Statistics v 29.0.1.0 software. Descriptive statistics were used to characterize the center's profile. The chi-square test was used to compare categorical variables. RESULTS: There were 53 responses from public centers (11 excluded). Most centers were concentrated in the Southeastern (n=22/52.4%) and only 1 (2.4%) in the Northern region of Brazil. Thirty-nine centers (92.9%) perform endoscopic procedures, but only 9 (21.4%) have access to enteroscopy and/or small bowel capsule endoscopy. Thirty-three centers (78.6%) offer infusion therapy locally, 26 (61.9%) maintain IBD patient records, 13 (31.0%) reported having an IBD nurse, 34 (81.0%) have specific evidence-based protocols and only 7 (16.7%) have a patient satisfaction methodology. In the private scenario there were 56 responses (10 excluded). There is also a concentration in the Southeastern and Southern regions. Thirty-nine centers (84.8%) have access to endoscopic procedures and 19 perform enteroscopy and/or small bowel capsule endoscopy, more than what is observed in the public environment. Infusion therapy is available in 24 centers (52.2%). Thirty-nine centers (84.8%) maintain a specific IBD patient database, 17 (37%) have an IBD nurse, 36 (78.3%) have specific evidence-based protocols, and 22 (47. 8%) apply a patient satisfaction methodology. CONCLUSION: IBD CCU in Brazil were mainly located in the Southeastern and Southern regions of the country. Most centers have dedicated multidisciplinary teams and IBD specialists. There is still a current need to improve the proportion of IBD nurses in IBD care in Brazil. BACKGROUND: •In Brazil, there is no validated methodology for evaluating health services recognized as comprehensive care units (CCU), making it difficult to assess the quality of care provided. BACKGROUND: •Most CCU were concentrated in the Southeast region and only one (2.4%) in the Northeast region of Brazil. This pattern follows the epidemiological trends of IBD in the country. BACKGROUND: •There is still difficulty in accessing enteroscopy and/or small bowel capsule endoscopy in the public health system. BACKGROUND: •Most centers have dedicated multidisciplinary teams and IBD specialist doctors. BACKGROUND: •There is still a current need to improve the proportion of nurses treating IBD in Brazil.

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We present two patients with chronic diarrhea, with multiple negative studies, both had in common vitamin B12 deficiency. Both patients had multiple studies of parasites in negative stool. Only after colonoscopy in the first case and capsule endoscopy in the second case, it was possible to diagnose the adult forms of Diphyllobotrium spp. After treatment, both patients completely resolved their symptoms.

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BACKGROUND: Studies show higher rates of dissatisfaction with antireflux surgery (ARS) outcomes in patients with chronic constipation. This suggests a relationship between colonic dysmotility and suboptimal surgical outcome. However, due to limitations in technology, there is no objective data available examining this relationship. The wireless motility capsule (WMC) is a novel technology consisting of an ingestible capsule equipped with pH, temperature, and pressure sensors, which provide information regarding regional and whole gut transit times, pH and motility. The aim of this study was to assess the impact of objective regional and whole gut motility data on the outcomes of ARS. STUDY DESIGN: This was a retrospective review of patients who underwent WMC testing before ARS. Transit times, motility, and pH data obtained from different gastrointestinal tract regions were used in analysis to determine factors that impact surgical outcome. A favorable outcome was defined as complete resolution of the predominant reflux symptom and freedom from antisecretory medications. RESULTS: The final study population consisted of 48 patients (fundoplication [n = 29] and magnetic sphincter augmentation [n = 19]). Of those patients, 87.5% were females and the mean age ± SD was 51.8 ± 14.5 years. At follow-up (mean ± SD, 16.8 ± 13.2 months), 87.5% of all patients achieved favorable outcomes. Patients with unfavorable outcomes had longer mean whole gut transit times (92.0 hours vs 55.7 hours; p = 0.024) and colonic transit times (78.6 hours vs 47.3 hours; p = 0.028), higher mean peak colonic pH (8.8 vs 8.15; p = 0.009), and higher mean antral motility indexes (310 vs 90.1; p = 0.050). CONCLUSIONS: This is the first study to demonstrate that objective colonic dysmotility leads to suboptimal outcomes after ARS. WMC testing can assist with preoperative risk assessment and counseling for patients seeking ARS.

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INTRODUCTION AND AIMS: The patency capsule is an effective diagnostic method for preventing video capsule retention in the small bowel during capsule endoscopy. The most frequently associated complication when using the patency capsule is symptomatic retention. The aim of the present study was to evaluate the effectiveness and safety of patency capsules administered to patients at a tertiary care hospital center. MATERIALS AND METHODS: A retrospective observational study was conducted that included all the patients with confirmed Crohn's disease that were administered a patency capsule, within the time frame of January 2019 and December 2020. PC diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value were evaluated, in relation to capsule endoscopy and double-balloon endoscopy findings. Complications associated with the patency capsule were also identified. RESULTS: Thirty patients were included, in whom the patency capsule had 83% sensitivity, 100% specificity, 100% positive predictive value, and 96% negative predictive value, with a diagnostic yield of 96.7%. There was one complication (3.3%) and it resolved spontaneously. CONCLUSIONS: The patency capsule is a safe and effective method for reducing video capsule retention during capsule endoscopy in patients with Crohn's disease.

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We report a clinical case from a patient with alcoholic cirrhosis who had chronic anemia and carried out several endoscopic studies without evidence of active bleeding, a complementary study with endoscopic capsule was requested to search for a source of bleeding. In the analysis of laboratory data, the presence of hypereosinophilia stands out in parallel. The images obtained in the video capsule study show geoparasites helminth-type. After parasite treatment, anemia improves and the absolute eosinophil count is normalized.

Reportamos el caso de un paciente cirrótico por alcohol con anemia crónica quien se realizó varios estudios endoscópicos sin evidencia de sangrado activo, por tal motivo se solicitó estudio complementario con cápsula endoscópica para búsqueda de fuente de sangrado. En el análisis de los datos de laboratorio paralelamente destaca la presencia de hipereosinofilia. Las imágenes obtenidas en el estudio de la video cápsula muestran varios geoparásitos de tipo helmintos. Posterior al tratamiento antiparasitario mejora la anemia y se normaliza el recuento absoluto de eosinófilos.

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Background and study aims: Small-bowel capsule endoscopy (SBCE) is a safe and efficient method for diagnosis of small-bowel diseases. Since its development, different models have appeared. The aim of this study was to analyze which of the different models of SBCE has the best diagnostic yield. Patients and methods: Extensive medical literature research was reviewed, using MESH terms, searching studies comparing different SBCE types. We analyzed the diagnostic yield of all the comparisons and when there were 2 or more studies that compared the same model of SBCEs, a meta-analysis was performed. Results: Ten eligible studies including 1065 SBCEs procedures were identified. The main indication was occult gastrointestinal bleeding in 9/10 studies. Two of them included anemia, chronic diarrhea and/or chronic abdominal pain. The indication in one article was celiac disease. In 9 studies, different types of SBCEs (MiroCam, Endocapsule, OMOM and CapsoCam) were compared with PillCam (SB, SB2 and SB3). Three studies compared MiroCam vs PillCam and CapsoCam vs PillCam, while two studies contrast Endocapsule vs PillCam. None of the SBCEs show superiority over PillCam [OR 0.78 (95%CI;0.60-1.01)]. One study compared SBCEs other than Pillcam (MiroCam vs Endocapsule). Nine studies did not find statistical differences between SBCEs, one showed better diagnostic yield of Mirocam compared with PillCam SB3 (p=0.02). The difference between these SBCE was not replayed in the metaanalysis [OR 0.77 (95%CI;0.49-1.21)]. Conclusions: Despite the appearance of new SBCE models, there are no differences in diagnostic yield; therefore, SBCE endoscopist's performance should be based on experience and availability.

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BACKGROUND: Capsule endoscopy is a gold standard diagnostic method for small bowel lesions. There is scarce evidence regarding vari- ables that may increase the odds of identifying small bowel lesions with this endoscopic method. The aim of this work is to describe variables associated with a higher probability of finding small bowel lesions on capsule endoscopy. METHODS: Cross-sectional study was performed using our Department's adult patients' capsule endoscopy database. The presence of any small bowel mucosal lesion was registered. Other variables were examined: age, gender, reason for referral, quality of bowel cleans- ing, and intestinal transit time. These variables were compared between those patients showing at least 1 lesion versus those without lesions. Univariate and multivariate analysis was performed to determine variables significantly associated with the presence of bowel lesions. RESULTS: In total, 140 studies were analyzed; 90% were performed due to occult gastrointestinal bleeding. Median age was 69 years (60-75); 54.29% were males. Bowel cleansing was adequate in 94.29%; 68.57% showed at least 1 lesion. Non-significant difference was observed in terms of age between groups of comparison (70 [61-76] vs 63 [59-74], P = .07). No difference was found comparing bowel cleansing, gender, or reason for referral. Intestinal transit time was significantly longer among those patients with a bowel lesion (359 minutes [257-427] vs 279 minutes [200-333], P = .05). On multivariate analysis, age and intestinal time were significantly associ- ated with the presence of at least one small bowel lesion (odds ratio 1.02 [1-1.06] and 1.09 [1.03-1.12], respectively). CONCLUSION: Age and intestinal transit time were significantly associated with the presence of abnormal findings on capsule endoscopy.

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Clinical case of a patient who underwent small bowel examination with endoscopic capsule which was never recovered and two years later presented with dysphagia and was found with the capsule inside a Zenker´s diverticulum.

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