<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452021000400274</article-id>
<article-id pub-id-type="doi">10.1159/000509195</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Strongyloides stercoralis Gastric Ulcer: A Rare Cause of Upper Gastrointestinal Bleeding]]></article-title>
<article-title xml:lang="pt"><![CDATA[Úlcera Gástrica por Strongyloides stercoralis: Uma Causa Rara de Hemorragia Digestiva Alta]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Silva]]></surname>
<given-names><![CDATA[Ryan Costa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[Joana Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Crespo]]></surname>
<given-names><![CDATA[Ricardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martins]]></surname>
<given-names><![CDATA[Joana Rosa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zózimo]]></surname>
<given-names><![CDATA[Nídia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marinho]]></surname>
<given-names><![CDATA[Rui Tato]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar Universitário Lisboa Norte Hospital de Santa Maria Serviço de Medicina I]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Faculdade de Medicina de Lisboa Clinica Universitária de Medicina 1 ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Centro Hospitalar Universitário Lisboa Norte Hospital de Santa Maria Serviço de Gastrenterologia e Hepatologia]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>08</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>08</month>
<year>2021</year>
</pub-date>
<volume>28</volume>
<numero>4</numero>
<fpage>274</fpage>
<lpage>278</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452021000400274&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452021000400274&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452021000400274&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Strongyloidiasis is an infection caused by Strongyloides stercoralis. Gastrointestinal manifestations typically include duodenitis, chronic enterocolitis, and malabsorption, while gastric involvement is very rare. In this case report, the authors present a case of upper gastrointestinal bleeding caused by a gastric ulcer with a challenging etiological diagnosis. In Portugal, there have been reports in the past century of autochthonous cases of S. stercoralis infection suggesting endemic zones, but with the current sanitation infrastructure strongyloidiasis is thought to be rare. A 56-year-old Caucasian male smoker with a history of significant weight loss presented to the emergency department with hema temesis and abdominal pain. Upper endoscopy revealed a giant gastric ulcer with a macroscopic appearance suggestive of malignancy. Further investigation with CT scan highlighted gastric wall thickness and a spiculated lung lesion in the upper right lobe without lymph node involvement or metastatic disease. Bronchoscopy with bronchial brushing was performed. Histological examination identified squamous cell carcinoma of the lung and the patient was referred to Oncological Pneumology. Gastric ulcer biopsies ruled out malignancy and identified fragments of nematodes with inflammatory infiltrates and fibrinogranulocytic exudate, suggestive of S. stercoralis. Accordingly, the diagnosis of strongyloidiasis was made and further confirmed with molecular methods and serology. The giant gastric ulcer was affirmed to be caused by S. stercoralis infection and the patient was treated with ivermectin with improvement of epigastric pain. On reevaluation 6 weeks later the patient was asymptomatic, had gained weight, parasitological stool examinations were negative, and upper endoscopy showed complete ulcer healing. Further tests were done targeting risk factors for strongyloidiasis, and in addition to the presence of malignancy, other underlying causes for immunosuppression were ruled out. In this case report strongyloidiasis was manifested by gastric involvement with upper gastrointestinal bleeding in a patient who was subsequently diagnosed with squamous cell carcinoma of the lung.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: A estrongiloidíase é uma infecção causada por Strongyloides stercoralis. As manifestações gastrointestinais tipicamente incluem duodenite, enterocolite crónica e má absorção, sendo o envolvimento gástrico muito raro. Neste caso clínico, os autores apresentam um caso de hemorragia digestiva alta causada por uma úlcera gástrica com um diagnóstico etiológico desafiante. Em Portugal no século passado existiram casos autóctones de infecção a S. stercoralis sugerindo zonas endémicas, mas com a actual infraestrutura de saneamento a estrongiloidíase é rara. Homem de 56 anos de idade, caucasiano, fumador, com história de perda ponderal significativa, admitido no Serviço de Urgência por hematemeses e dor abdominal. A endoscopia digestiva alta realizada revelou uma úlcera gástrica gigante com aparência macroscópica sugestiva de malignidade. A investigação subsequente com tomografia computadorizada (TC) destacou a presença de espessamento gástrico e uma lesão pulmonar espiculada no lobo superior direito, sem envolvimento ganglionar ou doença metastática. Foi realizada broncofibroscopia com escovado brônquico tendo o exame histológico identificado carcinoma pavimento celular do pulmão, pelo que o doente foi referenciado para a Pneumologia Oncológica. As biópsias da úlcera gástrica descartaram malignidade e identificaram fragmentos de nemátodes com infiltrados inflamatórios e exsudado fibrino-granulocítico, sugestivo de Strongyloides stercoralis. Consequentemente, foi feito o diagnóstico de estrongiloidíase, confirmado com métodos moleculares e sorologia. Admitiu-se que a úlcera gástrica gigante terá sido causada pela infecção por Strongyloides stercoralis e o doente foi tratado com ivermectina com melhoria da dor epigástrica. Em reavaliação, seis semanas depois, o doente estava assintomático, com ganho ponderal, os exames parasitológicos das fezes estavam negativos e a endoscopia digestiva alta mostrou cicatrização completa da úlcera. Foram realizados exames adicionais para investigação de factores de risco para estrongiloidíase, tendo sido excluídas outras causas de imunossupressão subjacente para além da presença de malignidade. Neste caso clínico, a estrongiloidíase manifestou-se por envolvimento gástrico com hemorragia digestiva alta num doente que foi posteriormente diagnosticado com carcinoma pavimento celular do pulmão.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Strongyloides stercoralis]]></kwd>
<kwd lng="en"><![CDATA[Gastric ulcer]]></kwd>
<kwd lng="en"><![CDATA[Hematemesis]]></kwd>
<kwd lng="pt"><![CDATA[Strongyloides stercoralis]]></kwd>
<kwd lng="pt"><![CDATA[Úlcera gástrica]]></kwd>
<kwd lng="pt"><![CDATA[Hematemeses]]></kwd>
</kwd-group>
</article-meta>
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