domingo, 29 de julho de 2018

Uso de omeprazol associado ao aumento do risco de síndrome metabólica e gordura no fígado em Celíacos

Inibidores da bomba de prótons como fator de risco para síndrome metabólica e esteatose hepática em pacientes com doença celíaca em dieta isenta de glúten


Nicola Imperatore, Raffaella Tortora, Anna Testa, Nicolò Gerbino, Nicola Caporaso, Antonio Rispo

Journal of Gastroenterology
Abril de 2018, Volume 53, edição 4 , pp 507-516

Tradução: Google | Adaptação: Raquel Benati


RESUMO

Pesquisas recentes mostraram que pacientes com doença celíaca (DC) correm o risco de desenvolver síndrome metabólica (SM) e esteatose hepática (EH) após o início de uma dieta isenta de glúten (DIG). Este estudo teve como objetivo avaliar os fatores preditivos para SM e EH em DC após 1 ano de DIG.

Métodos
Foram incluídos pacientes com diagnóstico recente de DC. Coletamos prospectivamente dados sobre o IMC; circunferência da cintura; pressão sanguínea; colesterol; triglicerídeos, glicose e insulina no sangue; resistência à insulina (através da avaliação do modelo homeostático HOMA-IR) e tratamento com inibidores da bomba de prótons (IBP). O diagnóstico da SM foi feito de acordo com as diretrizes atuais e a EH foi diagnosticada por ultrassonografia. A prevalência de SM e EH foi reavaliada após 1 ano de DIG. Uma análise de regressão logística foi realizada para identificar os fatores de risco para a ocorrência de SM e EH após 1 ano de DIG.

Resultados
Dos 301 pacientes com diagnóstico recente de DC, 4,3% preencheram os critérios para o diagnóstico de SM e 25,9% apresentaram EH no momento do diagnóstico de DC; 99 indivíduos (32,8%) tiveram exposição a longo prazo ao IBP durante o período do estudo. Após 1 ano, 72 (23,9%) pacientes desenvolveram SM (4,3 vs 23,9%; p  <0,001, OR 6,9) e 112 (37,2%) desenvolveram EH (25,9 vs 37,2%; p  <0,01, OR 1,69). 

Na análise multivariada:
  •  IMC elevado no momento do diagnóstico (OR 10,8; p  <0,001) e exposição ao IBP (OR 22,9; p  <0,001) foram os únicos fatores associados à ocorrência de Síndrome Metabólica; 
  • HOMA-IR (OR 9,7; p  <0,001) e exposição ao IBP (OR 9,2; p  <0,001) foram os únicos fatores associados à ocorrência de Esteatose Hepática.
Conclusões
A exposição à Inibidores da Bomba de Protons (IBP) acrescenta maior risco de ocorrência de Síndrome Metabólica e Esteatose Hepática para pacientes com Doença Celíaca na dieta isenta de glúten. O uso de IBP em pacientes celíacos em dieta sem glúten deve ser limitado a indicações estritas.


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