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Conflict of interest: No Introduction and Objectives: The term “recompensation” of cirrhosis was proposed in the latest BAVENO VII, underlying dynamic events and prognosis in cirrhosis. However, there is uncertainty regarding its prognosis in patients with advanced hepatocellular carcinoma (HCC) treated with first line systemic therapies (1L). We aimed to compare post-1L survival between compensated (CC), decompensated (DC), and recompensated (RC) cirrhosis. Patients / Materials and Methods: A multicenter prospective Latin-American cohort study including advanced HCC patients with cirrhosis who received any 1L was conducted from 2018 to 2024. Three groups were defined: CC (had never presented decompensation); DC (presenting any decompensated event associated with portal hypertension at time of 1L), and RC group (prior history of any decompensation event at HCC diagnosis who were compensated at time of 1L). Survival since date of 1L was compared using Cox proportional hazard analysis. Results and Discussion: Overall, 306 patients received 1L, including sorafenib 60.5%, atezolizumab + bevacizumab 29.7%, lenvatinib 9.1%, and nivo/pembrolizumab 0.6%. Of these, 83.3% presented cirrhosis. Median 1L treatment duration was 5.1 months with a median overall survival since 1L of 16.0 months (range 12.9-18.3). Significant differences were observed between CC (n=167), DC (n=31) and RC (n=42) groups (Table). In the RC group, median time from decompensation to recompensation was 12.0 months (range 1.9-25.9); being ascites the most frequent event (78.6%). DC group presented decreased post-1L survival [median 8.6 months vs 17.2 months in CC [adjusted HR 1.9 (95% CI 1.05-3.5); P=0.03], while no significant survival difference was observed between RC and CC [median survival 12.5 months; aHR 1.3 (95% CI 0.81-2.1); P=0.28] (Figure). Lower access to second line therapy was observed in DC group. Conclusions: Patients with cirrhosis and advanced HCC who achieve recompensation may benefit from systemic therapies. This demands an observation period of follow up before precluding 1L in decompensated cirrhosis.

Conflict of interest: No Introduction and Objectives: Background: Severe alcohol-associated hepatitis (AH) is considered a common precipitant of acute-on-chronic liver failure (ACLF). This study aims to characterize the association between AH and ACLF, focusing on mortality across different ACLF grades. Patients / Materials and Methods: Multicenter prospective cohort study. We included patients admitted with severe AH between 2015–2022. The main outcome was mortality by ACLF grade during admission. The analysis included survival analysis using Cox regression. We adjusted multivariable models based on the main predictors of mortality observed in prior studies. Results and Discussion: We prospectively included 646 patients from 24 centers and 8 countries. Age 49.9±11.7 years, 85.1% of men and 64.4% had a previous diagnosis of cirrhosis. Median MELD at admission was 25 [20-31] points, 46.5% of patients were treated with corticosteroids, and only 2.2% underwent liver transplantation (LT). Around 67.4% of patients fulfilled ACLF criteria: 10.1% grade 1, 19.2% grade 2, and 38.1% grade 3. The most frequent organ dysfunctions were 76.2% liver, 40.8% brain, 43.2% coagulation, 29.6% renal, 29.4% circulatory, and 18.9% lung failure. Survival at 180 days was 77.8% (95%CI: 72.1-82.6%) in those without ACLF grade 3 and 28.0% (95%CI: 20.5–36.0%) in those with ACLF grade 3 (p

Conflict of interest: No Introduction and Objectives: The 2024 WHO guidelines for chronic hepatitis B (CHB) aim to expand and simplify treatment eligibility, but these criteria have not been assessed. We aimed to estimate treatment eligibility and uptake according to country-specific guidelines and evaluate potential treatment expansion based on the WHO guidelines. Patients / Materials and Methods: This cross-sectional study included consecutive treatment-naïve CHB patients from Argentina, Brazil, Chile, and Uruguay who were referred for the first time to hepatology evaluation between January 2010 and June 2024. Treatment candidacy was evaluated according to both country-specific and WHO guidelines. We then estimated the difference in treatment candidacy between these two approaches. Results and Discussion: A total of 719 patients with CHB had complete data available to evaluate treatment candidacy according to both guidelines. Of these patients, 67% were male with a median age of 52 years (IQR 38-62), and 8.1% presented with liver decompensation. Among patients, 64% were HBeAg-negative, median HBV DNA level was 43,000 IU/ml (IQR 633-110,000,000 IU/ml), median ALT was 41 U/L (IQR 23-99 U/L), and 47% had an APRI >0.5. According to country-specific guidelines, 57% (95% CI: 53-60) met criteria for treatment. Antiviral treatment was initiated in 84% of eligible patients, primarily with entecavir (63%) and tenofovir (32%). Compared to country-specific guidelines, the proportion of patients meeting treatment criteria under the WHO guidelines increased to 67% (95% CI: 63.8-70.6), resulting in a 10% (95% CI: 8-13) increase in treatment candidacy (table). Treatment expansion was higher in women (15%; 95% CI: 10-20) than in men (8%; 95% CI: 5-11). Conclusions: According to WHO guidelines, a considerable proportion of CHB patients who do not meet country-specific criteria are eligible for antiviral therapy. Notably, treatment expansion is higher in women. Implementing WHO criteria can enhance treatment rates and advance efforts toward CHB elimination.

Conflict of interest: No Introduction and Objectives: Aminoglycosides are a group of broad-spectrum antibiotics, which have action especially against gram-negative bacteria. It is associated with nephrotoxicity in 10-20% of cases, a figure that increases in patients with liver cirrhosis. Amikacin is frequently used in sepsis, with little information about the risk of nephrotoxicity in cirrhosis. The aim was to determine the association between amikacin use and renal function deterioration in patients with liver cirrhosis and sepsis. Patients / Materials and Methods: Retrospective, observational, analytical study in patients with liver cirrhosis of any etiology, who required hospitalization for sepsis between 2017 and 2023, and who received antibiotic therapy. An increase in serum creatinine ≥ 0.3 mg/dl in the first 7 days of hospitalization was used as a marker of renal function deterioration. Clinical variables, renal failure and mortality were compared between patients who received amikacin and those who did not. Stata 13.0 was used for data analysis with a statistical significance of 0.05. Results and Discussion: In this study 228 patients were included, median age 65 years (54-70), 100 (44%) women, 70 received amikacin (31%). Renal function deterioration was present in 25 (36%) patients with amikacin and 33 (21%) without amikacin. In patients with initial serum creatinine > 2.0 mg/dl and in those with Child-Pugh C cirrhosis, the probability of developing renal function deterioration was higher in those who received Amikacin (OR 7.5; 95% CI 1.1 – 48.0, p= 0.031 and OR 2.51; 95% CI 1.06 – 5.97, p = 0.036, respectively). A comparative table of different subgroups is attached. Conclusions: The use of amikacin was associated with renal function deterioration in patients with liver cirrhosis and sepsis, mainly in Child-Pugh C cirrhosis and with initial serum creatinine > 2.0 mg/dl.

Conflict of interest: No Introduction and Objectives: The prevalence of fatty liver disease associated with metabolic dysfunction (MASLD) has been increasing. Its most advanced stage is F3-F4 fibrosis with eventual decompensation and the need for liver transplantation. The aim was to identify the factors associated with advanced fibrosis as observed by liver elastography (Fibroscan®) in patients with MASLD and in a subgroup of patients with diabetes mellitus (DM). Patients / Materials and Methods: Retrospective, descriptive study of patients with MASLD who underwent Fibroscan® in our center between October 2023 and June 2024. Patients were categorized into 2 groups: without advanced fibrosis (F0-F2) and with advanced fibrosis (F3-F4). Sociodemographic variables, clinical and laboratory history were analyzed between groups, using chi2 and Mann-Whitney in Stata 16.0 software. Results and Discussion: Of 1297 Fibroscan® performed in the study period, 577 (44%) patients met MASLD criteria for analysis; 62% women, median age 58 years (interquartile range 48 – 66); Advanced fibrosis was presented in 132 (33%) patients. The table compares the sociodemographic and clinical characteristics of the patients according to the degree of fibrosis. Older age, Fonasa health insurance, hypertension, diabetes mellitus, obesity, higher level of glycosylated hemoglobin and higher CAP (Coefficient Attenuated Parameter) were associated with advanced fibrosis. A sub-analysis was carried out in patients with MASLD and DM (n = 151), observing that Fonasa health insurance (65% vs 47%; p=0.032) and obesity (67% vs 43%; p=0.004) were associated with advanced fibrosis. Conclusions: In patients with MASLD who present cardio metabolic risk factors such as older age, hypertension, diabetes mellitus, and obesity, the presence of advanced fibrosis should be evaluated to prevent associated complications.

Conflict of interest: No Introduction and Objectives: Liver transplantation is the only curative procedure for liver cirrhosis, where pharmacotherapeutic factors are crucial to avoid complications. Transplant rejection is an adverse event that endangers the transplanted organ and the patient's life. Objective: To determine the clinical, pharmacotherapeutic, and morbid factors associated with rejection and mortality in patients during the first year after orthotopic liver transplantation. Patients / Materials and Methods: Retrospective cohort study in patients who underwent liver transplantation at the Clinical Hospital of the University of Chile from August 2019 to August 2022, with at least one year of post-transplant follow-up. The days until rejection (confirmed by biopsy) and death were recorded to perform a survival analysis using Cox Proportional Hazards Regression. The effect magnitude of each associated factor was evaluated using Hazard Ratio (HR) and its 95% Confidence Interval (95% CI). Results and Discussion: During the study period, 63 patients underwent transplantation; 60% (38) were men, and the median age was 60 (IQR 52-63) years. The incidence of rejection was 43% (27), of which 11 (17%) were biopsy-confirmed, and 6% (4) of the patients died during the first year.Risk factors for biopsy-confirmed rejection included using analgesics before transplantation (HR: 8.7, 95% CI: 2.2 – 34.5) and the average prednisone dose in the first month (HR: 1.1, 95% CI: 1.02 – 1.18). Protective factors included age (HR: 0.96, 95% CI: 0.92 – 0.99), average tacrolimus dose (HR: 0.5, 95% CI: 0.38 – 0.71), and average mycophenolate dose (HR: 0.998, 95% CI: 0.996 – 0.999).Regarding mortality, the risk factor identified was the occurrence of re-transplantation (HR: 11.3, 95% CI: 1.16 – 109.3). Conclusions: Higher doses of tacrolimus and mycophenolate were associated with a lower risk of rejection, while higher doses of prednisone were associated with a higher risk of the event. Considering the factors that can predict the event would help optimize therapy and improve clinical outcomes.

Conflict of interest: Yes, Laboratorio Gador financió los tests rápidos. Introduction and Objectives: Hepatitis B (HBV) and C (HCV) viruses are one of the main causes of morbidity and mortality worldwide. Their epidemiology in Chile is not completely known, with an estimated prevalence of 0.034-0.15% for HBV and 0.1-0.19% for HCV. Although, in Chile, there is a wide coverage and availability of antiviral treatments, the main barrier to achieve the elimination of these viruses is the lack of knowledge of the serological condition. Objectives: To stablish the prevalence of HBV and HCV infection in the population at risk in Chile. Patients / Materials and Methods: Cross-sectional, multicenter study, with participation of 8 Chilean health centers. HBV/HCV rapid tests (CTK-BIOTECH) were applied in people aged 18 years-old or older with at least 1 risk factor. Demographic and clinical data were collected using REDCap®. Statistical analysis was performed using Stata 16.0 software. Results and Discussion: A total of 806 patients were included in the analysis, mean age was 44.6 ± 15.1 years and 53.6% were women. The main risk factors were: being in prison (22.5%), exposed health care personnel (16.9%) and obesity with steatotic liver disease (16.6%). Three patients tested positive for HBV and one patient had HBV/HCV coinfection. Seroprevalence of HBV and HCV infection was 0.49% and 0.12%, respectively. Two of the patients had coinfection with HIV. Serological confirmation to date was done in 3 of the 5 positive tests and confirmed the diagnosis in 3 of them (2 HBV and 1 HCV). Conclusions: In this preliminary study, the prevalence of HBV and HCV infection in the population at risk is low. Further patient recruitment is required to identify the population on which to focus screening efforts and other preventive public health measures.

Conflict of interest: No Introduction and Objectives: One of the primary challenges following liver transplantation is preventing graft rejection, for which immunosuppressive therapy is essential. The success of this therapy depends, among other factors, on patient adherence to the prescribed medication regimen. The aim was to evaluate adherence to immunosuppressive therapy and the possible factors associated to adherence in liver transplant patients. Patients / Materials and Methods: This is an analytical, observational, cross-sectional study conducted with liver transplant patients between 2004 and 2023 at Hospital Clínico Universidad de Chile. Participants were required to complete two self-administered questionnaires: the ''Simplified Medication Adherence Questionnaire'' (SMAQ) to assess adherence (classified as adherent or non-adherent) and the ''European Quality of Life-5 Dimensions'' (EQ-5D) to assess quality of life. Additionally, a form was used to collect sociodemographic and clinical data, supplemented with information from the hospital's medical records. All data were recorded using the REDCap® platform. Results and Discussion: The study included 29 patients with a median post-transplant follow-up of 37 months (range: 1 – 237 months). Of these patients, 41% (12 patients) were identified as non-adherent to immunosuppressive therapy, with occasional forgetfulness being the primary cause. Analysis revealed that younger patients, those with less comorbidity, and those with a longer time since transplantation were less adherent to the therapy. Tacrolimus was the most commonly used drug, and no significant differences in adherence were found based on the type of immunosuppressant used. Adherent patients reported a better quality of life compared to non-adherent patients. Conclusions: A significant proportion of liver transplant patients exhibit non-adherence to immunosuppressive therapy. Factors such as medication forgetfulness, time since transplantation, and the presence of chronic illnesses impact adherence. It is recommended to enhance patient-provider relationships, regularly assess adherence, and provide patient education to improve quality of life and minimize the risk of graft rejection.

Conflict of interest: No Introduction and Objectives: Infections are a frequent cause of decompensation in patients with liver cirrhosis (LC). Understanding local microbiology is important for the correct choice of antibiotics and achieving good clinical outcomes. Objective: To evaluate the microbiology of infections in patients with cirrhosis who were hospitalized in our institution between 2015 and 2022. Patients / Materials and Methods: A retrospective, observational, and analytical study of LC patients hospitalized for any reason between 2015 and 2022. Positive cultures in LC patients (1036 in total) were reviewed, focusing on blood cultures, ascitic fluid cultures, and other types (bronchial secretions, devices and pleural fluid). Urine cultures, non-infection-related episodes, and contamination cases were excluded. Clinical characteristics of patients in each episode, as well as antimicrobial resistance of each organism, were analyzed. STATA 13.0 was used for data analysis with significance set at < 0.05. Results and Discussion: A total of 494 episodes of positive cultures from 187 LC patients were included; median age was 61 years (20-81), with 62% male. In 41% of episodes, the patient was immunosuppressed, and 47% were on prophylactic antibiotics. Forty percent of cultures were blood cultures, 20% ascitic fluid, and 40% other types of cultures. The most frequently isolated microorganisms were Enterobacteriaceae and Gram-positive bacteria. Resistance to extended-spectrum beta-lactamases, Vancomycin, and carbapenemases was evaluated, with Vancomycin resistance being the most frequent, only evaluated in enterococci. Immunosuppression was significantly associated with antibiotic resistance (56% vs 25%; p=0.001), whereas prior use of prophylactic antibiotics did not show a significant association (40% in both groups). Conclusions: The results suggest the need for empirical therapies for our patients and emphasize the importance of rational antibiotic use.

Conflict of interest: No Introduction and Objectives: Milan criteria (MC) have been the standard for selecting candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC). New strategies including alpha-fetoprotein with tumor number and diameter, such as the French alpha-fetoprotein model (FM) and Metroticket2.0 (MT), improve prediction of recurrence and prognosis. Objectives:To compare these three tools in terms of survival and tumor recurrence. Patients / Materials and Methods: A cohort study of 79 LT patients with HCC (2006-2020). Patients were divided by MC: within (WMC) and outside (OMC). They were reclassified using FM into low risk (LRFM) and high risk (HRFM), and with Metroticket2.0: ≥75% 5 year survival (MT≥75) and

Conflict of interest: No Introduction and Objectives: Patients with cirrhosis and septic shock face a high mortality rate, reaching up to 40%. There is limited literature from Latin America on this condition and associated mortality variables. The aim was to describe mortality in patients with liver cirrhosis and septic shock and analyze the associated variables. Patients / Materials and Methods: A retrospective, observational, analytical study was conducted on patients with liver cirrhosis, who were diagnosed with septic shock, according to Sepsis-3 criteria, during their hospitalization in Hospital Clínico Universidad de Chile, between 2017 and 2023. A confidence level was set at 95% with a statistical significance of p = 0.05. Results and Discussion: A total of 68 patients with septic shock were included, with a mean age of 61 years; the majority were male (57%). The primary etiologies of cirrhosis were alcohol-related (31%) and metabolic-associated (27%). Most patients had a Child-Pugh score of B or C (95%). The 28-day mortality rate was 38%, and the one-year mortality rate was 54%. These patients experienced 74 episodes of septic shock. Of these, 61% were associated with healthcare-related infections, and in 47% a Gram-negative microorganism was identified. Significant variables associated with 28-day mortality included a history of hepatic encephalopathy, low platelet count at admission, elevated total bilirubin, and higher severity scores (SOFA, Meld-Na, CLIF-SOFA). One-year survival was significantly higher among patients who received a liver transplant (HR 0.11, 95% CI 0.01 – 0.86, p = 0.036) (Figure 1). Conclusions: Mortality among cirrhotic patients with septic shock in Chile is high and comparable to international cohorts. Liver transplantation reduces mortality in this patient group. Higher SOFA, Meld-Na, and CLIF-SOFA scores at admission are associated with increased mortality.

Introduction and Objectives: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at an increased cardiovascular risk. On the contrary, non-alcoholic fatty liver disease (NAFLD) is highly prevalent in patients with coronary heart disease (CHD). However, it is not known whether patients with significant CHD show a higher frequency of liver fibrosis. This study aimed to determine the frequency of MASLD and liver fibrosis in patients with CHD and to assess whether coronary stenosis is significantly associated with MASLD and fibrosis. Patients and Methods: This observational and analytical study included adult patients without any known liver disease who underwent coronary angiography for suspected coronary artery disease (Jul 2021–Jul 2022). The presence of significant CHD (> 50% stenosis of at least one coronary artery) was determined. Liver elastography (FibroScan®) was performed up to 6 months after the coronary angiographic study to determine liver fibrosis, a measurement of liver stiffness (> 6.5 Kpa). Fisher's test, Mann–Whitney U test, and logistic regression models were used (p < 0.05). Results: The study included 113 patients (76% men, average age: 63 years [standard deviation: 9.9]), of which 72% presented with significant CHD. The prevalence rate of MASLD was 52%. Liver fibrosis was present in 12% of the patients and all patients in the significant CHD group (p = 0.007). An increase in the number of vessels with significant CHD increased the probability of liver fibrosis (odds ratio, 1.79; 95% confidence interval, 1.06–3.04; p = 0.029). Conclusions: MASLD is highly prevalent in patients with significant CHD but without known liver damage. These data suggest that MASLD and liver fibrosis should be investigated in patients with CHD. The presence of confounding variables, especially the presence of type 2 diabetes mellitus, should be evaluated in further studies.

Introduction and Objectives: Patients with nonalcoholic fatty liver disease (NAFLD) are at increased cardiovascular risk, and there is a higher prevalence of this disease in patients with coronary heart disease (CHD). However, the evidence in favor of NAFLD as a risk factor for CHD is scarce. This study aimed to determine the prevalence of NAFLD in patients with CHD and to assess whether significant CHD is associated with NAFLD and liver fibrosis. Materials and Methods: Observational, analytical study in adult patients with coronary angiography for suspected coronary artery disease between July 2021-July 2022. The number of affected coronary vessels and the presence of significant CHD (stenosis >50%) were determined. In addition, FibroScan® was performed to evaluate steatosis and liver fibrosis up to 6 months after the coronary study, considering the presence of fibrosis at F>0. Descriptive statistics, Fisher's exact test and logistic regression models were reported for inferential analysis. Results: Ninety-seven patients were included, 73% male, age 63 ± 10 years (Table 1). 71% presented significant CHD, with 37% multivessel disease (2 or more). The prevalence of NAFLD was 38%, with no differences between those with and without CHD (43% vs. 36%, p=0.646). In turn, 16% of patients presented some degree of fibrosis, linearly associated with the number of vessels involved (OR=1.8, p=0.022), with an even higher risk in patients with two or more vessels involved (OR=3.5, p=0.027). Conclusions: There is a high prevalence of NAFLD in patients with CHD, with no differences between patients with significant stenosis vs not. Patients with multivessel disease have higher odd of presenting some degree of fibrosis. Although the presence of confounders should be evaluated in other studies, these data support the search for NAFLD and fibrosis in patients with CHD.

Introduction and Objectives: To achieve WHO's goal of eliminating HCV, innovative strategies must be designed to diagnose and treat more patients. This study aimed to describe an implementation strategy to identify patients with HCV who were lost to follow-up (LTFU) and offer them re-linkage to Figure 1. Analysis of global DNA methylation. A) Representative dot blot using anti-5mC which recognizes global methylated DNA, anti-IgG as negative control and methylene blue staining as total DNA loading control. B) Graphs shows mean ± standard deviation of 5mC densitometry brand intensity of study groups. C) Graph that represents the percentage of global methylation of the DNA analyzed with ELISA.A one-way ANOVA statistical test and a Tukey post hoc test were performed. Group NT: only received vehicle; Group HCC: damage group induced by weekly administration of DEN and 2-AAF for 12 weeks; and Group HCC/PFD: which received the same treatment as Group HCC, plus PFD (300 mg/kg) (**p

Introduction and Objectives: In chronic pathologies, such as cirrhosis, information is essential for disease acceptance, adherence to treatment and prevention of complications. This study aimed to determine whether written information in patients with cirrhosis has an effect on the level of knowledge and treatment adherence and to evaluate possible factors associated with disease-related knowledge in cirrhosis. Materials and Methods: Longitudinal, analytical study. Adult outpatients with cirrhosis were included in July-December 2021. Self-completed survey with demographic, clinical information, disease-related knowledge with ''Cirrhosis Knowledge Questionnaire'' (1 - 7 points) and treatment adherence with Morisky-Green-Levine scale (Low, Medium, High) were assessed. History of complications and hospitalizations in the last two years were obtained from clinical records. Patients were provided with an educational brochure and after four months, the disease-related knowledge and treatment adherence were re-evaluated. Comparative analysis was performed with T Student or ANOVA. Multiple linear regression models were assessed to identify possible associated factors (p < 0.05). Results: We included 104 patients, 53% men, the median age of 64 years, and 80% of them with middle or higher education. The most frequent etiologies of cirrhosis were alcohol (27%) and non-alcoholic steatohepatitis (26%). The median level of disease-related knowledge was 3 (RIC 2 - 5). Forty-three percent of the patients answered >50% of the answers correctly. Bivariate and multivariate analyses of the disease-related knowledge are described in Table 1. Disease-related knowledge levels increased after delivery of written information at the 4-month follow-up (3.21 vs. 3.96; p=0.0007), but treatment adherence did not. Conclusions: Less than half of the patients answered > 50% of disease-related knowledge correctly. Higher educational levels, history of hospitalization and complications due to cirrhosis were associated with a higher disease-related knowledge level score. The provision of written information is associated with an increase in disease-related knowledge levels in patients with cirrhosis.

Resumen: La enfermedad inflamatoria intestinal (EII), cuyos fenotipos más frecuentes son la enfermedad de Crohn (EC) y la colitis ulcerosa (CU), tiene una etiología multifactorial, que resulta de la interacción de factores genéticos, ambientales y del microbioma. Su incidencia ha aumentado en las últimas décadas, así como también lo ha hecho la occidentalización de la dieta: alta en grasas, carbohidratos refinados, azúcar, carnes rojas y alimentos procesados. Una dieta occidental es considerada como factor de riesgo para el desarrollo de EII, ya que está asociada a disbiosis, alteración de la barrera intestinal y de la inmunidad del huésped. Existen diversas dietas de eliminación que podrían ejercer un rol en la inducción/mantención de la remisión. Sin embargo, la mayoría requiere estudios de mejor calidad científica para poder recomendarlas. A su vez, existen suplementos nutricionales que estarían asociados a la incidencia y curso de la enfermedad. El objetivo de esta revisión es mostrar el posible rol de la dieta en la incidencia de la EII, y las estrategias dieto-terapéuticas, incluyendo suplementos específicos y nutrición enteral, considerando periodos de crisis y remisión. Summary: Inflammatory bowel diseases (IBD), most frequent phenotypes Crohn's disease and Ulcerative colitis, have a multifactorial etiology, resulting from genetics, environmental triggers and microbiome alterations. Its incidence has been increasing as well as the western diet, high in fat, refined carbohydrates, sugar, red meat and processed foods. A western diet is considered a risk factor for the development of IBD, since it is associated with dysbiosis, alteration of the intestinal barrier and host immunity. There are several elimination diets that could play a role in induction/maintenance of remission. However, most of them require better quality scientific studies. Also, there are nutritional supplements associated with the incidence and evolution of the disease. The aim of this review is to show the possible role of the diet in the incidence, and diet-therapeutic strategies, including specific supplements and enteral nutrition, considering periods of active disease and remission.

Resumen: Actualmente, existe una mayor evidencia acerca de los efectos positivos de la actividad física, y en especial del ejercicio, sobre algunas enfermedades del sistema gastrointestinal, lo cual tiene relación principalmente con su rol antiinflamatorio a nivel sistémico. Sin embargo, es necesario considerar algunas variables del ejercicio, tales como el volumen e intensidad de éste. Específicamente, el realizar ejercicios de larga duración y alta intensidad, asociados a estados de deshidratación, postprandiales y con altas temperaturas ambientales, podría contribuir a la expresión fisiológica del síndrome gastrointestinal inducido por el ejercicio y a la aparición y/o empeoramiento de los síntomas en las enfermedades del tracto gastrointestinal. Si se controlan dichas variables, realizar ejercicio aeróbico de moderada intensidad y, adicionalmente, durante menos de 60 minutos, serían seguros para disminuir el riesgo y controlar de mejor manera los síntomas de algunas patologías gastrointestinales.El Propósito De La Siguiente Revisión, Es Presentar Los Avances Respecto A Los Potenciales Beneficios Del Ejercicio Físico En El Reflujo Gastroesofágico, Cáncer Gastrointestinal, Enfermedad Inflamatoria Intestinal Y El Síndrome De Intestino Irritable, Considerando Los Mecanismos Fisiológicos Implicados, Y Establecer Las Variables Del Ejercicio Que Pueden Repercutir Negativamente En Los Síntomas Gastrointestinales. Summary: Currently, there is an increase evidence about the beneficial effects of physical activity, particularly of physical exercise in some diseases of the gastrointestinal system, related to its systemic anti-inflammatory role. However, it is necessary to consider some of the exercise variables such as volume and exercise intensity. Specifically, the execution of long duration and high intensity exercises, together with a state of dehydration, postprandial and high environmental temperature, could contribute to the physiological expression of the exercise-induced gastrointestinal syndrome and the expression and/or worsening of gastrointestinal diseases symptoms.

ABSTRACT Objective: To describe baseline characteristics of outpatients with a positive RT-PCR for SARS-CoV-2 and to define whether “red flags” (new-onset fever, dyspnea, and chest pain) can predict clinical worsening during the isolation period. Methods: This was an epidemiological, observational, descriptive study. Between March and September of 2020, all outpatients who tested positive for SARS-CoV-2 at a tertiary medical center located in Santiago de Chile were included. Demographic variables, comorbidities, red flags, and other symptoms were compiled using follow-up surveys at specific time points. The risk of clinical worsening (hospitalization) and adjusted hazard ratios (HRs) were calculated. Results: A total of 7,108 patients were included. The median age was 38 years (range, 0-101), and 52% were men. At baseline, 77% of the patients reported having characteristic symptoms of SARS-CoV-2 infection. The most prevalent onset symptoms were headache (53%), myalgia (47%), and fever (33%). According to the follow-up surveys, the incidence of symptoms decreased during the isolation period; however, 28% of the patients still presented with symptoms on day 14. The risk of hospitalization for patients with new-onset fever and dyspnea during the follow-up period was HR = 7.43 (95% CI, 3.85-14.3, p

Las técnicas no invasivas son útiles para cuantificar el grado fibrosis hepática. La elastografía hepática por ARFI (acoustic radiation force impulse) ha sido poco estudiada en nuestro medio. Objetivo: Describir pacientes con enfermedad hepática crónica (EHC) estudiados por ARFI, evaluando concordancia, ventajas o limitaciones comparada con scores bioquímicos no invasivos (APRI [índice de relación de AST/recuento de plaquetas] y FIB-4 [índice que incluye edad, niveles de AST, ALT y recuento plaquetario]) para graduar fibrosis hepática. Pacientes y métodos: Estudio retrospectivo y descriptivo de pacientes sometidos a ARFI entre 2013 y 2019 con antecedentes clínicos y datos de laboratorio obtenidos de ficha clínica electrónica. Se usó estadística descriptiva y asociación por χ2, con valor de significación de p < 0,05. Resultados: Se realizó ARFI en 815 ocasiones en 731 pacientes; 488 sujetos cumplían criterios de inclusión. La ARFI se comparó entre patologías más frecuentes. Hubo mayor frecuencia de fibrosis avanzada (F3-F4) en enfermedad hepática alcohólica (EHA) (42%) y virus de la hepatitis C (VHC) (29%) (p < 0,001) y ausencia o mínima fibrosis (F0-F1) en enfermedad hepática grasa no alcohólica (EHGNA) (89%), virus de la hepatitis B (VHB) (77%) y enfermedad hepática autoinmune (73%) (p < 0,001). La esplenomegalia se asoció a F3-F4 (p < 0,001). Mayor ecogenicidad hepática se observó en EHGNA (93%), EHA (84%) y VHC (74%) (p < 0,001). La puntuación de ARFI, FIB-4 y APRI tendió a aumentar según grado de fibrosis, siendo concordante en F3-4. Al comparar F0-F1 por ARFI con FIB-4 y APRI, existió dispersión de los valores en los scores serológicos. Conclusión: FIB-4, APRI y ARFI pueden constituir una ayuda en la estimación de F3- F4, sin embargo, podrían subestimar o sobreestimar la severidad en F0-F1. La ARFI agregaría aspectos morfológicos relevantes en EHC.

RESUMEN: La escasez de investigación en Chile nos hace depender de manera excesiva de los resultados de la investigación foránea, los cuales no siempre son aplicables a la realidad nacional. Investigar siempre será necesario, sobre todo cuando los resultados están destinados a resolver los problemas de nuestra población. Los integrantes de un equipo multidisciplinario requieren de un pensamiento crítico frente al crecimiento explosivo del conocimiento, necesitando además un juicio científico para decidir la incorporación de nuevas estrategias diagnósticas y terapéuticas. La Enfermedad Inflamatoria Intestinal (EII) ha aumentado de manera creciente en nuestro país, esta tendencia plantea la opción de realizar proyectos de investigación local que permitan determinar la presencia de factores que influyan en su desarrollo y evolución. Para establecer las prioridades de investigación en EII se requiere una asociación entre los profesionales de la salud, los pacientes, las instituciones de salud y los organismos gubernamentales. ABSTRACT: The scarcity of local research makes us depend too much on the results of foreign research, which are not always applicable to the local health situation. Research is always necessary, especially when the results are intended to solve problems of our population. All the members of a multidisciplinary team require critical thinking in face of the explosive growth of knowledge, in addition to needing a scientific judgment to decide on the incorporation of new diagnostic and therapeutic strategies. Intestinal Inflammatory Disease (IBD) has increased progressively in our country; this trend raises the option of carrying out local research projects to determine the presence of factors that influence its development and evolution. Setting research priorities in IBD requires a partnership between health care professionals, patients, health institutions, and government agencies. Palabras clave: Enfermedad inflamatoria intestinal, investigación, educación médica, centros académicos, Keywords: Inflammatory bowel disease, research, medical education, academic medical centers

RESUMEN: La legislación en Chile ha regulado el desarrollo de investigación clínica aplicada. Actualmente, es posible utilizar los datos de la ficha clínica de los pacientes, con fines de investigación, previa autorización del sujeto a través del proceso de consentimiento informado respectivo. La gran cantidad de datos clínicos acumulados en los registros de salud representan una oportunidad para el desarrollo de investigación, más aún cuando los registros son electrónicos.En el año 2012, la Subdirección de Investigación en conjunto con el Comité de Ética de Clínica Las Condes, elaboraron un documento para regular, orientar y potenciar el uso de registros con fines de investigación biomédica por los profesionales de la salud de la institución.El objetivo de este artículo es compartir la experiencia en la creación de registros con fines de investigación científica, su desarrollo y la modalidad de funcionamiento en base a la regulación ético-legal chilena. ABSTRACT: Legislation in Chile has regulated the development of clinical research. At present, it is possible to use patient's health clinical records for research purposes, with prior authorization of the subject through the respective informed consent process. The large amount of clinical data accumulated in health records represents an opportunity for research development, especially when the records are electronic.In 2012, the Academic Research Unit and the Ethics Committee of Clínica Las Condes, developed a Protocol to regulate, guide and enhance the use of health clinical records for biomedical research purposes by healthcare professionals of the institution.The aim of this article is to share the experience of the development of clinical registries for scientific research, based on the local ethics and legal regulation. Palabras clave: Investigación, registros en salud, ficha clínica, base de datos, Keywords: Biomedical research, electronic health records, registries, data collection

RESUMEN: La investigación científica se ha consolidado como el mejor modo de generar conocimiento confiable, válido, verificable y reproducible. En el ámbito de la salud humana, la investigación biomédica ha permitido ampliar la comprensión de las enfermedades y avanzar en su prevención y en el tratamiento y rehabilitación de las personas en situación de enfermedad. El método científico es un sistema ordenado de generación de conocimiento mediante pasos secuenciales, que brindan mayor certidumbre a un resultado y permiten obtener conclusiones válidas, que aporten verosimilitud al nuevo conocimiento generado. Al planificar un proyecto de investigación, se debe tener presente que existe el riesgo de dilapidar tiempo, energía y recursos para finalmente obtener resultados pobres, decepcionantes y a veces inútiles. Para minimizar estos riesgos, la planificación ofrece un modo de anticipar eventos y obstáculos, a la vez de reconocer alternativas que hagan del proyecto, un producto útil, que logre su objetivo y que sea eficiente en el uso de los recursos. Respecto a estos recursos, el análisis de factibilidad del proyecto permitirá conocer en detalle los recursos necesarios para su mejor ejecución y cumplir así, los objetivos del estudio. ABSTRACT: Scientific research is the best way to generate reliable, valid, verifiable and reproducible knowledge. In human health, biomedical research has allowed a better understanding of human diseases and to make progress in the prevention, treatment and rehabilitation of persons suffering from diseases. The scientific method is a sorted and structured system of generation of knowledge, through a series of sequential steps, that provide greater certainty to a result and allows to obtain valid conclusions, that provide credibility to new knowledge. When planning a research project, it should be noted that, there is actual risk to waste time, energy and resources to finally get a poorer, disappointing and sometimes useless outcome than expected. To minimize these risks, the planning gives a way of anticipating events and obstacles, and at the same time recognizing alternatives that make project, a useful product, which achieved its objective and to be efficient in the use of resources. With respect to these resources, the project feasibility analysis allows to recognize in detail the resources needed for its best execution and to meet the objectives of the study. Palabras clave: Proyecto, investigación, planificación, factibilidad, ejecución, Keywords: Project, research, planning, implementing, execution

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) and can be treated with glucocorticoids (GC), although some patients are unresponsive to this therapy. The transcription factor LRH-1/NR5A2 is critical to intestinal cortisol production (intestinal steroidogenesis), being reduced in UC patients. However, the relationship between LRH-1 expression and distribution with altered corticosteroid responses is unknown. To address this, we categorized UC patients by their steroid response. Here, we found that steroid-dependent and refractory patients presented reduced glucocorticoid receptor (GR)-mediated intestinal steroidogenesis compared to healthy individuals and responder patients, possibly related to increased colonic mucosa GR isoform beta (GRβ) content and cytoplasmic LRH-1 levels in epithelial and lamina propria cells. Interestingly, an intestinal epithelium-specific GR-induced knockout (GRiKO) dextran sodium sulfate (DSS)-colitis mice model presented decreased epithelial LRH-1 expression, whilst it increased in the lamina propria compared to DSS-treated control mice. Mechanistically, GR directly induced NR5A2 gene expression in CCD841CoN cells and human colonic organoids. Furthermore, GR bound to two glucocorticoid-response elements within the NR5A2 promoter in dexamethasone-stimulated CCD841CoN cells. We conclude that GR contributes to intestinal steroidogenesis by inducing LRH-1 in epithelial cells, suggesting LRH-1 as a potential marker for glucocorticoid-impaired response in UC. However, further studies with a larger patient cohort will be necessary to confirm role of LRH-1 as a therapeutic biomarker.

Molecular classification of colorectal cancer is difficult to implement in clinical settings where hundreds of genes are involved, and resources are limited. This study aims to characterize the molecular subtypes of patients with sporadic colorectal cancer based on the three main carcinogenic pathways microsatellite instability (MSI), CpG island methylator phenotype (CIMP), and chromosomal instability (CIN) in a Chilean population. Although several reports have characterized colorectal cancer, most do not represent Latin-American populations. Our study includes 103 colorectal cancer patients who underwent surgery, without neoadjuvant treatment, in a private hospital between 2008 and 2017. MSI, CIN, and CIMP status were assessed. Frequent mutations in KRAS, BRAF, and PIK3CA genes were analyzed by Sanger sequencing, and statistical analysis was performed by Fisher’s exact and/or chi-square test. Survival curves were estimated with Kaplan–Meier and log-rank test. Based on our observations, we can classify the tumors in four subgroups, Group 1: MSI-high tumors (15%) are located in the right colon, occur at older age, and 60% show a BRAF mutation; Group 2: CIN-high tumors (38%) are in the left colon, and 26% have KRAS mutations. Group 3: [MSI/CIN/CIMP]-low/negative tumors (30%) are left-sided, and 39% have KRAS mutations; Group 4: CIMP-high tumors (15%) were more frequent in men and left side colon, with 27% KRAS and 7% presented BRAF mutations. Three percent of patients could not be classified. We found that CIMP-high was associated with a worse prognosis, both in MSI-high and MSI stable patients (p = 0.0452). Group 3 (Low/negative tumors) tend to have better overall survival compared with MSI-high, CIMP-high, and CIN-high tumors. This study contributes to understanding the heterogeneity of tumors in the Chilean population being one of the few characterizations performed in Latin-America. Given the limited resources of these countries, these results allow to improve molecular characterization in Latin-American colorectal cancer populations and confirm the possibility of using the three main carcinogenic pathways to define therapeutic strategies.

RESUMEN: La Enfermedad de Crohn es una enfermedad crónica progresiva que afecta el tubo digestivo. El objetivo de tratamiento es un control adecuado de la enfermedad para evitar progresión y deterioro de la calidad de vida, pudiendo con una terapia personalizada lograr un buen pronóstico. En este artículo se proponen algoritmos de tratamiento y de seguimiento de los escenarios más frecuentes que presentan los pacientes con Enfermedad de Crohn. ABSTRACT: Crohn's disease is a chronic and progressive disease that affects the gut. Currently treatment should be based on treat to target concept to prevent progression and deterioration of the quality of life. With a personalized therapy it could be possible to achieve a good prognosis. In this article we propose algorithms for treatment and follow-up of the most frequent scenarios presented by patients with Crohn's disease. Palabras clave: Enfermedad de Crohn, enfermedad inflamatoria intestinal, biomarcadores, tratamiento individualizado, terapia según objetivos, Keywords: Crohn's Disease, inflammatory bowel disease, biomarkers, individualized therapy, treat to target

Resumen: La colitis ulcerosa (CU) es un trastorno inflamatorio crónico mediado inmunológicamente que compromete al recto y colon. Su patogenia es multifactorial donde se ven involucrados aspectos genéticos, microbiota, respuesta inmune y factores ambientales. El objetivo actual de tratamiento no está acotado solamente a la mejoría clínica, si no que a lograr la curación de la mucosa de manera de alcanzar un mejor pronóstico y calidad de vida. En este artículo proponemos algoritmos de tratamiento y de seguimiento individualizados de la CU destinados a conseguir estos objetivos. Abstract: Ulcerative colitis (UC) is an immune mediated chronic inflammatory disorder that affects the rectum and colon. Its pathogenesis is multifactorial where genetic aspects, microbiota, immune response and environmental factors are involved. The current goals of treatment are not limited to improve clinical symptoms, but rather to heal the mucosa for a better prognosis and improve quality of life. In this article we propose treatment algorithms and personalized monitoring of UC to achieve these objectives. Palabras clave: Enfermedad inflamatoria intestinal, colitis ulcerosa, calprotectina fecal, curación mucosa, tratamiento por objetivo, Keywords: Inflammatory bowel disease, ulcerative colitis, fecal calprotectin, mucosal healing,

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterized by mucosa damage associated with an uncontrolled inflammatory response. This immunological impairment leads to altered inflammatory mediators such as IL-33, which is shown to increase in the mucosa of active UC (aUC) patients. MicroRNAs present a distorted feature in inflamed colonic mucosa and are potential IL-33 regulating candidates in UC. Therefore, we studied the microRNA and mRNA profiles in inflamed colonic samples of UC patients, evaluating the effect of a microRNA (selected by in silico analysis and its expression in UC patients), on IL-33 under inflammatory conditions. We found that inflamed mucosa (n = 8) showed increased expression of 40 microRNAs and 2,120 mRNAs, while 49 microRNAs and 1,734 mRNAs were decreased, as determined by microarrays. In particular, IL-33 mRNA showed a 3.8-fold increase and eight members of a microRNA family (miR-378), which targets IL-33 mRNA in the 3′UTR, were decreased (−3.9 to −3.0 times). We selected three members of the miR-378 family (miR-378a-3p, miR-422a, and miR-378c) according to background information and interaction energy analysis, for further correlation analyses with IL-33 expression through qPCR and ELISA, respectively. We determined that aUC (n = 24) showed high IL-33 levels, and decreased expression of miR-378a-3p and miR-422a compared to inactive UC (n = 10) and controls (n = 6). Moreover, both microRNAs were inversely correlated with IL-33 expression, while miR-378c does not show a significant difference. To evaluate the effect of TNFα on the studied microRNAs, aUC patients with anti-TNF therapy were compared to aUC receiving other treatments. The levels of miR-378a-3p and miR-378c were higher in aUC patients with anti-TNF. Based on these findings, we selected miR-378a-3p to exploring the molecular mechanism involved by in vitro assays, showing that over-expression of miR-378a-3p decreased the levels of an IL-33 target sequence β-gal-reporter gene in HEK293 cells. Stable miR-378a-3p over-expression/inhibition inversely modulated IL-33 content and altered viability of HT-29 cells. Additionally, in an inflammatory context, TNFα decreased miR-378a-3p levels in HT-29 cells enhancing IL-33 expression. Together, our results propose a regulatory mechanism of IL-33 expression exerted by miR-378a-3p in an inflammatory environment, contributing to the understanding of UC pathogenesis.

In colorectal cancer (CRC), cancer-associated fibroblasts (CAFs) are the most abundant component from the tumor microenvironment (TM). CAFs facilitate tumor progression by inducing angiogenesis, immune suppression and invasion, thus altering the organization/composition of the extracellular matrix (i.e., desmoplasia) and/or activating epithelial-mesenchymal transition (EMT). Soluble factors from the TM can also contribute to cell invasion through secretion of cytokines and recently, IL-33/ST2 pathway has gained huge interest as a protumor alarmin, promoting progression to metastasis by inducing changes in TM. Hence, we analyzed IL-33 and ST2 content in tumor and healthy tissue lysates and plasma from CRC patients. Tissue localization and distribution of these molecules was evaluated by immunohistochemistry (using localization reference markers α-smooth muscle actin or α-SMA and E-cadherin), and clinical/histopathological information was obtained from CRC patients. In vitro experiments were conducted in primary cultures of CAFs and normal fibroblasts (NFs) isolated from tumor and healthy tissue taken from CRC patients. Additionally, migration and proliferation analysis were performed in HT29 and HCT116 cell lines. It was found that IL-33 content increases in left-sided CRC patients with lymphatic metastasis, with localization in tumor epithelia associated with abundant desmoplasia. Although ST2 content showed similarities between tumor and healthy tissue, a decreased immunoreactivity was observed in left-sided tumor stroma, associated to metastasis related factors (advanced stages, abundant desmoplasia, and presence of tumor budding). A principal component analysis (including stromal and epithelial IL-33/ST2 and α-SMA immunoreactivity with extent of desmoplasia) allowed us to distinguish clusters of low, intermediate and abundant desmoplasia, with potential to develop a diagnostic signature with benefits for further therapeutic targets. IL-33 transcript levels from CAFs directly correlated with CRC cell line migration induced by CAFs conditioned media, with rhIL-33 inducing a mesenchymal phenotype in HT29 cells. These results indicate a role of IL-33/ST2 in tumor microenvironment, specifically in the interaction between CAFs and epithelial tumor cells, thus contributing to invasion and metastasis in left-sided CRC, most likely by activating desmoplasia.

A complex network of chemokines can influence cancer progression with the recruitment and activation of hematopoietic cells, including macrophages to the supporting tumor stroma promoting carcinogenesis and metastasis. The aim of this study was to investigate the relation between tissue and plasma chemokine levels involved in macrophage recruitment with tumor-associated macrophage profile markers and clinicopathological features such as tumor–node–metastases stage, desmoplasia, tumor necrosis factor-α, and vascular endothelial growth factor plasma content. Plasma and tumor/healthy mucosa were obtained from Chilean patients undergoing colon cancer surgery. Chemokines were evaluated from tissue lysates (CCL2, CCL3, CCL4, CCL5, and CX3CL1) by Luminex. Statistical analysis was performed using Wilcoxon match-paired test ( p < 0.05). Macrophage markers (CD68, CD163, and iNOS) were evaluated by immunohistochemistry samples derived from colorectal cancer patients. Correlation analysis between chemokines and macrophage markers and clinicopathological features were performed using Spearman’s test. Plasmatic levels of chemokines and inflammatory mediators’ vascular endothelial growth factor and tumor necrosis factor-α were evaluated by Luminex. Tumor levels of CCL2 (mean ± standard deviation = 530.1 ± 613.9 pg/mg), CCL3 (102.7 ± 106.0 pg/mg), and CCL4 (64.98 ± 48.09 pg/mg) were higher than those found in healthy tissue (182.1 ± 116.5, 26.79 ± 22.40, and 27.06 ± 23.69 pg/mg, respectively p

HIGHLIGHTSWhat is already known about this subject?Celiac disease (CD) has a high clinical and histological diversity and the mechanisms underlying this phenomenon remain elusive.H. pylori is a bacterium that chronically infect gastric and duodenal mucosa activating both a Th1/Th17 and T-reg pathways.The role of H. pylori (and the effect of their virulence factors) in CD have not yet completely elucidated.What are the new findings?cagA+ H. pylori strains are associated to milder histological damage in infected CD patients.In active-CD patients the presence of cagA+ H. pylori is associated to an increase in T-reg markers, contrasting with a downregulation in cagA+ infected potential-CD individuals.How might it impact on clinical practice in the foreseeable future?The identification of microbiological factors that could modulate inflammation and clinical expression of CD may be used in the future as preventive strategies or as supplementary treatment in patients that cannot achieve complete remission, contributing to the better care of these patients.Background: Mechanisms underlying the high clinical and histological diversity of celiac disease (CD) remain elusive. Helicobacter pylori (Hp) chronically infects gastric and duodenal mucosa and has been associated with protection against some immune-mediated conditions, but its role (specifically of cagA+ strains) in CD is unclear.Objective: To assess the relationship between gastric Hp infection (cagA+ strains) and duodenal histological damage in patients with CD.Design: Case-control study including patients with active-CD, potential-CD and non-celiac individuals. Clinical presentation, HLA genotype, Hp/cagA gene detection in gastric mucosa, duodenal histology, Foxp3 positive cells and TGF-β expression in duodenal lamina propria were analyzed.Results: We recruited 116 patients, 29 active-CD, 37 potential-CD, and 50 non-CD controls. Hp detection was similar in the three groups (~30–40%), but cagA+ strains were more common in infected potential-CD than in active-CD (10/11 vs. 4/10; p = 0.020) and non-CD (10/20; p = 0.025). Among active-CD patients, Foxp3 positivity was significantly higher in subjects with cagA+ Hp+ compared to cagA- Hp+ (p < 0.01) and Hp- (p < 0.01). In cagA+ Hp+ individuals, Foxp3 positivity was also higher comparing active- to potential-CD (p < 0.01). TGF-β expression in duodenum was similar in active-CD with cagA+ Hp+ compared to Hp- and was significantly downregulated in cagA+ potential-CD subjects compared to other groups.Conclusion: Hp infection rates were similar among individuals with/without CD, but infection with cagA+ strains was associated with milder histological damage in celiac patients infected by Hp, and in active-CD cases with higher expression of T-reg markers. Results suggest that infection by cagA+ Hp may be protective for CD progression, or conversely, that these strains are prone to colonize intestinal mucosa with less severe damage.