{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T08:21:46Z","timestamp":1793866906788,"version":"4.6.1"},"reference-count":45,"publisher":"FapUNIFESP (SciELO)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Gastroenterol."],"published-print":{"date-parts":[[2000,4]]},"abstract":"<jats:p>As principais causas de inflama\u00e7\u00e3o pancre\u00e1tica no mundo s\u00e3o a lit\u00edase biliar e o alcoolismo cr\u00f4nico. Admite-se que 10 a 30% das pancreatites agudas sejam idiop\u00e1ticas. Sugere-se que parte destas s\u00e3o causadas por microlit\u00edase ou barro biliar, identificados pela presen\u00e7a de microcristais no sedimento biliar. Neste estudo, realizou-se an\u00e1lise microsc\u00f3pica da bile obtida por colangiopancreatografia endosc\u00f3pica, em pacientes com pancreatite aguda idiop\u00e1tica, pancreatite aguda biliar e pancreatite cr\u00f4nica alco\u00f3lica - 20 em cada grupo. Pacientes com pancreatite aguda idiop\u00e1tica e microcristais na bile foram submetidos a colecistectomia. Naqueles inaptos \u00e0 cirurgia efetuou-se esfincterotomia endosc\u00f3pica ou tratamento com \u00e1cido ursodesoxic\u00f3lico. Pacientes com pancreatite aguda idiop\u00e1tica sem cristais n\u00e3o receberam tratamento espec\u00edfico. A preval\u00eancia de microcristais biliares em pacientes com pancreatite aguda idiop\u00e1tica (75%) e pancreatite aguda biliar (90%) foi significativamente maior que naqueles com pancreatite cr\u00f4nica alco\u00f3lica (15%). A detec\u00e7\u00e3o de microcristais apresentou sensibilidade de 90%, especificidade de 85%, valor preditivo positivo de 85,7%, valor preditivo negativo de 89,4% e acur\u00e1cia de 87,5% em identificar pancreatite de origem biliar. Nos pacientes com pancreatite aguda idiop\u00e1tica recurrente, cursando com microcristais, houve redu\u00e7\u00e3o significante dos epis\u00f3dios de pancreatite ap\u00f3s tratamento espec\u00edfico. No seguimento deste grupo durante 23,3 meses, recidiva ocorreu apenas naqueles que apresentavam \"fator biliar persistente\" (coledocolit\u00edase ou microcristais). Todos os pacientes com pancreatite aguda idiop\u00e1tica submetidos a colecistectomia apresentavam colecistite cr\u00f4nica, e microlit\u00edase foi observada em um paciente. No seguimento ultra-sonogr\u00e1fico, colelit\u00edase foi detectada em um dos casos. No subgrupo de cinco pacientes com pancreatite aguda idiop\u00e1tica sem microcristais houve uma recidiva. Estudo ultra-sonogr\u00e1fico durante o seguimento n\u00e3o revelou c\u00e1lculo biliar em nenhum destes. Concluiu-se que a detec\u00e7\u00e3o de microcristais biliares na pancreatite aguda idiop\u00e1tica sugeriu etiologia biliar oculta subjacente. Adicionalmente, interven\u00e7\u00e3o terap\u00eautica espec\u00edfica nos pacientes com pancreatite aguda idiop\u00e1tica recurrente e microcristais reduziu as recidivas durante o seguimento. Finalmente, pancreatite aguda (particularmente, recurrente) n\u00e3o deveria ser rotulada como idiop\u00e1tica antes da an\u00e1lise microsc\u00f3pica da bile visando a detec\u00e7\u00e3o ou exclus\u00e3o da presen\u00e7a de microcristais.<\/jats:p>","DOI":"10.1590\/s0004-28032000000200005","type":"journal-article","created":{"date-parts":[[2005,4,15]],"date-time":"2005-04-15T14:18:39Z","timestamp":1113574719000},"page":"93-101","source":"Crossref","is-referenced-by-count":15,"title":["Microcristais biliares na pancreatite aguda idiop\u00e1tica: ind\u00edcio para etiologia biliar oculta subjacente"],"prefix":"10.1590","volume":"37","author":[{"given":"J\u00falio Maria Fonseca","family":"CHEBLI","sequence":"first","affiliation":[{"name":"Universidade Federal de Juiz de Fora; Universidade Federal de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c2ngelo Paulo","family":"FERRARI Jr.","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Regina Regis","family":"SILVA","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Durval Rosa","family":"BORGES","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1lvaro Nagib","family":"ATALLAH","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoel Martins das","family":"NEVES","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","reference":[{"key":"ref1","first-page":"118","article-title":"Etiology and pathogenesis of acute biliary pancreatitis","volume":"88","author":"Acosta 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