Liver cirrhosis is often complicated by an immunological imbalance known as cirrhosis-associated immune dysfunction. This study aimed to investigate disturbances in circulating monocytes and dendritic cells in patients with acute decompensation (AD) of cirrhosis. The sample included 39 adult cirrhotic patients hospitalized for AD, 29 patients with stable cirrhosis (SC), and 30 healthy controls (CTR). Flow cytometry was used to analyze monocyte and dendritic cell subsets in whole blood and quantify cytokines in plasma samples. Cirrhotic groups showed higher frequencies of intermediate monocytes (iMo) than CTR. AD patients had lower percentages of nonclassical monocytes than CTR and SC. Cirrhotic patients had a profound reduction in absolute and relative dendritic cell numbers compared with CTR and showed higher plasmacytoid/classical dendritic cell ratios. Increased plasma levels of IL-6, IL-10, and IL-17A, elevated percentages of CD62L+ monocytes, and reduced HLA-DR expression on classical monocytes (cMo) were also observed in cirrhotic patients. Patients with more advanced liver disease showed increased cMo and reduced tissue macrophages (TiMas) frequencies. It was found that cMo percentages greater than 90.0% within the monocyte compartment and iMo and TiMas percentages lower than 5.7% and 8.6%, respectively, were associated with increased 90-day mortality. Monocytes and dendritic cells are deeply altered in cirrhotic patients, and subset profiles differ between stable and advanced liver disease. High cMo and low TiMas frequencies may be useful biomarkers of disease severity and mortality in liver cirrhosis.

DESCRITORES -Inibidores da bomba de prótons. Mucosa gástrica. Pólipos. ABSTRACT -Background -The medications most often prescribed and used chronically by patients with dyspeptic symptoms belong to the group of inhibitors of proton pump whose main representative is omeprazole, used clinically about 20 years. Recent studies have postulated the relationship between chronic use of this medication and macroscopic and microscopic proliferative changes in mucosal of gastric body, especially the fundic gland polyps. Aim -To analyze the frequency and type of gastric proliferative changes in chronic users of proton pump inhibitors proton and its association with age, dose, time of use, symptoms and Helicobacter pylori infection. Methods -A survey of prevalence was conducted in Digestive Endoscopy Service, Hospital de Clínicas, Federal University of Paraná, using questionnaire referring the use of these drugs and performed in subjects using this class of drugs during at least 12 months prior to the endoscopy. Gastric biopsies of fundus, body and antrum were performed in all patients. Polyps were removed when present for histopathological analysis. Research on Helicobacter pylori was done by urease test and histopathology. RESUMO -RacionalResults -Twenty-two individuals were included of which six (27.3%) had proliferative changes of the mucosa. Of these, two (9.1%) had sporadic fundic polyps and four only microscopic proliferative change as cystic glandular formation. Statistic significant (p <0.05) association between age ≥ 60 years and these changes was found. There was no association between dose of use, time of use, symptoms and Helicobacter pylori infection. Conclusions -It was observed the existence of proliferative mucosa changes in individuals with chronic use of inhibitors of proton pump. In this group, the association between age and proliferative changes was significant.

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Background Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients, as public reimbursement is relatively recent. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian UC patients, and evaluate possible factors associated with remission after 1 year of treatment. Methods A national retrospective multicenter study (24 centers) was carried out including patients with moderate-to-severe UC treated with anti-TNF therapy. Disease activity was categorized using Mayo score at baseline, weeks 8, 26 and 52. Clinical remission was defined as a partial Mayo score ≤ 2. Endoscopic remission was defined as a Mayo endoscopic subscore ≤ 1. Patients were allocated in 2 groups (ADA and IFX) and a comparative efficacy study was performed. Statistical analysis: logistic regression model was used to study effects of predictor variables on categorical outcomes, such as presence or absence of remission at week 52. Statistical significance was assumed if p &lt;0.05. Results Overall, 393 patients were included (111 ADA and 282 IFX). The mean age was 41.86 ± 13.60 y, 61.58% women, most patients had extensive colitis (62.40%) and 19.39% previous exposure to biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65 %, p &lt;0.0001) and 52 (65.24% vs. 51.35%, p &lt;0.0001) – figure 1. Overall, endoscopic remission was observed in 50% of patients at week 26 and in 65.98% at week 52, with no difference between the two groups (p = 0.114). Colectomy was performed in 23 patients (5.99%). The variables associated with clinical remission after 1 year of treatment were age, non-prior exposure to biological therapy, use of IFX, endoscopic remission at week 26 and no need for optimization (table 1). The variables associated with endoscopic remission after 1 year were non-prior exposure to biological therapy, clinical and endoscopic remission at week 26 and no need for optimization. Conclusion In this national multicentric study, overall efficacy of anti-TNF therapy was similar to real world data with IFX and ADA. IFX treatment was associated with higher rates of clinical remission after 1 year in comparison to ADA. Patients naive to biological therapy presented higher rates of clinical and endoscopic remission. This is the first real world national study analyzing efficacy of anti-TNF agents in UC in Brazil.

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