Clinical and Prognostic Factors Associated With Inflammatory Bowel Disease in a Highly Admixed Population With Primary Sclerosing Cholangitis Mateus Jorge Nardelli, Guilherme Grossi Lopes Cançado, Luísa Leite Barros, Diogo Delgado Dotta, Luciana Costa Faria, et al. Journal of Clinical Gastroenterology, 2025 Goals: To investigate the prevalence of inflammatory bowel disease (IBD) in a cohort of Brazilian patients with primary sclerosing cholangitis (PSC) and evaluate clinical and prognostic factors associated with concomitant IBD. Background: IBD is reported worldwide in 62% to 81% of patients with PSC, especially in males and north Europeans. Little is known about the association of IBD and PSC in population from multigenetic ethnic origin. Study: Data of PSC patients from the Brazilian Cholestasis Study Group database were retrospectively reviewed to compare demographic, clinical, laboratory, and transplant-free survival between those with and without IBD. Results: After exclusion of 59 (14%) participants with overlap syndrome with autoimmune hepatitis, 359 individuals with PSC were included {56% male, median age 44 [interquartile range (IQR): 33 to 54] y}. IBD was investigated in 298 (83%) participants and diagnosed in 217 (73%), including ulcerative colitis (83%), Crohn’s disease (13%), and indeterminate colitis (4%). Male sex frequency was similar in patients with and without IBD (58% vs. 47%, P=0.073). IBD was more frequently diagnosed in patients without obesity (P=0.035), positive for antinuclear antibody (P=0.006), and positive for anti-smooth muscle antibody (P=0.046). IBD diagnosis occurred before, concomitant, or after PSC diagnosis in 59%, 22%, and 19% of cases, respectively. IBD was more frequently diagnosed before PSC in participants asymptomatic for liver disease (P=0.017), without advanced liver disease (P=0.017), before liver transplantation (LT) (P<0.001), and positive for antinuclear antibody (P=0.021). In a median follow-up of 69 months (IQR 31-124), LT occurred in 27.7% and cohort mortality was 11.4%. IBD was neither associated with the combined outcome of death or LT (P=0.745) nor with transplant-free survival (P=0.902). Conclusions: In Brazilian PSC patients, IBD frequency was similar to that reported in other populations but exhibited a balanced proportion between males and females. IBD diagnosis occurred before PSC in most patients, especially those without advanced liver disease. IBD presence was not associated with worse PSC prognosis.
Recurrence of Primary Sclerosing Cholangitis and De Novo Cholangiocarcinoma After Liver Transplantation: Results From the Brazilian Cholestasis Consortium Paulo Lisboa Bittencourt, Mateus Jorge Nardelli, Luísa Leite Barros, Guilherme Grossi Lopes Cançado, Eduardo Luiz Rachid Cançado, et al. Clinical Transplantation, 2024 Background and AimPrimary sclerosing cholangitis (PSC) has been shown to recur after liver transplantation (LT). Some studies have identified certain clinical and laboratory variables associated with an increased risk for recurrent PSC (rPSC) in Caucasians. Furthermore, de novo cholangiocarcinoma (CCA) has been reported anecdotally in patients with rPSC. This study aims to assess the prevalence of rPSC, identify its associated risk factors, and investigate the occurrence of de novo CCA in a highly admixed population from Brazil.MethodsAll patients submitted to LT for PSC enrolled in the Brazilian Cholestasis Study Group database were retrospectively reviewed for the occurrence of rPSC and de novo CCA.ResultsNinety‐six (58 males, mean age 32 ± 13 years) patients with PSC underwent LT. After 90 (39–154) months of follow‐up (FU), rPSC was observed in 29 (30%) subjects. There were no significant associations between rPSC and age, gender, concurrent or de novo inflammatory bowel disease, MELD score at the time of LT or allograft rejection. The only factor associated with an increased risk of disease recurrence was time after LT. Although survival was decreased in patients who developed rPSC, this difference was not significant. Only one female patient developed de novo CCA after rPSC, 11 years after LT.ConclusionsRecurrent PSC was observed in one‐third of PSC LT patients in Brazil and was associated with longer time after LT. Despite its frequency, rPSC was not associated with a higher risk of graft loss or a significant reduction in posttransplant survival.
A new and simple score to predict adequate and deep response to ursodeoxycholic acid in patients with primary biliary cholangitis: the ALP-A score Guilherme Grossi Lopes Cançado, Nathalia Mota de Faria Gomes, Cláudia Alves Couto, Eduardo Luiz Rachid Cançado, Debora Raquel Benedita Terrabuio, et al. European Journal of Gastroenterology and Hepatology, 2024 Background Ursodeoxycholic acid (UDCA) is the standard treatment for primary biliary cholangitis (PBC), but a significant proportion of patients do not respond adequately, leading to increased risk of adverse outcomes. This study aims to develop a new and straightforward predictive score to identify PBC patients likely to achieve a complete response to UDCA. Methods A logistic regression analysis was conducted using a derivation cohort of PBC patients to identify pre-treatment variables associated with response to UDCA. This analysis led to the development of the ALP-A score, calculated as: Age at diagnosis divided by (alkaline phosphatase at diagnosis/upper limit of normal). ALP-A score accuracy was evaluated using the area under the ROC curve, validated with a large external cohort from Brazil. Additionally, the correlation between the ALP-A score and the previously validated UDCA response score (URS) was assessed. Results ALP-A score had good predictive power for adequate (AUC 0.794; 95% CI, 0.737–0.852) and deep (0.76; 95% CI, 0.69–0.83) UDCA response at 1 year of treatment. A cutoff score of 17 and 23 points was determined to be the optimal threshold for distinguishing adequate and deep responders, respectively, from non-responders. ALP-A score demonstrated a sensitivity of 73%, specificity of 71%, positive predictive value of 65%, negative predictive value of 78%, and overall accuracy of 72% for biochemical response. The URS displayed similar discriminative ability (AUC 0.798; 95% CI, 0.741–0.855). Conclusion ALP-A score performs comparably to URS but offers the great advantage of simplicity for routine clinical use. It serves as a valuable tool to identify PBC patients less likely to respond to UDCA treatment, facilitating early consideration of alternative therapeutic approaches.
Comparing diabetes prediction based on metabolic dysfunction-associated steatotic liver disease and nonalcoholic fatty liver disease: the ELSA-Brasil study Gabriela Wünsch Lopes, Scheine Leite Canhada, Rodrigo Citton Padilha dos Reis, Maria de Fátima Haueisen Sander Diniz, Alessandra Carvalho Goulart, et al. Cadernos De Saude Publica, 2024 We aimed to compare nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) definitions concerning diabetes prediction in a large sample of Brazilian adults. As a secondary objective, we compared associations between NAFLD/MASLD and diabetes across self-declared race/skin color groups. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study of Brazilian civil servants (35-74 years) enrolled from 2008 to 2010 and followed up from 2012-2014 and 2017-2019. We ascertained type 2 diabetes mellitus at baseline as well as follow-up visits based on self-reported diagnosis, medication use, and glycemic tests (fasting and 2h post-OGTT glucose and HbA1c). We excluded individuals with heavy alcohol consumption or self-reported cirrhosis/hepatitis. We analyzed 7,073 subjects. NAFLD was defined by ultrasound-based steatosis. Participants with steatosis and at least one cardiometabolic factor were considered as having MASLD. Cox proportional hazards models were performed to evaluate the association between NAFLD/MASLD and the incidence of type 2 diabetes mellitus. At baseline, 33.9% of individuals presented NAFLD and 32.5% presented MASLD. Over 9.4 years of follow-up, the relative increase in the incidence of diabetes was 78% for NAFLD (HR = 1.78; 95%CI: 1.58-2.01) and 88% for MASLD (HR = 1.88; 95%CI: 1.67-2.12). Associations did not differ significantly among race/skin color groups (p for interaction = 0.10 for MASLD and 0.08 for NAFLD). In this large cohort of middle-aged and older Brazilian adults, the relative incidence of diabetes was similar for NAFLD and MASLD definitions, with similar associations in all ethnic groups.
The microbiome and metabolome in nonalcoholic fatty liver disease Silvia M. Ferolla, Cláudia A. Couto, Maria de Lourdes A. Ferrari, Luciana Costa Faria, Murilo Pereira, et al. Microbiome and Metabolome in Diagnosis Therapy and Other Strategic Applications, 2019
MRSA outbreak at a transplantation unit R.M.C. Romanelli, W.T. Clemente, S.S.S. Lima, E.M. Rezende, G.H. Martinho, et al. Brazilian Journal of Infectious Diseases, 2010