RESUMO
New oncologic treatments, particularly immunotherapy (IT), have revolutionized the treatment of advanced-stage malignant tumors. Immune checkpoint inhibitors are the main form of IT and act by increasing T cell activity and the organism's immune response against neoplastic cells. Targeted therapy is another form of IT that acts by inhibiting oncogenes or inflammation signaling and tumor angiogenesis pathways. However, these mechanisms of tumor destruction can interfere with the host's immune self-tolerance or with the mechanisms of epithelial tissue repair and predispose to immune system-mediated adverse events that can affect multiple organs, including the digestive tract. The gastrointestinal manifestations of damage caused by IT can range from low-grade mucositis to ulceration, and in some cases, necrosis and perforation. Any part of the gastrointestinal tract can be affected, but there is greater involvement of the small bowel and colon, with a pattern similar to that seen in inflammatory bowel disease. The most common clinical manifestation is chronic diarrhea. The differential diagnosis includes enteropathogenic infections, especially those caused by opportunistic microorganisms; adverse drug reactions; and other inflammatory and malabsorption disorders. Treatment is guided by damage severity. Mild cases can be treated with antidiarrheals and rehydration in the outpatient setting; moderate cases with hospitalization, systemic steroids, and temporary suspension of IT; and severe cases with immunosuppressants or biologic agents and definitive suspension of IT.
Assuntos
Enterocolite , Gastroenterologistas , Neoplasias , Humanos , Neoplasias/etiologia , Imunoterapia/efeitos adversos , Enterocolite/etiologiaRESUMO
â¢Diagnosis of microscopic colitis necessitates effective communication among gastroenterologists, endoscopists, and pathologists. â¢The gastroenterologist should refer every patient with chronic watery diarrhea to perform a colonoscopy in spite of the benign course of the disease and the absence of alarm symptoms. â¢The endoscopist should take 2 or 3 biopsy samples of the colonic mucosa from the right and left colon, put in separate recipients, despite that the mucosa looked macroscopically normal. â¢The pathologist should be encouraged to use objective histological criteria to make the diagnosis. Microscopic colitis is a chronic inflammatory bowel disease characterized by non-bloody diarrhea that can range from mild to severe. It is difficult to attribute up to 10-20% of chronic diarrhea to microscopic colitis. The three determinants factors of the diagnosis are characteristic clinical symptoms, normal endoscopic picture of the colon, and pathognomonic histological picture. This manuscript aimed to update considerations and recommendations for professionals involved (gastroenterologist, endoscopists and pathologist) in the diagnosis of MC. In addition, a short recommendation about treatment.
Assuntos
Colite Microscópica , Colite , Gastroenterologistas , Humanos , Patologistas , Biópsia , Colite Microscópica/diagnóstico , Colite Microscópica/tratamento farmacológico , Colite Microscópica/patologia , Colo , Colonoscopia , DiarreiaRESUMO
Our objective was to determine whether the clinical focus of gastroenterology practice would affect screening colonoscopy quality metrics, specifically adenoma detection (AD). In a retrospective study of screening colonoscopies, gastroenterologists were categorized based on their clinical subspecialty focus into general/motility, hepatology, inflammatory bowel disease (IBD), and interventional endoscopy. The primary outcome was AD with a secondary outcome of adenoma and/or sessile serrated polyp (SSP) detection (ADâ +â SSP). A total of 5271 (male: 49.1%) complete colonoscopies were performed between 2010 and 2020 by 16 gastroenterologists (male: 62.5%, general/motility specialists: 3, hepatologists: 3, IBD specialists: 4, interventional endoscopists: 6). The AD and ADâ +â SSP rate between each specialty focus were 27.5% and 31.0% for general/motility, 31.4% and 35.5% for hepatology, 38.4% and 43.6% for IBD, and 37.5% and 43.2% for interventional endoscopy. In regression analysis, patient's male gender (odds ratios [OR]: 1.81, 95% CI: 1.60-2.05, Pâ <â .001), longer withdrawal time (OR: 1.16, 95% CI: 1.14-1.18, Pâ <â .001), hepatologist (OR: 1.25, 95% CI: 1.02-1.53, Pâ =â .029), IBD subspecialist (OR: 1.60, 95% CI: 1.30-1.98, Pâ <â .001), and interventional endoscopist (OR: 1.36, 95% CI: 1.13-1.64, Pâ <â .001) were independently associated with AD. Moreover, patient's male gender (OR: 1.64, 95% CI: 1.45-1.85, Pâ <â .001), acceptable bowel preparation (OR: 1.29, 95% CI: 1.06-1.56, Pâ =â .010), withdrawal time (1.20, 95% CI: 1.18-1.22, Pâ <â .001), hepatologist (OR: 1.30, 95% CI: 1.07-1.59, Pâ =â .008), IBD subspecialist (OR: 1.72, 95% CI: 1.39-2.12, Pâ <â .001), interventional endoscopist (OR: 1.44, 95% CI: 1.20-1.72, Pâ <â .001) were independent factors that improved detection of ADâ +â SSP. Subspecialty focus of practice was an important factor in AD rate along with the male gender of the patient, bowel preparation, and withdrawal time.
Assuntos
Adenoma , Pólipos do Colo , Neoplasias Colorretais , Gastroenterologistas , Humanos , Masculino , Pólipos do Colo/diagnóstico , Estudos Retrospectivos , Colonoscopia , Adenoma/diagnóstico , Neoplasias Colorretais/diagnósticoRESUMO
Abstract Rectal cancer is the third most frequent cancer in Colombia and constitutes a diagnostic and therapeutic challenge for gastroenterologists, surgeons, and oncologists. Diagnostic evaluation and the study of its locoregional and systemic extension have been modified by new imaging methods, enabling an accurate view of anatomical structures that could not be easily examined before. The availability of these new tools in disease staging has significantly impacted therapeutic decisions and the choice of a specific treatment path for each patient, rationalizing the use of neoadjuvant therapies and the performance of surgery with correct anatomical criteria. The preceding has been essential to achieving the best outcomes with the least associated postoperative morbidity. This article will review and explain in detail the most recent changes and up-to-date recommendations for managing rectal cancer.
Resumen El cáncer de recto es el tercer cáncer en frecuencia en Colombia, y constituye un reto diagnóstico y terapéutico para gastroenterólogos, cirujanos y oncólogos. La evaluación diagnóstica y el estudio de su extensión locorregional y sistémica se han modificado por nuevos métodos de imagen, que permiten una visualización precisa de estructuras anatómicas que antes no se podían evaluar fácilmente. La disponibilidad de estas nuevas herramientas en la estadificación de la enfermedad ha tenido un gran impacto en las decisiones terapéuticas y en la escogencia de una ruta de tratamiento específica para cada paciente, lo que ha racionalizado el uso de terapias neoadyuvantes y la realización de cirugía con criterios anatómicos correctos. Esto ha sido fundamental en el objetivo de lograr los mejores desenlaces con la menor morbilidad posoperatoria asociada. En este artículo se revisarán y explicarán en detalle cuáles han sido los cambios más recientes y las recomendaciones más actualizadas para el manejo del cáncer de recto.